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


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.

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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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Correspondence to Stella T. Alamo.

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Alamo, S.T., Wagner, G.J., Ouma, J. et al. Strategies for Optimizing Clinic Efficiency in a Community-Based Antiretroviral Treatment Programme in Uganda. AIDS Behav 17, 274–283 (2013).

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  • Clinic efficiency
  • Waiting time
  • Time and motion
  • Triage
  • Antiretroviral therapy