Clinical mentorship of nurse-initiated Antiretroviral Therapy (ART) in Khayelitsha, South Africa: a quality of care assessment

Master Thesis


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University of Cape Town

South Africa’s National Strategic Plan calls for task shifting of HIV care from doctors to nurses by 2016 to increase access to ART. There is little research demonstrating sustainable success of competent HIV management by nurses after training and mentorship. In February 2011, Medecins Sans Frontieres (MSF) partnered with the City of Cape Town Department of Health to implement a NIMART mentorship programme and assess quality of clinical care provided by nurse graduates. A before-after cross-sectional study was conducted on nurses completing mentorship from February 2011-September 2012. Routine clinical data from 229 patient folders and 21 selfassessment questionnaires was collected to determine the number of patients initiated on ART by individual nurses; quality of ART-management before and after mentorship; patient characteristics for doctor and nurse ART-initiations; and nurse self-assessments. 21 nurses were authorized by one nurse mentor with one part-time medical officer’s support, resulting in nurses initiating 77% of eligible patients. Improvements in ART management were found for drawing required bloods (91% vs 99%, p=0.03), assessing adherence (50% vs 78%, p<;0.001) and WHO staging (63% vs 91%, p<;0.001). Nurse ART initiation indicators were successfully completed 95-100% of the time for 10 out of 16 indicators: clinical presentation, past medical history, prior ART history, WHO stage, STI screening, patient weight, baseline blood work (CD4 count, creatinine, and haemoglobin), treatment plan, and medications prescribed. Doctors initiated more patients with TB/HIV co-infection and Stage 3 or 4 disease than nurses; 24% of patients initiated by nurses were seen or discussed with a doctor in the month prior to initiation. Nurse confidence improved for the management of HIV-infected children and pregnant women, blood result interpretation, and long-term side effects following completion of the mentorship programme.

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