Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: A qualitative process evaluation of the STRETCH trial

Daniella Georgeu; Christopher J. Colvin; Simon Lewin; Lara Fairall; Max O. Bachmann; Kerry Uebel; Merrick Zwarenstein; Beverly Draper; Eric D. Bateman

doi:10.1186/1748-5908-7-66

Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: A qualitative process evaluation of the STRETCH trial

Daniella Georgeu, Christopher J. Colvin, Simon Lewin, Lara Fairall, Max O. Bachmann, Kerry Uebel, Merrick Zwarenstein, Beverly Draper, Eric D. Bateman

Research output: Contribution to journal › Article › peer-review

83 Citations (Scopus)

Abstract

Task-shifting is promoted widely as a mechanism for expanding antiretroviral treatment (ART) access. However, the evidence for nurse-initiated and managed ART (NIMART) in Africa is limited, and little is known about the key barriers and enablers to implementing NIMART programmes on a large scale. The STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) programme was a complex educational and organisational intervention implemented in the Free State Province of South Africa to enable nurses providing primary HIV/AIDS care to expand their roles and include aspects of care and treatment usually provided by physicians. STRETCH used a phased implementation approach and ART treatment guidelines tailored specifically to nurses. The effects of STRETCH on pre-ART mortality, ART provision, and the quality of HIV/ART care were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of factors affecting the implementation of the programme.

Original language	English
Article number	66
Journal	Implementation Science
Volume	7
DOIs	https://doi.org/10.1186/1748-5908-7-66
Publication status	Published - 16 Jul 2012

Keywords

Qualitative Research
Clinical Competence
Randomized Controlled Trials as Topic
Workload
Anti-HIV Agents
Attitude of Health Personnel
Humans
Primary Health Care
Nursing Staff
Process Assessment (Health Care)
Inservice Training
HIV Infections
Patient Acceptance of Health Care
Health Plan Implementation
South Africa
Nurse's Practice Patterns

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/1748-5908-7-66Licence: CC BY

Cite this

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title = "Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: A qualitative process evaluation of the STRETCH trial",

abstract = "Task-shifting is promoted widely as a mechanism for expanding antiretroviral treatment (ART) access. However, the evidence for nurse-initiated and managed ART (NIMART) in Africa is limited, and little is known about the key barriers and enablers to implementing NIMART programmes on a large scale. The STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) programme was a complex educational and organisational intervention implemented in the Free State Province of South Africa to enable nurses providing primary HIV/AIDS care to expand their roles and include aspects of care and treatment usually provided by physicians. STRETCH used a phased implementation approach and ART treatment guidelines tailored specifically to nurses. The effects of STRETCH on pre-ART mortality, ART provision, and the quality of HIV/ART care were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of factors affecting the implementation of the programme.",

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author = "Daniella Georgeu and Colvin, {Christopher J.} and Simon Lewin and Lara Fairall and Bachmann, {Max O.} and Kerry Uebel and Merrick Zwarenstein and Beverly Draper and Bateman, {Eric D.}",

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AU - Colvin, Christopher J.

AU - Lewin, Simon

AU - Fairall, Lara

AU - Bachmann, Max O.

AU - Uebel, Kerry

AU - Zwarenstein, Merrick

AU - Draper, Beverly

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AB - Task-shifting is promoted widely as a mechanism for expanding antiretroviral treatment (ART) access. However, the evidence for nurse-initiated and managed ART (NIMART) in Africa is limited, and little is known about the key barriers and enablers to implementing NIMART programmes on a large scale. The STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) programme was a complex educational and organisational intervention implemented in the Free State Province of South Africa to enable nurses providing primary HIV/AIDS care to expand their roles and include aspects of care and treatment usually provided by physicians. STRETCH used a phased implementation approach and ART treatment guidelines tailored specifically to nurses. The effects of STRETCH on pre-ART mortality, ART provision, and the quality of HIV/ART care were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of factors affecting the implementation of the programme.

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