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Background: Postpartum haemorrhage is one of the causes of the rise in maternal mortality. Midwives’ experiences related to postpartum haemorrhage (PPH) management remain unexplored, especially in Limpopo. The purpose of the study was to explore the challenges experienced by midwives in the management of women with PPH. Methods: Qualitative research was conducted to explore the challenges experienced by midwives in the management of women with PPH. Midwives were sampled purposefully. Unstructured interviews were conducted on 18 midwives working at primary health care facilities. Data were analysed after data saturation. Results: After data analysis, one theme emerged “challenges experienced by midwives managing women with PPH” and five subthemes, including: “difficulty experienced resulting in feelings of frustrations and confusion and lack of time and shortage of human resource inhibits guidelines consultation”. Conclusion: The study findings revealed that midwives experienced difficulty when managing women with postpartum haemorrhage. For successful implementation of maternal health care guidelines, midwives should be capacitated through training, supported and supervised in order to execute PPH management with ease. Keywords: Midwifery in South Africa; implementation of maternal guidelines; postpartum haemorrhage; maternal mortality.

Background: Pregnant woman’s personal experience of antenatal care services can either be positive or negative; however, knowledge and experience appear to be of paramount importance in shaping their attitudes towards any healthcare-related services. This implies that women's experience of antenatal care services may affect their decision for seeking antenatal care in their present pregnancy, which can lead them to delay seeking care. Purpose: This study sought to explore the attitudes of pregnant women towards antenatal care services provided in primary health care facilities of Mbombela Municipality, Mpumalanga Province, South Africa. Methods: A qualitative exploratory descriptive study design was used for this study. Purposive sampling technique was used to sample pregnant women who fail to attend antenatal services as expected. Data were collected through face to face unstructured in-depth interview. A total of eighteen pregnant women participated in the study until data saturation. Data were analysed using Tech’s method of analysis. Results: Results revealed the following theme and sub-themes: Attitudes of pregnant women related to individual perceptions, perceived barriers to utilizing antenatal care services,’ attitudes of healthcare providers, long waiting times in healthcare facilities, lack privacy and confidentiality in healthcare facilities and attitudes of pregnant women related to attendance of antenatal services. Conclusion: Attitudes of pregnant women about antenatal care are shaped by their knowledge and previous encounters with the health care services that they had previously received. It is therefore important to provide women-friendly services. It is recommended that health education regarding the importance of antenatal care services must be given to all women daily in the waiting areas of each primary health care facilities, thus, the healthcare providers should promote the active participation of pregnant women during the health education sessions and provide opportunities to ask questions.

Occupational exposure to human immunodeficiency virus (HIV) among nurses had been reported to be a major challenge in South African and broader African context. There seems to be an increase in the level of exposure and uptake of post-exposure prophylaxis (PEP) in Africa. This had warranted the need to establish a systematic review on the level of knowledge among nurses regarding PEP in the African continent. The search engines used included: EBSco Host (North-West University [NWU] library), Sabinet, Google Scholar, ScienceDirect, and PubMed. The search was limited to the current decade (2008-2018), including articles that are in English. Keywords used were: ‘knowledge’, ‘post-exposure prophylaxis/PEP’, ‘HIV’, and ‘nurs*’. Thematic evaluation to pick out commonalities of the applications covered in this review have been achieved. The themes identified from the review were: poor knowledge regarding PEP, receiving training on PEP for HIV, immediate steps to take after exposure to infected blood, exposure to HIV, and not taking PEP. There is a strong need to increase the awareness and knowledge regarding PEP as well as to implement training programs to train nurses on the process of PEP in healthcare settings, to increase knowledge on PEP, and thereby decrease seroconversion of HIV. y.

