PALSA PLUS stands for Practical Approach to Lung Health and HIV/AIDS in South Africa. PALSA combined evidence-based locally adapted symptom and sign-based guidelines with educational outreach, a guideline implementation strategy known to change the behaviour of health practitioners towards evidence-based choices. The approach has been developed and tested in the Free State province since 2003. A large randomised controlled trial found that PALSA substantially improved the quality of care for respiratory patients, increasing TB case detection by 68%, the provision of inhaled corticosteroids for patients with asthma by 80%, and the appropriate referral of severely ill patients by 120%.
The approach has since been expanded to cover the management of STIs and HIV/AIDS, including the monitoring of doctor-initiated antiretroviral treatment in adults. A second randomised controlled trial in the Free State found that the educational outreach component improved the provision of cotrimoxazole prophylaxis over and above intensive training that accompanied the implementation of the Comprehensive Care, Treatment and Management of HIV and AIDS Programme in that province. A third randomised controlled trial is underway in the Western Cape and provisional results should be available by the end of this year.
The findings from the first randomised trial, the expansion to HIV/AIDS and STIs and positive feedback from nurses and nurse trainers, prompted the Free State and Western Cape to implement the programme throughout their primary care facilities. As at the end of July 2007 the Knowledge Translation Unit (KTU) had trained and supported 150 nurse trainers who in turn have trained 2147 nurses in 248 facilities throughout the two provinces. The Knowledge Translation Unit is currently working with the National Department of Health to finalise plans to rollout PALSA PLUS throughout South Africa, prioritising TB crisis districts in the Eastern Cape and KwaZulu Natal.
Funding: International Development Research Centre, Free State Department of Health, Western Cape Department of Health