Table 3 Processes for ensuring rigor in case-study analysis adapted from Gilson et al. (2011)

Prolonged engagement

We spent 2–3 weeks at each of the six case-study facilities. Multiple on-site visits were spent engaging in informal discussions with ART clinic in-charges.

Use of theory

The analytical framework by Levesque et al. (2013) which proposes a multi-level perspective on factors affecting access to health care guided our analysis of the study findings.

Case selection

Six health facilities were purposefully selected in areas of Uganda with a relatively high HIV burden and a concentration of ART sites to enable purposive sampling.

Sampling

We aimed to have a sample that had appropriate representation of health facility demographics in Uganda with respect to a) setting (rural/urban), b) ownership-type (public, for-profit, not-for-profit), c) Level of care (tertiary, secondary, primary).

Multiple methods

Multiple methods were used including face-to-face interviews, focus group discussions (FGDs) and informal engagements with clinicians and ART Clinic in-charges.

Triangulation

Case descriptions were constructed based on triangulation across multiple data sources (Interviewee data and document review).

Negative case analysis

Emergent themes/ findings that contradicted initial assumptions were identified.

Peer debriefing and support

Data analysis at each of the four major stages involved a team-based process involving at least three authors.

Respondent validation

A multi-stakeholder data validation workshop was conducted at which the initial study findings were presented. Participant feedback informed the final analyses.