Patient and nurse perspectives of a nurse-led community-based model of HIV care delivery in Malawi: a qualitative study

Abstract

Background: Differentiated models of care (DMOC) are used to make antiretroviral therapy (ART) accessible to people living with HIV (PLHIV). In Malawi, Lighthouse Trust has piloted various DMOCs aimed at providing quality care while reducing personal and logistical barriers when accessing clinic-based healthcare. One of the approaches was community-based provision of ART by nurses to stable patients. Methods: To explore how the nurse-led community ART programme (NCAP) is perceived, we interviewed eighteen purposively selected patients receiving ART through NCAP and the four nurses providing the community-based health care. Information obtained from them was complemented with observations by the study team. Interviews were recorded and transcribed. Data was analysed using manual coding and thematic analysis. Results: Through the NCAP, patients were able to save money on transportation and the time it took them to travel to a health facility. Caseloads and waiting times were also reduced, which made patients more comfortable and gave nurses the time to conduct thorough consultations. Closer relationships were built between patients and care providers, creating a space for more open conversations (although this required care providers to set clear boundaries and stick to schedule). Patients' nutritional needs and concerns related to stigma remain a concern, while operational issues affect the quality of the services provided in the community. Considerations for community-led healthcare programmes include the provision of transportation for care providers; the physical structure of community sites (in regard to private spaces); the timely consolidation of data collected in the field to a central database; and the need for care providers to cover multiple facility-based staff roles. Conclusions: The patients interviewed in this study preferred the NCAP approach to the facility-based model of care because it saved them money on transport, reduced waiting-times, and allowed for a more thorough consultation, while continuing to provide quality HIV care. However, when considering a community-level DMOC approach, certain factorsincluding staff transportation and workloadmust be taken into consideration and purposefully planned.

Interventions to improve early retention of patients in antiretroviral therapy programmes in sub-Saharan Africa: A systematic review

“…The models included a community pharmacy-based ART refill, community based ART delivery programme and Family Clinic Day. Such model aim at providing quality care while reducing personal and logistical barriers to access to ART and are preferred by clients as it saves them money on transport, reduce waiting time and allow for a more thorough consultation while continuing to provide quality HIV care [ 45 ]. This review suggests that point of care HIV testing of infants at birth improve retention and viral suppression of infants in care.…”

“…reduce waiting time and allow for a more thorough consultation while continuing to provide quality HIV care [45]. This review suggests that point of care HIV testing of infants at birth improve retention and viral suppression of infants in care.…”

Experiences and Perceptions on Community Client-Led ART Delivery (CCLADS) Model of Antiretroviral (ART) Delivery: Patients’ and Providers’ Perspectives in South Western Uganda

“…This is similar to a study done in Malawi where stigma still remained a major concern. 34 Kizito’s study further emphasized that some patients still have not fully disclosed their status which prevents them from freely going to the meeting points to collect their refills associating it to lack of confidentiality. 26 …”

“…This is similar to a study done in Malawi where stigma still remained a major concern. 34 Kizito's study further emphasized that some patients still have not fully disclosed their status which prevents them from freely going to the meeting points to collect their refills associating it to lack of confidentiality. 26 Different clients shared what would be preventing adult HIV patients to join CCLADs where stigma was more prominent and this made members prefer not to be part of the CCLADS.…”

“…26 Different clients shared what would be preventing adult HIV patients to join CCLADs where stigma was more prominent and this made members prefer not to be part of the CCLADS. From the interviews, patients in CCLADs always gather up in one place for meetings or even when picking drugs, some of the group members tend to expose themselves and people in the community begin talking about them as people living with HIV which causes stigma to others who would like to join CCLADs which showed lack of confidentiality 34 . Also reduced drug stocks at the facility, leading to shorter refills which eventually make the CCLAD members frequent the facility and eventually causing missed appointments by some members.…”