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Quality of care in a differentiated HIV service delivery intervention in Tanzania: A mixed methods study

Citation

Okere, Nwanneka et al. (2021), Quality of care in a differentiated HIV service delivery intervention in Tanzania: A mixed methods study, Dryad, Dataset, https://doi.org/10.5061/dryad.bcc2fqzbj

Abstract

Background: Differentiated service delivery (DSD) offers benefits to people living with HIV (improved access, peer support), and the health system (clinic decongestion, efficient service delivery). ART clubs, 15-30 clients who usually meet within the community, are one of the most common DSD options. However, evidence about the quality of care (QoC) delivered in DSD is still limited.

Materials and Methods: We conducted a concurrent triangulation mixed methods study as part of the Test & Treat project in northwest Tanzania. We surveyed QoC among stable clients and health care workers (HCW) comparing between clinics and clubs. The Donabedian framework structured the analysis into three levels of assessment: structure (staff, equipment, supplies, venue), processes (time-spent, screenings, information, HCW-attitude), and outcomes (viral load, CD4 count, self-worth, health-status).

Results: We surveyed 629 clients (40% in club) and conducted eight focus group discussions, while 24 HCW (25% in club) were surveyed and 22 individual interviews were conducted. Quantitative results revealed that in terms of structure, clubs fared better than clinics except for perceived adequacy of service delivery venue (94.4% vs 50.0%, p=0.013). For processes, time spent receiving care was significantly more in clinics than clubs (119.9 vs 49.9 minutes, p=<0.001). Regarding outcomes, the proportion of clients with recent viral load <50 copies/ml was higher in clinics than clubs (100% vs 94.4%, p=<0.001). Qualitative results indicated that quality care was perceived similarly among clients in clinics and clubs but for different reasons. Clinics were generally perceived as places with expertise and clubs as efficient places with peer-support and empathy. In describing QoC, HCW emphasized structure-related attributes while clients focused on processes. Outcomes-related themes such as improved client health status, self-worth, and confidentiality were similarly perceived across clients and HCW.

Conclusion: We found better structure and process of care in clubs than clinics with comparable outcomes. While QoC was perceived similarly in clinics and clubs, its meaning was understood differently between clients. DSD catered to individual needs of clients, either technical care in the clinic or proximate and social care in the club. Our findings highlight that both clinic and DSD care are required as many elements of QoC were individually perceived.

Methods

For clients, Quantitative data was collected using an existing instrument, the QoC from the clients’ perspective - QUOTE-HIV which was adapted to suit the study setting. For HCW, appropriate questions exploring quality of care were developed. The Donabedian framework served as a general guide for developing all study questions. Data entry was doubly done using EpiData software and the validated data exported to STATA for analysis. 

Qualitative data was collected during focus group discussions with clients and individual interviews by HCW. The data contains identifying elements and can only be shared upon reasonable request to the authors.

Usage Notes

Data is mostly complete. There are less than 5% missing fields. See details in the attached ReadMe file.

Funding

Erasmus+, Award: Framework Partnership Agreement 2013-0039, Specific Grant Agreement 2014-0681