Understanding health facility challenges in the implementation of Option B+ guidelines in Ghana: the perspectives of health workers

Laar, Alexander Suuk; Dalinjong, Philip Ayizem; Ntim-Adu, Clarice; Anaman-Torgbor, Judith A.

doi:10.21037/jhmhp.2018.05.05

Cited by 4 publications

(13 citation statements)

References 17 publications

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“…I would have followed their instructions!' (Mother with HIV, Tanzania) (McMahon et al, 2017) As well as directly impacting on patients' experiences, these insufficiencies lead staff to feel overwhelmed, burned out, or frustrated in the face of being expected to deliver care without the necessary resources to do so (Chadambuka, et al, 2018;Doherty, et al, 2017;Hanrahan & Williams, 2017;Helova, et al, 2017;Katirayi, et al, 2016a;Kweyamba, et al, 2018;Laar, et al, 2018;Mulamba, et al, 2017;Napúa, et al, 2016;Nkhata, et al, 2016;Phiri, et al, 2018).…”

Section: Patient-provider Interactionsmentioning

confidence: 99%

“…'I tested my baby, and she was HIV-negative, then I thought I was fit and able to carry on with my daily activities, so I decided to stop taking the medication.' (Mother with HIV, Tanzania) (Sariah et al, 2019) Other studies highlighted that the quality of counselling was particularly problematic in terms of supporting clients' ability to cope with side effects and pill burden or HIV treatment fatigue (Buregyeya et al, 2017;Chadambuka et al, 2018;Erekaha et al, 2018;Flax et al, 2017b;Gill et al, 2017;Gugsa et al, 2017;Laar et al, 2018;Katirayi, L., 2016b;Katirayi, et al, 2017;Mamba & Hlongwana, 2018;McMahon et al, 2017;Nkhata et al, 2016;Phiri et al, 2018;Sariah et al, 2019;Zhou, 2016).…”

Section: Patient-provider Interactionsmentioning

confidence: 99%

“…(Mother with HIV, Rwanda) (Gill et al, 2017) Women who tested HIV positive at their first ANC visit faced a triple burden which included balancing the responsibility for attending ANC, coping with an HIV diagnosis and becoming ready to initiate ART. Women's lack of readiness to start treatment or fear of treatment often required ongoing psychosocial support, which was overlooked or not provided due to provider time constraints (Black et al, 2014;Cataldo et al, 2017;Flax et al, 2017a;Gill et al, 2017;Gugsa et al, 2017;Helova et al, 2017;Katirayi, et al, 2016a;Katirayi, L., 2016b;Kweyamba et al, 2018;Laar et al, 2018;Mamba & Hlongwana, 2018;McLean et al, 2017;McMahon et al, 2017).…”

Section: Patient-provider Interactionsmentioning

confidence: 99%

“…Health workers recognised that service access was affected by long waiting times with this being attributed to limited availability of qualified staff (Buregyeya, et al, 2017;Doherty, et al, 2017;Hanrahan, B., 2017;Helova, et al, 2017;Kweyamba, et al, 2018;Laar, et al, 2018;Mulamba, et al, 2017;Napúa, et al, 2016;Nkhata, et al, 2016).…”

Section: Services Accessibilitymentioning

confidence: 99%

“…There is too much workload on the few experienced ones around thus resulting in long waiting time for our clients.' (Healthcare Worker, Ghana) (Laar et al, 2018) Women reported how wait times led to feeling conflicted in terms of competing responsibilities, such as childcare or work commitments (;Cataldo, et al, 2017;Flax et al, 2017a;Flax et al, 2017b;Helova et al, 2017;Laar et al, 2018;McMahon et al, 2017;Napúa et al, 2016;Nkhata et al, 2016;Phiri et al, 2018). Some studies reported that women felt services were not available when they needed them.…”

Section: Services Accessibilitymentioning

confidence: 99%

See 4 more Smart Citations

Understanding the influence of health systems on women’s experiences of Option B+: A meta-ethnography of qualitative research from sub-Saharan Africa

Williams

Renju

Moshabela

et al. 2020

Global Public Health

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Section: Patient-provider Interactionsmentioning

confidence: 99%

Section: Patient-provider Interactionsmentioning

confidence: 99%

Section: Patient-provider Interactionsmentioning

confidence: 99%

Section: Services Accessibilitymentioning

confidence: 99%

Section: Services Accessibilitymentioning

confidence: 99%

See 3 more Smart Citations

Understanding the influence of health systems on women’s experiences of Option B+: A meta-ethnography of qualitative research from sub-Saharan Africa

Williams

Renju

Moshabela

et al. 2020

Global Public Health

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Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry

