Commentary: scaling up HIV treatment in resource-limited countries: the challenge of staff shortages

Scaling up antiretroviral therapy (ART) in resource-limited countries is a major challenge for health professionals and program managers due to the large number of patients and the severe shortage of health-care workers. The estimated number of patients in those settings requiring ART in 2009 was 14.6 million, of whom 64 per cent were not yet treated. The World Health Organization estimates that there is an overall deficit of more than 4 million physicians, nurses, midwives, and support workers for achieving the essential health interventions and the Millennium Development Goals (including the scaling up of HIV care). Strengthening the health systems through education, job-specific training, recruitment, and retention of health-care workers is imperative. In the meantime, task shifting is a key element of the response to the staff shortages, but further innovative models of care delivery are needed.