Mboweni Sheillah H, Makhado Lufuno
The Aurum Institute, Moretele Subdistrict, Johannesburg, South Africa.
School of Health Science, University of Venda, Thohoyandou, South Africa.
Health SA. 2020 Feb 20;25:1285. doi: 10.4102/hsag.v25i0.1285. eCollection 2020.
The implementation of nurse-initiated management of antiretroviral therapy (NIMART) management training is a challenge in the primary health care (PHC). It is evident from the literature reviewed and the data obtained from the North West province that gaps still exist. There is no conceptual framework providing guidance to NIMART training and implementation.
Therefore, the aim of this study was to develop a conceptual framework to strengthen NIMART training and implementation in the North West province to improve patients and human immunodeficiency virus (HIV) programme outcomes.
The study was conducted in the North West Province, South Africa.
A pragmatic, explanatory, sequential, mixed-methods research design was followed. A descriptive and explorative programme evaluation design was used. Data were collected from two sources: antiretroviral therapy (ART) statistics from District Health Information System (DHIS) & Tier.net of 10 PHC facilities to evaluate and determine the impact of NIMART on the HIV programme and five focus group discussions conducted amongst 28 NIMART nurses and three HIV programme managers to describe challenges influencing NIMART training and implementation.
The study revealed that there was low ART initiation compared to the number of clients who tested HIV-positive. There was poor monitoring of patients on ART, which was evident in the low viral load collection and suppression, high loss to follow-up and deaths related to HIV. Challenges exist and this was confirmed by the qualitative findings, including human resource ratios, training and mentoring and the entire absence of a conceptual framework or model that guides training and implementation.
The study findings were conceptualised to describe and develop a framework needed to facilitate and influence NIMART training and implementation to improve the HIV programme and patient outcomes. Dickoff, James and Wiedenbach's practice-oriented theory and Donabedian's structure process outcomes model provided a starting point in the ultimate development of the framework. Although the study was limited to the North West province's PHC clinics and community health centres and did not include hospitals, it is of high significance as there is no such conceptual framework in the province or in even South Africa.
在初级卫生保健（PHC）中实施由护士发起的抗逆转录病毒疗法（NIMART）管理培训是一项挑战。从所查阅的文献以及从西北省获得的数据来看，差距依然存在。目前尚无概念框架为NIMART培训与实施提供指导。
因此，本研究的目的是制定一个概念框架，以加强西北省的NIMART培训与实施，从而改善患者和人类免疫缺陷病毒（HIV）项目的成果。
该研究在南非西北省开展。
采用了实用、解释性、序列性混合方法研究设计。使用了描述性和探索性项目评估设计。数据从两个来源收集：10个初级卫生保健机构的地区卫生信息系统（DHIS）和Tier.net的抗逆转录病毒疗法（ART）统计数据，以评估和确定NIMART对HIV项目的影响；以及对28名NIMART护士和3名HIV项目经理进行的5次焦点小组讨论，以描述影响NIMART培训与实施的挑战。
研究表明，与HIV检测呈阳性的患者数量相比，ART启动率较低。对接受ART治疗的患者监测不力，这在低病毒载量采集与抑制、高失访率以及与HIV相关的死亡中表现明显。挑战确实存在，定性研究结果证实了这一点，包括人力资源比例、培训与指导，以及完全缺乏指导培训与实施的概念框架或模型。
研究结果被概念化，以描述和开发一个促进和影响NIMART培训与实施所需的框架，从而改善HIV项目和患者结局。迪科夫、詹姆斯和威登巴赫的实践导向理论以及唐纳贝迪安的结构 - 过程 - 结果模型为该框架的最终开发提供了一个起点。尽管该研究仅限于西北省的初级卫生保健诊所和社区卫生中心，未包括医院，但由于该省乃至南非都没有这样的概念框架，所以具有高度重要性。
