Improving healthcare effectiveness and equity for patients through integrated HIV-care into primary health care clinics in Free State, South Africa

purpose: Integration of HIV-care into primary health care (PHC) clinics can impact patients attending integrated clinics but is poorly understood. We aimed to describe positive and negative aspects on healthcare effectiveness and equity in Free State, South Africa.

methods: Qualitative data were collected from 14 focus group discussions with 114 health workers in four clinics in 2012 and eight clinics in 2013. Key informant interviews were conducted with 49 health system managers, non-governmental organisations, academics and policy makers in 2012 and 2013. Results were thematically coded and analysed utilising a health systems framework.

results: Concerning effectiveness, participants reported positive themes that included improved HIV testing and treatment, care across the HIV-care continuum, access to various health workers and strengthened relationships among HCWs, families, communities and patients. Negative themes reported encompassed decreased health education, non-HIV service utilisation and concerns with increasing numbers of HIV treatment defaulters. Concerning equity, positive themes reported included increased access to HIV treatment for farmworkers, psycho-social and community support, and reduced stigma by the normalisation of HIV. Negative themes included remaining gaps in treatment for HIV-positive men, issues with confidentiality, and fear of HIV-status disclosure within communities.

recommendations: According to health workers and key informants integrating HIV care into PHC has had many positive, and some negative consequences for patients attending PHC clinics. Overall, integration can be beneficial for patients attending PHC clinics and can lead to more effective and equitable service provision, especially when patient confidentiality is protected and health workforce is adequately resourced.