AIDS and Behavior

, Volume 17, Issue 1, pp 274–283 | Cite as

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

  • Stella T. AlamoEmail author
  • Glenn J. Wagner
  • Joseph Ouma
  • Pamela Sunday
  • Laga Marie
  • Robert Colebunders
  • Fred Wabwire-Mangen
Original Paper


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 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).


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Stella T. Alamo
    • 1
    Email author
  • Glenn J. Wagner
    • 2
  • Joseph Ouma
    • 3
  • Pamela Sunday
    • 4
  • Laga Marie
    • 5
  • Robert Colebunders
    • 6
    • 7
  • Fred Wabwire-Mangen
    • 8
  1. 1.Medical DepartmentReach Out Mbuya HIV/AIDS InitiativeKampalaUganda
  2. 2.Health UnitRAND CorporationSanta MonicaUSA
  3. 3.Department of Strategic PlanningManagement Sciences for HealthKampalaUganda
  4. 4.Monitoring and Evaluation DepartmentReach Out Mbuya Parish HIV/AIDS InitiativeKampalaUganda
  5. 5.HIV Epidemiology and Control UnitInstitute of Tropical MedicineAntwerpBelgium
  6. 6.Department of Clinical SciencesInstitute of Tropical MedicineAntwerpBelgium
  7. 7.Epidemiology and Social MedicineUniversity of AntwerpAntwerpBelgium
  8. 8.Department of Epidemiology and BiostatisticsMakerere University School of Public HealthKampalaUganda

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