Nicol

Mehlomakulu

Jama

et al. 2023

BMC Health Serv Res

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Background South Africa had an estimated 7.5 million people living with HIV (PLHIV), accounting for approximately 20% of the 38.4 million PLHIV globally in 2021. In 2015, the World Health Organization recommended the universal test and treat (UTT) intervention which was implemented in South Africa in September 2016. Evidence shows that UTT implementation faces challenges in terms of human resources capacity or infrastructure. We aim to explore healthcare providers (HCPs)’ perspectives on the implementation of the UTT strategy in uThukela District Municipality in KwaZulu-Natal province. Methods A qualitative study was conducted with one hundred and sixty-one (161) healthcare providers (HCPs) within 18 healthcare facilities in three subdistricts, comprising of Managers, Nurses, and Lay workers. HCPs were interviewed using an open ended-survey questions to explore their perceptions providing HIV care under the UTT strategy. All interviews were thematically analysed using both inductive and deductive approaches. Results Of the 161 participants (142 female and 19 male), 158 (98%) worked at the facility level, of which 82 (51%) were nurses, and 20 (12.5%) were managers (facility managers and PHC manager/supervisors). Despite a general acceptance of the UTT policy implementation, HCPs expressed challenges such as increased patient defaulter rates, increased work overload, caused by the increased number of service users, and physiological and psychological impacts. The surge in the workload under conditions of inadequate systems’ capacity and human resources, gave rise to a greater burden on HCPs in this study. However, increased life expectancy, good quality of life, and immediate treatment initiation were identified as perceived positive outcomes of UTT on service users. Perceived influence of UTT on the health system included, increased number of patients initiated, decreased burden on the system, meeting the 90-90-90 targets, and financial aspects. Conclusion Health system strengthening such as providing more systems’ capacity for expected increase in workload, proper training and retraining of HCPs with new policies in the management of patient readiness for lifelong ART journey, and ensuring availability of medicines, may reduce strain on HCPs, thus improving the delivery of the comprehensive UTT services to PLHIV.

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Health provider perspectives on the implementation of the same-day-ART initiation policy in the Gauteng province of South Africa

Onoya

Mokhele

Sineke

et al. 2021

Health Res Policy Sys

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Background In September 2016, South Africa (SA) began implementing the universal-test-and-treat (UTT) policy in hopes of attaining the UNAIDS 90-90-90 targets by 2020. The SA National Department of Health provided a further directive to initiate antiretroviral therapy (ART) on the day of HIV diagnosis in September 2017. We conducted a qualitative study to determine the progress in implementing UTT and examine health providers' perspectives on the implementation of the same-day initiation (SDI) policy, six months after the policy change. Methods We conducted in-depth interviews with three professional nurses, and four HIV lay counsellors of five primary health clinics in the Gauteng province, between October and December 2017. In September 2018, we also conducted a focus group discussion with ten professional nurses/clinic managers from ten clinic facilities. The interviews and focus groups covered the adoption and implementation of UTT and SDI policies. Interviews were conducted in English, Sotho or Zulu and audio-recorded with participant consent. Audio-recordings were transcribed verbatim, translated to English and analysed thematically using NVivo 11. Results The data indicates inconsistencies across facilities and incongruities between counsellor and nursing provider perspectives regarding the SDI policy implementation. While nurses highlighted the clinical benefits of early ART initiation, they expressed concerns that immediate ART may be overwhelming for some patients, who may be unprepared and likely to disengage from care soon after the initial acceptance of ART. Accordingly, the SDI implementation was slow due to limited patient demand, provider ambivalence to the policy implementations, as well as challenges with infrastructure and human resources. The process for assessing patient readiness was poorly defined by health providers across facilities, inconsistent and counsellor dependent. Providers were also unclear on how to ensure that patients who defer treatment return for ongoing counselling. Conclusions Our results highlight important gaps in the drive to achieve the ART initiation target and demonstrate the need for further engagement with health care providers around the implementation of same-day ART initiation, particularly with regards to infrastructural/capacity needs and the management of patient readiness for lifelong ART on the day of HIV diagnosis. Additionally, there is a need for improved promotion of the SDI provision both in health care settings and in media communications to increase patient demand for early and lifelong ART.

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Understanding health facility challenges in the implementation of Option B+ guidelines in Ghana: the perspectives of health workers

Cited by 4 publications

References 17 publications

Understanding the influence of health systems on women’s experiences of Option B+: A meta-ethnography of qualitative research from sub-Saharan Africa

Understanding the influence of health systems on women’s experiences of Option B+: A meta-ethnography of qualitative research from sub-Saharan Africa

Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry

Health provider perspectives on the implementation of the same-day-ART initiation policy in the Gauteng province of South Africa

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