Antiretroviral therapy initiation of pregnant women before and during the implementation of Nurse Initiated and Management of Antiretroviral Therapy in eThekwini District Community Health Centres.

Abstract

When the Prevention of Mother to Child Transmission of HIV programme was introduced in South Africa in 2002, doctors were the health professionals tasked with Antiretroviral Therapy (ART) initiation and management of patients. In a country with a known shortage of doctors and in which about 80% of the healthcare workers are nurses, the dependency on doctors negatively affected management of patients needing ART. The introduction of the Nurse Initiated Management of ART (NIMART) programme expanded the healthcare skill set necessary for ART initiation. With the implementation of NIMART, pregnant women who are regarded as a priority group in the country‟s ART programme would have ART initiation services offered as part of the antenatal care package. Aim The aim of this study was to evaluate ART initiation of pregnant women attending antenatal care in eThekwini district Community Health Centres (CHCs) between the Financial Years (FY) 10/11 (when NIMART was newly introduced) and FY13/14 (when NIMART was in full implementation). Methods An observational descriptive retrospective chart review study was conducted in 2015 at four eThekwini district CHCs. From these CHCs, records of pregnant women living with HIV that initiated ART in FY10/11 and FY13/14 were evaluated and compared. Results Approximately, 2749 pregnant women who attended antenatal care at the study sites during the two years were eligible for ART. Of the eligible women, 49% (N = 1334) attended antenatal care in FY10/11 while, 51% (N = 1414) attended in FY13/14. In FY10/11, 46% (n = 610) of the eligible women were initiated while 60 % (n = 855) of the1414 eligible in FY13/14 started ART during pregnancy. All women seen in FY10/11 were initiated at ART clinics. In FY13/14, 97% (n=826) of women initiated ART within the antenatal care clinics. ART in FY10/11 was started within 38 days after antenatal care booking while in FY13/14 initiations were within 4.12 days. Antenatal care booking before 20 weeks was found to have improved between the two years from 39 % to 58%.