Exploring barriers to switching "on time" to second-line antiretroviral therapy among nurses in primary health care facilities, Ekurhuleni Health District, South Africa
Ensuring that all HIV-infected people receive antiretroviral therapy (ART) and achieve viral suppression are key South African strategies to end the AIDS epidemic in the country. National HIV treatment guidelines recommend an immediate switch to second-line ART following virological failure with fir...
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| Veröffentlicht in: | PloS one 2023-04, Vol.18 (4), p.e0284996-e0284996 |
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| creator | Tenza, Immaculate Sabelile Njuguna, Christine Sodo, Pumla Pamella Ruch, Aviva Francis, Joel Msafiri Omole, Olufemi Babatunde Cooke, Richard Agbo, Samuel Baldwin-Ragaven, Laurel |
| description | Ensuring that all HIV-infected people receive antiretroviral therapy (ART) and achieve viral suppression are key South African strategies to end the AIDS epidemic in the country. National HIV treatment guidelines recommend an immediate switch to second-line ART following virological failure with first-line ART. Nurses based in district health facilities are at the forefront of implementing this recommendation. While there are often delays in switching and in some instances no switch, the reasons for and barriers to delayed switching are not well understood at the primary care level.
To explore the views of frontline nursing staff about factors contributing to delayed switching of patients who have failed first-line ART regimen in Ekurhuleni district, South Africa.
A qualitative study was conducted among 21 purposively sampled nurses who provide HIV treatment and care to patients in 12 primary health care (PHC) facilities in Ekurhuleni Health District, Gauteng Province, South Africa. Individual in-depth interviews explored nurses' experiences regarding their recognition of virological failure and understanding of "on time" switching to second-line ART. Interviews probed the circumstances contributing to delays in switching. After digital audio recording and transcription, manual inductive thematic analysis was used to analyse the data.
Multiple barriers were identified: 1) Healthcare provider factors included a lack of knowledge and confidence coupled with demotivation in the workplace; 2) Patient issues similarly comprised a lack of knowledge as well as resistance to being switched to another drug regimen and loss to follow up; 3) Systems factors were poor facility leadership, shortages of medication, staffing constraints, and the inability to trace laboratory results, especially for migrant patients.
Reasons for delayed switching of patients to second-line ART are multifactorial and require integrated interventions at health provider, patient and health system levels. |
| doi_str_mv | 10.1371/journal.pone.0284996 |
| format | Article |
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To explore the views of frontline nursing staff about factors contributing to delayed switching of patients who have failed first-line ART regimen in Ekurhuleni district, South Africa.
A qualitative study was conducted among 21 purposively sampled nurses who provide HIV treatment and care to patients in 12 primary health care (PHC) facilities in Ekurhuleni Health District, Gauteng Province, South Africa. Individual in-depth interviews explored nurses' experiences regarding their recognition of virological failure and understanding of "on time" switching to second-line ART. Interviews probed the circumstances contributing to delays in switching. After digital audio recording and transcription, manual inductive thematic analysis was used to analyse the data.
Multiple barriers were identified: 1) Healthcare provider factors included a lack of knowledge and confidence coupled with demotivation in the workplace; 2) Patient issues similarly comprised a lack of knowledge as well as resistance to being switched to another drug regimen and loss to follow up; 3) Systems factors were poor facility leadership, shortages of medication, staffing constraints, and the inability to trace laboratory results, especially for migrant patients.
