DELIVERY OF ANTIRETROVIRAL THERAPY BY NURSES IN SOUTH AFRICA: AN EVALUATION OF NIMART BY FACILITY TYPE

By  Dr. Lawrence Long  Professor Sydney Rosen  Dr. Alana Brennan  Moyo F  Sauls C  Dr. Denise Evans  Modi SL  Professor Ian Sanne  Dr. Matthew Fox  |  | 

When the South African national antiretroviral therapy (ART) program began in 2004, it relied primarily on hospital-based HIV clinics with services delivered by doctors [1]. In 2010, in the face of increasing demand for care and limited personnel, South Africa revised its treatment guidelines to allow the initiation and management of patients on ART by nurses at both hospitals and primary health clinics under a program known as Nurse Initiated and Managed Antiretroviral Therapy (NIMART) [2, 3]. NIMART increased the number of accredited ART delivery sites from approximately 500 to more than 4,000 [4]. With the advent of this model, South Africa now offers two major public sector approaches to NIMART: centralized, hospital-based HIV outpatient clinic and decentralized, full service, primary health clinics (PHCs).

While both approaches typically use NIMART, hospital- based clinics may use both nurses and doctors to manage ART patients whereas PHCs rely primarily on nurses. We evaluated the outcomes and costs of these two approaches to NIMART for HIV treatment delivery.

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