Nursing Care for HIV - HIV and Primary Care

Authors: Elizabeth Mokoka, RN, PhD; Debra M. Winters, APRN-BC, AACRN
Editors In Chief: Ian M. Sanne, MBBCH, FCP(SA) (More Info)

Last Reviewed: July 8, 2016 (What's New)

Credit Information

inPractice® Africa’s Continuing Education Unit (CEU) provider, the South African Medical Association, offers physicians 3 CPD points on a 70% pass rate for completing this individual module. Nonphysicians who successfully complete the module will receive a participation certificate. To learn more on CPD credits and participation certificates, click here.

Introduction

South Africa is one of the countries hardest hit by the linked epidemics of HIV/ AIDS and tuberculosis (TB). According to Statistics South Africa, 18.9% of the country’s adult population (15-49 years of age) was HIV positive in 2014—an estimated 6.5 million individuals, including approximately 3.5 million South African women of reproductive age.[UNAIDS 2014] Approximately 80% of South Africans are infected with TB,[ZA Natl Strategic Plan 2012] and South Africa has the second highest incident rate (per 100,000 population) of TB in the world.[WHO Global TB Report]

Initially, HIV care and treatment were delivered primarily as a stand-alone service within hospitals or clinics. This strategy was aimed at fulfilling the mandate of emergency scale-up, in line with the World Health Organisation 3 x 5 initiative of enrolling large numbers of HIV-infected patients onto treatment rapidly and bypassing the public health system’s bureaucracy.[Topp 2010] Although this strategy had some success, its sustainability was questionable, and some investigators found that it further weakened the public health system, limited access to care, negatively affected the distribution of human and material resources, and reinforced stigma (Management Guidelines).[Atun 2008; WHO Operations 2008]

Integration of services improves care and reduces missed opportunities for key interventions such as HIV counselling and testing of the wider population, implementation of prevention of mother-to-child transmission (PMTCT) programmes, timely provision of antiretroviral therapy, and management of opportunistic infections.[Atun 2008; WHO Operations 2008; WHO Health Systems 2008] Specific potential benefits include

  • More comprehensive patient care
  • Improved adherence to treatment in patients requiring multiple interventions
  • Reduction in patients being “lost” in the system
  • Improved efficiency
  • Reduced waiting times
  • Reduced costs (transportation, lost wages, childcare services) of clinic visits for patients
  • More comprehensive and efficient consultations for the clinical team
  • Increased equity in access to services when brought closer to where patients live

However, integration of services should not be regarded as a cure-all; rather, it must be carefully planned and implemented and its outcomes monitored. Although efforts to integrate HIV care, support, and treatment have been evident in some facilities, they need to be strengthened by providing services across the different levels of the healthcare system, thereby enhancing the quality of care for individuals, families, and communities.