Exploring healthcare workers’ experiences of managing patients returning to HIV care in Johannesburg, South Africa

ABSTRACT

Background

Retention of patients in HIV care is a critical barrier to reaching the UNAIDS 90–90-90 goals in South Africa. In January 2019, Anova Health Institute launched a campaign to encourage patients who had interrupted antiretroviral therapy to return to care. The Welcome Back campaign included training of health care workers and implementation of Médecins Sans Frontiers Welcome Services principles.

Objective

The aim of this study was to explore the experiences of healthcare workers managing patients reinitiating antiretroviral therapy following training, including barriers and facilitators to implementation.

Methods

Data were collected from six clinics. This study consisted of three components: 1) surveys; 2) semi-structured interviews and 3) reflexive feedback sessions. Each component covered staff attitudes and facility management of patients reinitiating antiretroviral therapy. A descriptive analysis was conducted of survey responses. A thematic approach was used to analyze interviews.

Results

Thirty-six healthcare workers completed the survey and interview. Following analysis, feedback sessions were conducted with 99 healthcare workers. Twenty-two (61%) participants were lay counsellors. The majority of healthcare workers reported managing patients returning to care appropriately. However, barriers persisted: 9 (25%) responded that patients were sent to the back of the queue and that service providers continued to insist on transfer letters. Twenty-five (69%) responded they had seen/heard other healthcare workers act poorly towards returning patients after training. Many poor behaviours from healthcare workers stemmed from frustration with the clinical flow and their overburdened work environment. Many participants (78%) believed that the Welcome Back approach helped improve client-provider relationships.

Conclusions

The Welcome Back approach supported healthcare workers to improve service provision for patients reinitiating antiretroviral therapy. Further support is needed to help providers consistently deliver services in line with the Welcome Back approach. Institutional level changes are required to implement patient-centred and trust-based models of care.

KEYWORDS:

• Re-engagement
• HIV
• retention
• organizational behavioural change
• differentiated care

Responsible Editor Jennifer Stewart Williams

Responsible Editor Jennifer Stewart Williams

Acknowledgments

Thank you to all the participants, Johannesburg Health District, the clinic staff, and Anova for allowing us to conduct this important research to help care for the HIV community.

Disclosure statement

The data are owned by the Anova Health Institute and governed by the Human Research Ethics Committee at the University of Witwatersrand, Johannesburg, South Africa. All data are stored in the central Anova repository. Data consist of interview transcripts that contain human identifying information and cannot be shared publicly for confidentiality reasons. Requests for further data may be sent to [email protected]. None of the authors have any competing interests.

Ethics and consent

Ethical approval for the study was granted by the Human Sciences Research Council, Research Ethics Committee (HREC) (approval HREC Number: REC 3/22/08/18). Written consent was obtained for interviews.

Paper context

Re-engaging clients who previously disengaged from HIV treatment programmes is critical. Certain health care workers’ attitudes and behaviours impact on the likelihood of retention and re-engagement. After training health care workers on positive re-engagement approaches, we found healthcare workers need ongoing support. Management should focus on creating an enabling environment for clients and healthcare workers, improving accountability and communication, fostering positive client-provider relationships and establishing clear client re-engagement processes that avoid disrupting existing workflows.

Additional information

Funding

This publication is made possible by the generous support of the American people through United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR) under Cooperative Agreement number 72067418CA00023 to the Anova Health Institute. The contents are the responsibility of Anova Health Institute and do not necessarily reflect the views of USAID or the United States Government. The funding body did not play a role in the design of the study, data collection, analysis, interpretation of data, or in writing the manuscript.