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Title: Factors influencing the development and implementation of nurse-led antiretroviral treatment clinics in Uganda
Author: Ikoona, Eric
ISNI:       0000 0004 6423 3364
Awarding Body: London School of Hygiene & Tropical Medicine
Current Institution: London School of Hygiene and Tropical Medicine (University of London)
Date of Award: 2017
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A major barrier to universal access to antiretroviral treatment (ART) in Uganda is the critical shortage of trained healthcare workers, particularly doctors. Although there are plans to legalise nurses to provide ART, little is known about the potential barriers and facilitators to the development and implementation of effective nurse-led ART clinics in Uganda. Thus, this study sought to understand the factors influencing the introduction of nurse-led ART clinics in Uganda as well as to determine nurses’ and doctors’ competencies in delivering HIV care to inform the design of strategies that would enhance their success. To this end, descriptive cross-sectional studies through a questionnaire survey, semi-structured interviews, and focus group discussions (FGDs) were conducted with numerous stakeholders including patients. HIV clinical vignette tests were used to assess doctors’ and nurses’ competencies in delivering ART. The results revealed that nurse-led ART clinics were already widespread in Uganda, albeit the lack of a policy allowing them to operate. Moreover, their successful development and implementation is critically dependent on nurses’ competence, self-confidence, motivation, authority, and autonomy, as well as on the availability of systems and human resource support and on the acceptability of nurses as providers of ART by patients and other stakeholders. Major challenges identified include the lack of patients’ and cmmunity support, the absence of legal and regulatory frameworks, and a weak general health system including inadequate equipment, supervision support and mentoring, among others. In conclusion, this study found that nurse-led ART clinics are already operating on a wide scale in Uganda, although on an ad hoc basis, and are viewed by stakeholders as a key strategy for scaling up human immune deficiency virus HIV services including ART. Now may be the appropriate time to plan adequately for the legalised and regulated development and implementation of these clinics while addressing the numerous factors that influence nurses’ ability and capacity to deliver HIV services efficiently and effectively.
Supervisor: Spicer, N. Sponsor: Commonwealth Scholarship UK
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral