Health provider perspectives on the implementation of the same‑day‑ART initiation policy in the Gauteng province of South Africa

By  Dr Dorina Onoya  Idah Mokhele  Tembeka Sineke  Bulelwa Mngoma  Dr. Aneesa Moolla  Marnie Vujovic  Dr. Jacob Bor  Jonas Langa  Dr. Matthew Fox  |  | 

Results: The data indicates inconsistencies across facilities and incongruities between counsellor and nursing provider perspectives regarding the SDI policy implementation. While nurses highlighted the clinical benefits of early  ART initiation, they expressed concerns that immediate ART may be overwhelming for some patients, who may be unprepared and likely to disengage from care soon after the initial acceptance of ART. Accordingly, the SDI implementation was slow due to limited patient demand, provider ambivalence to the policy implementations, as well as challenges with infrastructure and human resources. The process for assessing patient readiness was poorly defined by health providers across facilities, inconsistent and counsellor dependent. Providers were also unclear on how to ensure that patients who defer treatment return for ongoing counselling.
Conclusions: Our results highlight important gaps in the drive to achieve the ART initiation target and demonstrate
the need for further engagement with health care providers around the implementation of same-day ART initiation,
particularly with regards to infrastructural/capacity needs and the management of patient readiness for lifelong ART

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Health Research Policy and Systems