Effects of COVID-19 pandemic on ART Service delivery: perspectives of healthcare workers in a Teaching Hospital in Ghana

Abstract

Background Ghana has a generalized HIV epidemic and efforts have been made to curb the spread and reverse its effects on the general population. In the wake of COVID-19 pandemic, the health system was unsettled and antiretroviral therapy (ART) care has been impacted in diverse ways. The study sought to explore the effects of COVID-19 on ART service provision in Ghana from the perspectives of the healthcare workers. Methods An exploratory-descriptive qualitative approach was employed in this study. Using maximum variation sampling method, fifteen healthcare workers; nurses, data managers and pharmacists were recruited from an ART clinic in a Teaching Hospital in Ghana. In-depth interviews were conducted and analysed using Braun and Clarke thematic approach. Results Three themes emerged from the data; “… And the pandemic struck”, “Impact of the pandemic on ART service delivery”; “Effecting the needed change”. The healthcare workers’ initial reactions to the pandemic and their show of commitment in ensuring continued ART service was evident. COVID-19 impacted service delivery in three main ways; (1) clients’ clinic attendance was erratic at various stages of the pandemic, (2) irregular resource availability as shortage was reported due to affected last mile delivery as a result of the lockdown in Accra, and (3) the health worker-patient interaction became less engaging because of established COVID-19 protocols. The healthcare workers however instituted strategies such as adjusting the patient appointment schedule, health professionals’ work schedule, establishing several work stations, task-shifting, and ensuring the implementation of all the COVID-19 protocols within the ART unit to ensure consistent service delivery as well as patient and staff safety. The study also found a decline in the implementation of several strategies established in the ART clinic during the initial phases of the pandemic such as a decline in the supply of Personal Protective Equipment (PPEs) by hospital management. Conclusions Although several strategies were implemented to manage the effects of the pandemic on ART care, there is a need to establish pathways of support for healthcare workers within the ART clinic and to consolidate as well as institutionalise the changes that ensured continuous but safe service delivery.

Interruptions to HIV Care Delivery During Pandemics and Natural Disasters: A Qualitative Study of Challenges and Opportunities From Frontline Healthcare Providers in Western Kenya

“… 35 Additionally, there should be careful consideration and fair allocation of risk allowances, and collaboration with other community health workers for organized task-shifting. 35 – 37 …”

Service delivery challenges in HIV care during the first year of the COVID‐19 pandemic: results from a site assessment survey across the global IeDEA consortium

“…While there have been efforts to document the impact of the COVID‐19 pandemic on HIV care and treatment programmes, most existing studies have been narrow in geographic, programmatic and temporal scope—that is focused on single clinics [ 20 , 21 , 22 ] or countries [ 23 , 24 , 25 ], as well as services for special populations [ 26 , 27 , 28 ] and the initial months of the pandemic [ 24 , 25 , 29 ]. There are limited cross‐country data on the pandemic's impacts on HIV service delivery, apart from reporting on the expansion of multi‐month dispensing of ART in PEPFAR countries [ 30 ], along with disruptions to HIV programmes reported by the Global Fund [ 31 ].…”

Task shifting healthcare services in the post-COVID world: A scoping review

“…Role modifications, however need to be complemented by changes in staff organisation and management. Abraham et al [47] described central teaching hospital in Ghana changing staff roles and rosters to complement transferring medication prescribing and dispensing antiretroviral therapy (ART) at pharmacies to nurses. TS ensured continuity of ART and reduce patient waiting time at HIV clinics.…”