Search

Abstract Purpose This study aimed to examine the association between renal impairment and polypharmacy among older Palestinian patients visiting primary healthcare centers and to examine potentially inappropriate medications among older patients. Methods A cross-sectional study was conducted among PHC clinic attendees aged 65 and older. We used medical records and an interviewer-administered questionnaire for data collection. Participants with eGFR less than 60mls/min/1.73 m2 were categorized as renal impaired; we then calculated the prevalence of renal impairment and used Poisson multivariable regression model with robust variance to identify associated factors. Beer’s criteria and literature reviews were used to evaluate renal impairment patients’ medication and to determine the frequency of PIPs. Results The study included 421 participants (224 female, 197 male), and 66.3% were between the ages of 65 and 75. The prevalence of renal impairment was 30.2% (95%CI: 25.8–34.6%). Polypharmacy [aPR = 2.7, 95%CI: 1.7–4.3], stroke [aPR = 2.6, 95%CI: 1.1–2.3], females [aPR = 1.7, 95%CI: 1.2–2.5], and older patients over the age of 80 [aPR = 2.4, 95%CI: 1.6–3.5] were the main factors associated with renal impairment. RAAS (54.3%), metformin (39.3%), and sulfonylurea (20.4%) were the most frequently reported PIP in renal impairment patients. Conclusion This study demonstrates a relationship between polypharmacy and renal impairment. Some people with renal impairment receive drugs that those with kidney illness should avoid or use with caution. It is important to prescribe only necessary medication, choose non-nephrotoxic alternatives, and frequently monitor renal function.

Purpose: This study aimed to examine the association between renal impairment and polypharmacy among older Palestinian patients visiting primary healthcare centers and to examine potentially inappropriate medications among older patients. Methods: A cross-sectional study was conducted among PHC clinic attendees aged 65 and older. We used medical records and an interviewer-administered questionnaire for data collection. Participants with eGFR less than 60mls/min/1.73 m2 were categorized as renal impaired; we then calculated the prevalence of renal impairment and used Poisson multivariable regression model with robust variance to identify associated factors. Beer's criteria and literature reviews were used to evaluate renal impairment patients' medication and to determine the frequency of PIPs. Results: The study included 421 participants (224 female, 197 male), and 66.3% were between the ages of 65 and 75. The prevalence of renal impairment was 30.2% (95%CI: 25.8–34.6%). Polypharmacy [aPR = 2.7, 95%CI: 1.7–4.3], stroke [aPR = 2.6, 95%CI: 1.1–2.3], females [aPR = 1.7, 95%CI: 1.2–2.5], and older patients over the age of 80 [aPR = 2.4, 95%CI: 1.6–3.5] were the main factors associated with renal impairment. RAAS (54.3%), metformin (39.3%), and sulfonylurea (20.4%) were the most frequently reported PIP in renal impairment patients. Conclusion: This study demonstrates a relationship between polypharmacy and renal impairment. Some people with renal impairment receive drugs that those with kidney illness should avoid or use with caution. It is important to prescribe only necessary medication, choose non-nephrotoxic alternatives, and frequently monitor renal function. [ABSTRACT FROM AUTHOR]

Background: In South Africa (SA), approximately 16 000 stillbirths occur annually. Most are classified as unexplained and occur in district hospitals. Many of these deaths may be caused by undetected foetal growth restriction. Continuous wave Doppler ultrasound of the umbilical artery (CWDU-UmA) is a simple method for assessing placental function. This screening method may detect the foetus at risk of dying and growth-restricted foetuses, allowing for appropriate management. Methods: A cohort study was conducted across South Africa. Pregnant women attending primary health care clinics at 28--34 weeks gestation were screened using CWDU-UmA. Women not screened at those antenatal clinics served as control group 1. Control group 2 consisted of the subset of control group 1 with women detected with antenatal complications excluded. Women with foetuses identified with an abnormal CWDU-UmA test were referred and managed according to a standardised protocol. A comparison between the study and control groups was performed. Results: The study group consisted of 6536 pregnancies, and there were 66 stillbirths (stillbirth rate [SBR]: 10.1/1000 births). In control group 1, there were 193 stillbirths in 10 832 women (SBR: 17.8/1000 births), and in control group 2, 152 stillbirths in 9811 women (SBR: 15.5/1000 births) (risk ratio: 0.57, 95% confidence intervals: 0.29--0.85 and 0.65, 0.36--0.94, respectively). Conclusion: Screening a low-risk pregnant population identified the low-risk mother with a high-risk foetus, and acting on the information as described was associated with a significant reduction (35% -- 43%) in stillbirths. This demonstrates a step-change reduction in stillbirths and warrants screening in SA. [ABSTRACT FROM AUTHOR]