Background Zimbabwe has the highest teenage pregnancy rate in Sub Saharan Africa. Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) prevalence in adolescents that are from tribes that perform cultural initiations and subscribe to certain norms are higher than the national prevalence which is estimated at 12% (18 and 13.6% respectively) in Zimbabwe. Indigenous Health Systems (IHSs) and Modern Health Systems (MHSs) in Zimbabwe run parallel thereby introducing challenges in the management of adolescent sexual health due to conflicts. This study seeks to develop strategies that will facilitate the integration of IHSs and MHS in Mberengwa and Umguza districts. Methods This research will be conducted in two phases. The first phase would utilise a concurrent triangulation mixed methods design with both qualitative and quantitative approaches. The findings from the qualitative and quantitative approaches would be merged through a comparison of findings side by side. The second phase would focus on the development and validation of strategies that would facilitate the integration of IHSs and MHSs. The Strength, Weakness, Opportunity and Threat (SWOT) analysis would be applied on interfaced findings from phase one. The Basic Logic and the Build, Overcome, Explore and Minimise (BOEM) models would then be used to develop strategies based on the SWOT findings. The developed strategies would be validated through the application of Delphi technique and administration of checklist to selected key stakeholders through organised workshops. Discussion There have been no known studies found in the literature that explores the possibility and developed strategies of integrating IHSs and MHSs so as to promote safe sexual practices in adolescents. Most programs on sexual health have ignored the role of IHSs and MHSs in influencing safe sexual practices leading to them failing to attain desired goals. A lot of emphases has been targeted at minimising the spread of Sexually Transmitted Infections (STIs) through advocating for utilisation MHSs rather than focussing on an integrating systems that are meant to manage Adolescent Sexual Health (ASH) related issues. The study protocol was approved by the University of Venda Ethics Committee Registration (SHS/19/PH/17/2608) on the 26th of August 2019.

Background: Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) caregiving has created a foundation for stress and burnout amongst nurses as they are burdened by the increased workload of HIV and AIDS care. Objectives: This study aimed to develop a support model for nurses caring for people living with HIV and AIDS (PLWH). Method: The study employed concept analysis and the identified concept of interest within the caring context of HIV and AIDS was conceptualised using six elements of practice-oriented theory, namely, the context, agent, recipient, dynamic, procedure and purpose. Results: The framework consisted of six components: health service and legislative (context); nursing service managers (agents); nurses (recipients); decreasing power imbalance, participative and transformational leadership and trust (dynamics); initiation of support process through teamwork and mutual goal-setting, implementation and sustenance through reflections, monitoring and evaluation (process) and empowered nurses (outcome). Conclusion: Poor organisational support deteriorates the quality of nurses’ lives on a personal level and imposes a direct economic cost on the employer by decreasing overall nursing workforce productivity. The conceptual framework could be a guide to support nurses in healthcare services regarding the management of HIV and AIDS in the workplace.

Background: Strategies to improve sexual health outcomes have evolved over the years due to technology’s evolution to ensure that they are relevant. Challenges have been noticed in different systems that run parallel, particularly in Low-Income Countries where the majority utilise Indigenous Health Systems. Optimisation of resources and minimisation of conflicts could be realised through integrated health systems in the management of adolescents’ sexual health issues. This study sought to develop strategies to facilitate Indigenous Health System and Modern Health System integration to improve the management of Adolescent Sexual Health issues, leveraging results from 3 papers. Methods: A multi-stage approach was utilised, with Phase 1 focussing on a preliminary assessment through merging findings from the 4 papers. The Strengths, Weaknesses, Opportunities, and Threats analyses were then used, followed by the Basic Logic Model to identify critical aspects that needed to be considered in building the strategies. The second phase used the Build, Overcome, Eliminate and Minimise framework to build the strategies. Results: A total of 5 strategies were proposed to facilitate this integration, and these included revival of committees that were inclusive of all stakeholders; allocating Indigenous Health System space in clinics to work in; establishing adolescent-friendly clinics; intensifying information dissemination on sexual health-related issues, and developing clear Terms of Reference and procedures to govern this integration and ensure it is a success. Conclusions: Implementing these strategies could facilitate this integration and ensure that programs are planned and implemented in a complementary manner, thereby reducing conflicts between the 2 systems and ensuring collaborative efforts towards shared goals that would transform to better Sexual Health Outcomes for adolescents.

