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Table 2 Problems in delivery of care at ART sites, as identified in initial clinic meetings

From: Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention

Operational issues • Increasing workload as patients on ART were required to attend monthly to obtain supplies of ARVs
• Staff shortages and delays in filling vacant post in the ART programme
• Antagonism of primary care nurses toward ART nurses on account of their different post structures and remuneration leading to refusal to assist (some clinics)
• Long delays in taking of CD4 counts because of lack of capacity in primary care services in some areas to perform voluntary counselling and testing and CD4 counts
• Lack of integration of primary care services for patients on ART leading to multiple visits to healthcare facilities
Drug supply issues • Shortage of pharmacists and pharmacy assistants
• ARVs classified as hospital level medication which could only be dispensed by pharmacist
• Shortage of transport to deliver dispensed ARVs to assessment sites
• Lack of storage space and systems for locating individual patient's dispensed ARVs at assessment sites
• Difficulty looking for individual patient's pack of dispensed ARVs
• Differing availability of cotrimoxazole and fluconazole at ART service points
Transport issues • Patients unable to afford taxi fares to attend treatment sites for doctor's assessment
• Regular clinic transport systems becoming overwhelmed by increasing numbers of ART patients needing to go to assessment sites for monthly supply of ARVs
Communication issues at assessment sites • Few or no telephones
• No fax machines or photocopy machines
• No electricity (one clinic)
• Shortage of computers or poor connectivity causing back log in data collection
• Shortage of data clerks
Space issues • Lack of sufficient consulting rooms
• Lack of space for large drug readiness training classes
• Lack of waiting room space for ART patients