From PALSA PLUS to PALM PLUS: adapting and developing a South African guideline and training intervention to better integrate HIV/AIDS care with primary care in rural health centers in Malawi
Open accessAbstract
BACKGROUND: Only about one-third of eligible HIV/AIDS patients receive anti-retroviral treatment (ART). Decentralizing treatment is crucial to wider and more equitable access, but key obstacles are a shortage of trained healthcare workers (HCW) and challenges integrating HIV/AIDS care with other primary care. This report describes the development of a guideline and training program (PALM PLUS) designed to integrate HIV/AIDS care with other primary care in Malawi. PALM PLUS was adapted from PALSA PLUS, developed in South Africa, and targets middle-cadre HCWs (clinical officers, nurses, and medical assistants). We adapted it to align with Malawi's national treatment protocols, more varied healthcare workforce, and weaker health system infrastructure. METHODS/DESIGN: The international research team included the developers of the PALSA PLUS program, key Malawi-based team members and personnel from national and district level Ministry of Health (MoH), professional associations, and an international non-governmental organization. The PALSA PLUS guideline was extensively revised based on Malawi national disease-specific guidelines. Advice and input was sought from local clinical experts, including middle-cadre personnel, as well as Malawi MoH personnel and representatives of Malawian professional associations. RESULTS: An integrated guideline adapted to Malawian protocols for adults with respiratory conditions, HIV/AIDS, tuberculosis, and other primary care conditions was developed. The training program was adapted to Malawi's health system and district-level supervision structure. PALM PLUS is currently being piloted in a cluster-randomized trial in health centers in Malawi (ISRCTN47805230). DISCUSSION: The PALM PLUS guideline and training intervention targets primary care middle-cadre HCWs with the objective of improving HCW satisfaction and retention, and the quality of patient care. Successful adaptations are feasible, even across health systems as different as those of South Africa and Malawi.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Several projects have investigated integrated care in LMICs, including mWellCare and LatinMH.
“Several projects have investigated integrated care in LMICS, including: mWellCare (https://clinicaltrials.gov/ct2/show/NCT02480062); and LatinMH 96 .”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [96]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
How can we achieve and maintain high-quality performance of health workers in low-resource settings?
Rowe, A. K., de Savigny, D., Lanata, C. F., & Victora, C. G. (2005) · The Lancet · doi:10.1016/s0140-6736(05)67028-6 · Cited by 1,048 · see citing works
Lehmann, U., Dieleman, M., & Martineau, T. (2008) · BMC Health Services Research · doi:10.1186/1472-6963-8-19 · Cited by 650 · see citing works
Bedelu, M., Ford, N. P., Hilderbrand, K., & Reuter, H. (2007) · The Journal of Infectious Diseases · doi:10.1086/521114 · Cited by 263 · see citing works
Manzi, M., Zachariah, R., Teck, R., Buhendwa, L., Kazima, J., Bakali, E., Firmenich, P., & Humblet, P. (2005) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2005.01526.x · Cited by 261 · see citing works
Jahn, A., Floyd, S., Crampin, A. C., Mwaungulu, F. D., Mvula, H., Munthali, F., McGrath, N. M., Mwafilaso, J., Mwinuka, V., Mangongo, B., et al. (2008) · The Lancet · doi:10.1016/s0140-6736(08)60693-5 · Cited by 247 · see citing works
Scaling up access to antiretroviral treatment in southern Africa: who will do the job?