Introduction: integrated management of Human Immunodeficiency virus and Non communicable diseases is essential to improve clinical outcomes of patients living with HIV. there is poor implementation of integrated management of HIV and NCDs in Primary health care facilities in most of African countries. The aim of the study was to conduct the strengths, weaknesses, opportunities and threats (SWOT) analysis of the Vhembe district to determine the implementation of integrated management of HIV and NCDs among NIMART nurses in Limpopo Province ,South Africa .Material and Methods: A descriptive quantitative study was employed using checkilist and SWOT framework. We used 25 PHC facilities to collect facility data, NIMART nurses data and patients data to complete the four checklists. The collected data was analysed using SPSS version 26. the analysed data was further analysed and segregated into the SWOT framework.Results: From the total of 25 PHC facilities we found that 147(100%) were NIMART trained ,109 (74.1%) were not trained on Adult primary care guidelines. All 100% of facilities did not have the updated adult primary care guideline 2016/17. In all 25 (100%) despite the evidence of implementation integrated management of HIV and NCDs , patients were not screened for diabetes as per the guidelines.Conclusion: The SWOT analysis allowed the researchers to identify the areas which can be sustained , strengthened and addressed for successful implementation of integration of HIV and NCDs to improve patient clinical outcomes in PHC facilities. The results of the study may be applied to any context and maybe used by decision makers, managers, professionals and other relevant stakeholders to develop more policies or frameworks on the integrated management of HIV and NCDs.

Different stakeholders play varying roles in shaping up adolescent sexual behaviours that, in turn, influence their sexual experiences. In Zimbabwe, it has been reported that adolescents from cultural districts exhibit poor sexual health outcomes as compared to other districts. Therefore, this study sought to explore the role of different key community stakeholders in the indigenous health system and how it impacts on adolescent sexual health issues. The study further explored how the indigenous health system could be integrated into the modern health system. A qualitative cross-sectional survey was conducted on purposively and snowballed respondents in Umguza and Mberengwa districts. Interviews and focus group discussions were used to gather and record data from participants. The recorded data were transcribed verbatim, translated to English, coded and thematically analysed on MAXQDA Analytics Pro 2020. Four superordinate and 12 subordinate themes emerged from the data during analysis. Stakeholders play varied roles in adolescents’ upbringing and support though there are contradicting teachings from the indigenous health system and modern health system. It is possible to integrate these two systems though there were foreseen logistical challenges and clashes in the values and belief systems. Participants made suggestions on how these challenges could be overcome. There is a window of opportunity to pursue the suggested ways of integrating indigenous health systems and modern health systems for improved adolescent sexual health outcomes.

Background Globally, the burden of tuberculosis or human immunodeficiency virus (TB/HIV) is at 24% and this alarming rate compelled the World Health Organization (WHO) to declare the African region as a critical workforce shortage area. To facilitate adherence to treatment guidelines, WHO recommended a strategy of task shifting for countries with high health workforce shortages. The strategy aimed at the redistribution of health care tasks to available workers. The study aimed to determine the factors facilitating nurse-initiated management of antiretroviral therapy (NIMART) trained nurses’ adherence to TB/HIV treatment guidelines. Methods The study employed an exploratory-descriptive design. The study was conducted in Ugu and Ngaka Modiri Molema Districts of KwaZulu-Natal (KZN) and North West (NW) Provinces of South Africa. The population comprised of 24 participants who were purposively selected. The in-depth focus group discussions were conducted and ATLAS T.I. was used for data analysis following the basic steps of notice-collect-think (NCT) analysis. Trustworthiness and adherence to ethics were ensured. Results The singular theme of factors facilitating NIMART trained nurses’ adherence to treatment guidelines which included positive attitudinal needs and positive behavioural change emerged from raw data. Conclusion Continuous training, support supervision, and improved relationships with colleagues need to be enhanced to enable NIMART trained nurses to adhere to treatment guidelines.

