HIV/AIDS has significantly affected health care practices. The need for high adherence and regular clinic visits places pressure on health care providers and patients. Poor quality of care has been described in many contexts, but some clinics have achieved excellent treatment results. Using a success case approach, this study aimed to understand factors which contribute to successful care at a South African pediatric HIV/AIDS clinic with documented high patient adherence and follow-up rates. Data included over 50 hours of ethnographic observations and interviews with a total of 35 clinic staff and caregivers. Thematic analysis highlighted strong congruence between caregiver and staff perceptions. Factors which seemed to contribute to successful care included organizational routines, staff–patient relationships, communication, teamwork, leadership, job commitment, caregivers’ negative experiences at other clinics, and faith in the “life-saving” care at this clinic. Results suggest the need for all factors to be present in order to promote quality of care. Recommendations for other clinic settings are discussed.
BraunV.ClarkeV. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.
2.
BrinkerhoffR. (2003). The success case method. San Francisco, CA: Berrett-Koehler.
3.
CampbellC.ScottK.MadanhireC.NyamukapaC.GregsonS. (2011). A ‘good hospital’: Nurse and patient perceptions of good clinical care for HIV-positive people on antiretroviral treatment in rural Zimbabwe–A mixed-methods qualitative study. International Journal of Nursing Studies, 48, 175–183.
4.
CampbellS.RolandM.BuetowS. (2000). Defining quality of care. Social Science & Medicine, 51, 1611–1625.
5.
ChopraM.DaviaudE.PattinsonR.FonnS.LawnJ. (2009). Health in South Africa 2: Saving the lives of South Africa’s mothers, babies, and children: Can the health system deliver?Lancet, 374, 835–846.
6.
ChuC.SelwynP. (2011). An epidemic in evolution: The need for new models of HIV care in the chronic disease era. Journal of Urban Health, 88, 556–566.
7.
CoovadiaH.JewkesR.BarronP.SandersD.McIntyreD. (2009). Health in South Africa 1: The health and health system of South Africa: Historical roots of current public health challenges. Lancet, 374, 817–834.
8.
CrawfordP.BrownB. (2011). Commentary: Fast healthcare: Brief communication, traps and opportunities. Patient Education and Counseling, 82, 3–10.
9.
ErlandsonD.HarrisE.SkipperB.AllenS. (1993). Doing naturalistic inquiry: A guide to methods. London, England: Sage.
10.
GarciaM.LiM.SirilH.HawkinsC.KaayaS.IsmailS.HirschhornL. (2011). Health-care worker engagement in HIV-related quality improvement in Dar es Salaam, Tanzania. International Journal for Quality in Health Care, 23, 231–238.
11.
GreenhalghT. (2008). Role of routines in collaborative work in healthcare organisations. British Medical Journal, 337, 1269–1271.
12.
GreenhalghT.VoiseyC.RobbN. (2007). Interpreted consultations as ‘business as usual’? An analysis of organisational routines in general practices. Sociology of Health & Illness, 29, 931–954.
13.
HorwoodC.VoceA.VermaakK.RollinsN.QaziS. (2010). Routine checks for HIV in children attending primary health care facilities in South Africa: Attitudes of nurses and child caregivers. Social Science & Medicine, 70, 313–320.
14.
KarimS.ChurchyardG.KarimQ.LawnS. (2009). HIV infection and tuberculosis in South Africa: An urgent need to escalate the public health response. Lancet, 374, 921–933.
15.
LewinS.GreenJ. (2009). Ritual and the organisation of care in primary care clinics in Cape Town, South Africa. Social Science & Medicine, 68, 1464–1471.
16.
MapunjoS.UrassaD. (2007). Quality standards in provision of facility based HIV care and treatment: A case study from Dar es Salaam region, Tanzania. East African Journal of Public Health, 4, 12–18.
17.
MeadN.BowerP. (2000). Patient-centredness: A conceptual framework and review of the empirical literature. Social Science & Medicine, 51, 1087–1110.
