Health care workers responses to HIV/AIDS care and treatment in South Africa

Introduction
With antiretroviral treatment (ART) being rapidly scaled up in low and middle-income countries, there is increasing concern about the shortage of health care workers, especially nurses, to run programmes. This has generated interest in examining how public sector health care workers should be allocated between HIV care and other health services, and how to utilise their time and skills most efficiently. The potentially massive increase in work burden for service providers could lead to poor motivation and to opposition to reforms and failure to achieve desired results. This study explored how the expansion of ART has affected service providers' motivation to work in HIV care and to perform well by: exploring work-based incentives and barriers for health care workers involved in HIV services, perceptions of “task-shifting” towards nurse-driven ART delivery, and possible effects on motivation and inter-professional dynamics.

Methods
Qualitative research methods were used to collect data. The human resource management structures for ART health care workers were mapped through 14 key informant interviews and 25 in-depth interviews were conducted with different cadres of health care workers, predominantly nurses, in the public sector who are responsible for initiating ART and follow up visits or being trained to do so. Four focus group discussions were conducted with service users living with HIV at facilities where in-depth interviews with health care workers had also taken place. The data will be analysed using a modified grounded theory approach.

Results
This paper will report on findings in relation to the impacts, including gender impacts, of ARV scale-up on work-life balance. The lessons from this study may be relevant for other settings where health workers have to cope with rapid changes to the health system and to how their work is organised.

Discussion
Discussion to follow.