Page 20 - ONLINE – Nursing Matters October 2020_Vol 11

current issues
Can the nursing profession contribute
to realising the treatment and prevention
targets of the HIV, TB and STIs National
Strategic Plan 2017 – 2022?
Previously: CEO of the South African National AIDS Council Trust; Currently: Director General for Health, South Africa As the field of HIV treatment and antiretroviral therapy (NIMART) in the Moreover, the HIV workforce is aging,
What is
90-90-90?
90% of people living
with HIV know their
status; 90% of those who
know their status are on
treatment; and 90% of
those on treatment are
virally supressed
HIV Nursing Matters | October 2020 | page 18
contract HIV each year and have slashed and understand the physical and which leads to increased absenteeism,
new infections among young women by psychological needs of PLHIV, who may stress, and lower performance.
almost 40%. be admitted for treatment of any number
of non-communicable diseases (NCDs) In many ways, the advent of the AIDS
As we ask ourselves, ‘how do we reduce associated with advanced age, long- epidemic has intensified and broadened
new infections by 60% in a mere two term ART, or long-term complications challenges faced by South African nurses
years?’, the country recognises the need associated with advanced HIV disease as healthcare providers in institutionalised
to enhance commitment and support (AHD). In addition, nurses working in healthcare. If we are to achieve the targets
for nursing roles in meeting the goals of the community or primary care setting set out in the NSP, we need to support
90-90-90. Nurses, as both frontline HIV have numerous opportunities to identify nurses to engage in advocacy and in
care providers and the country’s largest patients at risk for HIV infection, inform lobbying. Nurses must be involved in the
health work force, are key to ensuring them of prevention strategies such as PrEP development of HIV programmes, as it is
we achieve 90-90-90, which will require and PEP, and to promote ART adherence nurses who have the practical knowledge
greater investments in nursing. among PLHIV, while teaching them of how health service delivery can be
strategies to reduce risk factors for other designed, co-ordinated and effectively
As the largest healthcare profession in chronic diseases, such as heart disease implemented.
the world, there is no doubt that nurses and diabetes. Working together, nurses
are key to the achievement of the NSP and other healthcare providers can help Moving forward, the South African
targets. Nurses are often the only health end the epidemic. healthcare system needs to: ensure that
professionals accessible to many people future nurses are equipped to manage
in their lifetime. Nurses are particularly Unfortunately, as the HIV/AIDS epidemic the complexities of caring for HIV-
well placed and often the most innovative has faded from headlines, HIV/AIDS positive patients of all ages; sustain the
in reaching under-served and key education has decreased in most nursing sense of community among HIV nurses
populations for HIV and TB. Rene Sparks, schools, and undergraduate students and patients since ‘people are in it for
a South African National AIDS Council receive minimal HIV/AIDS education. the long haul’; ensure the six building
civil society leader – herself a nurse – Many nursing students nearing gradu- blocks of health workforce strengthening
agrees with this sentiment, saying: ‘we ation report feeling unprepared to care for the nurse workforce: infrastructure
cannot continue ill-equipping nurses, for patients with HIV. This results from lack improvement, curricula revision, clinical
and should rather empower them to of knowledge, which can perpetuate fear skills development, in-service training,
comfortably supervise the first 90, manage and stigmatising attitudes towards PLHIV. faculty development and building
the second 90 and jointly monitor the third partnerships for policy and regulation
90 in collaboration with partners’. Also, with the introduction of task-shifting, to increase the quality and quantity of
Dr Sandile Buthelezi and nurse-initiated management of the nursing and midwifery workforce.
prevention is evolving rapidly, new public sector that enabled the country and there is a ‘need to bring in the new
therapies have transformed HIV into a to rapidly expand its HIV treatment guard of primary care providers’.
South African nurses currently support virally suppressed. Progress has been chronic disease, while the use of such programme, the need for easy access
an estimated 7.5 million people living made in the prevention of mother-to-child preventive strategies as pre- (PrEP) and to HIV and tuberculosis (TB) information National nurse associations have an
with HIV in South Africa and 4.7 million transmission of HIV (PMTCT) – recorded post-exposure prophylaxis (PEP) are increased. Challenges stemming from important role in informing, advising,
people on antiretroviral treatment (ART) in
at <1% nationally.
providing effective options for reducing a shortage of human resources, a lack encouraging and supporting nurses
the public health sector. Nurses are at the the risk of HIV infection. These medical of suitable materials to use when caring in their work. These associations must
frontline of the biggest ART programme Despite these achievements, HIV breakthroughs have enabled more for HIV-positive patients, unconducive continue to work with government, and
in the world and the fifth-largest TB
programme in the world. Through the prevalence remains high (20.4%) people living with HIV (PLHIV) to reach environments in which nurses are working, others, to strengthen the health system
older adulthood, but also mean that as well as high workload, low staff and create the conditions necessary
among the general population, and
implementation of the HIV, TB and STIs South Africa is lagging behind when it nurses are seeing more PLHIV who have morale and long working hours, have all to maximise the contribution of nurses,
National Strategic Plan 2017 – 2022 comes to reducing new HIV infections, been long-term on ART, and possess fuelled nurses’ frustrations. Non-standard including how nurses can fulfil the
(NSP), much progress has been made especially among adolescent girls and concurrent chronic conditions associated training, long curricula and unsustainable important role of helping to achieve the
towards reaching the 90-90-90 targets.
young women. An estimated 250 000 with aging. Nurses play a critical role in donor-funded HIV treatment programmes NSP targets.
The 2016 Human Sciences Research people contract HIV every year, and of caring for PLHIV and those at risk for HIV have contributed to hindering the ability
infection.
these almost 1 300 women between the
of nurses to enhance patient management The countdown towards an AIDS-free
Council HIV household survey suggested ages of 15 and 24 years became HIV- and ensure improved quality of care. Since generation is on. The clock is ticking and
that 85% of South Africans know their HIV
status, with 4.5-million on antiretrovirals – positive each week. This scenario needs To achieve the NSP targets, it is nurses can also be infected with HIV, they we are running out of time. Each and
the largest ART programme in the world to look different by 2022: we need to imperative that nurses working in the encounter discomfort, as well as fear, that every one of South African nurses can
– and 86% of those on treatment are have halved the number of people who acute care setting are able to anticipate their status will become known at work, make a difference.
HIV Nursing Matters | October 2020 | page 19