Background: In South Africa (SA), approximately 16 000 stillbirths occur annually. Most are classified as unexplained and occur in district hospitals. Many of these deaths may be caused by undetected foetal growth restriction. Continuous wave Doppler ultrasound of the umbilical artery (CWDU-UmA) is a simple method for assessing placental function. This screening method may detect the foetus at risk of dying and growth-restricted foetuses, allowing for appropriate management. Methods: A cohort study was conducted across South Africa. Pregnant women attending primary health care clinics at 28–34 weeks gestation were screened using CWDU-UmA. Women not screened at those antenatal clinics served as control group 1. Control group 2 consisted of the subset of control group 1 with women detected with antenatal complications excluded. Women with foetuses identified with an abnormal CWDU-UmA test were referred and managed according to a standardised protocol. A comparison between the study and control groups was performed. Results: The study group consisted of 6536 pregnancies, and there were 66 stillbirths (stillbirth rate [SBR]: 10.1/1000 births). In control group 1, there were 193 stillbirths in 10 832 women (SBR: 17.8/1000 births), and in control group 2, 152 stillbirths in 9811 women (SBR: 15.5/1000 births) (risk ratio: 0.57, 95% confidence intervals: 0.29–0.85 and 0.65, 0.36–0.94, respectively). Conclusion: Screening a low-risk pregnant population identified the low-risk mother with a high-risk foetus, and acting on the information as described was associated with a significant reduction (35% – 43%) in stillbirths. This demonstrates a step-change reduction in stillbirths and warrants screening in SA.

Introduction: : Tuberculosis (TB) remains the most common cause of death among people living with HIV. Integrating HIV and TB services reduces mortality but is sub‐optimally implemented. Quality improvement (QI) methods offer a low‐cost and easily implementable approach to strengthening healthcare delivery systems. This trial assessed a QI intervention on key process indicators for delivering integrated HIV‐TB care in rural South African primary healthcare (PHC) clinics. Methods: Sixteen nurse supervisors, (each with a cluster of clinics) overseeing 40 PHC clinics, were randomized 1:1 to the intervention or the standard of care (SOC) groups. The QI intervention comprised three key components: clinical and QI skills training, on‐site mentorship of nurse supervisors and clinic staff, and data quality improvement activities to enhance accuracy and completeness of routine clinic data. The SOC comprised monthly supervision and data feedback meetings. From 01 December 2016 to 31 December 2018, data were collected monthly by a team of study‐appointed data capturers from all study clinics. This study's outcomes were HIV testing services (HTS), TB screening, antiretroviral therapy (ART) initiation, isoniazid preventive therapy (IPT) initiation and viral load (VL) testing. Results: The QI group (eight clusters) comprised 244 clinic staff who attended to 13,347 patients during the trial compared to the SOC group (eight clusters) with 217 clinic staff who attended to 8141 patients. QI mentors completed 85% (510/600) of expected QI mentorship visits to QI clinics. HTS was 19% higher [94.5% vs. 79.6%; relative risk (RR)=1.19; 95% CI: 1.02–1.38; p=0.029] and IPT initiation was 66% higher (61.2 vs. 36.8; RR=1.66; 95% CI: 1.02–2.72; p=0·044), in the QI group compared to SOC group. The percentage of patients screened for TB (83.4% vs. 79.3%; RR=1.05; p=0.448), initiated on ART (91.7 vs. 95.5; RR=0.96; p=0.172) and VL testing (72.2% vs. 72.8%; RR=0.99; p=0.879) was similar in both groups. Conclusions: QI improved HIV testing and IPT initiation compared to SOC. TB screening, ART initiation and VL testing remained similar. Incorporating QI methods into routine supervision and support activities may strengthen integrated HIV‐TB service delivery and increase the success of future QI scale‐up activities. [ABSTRACT FROM AUTHOR]

