Client and Provider Perspectives of the Efficiency and Quality of Care in the Context of Rapid Scale-Up of Antiretroviral Therapy
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Date
2010
Journal Title
Journal ISSN
Volume Title
Publisher
AIDS patient care and STDs
Abstract
Global scale-up of antiretroviral therapy (ART) has focused on clinical outcomes with little attention on its
impact on existing health systems. In June–August 2008, we conducted a formative evaluation on ART scale-up
and clinic operations at three clinics in Uganda to generate lessons for informing policy and larger public health
care systems. Site visits and semistructured interviews with 10 ART clients and 6 providers at each clinic were
used to examine efficiency of clinic operations (patient flow, staff allocation to appropriate duties, scheduling of
clinic visits, record management) and quality of care (attending to both client and provider needs, and providing
support for treatment adherence and retention). Clients reported long waiting times but otherwise general
satisfaction with the quality of care. Providers reported good patient adherence and retention, and support
mechanisms for clients. Like clients, providers mentioned long waiting times and high workload as major
challenges to clinic expansion. Providers called for more human resources and stress-release mechanisms to
prevent staff burnout. Both providers and clients perceive these clinics to be delivering good quality care, despite
the recognition of congested clinics and long waiting times. These findings highlight the need to address clinic
efficiency as well as support for providers in the context of rapid scale-up.
Description
Keywords
antiretroviral therapy, HIV epidemic, health systems
Citation
Amanyire, G., Wanyenze, R., Alamo, S., Kwarisiima, D., Sunday, P., Sebikaari, G., ... & Wagner, G. (2010). Client and provider perspectives of the efficiency and quality of care in the context of rapid scale-up of antiretroviral therapy. AIDS patient care and STDs, 24(11), 719-727.10.1089/apc.2010.0108