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Implementation Science
Published in: Implementation Science 1/2011

Open Access 01-12-2011 | Research

Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention

Authors: Kerry E Uebel, Lara R Fairall, Dingie HCJ van Rensburg, Willie F Mollentze, Max O Bachmann, Simon Lewin, Merrick Zwarenstein, Christopher J Colvin, Daniella Georgeu, Pat Mayers, Gill M Faris, Carl Lombard, Eric D Bateman

Published in: Implementation Science | Issue 1/2011

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Abstract

Background

Task shifting and the integration of human immunodeficiency virus (HIV) care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment (ART). This paper describes the development and content of an intervention involving these two strategies, as part of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) pragmatic randomised controlled trial.

Methods: Developing the intervention

The intervention was developed following discussions with senior management, clinicians, and clinic staff. These discussions revealed that the establishment of separate antiretroviral treatment services for HIV had resulted in problems in accessing care due to the large number of patients at ART clinics. The intervention developed therefore combined the shifting from doctors to nurses of prescriptions of antiretrovirals (ARVs) for uncomplicated patients and the stepwise integration of HIV care into primary care services.

Results: Components of the intervention

The intervention consisted of regulatory changes, training, and guidelines to support nurse ART prescription, local management teams, an implementation toolkit, and a flexible, phased introduction. Nurse supervisors were equipped to train intervention clinic nurses in ART prescription using outreach education and an integrated primary care guideline. Management teams were set up and a STRETCH coordinator was appointed to oversee the implementation process.

Discussion

Three important processes were used in developing and implementing this intervention: active participation of clinic staff and local and provincial management, educational outreach to train nurses in intervention sites, and an external facilitator to support all stages of the intervention rollout.
The STRETCH trial is registered with Current Control Trials ISRCTN46836853.
Appendix
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Metadata
Title
Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention
Authors
Kerry E Uebel
Lara R Fairall
Dingie HCJ van Rensburg
Willie F Mollentze
Max O Bachmann
Simon Lewin
Merrick Zwarenstein
Christopher J Colvin
Daniella Georgeu
Pat Mayers
Gill M Faris
Carl Lombard
Eric D Bateman
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2011
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-6-86

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