Page 254 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 5 of 7 Original Research

Human immunodeficiency virus management setting) 3 years ago or less had significantly higher
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confidence knowledge scores (t[df70] = -3.5, p = 0.001). Those with no
training in dispensing had significantly higher knowledge
The mean HIV management confidence score was 68.7% scores, which is an unexpected finding. Knowledge scores of
(95% CI 66.3–71.1), with a minimum score of 45% and a participants who indicated that they received regular
maximum of 85%. The participants reported the highest feedback about their personal performance (t[df75] = 2.45,
confidence in the use of ART stationery (with 51.9%
considering themselves experts) and performing a physical p = 0.016) and the performance of the clinic related to the
examination (with 50.6% considering themselves experts). provision of ART (t[df75] = 3.5, p = 0.001) were significantly
They were less confident in identifying drug interactions in higher compared to those who did not. Bivariate analysis
commonly used medications, because only 14.3% considered indicated a low to moderate positive correlation between the
themselves to be experts, and stopping or switching drug HIV management knowledge score and the average number
treatments (with only 15.5% considering themselves as of patients initiated on ART in the last 3 months (r = 0.357,
experts). Low confidence was reported in prescribing for p = 0.002) and a moderate positive correlation for the average
concurrent illnesses and in identifying the signs and number of patients on ART followed up (r = 0.386, p = 0.001).
symptoms of immune reconstitution inflammatory A significant negative correlation was found between the
syndrome (fewer than 20% of participants considered HIV knowledge score and the average number of other or
themselves experts). non-ART patients the participants managed in the past 3
months (r = -0.367, p = 0.001).
The distribution of the HIV management confidence score
was the same across categories of district and facility type. Discussion
Bivariate analysis indicated a low to moderate positive Appropriate training is the beginning of the pathway to
correlation between the HIV management confidence score expertise. 5,23 In this study, a variety of HIV management
and the average number of patients on ART followed up in training courses were attended by the participants. All of the
the last 3 months (r = 0.328, p = 0.004). The distribution of
HIV management confidence scores was not the same across participants were trained in PACK, completed an HIV
categories of how long NIMART mentoring lasted (F[df4] = management course and participated in NIMART training as
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4.6; p = 0.002). Post hoc analysis revealed that participants per the NIMART guidelines of the Western Cape. Only
who received NIMART mentoring for 2 weeks had 57.1% of participants had completed a dispensing course,
significantly higher confidence scores than those who although this did not affect confidence and was associated
received mentoring for more than 2 months. None of the with lower knowledge scores. A dispensing certificate is not
other influencing factors has significant associations with a requirement for NIMART in the Western Cape and most
HIV management confidence (see Table 2). clinics have either a pharmacy assistant or a pharmacist who
can dispense medication. Cameron et al. found that 79% of
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Human immunodeficiency virus management the nurse participants in their study had previous formal
knowledge training in HIV management and 55% had formal training in
PHC, which is comparable to the 57.1% of participants in the
The mean HIV management knowledge score was 72.7% present study who had completed a postgraduate diploma in
(95% CI 69.8–75.6). The minimum score was 38% and the
maximum 100%. Participants had high knowledge scores PHC. A qualification in PHC (Health Assessment, Treatment
regarding treatment for peripheral neuropathy (97.4% and Care [R48]) and a dispensing certificate are therefore not
indicated the correct answer) and the side effects of tenofovir, requirements to prescribe ART in the study context, but the
with 89.6% indicating the correct answer. High knowledge PACK training and completing an HIV management course
scores were also identified for identifying pneumocystis are. Although no cause and effect can be inferred, it can be
pneumonia (88.3% correct) and ART contraindications (88.3% deduced from the results that recent PACK training (3 years
correct). The participants were less knowledgeable regarding or less) is likely to improve the HIV management knowledge
the treatment of toxoplasmosis (22.1% correct), oral hairy of nurses.
leukoplakia (39% correct) and tinea capitis (41.6% correct). A
few participants (41.6%) demonstrated an understanding of Clinical mentoring is depicted alongside clinical practise
virological failure and only 51.9% provided the correct and continuous assessment on the pathway to competency
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answer for the question related to drug–drug interactions. and proficiency. The purpose of mentoring is to acquire
skills to competently initiate, but also manage patients
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There was a significant difference in distribution of the HIV according to established clinical protocols. The Western
management knowledge score across categories of district Cape Department of Health guideline advises a minimum
(t[df75]= -2.9, p = 0.004). Participants in the Cape Winelands of 40 h of NIMART one-on-one mentorship following
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had a lower mean knowledge score (69.6%) compared to the didactic training. In a study in the health districts of
mean knowledge score of participants in the City of Cape Tshwane (Gauteng Province), Nkangala (Mpumalanga
Town (78.2%). Participants trained in Practical Approach to Province) and Capricorn and Vhembe (Limpopo Province),
Care Kit (PACK – flowchart-based guidelines designed for the median mentoring period was 25 months. It therefore
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assisting nurses manage various conditions in a primary care appears that there is no set period for mentoring. A total of

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