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

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 F...

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Bibliographic Details
Published in:PloS one 2014-06, Vol.9 (6), p.e98389-e98389
Main Authors: Green, Ann, de Azevedo, Virginia, Patten, Gabriela, Davies, Mary-Ann, Ibeto, Mary, Cox, Vivian
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
AIDS
AIDS (Disease)
AIDS treatment
Anti-HIV Agents - therapeutic use
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Blood
Care and treatment
CD4 antigen
Child
Children
Clinics
Confidence intervals
Creatinine
Disease control
Drug therapy
Epidemics
Ethics
Female
Government finance
Health care
Health facilities
Hemoglobin
Highly active antiretroviral therapy
HIV
HIV Infections - drug therapy
HIV Infections - nursing
HIV patients
Human immunodeficiency virus
Humans
Indicators
Medical care quality
Medical diagnosis
Medical personnel
Medicine
Medicine and Health Sciences
Mentoring
Mentors
Nurse-Patient Relations
Nurses
Nursing research
Patient care
Patients
Physicians
Pregnancy
Primary care
Professional development
Public health
Quality
Quality assessment
Science Policy
Self-assessment
Side effects
Social Sciences
South Africa
Systematic review
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Summary: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. 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. 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
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0098389