Nurse-initiation and maintenance of patients on antiretroviral therapy: Are nurses in primary care clinics initiating ART after attending NIMART training?

Abstract

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...

Exploring the Stumbling Blocks Lying along the Government-NGO Cooperation in the HIV/AIDS Domain Service Delivery: The Case of Institute of Youth Development South Africa (IYDSA) in East London, Eastern Cape Province

“…Literature also indicates that infrastructural shortages largely impeded the effectiveness of the programme because of lack of operational space in the health centres. From a study that sampled nurses from the 7 provinces of South Africa, they reported that their work was impeded because they did not have a room where they could consult the patients (Cameron et al 2012). This is further supported by other findings that indicate that infrastructural challenges such as consulting rooms were also impeding the success of the NIMART programme (Nyasulu et al 2013).…”

“…The government needs to improve the working conditions to avoid the nurses leaving to western world where they are paid handsomely (Oosthuizen & Ehlers 2007;Brier 2009). To further confirm this point other findings also indicated that the fact of overworking the nurses due to being fewer in number was affecting their motivation to work and possibly their output (Cameron et al 2012) It is therefore important that workers working environment is made conducive. The government needs to understand that there is an inextricable relationship between good and conducive working conditions and productivity (Lawler 1994).…”

“…Its aim is to increase the access to treatment and also as a cost effective programme. The programme's inception was also informed and driven by the acknowledgement that 80% deaths from PLWHA occurred to those who were diagnosed in their first year and yet were not accessed with the ART (Cameron et al 2012). However, although the programme started out well, the implementation was surrounded by problems especially where the NGOs were collaborating with the government.…”

Editors choice

“…Cameron and colleagues 4 found that, despites challenges, many primary care nurses working in the seven provinces surveyed have taken on the responsibility of sharing the task of initiating and maintaining HIV-positive patients on ART. To meet the targets of further ART treatment, urgent requirements are: addressing the shortage of nurses at primary care facilities; providing additional consulting rooms; further training in clinical skills and pharmacology; and expansion of clinical mentoring.…”

“…Three papers [2][3][4] provide messages of hope for the massive task of managing South Africa's huge HIV/AIDS pandemic.…”