Nepal in the pathway of reaching the first 90 of the 90-90-90 goal through task shifting.


Nepal in the pathway of reaching the first 90 of the 90-90-90 goal through task shifting.

Sanjeev Raj Neupane and Dr Imran Muhammad

Many developing countries around the world are facing acute shortage of trained health workforce. For achieving Universal Health Coverage trained and adequate number of health workforce is a must. Achieving universal health coverage is impossible without having the right people; with the right skills, in the right place. Many health programmes are facing serious problem due to shortage of trained health workforce. HIV programmes are also severely affected due to lack of trained health workforce. To tackle the HIV epidemic; the problem of shortage of human resources must be tackled. Without tackling the problem of shortage of human resources; the battle against HIV can’t be won. Production and training of health workforce is not only in the control of health ministries. Besides this the production and training of health workforce needs long time; huge investments and multi-sectoral involvement. We cant wait until there will be adequate human resources to tackle the problem of HIV epidemic. So the concept of “Task Shifting” which has already been used successfully in many other public health programs is being replicated in the field of HIV also.

(Figure Source: WHO HIV/AIDS Programme; Task Shifting to Tackle Health Worker Shortages)

Task shifting is a process of delegation of roles and responsibilities from specialized health workers to less specialized health workers or to the community people. In the absence of specialized physicians some of their tasks could be delegated to Medical officers; some of the tasks of medical officers could be delegated to Nurses; some of the tasks of nurses could be delegated to community health workers and some of the tasks of community health workers could be delegated to People living with HIV (PLHIV) themselves. However this needs to operate in public health approach. Regulation and training must be in the centre in the task shifting process.

To end the AIDS epidemic UNAIDS has come with an ambitious goal of 90-90-90 which simply means by 2020; 90% of all people living with HIV will know their HIV status; 90% of diagnosed HIV positive people will receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have HIV viral load suppressed. Once this three part target is achieved 73% of all people living with HIV worldwide will be virally suppressed. Modelling data suggest that achieving these targets by 2020 will enable the world to end AIDS epidemic by 2030, which in turn will generate profound health and economic benefits.

But with the current strategies and current pace it is almost impossible to achieve the ambitious goal of 90-90-90 by 2020. Public health scientists and HIV activists around the world are proposing different fast track strategies and approaches that could help world achieve the ambitious 90-90-90 target. One of the strategy proposed for achieving the first 90 is HIV testing by lay providers (which is often called Community led HIV testing). In 2015; WHO recommended that members of key population who are trained can independently conduct safe and effective HIV testing using rapid diagnostic tests. Many people are currently using similar kind of rapid diagnostic test kits for detection of blood sugar in home just by reading the user manual that comes with the test kit. The rapid diagnostic test kits are also similar so trained member of a key population can perform the HIV screening test accurately.

Since WHO recommended HIV testing by lay providers in 2015; many countries around the world are in the process of adopting this WHO recommendation as per their country epidemic. Nepal has already endorsed in its National HIV Strategic Plan 2016-21 that Nepal will also implement Community led HIV testing. Accordingly Nepal has already developed National Guideline for Community Led HIV testing and Nepal is all set to roll out of HIV testing by Lay providers in next few months. Once this is rolled out Nepal will be the first country in South Asia to implement HIV testing by Lay Providers and hopefully this new approach will help Nepal to reach the first 90 of the lofty 90-90-90 target.

June 10, 2018

Sanjeev Raj Neupane and Dr Imran Muhammad

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