Summary

This handbook intends to provide guidance on provision of Nurse-initiated Management of Antiretroviral Treatment (NIMART) services in Tanzania.

NIMART, a nurse centered task sharing ART delivery approach has been implemented in some African countries such as Rwanda, Zambia, Lesotho and South Africa with a number of studies indicating that it is effective in improving access to treatment and care for PLHIV. Experience from these countries has shown that a nurse-centered task sharing approach has led to increased number of clients enrolled in HIV services and number of clients (adults and children) started on ART. With regards to patient outcomes, studies showed that in settings where nurses provide the majority of the care, there were good treatment adherence rates and favorable clinical outcomes. Furthermore, there were no differences in mortality, viral failure or immune recovery between the doctors versus nurses-initiated ART services.

It is expected that NIMART, which enables professional nurses to initiate HIV positive persons on ART and manage their care at primary health care clinics, will improve access to care without significant increases in human resources. The effect of task sharing has been evaluated in various African countries, including South Africa, Ethiopia, Kenya, Malawi, Lesotho, Botswana, Swaziland, Nigeria, Cameroon, Zambia, Uganda, Mozambique and Rwanda, and found that the strategy can offer high-quality, cost- effective care to more clients than a physician-centered model. The strategy also has shown to be acceptable to patients.

This handbook clearly outlines tasks and responsibilities in NIMART to meet the demand for initiating and managing more patients on antiretroviral therapy. It is my hope that NIMART will propel Tanzania in realizing the UNAIDS set ‘90-90-90 targets’; aiming to diagnose 90% of all HIV positive people, provide antiretroviral therapy (ART) for 90% of those diagnosed and achieve viral suppression for 90% of those treated, by 2020....