Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry
Abstract 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...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-03-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-09281-2 |
| _version_ | 1827974704756948992 |
|---|---|
| author | Edward Nicol Vuyelwa Mehlomakulu Ngcwalisa Amanda Jama Mbuzeleni Hlongwa Wisdom Basera Desiree Pass Debbie Bradshaw |
| author_facet | Edward Nicol Vuyelwa Mehlomakulu Ngcwalisa Amanda Jama Mbuzeleni Hlongwa Wisdom Basera Desiree Pass Debbie Bradshaw |
| author_sort | Edward Nicol |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-09T19:58:39Z |
| format | Article |
| id | doaj.art-74470922d47c45ed8376c800befebf0f |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-09T19:58:39Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-74470922d47c45ed8376c800befebf0f2023-04-03T05:21:27ZengBMCBMC Health Services Research1472-69632023-03-0123111110.1186/s12913-023-09281-2Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiryEdward Nicol0Vuyelwa Mehlomakulu1Ngcwalisa Amanda Jama2Mbuzeleni Hlongwa3Wisdom Basera4Desiree Pass5Debbie Bradshaw6Burden of Disease Research Unit, South African Medical Research CouncilBurden of Disease Research Unit, South African Medical Research CouncilBurden of Disease Research Unit, South African Medical Research CouncilBurden of Disease Research Unit, South African Medical Research CouncilBurden of Disease Research Unit, South African Medical Research CouncilBurden of Disease Research Unit, South African Medical Research CouncilBurden of Disease Research Unit, South African Medical Research CouncilAbstract 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.https://doi.org/10.1186/s12913-023-09281-2Healthcare providerHIVPLHIVSame-day ARTUniversal-test-and-treat |
| spellingShingle | Edward Nicol Vuyelwa Mehlomakulu Ngcwalisa Amanda Jama Mbuzeleni Hlongwa Wisdom Basera Desiree Pass Debbie Bradshaw Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry BMC Health Services Research Healthcare provider HIV PLHIV Same-day ART Universal-test-and-treat |
| title | Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry |
| title_full | Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry |
| title_fullStr | Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry |
| title_full_unstemmed | Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry |
| title_short | Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry |
| title_sort | healthcare provider perceptions on the implementation of the universal test and treat policy in south africa a qualitative inquiry |
| topic | Healthcare provider HIV PLHIV Same-day ART Universal-test-and-treat |
| url | https://doi.org/10.1186/s12913-023-09281-2 |
| work_keys_str_mv | AT edwardnicol healthcareproviderperceptionsontheimplementationoftheuniversaltestandtreatpolicyinsouthafricaaqualitativeinquiry AT vuyelwamehlomakulu healthcareproviderperceptionsontheimplementationoftheuniversaltestandtreatpolicyinsouthafricaaqualitativeinquiry AT ngcwalisaamandajama healthcareproviderperceptionsontheimplementationoftheuniversaltestandtreatpolicyinsouthafricaaqualitativeinquiry AT mbuzelenihlongwa healthcareproviderperceptionsontheimplementationoftheuniversaltestandtreatpolicyinsouthafricaaqualitativeinquiry AT wisdombasera healthcareproviderperceptionsontheimplementationoftheuniversaltestandtreatpolicyinsouthafricaaqualitativeinquiry AT desireepass healthcareproviderperceptionsontheimplementationoftheuniversaltestandtreatpolicyinsouthafricaaqualitativeinquiry AT debbiebradshaw healthcareproviderperceptionsontheimplementationoftheuniversaltestandtreatpolicyinsouthafricaaqualitativeinquiry |