Isoniazid preventive therapy (IPT) is a strategy that has been proposed by the National Department of Health of South Africa and the World Health Organization for people living with HIV (PLWH) to prevent latent tuberculosis (TB) progressing to active TB. This research focused on exploring and describing experiences of PLWH regarding IPT provision in the Ngaka Modiri Molema district in the North West province of South Africa. A qualitative, exploratory, contextual and descriptive research design was used for this study. Semi-structured individual interviews were conducted to collect data from PLWH. The sample size consisted of 14 participants and data saturation was reached at participant 11. A thematic data analysis was employed in this study. The study consisted of 10 female participants and 4 male participants. Three main themes emerged during interviews, namely factors that facilitate IPT provision and uptake, factors that inhibit the adherence of patients to IPT, and strategies to improve provision or adherence. The provision of IPT at a community health centre in Ngaka Modiri Molema district municipality was reported to be satisfactorily although challenges were also marked. IPT must be available at all times to ensure the promotion of PLWH adherence, continuity of care and retention in HIV care. In addition, screening of PLWH for active TB disease before they can be initiated should be a priority. PLWH should be supported and followed up through the directly observed treatment, short-course strategy to promote adherence and this can also be facilitated through adherence social clubs.

Background Nurse-Initiated Management of Antiretroviral Therapy ( NIMART) training was introduced with the purpose of improving the knowledge, skills and competence of nurses in providing comprehensive quality care to people living with HIV (PLWH) and facilitating World Health Organisation task-shifting where nurses initiate antiretroviral therapy (ART) rather than doctors to meet the increasing demand of ART drugs. The aim of this review was to identify evidence of training strategies that can improve the implementation and deals with challenges that hinder quality. Methods A measurement tool to assess systematic reviews methodological systematic review tool was used to critically assess selected studies. Studies were sought using multiple databases including CINAHL (EBSCO), Google Scholar, ProQuest, academic journals, SA publications, electronic resources and OAISTER published from January 2012 to February 2017. The initial review of studies yielded 535 results excluding duplications. The screening of full-text articles was conducted, and 33 articles met the eligibility criteria and were included for quality assessment. The rest were excluded. The quality assessment research instrument was used to analyse and synthesise selected full-text articles (n=33). Results The studies indicate that NIMART or HIV training is used interchangeably and has the potential to empower nurses with knowledge and skills. It also has a positive impact on increasing ART uptake; however, nurses still lack confidence and competence to provide comprehensive quality patient-centred care. Studies suggest that a shift from the traditional didactics of lectures or slide presentation methods during training to the use of interactive training strategies that stimulate critical thinking in making decisions about HIV care, followed by mentoring and continuous professional development. Conclusion and recommendation This study reveals that the use of effective training techniques during NIMART training has a positive impact on the learning outcomes, implementation and performance of HIV programmes. The health care system should focus on dealing with barriers that negatively influence NIMART implementation. Given the lack of a framework or model related to NIMART or HIV training, the study recommends the development of a conceptual framework to strengthens the implementation of NIMART training.

Background Sexual and reproductive health are sensitive topics that may not be easily discussed among different age groups in most cultures. Most parents are uncomfortable to communicate with their children about sexual and reproductive health. The rate of teenage pregnancy and sexually transmitted infections continues to rise as parents shift the responsibility of discussing sexual health to other members of the family or teachers. Many sexual and reproductive ill-health exists among teenagers as a result of poor communication with parents or elders. The aim of the study was to explore the views of parents/guardians regarding t the discussion of sexual and reproductive health issues with teenagers. Methods The study was conducted in Capricorn and Mopani Districts of Limpopo Province where teenage pregnancy rates were reported to be very high. A qualitative explanatory approach was used. The population comprised of parents/guardians to teenagers who were pregnant or having children. Data were collected through individual face to face interview guided by one central question. Data were analysed using Tesch's method. Measures to ensure trustworthiness and ethical issues were ensured. Results Two themes emerged from the study: Views regarding discussing sexual and reproductive-related topics between parents and teenagers and Relationship of parents/guardians and their teenagers as an influence of discussions about SRH matters. Conclusion Parents/guardians still view discussing sexual and reproductive health issues with teenagers as taboo and difficult. However, discussing sexual and reproductive health issues with teenagers is seen as a beneficial practise as it might influence them positively and may decrease unwanted sexual risks such as teenage pregnancies and HIV infections.

