Abstract:
BACKGROUND : The South African Department of Health implemented the nurse-initiated
management of antiretroviral treatment (NIM-ART) programme as a policy to decentralise
services. Increasing access to ART through nurse initiation results in significant consequences.
AIM : This study evaluated the quality of care provided, the barriers to the effective rollout of
antiretroviral services and the role of a clinical mentor.
SETTING : The study was conducted at three NIM-ART facilities in South Africa. One clinic
provided a high standard of care, one had a high defaulter rate, and at the third clinic, treatment
failures were missed, and routine bloods were not collected.
METHODS : A mixed methods study design was used. Data were collected using patient
satisfaction surveys, review of clinical records, facility audits, focus group interviews, field
notes and a reflection diary.
RESULTS : NIM-ART nurses prescribed rationally and followed antiretroviral guidelines.
Mortality rates and loss to follow-up rates were lower than those at the surrounding hospitals,
and 91.1% of nurse-monitored patients had an undetectable viral load after a year. The quality
of care provided was comparable to doctor-monitored care. The facility audits found recurrent
shortages of essential drugs. Patients indicated a high level of satisfaction. Salary challenges,
excessive workload, a lack of trained nurses and infrastructural barriers were identified as
barriers. On-going mentoring and support by a clinical mentor strengthened each of the
facilities, facilitated quality improvement and stimulated health workers to address constraints.
CONCLUSION : Clinical mentors are the key to addressing institutional treatment barriers and
ensuring quality of patient care.
