Clinician Perceptions and Patient Experiences of Antiretroviral Treatment Integration in Primary Health Care Clinics, Tshwane, South Africa

Overview

Journal Curationis

Specialty Nursing

Date 2016 Feb 5

PMID 26841916

Citations 10

Authors

Maphuthego D Mathibe

Stephen J H Hendricks

Anne-Marie Bergh

Affiliations

Soon will be listed here.

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.

Citing Articles

Barriers to effective patient care as experienced by nurses in primary healthcare clinics in African countries: a systematic review of qualitative studies.

Nesengani T, Downing C, Ten Ham-Baloyi W BMC Nurs. 2025; 24(1):232.

PMID: 40022067 PMC: 11869662. DOI: 10.1186/s12912-025-02877-5.

Healthcare workers' perceptions and experiences of primary healthcare integration: a scoping review of qualitative evidence.

Moloi H, Daniels K, Brooke-Sumner C, Cooper S, Odendaal W, Thorne M Cochrane Database Syst Rev. 2023; 7:CD013603.

PMID: 37466272 PMC: 10355136. DOI: 10.1002/14651858.CD013603.pub3.

Healthcare workers' perceptions and experiences of primary healthcare integration: a scoping review of qualitative evidence.

Moloi H, Daniels K, Brooke-Sumner C, Cooper S, Odendaal W, Thorne M Cochrane Database Syst Rev. 2023; 7:CD013603.

PMID: 37434293 PMC: 10335778. DOI: 10.1002/14651858.CD013603.pub2.

Barriers to the Implementation of the HIV Universal Test and Treat Strategy in Selected Primary Care Facilities in South Africa's Eastern Cape Province.

Mnyaka O, Mabunda S, Chitha W, Nomatshila S, Ntlongweni X J Prim Care Community Health. 2021; 12:21501327211028706.

PMID: 34189991 PMC: 8252362. DOI: 10.1177/21501327211028706.

Identifying contextual determinants of problems in tuberculosis care provision in South Africa: a theory-generating case study.

Murdoch J, Curran R, J van Rensburg A, Awotiwon A, Dube A, Bachmann M Infect Dis Poverty. 2021; 10(1):67.

PMID: 33971979 PMC: 8108019. DOI: 10.1186/s40249-021-00840-5.

References

Uebel K, Guise A, Georgeu D, Colvin C, Lewin S . Integrating HIV care into nurse-led primary health care services in South Africa: a synthesis of three linked qualitative studies. BMC Health Serv Res. 2013; 13:171. PMC: 3652780. DOI: 10.1186/1472-6963-13-171. View

Chimbindi N, Barnighausen T, Newell M . Patient satisfaction with HIV and TB treatment in a public programme in rural KwaZulu-Natal: evidence from patient-exit interviews. BMC Health Serv Res. 2014; 14:32. PMC: 3904687. DOI: 10.1186/1472-6963-14-32. View

Hall E . Nursing attrition and the work environment in South African health facilities. Curationis. 2005; 27(4):28-36. DOI: 10.4102/curationis.v27i4.1018. View

Crowley T, Stellenberg E . Integrating HIV care and treatment into primary healthcare: are clinics equipped?. Afr J Prim Health Care Fam Med. 2015; 6(1):E1-7. PMC: 4502869. DOI: 10.4102/phcfm.v6i1.616. View

Van Rensburg D, Steyn F, Schneider H, Loffstadt L . Human resource development and antiretroviral treatment in Free State province, South Africa. Hum Resour Health. 2008; 6:15. PMC: 2531133. DOI: 10.1186/1478-4491-6-15. View

van der Merwe K, Chersich M, Technau K, Umurungi Y, Conradie F, Coovadia A . Integration of antiretroviral treatment within antenatal care in Gauteng Province, South Africa. J Acquir Immune Defic Syndr. 2006; 43(5):577-81. DOI: 10.1097/01.qai.0000243099.72770.d2. View

Louwagie G, Girdler-Brown B, Odendaal R, Rossouw T, Johnson S, van der Walt M . Missed opportunities for accessing HIV care among Tshwane tuberculosis patients under different models of care. Int J Tuberc Lung Dis. 2012; 16(8):1052-8. DOI: 10.5588/ijtld.11.0753. View

