Health facilities

These were observed with a focus on issues such as structural outlay, privacy, conducive environment (structure, cleanliness, and workers' attitudes, availability of Standard Treatment Guidelines (STG) and Standard Operating Procedures (SOP); availability of medicines, adherence reminders, and availability of adherence support strategies.

Health workers

Four client visits (for ART users) per facility were observed during consultation. The type of health workers observed varied from site to site and included: receptionist/data clerks; nurses; doctors; social worker/lay adherence counsellors; and pharmacy personnel. The laboratory personnel were not observed because blood tests relating to AIDS treatment management were done by the IDCC nurses. The duty roster for each cadre was used to randomly select the staff members to be interviewed during the day of the visit. The clients observed were randomly selected from the register or as they waited for their consultation. Patients were observed over two days with two observations per day at different times of the day.

The focus was on the following: attitude; greetings; whether the patient was invited to ask questions and listened to; whether the health worker examined the patient when necessary; whether the patient was allowed to talk about any symptoms they were experiencing; whether patients were told what to do, where to go and when to come for medicine refill and review, and asked about possible side-effects; how well patients understood the instructions given and what kind of questions patients asked.