**3. The importance of task-shifting mental health care management of rape survivors diagnosed with PTSD and depression to nurses**

Task shifting (also known as task sharing) is defined as "the rational redistribution of tasks among health workforce teams [27]". Task shifting as an approach has some roots in HIV and AIDS care, particularly in developing countries where human resource shortages and the burden on public health systems have been severe, limiting access to antiretroviral therapy (ART) [28].

Recent research has found that task-shifting models provide higher-quality, more cost-effective care to more HIV-infected patients than physician-centered models, and that they have increased access to ART [29]. Access to ART is good in South Africa and is led by professional nurses trained in Nurse-Initiated Management of Ante-Retroviral Treatment (NIMART) [30]. Therefore, the same model can be followed for task shifting, disseminating, and integrating mental health services for rape survivors who are diagnosed with PTSD and depression in primary health care in South Africa.

One study reported that interventions incorporating mental health into primary care or community services without utilizing specialist services were the most costeffective in reviewing mental illness costs and the cost-effectiveness of treatments [31]. Lund and Flisher [32] created a South African context- and need-specific model for calculating the costs of implementing an integrated community mental health service, emphasizing the cost-effectiveness of addressing mental health needs in communities through task-shifting approaches. However, specialist services will always be required regardless of how innovative and effective task-shifting approaches close the mental health treatment gap [33]. Thus, most medical examinations are offered by medical doctors within the South African context. In this regard, it is worth mentioning that nurses can provide medical services such as post-exposure prophylaxis (PEP) for HIV, prophylaxis for other sexually transmitted infections, emergency contraception, treatment of injuries, and even forensic examinations for rape survivors.

Hence, it is essential to shift, if not decentralize, the management of rape survivors diagnosed with PTSD and depression to professional nurses in the primary health care clinics. Also, when the task shifting is done in the primary health care setting, the management of rape survivors diagnosed with PTSD and depression can benefit society if carried out by professional nurses. This can be aided through preservice inclusion of management of rape survivors diagnosed with PTSD and depression among nurses in undergraduate training and in-service training among all professional nurses already in practice.
