Patients’ views on the care they receive in Express Care, a task-shifting model in HIV care, at AMPATH, Western Kenya

Abstract

The AMPATH programme has successfully operationalzed task-shifting in their Express Care (EC) model utilized in the HIV care programme, which is a clinician-supervised-nurse model. In this model, the clinician and nurse share patient visits, with majority of the visits offered by the nurse in an integrated one-stop-shop principally attending to stable patients. This model has resulted in a 50% reduction in the risk of death or lost-to-follow up in the high risk population. The views of the patients receiving EC care have not been evaluated as a measure of quality of care. The objective of the study was to explore patient views on quality of care received from the EC after implementation of the task shifting model in HIV care in Western Kenya. Cross-sectional descriptive research design was used. The study population comprised patients managed in the EC model during the study period in January and February 2011. A sample of 16 patients at saturation was selected. Data collection was by in- depth interviews and observation of patients attended to in EC. The collected data was then transcribed, categorized and coded to identify emerging themes relevant to their perceived quality of care. Of the 16 respondents interviewed majority were 40 years and above, others below, 13 were female three were men, 10 had primary education and below, 13 being stable and half of them married. Majority of the patients interviewed viewed services offered to them to be of good quality regarding patient flow, services provided and clinic environment. Only a minority of patients’ views suggested dissatisfaction on care offered during the mid-morning hours, unscheduled visits and some did not understand why they were in the EC program. It was concluded that the EC model is acceptable to patients. Task-shifting and integration used in this model is feasible and high volume HIV clinics should consider incorporating this model in their care programmes. Patient’ views should be included in improving quality of services provided to them.