Despite the remarkable achievement of the scale-up of antiretroviral therapy (ART) in South Africa over the past 7 years (about 1 million people on ART), the estimated number of people (1.2 million) requiring treatment in the next 2 years exceeds the capacity of the healthcare system if treatment continues to be initiated only by doctors. [1][2][3] In South Africa, there are 69 doctors and 388 nurses per 100 000 population.3 Task-shifting from doctors to nurses for initiating and maintaining ART is a logical strategy to meet the need of increased access.2,4,5 Nurse initiation and maintenance of antiretroviral therapy (NIMART) improves access, is cost effective, is not inferior to doctormanaged ART, and achieves similar outcomes of viral suppression, adherence, toxicity and death. 4,6 Further motivation to rapidly improve access is evidence showing that more than 80% of deaths during the first year after diagnosis of HIV infection occurred before these patients could be started on ART. 7Because of the need to scale-up access to ART, President Zuma announced on World AIDS Day, 1 December 2009, that any citizen would be able to access counselling, testing and treatment at any health centre.8 This meant increasing the number of sites providing ART from 496 to 4 333. 9 The Acting Director-General of Health, Dr K Chetty, authorised professional nurses who had the necessary training and supervision to initiate HIV-infected patients on ART from 1 April 2010.The Foundation for Professional Development (FPD) developed a 5-day NIMART training course that included a revision of basic HIV and opportunistic infections in adults and children, the appropriate investigations, and diagnosis and treatment of HIV, TB and STIs. The theory was reinforced by case study discussions and role-play exercises using the approach of the Integrated Management of Childhood Infections (IMCI) and Practical Approach to Lung Health and HIV/AIDS (Palsa Plus).Large-scale training of nurses in 7 provinces began in October 2010; by the end of March 2011, 1 736 nurses had attended one of the 39 NIMART courses facilitated by FPD faculty. All participants received a study manual containing all the lecture notes and a file containing the national guidelines on the management of HIV, TB, INH prophylactic therapy (IPT), prevention of mother-to-child transmission (PMTCT) and sexually transmitted infections. The Hlabisa Casebook, a pocket guide of drug interactions and a service directory of health resources in each province were also supplied. Each nurse received a laminated card with the telephone number of the HIV helpline (0800212506). This free service gives the caller access to advice from a clinical pharmacist in the Department of Pharmacology at the University of Cape Town. Nurses were also encouraged to contact the FPD faculty member facilitating the course, if they had clinical questions.A 60-question multiple choice open book test, with a pass mark of 70%, was administered on the last day of the course. Those who did not pass were given 2 opportuni...

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