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.
