**1. Introduction**

The dual burden of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) are global public health of concern and demands integrated TB/HIV services collaboratively to manage and control the dual epidemic as well as Prevention of Mother to Child Transmission (PMTCT). According to WHO and UNAIDS [1], there were approximately 37.7 million people living with HIV (PLWH) worldwide in 2020, of which 19.3 million are women, 16.7 men above 15 years, 1.7 million children and

adolescents less than 15 years old. Furthermore, an approximately 680,000 deaths from Acquired Immune Deficiency Syndrome (AIDS) have been reported from low and middle-income countries and reported a total of 190 million people who tested and receive results for HIV in 2018.

According to the UNAIDS [2] report, sub-Saharan Africa is the worst affected by HIV globally. It is home to the most significant number of PLWH, with an HIV prevalence of 6.7%, 730 00 new HIV infections, and 300,000 AIDS-related death. Young women, men who have sex with men, transgender people, sex workers, prisoners, and people who inject drugs are at an increased risk of acquiring HIV infection (UNAIDS, 2020). South Africa has the largest HIV population globally, with 8.2 million PLWH, HIV prevalence high at 20.4% in 2021, 200,000 new HIV infections, and 72,000 AIDS-related deaths. South Africa has the most extensive ART programme globally, with 3.4 million PLWH on ART because of the adoption of WHO task-shifting.

As a result, nurses rather than doctors initiate ART in the primary level of care, and it is crucial to train nurses in nurse-initiated management of ART (NIMART). Task shifting was adopted in South Africa, and training on NIMART was introduced in 2009 to improve access to ART. Therefore, it is crucial to enhance the NIMART training and implementation in South Africa by making all role players and stakeholders aware of the conceptual framework that can strengthen and optimize training and implementation to improve patient and HIV programme outcomes. The framework should cooperate with the national Department of Health policies and guidelines, including empirical studies on HIV management to enhance the quality of care, achieve the UNAIDS 95–95-95 target by 2030 and end the HIV and TB epidemic. The increasing number of PLWH in need of ART continues to exert excessive pressure on the health care system, which is already experiencing a dire shortage of resources and high staff turnover. This chapter will focus on the description of concepts related to enhancing NIMART training, education, and implementation, the objectives of NIMART training, the methodology of the conceptual framework, barriers and enablers of NIMART training and implementation, the HIV continuum of care, and the role and responsibilities of NIMART-trained nurses.
