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324190
Transforming community-based primary health care through the integration of HIV-care in Free State, South Africa


Tuesday, November 3, 2015

Angeli Rawat, PhD Candidate, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
Kerry Uebel, MBBS, PhD, Centre For Health Systems Research and Development, Free State Department of Health, Bloemfontein South Africa and the University of the Free State, Bloemfontein, AL, South Africa
David Moore, MD, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
Annalee Yassi, MD MSc FRCPC, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
Jerry Speigel, PhD, School of Population and Public Health and Liu Institute for Global Issues, University of British Columbia, Vancouver, BC, Canada
purpose: Integration of HIV-care into primary health care (PHC) clinics can impact the provision of community-based PHC and is poorly understood. We aimed to describe the benefits and challenges in integrated clinics in Free State, South Africa.

methods: Qualitative data were collected from 14 focus group discussions with 114 health workers in four clinics in 2012 and eight clinics in 2013. Key informant interviews were conducted with 49 health system managers, non-governmental organisations, academics and policy makers in 2012 and 2013. Results were thematically coded and analysed utilising a health systems framework.

major results: Participants identified many positive themes related to improved efficiencies in provision of community-based comprehensive PHC including increased coordination between screening, testing and treating patients who had HIV and other conditions, especially HIV-tuberculosis and mother-child health services. Participants perceived improved coordination and continuity of care between all services, health information and general health of the population due to expanded HIV treatment resulting in fewer observed HIV-related minor ailments and opportunistic infections. However, participants also reported negative effects of integration including increased complexity of consultations, increased workload leading to longer patient wait times, and poorer quality of care for chronic disease patients. Concerns of patients defaulting due to overcrowding in clinics and disparities between HIV and non-HIV focused service provision were reported.

recommendations: The integration of HIV-care into PHC clinics can result in improved coordination between HIV and PHC service delivery. However, lack of human resources can negate the benefits and potentially compromise community-based PHC service delivery.

Learning Areas:

Program planning
Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
Describe the benefits and challenges of integrated HIV-care into primary health care clinics on community-based primary health care service provision in a high-HIV burdened, low resource context.

Keyword(s): Primary Care, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have am a PhD Candidate who has completed a multi-year province wide student focusing on the health system impact on the integration of HIV care in Primary Health Care in South Africa.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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