Henry Barigye

It is clear that large-scale treatment for HIV will depend on re-thinking the use of human resources if it is to have public health benefits. Health care staff working in multi-disciplinary teams providing long-term HIV care may find their roles changing over time in ways that will need careful management. The role of nurses is of particular importance in many settings, and there is clearly scope for expanding that role with appropriate training and support. Nurse practitioners trained to prescribe a range of medicines and nurse-led clinics are among the options that need to be explored. Specialised pharmacists can also take on a major role in supporting people with HIV on treatment. A system that chooses first-line regimens that can be managed with limited direct involvement from doctors will be able to make more use of other health care staff in managing them. Human resource issues are therefore directly connected with the development of national treatment guidelines. Lay involvement, starting with peer support, may also be needed for a successful large-scale treatment programme. A variety of models for peer support and treatment education are available for use. Social stigma doesn't automatically disappear when services are established (though treatment certainly helps to overcome it). As well as training, resources are needed to prevent occupational exposure to HIV. Continuing professional support and development are needed by all staff involved in delivering HIV treatment, and not only in relation to ARVs.