Abstract Introduction : Tuberculosis (TB) remains the most common cause of death among people living with HIV. Integrating HIV and TB services reduces mortality but is sub‐optimally implemented. Quality improvement (QI) methods offer a low‐cost and easily implementable approach to strengthening healthcare delivery systems. This trial assessed a QI intervention on key process indicators for delivering integrated HIV‐TB care in rural South African primary healthcare (PHC) clinics. Methods Sixteen nurse supervisors, (each with a cluster of clinics) overseeing 40 PHC clinics, were randomized 1:1 to the intervention or the standard of care (SOC) groups. The QI intervention comprised three key components: clinical and QI skills training, on‐site mentorship of nurse supervisors and clinic staff, and data quality improvement activities to enhance accuracy and completeness of routine clinic data. The SOC comprised monthly supervision and data feedback meetings. From 01 December 2016 to 31 December 2018, data were collected monthly by a team of study‐appointed data capturers from all study clinics. This study's outcomes were HIV testing services (HTS), TB screening, antiretroviral therapy (ART) initiation, isoniazid preventive therapy (IPT) initiation and viral load (VL) testing. Results The QI group (eight clusters) comprised 244 clinic staff who attended to 13,347 patients during the trial compared to the SOC group (eight clusters) with 217 clinic staff who attended to 8141 patients. QI mentors completed 85% (510/600) of expected QI mentorship visits to QI clinics. HTS was 19% higher [94.5% vs. 79.6%; relative risk (RR)=1.19; 95% CI: 1.02–1.38; p=0.029] and IPT initiation was 66% higher (61.2 vs. 36.8; RR=1.66; 95% CI: 1.02–2.72; p=0·044), in the QI group compared to SOC group. The percentage of patients screened for TB (83.4% vs. 79.3%; RR=1.05; p=0.448), initiated on ART (91.7 vs. 95.5; RR=0.96; p=0.172) and VL testing (72.2% vs. 72.8%; RR=0.99; p=0.879) was similar in both groups. Conclusions QI improved HIV testing and IPT initiation compared to SOC. TB screening, ART initiation and VL testing remained similar. Incorporating QI methods into routine supervision and support activities may strengthen integrated HIV‐TB service delivery and increase the success of future QI scale‐up activities.

Background: The South African Minister of Health stated that compliance with quality standards in health services is non-negotiable as it is fundamental in improving South Africa’s current poor health outcomes, restoring patient and staff confidence in the public healthcare system, achieving widespread sustainable development and providing basic quality healthcare in South Africa. Non-compliance with quality standards, as evidenced by increased quality-related queries from the community, prompted the researcher to explore and describe the reasons for such at primary healthcare clinics in Ekurhuleni. Aim: This study sought to explore and describe the reasons for non-compliance with quality standards at the primary healthcare in Ekurhuleni in order to propose recommendations to facilitate compliance with quality standards. Setting: The study was conducted at primary healthcare clinics in Ekurhuleni, one of the metropolitan districts, situated in an area east of the Gauteng province. Methods: A qualitative, exploratory, descriptive and contextual research design was used for this study. Participants were purposefully selected from the population and consisted of individuals who willingly consented to participate. Twelve semi-structured individual interviews were conducted. Results: The study findings revealed challenges with management practices, for example, non-involvement in decision-making, lack of support and poor internal communication practices. In addition, challenges with human, material and financial resources were stated as reasons for non-compliance with quality standards. Conclusion: Recommendations to facilitate compliance with quality standards were described, which included implementation of effective management practices and allocation of adequate healthcare resources required to facilitate such compliance.

Background: Hypertension is a global health burden affecting developed and developing countries, and South Africa is no exception. Aim: This article aims to highlight the language and content used in health education on hypertension in primary healthcare (PHC) by health promoters and in pamphlets. Methods: The study design was quantitative descriptive. The population comprised a purposive selected sample of 12 health promoters in 12 PHC clinics and 50 pamphlets relating to health education on hypertension. An audio recorder was used to record health education provided by health promoters. Quantitative content analysis and frequency distribution was used to analyse the data. Results: The health promoters used various South African languages mixed with English (code switching). Patients were taught about lifestyle modifications and encouraged to adhere to management therapy. The switching in language usage may affect the understanding of those who do not speak the local language and that may explain the reason for lack of hypertension-suited life modification required by health education. Conclusion: It is important that heath education on hypertension should be standardised so that the content of health education in clinic A is similar to that in clinic B. Information contained in pamphlets should be summarised and standardised to the content presented by health promoters.

