Globally, 34 million people are currently living with HIV. Remarkable progress has been made over the last decade in the expansion of HIV treatment, care and support, particularly in Africa, home to more than two-thirds of people living with the virus. In 2003, only 100,000 people in Africa had access to treatment; by 2013, more than 7 million men, women and children were on antiretroviral therapy (ART).
Jhpiego, a leader in building capacity of health care providers and strengthening health systems for improved quality of care, has supported governments across the continent to expand access to HIV treatment for women and their families. Jhpiego has long recognized the role of nurses and midwives in providing comprehensive care to women of reproductive age and began supporting governments early on in scaling up ART to ensure that these essential health care providers are engaged in policy, planning and service delivery. Building the capacity of nurses and midwives to provide ART sets the stage for effective integration of prevention of mother-to-child transmission (PMTCT) services into maternal and child health services. It also empowers frontline health care workers to meet the prevention, care and treatment needs of the entire family at the primary care level.
In South Africa, where one out of every six people in the world living with HIV resides, Jhpiego conducted a situational analysis in 2008 to assess, document and advocate for the role of nurses and midwives in providing HIV treatment services. The analysis highlighted competency-based training, health systems strengthening, political advocacy and policies supporting expanded scopes of practice as essential aspects for institutionalization of skills that nurses and midwives were already performing in many settings. In collaboration with Stellenbosch University, Jhpiego developed an accredited, six-month course, “Clinical Competency in Antiretroviral and Tuberculosis Treatment,” to train more than 200 nurses and midwives. The course continues to be offered by the university.
In Mozambique, 11.5 percent of adults between the ages of 15 and 49 are living with HIV. Although this African country is slightly larger than the state of Texas, with a similar population size, there are fewer than 1,000 doctors to serve the population of 24 million, as compared to the 43,000 physicians in Texas. As a result, nurses are the backbone of the health care system, particularly in rural areas. Jhpiego has been supporting the government and nursing education institutions in Mozambique to ensure that the curriculum for training new nurses is evidence-based and adequately addresses the country’s health priorities, including universal access to ART. As such, nursing educators as well as students have been empowered to initiate and manage pregnant women on ART to keep mothers alive and healthy, as well as prevent transmission of HIV to their children.
In Côte d’Ivoire, Jhpiego has led advocacy efforts to sensitize relevant departments within the Ministry of Health to the role of nurses in expanding access to lifesaving ART to the most underserved populations. In coordination with the Ministry, Jhpiego also led the development and implementation of competency-based training for practicing nurses and midwives for the country’s first-ever demonstration project whereby nurses comprehensively manage people living with HIV.
Only by harnessing the skills and commitments of nurses and midwives have countries managed to scale up the provision of ART. The dedication of these competent and confident essential health care providers prevents unnecessary HIV-related deaths. Through prompt identification of HIV during pregnancy and early initiation of ART, mothers are alive and well, caring for their HIV-free children.
Through Jhpiego’s leadership in expanding the role of nurses and midwives to provide HIV services, thousands of women and families who normally would not have received HIV services are now receiving high-quality care.