Background: The implementation of nurse-initiated management of antiretroviral therapy (NIMART) management training is a challenge in the primary health care (PHC). It is evident from the literature reviewed and the data obtained from the North West province that gaps still exist. There is no conceptual framework providing guidance to NIMART training and implementation. Aim: Therefore, the aim of this study was to develop a conceptual framework to strengthen NIMART training and implementation in the North West province to improve patients and human immunodeficiency virus (HIV) programme outcomes. Setting: The study was conducted in the North West Province, South Africa. Methods: A pragmatic, explanatory, sequential, mixed-methods research design was followed. A descriptive and explorative programme evaluation design was used. Data were collected from two sources: antiretroviral therapy (ART) statistics from District Health Information System (DHIS) & Tier.net of 10 PHC facilities to evaluate and determine the impact of NIMART on the HIV programme and five focus group discussions conducted amongst 28 NIMART nurses and three HIV programme managers to describe challenges influencing NIMART training and implementation. Results: The study revealed that there was low ART initiation compared to the number of clients who tested HIV-positive. There was poor monitoring of patients on ART, which was evident in the low viral load collection and suppression, high loss to follow-up and deaths related to HIV. Challenges exist and this was confirmed by the qualitative findings, including human resource ratios, training and mentoring and the entire absence of a conceptual framework or model that guides training and implementation. Conclusion: The study findings were conceptualised to describe and develop a framework needed to facilitate and influence NIMART training and implementation to improve the HIV programme and patient outcomes. Dickoff, James and Wiedenbach’s practice-oriented theory and Donabedian’s structure process outcomes model provided a starting point in the ultimate development of the framework. Although the study was limited to the North West province’s PHC clinics and community health centres and did not include hospitals, it is of high significance as there is no such conceptual framework in the province or in even South Africa.

The challenges of caring for people living with HIV (PLWH) in a low-resource setting has had a negative impact on the nursing profession, resulting in a shortage of skilled nurses. In response to this shortage and perceived negative impact, we conducted a descriptive, cross-sectional study to describe the level of knowledge and psychosocial wellbeing of nurses caring for PLWH at a regional hospital in Limpopo Province, South Africa. A total of 233 nurses, the majority being female, participated and were stratified into professional nurses (n =108), enrolled nurses (n = 58) and enrolled nursing auxiliaries (n = 66). Data were collected using HIV/AIDS knowledge questionnaire, Maslach Burnout Inventory; AIDS Impact Scale and Beck's Depression Inventory. The total knowledge score obtained by all the participants ranged from 2 to 16, with an average of 12.93 (SD = 1.92) on HIV/AIDS knowledge. Depersonalization (D) (83.7%) and emotional exhaustion (EE) (53.2%) were reported among participating nurses caring for PLWH. Burnout was higher among professional nurses as compared to both enrolled nurses and enrolled nursing auxiliaries. There was a moderate negative significant correlation between HIV knowledge with the nurses' emotional exhaustion (r = 0.592), depression (r = 0.584) and stigma and discrimination (r = 0.637). A moderate to high level of burnout was evident among all levels of nurses. These findings lead to the recommendations for support of nurses caring for PLWH that include structured nursing educational support, organisational support with respect to employee wellness programmes that address depression and work burnout, as well as social support. The provision of these support mechanisms has the potential of creating a positive practice environment for nurses in the Vhembe District of the Limpopo Province in particular, and South Africa in general, and in improved care for PLWH.

