Table 1 Allocation of HIV and TB tasks for doctors, nurses and lay counsellors at primary health care level
District level | Tasks |
Public health nurse | - Carries out monthly visits to health centres - Conducts quarterly supervision visits - Provides refresher trainings |
Doctor | - Provides clinical mentorship at health centres (and OPD) during bi-weekly clinic visits - Provides referral support for complicated cases - Prescribes ART for non-ARV naïve patients - Prescribes TB treatment for HIV+ patients with sputum negative and/or EP TB in a patient who is in the first three months of ART - Manages patients suspected to have TB IRIS - Makes clinical decision about switching to second-line therapy, as needed - Manages Grade 4 side effects - Formally admits patients to hospital and provides inpatient care |
Health centre level Nurse clinician MOHSW minimum staffing: 1 per health centre | - Initiates and manages first-line ART for adults and children - Interprets chest x-rays to diagnose smear negative TB using the smear negative algorithm and detects unilateral pleural effusion and miliary patterns (if specifically trained) - Initiates second-line ART in the case of treatment failure, after doctor's approval - Interrupts treatment in the case of severe adverse events and manages treatment substitutions for first line as needed - All of the below |
Professional nurse MOHSW minimum staffing: 1 per health centre | - Initiates and manages first-line ART for adults and children - Makes a presumptive diagnosis of severe HIV disease in children <18 months (in the absence of DNA PCR) - Refers patients to hospital - Initiates isoniazid prophylaxis - Initiates TB treatment for patients newly initiated on ART - All of the below |
Trained nurse assistant MOHSW minimum staffing: 2 per health centre | - Initiates and manages first-line ART for adults and children - Stages HIV+ adults and children according to WHO classification and determines clinical need for ART - Manages opportunistic infections - Initiates cotrimoxazole as prophylaxis - Initiates short-course AZT prophylaxis for PMTCT - Prepares children's caregivers to provide ART - Provides education and counselling on feeding options for HIV+ pregnant women - Identifies DR-TB suspects and orders DST |
HIV/TB lay counsellor (adherence) Recommended minimum staffing: 1 per health centre | - Provides preparatory counselling before patients are initiated on ART - Provides ART and TB treatment adherence counselling - Identifies TB and ART defaulters and mobilises community-based health workers to trace them - Facilitates support groups and provides health talks on pertinent topics (e.g., ANC and PMTCT, HTC, TB, ART) - Counsels pregnant women on PMTCT and testing schedule for infants - Schedules appointments for HIV patients, including: labs, counselling, refills and clinical exams, according to national guidelines - Assists in recording basic information in registers and compiling monthly reports, including pre-ART, ART, HTC, PMTCT, TB suspect, and general TB registers - Manages folders of HIV patients and files/cards of TB patients - All of the below |
HIV/TB lay counsellor (HTC) Recommended minimum staffing: 1 per health centre | - Provides HIV testing and counselling for adults and children via rapid tests - Collects dried blood spots for PCR testing of infants, after training - Provides TB and STI screening and refers to nurse accordingly for all HIV+ patients - Weighs patients, carries out basic cough triage and other clinic support tasks - Provides prevention education and commodities - Provides sputum production education, fills out lab specimen request forms, collects and prepares lab samples for transport |
Community-based health worker | - Traces TB treatment and ART defaulters - Provides education and encourages uptake of HIV- and TB-related services - Refers symptomatic patients to health centre - Carries out awareness-raising activities |