Nurse and manager perceptions of nurse initiated and managed antiretroviral therapy (NIMART) implementation in South Africa: a qualitative study

OBJECTIVE To explore nurse and facility and programme manager perceptions of nurse initiated and managed antiretroviral therapy (NIMART) implementation in Gauteng, South Africa. DESIGN In this qualitative study, in-depth interviews and focus group discussions were conducted to gain insight into participants' experiences of NIMART implementation. SETTING Participants came from urban, peri-urban and rural primary healthcare clinics in two Gauteng Province municipalities. PARTICIPANTS 25 nurses and 18 managers who were actively involved in NIMART implementation were purposively sampled. RESULTS The findings from this study reveal that, despite encountering numerous challenges including human resources, training and clinical mentoring and health systems issues, NIMART nurses and managers remained optimistic about their work. Study participants felt empowered by their expanded roles. Increased responsibilities associated with NIMART implementation encouraged better use of creative problem-solving and teamwork to facilitate integration of NIMART into existing clinic services. NIMART nurses perceived antiretroviral therapy (ART) patients to be more insightful about their illness, engaged in their HIV treatment and aware of the importance of adherence which enhanced nurse-patient relationships and increased their sense of job satisfaction. CONCLUSIONS Although the implementation of NIMART is complex, when NIMART is implemented well, ART access is increased and patient outcomes are improved. Supportive interventions which address the specific challenges faced by nurses providing NIMART now need to be implemented. Attempts should be made to replicate the positive aspects of NIMART implementation identified by participants as this may improve healthcare providers' experiences of task-shifting.