HIV management by nurse prescribers compared with doctors at a paediatric centre in Gaborone, Botswana.

OBJECTIVES: To compare compliance with national paediatric HIV treatment guidelines between nurse prescribers and doctors at a paediatric referral centre in Gaborone, Botswana. METHODS: A cross-sectional study was conducted in 2009 at the Botswana-Baylor Children's Clinical Centre of Excellence (COE), Gaborone, Botswana, comparing the performance of nurse prescribers and physicians caring for HIV-infected paediatric patients. Selected by stratified random sampling, 100 physician and 97 nurse prescriber encounters were retrospectively reviewed for successful documentation of eight separate clinically relevant variables: pill count charted; chief complaint listed; social history updated; disclosure reviewed; physical exam; laboratory testing; World Health Organization (WHO) staging documented; paediatric dosing. RESULTS: Nurse prescribers and physicians correctly documented 96.0% and 94.9% of the time, respectively. There was a trend towards a higher proportion of social history documentation by the nurses, but no significant difference in any other documentation items. CONCLUSIONS: Our findings support the continued investment in programmes employing properly trained nurses in southern Africa to provide quality care and ART services to HIV-infected children who are stable on therapy. Task shifting remains a promising strategy to scale up and sustain adult and paediatric ART more effectively, particularly where provider shortages threaten ART rollout. Policies guiding ART services in southern Africa should avoid restricting the delivery of crucial services to doctors, especially where their numbers are limited.

Issues of expressed stigma of HIV/AIDS among professionals in Southern Sudan.

HIV-related stigma continues to be a significant barrier to HIV testing, treatment, and care. Understanding the factors that underlie this stigma could help remove barriers to HIV/AIDS intervention. We identified these factors among nurses as well as community leaders in Lui, Southern Sudan. Participants included health workers at a local hospital, a women's group, local market traders, religious leaders, and teachers. We categorized the responses generated from group interaction forums as concerns, fears, and perceptions. We found that stigma persisted not only toward people with conspicuous signs of full-blown AIDS, but also toward community programs, like voluntary counseling and testing centers. Future interventions, including delabeling the counseling and testing centers and demonstrating the efficacy of highly active antiretroviral therapy, will be critical in reducing the stigma of HIV/AIDS in communities.