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

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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 languageEnglish
Article number66
JournalImplementation Science
Publication statusPublished - 16 Jul 2012


  • 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

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