Given that antiretroviral (ARV) medication adherence has been shown to be high in resource-limited countries, the question remains as to whether adherence will remain at that level as medications become more widely available. Comparing adherence to tuberculosis (TB) medications, which have been readily available, and ARV medications may help to indicate the likely future adherence to ARVs as access to these medications becomes more widespread. This study examined sense of coherence, social support, symptom status, quality of life, and adherence to medications in two samples of individuals being treated either for TB or human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) at clinics in Durban, South Africa. Findings revealed the distinctive socio-economic backgrounds of the two cohorts. Although there were significant differences with regard to the psychosocial variables, there were no significant differences by the two samples in adherence to medications as well as adherence to appointments. Given the self-selected nature of the participants in this study, namely those able to attend clinic, as well as those likely to be adherent to ARVs, there is every reason for caution in the interpretations of these findings. As access to ARV medications becomes more widely available in South Africa, the question remains as to whether such high adherence will be maintained given the constraints of access to food and other basic necessities.

Ambiguities and role confusion exist with regard to specialist and clinically advanced nursing/midwifery practice globally and in most healthcare settings. This confusion requires clarification in such a way that specialist/clinical advanced nursing and midwifery practice (as a category of the clinical specialist) are clearly delineated. In South Africa, this is further complicated by the introduction of the Occupation Specific Dispensation (OSD) of the Department of Health (2007) which makes provision for a grade called Professional Nurse (Specialty Nursing) and also for a further grade called Clinical Nurse Specialist (Level 3 Hospitals). The Specialty Nursing category has been implemented in most health services and nurses who have qualifications at post-basic and postgraduate diploma level in the areas described in Regulation 212 can benefit from this progression. The higher level of Clinical Nurse Specialist (OSD term for advanced specialist) has not yet been implemented. The OSD document indicates that appointments to these posts will require significant clinical experience and a clinical master's degree. This is in line with the ICN stance that clinical advanced specialist nursing and midwifery practice require masters and PhD-level education linked to significant clinical practice experience. This chapter presents a differentiation between the two levels of specialist practice − the advanced nurse/midwife practitioner and the specialist nurse/midwife from a South African perspective and in line with the International Council of Nurses (ICN) framework.

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