Ten years of nurse-initiated antiretroviral treatment in South Africa: A narrative review of enablers and barriers

Crowley, Talitha; Mokoka, Elizabeth; Geyer, Nelouise

doi:10.4102/sajhivmed.v22i1.1196

Cited by 16 publications

(14 citation statements)

References 36 publications

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“…Tackling knowledge gaps in HIV care amongst nurses may require strong leadership skills that will facilitate the prioritization of continuous professional development and inservice training. Crowley et al (2021), in a narrative review of enablers and barriers of nurseinitiated antiretroviral treatment in South Africa, reported training of nurses as an important enabler [30]. Similarly, Makhado et al (2020) reported continuous education (in-service, refresher, follow-up training) as facilitating HIV guideline adherence by nurses in South Africa.…”

Section: Discussionmentioning

confidence: 99%

Exploring barriers to switching “on time” to second-line antiretroviral therapy among nurses in primary health care facilities, Ekurhuleni Health District, South Africa

et al. 2023

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Background Ensuring that all HIV-infected people receive antiretroviral therapy (ART) and achieve viral suppression are key South African strategies to end the AIDS epidemic in the country. National HIV treatment guidelines recommend an immediate switch to second-line ART following virological failure with first-line ART. Nurses based in district health facilities are at the forefront of implementing this recommendation. While there are often delays in switching and in some instances no switch, the reasons for and barriers to delayed switching are not well understood at the primary care level. Aim To explore the views of frontline nursing staff about factors contributing to delayed switching of patients who have failed first-line ART regimen in Ekurhuleni district, South Africa. Methods A qualitative study was conducted among 21 purposively sampled nurses who provide HIV treatment and care to patients in 12 primary health care (PHC) facilities in Ekurhuleni Health District, Gauteng Province, South Africa. Individual in-depth interviews explored nurses’ experiences regarding their recognition of virological failure and understanding of “on time” switching to second-line ART. Interviews probed the circumstances contributing to delays in switching. After digital audio recording and transcription, manual inductive thematic analysis was used to analyse the data. Findings Multiple barriers were identified: 1) Healthcare provider factors included a lack of knowledge and confidence coupled with demotivation in the workplace; 2) Patient issues similarly comprised a lack of knowledge as well as resistance to being switched to another drug regimen and loss to follow up; 3) Systems factors were poor facility leadership, shortages of medication, staffing constraints, and the inability to trace laboratory results, especially for migrant patients. Conclusion Reasons for delayed switching of patients to second-line ART are multifactorial and require integrated interventions at health provider, patient and health system levels.

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Section: Discussionmentioning

confidence: 99%

Exploring barriers to switching “on time” to second-line antiretroviral therapy among nurses in primary health care facilities, Ekurhuleni Health District, South Africa

et al. 2023

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“…12,13 Finally, ensuring the TB program is nurse-led and clinic-based is important for feasibility, cost, and scalability. 14,15 In summary, participants were enthusiastic, but felt the need for more knowledge, clear guidelines, speci c work ows, and continuous momentum. 19 Ensuring the program is patient-centered and aligns with the WHO's End TB Strategy Pillar One, which "puts patients at the heart of service delivery" is also important.…”

Section: Discussionmentioning

confidence: 99%

“… 12 , 13 Finally, ensuring the TB program is nurse-led and clinic-based is important for feasibility, cost, and scalability. 14 , 15 In summary, participants were enthusiastic, but felt the need for more knowledge, clear guidelines, specific workflows, and continuous momentum. Table 4 describes next steps for program implementation.…”

Section: Discussionmentioning

confidence: 99%

Healthcare worker knowledge, attitudes, and beliefs regarding tuberculosis preventive therapy in rural South Africa: A content analysis using the consolidated framework for implementation research

