Clinician and patient views on antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa

Abstract

Background: Primary health care (PHC) clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions of integrated care and the management of people living with HIV/AIDS in PHC facilities is necessary for successful implementation and sustainability. Objective: This study explored clinician and patient perceptions of integration of antiretroviral treatment in PHC clinics. Method: An exploratory, qualitative design was used. Four City of Tshwane PHC facilities were purposively selected, two urban and two rural. A self-administered questionnaire was distributed to 35 clinicians and four focus group interviews were conducted with HIV patients. Results: Models of care implemented were: full integration; partial integration; and separate services. Workload, staff development and support for integration affected clinicians’ performance and viewpoints. Promotion of privacy, reduced discrimination and increased access to comprehensive care were perceived as benefits of service integration and delays, poor patient care and patient dissatisfaction as negative aspects. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, while the reverse was true in separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation were viewed negatively, as well as staff attitudes, poor communication and long waiting times. Conclusion: Integration of ART service in primary health services improved accessibility of the comprehensive service packages and coverage. The fully integrated model shared resources and had equitable work distribution amongst clinicians.