Understanding health systems challenges in providing Advanced HIV Disease (AHD) care in a hub and spoke model: a qualitative analysis to improve AHD care program in Malawi
Abstract Background Despite tremendous progress in antiretroviral therapy (ART) and access to ART, many patients have advanced human immunodeficiency virus (HIV) disease (AHD). Patients on AHD, whether initiating ART or providing care after disengagement, have an increased risk of morbidity and mort...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-024-10700-1 |
| _version_ | 1797275331999039488 |
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| author | Thulani Maphosa Lise Denoeud-Ndam Lester Kapanda Sarah Khatib Lloyd Chilikutali Eddington Matiya Boswell Munthali Rosalia Dambe Brown Chiwandira Bilaal Wilson Rose Nyirenda Laywell Nyirenda Bongani Chikwapulo Owen Madeira Musopole Appolinaire Tiam Leila Katirayi |
| author_facet | Thulani Maphosa Lise Denoeud-Ndam Lester Kapanda Sarah Khatib Lloyd Chilikutali Eddington Matiya Boswell Munthali Rosalia Dambe Brown Chiwandira Bilaal Wilson Rose Nyirenda Laywell Nyirenda Bongani Chikwapulo Owen Madeira Musopole Appolinaire Tiam Leila Katirayi |
| author_sort | Thulani Maphosa |
| collection | DOAJ |
| description | Abstract Background Despite tremendous progress in antiretroviral therapy (ART) and access to ART, many patients have advanced human immunodeficiency virus (HIV) disease (AHD). Patients on AHD, whether initiating ART or providing care after disengagement, have an increased risk of morbidity and mortality. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) launched an enhanced care package using a hub-and-spoke model to optimize AHD care in Malawi. This model improves supply availability and appropriate linkage to care. We utilized a hub-and-spoke model to share health facility challenges and recommendations on the AHD package for screening and diagnosis, prophylaxis, treatment, and adherence support. Methods This qualitative study assessed the facility-level experiences of healthcare workers (HCWs) and lay cadres (LCs) providing AHD services to patients through an intervention package. The study population included HCWs and LCs supporting HIV care at four intervention sites. Eligible study participants were recruited by trained Research Assistants with support from the health facility nurse to identify those most involved in supporting patients with AHD. A total of 32 in-depth interviews were conducted. Thematic content analysis identified recurrent themes and patterns across participants’ responses. Results While HCWs and LCs stated that most medications are often available at both hub and spoke sites, they reported that there are sometimes limited supplies and equipment to run samples and tests necessary to provide AHD care. More than half of the HCWs stated that AHD training sufficiently prepared them to handle AHD patients at both the hub and spoke levels. HCWs and LCs reported weaknesses in the patient referral system within the hub-and-spoke model in providing a linkage of care to facilities, specifically improper referral documentation, incorrect labeling of samples, and inconsistent availability of transportation. While HCWs felt that AHD registers were time-consuming, they remained motivated as they thought they provided better patient services. Conclusions These findings highlight the importance of offering comprehensive AHD services. The enhanced AHD program addressed weaknesses in service delivery through decentralization and provided services through a hub-and-spoke model, improved supply availability, and strengthened linkage to care. Additionally, addressing the recommendations of service providers and patients is essential to improve the health and survival of patients with AHD. |
| first_indexed | 2024-03-07T15:12:48Z |
| format | Article |
| id | doaj.art-251cde25fab3443d94b63db4cab2cc8e |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-07T15:12:48Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-251cde25fab3443d94b63db4cab2cc8e2024-03-05T18:05:36ZengBMCBMC Health Services Research1472-69632024-02-0124111110.1186/s12913-024-10700-1Understanding health systems challenges in providing Advanced HIV Disease (AHD) care in a hub and spoke model: a qualitative analysis to improve AHD care program in MalawiThulani Maphosa0Lise Denoeud-Ndam1Lester Kapanda2Sarah Khatib3Lloyd Chilikutali4Eddington Matiya5Boswell Munthali6Rosalia Dambe7Brown Chiwandira8Bilaal Wilson9Rose Nyirenda10Laywell Nyirenda11Bongani Chikwapulo12Owen Madeira Musopole13Appolinaire Tiam14Leila Katirayi15Elizabeth Glaser Pediatric AIDS FoundationElizabeth Glaser Pediatric AIDS FoundationElizabeth Glaser Pediatric AIDS FoundationGeorge Washington UniversityElizabeth Glaser Pediatric AIDS FoundationElizabeth Glaser Pediatric AIDS FoundationElizabeth Glaser Pediatric AIDS FoundationElizabeth Glaser Pediatric AIDS FoundationDepartment of HIV and AIDS, Ministry of HealthDepartment of HIV and AIDS, Ministry of HealthDepartment of HIV and AIDS, Ministry of HealthElizabeth Glaser Pediatric AIDS FoundationMinistry of Health, Quality Management DirectorateMinistry of Health, Quality Management DirectorateElizabeth Glaser Pediatric AIDS FoundationElizabeth Glaser Pediatric AIDS FoundationAbstract Background Despite tremendous progress in antiretroviral therapy (ART) and access to ART, many patients have advanced human immunodeficiency virus (HIV) disease (AHD). Patients on AHD, whether initiating ART or providing care after disengagement, have an increased risk of morbidity and mortality. