Review: A workforce in jeopardy: identifying the challenges of ensuring a sustainable advanced HIV nursing workforce

It is now over a decade since I was involved in establishing and subsequently evaluating one of the early nurse-led services for people living with HIV in central London (Dave et al., 2004; Griffiths et al., 2006, 2007). It was an exciting time, particularly for the nurses involved as this was considered ground-breaking in a specialty that had been traditionally driven and delivered by HIV trained doctors. Patients embraced the specialist nurses who became highly skilled providers of routine non-complex HIV care, including the prescription of antiretroviral therapy. The nurses also proved themselves as health promotion, HIV/sexually transmitted infection prevention and psychosocial support specialists. Several were trained to inject poly-l-lactic acid – normally the domain of dermatologists – for the treatment of facial lipoatrophy, a prominent side-effect associated with HIV treatments at the time.

Internationally, shifting the responsibility of HIV care from doctors to adequately trained and supported nurses has consistently demonstrated that quality of care is not compromised (Callaghan et al., 2010; Kredo et al., 2014), may decrease the numbers of patients lost to follow-up (Emdin et al., 2013), can potentially reduce costs of antiretroviral therapy provision (Mdege et al., 2013) and increases job satisfaction for those nurses involved (Iwu and Holzemer, 2014). Although this evidence is largely centred on low-resource settings and may not directly apply to services in the United Kingdom, it is compelling. Consequently, task-shifting of HIV care from medical to nursing staff (and even lay providers) is now well established as part of broader human resources reforms to improve HIV service accessibility, efficiency and quality. Such approaches have already enabled rapid scale-up of HIV testing, treatment and other services in low-resource settings (World Health Organization, 2016).

The results of the reviewed paper were drawn from 63 participants purposively selected using a simple but well considered recruitment strategy covering 21 different HIV services across England. The analysis was appropriate to achieve the desired objectives of the study and the outcomes are presented clearly.

The findings portray a disheartening picture in terms of workforce and career development impediments, which study participants largely ascribed to changing NHS commissioning arrangements. It is clear the environment for advancing HIV nursing practice is less conducive than it was a decade ago and the authors rightly raise concerns about the future of the HIV nursing specialty, particularly in terms of the threats to staff recruitment, training and retention. The authors of the reviewed study provide useful suggestions for policy and practice, which include giving prominence to recent developments by the National HIV Nurses Association (NHIVNA). However, despite attributing many of the challenges to commissioning, there is no suggestion as to how and whether further effects can be mitigated by tackling the highly politicised commissioning agenda. The work of NHIVNA will go some way to strengthen advanced HIV nursing practice, but as stressed by the authors, this alone cannot be achieved without the full support of provider organisations and commissioners to embrace fully, develop further and sustain the nursing developments that have come so far from the early days of HIV treatment, care and support.

Biography

Kevin Miles is a health services development specialist with senior programme management experience that extends across the public, academic, corporate, non-governmental organisation and consultancy sectors. He has worked in Papua New Guinea for the past 7 years and has also worked in Australia, the UK, the Gambia, Botswana, Sierra Leone, Yemen and the South Atlantic British Overseas Territories.