Crowley Talitha, Mokoka Elizabeth, Geyer Nelouise
Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Forum of University Nursing Deans of South Africa (FUNDISA), Pretoria, South Africa.
South Afr J HIV Med. 2021 Mar 11;22(1):1196. doi: 10.4102/sajhivmed.v22i1.1196. eCollection 2021.
The roll out of nurse-initiated and managed antiretroviral treatment (NIMART) was implemented in 2010 by the National Department of Health (NDoH) in South Africa in response to the large numbers of persons living with HIV who needed treatment. To enable access to treatment requires shifting the task from doctors to nurses, which had its own challenges, barriers and enablers.
The aim of this narrative is to review content on the implementation of NIMART in South Africa over the period 2010-2020, with a focus on enablers and barriers to the implementation.
A comprehensive search of databases, namely, PubMed, Google Scholar and Cumulative Index to Nursing and Allied Health Literature (CINAHL), yielded qualitative, quantitative and mixed-method studies that addressed various topics on NIMART. Inclusion and exclusion criteria were set and 38 publications met the inclusion criteria for the review.
Training, mentorship, tailored tuberculosis (TB) and HIV guidelines, integration of services and monitoring and support have enabled the implementation of NIMART. This resulted in increased knowledge and confidence of nurses to initiate patients on antiretroviral treatment (ART) and decreased time to initiation and loads on referral facilities. Barriers such as non-standardised training, inadequate mentoring, human resource constraints, health system challenges, lack of support and empowerment, and challenges with legislation, policy and guidelines still hinder NIMART implementation.
Identifying barriers and enablers will assist policymakers in implementing a structured programme for NIMART in South Africa and improve access, as well as the training and mentoring of professional nurses, which will enhance their competence and confidence.
2010年，南非国家卫生部（NDoH）推行了由护士发起并管理的抗逆转录病毒治疗（NIMART），以应对大量需要治疗的艾滋病毒感染者。为了使患者能够获得治疗，需要将任务从医生转移到护士身上，这带来了自身的挑战、障碍和推动因素。
本叙述性综述的目的是回顾2010年至2020年期间南非NIMART实施情况的相关内容，重点关注实施的推动因素和障碍。
对PubMed、谷歌学术和护理及联合健康文献累积索引（CINAHL）等数据库进行全面检索，获得了定性、定量和混合方法研究，这些研究涉及NIMART的各种主题。设定了纳入和排除标准，38篇出版物符合综述的纳入标准。
培训、指导、量身定制的结核病（TB）和艾滋病毒指南、服务整合以及监测和支持推动了NIMART的实施。这提高了护士启动患者抗逆转录病毒治疗（ART）的知识和信心，并减少了启动时间和转诊机构的负担。非标准化培训、指导不足、人力资源限制、卫生系统挑战、缺乏支持和赋权以及立法、政策和指南方面的挑战等障碍仍然阻碍着NIMART的实施。
识别障碍和推动因素将有助于政策制定者在南非实施结构化的NIMART计划，并改善治疗可及性，以及专业护士的培训和指导，这将提高他们的能力和信心。
