An implementation evaluation study of a nurse initiated and managed antiretroviral therapy (NIMART) program in primary health care clinics in the Ugu district of KwaZulu-Natal.

Abstract

AIM The purpose of this study was to conduct an implementation evaluation study of Nurse Initiated and Managed Antiretroviral Therapy (NIMART) program in Primary Health Care (PHC) clinics in the Ugu district of KwaZulu-Natal. METHOD A quantitative non-experimental descriptive approach and evaluative design consisting of self-administered questionnaires was used to conduct the study to evaluate the availability of the latest Antiretroviral Therapy Guidelines, to evaluate the implementation of the Nurse Initiated and Managed Antiretroviral Therapy (NIMART) program and to evaluate the knowledge and practice of professional nurses towards the NIMART program in the 56 clinics of the Ugu district. Information leaflets were given to the participants and informed consent was obtained from each participant. The number of participants that were enrolled in the study was 52 because they met the inclusion criteria of working in the PHC clinics in the Ugu district and were trained in the NIMART course. The other 4 participants were not trained in the NIMART course and were excluded according to the exclusion criteria. RESULTS The study revealed that in 98% (n=51) of the clinics in the Ugu district, nurses were initiating adults on ART and only 2% (n=1) were still being initiated by the doctor. Furthermore, the majority of respondents indicated that children were initiated on ART in their clinics, while some respondents reported that in their clinics children are still initiated by the clinic visiting doctor or hospital doctor. The findings indicated that 98% (n=51) of clinics have the latest ART Guidelines available, while only 2% (n=1) of clinics indicated that they have outdated ART Guidelines available in the clinic. The study revealed that most respondents knew the correct ART regimens, ART eligibility criteria and when blood for CD4 count and viral load is taken, while there were still some respondents who did not know. CONCLUSIONS AND RECOMMENDATIONS The District HAST Manager and clinics’ Operational Managers must ensure that the latest 2015 National Consolidated Guidelines for PMTCT are available in all the PHC clinics. More nurses should be trained in NIMART. All the nurses that are NIMART trained should receive mentorship after the training so that they become competent and confident in initiating and managing HIV-positive patients on ART. The findings of this study revealed that there were some gaps in nurse’s knowledge around ART regimens, blood tests and eligibility criteria. This study can be used as a baseline to evaluate all the professional nurses trained in NIMART in Ugu district. The District Training Coordinator must arrange a workshop regarding the 2015 National Consolidated Guidelines to refresh NIMART nurses about ART regimens, about blood tests to be done and about the ART eligibility criteria.