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      Ten years of nurse-initiated antiretroviral treatment in South Africa: A narrative review of enablers and barriers

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          Abstract

          Background

          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.

          Objectives

          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.

          Method

          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.

          Results

          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.

          Conclusion

          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.

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          Most cited references52

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          Writing narrative literature reviews for peer-reviewed journals: secrets of the trade.

          To describe and discuss the process used to write a narrative review of the literature for publication in a peer-reviewed journal. Publication of narrative overviews of the literature should be standardized to increase their objectivity. In the past decade numerous changes in research methodology pertaining to reviews of the literature have occurred. These changes necessitate authors of review articles to be familiar with current standards in the publication process. Narrative overview of the literature synthesizing the findings of literature retrieved from searches of computerized databases, hand searches, and authoritative texts. An overview of the use of three types of reviews of the literature is presented. Step by step instructions for how to conduct and write a narrative overview utilizing a 'best-evidence synthesis' approach are discussed, starting with appropriate preparatory work and ending with how to create proper illustrations. Several resources for creating reviews of the literature are presented and a narrative overview critical appraisal worksheet is included. A bibliography of other useful reading is presented in an appendix. Narrative overviews can be a valuable contribution to the literature if prepared properly. New and experienced authors wishing to write a narrative overview should find this article useful in constructing such a paper and carrying out the research process. It is hoped that this article will stimulate scholarly dialog amongst colleagues about this research design and other complex literature review methods.
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            Expanding access to ART in South Africa: the role of nurse-initiated treatment.

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              A survey of nurse-initiated and -managed antiretroviral therapy (NIMART) in practice, education, policy, and regulation in east, central, and southern Africa.

              In sub-Saharan Africa, nurses and midwives perform many HIV service delivery tasks, such as diagnosis of HIV and prescription of antiretroviral therapy (ART), which used to be the responsibility of physicians. While this task shifting is critical to scaling-up HIV services in Africa, the extent of HIV task shifting is not well understood. A survey of senior nursing leadership teams from 15 African countries was carried out to describe the extent of nurse-initiated and -managed antiretroviral therapy (NIMART) in practice, education, policy, and regulation. The survey took place at the African Health Professions Regulatory Collaborative meeting in Pretoria, South Africa, in June 2012. The findings indicated that NIMART is widely practiced and authorized in policy, but is not reinforced by regulation nor incorporated into preservice education. Further investment in policy, regulation, and pre-service education is needed to ensure sustainable, high quality ART service expansion through the region.
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                Author and article information

                Journal
                South Afr J HIV Med
                South Afr J HIV Med
                HIVMED
                Southern African Journal of HIV Medicine
                AOSIS
                1608-9693
                2078-6751
                11 March 2021
                2021
                : 22
                : 1
                : 1196
                Affiliations
                [1 ]Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
                [2 ]Forum of University Nursing Deans of South Africa (FUNDISA), Pretoria, South Africa
                [3 ]Nursing Education Association, Pretoria, South Africa
                [4 ]Department of Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
                Author notes
                Corresponding author: Talitha Crowley, tcrowley@ 123456sun.ac.za
                Author information
                https://orcid.org/0000-0002-2993-6553
                https://orcid.org/0000-0001-6327-3573
                https://orcid.org/0000-0002-7797-428X
                Article
                HIVMED-22-1196
                10.4102/sajhivmed.v22i1.1196
                8007995
                33824736
                4a7a1ce0-3a42-4d1e-af86-541e01ef619e
                © 2021. The Authors

                Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

                History
                : 13 November 2020
                : 24 December 2020
                Categories
                Review Article

                nurse-initiated,nimart,south africa,antiretroviral treatment,enablers,barriers

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