Ruud K, Toverud E, Radloff S, Srinivas S . Antiretroviral treatment and follow-up of HIV-infected patients by health care providers in South African public primary health care. J Assoc Nurses AIDS Care. 2010; 21(5):417-28. DOI: 10.1016/j.jana.2009.12.003. View

Askew I, Berer M . The contribution of sexual and reproductive health services to the fight against HIV/AIDS: a review. Reprod Health Matters. 2004; 11(22):51-73. DOI: 10.1016/s0968-8080(03)22101-7. View

10.

Peltzer K, Matseke G, Mzolo T, Majaja M . Determinants of knowledge of HIV status in South Africa: results from a population-based HIV survey. BMC Public Health. 2009; 9:174. PMC: 2700104. DOI: 10.1186/1471-2458-9-174. View

11.

Wouters E, Heunis C, van Rensburg D, Meulemans H . Patient satisfaction with antiretroviral services at primary health-care facilities in the Free State, South Africa--a two-year study using four waves of cross-sectional data. BMC Health Serv Res. 2008; 8:210. PMC: 2575208. DOI: 10.1186/1472-6963-8-210. View

12.

Uebel K, Joubert G, Wouters E, Mollentze W, Van Rensburg D . Integrating HIV care into primary care services: quantifying progress of an intervention in South Africa. PLoS One. 2013; 8(1):e54266. PMC: 3551935. DOI: 10.1371/journal.pone.0054266. View

13.

Kerschberger B, Hilderbrand K, Boulle A, Coetzee D, Goemaere E, de Azevedo V . The effect of complete integration of HIV and TB services on time to initiation of antiretroviral therapy: a before-after study. PLoS One. 2012; 7(10):e46988. PMC: 3465310. DOI: 10.1371/journal.pone.0046988. View

14.

Callaghan M, Ford N, Schneider H . A systematic review of task- shifting for HIV treatment and care in Africa. Hum Resour Health. 2010; 8:8. PMC: 2873343. DOI: 10.1186/1478-4491-8-8. View

15.

Uebel K, Fairall L, van Rensburg D, Mollentze W, Bachmann M, Lewin S . Task shifting and integration of HIV care into primary care in South Africa: the development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention. Implement Sci. 2011; 6:86. PMC: 3163620. DOI: 10.1186/1748-5908-6-86. View

16.

Wandeler G, Keiser O, Pfeiffer K, Pestilli S, Fritz C, Labhardt N . Outcomes of antiretroviral treatment programs in rural Southern Africa. J Acquir Immune Defic Syndr. 2011; 59(2):e9-16. PMC: 3259205. DOI: 10.1097/QAI.0b013e31823edb6a. View

17.

Myer L, Rabkin M, Abrams E, Rosenfield A, El-Sadr W . Focus on women: linking HIV care and treatment with reproductive health services in the MTCT-Plus Initiative. Reprod Health Matters. 2005; 13(25):136-46. DOI: 10.1016/s0968-8080(05)25185-6. View

18.

Schwartz S, Rees H, Mehta S, Venter W, Taha T, Black V . High incidence of unplanned pregnancy after antiretroviral therapy initiation: findings from a prospective cohort study in South Africa. PLoS One. 2012; 7(4):e36039. PMC: 3338622. DOI: 10.1371/journal.pone.0036039. View

19.

Davies N, Homfray M, Venables E . Nurse and manager perceptions of nurse initiated and managed antiretroviral therapy (NIMART) implementation in South Africa: a qualitative study. BMJ Open. 2013; 3(11):e003840. PMC: 3831110. DOI: 10.1136/bmjopen-2013-003840. View

20.

Kinkel H, Adelekan A, Marcus T, Wolvaardt G . Assessment of service quality of public antiretroviral treatment (ART) clinics in South Africa: a cross-sectional study. BMC Health Serv Res. 2012; 12:228. PMC: 3468362. DOI: 10.1186/1472-6963-12-228. View