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Coe M, Kawakyu N, Gimbel S, Nyakuya B, Gabriel N, Leonard D, Chale S, Masiye F, Banda CM, Manangwa S, Moyo G, Boyle G, Freistadt F, Kohler P. Nursing Workforce Optimization Study: A Multi-method Evaluation and Process Improvement Intervention for HIV Service Delivery in Tanzania and Zambia. J Assoc Nurses AIDS Care 2023; 34:146-157. [PMID: 36752744 PMCID: PMC10237310 DOI: 10.1097/jnc.0000000000000388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT Nurses are often suboptimally used in HIV care, due to misalignment of training and practice, workflow inefficiencies, and management challenges. We sought to understand nursing workforce capacity and support implementation of process improvement strategies to improve efficiency of HIV service delivery in Tanzania and Zambia. We conducted time and motion observations and task analyses at 16 facilities followed by process improvement workshops. On average, each nurse cared for 45 clients per day in Tanzania and 29 in Zambia. Administrative tasks and documentation occupied large proportions of nurse time. Self-reported competency was low at baseline and higher at follow-up for identifying and managing treatment failure and prescribing antiretroviral therapy. After workshops, facilities changed care processes, provided additional training and mentorship, and changed staffing and supervision. Efficiency outcomes were stable despite staffing increases. Collaborative approaches to use workforce data to engage providers in improvement strategies can support roll-out of nurse-managed HIV treatment.
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Affiliation(s)
- Megan Coe
- Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Nami Kawakyu
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Sarah Gimbel
- Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Baraka Nyakuya
- International Training and Education Center for Health (I-TECH), Dar es Salaam, Tanzania
| | - Neema Gabriel
- International Training and Education Center for Health (I-TECH), Dar es Salaam, Tanzania
| | - Devotha Leonard
- Training Program Training Coordinator, International Training and Education Center for Health (I-TECH), Dar es Salaam, Tanzania
| | - Stella Chale
- International Training and Education Center for Health (I-TECH), Dar es Salaam, Tanzania
| | - Felix Masiye
- Dean of the School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia and an Affiliate Assistant Professor at the Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, USA
| | - Charles Masili Banda
- Department of Economics, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Saturini Manangwa
- Nursing and Midwifery Quality Improvement, Ministry of Health Community Development, Gender, Elderly and Children (MOHCDGEC) Dodoma, Tanzania
| | - Gustav Moyo
- Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) Dodoma, Tanzania
| | - Gabriela Boyle
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Fernanda Freistadt
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Pamela Kohler
- Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
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