title: Clinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: a quality of care assessment.
abstract: BACKGROUND
  To combat the AIDS epidemic and increase HIV treatment access, the South African government implemented a nurse-based, doctor-supported model of care that decentralizes administration of antiretroviral treatment (ART) for HIV positive patients through nurse initiated and managed ART. Médecins Sans Frontières (MSF) implemented a mentorship programme to ensure successful task-shifting, subsequently assessing the quality of clinical care provided by nurses.
  
  
  METHODS
  A before-after cross-sectional study was conducted on nurses completing the mentorship programme in Khayelitsha, South Africa, from February 2011-September 2012. Routine clinical data from 229 patient folders and 21 self-assessment questionnaires was collected to determine the number of patients initiated on ART by nurses; quality of ART management before-after mentorship; patient characteristics for doctor and nurse ART initiations; and nurse self-assessments after mentorship.
  
  
  RESULTS
  Twenty one nurses were authorized by one nurse mentor with one part-time medical officer's support, resulting in nurses initiating 77% of ART eligible patients. Improvements in ART management were found for drawing required bloods (91% vs 99%, p = 0.03), assessing adherence (50% vs 78%, p<0.001) and WHO staging (63% vs 91%, p<0.001). Nurse ART initiation indicators were successfully completed at 95-100% for 11 of 16 indicators: clinical presentation; patient weight; baseline blood work (CD4, creatinine, haemoglobin); STI screening; WHO stage, correlating medical history; medications prescribed appropriately; ART start date; and documented return date. Doctors initiated more patients with TB/HIV co-infection and WHO Stage 3 and 4 disease than nurses. Nurse confidence improved for managing HIV-infected children and pregnant women, blood result interpretation and long-term side effects.
  
  
  CONCLUSIONS
  Implementation of a clinical mentorship programme in Khayelitsha led to nurse initiation of a majority of eligible patients, enabling medical officers to manage complex cases. As mentorship can increase clinical confidence and enhance professional development, it should be considered essential for universal ART access in resource limited settings.
authors.affiliation: School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Ann
authors.initials: A
authors.lastname: Green
authors.affiliation: Department of Health, City of Cape Town, Cape Town, South Africa.
authors.forename: Virginia
authors.initials: V
authors.lastname: de Azevedo
authors.affiliation: Médecins Sans Frontières Khayelitsha, Khayelitsha, South Africa.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Patten
authors.affiliation: School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.affiliation: Médecins Sans Frontières Khayelitsha, Khayelitsha, South Africa.
authors.forename: Mary
authors.initials: M
authors.lastname: Ibeto
authors.affiliation: Médecins Sans Frontières Khayelitsha, Khayelitsha, South Africa.
authors.forename: Vivian
authors.initials: V
authors.lastname: Cox
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000451:nursing; D006801:Humans; D008611:Mentors; D009723:Nurse-Patient Relations; D011247:Pregnancy; D013019:South Africa
chemical_list: D019380:Anti-HIV Agents