AIDS and Behavior

, Volume 17, Issue 1, pp 274–283

Strategies for Optimizing Clinic Efficiency in a Community-Based Antiretroviral Treatment Programme in Uganda


    • Medical DepartmentReach Out Mbuya HIV/AIDS Initiative
  • Glenn J. Wagner
    • Health UnitRAND Corporation
  • Joseph Ouma
    • Department of Strategic PlanningManagement Sciences for Health
  • Pamela Sunday
    • Monitoring and Evaluation DepartmentReach Out Mbuya Parish HIV/AIDS Initiative
  • Laga Marie
    • HIV Epidemiology and Control UnitInstitute of Tropical Medicine
  • Robert Colebunders
    • Department of Clinical SciencesInstitute of Tropical Medicine
    • Epidemiology and Social MedicineUniversity of Antwerp
  • Fred Wabwire-Mangen
    • Department of Epidemiology and BiostatisticsMakerere University School of Public Health
Original Paper

DOI: 10.1007/s10461-012-0199-9

Cite this article as:
Alamo, S.T., Wagner, G.J., Ouma, J. et al. AIDS Behav (2013) 17: 274. doi:10.1007/s10461-012-0199-9


We address a critical aspect of antiretroviral therapy (ART) scale-up: poor clinic organization leading to long waiting times and reduced patient retention. Using a before and after study design, time and motion studies and qualitative methods we evaluated the impact of triage and longer clinic appointment intervals (triage) on clinic efficiency in a community-based program in Uganda. We compared time waiting to see and time spent with providers for various patient categories and examined patient and provider satisfaction with the triage. Overall, median time spent at the clinic reduced from 206 to 83 min. Total median time waiting to see providers for stable-ART patients reduced from 102 to 20 min while that for patients undergoing ART preparation reduced 88–37 min. Improved patient flow, patient and provider satisfaction and reduced waiting times allowed for service delivery to more patients using the same staff following the implementation of triage.


Clinic efficiencyWaiting timeTime and motionTriageAntiretroviral therapy

Copyright information

© Springer Science+Business Media, LLC 2012