Practical Approach to Lung Health and HIV/AIDS in South Africa
The PALSA PLUS guideline was originally developed by the Knowledge Translation Unit from the World Health Organisation’s Practical Approach to Lung Health (PAL) strategy to equip nurses to diagnose and manage respiratory diseases including tuberculosis in primary care settings. The Unit expanded it to include HIV and published annual editions – eighth in Western Cape (2006-2013) and five nationally (2009-2013) thus keeping up to date with evolving policy and emerging evidence. This made it the go-to resource for the almost 19 000 health workers who were trained to use it in 1926 South African primary care facilities. Supported by the positive outcomes of the Unit’s three pragmatic trials (1, 2, 3), the PALSA PLUS training programme was absorbed into the Department of Health’s national and regional training programmes, with the educational outreach on-site model of training regarded as best practice. It was the request by clinician end-users, managers and trainers for an expanded version of PALSA PLUS to include common chronic conditions like diabetes and hypertension that prompted the development of the Primary Care 101 and PACK Adult guidelines and these two programmes have now superseded PALSA PLUS in the Western Cape and throughout South Africa.
PALSA PLUS contents (click image to enlarge)
PALSA PLUS example pages
- Fairall L, Zwarenstein M, Bateman ED, Bachmann OM, Lombard C, Majara B, Joubert G, English RG, Bheekie A, van Rensburg HCJ, Mayers P, Peters AC, Chapman RD. Educational outreach to nurses improves tuberculosis case detection and primary care of respiratory illness: a pragmatic cluster randomized controlled trial BMJ. 2005; 331:750-754.
- Zwarenstein M, Fairall LR, Lombard C, Mayers P, Bheekie A, English RG, et al. Outreach education for integration of HIV/AIDS care, antiretroviral treatment, and tuberculosis care in primary care clinics in South Africa: PALSA PLUS pragmatic cluster randomised trial. BMJ. 2011;342:d2022.
- Fairall, Lara, Max O Bachmann, Carl Lombard, Venessa Timmerman, Kerry Uebel, Merrick Zwarenstein, Andrew Boulle, et al. Task Shifting of Antiretroviral Treatment from Doctors to Primary-care Nurses in South Africa (STRETCH): a Pragmatic, Parallel, Cluster-randomised Trial. Lancet 380, no. 9845 (September 8, 2012): 889–898. doi:10.1016/S0140-6736(12)60730-2.