Barriers and facilitators to improvement in quality of care under facility-level differentiated Anti-Retroviral Therapy Service Delivery (DASD) in Bushenyi district, Uganda

Abstract

The purpose of this study was to understand the facilitators and barriers to the improvement in the quality of care under differentiated ART service delivery in Bushenyi District, Uganda. The study was conducted at four health Centre’s in the district with ART clinics including Kyabugimbi Health Centre IV, Bitooma Health Centre III, Ruhumuro Health Centre III and Kyeizooba Health Centre III. The study employed a cross sectional design and also employed both qualitative and quantitative methods. The total sample size for the quantitative study comprising of 50 health workers and 30 PLHIV from the population of 93 and 60 respectively was determined using Krejcie and Morgan`s table. The researcher also used systematic random sampling to select representative health centers. Qualitatively, the researcher used Purposive sampling to select 5 HIV service focal persons from the District health team actors for key informant interviews and 8 clients for in-depth interviews. More so, Survey was used to collect quantitative data and also KIIs and IDIs to collect qualitative data. Findings of the study revealed that health workers offer more than one of the HIV management services offered at the health centers, there is sharing of responsibilities, health workers have appropriate knowledge regarding the HIV care and treatment under facility level DASD. Challenges in the facility level under DASD include inadequate HIV care facilities and equipment’s, health workers not satisfied and motivated towards work and the work conditions, and clients still paying for some of the drugs and services. The adoption of facility level differentiated ART service delivery is anticipated to better patient outcomes, improve coverage and quality of HIV services and lead to better health systems efficiencies. However, some health systems factors hurdles the improvement in the quality of care under facility level differentiated ART service delivery and clients’ satisfaction.