Nurses can monitor the administration of antiretroviral therapy (ART) as well as doctors, suggest the results of a 120-week trial conducted in South Africa.

"Findings from this study lend support to task-shifting to appropriately trained nurses for monitoring of ART," the study authors wrote.

HIV patients were randomized to care from a doctor (408) or a nurse (404). The patients had a CD4 cell count of less than 350 cells per microliter or World Health Organization stage 3 or 4 disease.

The primary objective was a composite endpoint of treatment-limiting events, incorporating viral failure, toxic effects, adherence to visit schedule, and mortality.

A total of 371 patients experienced treatment failure in comparable numbers between the two groups. Nurses followed 192 of such patients, and 179 were followed by doctors. Sicker patients tended by doctors had somewhat better outcomes than those followed by nurses.

The availability of health care personnel is critical in sub-Saharan Africa, where an estimated 3.8 million people are in need of treatment. Even the wealthiest sub-Saharan nation, South Africa, has just 17.4 doctors per 100,000 residents, and they are concentrated in urban areas.

The full report, "Nurse Versus Doctor Management of HIV-Infected Patients Receiving Antiretroviral Therapy (CAPRA-SA): A Randomized Non-Inferiority Trial," was published in The Lancet (2010:doi:10.1016/S0140-6736(10)60894-X).