An evaluation of the effectiveness of the nurse-initiated- and managed antiretroviral treatment (NIMART) programme, Waterberg District, Limpopo Province

Abstract

Nurse-initiated and management of patients on antiretroviral therapy (NIMART) was implemented as a mechanism to increase the intake of antiretroviral therapy (ART) in South Africa. The aim of this study was to evaluate the effectiveness of the NIMART programme implemented in the Waterberg District, Limpopo Province. The study adopted a descriptive cross-sectional method using a quantitative research approach. The study was conducted in the Waterberg District, which is one of the five Districts in the Limpopo Province. All the primary health care (PH ) facilities and all NIMART professional nurses in the Waterberg District were involved in this study. Data were collected using two types of instruments-a questionnaire and a data collection sheet. Data were entered into Microsoft Excel™ and then analyzed using the tatistical Package for Social ciences (SPSS), version 22, 2014. Data were pre ented de criptively in tables and charts. The study revealed that it took on average 1.1 hour to initiate clients on antiretrovirals (ARVs). The majority of professional nurses who are NIMART trained complained of workload due to administrative duties inherent in the IMART programme. Most PHC facilities had insufficient consultation rooms which impacted negatively on the implementation of the programme. The number of clients initiated on ARVs in the hospital dropped drastically from 4597 in 2011 to 900 in 2013. This was due to the fact that PHC facilities started to initiate ARVs as from 2010. The number of patients who defaulted ARVs decreased drastically between 2011 and 2013. The number of deaths of patients on ARVs increased from 2010 to 2012 due to the large number of clients initiated on ARVs, and also dropped sharply in 2013, perhaps due to the good experience of the nurses. PHC facilities are not doing well regarding initiation of children on ARVs. All Waterberg District mobile clinics were not offering ARVs services, which implies that there are still clients who do not have access to ARV services. The study concluded that although the IMART programme is effective, it is encountering numerous challenges, including human resources, managerial support, health systems issues and clinical mentoring. Increased responsibilities associated with NIMART implementation increases the workload in PHC facilities.