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Clinical Trial
. 2021 Mar;14(2):175-186.
doi: 10.1007/s40271-020-00437-4.

Patient Perspectives of Quality of the Same-Day Antiretroviral Therapy Initiation Process in Gauteng Province, South Africa: Qualitative Dominant Mixed-Methods Analysis of the SLATE II Trial

Nancy A Scott  1 , Mhairi Maskew  2 , Rachel M Fong  3 , Ingrid E Olson  3 , Alana T Brennan  3   2   4 , Matthew P Fox  3   2   4 , Lungisile Vezi  2 , Peter D Ehrenkranz  5 , Sydney Rosen  3   2
Affiliations
Clinical Trial

Patient Perspectives of Quality of the Same-Day Antiretroviral Therapy Initiation Process in Gauteng Province, South Africa: Qualitative Dominant Mixed-Methods Analysis of the SLATE II Trial

Nancy A Scott et al. Patient. 2021 Mar.

Abstract

Background: HIV patients in South Africa continue to report operational barriers to starting antiretroviral therapy (ART). In the Simplified Algorithm for Treatment Eligibility (SLATE) II trial, same-day initiation (SDI) of ART increased the number of patients commencing ART and achieving HIV viral suppression by using a screening tool to distinguish between patients eligible for SDI and those requiring additional care before starting treatment. We conducted a mixed-methods evaluation to explore trial patients' perceptions and experiences of SDI.

Methods: SLATE II was implemented at three urban, public primary health care clinics in Gauteng Province, South Africa. We conducted a short quantitative survey and in-depth interviews among a purposive sample of 89 of the 593 trial participants in the intervention and standard arms, using a mixed inductive-deductive framework approach.

Results: Nearly all respondents (95%) were satisfied with their care, despite reporting clinic wait times of ≥ 3 h (72%). Intervention patients found the initiation process to be easy; standard patients found it complicated and were frustrated with being shuffled around the clinic. No intervention arm patients felt that SDI was "too fast" or indicated a preference for a more gradual process. Both groups highlighted the need for good counselling and non-judgmental, respectful staff. Standard patients suggested improving patient-provider relations, strengthening counselling, reducing wait times, and minimising referrals.

Conclusions: While it is difficult to untangle the role of providers from that of the SLATE algorithm in influencing patient experiences, adoption of SLATE II implementation procedures could improve patient experience of treatment initiation.

Trial registration: Clinicaltrials.gov NCT03315013, registered October 19, 2017.

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Conflict of interest statement

PDE is an employee of the Bill & Melinda Gates Foundation, which is funding this work. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient satisfaction responses at time of interview (mean, SD). ART antiretroviral therapy, SD standard deviation
See this image and copyright information in PMC

References

    1. World Health Organization. Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy. Geneva; 2017. - PubMed
    1. National Department of Health. Pillay - 2017 - Same-day antiretroviral therapy (ART) initiation for HIV positive patients-annotated.pdf. 2017.
    1. Rosen S, Maskew M, Larson BA, Brennan AT, Tsikhutsu I, Fox MP, et al. Simplified clinical algorithm for identifying patients eligible for same-day HIV treatment initiation (SLATE): results from an individually randomized trial in South Africa and Kenya Title. PLoS Med. 2019;16(9):e1002912. doi: 10.1371/journal.pmed.1002912. - DOI - PMC - PubMed
    1. Rosen SSS, Maskew M, Fox MPMMP, Nyoni C, Mongwenyana C, Malete G, et al. Initiating antiretroviral therapy for HIV at a patient’s first clinic visit: the RapIT randomized controlled trial. Binagwaho A, editor. PLoS Med. 2016;13(5):1002015. doi: 10.1371/journal.pmed.1002015. - DOI - PMC - PubMed
    1. Seekaew P. Same-day antiretroviral therapy initiation in Thailand: different models and initial outcomes from scale-up in 6 provinces in Thailand. In: IAS 2009 Conf. 2019.

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