Table 5 Overview of promoting and inhibiting factors of ETA normalization

Interactional workability

Congruence

Clear roles

Lay health workers performing duties outside their set roles

Lack of internalisation of the empowerment approach and patronising attitude to patients

Disposal

Efficiency of work: reduced crowding, queues and easier follow-up Teamwork

Lack of trust in patients and doubts regarding patient adherence

Relational integration

Accountability

Training sessions

Nurses' non-attendance of training

Dedicated project manager Treatment supporters' tacit knowledge

Strained relationships between staff

Nurses questioning lay health worker abilities; loss of less literate but more experienced lay health workers

Confidence

Patient appreciation of the programme

Fewer challenges and increased confidence later in the programme, possibly due to reports of positive outcomes

Lack of initial buy-in (acceptance of the model) from nursing staff and lay health workers, based on the perception that HIV programmes cannot work for TB

Skill-set workability

Allocation

Clear allocation of tasks

Hierarchical nature of staff relations

Late and insufficient lay health worker stipend payments

Lay health worker attrition

Performance

Hope for programme impact and reduced work

Introducing patients to the programme perceived as time consuming

Patient reception of adherence counsellors' work

Administrative tasks were seen as time consuming and complicated

Treatment supporter safety in the community

Uncertainty about, and training needs for, questions about HIV/AIDS

Contextual integration

Execution

Resources allocated to the programme

Late and insufficient stipends for lay health workers

High level management and NGO support

Lack of space within clinics for the programme

Realisation

Dedicated project manager

Lack of participation from facility managers

Lay health worker attrition