Abstract:
BACKGROUND : Primary Health Care (PHC) clinicians and patients are major role players in
the South African antiretroviral treatment programme. Understanding their perceptions and
experiences of integrated care and the management of people living with HIV and AIDS in
PHC facilities is necessary for successful implementation and sustainability of integration.
OBJECTIVE : This study explored clinician perceptions and patient experiences of integration of
antiretroviral treatment in PHC clinics.
METHOD : An exploratory, qualitative study was conducted in four city of Tshwane PHC
facilities. Two urban and two rural facilities following different models of integration were
included. A self-administered questionnaire with open-ended items was completed by 35
clinicians and four focus group interviews were conducted with HIV-positive patients. The
data were coded and categories were grouped into sub-themes and themes.
RESULTS : Workload, staff development and support for integration affected clinicians’
performance and viewpoints. They perceived promotion of privacy, reduced discrimination
and increased access to comprehensive care as benefits of service integration. Delays, poor
patient care and patient dissatisfaction were viewed as negative aspects of integration. In
three facilities patients were satisfied with integration or semi-integration and felt common
queues prevented stigma and discrimination, whilst the reverse was true in the facility
with separate services. Single-month issuance of antiretroviral drugs and clinic schedule
organisation was viewed negatively, as well as poor staff attitudes, poor communication and
long waiting times.
CONCLUSION : Although a fully integrated service model is preferable, aspects that need further
attention are management support from health authorities for health facilities, improved
working conditions and appropriate staff development opportunities.