Nursing is an occupation that is subjected to a high degree of stress. Stress had been seen as a predictor of the nature of care provided by nurses caring for people living with Human Immunodeficiency Virus (HIV) (PLWH). The purpose was to develop a conceptual model for establishment of Nurse-Environment-Patient Relationship in hospital setting. A descriptive, cross-sectional paper was conducted. The Maslach Burnout (MBI) and Beck’s Depression Inventories (BDI), and Acquired Immunodeficiency Syndrome (AIDS) impact scale was used to assess the impact of caring for PLWH among nurses. The paper adopted the assumptions of cognitivism and cognitive appraisal theory. Majority of nurses reported to suffer grief and loss and identification with their patients. A moderate to high level of burnout was marked. A conceptual model of psychosocial impact of caring for PLWH is a comprehensive model that projects the impact of caring for PLWH among nurses and a link between nurses, their working environment and p...

Nurses are faced with challenges regarding inadequate precautionary resources and the lack of support for occupational health practices still experienced in the clinical setting which expose them to the risk of contracting TB and HIV. Hence this study sought to investigate TB/HIV exposure among nursing students in the clinical practice environment. A cross-sectional descriptive design was used in this study. The study sample included nursing students from first to fourth year level from the School of Nursing Sciences at the North-West University who were purposively selected. A high percentage of nursing students reported that they have experienced a situation where they were afraid that they might have been infected with both TB and HIV. Awareness about post-exposure prophylaxis (PEP) was marked among the majority of nursing students. The uptake of PEP differed across junior and senior levels of nursing students. The results revealed that the higher the level of study, the greater the exposure. The lack of sufficient clinical support from nursing staff and preceptors had equally contributed to the exposure of nursing students to both HIV and TB, therefore, more support must be provided to nursing students.

Introduction management of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) within primary health care (PHC) facilities involve nursing students as part of them integrating theory to practice. Clinical learning for nursing students requires adequate support from the Nursing Education Institution (NEI) and nursing professionals. Given the dearth of literature regarding clinical support for nursing students in the management of TB/HIV in PHC setting, this study is aimed at exploring and describing nursing students' experiences regarding clinical support. Methods a phenomenological design was used to explore and describe the experiences of nursing students using an individual, unstructured, in-depth interview. Audio-taped interviews were transcribed verbatim and analysed using Atlas TI software. Results themes derived from the study were factors inhibiting clinical support which incorporated shortage of professional nurses (PNs), lack of accompaniment, fear of managing TB/HIV patients and negative attitudes of PNs; outcomes of poor clinical support included inability to integrate TB/HIV theory to practice and lack of confidence among nursing students; nursing students' desired outcomes through clinical support included becoming a competent TB/HIV nurse and the ability to integrate TB/HIV theory to practice; and strategies to strengthen and promote clinical support in TB/HIV management through strengthened occupational health and safety learning, provision of knowledge regarding post-exposure prophylaxis and infection control, and appointed clinical PN for students in each facility. Conclusion the development of policies for clinical support, increasing supervision, appointment of clinical preceptors and accompanists in facilities where nursing students are placed would promote clinical learning within the NEI and the production of competent and confident nurses.

Background: Nurses, as front-line care providers in the South Africa’s health care system, are called upon to deliver integrated interventions for tuberculosis and human immunodeficiency virus (TB and HIV) including nurse-initiated management of anti-retroviral therapy (NIMART) and anti-TB treatment. Adherence to treatment guidelines and factors associated with non-adherence to treatment guidelines among nurses remain under explored.Purpose: To explore and describe barriers to treatment guidelines adherence among nurses initiating and managing anti-retroviral therapy and anti-TB treatment in KwaZulu-Natal and North West provinces.Design: This study employed a qualitative exploratory descriptive design.Methods: Four semi-structured focus group interviews were conducted during 2014 each consisting of four to eight NIMART trained nurses. Audiotaped interviews were transcribed verbatim and analysed using Atlas T.I. software.Findings: During data analysis, two themes emerged: (1) NIMART trained nurses’ distress about TB and HIV guidelines adherence that is inclusive of lack of agreement with guidelines, poor motivation to implement guidelines, poor clinical support and supervision, resistance to change, insufficient knowledge or lack of awareness and (2) exterior factors inhibiting nurses’ adherence to treatment guidelines which incorporated organisational factors, guidelines-related factors and patient-related factors.Conclusion: This qualitative study identified that nurses have substantial concerns over guideline adherence. If NIMART trained nurses’ barriers inhibiting adherence to treatment guidelines cannot be remedied, patient outcomes may suffer and South Africa will struggle to meet the 90-90-90 targets.