Reasons for delayed switching of patients to second-line ART are multifactorial and require integrated interventions at health provider, patient and health system levels.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0284996</identifier><identifier>PMID: 37099552</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>AIDS treatment ; Analysis ; Anti-HIV Agents - therapeutic use ; Anti-Retroviral Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Beliefs, opinions and attitudes ; Biology and Life Sciences ; Care and treatment ; Complications and side effects ; Data collection ; Drug therapy ; Efavirenz ; Employees ; Emtricitabine ; Epidemics ; Evaluation ; Health care ; Health care facilities ; Health care industry ; Health services ; Highly active antiretroviral therapy ; HIV ; HIV (Viruses) ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; Human immunodeficiency virus ; Humans ; Interviews ; Laboratories ; Medical care ; Medical diagnosis ; Medicine and Health Sciences ; Nurses ; Patient outcomes ; Patients ; People and Places ; Primary care ; Primary Health Care ; Primary nursing ; Public health ; Qualitative research ; Quality management ; South Africa ; South Africa - epidemiology ; Sub-Saharan Africa ; Switching ; Viral Load</subject><ispartof>PloS one, 2023-04, Vol.18 (4), p.e0284996-e0284996</ispartof><rights>Copyright: © 2023 Tenza et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Tenza et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Tenza et al 2023 Tenza et al</rights><rights>2023 Tenza et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c642t-82b211019d1de8ce437d490fcc6a8946b7753973804ff7f3918a2d1a44d7ac083</cites><orcidid>0000-0003-0286-9183 ; 0000-0002-6744-3768 ; 0000-0002-2542-6038</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10132530/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10132530/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37099552$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tenza, Immaculate Sabelile</creatorcontrib><creatorcontrib>Njuguna, Christine</creatorcontrib><creatorcontrib>Sodo, Pumla Pamella</creatorcontrib><creatorcontrib>Ruch, Aviva</creatorcontrib><creatorcontrib>Francis, Joel Msafiri</creatorcontrib><creatorcontrib>Omole, Olufemi Babatunde</creatorcontrib><creatorcontrib>Cooke, Richard</creatorcontrib><creatorcontrib>Agbo, Samuel</creatorcontrib><creatorcontrib>Baldwin-Ragaven, Laurel</creatorcontrib><title>Exploring barriers to switching "on time" to second-line antiretroviral therapy among nurses in primary health care facilities, Ekurhuleni Health District, South Africa</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Ensuring that all HIV-infected people receive antiretroviral therapy (ART) and achieve viral suppression are key South African strategies to end the AIDS epidemic in the country. National HIV treatment guidelines recommend an immediate switch to second-line ART following virological failure with first-line ART. Nurses based in district health facilities are at the forefront of implementing this recommendation. While there are often delays in switching and in some instances no switch, the reasons for and barriers to delayed switching are not well understood at the primary care level.
To explore the views of frontline nursing staff about factors contributing to delayed switching of patients who have failed first-line ART regimen in Ekurhuleni district, South Africa.
A qualitative study was conducted among 21 purposively sampled nurses who provide HIV treatment and care to patients in 12 primary health care (PHC) facilities in Ekurhuleni Health District, Gauteng Province, South Africa. Individual in-depth interviews explored nurses' experiences regarding their recognition of virological failure and understanding of "on time" switching to second-line ART. Interviews probed the circumstances contributing to delays in switching. After digital audio recording and transcription, manual inductive thematic analysis was used to analyse the data.
Multiple barriers were identified: 1) Healthcare provider factors included a lack of knowledge and confidence coupled with demotivation in the workplace; 2) Patient issues similarly comprised a lack of knowledge as well as resistance to being switched to another drug regimen and loss to follow up; 3) Systems factors were poor facility leadership, shortages of medication, staffing constraints, and the inability to trace laboratory results, especially for migrant patients.
Reasons for delayed switching of patients to second-line ART are multifactorial and require integrated interventions at health provider, patient and health system levels.</description><subject>AIDS treatment</subject><subject>Analysis</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Anti-Retroviral Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Beliefs, opinions and attitudes</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Complications and side effects</subject><subject>Data collection</subject><subject>Drug therapy</subject><subject>Efavirenz</subject><subject>Employees</subject><subject>Emtricitabine</subject><subject>Epidemics</subject><subject>Evaluation</subject><subject>Health care</subject><subject>Health care facilities</subject><subject>Health care industry</subject><subject>Health services</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV (Viruses)</subject><subject>HIV Infections - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tenza, Immaculate Sabelile</au><au>Njuguna, Christine</au><au>Sodo, Pumla Pamella</au><au>Ruch, Aviva</au><au>Francis, Joel Msafiri</au><au>Omole, Olufemi Babatunde</au><au>Cooke, Richard</au><au>Agbo, Samuel</au><au>Baldwin-Ragaven, Laurel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Exploring barriers to switching "on time" to second-line antiretroviral therapy among nurses in primary health care facilities, Ekurhuleni Health District, South Africa</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2023-04-26</date><risdate>2023</risdate><volume>18</volume><issue>4</issue><spage>e0284996</spage><epage>e0284996</epage><pages>e0284996-e0284996</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Ensuring that all HIV-infected people receive antiretroviral therapy (ART) and achieve viral suppression are key South African strategies to end the AIDS epidemic in the country. National HIV treatment guidelines recommend an immediate switch to second-line ART following virological failure with first-line ART. Nurses based in district health facilities are at the forefront of implementing this recommendation. While there are often delays in switching and in some instances no switch, the reasons for and barriers to delayed switching are not well understood at the primary care level.
