A conceptual framework for developing a boundary-based confidentiality training programme for primary healthcare nurses managing patients living with HIV

Background: Loss to follow-up and treatment defaulting in HIV care led to hospitalisations for advanced complications, undermining retention strategies. Breaches of confidentiality compel patients into transferring clinics to conceal their HIV status. The shift from traditional nurse–patient relationships to team-based care, while improving comprehensive services, complicates confidentiality maintenance and can increase risks of unintended disclosures, eroding trust. Observations across ten community health centres with nurse-led HIV and AIDS services in the OR Tambo district revealed high rates of antiretroviral therapy (ART) defaulting. The absence of a formal confidentiality training framework leads to inconsistent practices and nonadherence to confidentiality guidelines. Objectives: This study aimed to develop a contextually relevant conceptual framework guiding the design and implementation of a boundary-based confidentiality training programme for HIV care providers. Method: Empirical data were collected by semistructured interviews with nurses across ten centres and analysed thematically Dickoff’s six factors, comprising agent, recipient, context, procedure, dynamics and terminus, was used to guide the conceptual framework and ensure relevance and feasibility. Results: Four themes and twelve sub-themes formed the basis for the framework’s six components. These components provide a systematic approach to addressing training elements aligned with programme goals. Conclusion: The developed framework offers a structured foundation for tailored confidentiality training, guided by Dickoff’s model. This approach aims to improve confidentiality adherence, foster patient trust and promote treatment retention among HIV clients. Contribution: The framework bridges research, practice and education by providing an evidence-based, practically applicable and educationally effective approach to confidentiality training, ultimately improving knowledge and understanding of HIV care.