Abstract Background The World Health Organization (WHO) called for new clinical diagnostic for settings with limited access to laboratory services. Access to diagnostic testing may not be uniform in rural settings, which may result in poor access to essential healthcare services. The aim of this study is to determine the availability, current usage, and need for point-of-care (POC) diagnostic tests among rural primary healthcare (PHC) clinics in South Africa’s KwaZulu-Natal (KZN) province. Methods We used the KZN’s Department of Health (DoH) clinic classification to identify the 232 rural PHC clinics in KZN, South Africa. We then randomly sampled 100 of 232 rural PHC clinics. Selected health clinics were surveyed between April to August 2015 to obtain clinic-level data for health-worker volume and to determine the accessibility, availability, usage and need for POC tests. Professional healthcare workers responsible for POC testing at each clinic were interviewed to assess the awareness of POC testing. Data were survey weighted and analysed using Stata 13. Results Among 100 rural clinics, the average number of patients seen per week was 2865 ± 2231 (range 374–11,731). The average number of POC tests available and in use was 6.3 (CI: 6.2–6.5) out of a potential of 51 tests. The following POC tests were universally available in all rural clinics: urine total protein, urine leukocytes, urine nitrate, urine pregnancy, HIV antibody and blood glucose test. The average number of desired POC diagnostic tests reported by the clinical staff was estimated at 15 (CI: 13–17) per clinic. The most requested POC tests reported were serum creatinine (37%), CD4 count (37%), cholesterol (32%), tuberculosis (31%), and HIV viral load (23%). Conclusion Several POC tests are widely available and in use at rural PHC clinics in South Africa’s KZN province. However, healthcare workers have requested additional POC tests to improve detection and management of priority disease conditions. Trial registration Clinical Trials.gov Identifier: NCT02692274

Background: The South African Minister of Health stated that compliance with quality standards in health services is non-negotiable as it is fundamental in improving South Africa's current poor health outcomes, restoring patient and staff confidence in the public healthcare system, achieving widespread sustainable development and providing basic quality healthcare in South Africa. Non-compliance with quality standards, as evidenced by increased quality-related queries from the community, prompted the researcher to explore and describe the reasons for such at primary healthcare clinics in Ekurhuleni. Aim: This study sought to explore and describe the reasons for non-compliance with quality standards at the primary healthcare in Ekurhuleni in order to propose recommendations to facilitate compliance with quality standards. Setting: The study was conducted at primary healthcare clinics in Ekurhuleni, one of the metropolitan districts, situated in an area east of the Gauteng province. Methods: A qualitative, exploratory, descriptive and contextual research design was used for this study. Participants were purposefully selected from the population and consisted of individuals who willingly consented to participate. Twelve semi-structured individual interviews were conducted. Results: The study findings revealed challenges with management practices, for example, non-involvement in decision-making, lack of support and poor internal communication practices. In addition, challenges with human, material and financial resources were stated as reasons for non-compliance with quality standards. Conclusion: Recommendations to facilitate compliance with quality standards were described, which included implementation of effective management practices and allocation of adequate healthcare resources required to facilitate such compliance. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a global health burden affecting developed and developing countries, and South Africa is no exception. Aim: This article aims to highlight the language and content used in health education on hypertension in primary healthcare (PHC) by health promoters and in pamphlets. Methods: The study design was quantitative descriptive. The population comprised a purposive selected sample of 12 health promoters in 12 PHC clinics and 50 pamphlets relating to health education on hypertension. An audio recorder was used to record health education provided by health promoters. Quantitative content analysis and frequency distribution was used to analyse the data. Results: The health promoters used various South African languages mixed with English (code switching). Patients were taught about lifestyle modifications and encouraged to adhere to management therapy. The switching in language usage may affect the understanding of those who do not speak the local language and that may explain the reason for lack of hypertension-suited life modification required by health education. Conclusion: It is important that heath education on hypertension should be standardised so that the content of health education in clinic A is similar to that in clinic B. Information contained in pamphlets should be summarised and standardised to the content presented by health promoters. [ABSTRACT FROM AUTHOR]

Background: The high burden of disease in South Africa presents challenges to public health services. Point-of-care (POC) technologies have the potential to address these gaps and improve healthcare systems. This study ascertained the acceptability and impact of POC CD4 testing on patients’ health and clinical management. Methods: We conducted a qualitative survey study with patients (n = 642) and healthcare providers (n = 13) at the Lancers Road (experienced POC) and Chesterville (non-experienced POC) primary healthcare (PHC) clinics from September 2015 to June 2016. Results: Patients (99%) at Lancers and Chesterville PHCs were positive about POC CD4 testing, identifying benefits: No loss/delay of test results (6.4%), cost/time saving (19.5%), and no anxiety (5.1%), and 58.2% were ready to initiate treatment. Significantly more patients at Chesterville than Lancers Road PHC felt POC would provide rapid clinical decision making (64.7% vs. 48.1%; p < 0.0001) and better clinic accessibility (40.4% vs. 24.7%; p < 0.0001) respectively. Healthcare providers thought same-day CD4 results would impact: Clinical management (46.2%), patient readiness (46.2%), and adherence (23.0%), and would reduce follow-up visits (7.7%), while 38.5% were concerned that further tests and training (15.4%) were required before antiretroviral therapy (ART) initiation. Conclusion: The high acceptability of POC CD4 testing and the immediate health, structural, and clinical management benefits necessitates POC implementation studies.

