Provision of antiretroviral therapy for children in Nelson Mandela Bay: Health care professionals’ challenges

Abstract

BackgroundThe human immunodeficiency virus and/or acquired immune deficiency syndrome (HIV/AIDS) pandemic continues to increase in prevalence worldwide, particularly in South Africa, and includes the often overlooked paediatric population. The provision of paediatric antiretroviral treatment (ART) is as essential for children as for adults, and has numerous obstacles, not least of which is lack of decentralisation of facilities to provide essential treatment. Optimising ART, care and support for HIV-positive children, and their caregivers, at public sector primary health care (PHC) clinics is crucial to improve morbidity and mortality rates in children.AimTo explore the experiences of health care professionals regarding the provision of ART for children at PHC clinics.SettingThe study was conducted in six PHC clinics in Nelson Mandela Bay Health District, Eastern Cape, South Africa.MethodologyThe researchers used a qualitative, explorative, descriptive and contextual research design with in-depth interviews. We used non-probability purposive sampling. Data collected were thematically analysed using Creswell’s data analysis spiral. We used Lincoln and Guba’s model to ensure trustworthiness. Ethical standards were applied.ResultsHealth care professionals experienced numerous challenges, such as lack of resources, need for training, mentoring and debriefing, all related to providing decentralised ART for HIV-positive children at the PHC level.ConclusionCapacitation of the health care system, integration of services, competent management and visionary leadership to invoke a collaborative interdisciplinary team approach is required to ensure that HIV is treated as a chronic disease at the PHC clinic level.

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

“…Nurses were apprehensive to work with children and noticed incongruence in the interpretation of ART side effects in children. 29 …”

“…21 In the Eastern Cape, barriers to paediatric NIMART implementation included ineffective management, disharmony and non-conducive work environments. 29 …”

“…28 Accelerating NIMART in paediatric patients, coupled with mentoring and support were considered enablers in the provision of ART in infants and children living with HIV in the Eastern 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.…”

“…Nurses were apprehensive to work with children and noticed incongruence in the interpretation of ART side effects in children. 29 An analysis of nurses' queries to the National HIV and TB Health Worker Hotline showed that 66% of the queries received were from NIMART-trained nurses and most were related to ART initiation and adverse drug reactions. The most common knowledge gap identified was on the interpretation of blood results before initiation of ART, 42 which was also confirmed by Rasalanavho.…”

“…21 In the Eastern Cape, barriers to paediatric NIMART implementation included ineffective management, disharmony and non-conducive work environments. 29 A negative attitude towards the management of HIV and TB patients was identified by Mboweni and Makhado. 38 Negative attitudes and discrimination from non-NIMART-trained nurses and refusal to manage HIV positive patients was also reported in a study conducted in Venda.…”