Integrated care in primary care nursing discusses an approach that brings together different healthcare professionals, services, and systems to provide comprehensive and coordinated care to patients especially the Human Immunodeficiency Virus (HIV), Tuberculosis (TB) and Non-Communicable Diseases (NCDs) comorbidity. The goal is to ensure that patients receive comprehensive, high-quality care that addresses their physical, emotional, and social needs.

The theme for this edition of HIV Nursing Matters is “Integrated and Differentiated care”. The articles cover topics such as the unique needs of Transgender Women (TGW), managing HIV and cancer co-morbidities, pharmacy staff competencies in PrEP delivery, and embedding Quality Improvement (QI) within health systems for better HIV and TB care. Integrating HIV literacy and undetectable equals untransmittable (U=U) messaging into nursing education also empowers future healthcare providers to enhance care for people living with HIV (PLHIV). This collection of articles highlights the importance of strengthening integrated care to ensure it is both comprehensive and interdisciplinary.

In the article entitled “Promoting Authentic Health for Transgender Women (TGW) through the Integration of a Gender Affirming Health Care (GAHC) Model from Aurum POP INN,” Xaba and colleagues discuss the unique healthcare needs of TGW and present peer-reviewed studies highlighting the disproportionately high prevalence of HIV among TGW compared to other key populations. The authors emphasise that integrating the GAHC Model from Aurum POP INN is essential for providing comprehensive, gender-affirming care that meets the specific health needs of TGW. In addition, Moodley and colleagues highlight the urgent need for effective strategies to enhance the quality and scope of services for patients with HIV and TB, aiming to reduce morbidity and mortality among people living with HIV (PLWH) and those newly diagnosed with TB. Integrating quality improvement (QI) activities within the health system offers an innovative, lowcost approach to strengthen health system performance and deliver more comprehensive HIV and TB services.

Mkansi and colleagues conducted a pilot study to assess the feasibility of delivering HIV pre-exposure prophylaxis (PrEP) for HIV prevention through community pharmacies in Gauteng and the Western Cape, following NDOH guidelines. The qualitative findings revealed knowledge and training gaps among pharmacy staff, with some unable to differentiate between PrEP and PEP, partly due to regulatory restrictions on prescribing. These results highlight the need for training to improve pharmacy staff’s capacity for PrEP delivery. More formulations for PrEP are becoming available in South Africa, including injectables. Prof Bekker and researchers report that new PrEP formulations, including injectables, are becoming available in South Africa. Prof Bekker reports that researchers studied the effectiveness of Lenacapavir (a longacting injectable given 6 monthly) and F/TAF (a new HIV prevention tablet) in preventing HIV among cisgender women over 12 months. Results from the controlled clinical trials showed that Lenacapavir prevented HIV in 100% of women, with most participants adhering to the prescribed regimen. In contrast, the overall F/TAF group did not show reduced HIV incidence due to low adherence; however, women who took F/TAF as prescribed were protected.

Integrated care can only be realised if nurses are comprehensively trained. On 21 August 2024, the South African National Aids Council (SANAC) met with South African Nursing Education Institutions (NEIs) to advance patient empowerment through HIV literacy. Discussions underscored the need for integrating health literacy and the undetectable equals untransmittable (U=U) message into the nursing curriculum, standardising HIV content, and strengthening SANAC-NEI collaboration. Recommendations included involving postgraduate students in SANAC programmes, sharing updated HIV statistics with NEIs, and forming a working group to address research priorities and curriculum gaps. This consultation marked a key step towards empowering future healthcare professionals in HIV care.

Integrated and differentiated care is essential in the holistic offering of care to PLHIV, TB and related co-morbidities to achieve best outcomes.