Background: The purpose of NIMART training is to upscale the capacity of PNs with knowledge, skills, confidence and competencies to provide comprehensive and quality health care services to PLWH and thereby improve the performance of the HIV programme. Therefore, this study evaluates the impact of NIMART training on the implementation of the HIV programme to identify gaps and extend best practices. Objectives: The objective of the study is to determine and evaluate the impact of NIMART training on HIV programme in order to make recommendations leading to effective training and implementation. Methods: A quantitative descriptive design for programme evaluation was used to examine the impact of NIMART training on the implementation of the HIV programme. The study was conducted in rural districts of the North West province. A stratified simple random sampling method was used to select n = 10 PHC fixed clinics and community health centres that met the inclusion criteria. Five sub-districts were selected to participate in the study to allow a greater degree of representativeness. The statistics of ART indicators were collected from the DHIS from January 2012 to December 2016. These ART indicators have been measured against the number of PNs trained on NIMART. Descriptive statistics were used to analyse data. Results: The study results revealed ineffectiveness in the implementation of NIMART training programme and inefficiency in the management of HIV as there is no steady increase of new ART initiation in adults, children, and ANC pregnant women and below 90%, despite 99% of PHC selected facilities having 75% on PNs trained on NIMART, 42.8% were not certificated for competence and only 23% not trained, including the changes in eligibility criteria for treatment, introduction of PMTCT policy and universal test and treat (UTT) in September 2016. Sustainability of patient on ART is poor as the study results revealed fluctuation in both adults and children TROA and high LTFU at an average of 14%. Again, of Viral load collection (54%) & Viral load suppression (56%) rate at 12 months after ART initiation is far below the 90% target and had negative impact on patient treatment outcomes including decanting of stable patients out of the overcrowded facilities. However, adult patient death after 12 months of starting treatment declined. Conclusion and Recommendations: There is a significant impact of NIMART training on HIV management with regard to increased access to PHC facilities. However, challenges still exist that reveal poor quality of HIV management, non-compliance to guidelines and monitoring of treatment effectiveness despite PNs trained on NIMART. Challenges or barriers that lead to the identified gaps need to be investigated in order to make recommendations that strengthen NIMART training and implementation. Keywords: NIMART- Nurse initiated management of anti-retroviral therapy training, HIV programme, Impact, PHC facilities, Professional nurses

Background: Nurses caring for people living with HIV (PLWH) are at higher risk of exposure to the human immunodeficiency virus (HIV) by needle sticks, cuts, getting body fluids in their eyes or mouth and skin when bruised or affected by dermatitis. Objectives: To determine knowledge, insight and uptake of occupational post-exposure prophylaxis (OPEP) amongst nurses caring for PLWH. Method: A cross-sectional descriptive design was used in this study. Stratified random sampling was used to sample 240 nurses. The study was conducted in a regional hospital in Limpopo province. Both parametric and non-parametric statistics were employed to analyse data. Results: A total of 233 nurses participated in the study. Sixty per cent ( n = 138) of all nurses had a situation at work when they thought that they were infected by HIV and 100 (43%) nurses had experienced the situation once or more in the past 12 month. Approximately 40% did not know what PEP (post-exposure prophylaxis) is, and 22% did not know or were not sure if it was available in the hospital. Only few participants ( n = 68, 29%) had sought PEP and most ( n = 37, 54%) of them did not receive PEP when they needed it. There was a significant association between the knowledge and availability of PEP ( r = 0.622). Conclusion : The study recommend an urgent need for policy makers in the health sector to put in place policies, guidelines and programmes that will rapidly scale up PEP services in health care settings, so that preventable occupationally acquired HIV infection can be minimised amongst nurses. Keywords: Post-Exposure Prophylaxis; Nurses; HIV, Occupational Exposure; PLWH