Worldwide, an estimated 34 million people were living with HIV, but only 47% of the people
in low- and middle-income countries eligible for antiretroviral therapy (ART) were receiving
treatment at the end of 2013. Zimbabwe initiated its national ART programme in April 2004,
and since that time the benefits of such therapy have been widely documented in the
country. The scaling up of the ART programme is facilitated by the identification and
approval of ART-initiating sites using standardized assessment tools and simplified treatment
guidelines that employ the public-health approach as well as the family-centred approach. It
is now widely accepted that even resource-poor countries using a public-health approach to
HIV and AIDS care and treatment can achieve similar effectiveness with these antiretrovirals
(ARVs)as observed inmore affluent settings.
The aim of this study is to assess the effectiveness of the two different rebooking methods
practiced by Mpilo and Parirenyatwa Central Hospitals in the provision of the ART and OI
services in Zimbabwe while exploiting the work done by others on gender mainstreaming
theory, the queuing theory and deducting from McGregor‟s Theories X and Y. The study also
set to elucidate on how the need to rebook appointments arose in the health facilities in
Zimbabwe. Some of the factors that cause clients not to honour their booked appointments
were explained and validated as the study progressed to look at the best way to deal with this
seemingly minority population of People Living With HIV (PLWHIV) in Zimbabwe. This
key population is quite crucial if Zimbabwe is to put up a successful fight against HIV/AIDS.
There are deadly consequences ranging from treatment failure to multiple drug resistance up
to the much dreaded revival of the HIV related mortality/death rates that were beginning to
decline. The epitome of this study is when it will assess the performance of different patient
re-booking approaches in terms of the treatment outcomes for the patients who have been
rebooked. The study also focuses on the human-work relationships in order to assess the
silent yet salient factors that affect patient care for those patients who miss their normal
booked times in the OI/ART clinics of both Mpilo and Parirenyatwa Central Hospitals.
[iv]
Methods: Patient level treatment andCD4count measurementdata from the two facilities was
extracted using the electronic Patient Monitoring System (ePMS) in the AIDS and TB Unit of
the Ministry of Health and Child care. A sample of 10,000 patient visit records were
extracted from both facilities (giving a total of 20,000 records) from which rebooked visits
were taken (n=1219). The variables for analysis included gender, age, baseline and
subsequent CD4 counts. Key Informant Interview (KII) questionnaires were also
administered as a way of trying to get more insights and to validate the trends coming out of
the collected data. KIIs were used to assess the attitude and perceptions of the Health Care
Providers and Managers torwards patients who miss their appointments. The researcher also
undertook to observe the workflow, processes and procedures as patients came for their ART
clinics at both facilities. A desk review was also done to inform the researcher about
documentation, Standard Operating Procedures (SOPs), policies and other official
documentation or articles on public health in Zimbabwe.
Results: Of the 1,219 rebooked appointments, 842 of them were coming from one facility
while only 377 were form the other. Data was analysed using SPSS and Stata. Descriptive
statistics showed by a wide margin, the superior health seeking behaviour of the feminine
gender and this was further validated by the results of the KIIs. CD 4 count median trends
were used because the gathered data was not following any normal distribution curve. The
analysis however managed to convince the researcher that better CD4 counts were observed
at the Mpilo Central Hospital. To a greater extent positive initiatives employed in the ART
clinics resulted in fewer rebooked visits and better patient outcomes. There is currently no
electronic appointment booking and reminder systems in both facilities.
Conclusion: Although Mpilo Hospital proved to be doing everything in order to save
thousands of lives through the way that they are administering their rebooking procedure,
efforts still need to be put towards taking the ART programme to the people and improve
access to care and treatment if Zimbabwe is to completely be on top of the situation in the
fight against HIV/AIDS. This study is just the beginning of a series of studies meant to
validate and strengthen the way ART is offered in Zimbabwe after overcoming the early
stages where stigmatisation was a major hindrance and a stumbling block for many people
who died yesteryear. The research proved that where the better of the tworebooking methods
was in use, there was better patient outcomes and the health care providers are more positive.
ART treatment guidelines must not be used as an end in themselves but as a means to a
[v]
defined end. Parirenyatwa Hospital management needs to do more in order to allow
innovation and flexibility in their ART clinic. Their policies and procedures need to be more
patient focused while not neglecting the health care providers at the same time.