Conceptual framework for strengthening nurse-initiated management of ART training and implementation in the North West Province

Abstract

Background: The implementation of NIMART or HIV management training is a challenge in the PHC, after the adoption of task shifting. It is evident from the literature reviewed and the data obtained from the North West Province in South Africa in the HAST report that gaps still exist. There is no conceptual framework that provides guidance and strengthens implementation of NIMART. Therefore the researcher identified a need to develop such a conceptual framework. Aim: This thesis seeks to conceptualise the study findings to develop and describe a conceptual framework that provides guidance and strengthens NIMART training and implementation in order to improve patient and HIV programme outcomes in the NW province. This was achieved through four manuscripts as indicated in the outline of the thesis (see Page ii) Method: An explanatory sequential mixed method research strategy (QUAN-qual) was followed. A descriptive and explorative programme evaluation design was used and data collected from two sources DHIS, Tier.net of n=10 PHC facilities to determine the impact of NIMART on the HIV programme and five FGDs n=28 conducted from NIMART nurses and programme managers directly involved in the management of HIV and TB programme until data saturation. Results: The study revealed that there is low ART initiation as compared to the number of clients who tested HIV positive, especially amongst children and ANC pregnant women. There is poor monitoring of patients on ART, evident in the low viral load collection and suppression, fluctuating TROA, high LTFU and deaths related to HIV. Challenges exist and this was confirmed by the qualitative findings, including health care organisation, patient, human resource ratios, training and mentoring and the absence of a conceptual framework that guides NIMART training and implementation. Conclusion: The study findings were conceptualised to develop and describe a framework needed to facilitate and influence NIMART training and implementation in order to improve the HIV programme and patient outcomes. Dickoff, James and Wiedenbach practice-orientated theory and Donabedian's SPO model provided a starting point in the ultimate development of the framework. The conceptual framework was developed to strengthen NIMART training and implementation in the North West Province.