Kober, K., & Damme, W. V. (2004) · The Lancet · doi:10.1016/s0140-6736(04)16597-5 · Cited by 244 · see citing works
Resistance of the Breast-fed Infant to Gastroenteritis
Bullen, C. L., & Willis, A. T. (1971) · BMJ · doi:10.1136/bmj.3.5770.338 · Cited by 185 · see citing works
Rapid Expansion of the Health Workforce in Response to the HIV Epidemic
Samb, B., Celletti, F. L., Holloway, J., Damme, W. V., Cock, K. M. D., & Dybul, M. R. (2007) · New England Journal of Medicine · doi:10.1056/nejmsb071889 · Cited by 184 · see citing works
Fairall, L. R., Zwarenstein, M., Bateman, E. D., Bachmann, M. O., Lombard, C. J., Majara, B. P., Joubert, G., English, R., Bheekie, A., van Rensburg, D. H., et al. (2005) · BMJ · doi:10.1136/bmj.331.7519.750 · Cited by 171 · see citing works
Damme, W. V., Kober, K., & Kegels, G. (2008) · Social Science & Medicine · doi:10.1016/j.socscimed.2008.01.043 · Cited by 155 · see citing works
Human Resources for Treating HIV/AIDS: Needs, Capacities, and Gaps
Bärnighausen, T., Bloom, D. E., & Humair, S. (2007) · AIDS Patient Care and STDs · doi:10.1089/apc.2007.0193 · Cited by 133 · see citing works
Bradley, S., & McAuliffe, É. (2009) · Human Resources for Health · doi:10.1186/1478-4491-7-14 · Cited by 116 · see citing works
Measuring and managing the work environment of the mid-level provider – the neglected human resource
McAuliffe, É., Bowie, C., Manafa, O., Maseko, F., MacLachlan, M., Hevey, D., Normand, C. E. M., & Chirwa, M. L. (2009) · Human Resources for Health · doi:10.1186/1478-4491-7-13 · Cited by 100 · see citing works
Rowe, A. K., Hirnschall, G. O., Lambrechts, T., & Bryce, J. (1999) · Europe PMC (PubMed Central) · Cited by 88 · see citing works
Price, J., Leslie, J., Welsh, M., & Binagwaho, A. (2009) · AIDS Care · doi:10.1080/09540120802310957 · Cited by 82 · see citing works
Rutenberg, N., & Baek, C. (2005) · Studies in Family Planning · doi:10.1111/j.1728-4465.2005.00064.x · Cited by 78 · see citing works
Zwarenstein, M., Fairall, L. R., Lombard, C., Mayers, P., Bheekie, A., English, R. G., Lewin, S., Bachmann, M. O., & Bateman, E. (2011) · BMJ · doi:10.1136/bmj.d2022 · Cited by 77 · see citing works
Stein, J., Lewin, S. A., & Fairall, L. R. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2006.10.028 · Cited by 68 · see citing works
Stein, J., Lewin, S., Fairall, L., Mayers, P., English, R., Bheekie, A., Bateman, E., & Zwarenstein, M. (2008) · BMC Health Services Research · doi:10.1186/1472-6963-8-240 · Cited by 59 · see citing works
Harries, A. D., Zachariah, R., Jahn, A., Schouten, E. J., & Kamoto, K. (2009) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e3181bbc99e · Cited by 54 · see citing works
The dangers of disease specific programmes for developing countries
England, R. (2007) · BMJ · doi:10.1136/bmj.39335.520463.94 · Cited by 53 · see citing works
English, R., Bachmann, M. O., Bateman, E. D., Zwarenstein, M., Fairall, L. R., Bheekie, A., Majara, B. P., Lombard, C. J., Scherpbier, R. W., & Ottomani, S. E. (2006) · BMC Pulmonary Medicine · doi:10.1186/1471-2466-6-22 · Cited by 52 · see citing works
Development of a South African integrated syndromic respiratory disease guideline for primary care
English, R., Bateman, E. D., Zwarenstein, M., Fairall, L. R., Bheekie, A., Bachmann, M. O., Majara, B. P., Ottmani, S.-E., & Scherpbier, R. W. (2008) · Primary Care Respiratory Journal · doi:10.3132/pcrj.2008.00044 · Cited by 33 · see citing works
FROM PMTCT TO A MORE COMPREHENSIVE AIDS RESPONSE FOR WOMEN: A MUCH‐NEEDED SHIFT
Eyakuze, C., Jones, D. A., Starrs, A., & SORKIN, N. (2008) · Developing World Bioethics · doi:10.1111/j.1471-8847.2008.00230.x · Cited by 31 · see citing works
Integrating quality postnatal care into PMTCT in Swaziland
Mazia, G., Narayanan, I., Warren, C., Mahdi, M., Chibuye, P. S., Walligo, A., Mabuza, P. L., Shongwe, R., & Hainsworth, M. (2009) · Global Public Health · doi:10.1080/17441690902769669 · Cited by 30 · see citing works
Rosenfield, A. G. (1993) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(93)90146-a · Cited by 25 · see citing works
Uys, L. R., Minnaar, A., Reid, S., & Naidoo, J. R. (2004) · Curationis · doi:10.4102/curationis.v27i2.976 · Cited by 24 · see citing works
HIV-related tuberculosis: how well are we doing with current control efforts?
Maher, D., Borgdorff, M. W., & Boerma, T. (2005) · PubMed · Cited by 20 · see citing works
Interaction of malaria and HIV in Africa
Reithinger, R., Kamya, M. R., Whitty, C. W. M., Dorsey, G., & Vermund, S. H. (2009) · BMJ · doi:10.1136/bmj.b2141 · Cited by 18 · see citing works
Schull, M. J., Banda, H., Kathyola, D., Fairall, L. R., Martiniuk, A. L. C., Burciul, B., Zwarenstein, M., Sodhi, S. K., Thompson, S., Joshua, M., et al. (2010) · Trials · doi:10.1186/1745-6215-11-118 · Cited by 18 · see citing works
Reproductive Health and AIDS-Related Services For Women: How Well Are they Integrated?
