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Table 1 Summary of phased implementation of the STRETCH intervention

From: Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: a qualitative process evaluation of the STRETCH trial

Phase 1 Phase 2 Phase 3
Site preparation Decentralisation of HIV care and ART monitoring Initiation of ART treatment by STRETCH nurses
- Implement PALSA PLUS and STRETCH guideline training with all clinic nurses using a middle- manager trainer delivering case-scenario based training - Consolidate efforts to decentralise elements of routine HIV care such as initial laboratory workup, drug readiness training and monthly supply of ART to PHC nurses - Triage by STRETCH nurses of all clients referred for ART and initiation of treatment in new patients without clinical complications requiring referral
- Convene support team composed of current facility staff and local management for each STRETCH facility to initiate systems changes for Phases 2 and 3 - ART monitoring decentralised to nurses at STRETCH facilities - Referral of patients not eligible for nurse-initiation to physician
- Start decentralisation of routine HIV care e.g. VCT and CD4s to be done at local PHC clinic - Re-prescription of ART by STRETCH nurses for previously-initiated patients stable for six months or more - STRETCH support team meetings continue
- Weekly STRETCH support team meetings