Strategies for Optimizing Clinic Efficiency in a Community-Based Antiretroviral Treatment Programme in Uganda
- 280 Downloads
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.
KeywordsClinic efficiency Waiting time Time and motion Triage Antiretroviral therapy
We acknowledge clients and staff from ROM for providing all the information used in this study. We thank the Ugandan Ministry of Health for supporting care and treatment at ROM and the U.S. President’s Emergency Plan for AIDS Relief for the funding of HIV care. The work reported here was supported by the National Institutes of Health, Department of Health and Human Services, Public Health Services (grant number 1R24HD056651-D1).
- 1.AIDS Epidemic Update 2009 Reports 2009 [web site]. UNAIDS, Geneva. 2009. http://www.unaids.org/en/dataanalysis/epidemiology/2009aidsepidemicupdate/Country Progress All Countries.asp. Accessed 11 October 2010.
- 2.WHO, UNICEF and UNAIDS. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. Progress report 2010. World Health Organization, Geneva. 2010. http://www.who.int/hiv/pub/2008progressreport/en/. Accessed 11 October 2010.
- 3.Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach. 2010 revision. World Health Organization, Geneva. 2010. http://www.who.int/hiv/pub/arv/adult2010/en/index.html. Accessed 17 October 2010.
- 4.World Health Organization, UNAIDS, UNICEF: Towards Universal Access. Scaling up priority HIV/AIDS interventions in the health sector. Progress Report, April 2007.Google Scholar
- 19.Hendrich A, Chow M, Skierczynski BA, Lu Z. A 36-hospital time and motion study: how do medical-surgical nurses spend their time? Permanente J. 2008;12:25–34.Google Scholar
- 25.Antiretroviral Treatment in Lower Income Countries (ART-LINC) Collaboration [web site]. ART-LINC, Berne. 2010. http://ije.oxfordjournals.org/content/34/5/979.full. Accessed 17 October 2010.
- 27.Uganda National Policy on HIV Counseling and Testing. Ministry of Health, Kampala. September 2005.Google Scholar
- 28.WHO/UNAIDS. Guidance on provider-initiated HIV testing and counseling in health facilities; May 2007. http://www.who.int/mediacentre/news/releases/2007/pr24/en/index.html/. Accessed 17 September 2009.