HIV drugs can be administered as effectively by nurses as by doctors, a finding that could yield major benefits in the fight against AIDS in Africa, researchers said yesterday.
In a trial carried out at two South African front-line clinics, 408 patients with HIV were assigned to anti-retroviral (ART) drugs monitored by doctors and 404 others to drugs monitored by nurses.
The goal was to see whether nurses were as observant and reactive as doctors in administering ART. Would they spot that a patient was responding to the drugs, failing in the treatment or suffering from toxic side effects?
A total of 371 patients encountered treatment failure over the 120-week length of the experiment, but the results were similar in both groups — 192 in the nurses group and 179 in the doctors group.
Ten patient deaths occurred among the nurses group compared with 11 among the doctors. There were equally close results among patients who failed to respond to a specific ART combination, fell ill from them or dropped out of the program.
“Nurse-monitored ART is non-inferior to doctor-monitored therapy,” said the paper, published online by the Lancet. “Findings from this study lend support to task-shifting to appropriately trained nurses for monitoring of ART.”
The findings are important because Africa, the worst-hit continent for AIDS, suffers from a chronic lack of doctors — and health watchdogs have been wondering desperately whether less-trained personnel can be used as substitutes.
Of the 22.4 million people living with HIV in sub-Saharan Africa, an estimated 3.8 million are in urgent need of treatment.
But in South Africa, the wealthiest country south of the Sahara, there are only 17.4 doctors per 100,000 people, and these doctors are overwhelmingly concentrated in urban areas.
ART first became available in 1996, but for almost a decade, its high cost limited its spread to rich countries.
Further hampering distribution to Africa was the argument that the drugs were too complex to administer in resource-poor settings, as they required lab support and highly qualified personnel.
The new study, while approving the “task-shifting” to nurses, adds that staff still need to be trained to supervise use of these powerful drugs.
In addition, it found that patients in a more sever stage of infection did somewhat better when monitored by doctors as opposed to nurses.
The research did not look at the question as to whether nurses performed well in initiating drug treatment. Under South African law, only doctors have the right to prescribe licensed drugs such as ART.
Ukraine’s military intelligence agency and the Pentagon on Monday said that some North Korean troops have been killed during combat against Ukrainian forces in Russia’s Kursk border region. Those are the first reported casualties since the US and Ukraine announced that North Korea had sent 10,000 to 12,000 troops to Russia to help it in the almost three-year war. Ukraine’s military intelligence agency said that about 30 North Korean troops were killed or wounded during a battle with the Ukrainian army at the weekend. The casualties occurred around three villages in Kursk, where Russia has for four months been trying to quash a
FREEDOM NO MORE: Today, protests in Macau are just a memory after Beijing launched measures over the past few years that chilled free speech A decade ago, the elegant cobblestone streets of Macau’s Tap Seac Square were jam-packed with people clamouring for change and government accountability — the high-water mark for the former Portuguese colony’s political awakening. Now as Macau prepares to mark the 25th anniversary of its handover to China tomorrow, the territory’s democracy movement is all but over and the protests of 2014 no more than a memory. “Macau’s civil society is relatively docile and obedient, that’s the truth,” said Au Kam-san (歐錦新), 67, a schoolteacher who became one of Macau’s longest-serving pro-democracy legislators. “But if that were totally true, we wouldn’t
ROYAL TARGET: After Prince Andrew lost much of his income due to his friendship with Jeffrey Epstein, he became vulnerable to foreign agents, an author said British lawmakers failed to act on advice to tighten security laws that could have prevented an alleged Chinese spy from targeting Britain’s Prince Andrew, a former attorney general has said. Dominic Grieve, a former lawmaker who chaired the British Parliament’s Intelligence and Security Committee (ISC) until 2019, said ministers were advised five years ago to introduce laws to criminalize foreign agents, but failed to do so. Similar laws exist in the US and Australia. “We remain without an important weapon in our armory,” Grieve said. “We asked for [this law] in the context of the Russia inquiry report” — which accused the government
TRUDEAU IN TROUBLE: US president-elect Donald Trump reacted to Chrystia Freeland’s departure, saying: ‘Her behavior was totally toxic, and not at all conducive to making deals Canadian Deputy Prime Minister Chrystia Freeland on Monday quit in a surprise move after disagreeing with Canadian Prime Minister Justin Trudeau over US president-elect Donald Trump’s tariff threats. The resignation of Freeland, 56, who also stepped down as finance minister, marked the first open dissent against Trudeau from within his Cabinet, and could threaten his hold on power. Liberal leader Trudeau lags 20 points in polls behind his main rival, Conservative Pierre Poilievre, who has tried three times since September to topple the government and force a snap election. “It’s not been an easy day,” Trudeau said at a fundraiser Monday evening, but
RSS