Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention
| Autor: | Lara Fairall, Eric D. Bateman, Merrick Zwarenstein, Max O Bachmann, Daniella Georgeu, Carl Lombard, Christopher J. Colvin, W F Mollentze, Dingie van Rensburg, Gill Faris, Pat Mayers, Simon Lewin, Kerry Uebel |
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| Přispěvatelé: | Division of Pulmonology, Faculty of Health Sciences |
| Rok vydání: | 2011 |
| Předmět: |
medicine.medical_specialty
Anti-HIV Agents education MEDLINE HIV Infections Health Informatics Ambulatory Care Facilities Nurse's Role Health informatics Health administration law.invention Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) South Africa Education Nursing Continuing Nursing Randomized controlled trial law Intervention (counseling) Humans Medicine Health policy Medicine(all) lcsh:R5-920 Primary Health Care business.industry Research Health Policy Public health Public Health Environmental and Occupational Health Health services research General Medicine HIV care lcsh:Medicine (General) business Delivery of Health Care |
| Zdroj: | Implementation Science, Vol 6, Iss 1, p 86 (2011) Implementation Science : IS Implementation Science |
| ISSN: | 1748-5908 4683-6853 |
| Popis: | Background Task shifting and the integration of human immunodeficiency virus (HIV) care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment (ART). This paper describes the development and content of an intervention involving these two strategies, as part of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) pragmatic randomised controlled trial. Methods: Developing the intervention The intervention was developed following discussions with senior management, clinicians, and clinic staff. These discussions revealed that the establishment of separate antiretroviral treatment services for HIV had resulted in problems in accessing care due to the large number of patients at ART clinics. The intervention developed therefore combined the shifting from doctors to nurses of prescriptions of antiretrovirals (ARVs) for uncomplicated patients and the stepwise integration of HIV care into primary care services. Results: Components of the intervention The intervention consisted of regulatory changes, training, and guidelines to support nurse ART prescription, local management teams, an implementation toolkit, and a flexible, phased introduction. Nurse supervisors were equipped to train intervention clinic nurses in ART prescription using outreach education and an integrated primary care guideline. Management teams were set up and a STRETCH coordinator was appointed to oversee the implementation process. Discussion Three important processes were used in developing and implementing this intervention: active participation of clinic staff and local and provincial management, educational outreach to train nurses in intervention sites, and an external facilitator to support all stages of the intervention rollout. The STRETCH trial is registered with Current Control Trials ISRCTN46836853. |
| Databáze: | OpenAIRE |
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