A survey of nurse-initiated and -managed antiretroviral therapy (NIMART) in practice, education, policy, and regulation in east, central, and southern Africa

J Assoc Nurses AIDS Care. 2014 Nov-Dec;25(6):520-31. doi: 10.1016/j.jana.2014.02.003. Epub 2014 Apr 13.


In sub-Saharan Africa, nurses and midwives perform many HIV service delivery tasks, such as diagnosis of HIV and prescription of antiretroviral therapy (ART), which used to be the responsibility of physicians. While this task shifting is critical to scaling-up HIV services in Africa, the extent of HIV task shifting is not well understood. A survey of senior nursing leadership teams from 15 African countries was carried out to describe the extent of nurse-initiated and -managed antiretroviral therapy (NIMART) in practice, education, policy, and regulation. The survey took place at the African Health Professions Regulatory Collaborative meeting in Pretoria, South Africa, in June 2012. The findings indicated that NIMART is widely practiced and authorized in policy, but is not reinforced by regulation nor incorporated into preservice education. Further investment in policy, regulation, and pre-service education is needed to ensure sustainable, high quality ART service expansion through the region.

Keywords: Africa; midwifery; nurse initiated and managed of antiretroviral therapy (NIMART); nursing; task shifting.

MeSH terms

  • Africa, Central
  • Africa, Eastern
  • Africa, Southern
  • Anti-HIV Agents / administration & dosage*
  • Cross-Sectional Studies
  • HIV Infections / drug therapy*
  • HIV Infections / nursing*
  • Health Plan Implementation*
  • Health Surveys
  • Humans
  • Medication Therapy Management
  • Nurse's Role*
  • Nursing Staff / education
  • Practice Patterns, Nurses'*
  • Primary Health Care
  • Process Assessment, Health Care*


  • Anti-HIV Agents