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Table 1 Roles of primary care clinics with and without ART assessment sites in the delivery of elements of HIV care before and during the STRETCH intervention

From: Integrating HIV care into nurse-led primary health care services in South Africa: a synthesis of three linked qualitative studies

 

Primary care clinics without accredited ART site

Primary care clinics with accredited ART assessment site functioning within the clinic

Organisation of HIV care before the STRETCH trial

Delivery of pre-ART care (voluntary counselling and testing, initial CD4, 6–12 monthly HIV care) and ART care (baseline bloods, drug readiness training and monthly issuing of ARVs)

• Primary care nurses identify and refer HIV positive patients to ART nurses at their referral primary care clinic with an accredited ART assessment site

• Primary care nurses identify and refer HIV positive patients to ART nurses working within that clinic

• ART nurses provide pre-ART and ART care for all patients referred from primary care services

• All patients needing ART initiation and re-prescription referred by ART nurses to doctors at ART treatment sites

Organisation of HIV care during the STRETCH trial (intervention clinics and their referring primary care clinics only)

Delivery of pre-ART care (voluntary counselling and testing, initial CD4, 6–12 monthly HIV care)

Mainstreaming pre-ART care”

“Internal integration of pre-ART care’

• Primary care clinic enabled to provide pre-ART care to their own patients

• All professional nurses (ART and primary care nurses) at intervention clinic encouraged to provide pre-ART care as part of routine consultations

Delivery of ART care (baseline bloods, drug readiness training and monthly issuing of ARVs)

“Mainstreaming ART care”

“Internal integration of ART care”

• Primary care clinic enabled to provide ART care to their own patients

• All professional nurses (ART and primary care nurses) at intervention clinic encouraged to provide ART care as part of routine consultations

Initiation and re-prescription of ART during STRETCH intervention

• All patients needing an ART prescription referred to ART nurses at intervention clinic

• All professional nurses (ART and primary care nurses) at intervention ART sites trained and authorised to initiate and repeat ART prescriptions

• Complicated patients referred to doctor at ART treatment site