DOI: 10.5061/dryad.bcc2fqzbj
title: Quality of care in a differentiated HIV service delivery intervention in Tanzania: A mixed methods study

description: Background: Differentiated service delivery (DSD) offers benefits to
 people living with HIV (improved access, peer support), and the health
 system (clinic decongestion, efficient service delivery). ART clubs, 15-30
 clients who usually meet within the community, are one of the most common
 DSD options. However, evidence about the quality of care (QoC) delivered
 in DSD is still limited. Materials and Methods: We conducted a concurrent
 triangulation mixed methods study as part of the Test & Treat
 project in northwest Tanzania. We surveyed QoC among stable clients and
 health care workers (HCW) comparing between clinics and clubs. The
 Donabedian framework structured the analysis into three levels of
 assessment: structure (staff, equipment, supplies, venue), processes
 (time-spent, screenings, information, HCW-attitude), and outcomes (viral
 load, CD4 count, self-worth, health-status). Results: We surveyed 629
 clients (40% in club) and conducted eight focus group discussions, while
 24 HCW (25% in club) were surveyed and 22 individual interviews were
 conducted. Quantitative results revealed that in terms of structure, clubs
 fared better than clinics except for perceived adequacy of service
 delivery venue (94.4% vs 50.0%, p=0.013). For processes, time spent
 receiving care was significantly more in clinics than clubs (119.9 vs 49.9
 minutes, p=&lt;0.001). Regarding outcomes, the proportion of clients
 with recent viral load &lt;50 copies/ml was higher in clinics than
 clubs (100% vs 94.4%, p=&lt;0.001). Qualitative results indicated that
 quality care was perceived similarly among clients in clinics and clubs
 but for different reasons. Clinics were generally perceived as places with
 expertise and clubs as efficient places with peer-support and empathy. In
 describing QoC, HCW emphasized structure-related attributes while clients
 focused on processes. Outcomes-related themes such as improved client
 health status, self-worth, and confidentiality were similarly perceived
 across clients and HCW. Conclusion: We found better structure and process
 of care in clubs than clinics with comparable outcomes. While QoC was
 perceived similarly in clinics and clubs, its meaning was understood
 differently between clients. DSD catered to individual needs of clients,
 either technical care in the clinic or proximate and social care in the
 club. Our findings highlight that both clinic and DSD care are required as
 many elements of QoC were individually perceived.
description: For clients, Quantitative data was collected using an existing
 instrument, the QoC from the clients’ perspective - QUOTE-HIV which was
 adapted to suit the study setting. For HCW, appropriate questions
 exploring quality of care were developed. The Donabedian framework served
 as a general guide for developing all study questions. Data entry was
 doubly done using EpiData software and the validated data exported to
 STATA for analysis.  Qualitative data was collected
 during focus group discussions with clients and individual interviews by
 HCW. The data contains identifying elements and can only be shared upon
 reasonable request to the authors.
description: Data is mostly complete. There are less than 5% missing fields.
 See details in the attached ReadMe file.