Abstract
Background: While HIV Testing Services (HTS) have increased, many South Africans have not been tested. Non-communicable diseases (NCDs) are the top cause of death worldwide. Integrated NCD-HTS could be a strategy to control both epidemics. Healthcare service strategies depends partially on positive user experience. We investigated client satisfaction of services and clinic flow time of an integrated NCD-HTS clinic. Methods: This prospective, cross-sectional study evaluated HTS client satisfaction with an HTS clinic at two phases. Phase 1 (February–June 2018) utilised standard HTS services: counsellor-led height/weight/BP measurements, HIV rapid testing, and symptoms screening for sexually transmitted infections/Tuberculosis. Phase 2 (June 2018–March 2019) further integrated counsellor-led obesity screening (BMI/abdominal measurements), rapid cholesterol/glucose testing; and nurse-led Chlamydia and HPV/cervical cancer screening. Socio-demographics, proportion of repeat clients, clinic flow time, and client survey data (open/closed-ended questions using five-point Likert scale) are reported. Fisher’s exact test, chi-square analysis, Kruskal Wallis test conducted comparisons. Multiple linear regression determined predictors associated with clinic time. Content thematic analysis was conducted for free response data. Results: 284 and 333 participants were from Phase 1 and 2, respectively (N=617). Phase 1 participants were significantly older (median age 36.5 (28.0–43.0) years vs. 31.0 (25.0–40.0) years; p=0.0003), divorced/widowed (6.7%, [n=19/282] vs. 2.4%, [n=8/332]; p=0.0091); had tertiary education (27.9%, [n=79/283] vs. 20.1%, [n=67/333]; p=0.0234); and were less female (53.9%, [n=153/284] vs 67.6%, [n=225/333]; p=0.0005), compared to Phase 2. Phase 2 had 10.2% repeat clients (n=34/333), and 97.9% (n=320/327) were ‘ very satisfied’ with integrated NCD-HTS, despite standard HTS having significantly shorter median time for counsellor-led HTS (36.5, interquartile range [IQR]: 31.0-45.0 vs. 41.5, IQR: 35.0-51.0; p<0.0001). Phase 2 associations with longer clinic time were clients living together/married (est=6.548; p=0.0467), more tests conducted (est=3.922; p<0.0001), higher overall satisfaction score (est=1.210; p=0.0201). Matriculated clients experienced less clinic time (est=-7.250; p=0.0253). Conclusions: It is possible to integrate counsellor-led NCD rapid testing into standard HTS within historical HTS timeframes, yielding client satisfaction. Rapid cholesterol/glucose testing should be integrated into standard HTS. Research is required on the impact of cervical cancer/HPV screenings to HTS clinic flow to determine if it could be scaled up within the public sector.
A cross-sectional study using freedom of information requests to evaluate variation in local authority commissioning of community pharmacy public health services in England