Background: The human immunodeficiency virus and/or acquired immune deficiency syndrome (HIV/AIDS) pandemic continues to increase in prevalence worldwide, particularly in South Africa, and includes the often overlooked paediatric population. The provision of paediatric antiretroviral treatment (ART) is as essential for children as for adults, and has numerous obstacles, not least of which is lack of decentralisation of facilities to provide essential treatment. Optimising ART, care and support for HIV-positive children, and their caregivers, at public sector primary health care (PHC) clinics is crucial to improve morbidity and mortality rates in children. Aim: To explore the experiences of health care professionals regarding the provision of ART for children at PHC clinics. Setting: The study was conducted in six PHC clinics in Nelson Mandela Bay Health District, Eastern Cape, South Africa. Methodology: The researchers used a qualitative, explorative, descriptive and contextual research design with in-depth interviews. We used non-probability purposive sampling. Data collected were thematically analysed using Creswell’s data analysis spiral. We used Lincoln and Guba’s model to ensure trustworthiness. Ethical standards were applied. Results: Health care professionals experienced numerous challenges, such as lack of resources, need for training, mentoring and debriefing, all related to providing decentralised ART for HIV-positive children at the PHC level. Conclusion: Capacitation of the health care system, integration of services, competent management and visionary leadership to invoke a collaborative interdisciplinary team approach is required to ensure that HIV is treated as a chronic disease at the PHC clinic level.

Background Private general practitioners ( GPs) in Malaysia mainly operate solo practices with little interdisciplinary collaboration or co-ordination with other healthcare providers which potentially fragments and limits patient care. Pharmacists as medication experts can contribute to the private primary care sector using their influence to ensure quality use of medicines. Aim To explore the views of private GPs in Malaysia on integration of pharmacists into private primary healthcare clinics. Method A combination of purposive and snowballing sampling was used to recruit private sector GPs to participate in focus groups and semi-structured interviews in Malaysia. Sessions were audio recorded, transcribed verbatim and thematically analysed using NVivo 10. Results Thirteen private GPs participated in one focus group and ten semi-structured interviews. Four major themes were identified: (i) poor understanding of pharmacists' roles; (ii) readiness to accept pharmacists in private primary healthcare clinics; (iii) lack of confidence and trust in pharmacists; and (iv) perceived increased costs with pharmacist integration. Results indicated participants' views and acceptance were largely influenced by the amount of exposure and experience they had working alongside pharmacists. Participants viewed a lack of confidence in pharmacists and increase in costs associated with an employed pharmacist within private primary healthcare clinics as barriers to integration. Conclusion Private GPs expressed reservations toward this new model due to the lack of understanding of pharmacists' roles and responsibilities. There is a need for awareness among private GPs on pharmacists' roles to improve their acceptance of the integration of pharmacists into private primary healthcare clinics in Malaysia. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of the study were to assess the perceptions of nursing staff on the Road to Health Booklet (RTHB), to assess their knowledge of the RTHB growth charts, and to determine whether the level of knowledge was acceptable for successful utilisation of the RTHB growth charts. Design: A cross-sectional descriptive survey. Setting: Twelve primary healthcare clinics in the Tygerberg subdistrict. Subjects: Nursing staff who were going to work with the RTHB on a daily basis. Outcomes measures: The knowledge and perceptions of the nursing staff on the new RTHB were measured using a self-administered questionnaire. Results: The study highlighted that the majority of the nursing staff did not possess sufficient knowledge to successfully utilise the RTHB. The mean score percentage for the total 12 knowledge questions was 55%. Less than a third (n = 13) of participants could correctly interpret the cut-off value for mid-upper-arm circumference. Only 38% and 52% correctly knew that -2 standard deviation for weight-for-age and weight-for-length represents underweight and wasting, respectively. Fifty-five per cent could correctly interpret the growth faltering graph. Forty-three per cent of participants felt the change to the RTHB was unnecessary, and 55% thought that mothers or caregivers would not easily understand the RTHB. More than half (n = 22) of the participants said that they had adequate knowledge to work with the RTHB, while the rest reported that they did not. Conclusion: The RTHB has the potential to decrease the prevalence of malnutrition in children. However, to achieve this, effective usage and understanding of the RTHB is critical. [ABSTRACT FROM AUTHOR]

