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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Clinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: A quality of care assessment
PLoS ONE, Volume 9, No. 6, Article e98389, Year 2014
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Description
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 selfassessments 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 coinfection 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. © 2014 Green et al.
Authors & Co-Authors
Green, Ann F.
South Africa, Cape Town
University of Cape Town
United States, Nashville
Vanderbilt University Medical Center
de Azevedo, Virginia
Unknown Affiliation
Patten, Gabriela E.M.
Switzerland, Geneva
Medecins Sans Frontieres
Davies, M. A.
South Africa, Cape Town
University of Cape Town
Ibeto, Maryrene
Switzerland, Geneva
Medecins Sans Frontieres
Cox, Vivian
Switzerland, Geneva
Medecins Sans Frontieres
Statistics
Citations: 37
Authors: 6
Affiliations: 3
Identifiers
Doi:
10.1371/journal.pone.0098389
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
South Africa
Participants Gender
Female