title: 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.
abstract: 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.
authors.affiliation: Health, Community and Development, Institute of Social Psychology, London School of Economics, London, United Kingdom. C.Campbell@lse.ac.uk
authors.forename: Catherine
authors.initials: C
authors.lastname: Campbell
authors.forename: Kerry
authors.initials: K
authors.lastname: Scott
authors.forename: Claudius
authors.initials: C
authors.lastname: Madanhire
authors.forename: Constance
authors.initials: C
authors.lastname: Nyamukapa
authors.forename: Simon
authors.initials: S
authors.lastname: Gregson
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents
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