Factors influencing the confidence and knowledge of nurses prescribing antiretroviral treatment in a rural and urban district in the Western Cape province

Abstract

Background Since the introduction of nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa in 2010, initiation of antiretroviral therapy (ART) in primary care has become the responsibility of nurses. The continued success of this approach is dependent on factors such as adequate training and effective support systems. Objectives This study aimed to investigate factors influencing the knowledge and confidence of professional nurses in managing patients living with human immunodeficiency virus (HIV) in primary healthcare settings in a rural and urban district in the Western Cape. Methods A cross-sectional survey was conducted amongst 77 NIMART-trained nurses from 29 healthcare facilities to measure demographic details, influencing factors, HIV management confidence and HIV management knowledge. Results The majority of participants had adequate HIV management knowledge and reported being very confident or expert in the HIV management skills or competencies. Participants trained recently on local guidelines (Practical Approach to Care Kit) (3 years ago or less) had significantly higher knowledge scores. Regular feedback about clinic and personal performance was associated with higher HIV management knowledge. Participants who received NIMART mentoring over a period of 2 weeks had a higher mean confidence score compared to other periods of mentoring. A higher caseload of patients living with HIV was also associated with higher knowledge and confidence. Conclusion Training, mentorship and clinical practice experience are associated with knowledge and confidence. Recommendations include the strengthening of current training and mentoring and ensuring that NIMART-trained nurses are provided with regular updates and sufficient opportunities for clinical practice.

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

“…2,18,19 Adequate training results in improved knowledge of HIV management, greater confidence and clinical competence, particularly if accompanied by mentoring. 14,20,21,22 A study conducted in an urban and rural district in the Western Cape found that the majority of NIMART-trained nurses had adequate HIV management knowledge and were very confident to manage adult patients. 22 The survey was specific to adult HIV management as nurses are only involved to a limited extent in the management of children in the Western Cape.…”

“…29 Clinical exposure further contributes to knowledge and confidence as was found in a study conducted in the Western Cape where a higher caseload of HIV patients was associated with higher knowledge and confidence. 22 In the North West province, effective placement, specifically at Community Health Centres, contributed to POE completion. 24 The mentoring of nurses had a positive effect on patient care by improving the clinical skills of professional nurses and by raising the standard of HIV care in the Eastern Cape.…”

“…A period of 2 weeks of 'dedicated mentoring-time' with a mentor may be sufficient to complete competencies. 22 Jobson et al 31 conducted a qualitative study, evaluating the role of mentoring in the support of the scale-up of ART across three provinces of South Africa. The study explored the role of targeted mentoring using a needs-based approach to support NIMART, pharmacy management and data management.…”

“…A study conducted in the Western Cape found that NIMART nurses with recent training on guidelines (less than 3 years) had better knowledge compared with nurses who reported to be trained more than 3 years ago. 22 In general, NIMARTtrained nurses identified the need for continuing education. 2,19,20,21,35,39 Whilst NIMART training enabled access, a lack of mentoring following training was a barrier in terms of the gap between the number of nurses who received training and those who could initiate treatment.…”

Integralidade na Atenção Primária: análise do discurso acerca da organização da oferta do teste rápido anti-HIV

“…21,22 Longitudinality enhances the completeness attribute, aiming at early and accurate diagnosis in order to initiate Antiretroviral Therapy (ART), as seen in a study conducted in South Africa, in which ART is provided in PHC and prescribed by professional nurses in HIV management, to decrease the viral load in blood circulation, which consequently decreases the spread of the virus. 23 Organizational devices have emerged in the discourses that optimize the RT provision strengthening the attribute of completeness, such as: waiting room and active search, according to the discursive sequences -"prevention activities are done [...] in waiting room care, [...] active search of patients who have and seek the service". Thus, the waiting room constitutes an optimizing space for users to report their daily experiences, reflect on the health-disease process and be sensitized to perform anti-HIV testing.…”