A systematic review evaluating the impact of task shifting on access to antiretroviral therapy in sub-Saharan Africa

Background: Task shifting, defined for this review as the shifting of ART initiation and management from physicians to nurses, has been proposed as a possible method to increase access to HIV treatment in Sub-Saharan Africa. Objective: To critically evaluate the literature on task shifting, determining if there is evidence to support this view. Methods: A systematic search of the literature was undertaken, with both peer reviewed publications and conference abstracts presenting original data eligible for inclusion. Studies were evaluated according to methodology and discussion of confounding factors. Results: We identified 25 articles which evaluated the effect of task shifting on access to ART. The evidence was mixed. Although there is a significant body of field reports indicating that task shifting increases access, these studies were of low methodological quality. The only randomized controlled trial included in this review did not find that task shifting increased in access. Conclusion: Task shifting appears to be most effective at increasing access when combined with other interventions and financial support. There is a need for more research into the effects of task shifting policies, especially randomized controlled trials and high quality cohort studies.