Water

Wilson

Roux

et al. 2023

Preprint

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Background: South African national tuberculosis (TB) guidelines, in accordance with the World Health Organization, recommend conducting routine household TB contact investigation with provision of TB preventive therapy (TPT) for those who qualify. However, implementation of TPT has been suboptimal in rural South Africa. We sought to identify barriers and facilitators to TB contact investigations and TPT management in rural Eastern Cape, South Africa to inform the development of an implementation strategy to launch a comprehensive TB program. Methods: We collected qualitative data through individual semi-structured interviews with 19 healthcare workers at a district hospital and four surrounding primary-care clinics referring to the hospital. The consolidated framework for implementation research (CFIR) was used to develop interview questions as well as guide deductive content analysis to determine potential drivers of implementation success or failure. Results: A total of 19 healthcare workers were interviewed. Identified common barriers included lack of provider knowledge regarding efficacy of TPT, lack of TPT documentation workflows for clinicians, and widespread community resource constraints. Facilitators identified included healthcare workers high interest to learn more about the effectiveness of TPT, interest in problem-solving logistical barriers in provision of comprehensive TB care (including TPT), and desire for clinic and nurse-led TB prevention efforts. Conclusion: The use of the CFIR, a validated implementation determinants framework, provided a systematic approach to identify barriers and facilitators to TB household contact investigation, specifically the provision and management of TPT in this rural, high TB burden setting. Specific resources – time, trainings, and evidence – are necessary to ensure healthcare providers feel knowledgeable and competent about TPT prior to prescribing it more broadly. Tangible resources such as improved data systems coupled with political coordination and funding for TPT programming are essential for sustainability.

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“…In addition, quality improvement strategies such as integrated management of childhood illness (IMCI), 13 practical approach to care kit (PACK) 14 and basic antenatal care (BANC) 15 have all been introduced in PHC. Despite these quality improvement strategies, PHC nurses still report challenges with legislation, policy and guidelines, 12 , 16 inadequate support and mentoring, 16 , 17 non-standardised training and inadequate training and awareness. 13 , 16 , 17 …”

Section: Introductionmentioning

confidence: 99%

Training needs of professional nurses in primary health care in the Cape Metropole, South Africa

Kordom

Daniels

Chipps

2023

Afr. j. prim. health care fam. med.

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Background: In the fast-changing healthcare environment, it is important to ensure that primary health care (PHC) nurses are suitably qualified and have access to appropriate and relevant ongoing education.Aim: The aim of this study was to determine the training needs of professional nurses working in PHC facilities.Setting: The research was conducted in PHC facilities in the Cape Metropole, Western Cape, South Africa.Methods: A quantitative descriptive survey with all-inclusive sampling was used. All professional nurses (N = 303), employed for at least a minimum of 6 months in PHC facilities were included in the study. The Hennessy–Hicks Training Needs Analysis (TNA) questionnaire was used to collect the data on professional tasks training needs and open-ended questions for specific PHC contextual training needs. Importance and performance means for each of the TNA subsections and training needs were calculated. Open-ended questions were analysed using content analysis, identifying training domains and topics in terms of frequency and ranking.Results: The TNA identified ‘Research’ as the highest training need. Research tasks were significantly rated as the least important and the lowest rated performance compared to other domains. Child mental health was rated as the most important specific training need.Conclusion: The results of this survey provide insight into the training needs of professional nurses employed in PHC facilities and highlight the need for child mental healthcare and research training in this setting.Contribution: The study contributes to the understanding of the training and education needs of professional nurses working in PHC facilities.

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Ten years of nurse-initiated antiretroviral treatment in South Africa: A narrative review of enablers and barriers

Cited by 16 publications

References 36 publications

Exploring barriers to switching “on time” to second-line antiretroviral therapy among nurses in primary health care facilities, Ekurhuleni Health District, South Africa

Exploring barriers to switching “on time” to second-line antiretroviral therapy among nurses in primary health care facilities, Ekurhuleni Health District, South Africa

Healthcare worker knowledge, attitudes, and beliefs regarding tuberculosis preventive therapy in rural South Africa: A content analysis using the consolidated framework for implementation research

Training needs of professional nurses in primary health care in the Cape Metropole, South Africa

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