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