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Trained laypersons can assume more of the responsibilities associated with the care of individuals with HIV, thanks to a new HIV Medics program at the Indira Gandhi National Open University (IGNOU) in New Delhi. This 12-week program, developed by the AIDS Healthcare Foundation, trains people with no medical background to take on basic clinical tasks, such as drawing blood and dispensing medication, as well as administrative responsibilities, such as taking patient histories and referring patients to doctors. Students in the program are also trained to provide treatment adherence counseling to HIV patients. The first class of HIV Medics graduated on June 8, 2009.

The training provided by this program and others like it facilitates task-shifting from other medical professionals, such as doctors and nurses, to individuals without high-level medical qualifications. As a result, doctors and nurses have more time to devote to treating multiple patients. Therefore, task-shifting can help relieve the burden on doctors and nurses in settings where medical professionals are scarce.

The lack of medical professionals in many countries with a high HIV prevalence has led the WHO to make task-shifting a prominent goal in the improvement of HIV treatment in resource-poor settings, as detailed in the 2006 “Treat, Train, Retain” workforce plan. Two examples of successful HIV-focused programs that have used trained laypersons are an antiretroviral treatment program in Uganda and an HIV counseling and testing program in Zambia.

Having trained laypersons take over many of the tasks associated with the care of HIV-positive individuals does not come without its own set of problems. One problem is poor retention of trained HIV workers, which can limit the success of task-shifting programs. Poor pay (or no pay) can lead trained HIV workers to seek other employment, which might not even be related to medical care. The loss of HIV workers due to the lack of adequate wages was one of the primary concerns expressed by the health center managers interviewed in Zambia. The fact that the WHO made retention one of the three focus points of the 2006 workforce plan reflects the importance of these types of problems. Another concern with respect to task-shifting programs is maintaining the quality of care, a point highlighted in a 2006 Lancet Viewpoint piece.

Although there are many obstacles in the implementation of task-shifting programs, the introduction of rigorous training programs for HIV workers, such as the HIV Medics program at IGNOU, is an important step in ensuring the success of task-shifting programs and in providing proper care to people with HIV.

For more information, see the AIDS Healthcare Foundation’s India Factsheet.