How does specialist nursing contribute to HIV service delivery across England?

Objectives: This study aimed to examine what specialist nursing contributes to HIV service delivery across England and how it could be optimized. Methods: A three part multi-method qualitative study involving: (1) interviews with 19 stakeholders representing professional or service user groups; (2) interviews with nurse/physician pairs from 21 HIV services; (3) case studies involving site visits to 5 services. A framework analysis approach was used to manage and analyse the data. Results: There was substantial variability in specialist nursing roles and the extent of role development. Most hospital-based HIV nurses (13/19) were running nurse-led clinics, primarily for stable patients with almost half (6/13) also managing more complex patients. Role development was supported by non-medical prescribing, a robust governance framework and appropriate workload allocation. The availability and organisation of community HIV nursing provision determined how services supported vulnerable patients to keep them engaged in care. Four service models were identified. Conclusion: There is scope for providing a greater proportion of routine care through nurse-led clinics. HIV community nursing can influence health outcomes for vulnerable patients, but provision is variable. With limited financial resources, services may need to decide how to deploy their specialist nurses for best effect.