MIN/Sp/AU/CAMH3/6 HIV/AIDS Page 8 serve those who need care most. Task shifting happens when lower level health workers are trained and given tasks, which are normally reserved for highly trained workers, such as doctors. Although TTR is a new concept, some of its elements, such as task shifting, are already operational in a number of countries in the region. Of the 35 countries that reported, 18 (46%) have a policy that allows lower level health workers— once trained—to provide second-level services, such as managing patients with HIV and AIDS (Figure 3.3). Figure 3.3: Percent of countries with national policy on: Task shifting policy Free lab monitoring 46 57 Free HTC 80 Free ART 80 Although the cost of HIV care and treatment services is gradually becoming affordable, these are still beyond the means for millions of poor people infected or affected by the epidemic. As part of the Abuja and UNGASS commitments, African leaders resolved to make these life-saving interventions free for those who cannot afford. About one third of reporting countries (57%) indicated to have a national policy which offers free laboratory monitoring services for patients on ART. Such services include CD4 count or viral loads, which otherwise cost more than the treatment. An equal number of countries (28) reported having a policy of free HIV testing and counseling as well as ART services for their citizens. In other countries such as Sudan, a high rate of turn-over of staff limits the ability to meet the long-term requirements of policy response. In Tunisia the emphasis is on information, education and communication as a policy strategy. Whereas in Egypt, HIVrelated activities have been mainstreamed into and initiated within programmes addressing people most likely to be exposed to HIV. In Somalia, the continuing humanitarian crisis, conflict and emergencies directly affect sustainability of any policy for an effective long-term response.