TABLE 1.

Comparison of Standard Practice for PHC-Based HIV Services, Pre-Intervention, and Post-Intervention Hospital HIV Services, Johannesburg, South Africa

	PHC Facilities	Before Intervention: Hospitals	After Intervention: Hospitals
HTS	Lay counselors provide HTS Nurse clinicians offer PICT to all HIV negative/unknown status PHC clients Point-of-care rapid antibody tests with immediate results communicated to client HIV tests and results recorded in national HIV testing register	Doctor-driven PICT inconsistent, particularly in nonmedical wards, may order lab-based ELISA Lay counselors conduct rapid HIV testing only on doctor referral Results often unavailable before discharge ELISA results not captured in register	Lay counselor-driven Daily counselor ward rounds for new admissions Bedside rapid point-of-care antibody HIV tests Immediate communication of results to patient and NIMART nurse HIV test and result recorded in national HIV testing register
ART initiation	Lay counselors refer all clients to facility NIMART for same day initiation if eligible Standard clinical stationery used and captured daily onto database (i.e., TIER.Net)	ART initiation dependent on available ELISA result pre-discharge & sufficiently trained/confident doctor No NIMART nurses in hospitals Often deferred for initiation at PHC facility Initiation data often not captured on TIER.Net	Provincial permission for NIMART nurses’ appointment Counselors refer clients for bedside same day ART assessment/ initiation NIMART nurses work with ward doctors Standard clinical stationery used and initiations captured weekly on TIER.Net
Linkage to ART continuation or deferred ART initiation	TIER identifies missed appointment or loss to follow up after initiation Lay counselors provide adherence/treatment literacy sessions Monitoring: follow-up visits on standardized clinical stationery, captured on TIER.Net, enables tracing/recall of missed appointments NAG standardized approach	Inconsistent use of stationery Limited mechanisms to confirm linkage ART continuation post-discharge Poor hospital-PHC facility referral pathways Inconsistent NAG implementation with limited adherence/treatment literacy counseling	New clients referred to linkage officer for NAG -based adherence/treatment literacy counseling Standardized transfer letter from NIMART nurse accompanies discharge summary Linkage officer discusses discharge plan and provides 28-day telephonic follow-up Linkage officer completes 28-day register Data capturer captures transfers on TIER.Net

Abbreviations: ART, antiretroviral therapy; ELISA, enzyme-linked immunosorbent assay; HTS, HIV testing and counseling services; NAG, National Adherence Guidelines, NIMART, nurse initiated and managed ART; PHC, primary health care; PICT, provider-initiated counseling and testing; PLHIV, people living with HIV.