Open AccessA comparison of HIV outpatient care in primary and secondary healthcare-level settings in Zimbabwe
Author(s) -
Grace McHugh,
A Brunskill,
Ethel Dauya,
Tsitsi Bandason,
Tapiwanashe Bwakura,
Clemence Duri,
Shungu Munyati,
Rashida A Ferrand
Publication year - 2020
Publication title -
public health action
Language(s) - English
Resource type - Journals
ISSN - 2220-8372
DOI - 10.5588/pha.20.0006
Subject(s) - medicine , family medicine , primary health care , referral , human immunodeficiency virus (hiv) , primary care , health care , gynecology , nursing , pediatrics , population , environmental health , economics , economic growth
Setting: Decentralisation of HIV care to nurse-led primary care services is being implemented across low- and middle-income countries in sub-Saharan Africa. Objective: To compare services offered to clients attending for HIV care at a physician-led and a nurse-led service in Harare, Zimbabwe. Design: A cross-sectional study was performed at Harare Central Hospital (HCH) and Budiriro Primary Care Clinic (PCC) from June to August 2018. An interviewer-administered questionnaire was used to collect sociodemographics, HIV treatment and clinical history from clients attending for routine HIV care. The Mann-Whitney U -test was used to evaluate for differences between groups for continuous variables. For categorical variables, the χ 2 test was used. Results: The median age of the 404 participants recruited was 38 years (IQR 28–47); 69% were female. Viral suppression was comparable between sites (HCH, 70% vs. PCC, 80%; P = 0.07); however, screening for comorbidities such as cervical cancer screening (HCH, 61% vs. PCC, 41%; P = 0.001) and provision of referral services (HCH, 23% vs. PCC, 13%; P = 0.01) differed between sites. Conclusion: Efforts to improve service provision in primary care settings are needed to ensure equity for users of health services.