Exploring attitudes and perceptions of patients and staff towards an after-hours co-pay clinic supplementing free HIV services in Kampala, Uganda

Abstract

BackgroundThere has been a rapid scale up of HIV services and access to anti-retroviral therapy in Africa over the last 10 years as a result of multilateral donor funding mechanisms. However, in order to continue to expand and to sustain these services it is important that “in country” options are explored. This study sought to explore attitudes and perceptions of people living with HIV (PLHIV) and health care staff towards using a fee-based “after hours” clinic (AHC) at the Infectious Diseases Institute (IDI) in Kampala, Uganda.MethodsA cross-sectional study design, using qualitative methods for data collection was used. A purposeful sample of 188 adults including PLHIV accessing care at IDI and IDI staff were selected. We conducted 14 focus group discussions and 55 in-depth interviews. Thematic content analysis was conducted and Nvivo Software Version 10 was used to manage data.ResultsFindings suggested that some respondents were willing to pay for consultation, brand-name drugs, laboratory tests and other services. Many were willing to recommend the AHC to friends and/or relatives. However, there were concerns expressed of a risk that the co-pay model may lead to reduction in quality or provision of the free service. Respondents agreed that, as a sign of social responsibility, fees for service could help underprivileged patients.ConclusionThe IDI AHC clinic is perceived as beneficial to PLHIV because it provides access to HIV services at convenient times. Many PLHIV are willing to pay for this enhanced service. Innovations in HIV care delivery such as quality private-public partnerships may help to improve overall coverage and sustain quality HIV services in Uganda in the long term.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2524-5) contains supplementary material, which is available to authorized users.

“You would not be in a hurry to go back home”: patients’ willingness to participate in HIV/AIDS clinical trials at a clinical and research facility in Kampala, Uganda

“…This meant that one spent less time during the clinic visits and were able to attend to other personal activities. Previous studies have shown similar findings and describe the importance of patients spending less time in the clinic [ 42 , 43 ]. In addition, a sense of care and belonging was associated with receipt of regular communication on adherence and reminders about clinic appointments.…”

Leveraging the lessons learned from financing HIV programs to advance the universal health coverage (UHC) agenda in the East African Community

“…These innovations have been key in diversifying funding away from a heavy dependence on traditional partners such as PEPFAR and The Global Fund [26]. These innovations include the introduction of ‘VIP’ or ‘Executive’ HIV clinics which cater to ‘higher-tier’ clients and accordingly charge higher service fees for upper middle class Ugandans in an after-hours clinic model implemented at the Infectious Diseases Institute (IDI) clinic in Kampala in November 2013 [48, 49]. The higher service charges for these ‘higher-tier’ recipients of care are then ploughed back to support poorer HIV patients [49].…”

“…These innovations include the introduction of ‘VIP’ or ‘Executive’ HIV clinics which cater to ‘higher-tier’ clients and accordingly charge higher service fees for upper middle class Ugandans in an after-hours clinic model implemented at the Infectious Diseases Institute (IDI) clinic in Kampala in November 2013 [48, 49]. The higher service charges for these ‘higher-tier’ recipients of care are then ploughed back to support poorer HIV patients [49]. Furthermore, a section of for-profit clinics in Uganda introduced a private ‘special HIV insurance’ scheme for patients that is based on a paid annual premium that offers ‘umbrella’ coverage for all HIV-associated costs for insured clients during the year [26].…”

Understanding the dynamic interactions driving the sustainability of ART scale-up implementation in Uganda

“…In this connection, calls for increasing country ownership of ART programs in Uganda and the broader Sub Saharan Africa region are warranted. Our study adds to calls for increased domestic spending on national HIV responses [ 3 , 7 ], leveraging the growth in Uganda’s middle class by co-opting them in contributing to meeting the costs of HIV treatment [ 2 , 53 ], introduction of innovative government levies to support HIV programs such as Uganda’s proposed AIDS Trust Fund to be financed through a levy on soft drinks [ 34 ]. Although numerous studies have focused on funding for ART scale-up from the perspective of GHIs [ 27 , 28 ] and at the level of domestic government level [ 29 , 30 ], our findings demonstrate that leadership at the level of ART-providing organizations plays a critical role in raising supplemental funding for ART programs thereby promoting long-term sustainability.…”