TY - JOUR
T1 - Quality of care in a differentiated HIV service delivery intervention in Tanzania
T2 - A mixed-methods study
AU - Okere, Nwanneka Ebelechukwu
AU - Meta, Judith
AU - Maokola, Werner
AU - Martelli, Giulia
AU - van Praag, Eric
AU - Naniche, Denise
AU - Gomez, Gabriela B.
AU - Pozniak, Anton
AU - de Wit, Tobias Rinke
AU - de Klerk, Josien
AU - Hermans, Sabine
N1 - Funding Information: The Shinyanga and Simiyu Test & Treat program in Tanzania is funded by Gilead Sciences (USA) and the Diocese of Shinyanga through the Good Samaritan Foundation (Vatican). ONE was funded by the Erasmus Mundus Joint Doctorate Trans Global Health Programme EMJD-TGH (Framework Partnership Agreement 2013-0039, Specific Grant Agreement 2014-0681) http://www. transglobalhealth.org/ and the Amsterdam Institute for Global Health and Development (AIGHD). The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2022 Okere et al.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Background: Differentiated service delivery (DSD) offers benefits to people living with HIV (improved access, peer support), and the health system (clinic decongestion, efficient service delivery). ART clubs, 15-30 clients who usually meet within the community, are one of the most common DSD options. However, evidence about the quality of care (QoC) delivered in ART clubs is still limited. Materials and methods: We conducted a concurrent triangulation mixed-methods study as part of the Test & Treat project in northwest Tanzania. We surveyed QoC among stable clients and health care workers (HCW) comparing between clinics and clubs. Using a Donabedian framework we structured the analysis into three levels of assessment: structure (staff, equipment, supplies, venue), processes (time-spent, screenings, information, HCW-attitude), and outcomes (viral load, CD4 count, retention, self-worth). Results: We surveyed 629 clients (40% in club) and conducted eight focus group discussions, while 24 HCW (25% in club) were surveyed and 22 individual interviews were conducted. Quantitative results revealed that in terms of structure, clubs fared better than clinics except for perceived adequacy of service delivery venue (94.4% vs 50.0%, p = 0.013). For processes, time spent receiving care was significantly more in clinics than clubs (119.9 vs 49.9 minutes). Regarding outcomes, retention was higher in the clubs (97.6% vs 100%), while the proportion of clients with recent viral load <50 copies/ml was higher in clinics (100% vs 94.4%). Qualitative results indicated that quality care was perceived similarly among clients in clinics and clubs but for different reasons. Clinics were generally perceived as places with expertise and clubs as efficient places with peer support and empathy. In describing QoC, HCW emphasized structure-related attributes while clients focused on processes. Outcomes- related themes such as improved client health status, self-worth, and confidentiality were similarly perceived across clients and HCW. Conclusion: We found better structure and process of care in clubs than clinics with comparable outcomes. While QoC was perceived similarly in clinics and clubs, its meaning was understood differently between clients. DSD catered to the individual needs of clients, either technical care in the clinic or proximate and social care in the club. Our findings highlight that both clinic and DSD care are required as many elements of QoC were individually perceived.
AB - Background: Differentiated service delivery (DSD) offers benefits to people living with HIV (improved access, peer support), and the health system (clinic decongestion, efficient service delivery). ART clubs, 15-30 clients who usually meet within the community, are one of the most common DSD options. However, evidence about the quality of care (QoC) delivered in ART clubs is still limited. Materials and methods: We conducted a concurrent triangulation mixed-methods study as part of the Test & Treat project in northwest Tanzania. We surveyed QoC among stable clients and health care workers (HCW) comparing between clinics and clubs. Using a Donabedian framework we structured the analysis into three levels of assessment: structure (staff, equipment, supplies, venue), processes (time-spent, screenings, information, HCW-attitude), and outcomes (viral load, CD4 count, retention, self-worth). Results: We surveyed 629 clients (40% in club) and conducted eight focus group discussions, while 24 HCW (25% in club) were surveyed and 22 individual interviews were conducted. Quantitative results revealed that in terms of structure, clubs fared better than clinics except for perceived adequacy of service delivery venue (94.4% vs 50.0%, p = 0.013). For processes, time spent receiving care was significantly more in clinics than clubs (119.9 vs 49.9 minutes). Regarding outcomes, retention was higher in the clubs (97.6% vs 100%), while the proportion of clients with recent viral load <50 copies/ml was higher in clinics (100% vs 94.4%). Qualitative results indicated that quality care was perceived similarly among clients in clinics and clubs but for different reasons. Clinics were generally perceived as places with expertise and clubs as efficient places with peer support and empathy. In describing QoC, HCW emphasized structure-related attributes while clients focused on processes. Outcomes- related themes such as improved client health status, self-worth, and confidentiality were similarly perceived across clients and HCW. Conclusion: We found better structure and process of care in clubs than clinics with comparable outcomes. While QoC was perceived similarly in clinics and clubs, its meaning was understood differently between clients. DSD catered to the individual needs of clients, either technical care in the clinic or proximate and social care in the club. Our findings highlight that both clinic and DSD care are required as many elements of QoC were individually perceived.
UR - http://www.scopus.com/inward/record.url?scp=85126606441&partnerID=8YFLogxK
U2 - https://doi.org/10.1371/journal.pone.0265307
DO - https://doi.org/10.1371/journal.pone.0265307
M3 - Article
C2 - 35290989
SN - 1932-6203
VL - 17
JO - PLOS ONE
JF - PLOS ONE
IS - 3 March
M1 - e0265307
ER -