Beyond Role Expansion: Building Prepared, Empowered and Accountable Nurse Leaders for the HIV Response.

Nurses are central to HIV testing, treatment, prevention, differentiated service delivery, and increasingly integrated care. However, expanding their clinical responsibilities without corresponding leadership preparation, decision-making authority, and institutional support risks creating symbolic rather than effective leadership. This Viewpoint argues that the next phase of the HIV response requires prepared and accountable nurse leaders who can use program data, redesign workflows, strengthen referral systems, support quality improvement, and contribute to policy and resource decisions. Accountability must be reciprocal: nurse leaders should be responsible for quality, equity, patient experience, and workforce well-being, while institutions must provide adequate staffing, mentorship, reliable supplies, usable data, and enabling scopes of practice. Ministries, regulators, implementing partners, and HIV governance bodies should establish competency-based leadership preparation, align authority with responsibility, include nurses in decision-making, and involve communities in service design. Nursing leadership should be treated as essential HIV program infrastructure, not optional professional development.