Estimating health workforce needs for antiretroviral therapy in resource-limited settings

We reviewed the published literature and selected plans and scaling-up proposals, interviewed experts and collected data on staffing patterns at existing treatment sites through a structured survey and site visits.We found a wide range of staffing patterns and patient-provider ratios in existing and planned treatment programmes. Many factors influenced health workforce needs, including task assignments, delivery models, other staff responsibilities and programme size. Overall, the number of health care workers required to provide ART to 1000 patients included 1–2 physicians, 2–7 nurses, <1 to 3 pharmacy staff, and a much wider range of counsellors and treatment supporters. We estimate from these data that the equivalent of 20 000 to 100 000 physicians, nurses, pharmacists and other core clinical staff will be needed to meet the WHO target of treating 3 million people by the end of 2005. The total number of staff, including counsellors, administrators and other cadres, could be substantially higher.These data are consistent with other estimates of human resource requirements for antiretroviral therapy, but highlight the considerable variability of current staffing models and the importance of a broad range of factors in determining personnel needs. Few outcome or cost data are currently available to assess the effectiveness and efficiency of different staffing models, and it will be important to develop improved methods for gathering this information as treatment programmes are scaled up.The availability of effective treatment for HIV/AIDS through antiretroviral therapy (ART) has resulted in dramatic declines in morbidity, mortality and mother-to-child transmission (MTCT) in resource-rich countries [1,2]. Similar results have been reported in well-designed and -staffed programmes providing ART in resource-limited settings [3,4]. Decreased cost of antiretrovirals (ARVs) combined with simpler recommendations for initiation and monitoring from the World Health Organizat