Abstract
BackgroundThe increasing number of people testing human immunodeficiency virus positive and who demand antiretroviral therapy (ART) prompted the Department of Health to adopt World Health Organization’s task shifting where professional nurses (PNs) initiate ART rather than doctors. This resulted in decentralisation of services to primary healthcare (PHC), generating a need to capacitate PNs on nurse-initiated-management of ART (NIMART). The impact of NIMART was assessed and even though there was an increased number of patients on ART, the quality of care is of serious concern.AimThe aim of this study was to explore and describe the challenges influencing NIMART training and implementation amongst PNs and programme managers.SettingThe study was conducted from the PHC facilities, in the rural districts of the North West province.MethodsAn exploratory programme evaluation and contextual research design was used in the study. Purposive sampling was used. Focus group discussion (n = 28) and individual interviews were used to collect data. Data was analysed using ATLAS.ti software.ResultsThe results revealed two themes: inadequacy in NIMART training and the healthcare system challenges that influence NIMART training and implementation. Theme 1 included among others the lack of standardised curriculum and model or conceptual framework to strengthen NIMART training. And theme 2 included patient and district healthcare structural system.ConclusionThere a need to improve NIMART training and implementation through the standardisation of NIMART curriculum, introduction of pre-service NIMART training in institutions of higher learning, addressing staff shortages and negative attitude of PNs providing ART.
Highlights
Introduction and backgroundThe increasing number of people living with human immunodeficiency virus (HIV) and the increasing demand for antiretroviral therapy (ART) exert increased pressure on the South African healthcare system which is already experiencing challenges in human resources (HRs) (Joint United Nations on HIV/AIDS [UNAIDS] 2017)
Five focus group discussion (FGD) were conducted with 28 professional nurses (PNs) trained on nurseinitiated management of antiretroviral therapy (NIMART) from Ngaka Modiri Molema (NMM) primary healthcare (PHC) facilities who participated in the study
The majority of participants were working in rural PHC facilities (79%) and 68% of PNs were working at PHC clinics
Summary
Introduction and backgroundThe increasing number of people living with human immunodeficiency virus (HIV) and the increasing demand for antiretroviral therapy (ART) exert increased pressure on the South African healthcare system which is already experiencing challenges in human resources (HRs) (Joint United Nations on HIV/AIDS [UNAIDS] 2017). According to Simelela and Venter (2014), the Republic of South Africa (RSA) adopted WHO recommendations of task shifting where professional nurses (PNs) initiate ART to complement doctors and address the challenge of inaccessibility to ART services from the PHC facilities This task shifting calls for the intense training of PNs on nurseinitiated management of antiretroviral therapy (NIMART) in PHC facilities in the country. The increasing number of people testing human immunodeficiency virus positive and who demand antiretroviral therapy (ART) prompted the Department of Health to adopt World Health Organization’s task shifting where professional nurses (PNs) initiate ART rather than doctors. This resulted in decentralisation of services to primary healthcare (PHC), generating a need to capacitate PNs on nurse-initiated-management of ART (NIMART). The impact of NIMART was assessed and even though there was an increased number of patients on ART, the quality of care is of serious concern
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