Most of the clients interviewed were very thankful that they were on ART and commended the Government's efforts to roll out the ARV programme. They described the ART programme as a "life-saving" one which had given them new hope:
"Drugs bring our energy back and we are getting hope of living."
Both ARV users and staff in the facilities involved offered a number of suggestions on ways of improving the provision of ARV services. Some of the ARV users suggested that separate rooms for consultation should be made available in the facilities and that ARV medicines should be dispensed in consultation rooms to enhance client confidentiality. There were frequent requests from patients for an increase in the number of staff in order to help reduce waiting times. It was also suggested that frequent seminars should be held to remind ARV users of the importance of the appropriate use of ARVs. Other suggestions included ensuring the availability of laboratory services (including reagents) at health facilities and ensuring that medications to treat opportunistic infections were provided free of charge. In addition, some staff at Arumeru Hospital suggested that the working environment at that hospital should be improved, particularly the waiting rooms and consultation rooms.
There was a request that the Government should provide financial support to facilitate sustainable income-generating projects and food assistance for ARV users who are poor. Meanwhile, the local government was encouraged to raise awareness of HIV-related issues at community level in order to help reduce stigma. Some patients also proposed that researchers should visit them once a year to ask about the kind of problems they are facing.
Staff in the various facilities had a range of different opinions on employment-related issues, such as staffing and conditions of service, education and training, and working conditions. The most common request was that more staff should be employed in order to cope with the increasing number of ARV users. Staff working with ARV users also called for the payment of a topping-up allowance. Even those currently receiving some allowances indicated dissatisfaction at the meagre amount they receive and argued that they should be paid adequate salaries. Staff also suggested that transport should be made available for staff who provide home-based care for ARV users (monitoring treatment progress and counselling both ARV users and family members on treatment adherence). Another suggestion was that nurses on ARV programmes should be exempted from routine ward work. Meanwhile, a pharmacist working in a private health care facility in Dar es Salaam recommended that at each treatment facility a pharmacist should be responsible for dispensing ARVs.
On the issue of education and training needs, the staff recommended that community-based education and training should be made available for both ARV users and carers to help ensure that patients follow prescription instructions properly. In addition, the staff said there was a need to train staff members in HIV-related health issues, such as minimizing the risk of tuberculosis infection when caring for patients who are co-infected with tuberculosis and HIV.