Healthcare workers' perception of quality of care rendered to people living with HIV and non-communicable diseases at an urban district hospital in KwaZulu Natal, South Africa: a mixed mode study.

backgroundThe integrated chronic disease model (ICDM) was implemented to address two major health concerns in South Africa (SA), namely Human Immunodeficiency Virus (HIV) and non-communicable diseases (NCDs). Many facilities have adopted integrated care to manage HIV and NCDs better; however, some facilities have not fully implemented the ICDM due to challenges.

methodsThis study explored healthcare workers’ (HCWs) perceptions of the quality of care (QoC) rendered to patients with multiple comorbidities amidst these challenges. Wentworth Hospital in KwaZulu Natal, SA, was the study setting. The study’s three phases of data collection involved a structured questionnaire(n = 15), semi-structured qualitative interviews (n = 7), and a focus group discussion (FGD), (n = 6) with HCWs from the district health facility. Participants for both the quantitative and qualitative studies were purposively sampled as these were the HCWs who were directly involved in HIV and NCD management. Frequency analysis was conducted for the quantitative data. Deductive thematic content analysis was conducted for the qualitative interviews and aligned to the Donabedian Framework.

resultsFifteen participants, comprising of doctors and nurses, reported that HIV and NCDs were diagnosed, investigated and managed at the hospital. Ten participants reported that patients were referred to OPD for NCDs. The following themes aligned to the conceptual framework emerged: structure: availability of equipment and screening, staff shortages versus waiting times, accessibility, stigma; Process: integrated versus fragmented care, staff training; Outcomes: self-management, adherence and prioritisation of treatment, health education and counselling, patient outcomes and patients satisfaction.

conclusionHealthcare workers’ perceptions were that care was fragmented. Human resources, staff attitudes, waiting times, training, and high patient burdens were identified as factors that need to be addressed. This study contributes to the need to strengthen existing health systems, yielding insight into the QoC at this facility. There are many benefits and facilitators of integrating care for HIV and NCDs, but this requires support from structural and process elements. Future studies should be conducted on a bigger scale for KZN to provide evidence on models of care occurring in KZN and allow for the strengthening of health systems.