18.
MeyersT.MoultrieH.NaidooK.CottonM.EleyB.ShermanG. (2007). Challenges to pediatric HIV care and treatment in South Africa. Journal of Infectious Diseases, 196, S474–S481.
19.
MillerC.KetlhapileM.Rybasack-SmithH.RosenS. (2010). Why are antiretroviral treatment patients lost to follow-up? A qualitative study from South Africa. Tropical Medicine and International Health, 15, 48–54.
20.
MunroK. (2008). Addressing adherence to antiretroviral therapy in Ouagadougou, Burkina Faso: Insights from hospital ethnography (Unpublished masters dissertation, University of Montreal, Canada).
21.
NattrassN. (2006). Antiretroviral treatment and the problem of political will in South Africa. Southern African Journal of HIV Medicine, 23, 29–31.
22.
PattonM. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage.
23.
PennC.WatermeyerJ.EvansM. (2011). Why don’t patients take their drugs? The role of communication, context and culture in patient adherence and the work of the pharmacist in HIV/Aids. Patient Education and Counseling, 83, 310–318.
24.
RapleyT. (2011). Some pragmatics of qualitative data analysis. In SilvermanD. (Ed.), Qualitative research (3rd ed., pp. 273–290). Los Angeles, CA: Sage.
25.
RodriguezH.RogersW.MarshallR.SafranD. (2007). Multidisciplinary primary care teams: Effects on the quality of clinician-patient interactions and organizational features of care. Medical Care, 45, 19–27.
26.
RohlederP.SwartzL. (2005). ‘What I’ve noticed what they need is the stats’: Lay HIV counsellors’ reports of working in a task-orientated health care system. AIDS Care, 17, 397–406.
27.
RosenS.KetlhapileM.SanneI.Bachman DeSilvaM. (2007). Cost to patients of obtaining treatment for HIV/AIDS in South Africa. South African Medical Journal, 97, 524–529.
28.
SilvermanD.JonesJ. (1976). Organisational work: The language of grading, the grading of language. London, England: Collier MacMillan.
29.
SteinJ.LewinS.FairallL. (2007). Hope is the pillar of the universe: Health-care providers’ experiences of delivering anti-retroviral therapy in primary health-care clinics in the free state province of South Africa. Social Science & Medicine, 64, 954–964.
30.
StreetR. (2003). Communication in medical encounters: an ecological perspective. In ThompsonT.DorseyA.MillerK.ParrottR. (Eds.), The handbook of health communication (pp. 63–90). Mahwah, NJ: Lawrence Erlbaum.
31.
SutcliffeC.van DijkJ.BoltonC.PersaudD.MossW. (2008). Effectiveness of antiretroviral therapy among HIV-infected children in sub-Saharan Africa. Lancet Infectious Diseases, 8, 477–489.
32.
ThandrayenK.SaloojeeH. (2010). Quality of care offered to children attending primary health care clinics in Johannesburg. South African Journal of Child Health, 4, 73–77.
33.
ThomsonD.HassenkampA. (2008). The social meaning and function of food rituals in healthcare practice: an ethnography. Human Relations, 61, 1775–1802.
34.
TobiP.GeorgeG.SchmidtE.RentonA. (2008). Antiretroviral treatment and the health workforce in South Africa: How have ART workers been affected by scaling up?Tropical Medicine and International Health, 13, 1452–1458.
35.
Van der GeestS.FinklerK. (2004). Hospital ethnography: Introduction. Social Science & Medicine, 59, 1995–2001.
36.
WilsonI.LandonB.HirschhornL.McInnesK.DingL.MarsdenP.ClearyP. (2005). Quality of HIV care provided by nurse practitioners, physician assistants, and physicians. Annals of Internal Medicine, 143, 729–736.
World Health Organization. (2004). Standards for quality HIV care: A tool for quality assessment, improvement, and accreditation. Geneva, Switzerland: Author.
