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.
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.
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 fourth year, through up-skilling nurses Nimart training is helping more patients access ARVs at more facilities and 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.
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.
Management and skills training.
Anova’s accredited (MPP) Management Performance Programme was launched in June 2015. The focus is on developing managers and management essential skills.
Currently there are two groups being trained in Gauteng and one in Limpopo including 60 managers from priority clinics with more set to begin in the coming months.
The programme runs for a full year with managers completing the training in July 2016. The programme supports the current objectives of the DoH in the Realisation of the Ideal Clinic as well as 90-90-90, and aims to make management best practice part of an Ideal Managers DNA. Many of the mangers that run facilities are professional nurses who have performed well and have been put into management positions because they have proved themselves as competent nurses.
Managing a facility is a big challenge and the programme is tailor made to develop the essential skills required to drive the objectives of the DoH.