PMID- 31018846 OWN - NLM STAT- MEDLINE DCOM- 20190709 LR - 20231011 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 19 IP - 1 DP - 2019 Apr 24 TI - Operational characteristics of antiretroviral therapy clinics in Zambia: a time and motion analysis. PG - 244 LID - 10.1186/s12913-019-4096-z [doi] LID - 244 AB - BACKGROUND: The mass scale-up of antiretroviral therapy (ART) in Zambia has taken place in the context of limited infrastructure and human resources resulting in many operational side-effects. In this study, we aimed to empirically measure current workload of ART clinic staff and patient wait times and service utilization. METHODS: We conducted time and motion (TAM) studies from both the healthcare worker (HCW) and patient perspectives at 10 ART clinics throughout Zambia. Trained personnel recorded times for consecutive discrete activities based on direct observation of clinical and non-clinical activities performed by counselors, clinical officers, nurses, and pharmacy technicians. For patient TAM, we recruited consenting patients and recorded times of arrival and departure and major ART services utilized. Data from 10 clinics were pooled to evaluate median time per patient spent for each activity and patient duration of stay in the clinic. RESULTS: The percentage of observed clinical time for direct patient interaction (median time per patient encounter) was 43.1% for ART counselors (4 min, interquartile range [IQR] 2-7), 46.1% for nurses (3 min, IQR 2-4), 57.2% for pharmacy technicians (2 min, IQR 1-2), and 78.5% for clinical officers (3 min, IQR 2-5). Patient workloads for HCWs were heaviest between 8 AM and 12 PM with few clinical activities observed after 2 PM. The length of patient visits was inversely associated with arrival time - patients arriving prior to 8 AM spent 61% longer at the clinic than those arriving after 8 AM (277 vs. 171 min). Overall, patients spent 219 min on average for non-clinical visits, and 244 min for clinical visits, but this difference was not significant in rural clinics. In comparison, total time patients spent directly with clinic staff were 9 and 12 min on average for non-clinical and clinical visits. CONCLUSION: Current Zambian ART clinic operations include substantial inefficiencies for both patients and HCWs, with workloads heavily concentrated in the first few hours of clinic opening, limiting HCW and patient interaction time. Use of a differentiated care model may help to redistribute workloads during operational hours and prevent backlogs of patients waiting for hours before clinic opening, which may substantially improve ART delivery in the Zambian context. FAU - Tampi, Radhika P AU - Tampi RP AD - Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. FAU - Tembo, Taniya AU - Tembo T AD - Centers for Infectious Disease Research (CIDRZ), Lusaka, Zambia. FAU - Mukumba-Mwenechanya, Mpande AU - Mukumba-Mwenechanya M AD - Centers for Infectious Disease Research (CIDRZ), Lusaka, Zambia. FAU - Sharma, Anjali AU - Sharma A AD - Centers for Infectious Disease Research (CIDRZ), Lusaka, Zambia. FAU - Dowdy, David W AU - Dowdy DW AD - Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. FAU - Holmes, Charles B AU - Holmes CB AD - Centers for Infectious Disease Research (CIDRZ), Lusaka, Zambia. FAU - Bolton-Moore, Carolyn AU - Bolton-Moore C AD - Centers for Infectious Disease Research (CIDRZ), Lusaka, Zambia. FAU - Sikazwe, Izukanji AU - Sikazwe I AD - Centers for Infectious Disease Research (CIDRZ), Lusaka, Zambia. FAU - Tucker, Austin AU - Tucker A AD - Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. FAU - Sohn, Hojoon AU - Sohn H AUID- ORCID: 0000-0001-5837-3844 AD - Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. hsohn6@jhu.edu. LA - eng GR - OPP1115306/Bill and Melinda Gates Foundation/ PT - Journal Article DEP - 20190424 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 RN - 0 (Anti-Retroviral Agents) SB - IM MH - Ambulatory Care Facilities/*organization & administration MH - Anti-Retroviral Agents/*therapeutic use MH - HIV Infections/*drug therapy MH - *Health Personnel MH - Humans MH - Rural Health Services/organization & administration MH - *Time and Motion Studies MH - Workload MH - Zambia PMC - PMC6480736 OTO - NOTNLM OT - Allocation of resources OT - Antiretroviral therapy care evaluation OT - Antiretroviral therapy program monitoring OT - Program efficiency OT - Time and motion studies OT - Workload COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: All participants provided verbal consent, as no identifiers were collected, and provision of written consent would have increased risks to participants while also biasing the study sample. The economic evaluation study protocol, inclusive of the TAM study and verbal consent, was reviewed and approved by the Institutional Review Board in Lusaka, the University of Zambia Biomedical Research Ethics Committee (UNZA BREC). CONSENT FOR PUBLICATION: Individual data was not used in any form for this study, thus consent for publication is not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2019/04/26 06:00 MHDA- 2019/07/10 06:00 PMCR- 2019/04/24 CRDT- 2019/04/26 06:00 PHST- 2018/04/23 00:00 [received] PHST- 2019/04/12 00:00 [accepted] PHST- 2019/04/26 06:00 [entrez] PHST- 2019/04/26 06:00 [pubmed] PHST- 2019/07/10 06:00 [medline] PHST- 2019/04/24 00:00 [pmc-release] AID - 10.1186/s12913-019-4096-z [pii] AID - 4096 [pii] AID - 10.1186/s12913-019-4096-z [doi] PST - epublish SO - BMC Health Serv Res. 2019 Apr 24;19(1):244. doi: 10.1186/s12913-019-4096-z.