Analysing implementation of the integrated tuberculosis, HIV and AIDS policy in a rural sub-district, Western Cape
Globally, tuberculosis (TB) and AIDS are the leading causes of morbidity and mortality of people, particularly in many developing countries. South Africa is among those countries with a high double burden of TB and HIV infections in the world. Although policy guidelines have been developed to mitigate the problems of TB and HIV coinfection, there are still challenges with their implementation. The aim of this study was to analyse the implementation of the integrated TB and HIV policy in a rural sub-district of the Western Cape. The study applied a descriptive survey method to collect data from 60 respondents selected using an all-inclusive sampling strategy. A self-reporting questionnaire was used, and data were analysed using the Statistical Package for Social Sciences (SPSS) program version 23. Descriptive statistics are presented with graphs and percentages. All ethical principles were adhered to. The results showed that 86% of the respondents were female nurses, 59% were registered nurses, and the rest were enrolled and assistant nurses. The general view of participants was that implementation of the integrated TB and HIV policy was poor, as only 25% (11) felt that they have sufficient knowledge and skills to implement it, while 50% (22) did not feel equipped to implement the integrated policy. These perceptions of inadequacy were justified by a lack of sufficient training, with only 32% of the respondents having attended training on integrated TB and HIV management. The nurses’ responses on actual practices ranged from poor to sufficient, and example being the management of HIV-positive TB patients with CD4 count of <100/μl, where 27.9% were unsure when to initiate antiretroviral therapy and 44.7% were unsure when isoniazid prophylaxis could not be given to HIVpositive patients. However, the findings indicated that TB and HIV policy guidelines were 86% and 85.7% accessible respectively. The study concluded that nurses do not implement the integrated TB and HIV policy guidelines sufficiently, mainly due to lack of adequate training which resulted in limited knowledge thus poor practice. It is recommended that a continuous staff capacity development programme, which includes suitable pre-service and in-service training in TB and HIV/AIDS management be developed and implemented as it has the potential to address the current knowledge and skills gaps which impact on implementation of the integrated TB and HIV policy.