Jinja Regional Referral Hospital (JRRH) is located in the industrial town of Jinja, 80 km east of the capital city, Kampala, in the eastern region of Uganda. Established in the 1920s, it now serves as both a primary contact hospital and as a regional referral hospital for seven districts (Bugiri, Iganga, Jinja, Kaliro, Kamuli, Kayunga and Mayuge) with an overall population of 3.5 million people. The hospital has 500 beds and a staff of 360 instead of the 480 approved by the MoH.

In addition to the usual medical care programmes, the hospital is involved in regional training programmes for the Integrated Management of Childhood Illnesses (IMCI), pMTCT, VCT, and ART.

The hospital's HIV clinic runs all HIV-related programmes including ART. The hospital has three programmes for ART access:

• Free MoH programme
• Free Treat Orphans programme (JCRC-coordinated)
• Cash and Carry programme for paying patients (JCRC-coordinated).

All participants in the study at this facility were chosen from the free MoH programme. This was because the other free programme, the Treat Orphans programme, caters only for children. The patients on the free programmes collect their refills on the weekly clinic day, while the patients in the Cash and Carry programme can come on any working day to collect their refills. The Cash and Carry programme is available for anyone who does not want the inconvenience of queuing for treatment and is able to pay for the medicines.

A total of 300 patients are currently enrolled on ART through these programmes (230 on the free MoH programme, 65 on the free Treat Orphans programme and five on the Cash and Carry programme). The hospital uses the MoH treatment policy and criteria and thus offers the recommended treatment regimens for ART.

The clinic attends to all HIV-related cases one day a week. During other days of the week, patients with HIV-related problems are identified and advised to attend the weekly HIV clinic.

On a typical weekly HIV clinic day, two rooms are converted to one reception and one consultation room (on other days the same rooms are used for other routine hospital activities). Two doctors and seven nurses are assigned to attend to the HIV patients, including those on ART. Some of the nurses act as both receptionists and counsellors. About 80 patients attend the weekly clinic, of whom about 50 are already on ART. The clinic opens at 0830 hours and patients start arriving as early as 0700 hours. The patients report to reception, where their names and numbers are taken and their file retrieved from the filing cabinet. The patient's file is taken to the counsellor, who calls in the patient from the shady waiting area. After the counselling session, the patient has to queue again if they need to see the doctor. Otherwise the counsellor/nurse writes a refill prescription for the patient, who then takes the prescription to the pharmacy and sits outside waiting to be called in.