In 2013, Tanzania adopted Option B+ for pregnant women in all reproductive and child health (RCH) clinics. This provided lifetime access to HIV treatment and facilitated administration of antiretroviral therapy (ART) outside of specialized HIV clinics. However, the Ministry of Health and Social Welfare reported that adherence to ART and retention in treatment were problematic under the program.
RCH Option B+ clinics lacked efficient appointment systems and could not identify patients who had not arrived when expected. The ministry distributed patient appointment books and tracking systems to the clinics. However, without formal orientation on their use, staff could not understand how to use the system and promote consistent clinic attendance by HIV-positive patients.
Evaluating a new appointment and tracking system
3ie funded an impact evaluation to assess whether orienting RCH Option B+ staff on the use of a patient appointment and tracking system could improve the consistency of clinic attendance. The researchers randomized 24 matched pairs of clinics located in urban and rural areas in the Mbeya region. They interviewed key district health officials and clinic staff, and surveyed women receiving ART about their views on clinic efficiency, patient engagement, and barriers to treatment adherence and retention.
Staff members from the Option B+ clinic and the ART clinic for each intervention facility received training, followed by four rounds of monthly supportive supervision visits. Supervisors ensured that staff understood the processes for scheduling appointments, recording clinic visits, rapidly following up on missing patients and calculating monthly attendance indicators.