Abstract
Decentralisation of HIV care to nurse-led primary care services is being implemented across low- and middle-income countries in sub-Saharan Africa. To compare services offered to clients attending for HIV care at a physician-led and a nurse-led service in Harare, Zimbabwe. A cross-sectional study was performed at Harare Central Hospital (HCH) and Budiriro Primary Care Clinic (PCC) from June to August 2018. An interviewer-administered questionnaire was used to collect sociodemographics, HIV treatment and clinical history from clients attending for routine HIV care. The Mann-Whitney U-test was used to evaluate for differences between groups for continuous variables. For categorical variables, the χ2 test was used. The median age of the 404 participants recruited was 38 years (IQR 28-47); 69% were female. Viral suppression was comparable between sites (HCH, 70% vs. PCC, 80%; P = 0.07); however, screening for comorbidities such as cervical cancer screening (HCH, 61% vs. PCC, 41%; P = 0.001) and provision of referral services (HCH, 23% vs. PCC, 13%; P = 0.01) differed between sites. Efforts to improve service provision in primary care settings are needed to ensure equity for users of health services.
Highlights
As efforts to implement universal testing and treatment and achieve UNAIDS 90-90-90 targets (90% of people living with HIV [PLHIV] know their diagnosis, 90% of these people are accessing treatment and 90% of those on ART have achieved viral suppression) intensify globally, more people than ever are accessing antiretroviral therapy (ART)
While participants attending Harare Central Hospital (HCH) received HIV care free of charge, 186 (93%) participants at Budiriro PHC incurred a consultation fee at each visit; 14 (7%) clients were exempt from paying a consultation fee as they were older than 65 years or were employees of Harare City Municipal Service
Participants at Primary Care Clinic (PCC) were required to attend for clinical review on a 3-monthly basis compared to participants at HCH (HCH 75% vs. PCC 93%; P 0.001)
Summary
A cross-sectional study was performed at Harare Central Hospital (HCH) HIV clinic and the Budiriro Primary Care clinic (PCC) from June to August 2018. Its adult HIV outpatient clinic has 3200 registered adult clients (aged 18 years). The clinic is staffed by two physicians and 18 support staff, consisting of nurses and HIV counsellors. Budiriro PCC is situated in a high-population density suburb in south west Harare, within the catchment area of HCH. It is managed by Harare City municipal health services. It has 5400 registered clients with HIV aged 15 years. ART and cotrimoxazole are provided free of charge at this clinic; a user fee of US$1.00 is charged each time a client sees a nurse, which is required prior to collection of ART medication.
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