Health Care Workers Could Be Africa's Secret Weapon in AIDS War

Non-physician clinicians (NPCs), personnel with more clinical training than nurses but less than doctors, are an inexpensive way of addressing a shortage of doctors and ramping up access to AIDS drugs in more than two dozen sub-Saharan African countries, a new study shows.

In a report published in The Lancet, Fitzhugh Mullan and Seble Frehywot of George Washington University's School of Public Health said the number of NPCs equaled or exceeded the number of physicians in nine of the 47 countries investigated. NPCs typically are nurse practitioners, physicians' assistants, and clinical officers who have had secondary-school education followed by three to four years of basic health care training.

NPCs could help relieve the shortage of doctors by carrying out many of the diagnostic and clinic duties that physicians perform, including examining patients for opportunistic diseases and discussing drug side-effects with them.

There are obvious economic advantages: According to the researchers, a three-year training program for an NPC costs on average $3,000-$6,000 per person. The training is also practical, since much of it is rooted in local health problems, they noted.

The number of Africans receiving antiretrovirals increased ten-fold from December 2003 to June 2006, when approximately 1 million were getting treatment. However, that figure is still less than a quarter of the approximately 4.6 million patients in need of the drugs.

The report, "Non-Physician Clinicians in 47 Sub-Saharan African Countries," was published in an early online edition of The Lancet (2007;doi:10.1016/S0140-6736(07)60785-5).

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