Training, mentoring and skills sharing

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Nurses are in many ways at the frontline of the epidemic, making it critically important for them to be thoroughly equipped with the knowledge and skills to identify HIV risk or infection and to take the appropriate responses.

Anova is actively engaged in a number of initiatives in which nurses are trained and mentored to fulfil this vitally important role in HIV treatment and prevention.  

Provider Initiated Counselling and Testing

To this end, Anova has been encouraging nurses to initiate and provide HIV counselling and testing to all patients. Whilst most health facilities already offer HIV counselling and testing as a separate procedure, usually conducted by a trained counsellor, encouraging nurses to proactively offer a test during a general clinic visit ensures that more patients know their status. 

Anova’s Soweto-based Tirisanong team has trained over 250 nurses in Provider Initiated Counselling and Testing (PICT), where nurses are taught the appropriate counselling and testing procedures.

Nurse Initiated Management of Antiretroviral Therapy

After the training, Anova’s doctors continue to provide support and mentoring to the nurses. After the training, Anova’s doctors continue to provide support and mentoring to the nurses.
As the HIV epidemic matures, public health facilities have come under increasing pressure to meet the growing demand for antiretroviral treatment. Recognising that doctors alone would not be able to meet this need, on 1 April 2010 the Department of Health authorised nurses to initiate treatment. This change in protocol offered an opportunity to dramatically improve the effectiveness of HIV programmes in primary health settings. 

Nurse Initiated Management of Antiretroviral Therapy (NIMART) allowed HIV care to function more efficiently as a comprehensive whole. But in order for doctors to step down from what have become the more routine duties of HIV care, such as ART monitoring, adherence and dispensing, many nurses needed to be trained to take the lead with these tasks instead.

Anova began to offer its first training courses in NIMART in 2010. Now in its third year, through up-skilling nurses NIMART training is helping more patients access ARVs at more facilities. 

NIMART also frees up doctors to attend to more complicated and urgent cases. This reallocation of duties to maximise output is a prime example of how Anova is helping to improve the health system for better outcomes. 

Importantly, the training is giving nurses an opportunity for professional development in the direction of the country’s most pressing health concern. At Anova’s Soweto-based project 126 nurses and 28 doctors were trained in 2012 to initiate treatment. The Bushbuckridge-based team trained 98 nurses and doctors. After the training, Anova’s doctors continue to provide support and mentoring to the nurses. 

Pharmacovigillance 

Given their experience with treatment, nurses have also been the focus of Anova's Limpopo and Soweto teams’ pharmacovigilance training.

Whilst the benefits of antiretroviral treatment by far outweigh its risks, like any other medication, there are side effects. Whilst most of these instances are minor, properly detecting, recording and understanding the more adverse effects associated with ARVs is critical to improving treatment and minimising such effects in future. This process of active monitoring of adverse drug reactions is known as pharmacovigilance. 

Anova’s Limpopo team has shown its commitment to instituting a robust culture of pharmacovigilance in the Mopani district by hosting a training programme for around 70 selected pharmacists, pharmacist assistants and nurses. These trained health workers will now report side effects to the Medicines Control Council on a routine basis. As part of its vision to expand access to ART in 2010, the South African government implemented a plan that involved “task shifting” in the public health system.

 

A success story

If you travel out of Tzaneen and land yourself between Gopane and Giyani (a distance of 75km) you find Maphalle Clini, serving an immediate population of 77 850. Previously the hospitals in Gopane and Giyani were the only ART sites in this area. Now Maphalle can provide this service, thereby  reducing the burden on the hospitals, and bringing treatment to the community. Surrounded by cement pallisading, barren earth and a scattering of goats, Maphalle is a modest, rural clinic. Inside you will be welcomed by a sense of calm efficiency.

The sister-in-charge and the counsellor talk passionately about the difference Anova’s involvement has made. Before their training the counsellor says, “I thought ARVs are too complicated for me”. Now the tablets are demystified and it makes a huge difference.

The sister-in-charge explains the difference it makes to be able to dispense medication that prevents people with HIV getting really sick, rather than only being able to refer them to a hospital. “If somebody is positive you feel you can help immediately rather than seeing somebody getting very sick.” 

Both agree that being able to dispense ARVs as nurses has made a huge difference. But the real difference is that they are able to use their years of understanding and practice to treat their clients the way they know best -with knowledge and nurturing.

They are emphatic that the most important part of adherence is ensuring a person is ready to be on ARVs. To this end, they take great care in fully preparing their clients. As the sister-in-charge explains: “A person comes here, maybe with a cough. Then you counsel and advise them and they take a (HIV) test. When the result is positive, that person doesn’t remember anything you told them, because of shock, because of anger, because of denial.”

They then encourage attendance at support groups to assist the process of healthy living, adherence to ARVs (if necessary) and advice on dealing with disclosure.

This comprehensive approach is backed by the community outreach and the wellness clinics. Staff at clinics also report an increase in the number of clients returning for HIV services and acquiring additional information for their family members.