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Modeling the Impact of Integrating HIV and Outpatient Health Services on Patient Waiting Times in an Urban Health Clinic in Zambia

Author

Listed:
  • Sarang Deo
  • Stephanie M Topp
  • Ariel Garcia
  • Mallory Soldner
  • Kezban Yagci Sokat
  • Julien Chipukuma
  • Chibesa S Wamulume
  • Stewart E Reid
  • Julie Swann

Abstract

Background: Rapid scale up of HIV treatment programs in sub-Saharan Africa has refueled the long-standing health policy debate regarding the merits and drawbacks of vertical and integrated system. Recent pilots of integrating outpatient and HIV services have shown an improvement in some patient outcomes but deterioration in waiting times, which can lead to worse health outcomes in the long run. Methods: A pilot intervention involving integration of outpatient and HIV services in an urban primary care facility in Lusaka, Zambia was studied. Data on waiting time of patients during two seven-day periods before and six months after the integration were collected using a time and motion study. Statistical tests were conducted to investigate whether the two observation periods differed in operational details such as staffing, patient arrival rates, mix of patients etc. A discrete event simulation model was constructed to facilitate a fair comparison of waiting times before and after integration. The simulation model was also used to develop alternative configurations of integration and to estimate the resulting waiting times. Results: Comparison of raw data showed that waiting times increased by 32% and 36% after integration for OPD and ART patients respectively (p

Suggested Citation

  • Sarang Deo & Stephanie M Topp & Ariel Garcia & Mallory Soldner & Kezban Yagci Sokat & Julien Chipukuma & Chibesa S Wamulume & Stewart E Reid & Julie Swann, 2012. "Modeling the Impact of Integrating HIV and Outpatient Health Services on Patient Waiting Times in an Urban Health Clinic in Zambia," PLOS ONE, Public Library of Science, vol. 7(4), pages 1-9, April.
    • Handle: RePEc:plo:pone00:0035479
    DOI: 10.1371/journal.pone.0035479
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    References listed on IDEAS

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    1. Fabienne Shumbusho & Johan van Griensven & David Lowrance & Innocent Turate & Mark A Weaver & Jessica Price & Agnes Binagwaho, 2009. "Task Shifting for Scale-up of HIV Care: Evaluation of Nurse-Centered Antiretroviral Treatment at Rural Health Centers in Rwanda," PLOS Medicine, Public Library of Science, vol. 6(10), pages 1-12, October.
    2. Sydney Rosen & Matthew P Fox & Christopher J Gill, 2007. "Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic Review," PLOS Medicine, Public Library of Science, vol. 4(10), pages 1-11, October.
    3. Stephanie M Topp & Julien M Chipukuma & Mark Giganti & Linah K Mwango & Like M Chiko & Bushimbwa Tambatamba-Chapula & Chibesa S Wamulume & Stewart Reid, 2010. "Strengthening Health Systems at Facility-Level: Feasibility of Integrating Antiretroviral Therapy into Primary Health Care Services in Lusaka, Zambia," PLOS ONE, Public Library of Science, vol. 5(7), pages 1-11, July.
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