Daley, D. (1994) · Family Planning Perspectives · doi:10.2307/2135892 · Cited by 13 · see citing works
Integrating STI / HIV prevention into family planning services. Women's reproductive health.
Murphy, E. (1999) · PubMed · Cited by 2 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Malawi Antiretroviral Treatment Program Quarterly Report; Results up to 31st March 2010 Malawi Ministry of Health 1
Cited by
Sorted by citations
Fairall, L., Bachmann, M. O., Lombard, C., Timmerman, V., Uebel, K., Zwarenstein, M., Boulle, A., Georgeu, D., Colvin, C. J., Lewin, S., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60730-2 · Cited by 302 · see citing works
Self-citationThornicroft, G., Ahuja, S., Barber, S., Chisholm, D., Collins, P. Y., Docrat, S., Fairall, L., Lempp, H., Niaz, U., Ngo, V., et al. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30298-0 · Cited by 138 · see citing works
Self-citationInnovating to improve primary care in less developed countries: towards a global model
Fairall, L. R., Bateman, E. D., Cornick, R. V., Faris, G., Timmerman, V., Folb, N., Bachmann, M. O., Zwarenstein, M., & Smith, R. W. (2015) · BMJ Innovations · doi:10.1136/bmjinnov-2015-000045 · Cited by 73 · see citing works
Sodhi, S. K., Banda, H., Kathyola, D., Joshua, M., Richardson, F., Mah, E., MacGregor, H., Kanike, E., Thompson, S., Fairall, L. R., et al. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-s1-s8 · Cited by 56 · see citing works
Feyissa, Y. M., Hanlon, C., Ferede, S. E., Cornick, R. V., Fairall, L. R., Gebremichael, D., Teka, T., Shiferaw, S., Dagnaw, W. W., Mamo, Y., et al. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2018-001108 · Cited by 41 · see citing works
Vasan, A., Ellner, A., Lawn, S. D., Gove, S., Manzi, A., Gupta, N., Drobac, P. C., Nicholson, T., Seung, K. J., Mabey, D. C. W., et al. (2014) · BMC Medicine · doi:10.1186/1741-7015-12-6 · Cited by 37 · see citing works
Tsima, Setlhare, V., & Nkomazana, O. (2016) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s112466 · Cited by 30 · see citing works
Wattrus, C., Zepeda, J., Cornick, R. V., Zonta, R., de Andrade, M. P., Fairall, L. R., Georgeu-Pepper, D., Anderson, L. R., Eastman, T., Bateman, E. D., et al. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2018-001016 · Cited by 27 · see citing works
Cornick, R. V., Wattrus, C., Eastman, T., Ras, C., Awotiwon, A., Anderson, L. R., Bateman, E. D., Zepeda, J., Zwarenstein, M., Doherty, T., et al. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2018-001088 · Cited by 28 · see citing works
Ritchie, L. M. P., Schull, M. J., Martiniuk, A. L. C., Barnsley, J. M., Arenovich, T., van Lettow, M., Chan, A. K., Mills, E. J., Makwakwa, A., & Zwarenstein, M. (2015) · Implementation Science · doi:10.1186/s13012-015-0228-y · Cited by 26 · see citing works
South African Guideline Excellence (SAGE): What’s in a name?
