Integrating HIV care into primary care services: quantifying progress of an intervention in South Africa.

Gina Joubert,Kerry E Uebel,Willie F Mollentze,Edwin Wouters,Dingie H C J Van Rensburg

doi:10.1371/journal.pone.0054266

Gina Joubert, Kerry E Uebel + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0054266

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Journal: PloS one	Publication Date: Jan 22, 2013
Citations: 31	License type: CC BY 4.0

Affiliation: University of the Free State, University of Antwerp

Abstract

BackgroundIntegration of human immunodeficiency virus (HIV) care into primary care services is one strategy proposed to achieve universal access to antiretroviral treatment (ART) for HIV-positive patients in high burden countries. There is a need for controlled studies of programmes to integrate HIV care with details of the services being integrated.MethodsA semi-quantitative questionnaire was developed in consultation with clinic staff, tested for internal consistency using Cronbach's alpha coefficients and checked for inter-observer reliability. It was used to conduct four assessments of the integration of HIV care into referring primary care clinics (mainstreaming HIV) and into the work of all nurses within ART clinics (internal integration) and the integration of pre-ART and ART care during the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) trial in South Africa. Mean total integration and four component integration scores at intervention and control clinics were compared using one way analysis of variance (ANOVA). Repeated measures ANOVA was used to analyse changes in scores during the trial.ResultsCronbach's alpha coefficients for total integration, pre-ART and ART integration and mainstreaming HIV and internal integration scores showed good internal consistency. Mean total integration, mainstreaming HIV and ART integration scores increased significantly at intervention clinics by the third assessment. Mean pre-ART integration scores were almost maximal at the first assessment and showed no further change. There was no change in mean internal integration score.ConclusionThe questionnaire developed in this study is a valid tool with potential for monitoring integration of HIV care in other settings. The STRETCH trial interventions resulted in increased integration of HIV care, particularly ART care, by providing HIV care at referring primary care clinics, but had no effect on integrating HIV care into the work of all nurses with the ART clinic.

Highlights

There is international agreement that universal access to treatment for people with human immunodeficiency virus (HIV) in high-burden countries will not be achieved by vertical or single disease approaches to delivering HIV care, but rather by providing HIV care within general health systems [1,2,3]
This paper describes the development of a questionnaire as a tool to quantify integration of HIV care into primary care services achieved during a controlled trial of a complex intervention in the Free State Province of South Africa
Progress of integration In an initial analysis of the changes in scores across all clinics for individual questions, the four questions that showed the largest absolute increases in integration scores between the first and fourth assessments were questions 13,15,17 and 19 – all questions dealing with the mainstreaming of antiretroviral treatment (ART) care

Summary

Introduction

There is international agreement that universal access to treatment for people with human immunodeficiency virus (HIV) in high-burden countries will not be achieved by vertical or single disease approaches to delivering HIV care, but rather by providing HIV care within general health systems [1,2,3]. Calls have been made to use international funding and support for HIV care to strengthen general health systems, and broaden existing vertical HIV programmes so as to provide HIV care within general health systems – the so-called diagonal approach [4,5].Various strategies have been used in order to do this in countries with severe human resource shortages and struggling health care systems. These include shifting tasks from highly skilled to lower skilled and even lay health workers, mobilising community support and integrating HIV care into primary care services [3]. There is a need for controlled studies of programmes to integrate HIV care with details of the services being integrated

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Conclusion