A 'good hospital': nurse and patient perceptions of good clinical care for HIV-positive people on antiretroviral treatment in rural Zimbabwe--a mixed-methods qualitative study.
BACKGROUND
Antiretroviral treatment for HIV is gradually being made available across sub-Saharan Africa. With antiretroviral treatment, HIV can be approached as a chronic, manageable condition rather than a shorter-term issue of palliative care. This treatment involves repeated interaction between health staff and patients for ongoing check-ups and prescription refills.


OBJECTIVE
This study aimed to understand patient and healthcare staff perceptions of good clinical antiretroviral treatment care.


METHODS
Over 100 h of ethnographic observation at healthcare sites; interviews and focus groups with 25 healthcentre workers (mostly nurses), 53 HIV-positive adults taking ARVs and 40 carers of children on ART. The data were analyzed using thematic content analysis.


METHODS
Three healthcare sites providing free antiretroviral drugs in rural Zimbabwe, where the adult HIV infection rate is approximately 20%.


RESULTS
Contrary to reports of poor antiretroviral treatment adherence and task-oriented rather than patient-oriented nursing, our study found great patient commitment to adherence, outstanding nurse dedication and a pervasive sense of hope about coping with HIV. Within this context however there were some situations where patients and nurses had different expectations of the medical encounter, leading to stress and dissatisfaction. Patients and staff both emphasized the importance of nurse kindness, understanding, confidentiality and acceptance (i.e. treating HIV patients 'like normal') and patient adherence to medical directions. However, nurses at times overlooked the negative effects of long wait times and frequent hospital visits. Further, nurses sometimes conflated medical adherence with general patient obedience in all aspects of the nurse-patient relationships. Patients and staff were frustrated by the ambiguity and unpredictability surrounding key elements of hospital visits such as how much patients had to pay for service, how long it would take to be served, and whether drugs or the doctor's services would be available.
Campbell
Catherine
C
Health, Community and Development, Institute of Social Psychology, London School of Economics, London, United Kingdom. C.Campbell@lse.ac.uk
Scott
Kerry
K
Madanhire
Claudius
C
Nyamukapa
Constance
C
Gregson
Simon
S
D019380:Anti-HIV Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy* / Q000451:nursing / Q000523:psychology; D006801:Humans; D011787:Quality of Health Care; D012424:Rural Population; D015030:Zimbabwe
D019380:Anti-HIV Agents
BMC Public Health. 2008 Jul 30;8:265
18667066
PLoS Med. 2007 Oct 16;4(10):e298
17941716
Soc Sci Med. 1998 Dec;47(11):1781-95
9877348
J Nurs Adm. 1999 Jan;29(1):32-42
9921147
AIDS. 2003 Nov 21;17(17):2419-27
14600512
Hum Resour Health. 2009 Jun 23;7:50
19549319
Science. 2006 Feb 3;311(5761):664-6
16456081
Med Care. 1980 Nov;18(11):1146-57
7432014
Soc Sci Med. 2007 Feb;64(4):954-64
17140716
J Acquir Immune Defic Syndr. 2008 Aug 1;48(4):468-75
18614918
Ann Intern Med. 2009 Aug 4;151(3):157-66
19620143
AIDS Care. 2009 May;21(5):632-7
19444672
BMC Health Serv Res. 2008 Oct 09;8:210
18844998
AIDS Patient Care STDS. 2002 Jan;16(1):43-50
11839218
Int J Nurs Stud. 1994 Feb;31(1):77-86
8194938
Soc Sci Med. 2008 Jul;67(2):262-70
18455286
Bull World Health Organ. 2005 Apr;83(4):250-9
15868015
J Adv Nurs. 1999 Oct;30(4):907-15
10520104
J Acquir Immune Defic Syndr. 2008 Sep 1;49(1):107-10
18667926
AIDS. 2003 Jun 13;17(9):1369-75
12799558
Soc Sci Med. 2009 Apr;68(8):1464-71
19278764
Int J Nurs Stud. 2006 Aug;43(6):657-62
16436278
Soc Sci Med. 1993 Jun;36(11):1397-405
8511628