To explore the views of frontline nursing staff about factors contributing to delayed switching of patients who have failed first-line ART regimen in Ekurhuleni district, South Africa.
A qualitative study was conducted among 21 purposively sampled nurses who provide HIV treatment and care to patients in 12 primary health care (PHC) facilities in Ekurhuleni Health District, Gauteng Province, South Africa. Individual in-depth interviews explored nurses' experiences regarding their recognition of virological failure and understanding of "on time" switching to second-line ART. Interviews probed the circumstances contributing to delays in switching. After digital audio recording and transcription, manual inductive thematic analysis was used to analyse the data.
Multiple barriers were identified: 1) Healthcare provider factors included a lack of knowledge and confidence coupled with demotivation in the workplace; 2) Patient issues similarly comprised a lack of knowledge as well as resistance to being switched to another drug regimen and loss to follow up; 3) Systems factors were poor facility leadership, shortages of medication, staffing constraints, and the inability to trace laboratory results, especially for migrant patients.
Reasons for delayed switching of patients to second-line ART are multifactorial and require integrated interventions at health provider, patient and health system levels.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>37099552</pmid><doi>10.1371/journal.pone.0284996</doi><tpages>e0284996</tpages><orcidid>https://orcid.org/0000-0003-0286-9183</orcidid><orcidid>https://orcid.org/0000-0002-6744-3768</orcidid><orcidid>https://orcid.org/0000-0002-2542-6038</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2023-04, Vol.18 (4), p.e0284996-e0284996 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2806442015 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | AIDS treatment Analysis Anti-HIV Agents - therapeutic use Anti-Retroviral Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Beliefs, opinions and attitudes Biology and Life Sciences Care and treatment Complications and side effects Data collection Drug therapy Efavirenz Employees Emtricitabine Epidemics Evaluation Health care Health care facilities Health care industry Health services Highly active antiretroviral therapy HIV HIV (Viruses) HIV Infections - drug therapy HIV Infections - epidemiology Human immunodeficiency virus Humans Interviews Laboratories Medical care Medical diagnosis Medicine and Health Sciences Nurses Patient outcomes Patients People and Places Primary care Primary Health Care Primary nursing Public health Qualitative research Quality management South Africa South Africa - epidemiology Sub-Saharan Africa Switching Viral Load |
| title | Exploring barriers to switching "on time" to second-line antiretroviral therapy among nurses in primary health care facilities, Ekurhuleni Health District, South Africa |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-05T20%3A34%3A30IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Exploring%20barriers%20to%20switching%20%22on%20time%22%20to%20second-line%20antiretroviral%20therapy%20among%20nurses%20in%20primary%20health%20care%20facilities,%20Ekurhuleni%20Health%20District,%20South%20Africa&rft.jtitle=PloS%20one&rft.au=Tenza,%20Immaculate%20Sabelile&rft.date=2023-04-26&rft.volume=18&rft.issue=4&rft.spage=e0284996&rft.epage=e0284996&rft.pages=e0284996-e0284996&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0284996&rft_dat=%3Cgale_plos_%3EA747087103%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2806442015&rft_id=info:pmid/37099552&rft_galeid=A747087103&rft_doaj_id=oai_doaj_org_article_5e2041e429d94beeb2d53d8823187e44&rfr_iscdi=true |