Purpose: To gain insight into the experiences and handling of adverse drug reactions (ADRs) by the staffs of public primary healthcare (PHC) clinics in Eastern Cape Province, South Africa, as well as their perceptions of related adherence challenges in the treatment and follow-up of human immunodeficiency virus (HIV)-positive patients. Methods: Healthcare providers working at the PHC level in the public sector in the study area were approached and asked to participate in focus group discussions (FGDs). Seven FGDs were conducted with 32 healthcare providers (9 nurses, 23 auxiliary staff). Questions introduced by the moderator of each FGD were freely discussed by the participants. Discussions were audio-recorded and subjected to thematic content analysis. Results: Several challenges in the treatment and follow-up of patients on ART were identified. These include: (1) lack of training of healthcare providers in PHC clinics to confidently identify, manage and treat the ADRs HIV-positive patients receiving ART; (2) patients' difficulty in communicating information on ADRS; (3) insufficient pharmacovigilance; (4) role of poverty. Conclusion: Both nurses and auxiliary staff expressed lack of knowledge and confidence regarding ADRs in HIV patients and management of this. More emphasis is warranted on training the healthcare providers to identify ADRs and provide adequate advice for continued treatment of patients experiencing potential drug related problems. [ABSTRACT FROM AUTHOR]

Background: The high burden of disease in South Africa presents challenges to public health services. Point-of-care (POC) technologies have the potential to address these gaps and improve healthcare systems. This study ascertained the acceptability and impact of POC CD4 testing on patients' health and clinical management. Methods: We conducted a qualitative survey study with patients (n = 642) and healthcare providers (n = 13) at the Lancers Road (experienced POC) and Chesterville (non-experienced POC) primary healthcare (PHC) clinics from September 2015 to June 2016. Results: Patients (99%) at Lancers and Chesterville PHCs were positive about POC CD4 testing, identifying benefits: No loss/delay of test results (6.4%), cost/time saving (19.5%), and no anxiety (5.1%), and 58.2% were ready to initiate treatment. Significantly more patients at Chesterville than Lancers Road PHC felt POC would provide rapid clinical decision making (64.7% vs. 48.1%; p < 0.0001) and better clinic accessibility (40.4% vs. 24.7%; p < 0.0001) respectively. Healthcare providers thought same-day CD4 results would impact: Clinical management (46.2%), patient readiness (46.2%), and adherence (23.0%), and would reduce follow-up visits (7.7%), while 38.5% were concerned that further tests and training (15.4%) were required before antiretroviral therapy (ART) initiation. Conclusion: The high acceptability of POC CD4 testing and the immediate health, structural, and clinical management benefits necessitates POC implementation studies. [ABSTRACT FROM AUTHOR]

Background:  The human immunodeficiency virus and/or acquired immune deficiency syndrome (HIV/AIDS) pandemic continues to increase in prevalence worldwide, particularly in South Africa, and includes the often overlooked paediatric population. The provision of paediatric antiretroviral treatment (ART) is as essential for children as for adults, and has numerous obstacles, not least of which is lack of decentralisation of facilities to provide essential treatment. Optimising ART, care and support for HIV-positive children, and their caregivers, at public sector primary health care (PHC) clinics is crucial to improve morbidity and mortality rates in children., Aim:  To explore the experiences of health care professionals regarding the provision of ART for children at PHC clinics., Setting:  The study was conducted in six PHC clinics in Nelson Mandela Bay Health District, Eastern Cape, South Africa., Methodology:  The researchers used a qualitative, explorative, descriptive and contextual research design with in-depth interviews. We used non-probability purposive sampling. Data collected were thematically analysed using Creswell's data analysis spiral. We used Lincoln and Guba's model to ensure trustworthiness. Ethical standards were applied., Results:  Health care professionals experienced numerous challenges, such as lack of resources, need for training, mentoring and debriefing, all related to providing decentralised ART for HIV-positive children at the PHC level., Conclusion:  Capacitation of the health care system, integration of services, competent management and visionary leadership to invoke a collaborative interdisciplinary team approach is required to ensure that HIV is treated as a chronic disease at the PHC clinic level.