In January 2008, Family Health International (FHI), the Clinton Foundation HIV/AIDS Initiative (CHAI)-Rwanda, and CHAI’s Center for Strategic HIV Operations Research (CSHOR) collaborated to measure the impact on human resource needs of a task-shifting pilot project implemented by FHI and the Government of Rwanda. FHI previously demonstrated that trained nurses can effectively prescribe antiretroviral therapy (ART) and provide high quality first-line care and treatment of HIV. CSHOR’s project sought to augment FHI’s analysis by quantifying the physician-time saved as a result of task-shifting.

Using data from the patient population and the national care protocol, CSHOR developed a computer model to simulate HIV care history for the patients in the pilot program. The model calculated the service requirements of the pilot population and approximated the time needed to provide clinical care by nurses and physicians. Estimates were created for both the conventional physician-centered care model and the novel task-shifting care model. The model helped answer the following types of operations research questions:

• How much time would have been required by physicians in this pilot had they used a conventional physician-centered model?

• How much time was required by physicians in the task-shifting model? What are the savings of the novel approach?

• How many patients can be seen by nurses instead of physicians?

• What is the increase in physician capacity for non-HIV services in Rwanda if task-shifting is applied nationally?

This analysis indicated that task-shifting HIV care and treatment to nurses significantly reduces the demand for physician time. In a country with a severe shortage of physicians, task-shifting appears to be one reasonable approach to meet treatment scale-up goals. Based on the positive response from the Ministry of Health, steps are currently underway for an expansion of the pilot throughout Rwanda.