Mboweni Sheillah H, Makhado Lufuno
Aurum institute, Johannesburg, South Africa.
Department of Public Health, School of Health Science, University of Venda, Thohoyandou, South Africa.
Health SA. 2020 Mar 16;25:1174. doi: 10.4102/hsag.v25i0.1174. eCollection 2020.
The increasing number of people testing human immunodeficiency virus positive and who demand antiretroviral therapy (ART) prompted the Department of Health to adopt World Health Organization's task shifting where professional nurses (PNs) initiate ART rather than doctors. This resulted in decentralisation of services to primary healthcare (PHC), generating a need to capacitate PNs on nurse-initiated-management of ART (NIMART). The impact of NIMART was assessed and even though there was an increased number of patients on ART, the quality of care is of serious concern.
The aim of this study was to explore and describe the challenges influencing NIMART training and implementation amongst PNs and programme managers.
The study was conducted from the PHC facilities, in the rural districts of the North West province.
An exploratory programme evaluation and contextual research design was used in the study. Purposive sampling was used. Focus group discussion ( = 28) and individual interviews were used to collect data. Data was analysed using ATLAS.ti software.
The results revealed two themes: inadequacy in NIMART training and the healthcare system challenges that influence NIMART training and implementation. Theme 1 included among others the lack of standardised curriculum and model or conceptual framework to strengthen NIMART training. And theme 2 included patient and district healthcare structural system.
There a need to improve NIMART training and implementation through the standardisation of NIMART curriculum, introduction of pre-service NIMART training in institutions of higher learning, addressing staff shortages and negative attitude of PNs providing ART.
检测出人类免疫缺陷病毒呈阳性并要求接受抗逆转录病毒疗法（ART）的人数不断增加，促使卫生部采用世界卫生组织的任务转移策略，即由专业护士（PNs）启动抗逆转录病毒疗法，而非医生。这导致服务分散到初级卫生保健（PHC），因此需要使专业护士具备开展护士主导的抗逆转录病毒疗法管理（NIMART）的能力。对NIMART的影响进行了评估，尽管接受抗逆转录病毒疗法的患者数量有所增加，但护理质量仍令人严重担忧。
本研究的目的是探索和描述影响专业护士和项目管理人员进行NIMART培训与实施的挑战。
该研究在西北省农村地区的初级卫生保健机构进行。
本研究采用探索性项目评估和情境研究设计。采用目的抽样法。通过焦点小组讨论（n = 28）和个人访谈收集数据。使用ATLAS.ti软件对数据进行分析。
结果揭示了两个主题：NIMART培训不足以及影响NIMART培训与实施的医疗系统挑战。主题1尤其包括缺乏标准化课程以及加强NIMART培训的模式或概念框架。主题2包括患者和地区医疗结构系统。
有必要通过标准化NIMART课程、在高等院校引入职前NIMART培训、解决人员短缺问题以及改变提供抗逆转录病毒疗法的专业护士的消极态度，来改善NIMART培训与实施。
