Table 4 Challenges in providing AHD services to patients

Health Care Worker Training

I am the only one who attended the orientation [training] out of 3 clerks, which means that those who did not participate in the orientation do not know more about it apart from the information that those who attended the orientation, like me, shared with them.

(Female LC, Spoke, ART Clerk, 41)

Our friends [co-workers] advised us [information based on the training they attended]. However, second-hand information is complex because the way they understand the information in class and what they can grasp is different. I believe they did not explain everything, and some things were other because there is an element that while they were learning, they might have been on their phone, or they were thinking about something else, or they were outside, so they may not have explained everything because they missed it.

(Female LC, Hub, Adherence Support Officer, 31)

Supply availability

We often refer to significant hospitals because we need the necessary supplies to conduct the tests.

(Female HCW, Spoke, Clinician (MA/CO/MD), 29).

We need cartridges to conduct a CD4 cell count, but the supplier still needs to give us those things, so we cannot do a CD4 Cell count.

(Male HCW, Hub, Nurse Midwife tech, 27).

Patient referral forms

The main problem could be poor communication; the patients are being referred here [from the hubs] but need more documentation.

(Female HCW, Spoke, Nurse Midwife tech, 29)

Some challenges include labeling the samples; the labeling is done differently from the one on the form… most of the columns are not filled. For example, like staging, they do not fill anything on that. So, when they do not feel on the stage of the patient’s sample, it becomes difficult for us to conduct such test on such sample here at our laboratory because we do not know what difficulties we are supposed to conduct since staging guides us to know that for this sample, we are supposed to conduct such test. We have been trying to communicate with them about it, but they do not change; maybe they need another orientation on how to fill in the form.

(Male HCW, Hub, Lab technician, 50)

Patient referral systems: The issue is the means of transport. Suppose the means of transportation is available, and the ambulance has enough fuel. In that case, it is not that difficult to transfer an AHD patient from a spoke site to here as a hub site or transfer that same AHD patient from here [hub site] to a spoke site that is within the catchment area of their village where they will continue getting their medication. It is easy if the vehicle is available or if fuel is enough to cater for the transfer (Female HCW, 27).

Increased workload

Healthcare worker challenges providing services:

The AHD program increased our workload, which is vital because we assist patients fully, and it is an added task for one to have fully helped a patient without missing any condition.

(Female HCW, Spoke, Clinician (MA/CO/MD), 28).