Challenges influencing nurse-initiated management of antiretroviral therapy training and implementation in Ngaka Modiri Molema district, North West province

• Published in: Health SA = SA Gesondheid Vol. 25; no. 1; pp. 1 - 11
• Main Authors: Makhado, Lufuno, Mboweni, Sheillah H.
• Format: Journal Article
• Language: English
• Published: South Africa AOSIS 2020; African Online Scientific Information Systems (Pty) Ltd t/a AOSIS; AOSIS (Pty) Ltd; AOSIS Publishing on behalf of University of Johannesburg
• Subjects: Acquired immune deficiency syndrome; AIDS; AIDS (Disease); Antiretroviral agents; Antiretroviral drugs; Curriculum; Disease transmission; Drug therapy; Health aspects; Health care industry; Health care reform; Health Care Sciences & Services; Health Policy & Services; Highly active antiretroviral therapy; HIV; HIV programme; HIV tests; Human immunodeficiency virus; Interviews; Managers; Medical care quality; Medical personnel training; NIMART implementation; NIMART training; Nurses; Nursing research; Original Research; PHC facilities; Primary health care; Professional nurses; Public health; Research design; Sexually transmitted diseases; Training; Tuberculosis; World health; South Africa; NIMART implementation; HIV programme; NIMART training; PHC facilities; professional nurses
• ISSN: 1025-9848; 2071-9736; 2071-9736
• DOI: 10.4102/hsag.v25i0.1174

Background: 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.Aim: The aim of this study was to explore and describe the challenges influencing NIMART training and implementation amongst PNs and programme managers.Setting: The study was conducted from the PHC facilities, in the rural districts of the North West province.Methods: An 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.Results: The 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 tostrengthen NIMART training. And theme 2 included patient and district healthcare structural system.Conclusion: There 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.