Table 3 Components of the intervention compared to standard care at control clinics
Intervention component | Intervention clinics (n = 16) | Control clinics (n = 15) |
|---|---|---|
STRETCH Coordinator | • Teaching in the Free State ART training programme alongside ART programme doctors • Available for clinical advice for all staff in ART sites • Initial training and support of nurse trainers at intervention sites • Providing extra support to nurses prescribing ART at intervention sites • Facilitating the establishment of local management teams to implement the intervention | • Teaching in the Free State ART training programme alongside ART programme doctors • Available for clinical advice for all staff in ART sites |
Regulatory environment for prescription of ART | • Pharmaceutical and Therapeutics Committee of the Free State Department of Health gave permission for professional nurses at intervention sites to initiate and repeat prescriptions of ART for adults identified as eligible for nurse management. | • Only doctors were allowed to initiate and repeat prescriptions three or six monthly for patients needing ART |
Nurse Training | • All professional nurses completed two-week ART training and on-site training in PALSA PLUS guidelines--six to eight sessions in total • 16 PALSA PLUS trainers, one for each clinic, trained in use of STRETCH guidelines (TtTtT) • All professional nurses offered on-site training in the use of STRETCH guidelines to identify patients eligible for nurse management-four sessions in total | • All professional nurses completed two-week ART training and on-site training in PALSA PLUS guidelines-six to eight sessions in total |
Patient management guidelines for nurses | • Special 2007 STRETCH Free State edition of PALSA PLUS guidelines with extra STRETCH guidelines for nurse initiation and repeat prescription of ARVs issued to all staff at intervention sites | • Standard 2006 edition of PALSA PLUS issued to all staff at control sites during training in 2006 or 2007 |
Management support | • STRETCH team established at each intervention site to manage the introduction of changes in clinic function during the intervention • Local area management support teams were set up to support the integration of aspects of comprehensive HIV care into the services of these primary care clinics referring patients to the intervention site | • Standard management support by clinic supervisor, district ART coordinator and local area manager |
Implementation guideline | • STRETCH Toolkit issued to STRETCH teams at 16 intervention clinics to assist the teams in implementing the intervention | • None |
Phased introduction | • Phase one: Training and establishment of STRETCH teams at each intervention site • Phase two: Nurse repeat prescription of ART for patients on ART for six months or more and eligible for nurse management • Phase three: Nurse initiation of ART for adults eligible for nurse management | • None |