Task shifting has a time-honored place in resource-deficient environments. Task shifting, or transferring responsibilities that don’t demand highly specialized training to individuals with little medical background, is being taken to a whole new level – the patient – in a new HIV treatment strategy being employed in some personnel-strapped health care centers of sub-Saharan Africa.
Developed in 2006 by Doctors Without Borders physician Tom Decroo, HIV-positive patients are organized into groups of 6 and each share the responsibility of retrieving each other’s anti-retroviral medications to treat their conditions. This co-dependency of group members and their accountability to one another transfers the task of monitoring compliance with their medication regimen from the physician to patient. As a result, doctors are less burdened, allowing them to spend more time with patients and provide more effective treatments. This could ultimately lower health care costs.
Before this strategy came along, patients sometimes trekked for four hours on foot once a month to retrieve their anti-retroviral medications. However, participation in a 6 member medication group necessitates that each member only travels bi-annually to retrieve the entire group’s monthly refill of life sustaining anti-retroviral drugs and submit patients’ logs of their medication use. Fewer trips for the patient translate into lower transportation costs and allows for more time to be spent working and generating a living. Patients can also benefit from the group’s combined financial resources, which may allow them to afford public transportation. An additional benefit of group treatment is a built-in support system of fellow HIV sufferers, which helps individuals deal with the stigma of living with HIV. Due to these increased economic and psychological benefits of group-based medication retrieval, participants are more likely to continue treatment.
In a 2-year study published in The Journal of Acquired Immune Deficiency Syndromes of 300 patient medication group members in Tete, Mozambique, almost no patients stopped taking their medications and only 2% died. In comparison, individuals who sought treatment alone faced a 20% mortality or departure from treatment rate. Due to these promising results, Mozambique is implementing patient medication groups in all of its provinces.
However, some question the authenticity of the group-based treatment success, and rightly so. The aforementioned studies only included stable patients, so the mortality/left treatment numbers may be deceptively low. Additionally, no mention is made of contingences in case a group member’s condition becomes unstable and requires more direct medical attention. Are deteriorating patients forced to leave the group and are they immediately replaced? If not, I imagine that conflicts, which could damage the group dynamic, might arise over who would assume the departed member’s responsibilities.
Due to these lingering questions, there is need for supplemental analysis conducted by unaffiliated researchers on a patient population that includes unstable members. However, the idea of group-based medication retrieval seems like a promising tool that could be widely implemented for little to no cost, In the future, medication groups could even assume a greater role in community health by reporting additional patient data that could warn health care providers of outbreaks of disease like tuberculosis, which often co-infect HIV sufferers. Yet, this treatment strategy’s most intriguing aspect remains the capacity for such a simple approach to assist with such a complex issue.