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Integrating HIV Care into Primary Care Services: Quantifying Progress of an Intervention in South Africa

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  • Kerry E Uebel
  • Gina Joubert
  • Edwin Wouters
  • Willie F Mollentze
  • Dingie H C J van Rensburg

Abstract

Background: Integration of human immunodeficiency virus (HIV) care into primary care services is one strategy proposed to achieve universal access to antiretroviral treatment (ART) for HIV-positive patients in high burden countries. There is a need for controlled studies of programmes to integrate HIV care with details of the services being integrated. Methods: A semi-quantitative questionnaire was developed in consultation with clinic staff, tested for internal consistency using Cronbach's alpha coefficients and checked for inter-observer reliability. It was used to conduct four assessments of the integration of HIV care into referring primary care clinics (mainstreaming HIV) and into the work of all nurses within ART clinics (internal integration) and the integration of pre-ART and ART care during the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) trial in South Africa. Mean total integration and four component integration scores at intervention and control clinics were compared using one way analysis of variance (ANOVA). Repeated measures ANOVA was used to analyse changes in scores during the trial. Results: Cronbach's alpha coefficients for total integration, pre-ART and ART integration and mainstreaming HIV and internal integration scores showed good internal consistency. Mean total integration, mainstreaming HIV and ART integration scores increased significantly at intervention clinics by the third assessment. Mean pre-ART integration scores were almost maximal at the first assessment and showed no further change. There was no change in mean internal integration score. Conclusion: The questionnaire developed in this study is a valid tool with potential for monitoring integration of HIV care in other settings. The STRETCH trial interventions resulted in increased integration of HIV care, particularly ART care, by providing HIV care at referring primary care clinics, but had no effect on integrating HIV care into the work of all nurses with the ART clinic.

Suggested Citation

  • Kerry E Uebel & Gina Joubert & Edwin Wouters & Willie F Mollentze & Dingie H C J van Rensburg, 2013. "Integrating HIV Care into Primary Care Services: Quantifying Progress of an Intervention in South Africa," PLOS ONE, Public Library of Science, vol. 8(1), pages 1-8, January.
  • Handle: RePEc:plo:pone00:0054266
    DOI: 10.1371/journal.pone.0054266
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    References listed on IDEAS

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    1. McCoy, D. & Chopra, M. & Loewenson, R. & Aitken, J.-M. & Ngulube, T. & Muula, A. & Ray, S. & Kureyi, T. & Ijumba, P. & Rowson, M., 2005. "Expanding access to antiretroviral therapy in sub-Saharan Africa: Avoiding the pitfalls and dangers, capitalizing on the opportunities," American Journal of Public Health, American Public Health Association, vol. 95(1), pages 18-22.
    2. Wouters, Edwin & Van Damme, Wim & Van Loon, Francis & van Rensburg, Dingie & Meulemans, Herman, 2009. "Public-sector ART in the Free State Province, South Africa: Community support as an important determinant of outcome," Social Science & Medicine, Elsevier, vol. 69(8), pages 1177-1185, October.
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