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 |