Sustainability of long-term treatment in a rural district: The Lusikisiki model of decentralised HIV/AIDS care

Ford, Neil; Reuter, Hermann; Bedelu, Martha; Schneider, Helen

doi:10.4102/sajhivmed.v7i4.597

Cited by 14 publications

(8 citation statements)

References 5 publications

(4 reference statements)

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“…NIMART is a complex intervention intended to improve healthcare access and equity, ideally without compromising the quality of care, in resource-limited settings. 11 12 Optimal task-shifting requires well-resourced, multidimensional support including: health systems strengthening 13 ; intensive staff engagement, training and mentoring 14–16 ; redistributing basic tasks to non-clinical staff 17 and robust referral, drug supply and quality assurance systems. 18 South Africa's plan to rapidly implement NIMART on an unprecedented nationwide scale raised questions regarding its capacity to meet all of these requirements.…”

Section: Introductionmentioning

confidence: 99%

Nurse and manager perceptions of nurse initiated and managed antiretroviral therapy (NIMART) implementation in South Africa: a qualitative study

2013

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ObjectiveTo explore nurse and facility and programme manager perceptions of nurse initiated and managed antiretroviral therapy (NIMART) implementation in Gauteng, South Africa.DesignIn this qualitative study, in-depth interviews and focus group discussions were conducted to gain insight into participants’ experiences of NIMART implementation.SettingParticipants came from urban, peri-urban and rural primary healthcare clinics in two Gauteng Province municipalities.Participants25 nurses and 18 managers who were actively involved in NIMART implementation were purposively sampled.ResultsThe findings from this study reveal that, despite encountering numerous challenges including human resources, training and clinical mentoring and health systems issues, NIMART nurses and managers remained optimistic about their work. Study participants felt empowered by their expanded roles. Increased responsibilities associated with NIMART implementation encouraged better use of creative problem-solving and teamwork to facilitate integration of NIMART into existing clinic services. NIMART nurses perceived antiretroviral therapy (ART) patients to be more insightful about their illness, engaged in their HIV treatment and aware of the importance of adherence which enhanced nurse–patient relationships and increased their sense of job satisfaction.ConclusionsAlthough the implementation of NIMART is complex, when NIMART is implemented well, ART access is increased and patient outcomes are improved. Supportive interventions which address the specific challenges faced by nurses providing NIMART now need to be implemented. Attempts should be made to replicate the positive aspects of NIMART implementation identified by participants as this may improve healthcare providers’ experiences of task-shifting.

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Section: Introductionmentioning

confidence: 99%

Nurse and manager perceptions of nurse initiated and managed antiretroviral therapy (NIMART) implementation in South Africa: a qualitative study

2013

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“…Trained health workers carry out administration of ART and follow-up despite large distances between the primary health care facility and the many patients needing ART (>5 h by foot for some). Medecins sans Frontieres has assisted in setting up effective clinics in semi-rural regions of South Africa (Lusikisiki in the Eastern Cape [6] and also Khayelitsha in the Western Cape [3]), and similar programs have been successful in Nigeria [1]. UNAIDS has also launched pilot projects to improve ART access in Uganda, Cote d'Ivoire, Chile, and Vietnam [5] (see [7-9] for other recent reviews of the progress in resource-constrained settings).…”

Section: Introductionmentioning

confidence: 99%

How far will we need to go to reach HIV-infected people in rural South Africa?

Wilson

Blower

2007

BMC Med

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Background: The South African Government has outlined detailed plans for antiretroviral (ART) rollout in KwaZulu-Natal Province, but has not created a plan to address treatment accessibility in rural areas in KwaZulu-Natal. Here, we calculate the distance that People Living With HIV/AIDS (PLWHA) in rural areas in KwaZulu-Natal would have to travel to receive ART. Specifically, we address the health policy question 'How far will we need to go to reach PLWHA in rural KwaZuluNatal?'.

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“…Decentralizing ART services away from urban hospitals, not only improves accessibility for rural areas and creates community support, it also relieves the hospital bottleneck (24). Providing ART in rural clinics speeds up the initiation process, allows more people to receive care and frees up hospitals for other services (24). ART clinics can be quite basic and can be run primarily by community members and nurses (24).…”

Section: Decentralization and Simplificationmentioning

confidence: 99%

“…Providing ART in rural clinics speeds up the initiation process, allows more people to receive care and frees up hospitals for other services (24). ART clinics can be quite basic and can be run primarily by community members and nurses (24). In this decentralized approach, doctors play a more supervisory role, and delegate many of the tasks to nurses and medically trained community members.…”

Section: Decentralization and Simplificationmentioning

confidence: 99%

Will Universal Access to Antiretroviral Therapy Ever be Possible? The Health Care Worker Challenge

Maddison

Schlech

2010

Canadian Journal of Infectious Diseases and Medical Microbiolog

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The United Nations millennium development goal of providing universal access to antiretroviral therapy (ART) for patients living with HIV/AIDS by 2010 is unachievable. Currently, four million people are receiving ART, of an estimated 13.7 million who need it. A major challenge to achieving this goal is the shortage of health care workers in low-income and low-resource areas of the world. Sub-Saharan African countries have 68% of the world's burden of illness from AIDS, yet have only 3% of health care workers worldwide. The shortage of health care providers is primarily caused by a national and international 'brain drain,' poor distribution of health care workers within countries, and health care worker burnout.Even though the millennium development goal to provide universal access to ART will not be met by 2010, it is imperative to continue to build on the momentum created by these humanitarian goals. The present literature review was written with the purpose of attracting research and policy attention toward evidence from small-scale projects in sub-Saharan Africa, which have been successful at increasing access to ART. Specifically, a primary-care model of ART delivery, which focuses on decentralization of services, task shifting and community involvement will be discussed. To improve the health care worker shortage in sub-Saharan Africa, the conventional model of health care delivery must be replaced with an innovative model that utilizes doctors, nurses and community members more effectively.

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Sustainability of long-term treatment in a rural district: The Lusikisiki model of decentralised HIV/AIDS care

Abstract: No abstract available.

Cited by 14 publications

References 5 publications

Nurse and manager perceptions of nurse initiated and managed antiretroviral therapy (NIMART) implementation in South Africa: a qualitative study

Nurse and manager perceptions of nurse initiated and managed antiretroviral therapy (NIMART) implementation in South Africa: a qualitative study

How far will we need to go to reach HIV-infected people in rural South Africa?

Will Universal Access to Antiretroviral Therapy Ever be Possible? The Health Care Worker Challenge

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