Kredo, T., Machingaidze, S., Louw, Q. A., Young, T., & Grimmer, K. A. (2015) · South African Medical Journal · doi:10.7196/samj.2016.v106i1.10286 · Cited by 22 · see citing works
Picken, S., Hannington, J., Fairall, L. R., Doherty, T., Bateman, E. D., Richards, M., Wattrus, C., & Cornick, R. V. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2018-000957 · Cited by 24 · see citing works
Bachmann, M. O., Bateman, E. D., Stelmach, R., Cruz, Á. A., de Andrade, M. P., Zonta, R., Zepeda, J., Natal, S., Cornick, R. V., Wattrus, C., et al. (2018) · Journal of Thoracic Disease · doi:10.21037/jtd.2018.07.34 · Cited by 15 · see citing works
Musayón-Oblitas, F. Y., Cárcamo, C., Gimbel, S., Echevarria, J. I., & Graña, A. (2020) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.3117.3228 · Cited by 14 · see citing works
Pathak, B. G., Sandøy, I. F., Nisar, Y. B., Singh, M., Kumar, M., Madhur, T., Anand, V. K., Garg, N., Garg, S., Verma, S., et al. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12358-9 · Cited by 13 · see citing works
The ‘Practical Approach to Lung Health' in sub-Saharan Africa: a systematic review
Banda, H., Robinson, R., Thomson, R., Squire, S. B., & Mortimer, K. J. (2016) · The International Journal of Tuberculosis and Lung Disease · doi:10.5588/ijtld.15.0613 · Cited by 12 · see citing works
Oliveros, D., Konda, K. A., Madden, L. M., Montenegro-Idrogo, J. J., Quintanilla, K. T. T., Barbarán, K. S., Nikitin, B. M., Ponticiello, M. N., Benites, C. M., Sánchez, J., et al. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12618-8 · Cited by 6 · see citing works
Stander, J., Grimmer, K. A., & Brink, Y. (2020) · Physiotherapy Research International · doi:10.1002/pri.1883 · Cited by 5 · see citing works
Evaluation as evolution: a Darwinian proposal for health policy and systems research
Martiniuk, A. L. C., Abímbọ́lá, Ṣ., & Zwarenstein, M. (2015) · Health Research Policy and Systems · doi:10.1186/s12961-015-0007-x · Cited by 5 · see citing works
Chronic Lower Respiratory Tract Diseases
Pérez‐Padilla, R., Marks, G. B., Wong, G., Bateman, E. D., & Jarvis, D. (2017) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-0518-9_ch15 · Cited by 5 · see citing works
Perfil dos profissionais da Atenção Básica no Município de Araranguá/SC
Martins, A. P. L. T., Negro‐Dellacqua, M., Guedes, A. L. D. L., de Sousa, I. F., Biff, D., Elias, E., & Júnior, A. R. D. S. (2020) · Research Society and Development · doi:10.33448/rsd-v9i8.5668 · Cited by 4 · see citing works
Mangana, F., Massaquoi, L., Moudachirou, R., Harrison, R. E., Kaluangila, T., Mucinya, G., Ntabugi, N., Cutsem, G. V., Burton, R., & Isaakidis, P. (2020) · BMC Infectious Diseases · doi:10.1186/s12879-020-05470-0 · Cited by 3 · see citing works
Tyodugh, E. (2012) · British Microbiology Research Journal · doi:10.9734/bmrj/2012/1098
Implementation science and translational public health
Mate, K. S., Svoronos, T., & Fitzgerald, D. W. (2015) · doi:10.1093/med/9780199661756.003.0132
Introduction to Integrated Science of Global Epidemics
Rezaei, N., & Saghazadeh, A. (2023) · Integrated science · doi:10.1007/978-3-031-17778-1_1
- Authors
- Schull, M. J., Cornick, R., Thompson, S., Faris, G., Fairall, L., Burciul, B., Sodhi, S., Draper, B., Joshua, M., Mondiwa, M., Banda, H., Kathyola, D., Bateman, E., & Zwarenstein, M.
- Affiliations
- Dignitas International (CA)
- University of Cape Town (ZA)
- Ministry of Health (MW)
- Research for Equity And Community Health Trust (MW)
- Sunnybrook Health Science Centre (CA)
- Corresponding author
- Schull, Michael J
- Venue
- Implementation Science
- Published
- 2011-07-26
- Volume
- 6
- Issue
- 1
- Pages
- 82-82
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC3162564
- OpenAlex
- W2129840573
- Cited by
- 25
- References
- 32
- Citations by year
- 2025: 2 · 2023: 1 · 2020: 4 · 2018: 6 · 2017: 1 · 2016: 2 · 2015: 5 · 2014: 2 · 2012: 2
- FWCI
- 0.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- TSpace (University of Toronto) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Open University of Cape Town (University of Cape Town) (submittedVersion, cc-by)
- Greater South Information System
- Funders
- Government of Canada
- International Development Research Centre
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › HIV/AIDS Impact and Responses
- Keywords
- primary care, guideline adaptation, health professions education, rural health facilities, Malawi, South Africa, health workforce retention, health system adaptation
- MeSH terms
- Adult, Delivery of Health Care, Education, Nursing, Continuing, Health Policy, Health Services Accessibility, Humans, Malawi, Patient Care Planning, Primary Health Care, Public Health Nursing, Rural Health, Rural Population, HIV Infections, Practice Guidelines as Topic, Problem-Based Learning, Delivery of Health Care, Integrated, Rural Health Services, Anti-Retroviral Agents
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
