First the Rollout, Now the Reality

In a relatively short time, the number of people receiving antiretroviral therapy (ART) in resource-limited countries has risen dramatically — to more than 5 million. This remarkable scale-up of treatment has obviously been a challenge, and now the reality of widespread ART management is setting in.

One major problem that has come to light is that there are simply not enough physicians, let alone experienced ones, to take care of all the patients now on ART. “Task-shifting” has been proposed as a reasonable solution, but the evidence to support it has been limited. This year, a randomized trial in South Africa demonstrated that nurse-led monitoring of ART can be just as effective as physician-led monitoring. However, the outcomes in both gro…