Implementation considerations

• Defining roles and standards of care: Standards of care should be defined for different levels of the health system, including the private sector. The role of each cadre of health worker should match their skills and capacity, and the lines of responsibility should be clear and well understood. For example, health care staff at a decentralized facility should be able to identify signs and symptoms of advanced liver disease or interpretation of test (such as APRI or FIB-4) for the appropriate referral of persons in need of a higher level of care, especially among older patients. There is a need to ensure an appropriate mix of health care workers at peripheral facilities.
• Training and mentorship: Effective task sharing with non-specialist doctors or nurses requires provision of appropriate training and ongoing mentorship at the decentralized site and access to additional support or referral to tertiary or specialist sites for more complex cases (148)

• 168)This should include awareness-raising and training to provide non-stigmatizing, nondiscriminatory health care to key populations.

• Regulatory framework: An appropriate regulatory framework (legislation, regulations, policies and guidelines) is needed to enable tasks to be performed by different cadres of health care workers. In some countries task sharing and delegation may require changes to legislation and rules and procedures (160).
• The updated Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations now include an additional recommendation for peer navigators to support people from key populations to start HIV, viral hepatitis or STI treatment to remain in care.