Abstract
BackgroundSouth Africa recently launched a national antiretroviral treatment programme. This has created an urgent need for nurse-training in antiretroviral treatment (ART) delivery. The PALSA PLUS programme provides guidelines and training for primary health care (PHC) nurses in the management of adult lung diseases and HIV/AIDS, including ART. A process evaluation was undertaken to document the training, explore perceptions regarding the value of the training, and compare the PALSA PLUS training approach (used at intervention sites) with the provincial training model. The evaluation was conducted alongside a randomized controlled trial measuring the effects of the PALSA PLUS nurse-training (Trial reference number ISRCTN24820584).MethodsQualitative methods were utilized, including participant observation of training sessions, focus group discussions and interviews. Data were analyzed thematically.ResultsNurse uptake of PALSA PLUS training, with regard not only to ART specific components but also lung health, was high. The ongoing on-site training of all PHC nurses, as opposed to the once-off centralized training provided for ART nurses only at non-intervention clinics, enhanced nurses' experience of support for their work by allowing, not only for ongoing experiential learning, supervision and emotional support, but also for the ongoing managerial review of all those infrastructural and system-level changes required to facilitate health provider behaviour change and guideline implementation. The training of all PHC nurses in PALSA PLUS guideline use, as opposed to ART nurses only, was also perceived to better facilitate the integration of AIDS care within the clinic context.ConclusionPALSA PLUS training successfully engaged all PHC nurses in a comprehensive approach to a range of illnesses affecting both HIV positive and negative patients. PHC nurse-training for integrated systems-based interventions should be prioritized on the ART funding agenda. Training for individual provider behaviour change is nonetheless only one aspect of the ongoing system-wide interventions required to effect lasting improvements in patient care in the context of an over-burdened and under-resourced PHC system.
Highlights
South Africa recently launched a national antiretroviral treatment programme
primary health care (PHC) nursetraining for integrated systems-based interventions should be prioritized on the antiretroviral treatment (ART) funding agenda
We argue below that the added value of PALSA PLUS training included the use of an educational outreach training approach which facilitated interactive learning, thereby allowing for the integration of learning and practice and the provision of both emotional and operational support
Summary
South Africa recently launched a national antiretroviral treatment programme. This has created an urgent need for nurse-training in antiretroviral treatment (ART) delivery. The rapid expansion of the ART programme has refocused attention on the need for the provision of integrated primary health care This is partly because HIV, with its diverse manifestations, demands it. It is because without an integrated health systems approach, the South African ART programme, heavily-injected with donor funding and potentially the largest in the world, would become a mammoth vertical structure of little benefit to the overall health service [3,4,5]; which is fragile, overburdened and in urgent need of additional resources. The most compelling reason for an integrated PHC approach is that PHC in South Africa is conducted, almost exclusively, by nurses It is the only level of the public health care structure which reaches most South African people, and the only way for the ART programme to reach all those who need it. In the face of one of the most extensive AIDS epidemics in the world and a critical shortage of health care workers, especially doctors [6,7,8], it is clear that non-physician models of health care delivery are necessary if the constantly expanding ART programme is to be successful and sustainable [9]
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