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) launched an enhanced care package using a hub-and-spoke model to optimize AHD care in Malawi. This model improves supply availability and appropriate linkage to care. We utilized a hub-and-spoke model to share health facility challenges and recommendations on the AHD package for screening and diagnosis, prophylaxis, treatment, and adherence support. Methods This qualitative study assessed the facility-level experiences of healthcare workers (HCWs) and lay cadres (LCs) providing AHD services to patients through an intervention package. The study population included HCWs and LCs supporting HIV care at four intervention sites. Eligible study participants were recruited by trained Research Assistants with support from the health facility nurse to identify those most involved in supporting patients with AHD. A total of 32 in-depth interviews were conducted. Thematic content analysis identified recurrent themes and patterns across participants’ responses. Results While HCWs and LCs stated that most medications are often available at both hub and spoke sites, they reported that there are sometimes limited supplies and equipment to run samples and tests necessary to provide AHD care. More than half of the HCWs stated that AHD training sufficiently prepared them to handle AHD patients at both the hub and spoke levels. HCWs and LCs reported weaknesses in the patient referral system within the hub-and-spoke model in providing a linkage of care to facilities, specifically improper referral documentation, incorrect labeling of samples, and inconsistent availability of transportation. While HCWs felt that AHD registers were time-consuming, they remained motivated as they thought they provided better patient services. Conclusions These findings highlight the importance of offering comprehensive AHD services. The enhanced AHD program addressed weaknesses in service delivery through decentralization and provided services through a hub-and-spoke model, improved supply availability, and strengthened linkage to care. Additionally, addressing the recommendations of service providers and patients is essential to improve the health and survival of patients with AHD.https://doi.org/10.1186/s12913-024-10700-1HIVAdvanced HIVHealth systems challengesHub and spoke modelMalawi |
| spellingShingle | Thulani Maphosa Lise Denoeud-Ndam Lester Kapanda Sarah Khatib Lloyd Chilikutali Eddington Matiya Boswell Munthali Rosalia Dambe Brown Chiwandira Bilaal Wilson Rose Nyirenda Laywell Nyirenda Bongani Chikwapulo Owen Madeira Musopole Appolinaire Tiam Leila Katirayi Understanding health systems challenges in providing Advanced HIV Disease (AHD) care in a hub and spoke model: a qualitative analysis to improve AHD care program in Malawi BMC Health Services Research HIV Advanced HIV Health systems challenges Hub and spoke model Malawi |
| title | Understanding health systems challenges in providing Advanced HIV Disease (AHD) care in a hub and spoke model: a qualitative analysis to improve AHD care program in Malawi |
| title_full | Understanding health systems challenges in providing Advanced HIV Disease (AHD) care in a hub and spoke model: a qualitative analysis to improve AHD care program in Malawi |
| title_fullStr | Understanding health systems challenges in providing Advanced HIV Disease (AHD) care in a hub and spoke model: a qualitative analysis to improve AHD care program in Malawi |
| title_full_unstemmed | Understanding health systems challenges in providing Advanced HIV Disease (AHD) care in a hub and spoke model: a qualitative analysis to improve AHD care program in Malawi |
| title_short | Understanding health systems challenges in providing Advanced HIV Disease (AHD) care in a hub and spoke model: a qualitative analysis to improve AHD care program in Malawi |
| title_sort | understanding health systems challenges in providing advanced hiv disease ahd care in a hub and spoke model a qualitative analysis to improve ahd care program in malawi |
| topic | HIV Advanced HIV Health systems challenges Hub and spoke model Malawi |
| url | https://doi.org/10.1186/s12913-024-10700-1 |
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