The big news at the 5th
South African AIDS Conference, in June 2011, was that the response to HIV in
South Africa’s health services has undergone a major transformation (make-over)
in the last couple of years:
under 12 million South Africans got tested for HIV the year before the
conference— almost a quarter of the South African population
Almost 1700 South African facilities were providing antiretroviral therapy
million South Africans were taking ART, 400,000 of whom had started treatment
in the previous year and
There has been a sharp decline in mortality
in the country linked to ART; and finally
Parent-to-child transmission of HIV has been reduced to 3.5% in HIV-exposed
children around 6 weeks of age — and the country has also greatly improved the
survival of children who do become HIV-positive.
current government and the Minister of Health have of course made some big
changes —and one of these changes is for the health system to make much better
use of one of its most precious resources: its nurses.
make many of these achievements possible, and if the health department is going
to reach the targets of providing ART to all eligible South Africans — if
South Africa is ever going to achieve the goal of an AIDS-free generation —
nurses will have to make it happen.
"If South Africa is ever going to achieve the goal of an AIDS-free generation, nurses will have to make it happen"
they can do it. When given adequate training and support, studies show nurses
can initiate antiretroviral therapy and manage most people living with HIV on
treatment as well as doctors, referring the complicated cases when they arise
to a doctor/mentor. Nevertheless, nurses can initially be reluctant to begin
prescribing ART — it can take a while to gain confidence — but as nurses become
more comfortable using ART in people living with HIV, access to treatment will
increase and HIV care will become more convenient for the patient.
reports at the conference described how nurses worked together participating in
quality improvement exercises to improve their clinic performance or to start
providing new service, like providing isoniazid preventive therapy (IPT) to
anyone living with HIV who doesn’t have one of the key symptoms of TB (see
Quality improvement involves using
data from one’s own clinics to monitor performance, then nurses and other
healthcare workers discuss the clinic’s challenges and suggest potential
solutions to improve the performance of certain tasks. The team chooses one of
these ideas to try out as an experiment, plan and then launch the experiment, and
measure how it affects performance. If the idea improves performance, the
change can be implemented in their clinic, and the next round of
ideas/experiments can begin.
way, step by step, clinics have been able to greatly improve the quality of
care, and effectiveness of activities, such as the programme to prevent parent
to child transmission of HIV in South Africa. The nurses themselves suggested
and tested many of the solutions to fix that programme saving many infants in
Nurses have suggested and tested many of the improvements to the PMTCT programme in South Africa, saving many infants in the process.
that nurses have much more to contribute, doesn’t mean anyone should just dump
more work on their shoulders, however. To make the most of their skills to
manage and care for patients, the time nurses spend on more clerical tasks must
be reduced. One way to do so is by shifting these duties to staff with less
medical training. Meanwhile, community health workers and expert patients have shown
that they may be better suited to performing other time-consuming tasks that
are critical to the success of HIV and TB care, such as adherence support, and
tracking down patients who don’t make their scheduled clinic visits.
This first issue of the nurse bulletin is an introduction targeted to HATIP's readership who work as nurse trainers and mentors, but over time, our goal will be to highlight examples of task shifting in action that
have been shown to improve care delivery, and enable nurses to spend more time
with patients. The bulletin will try to provide tools, reminders and aids for nurses and
other caregivers that reinforce key messages for nurses related to the topics
discussed in that month’s HATiP, the
HATiP blog and
news from the www.aidsmap.com site — in a
way that is relevant and practical for a nurse’s everyday needs.