Table 2 Benefits of the improved AHD package of services

(1) Benefits of the quality improvement system

It [quality improvement] has added a certain kind of value to our work because when the results are shared in real time, it means that the patient will receive the necessary treatment in time, which is quite different from the previous days where when you collect a sample from an AHD patient, we were telling them to wait at home for one week before they return to the facility. However, this new process is helping our clients to start treatment on time. (Male HCW, Hub, Lab technician, 50)

We can track the progress of the work we are doing here and be able to recognize our flaws and be able to rectify the problem (Female HCW, Spoke, Nurse midwife technician, 27)

Quality improvement has helped us so much that we can sit down and discuss our problems based on the reports. We take the issues to the QI and then discuss how we can improve the problem that we have as a hospital. For example, a separate clinic was specially made for AHD patients because it was realized that they were not receiving the necessary assistance required when information was given to them as a whole group. That decision was made based on Quality improvement. (Male LC, Hub, Adherence Support Officer, 28)

(2) Improved job satisfaction

This has just motivated us to have a strong desire to stay focused on our clients and see that everyone is getting the proper support (Female LC, Spoke, ART Clerk, 46)

It [AHD program] has improved my satisfaction because I can see the change in the work we do; I can screen assess in any way possible, and not only are we targeting clients who have AHD but also the new ones so that we can be able to classify them (Male HCW, Hub, Nurse Midwife Technician, 27)

I am satisfied when I see the excellent results that are coming out because I believe that with the coming of the AHD as a program, the main goal is that we should reduce the mortality rate for those patients that are living with HIV so because we are following this procedure, we are reducing ART deaths. Secondly, it is also encouraging us that most patients are now having their viral load suppressed since we do not want to have more patients having a high viral load, which will show that we need to work harder. So when we noticed that we had an AHD patient, and later on, because of this AHD program when the person’s sample was collected and tested for viral load. The results are suppressed viral load such that it is undetectable; we know that we are working tirelessly for this, and we are happy to see such results. (Male HCW, Hub, Reg N/M, 47)

(3) Increased ability to care for AHD patients

Our work in this program has improved the care that AHD patients get from this facility. We were missing some things in the past because of a lack of knowledge, and we lost some of our patients. However, with the coming of AHD as a program, we can know that when our HIV patient is admitted to the ward, we need to screen them for other infections. In the screening process, we diagnose some other diseases like cryptococcal meningitis, and as soon as we analyze them, we prescribe drugs to this patient. At the end of everything, we can save a life, unlike when our patients were admitted to the wards without us knowing what was happening to them. So, the coming of AHD as a program has improved the care that AHD patients receive from this facility. We know now that this patient has such conditions, and this one has this condition. (Female HCW, Spoke, Nurse midwife tech, 30)