Clinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: a quality of care assessment

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dc.contributor.authorGreen, Annen_ZA
dc.contributor.authorde Azevedo, Virginiaen_ZA
dc.contributor.authorPatten, Gabrielaen_ZA
dc.contributor.authorDavies, Mary-Annen_ZA
dc.contributor.authorIbeto, Maryen_ZA
dc.contributor.authorCox, Vivianen_ZA
dc.date.accessioned2016-01-02T05:08:42Z
dc.date.available2016-01-02T05:08:42Z
dc.date.issued2014en_ZA
dc.description.abstractIntroduction To combat the AIDS epidemic and increase HIV treatment access, the South African government implemented a nurse-based, doctor-supported model of care that decentralizes administration of antiretroviral treatment (ART) for HIV positive patients through nurse initiated and managed ART. Médecins Sans Frontières (MSF) implemented a mentorship programme to ensure successful task-shifting, subsequently assessing the quality of clinical care provided by nurses. METHODS: A before-after cross-sectional study was conducted on nurses completing the mentorship programme in Khayelitsha, South Africa, from February 2011-September 2012. Routine clinical data from 229 patient folders and 21 self-assessment questionnaires was collected to determine the number of patients initiated on ART by nurses; quality of ART management before-after mentorship; patient characteristics for doctor and nurse ART initiations; and nurse self-assessments after mentorship. RESULTS: Twenty one nurses were authorized by one nurse mentor with one part-time medical officer's support, resulting in nurses initiating 77% of ART 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 at 95-100% for 11 of 16 indicators: clinical presentation; patient weight; baseline blood work (CD4, creatinine, haemoglobin); STI screening; WHO stage, correlating medical history; medications prescribed appropriately; ART start date; and documented return date. Doctors initiated more patients with TB/HIV co-infection and WHO Stage 3 and 4 disease than nurses. Nurse confidence improved for managing HIV-infected children and pregnant women, blood result interpretation and long-term side effects. CONCLUSIONS: Implementation of a clinical mentorship programme in Khayelitsha led to nurse initiation of a majority of eligible patients, enabling medical officers to manage complex cases. As mentorship can increase clinical confidence and enhance professional development, it should be considered essential for universal ART access in resource limited settings.en_ZA
dc.identifier.apacitationGreen, A., de Azevedo, V., Patten, G., Davies, M., Ibeto, M., & Cox, V. (2014). Clinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: a quality of care assessment. <i>PLoS One</i>, http://hdl.handle.net/11427/16190en_ZA
dc.identifier.chicagocitationGreen, Ann, Virginia de Azevedo, Gabriela Patten, Mary-Ann Davies, Mary Ibeto, and Vivian Cox "Clinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: a quality of care assessment." <i>PLoS One</i> (2014) http://hdl.handle.net/11427/16190en_ZA
dc.identifier.citationGreen, A., de Azevedo, V., Patten, G., Davies, M. A., Ibeto, M., & Cox, V. (2014). Clinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: a quality of care assessment. PloS one, 9(6), e98389. doi:10.1371/journal.pone.0098389en_ZA
dc.identifier.ris TY - Journal Article AU - Green, Ann AU - de Azevedo, Virginia AU - Patten, Gabriela AU - Davies, Mary-Ann AU - Ibeto, Mary AU - Cox, Vivian AB - Introduction To combat the AIDS epidemic and increase HIV treatment access, the South African government implemented a nurse-based, doctor-supported model of care that decentralizes administration of antiretroviral treatment (ART) for HIV positive patients through nurse initiated and managed ART. Médecins Sans Frontières (MSF) implemented a mentorship programme to ensure successful task-shifting, subsequently assessing the quality of clinical care provided by nurses. METHODS: A before-after cross-sectional study was conducted on nurses completing the mentorship programme in Khayelitsha, South Africa, from February 2011-September 2012. Routine clinical data from 229 patient folders and 21 self-assessment questionnaires was collected to determine the number of patients initiated on ART by nurses; quality of ART management before-after mentorship; patient characteristics for doctor and nurse ART initiations; and nurse self-assessments after mentorship. RESULTS: Twenty one nurses were authorized by one nurse mentor with one part-time medical officer's support, resulting in nurses initiating 77% of ART 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 at 95-100% for 11 of 16 indicators: clinical presentation; patient weight; baseline blood work (CD4, creatinine, haemoglobin); STI screening; WHO stage, correlating medical history; medications prescribed appropriately; ART start date; and documented return date. Doctors initiated more patients with TB/HIV co-infection and WHO Stage 3 and 4 disease than nurses. Nurse confidence improved for managing HIV-infected children and pregnant women, blood result interpretation and long-term side effects. CONCLUSIONS: Implementation of a clinical mentorship programme in Khayelitsha led to nurse initiation of a majority of eligible patients, enabling medical officers to manage complex cases. As mentorship can increase clinical confidence and enhance professional development, it should be considered essential for universal ART access in resource limited settings. DA - 2014 DB - OpenUCT DO - 10.1371/journal.pone.0098389 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Clinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: a quality of care assessment TI - Clinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: a quality of care assessment UR - http://hdl.handle.net/11427/16190 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16190
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0098389
dc.identifier.vancouvercitationGreen A, de Azevedo V, Patten G, Davies M, Ibeto M, Cox V. Clinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: a quality of care assessment. PLoS One. 2014; http://hdl.handle.net/11427/16190.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2014 Green et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherNursesen_ZA
dc.subject.otherHIV diagnosis and managementen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherGraduatesen_ZA
dc.subject.otherAdultsen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherMedical doctorsen_ZA
dc.subject.otherChildrenen_ZA
dc.titleClinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: a quality of care assessmenten_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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