“There’s hope now. In the past we could only give the Bactrim and say … there’s no hope and that is it. Now at least we can say, okay, if your CD4 is this and this, you can give this and that for it. So it gives us a little option, and you can see the difference in patients. Some are being pushed in wheelchairs and are malnourished … you know, they are very sick, and then after three months the same patients walk in here and they start working again. You know, looking for work and planning their lives again. That’s making it ….
worth it.” STRETCH nurse
Knowledge Translation Unit
The KNOWLEDGE TRANSLATION UNIT was formally established in 2005 to continue the work begun in 2000 to provide primary care guidelines for adults with respiratory disease.
It is now one of the Clinical Research Units of the Lung Institute whose focus is to develop guidelines for primary care in adults, training for the implementation of these guidelines and research that demonstrates its effectiveness in the health system.
The PRACTICAL APPROACH TO LUNG HEALTH AND HIV/AIDS, or PALSA PLUS, combines locally adapted symptom and sign-based guidelines with an outreach training programme for primary care nurses, and has been widely implemented in the Free State and Western Cape provinces. It is currently in various stages of implementation in the other 7 provinces. The guideline and training materials, backed by a ‘train the trainer’ cascade model enables a rapid upscale of nurse training and a consequent increase in appropriate treatment and referral of patients with respiratory disease including tuberculosis (TB), HIV/AIDS and sexually transmitted Infections.
PALSA PLUS has formed the basis for STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) which supports the integration and decentralisation of HIV services, including antiretroviral treatment initiation in selected adults by nurses.
The PALSA PLUS guideline has been expanded to Primary Care 101, a guideline which includes 40 symptoms and 20 chronic conditions in adults as well as sections on mental health and womens health. Primary Care 101 offers a comprehensive and integrated primary care approach.
The unit focuses exclusively on health systems research, promoting the uptake of research findings in clinical practice. Through research and training, it has engaged decision makers, managers, doctors and nurses to improve the primary care management of priority respiratory diseases including tuberculosis, and HIV/AIDS. Robust research using pragmatic randomised controlled trials has shown that the implementation of PALSA PLUS guidelines and training has significantly improved quality of care. Qualitative process evaluations alongside our trials in the Free State and Western Cape show that the intervention is highly acceptable to nurses who value its simple, clear guidelines and materials as well as ongoing clinic-based training and support.
Our Vision To improve the quality of primary healthcare for underserved communities through pragmatic research, evidence-based implementation, evaluation, and engagement of health systems, their planners and providers.
“I used to grab at straws, but since being trained in PALSA PLUS, I feel more at ease and a lot more confident. Simplifies the management of patient treatment and makes you enjoy your work.”
Primary Health Care Nurse
“Nurses who are consulting are coming back to me that they feel so confident seeing patients now because of the training of PALSA PLUS guideline, directing them towards proper care and treatment of clients. Also, the key messages helping them remember and communication skills helping them never to forget why they are nurses.” PALSA PLUS trainer