Table 5.

Recommendations from HCWs and LCs to improve AHD care across hubs and spokes

Theme	Recommendations from HCWs and LCs
Supplies and equipment	We need enough equipment always available for AHD; yes, they say cartilages for CD4 are expensive, but we need them, supply for material for screening should also be available, and if or when we run out of these things, they should quickly resupply. (Female HCW, Spoke, Clinician (MA/CO/MD), 29)
Training	Providing additional training and conducting refresher training to those healthcare workers that were trained way back would help improve our ability to provide care to AHD patients. (Female LC, Hub, HIV Diagnostic Assistant, 27) On the diagnosis, it [training] was sufficient, but on the management, it [training] needed to be increased, and we need the necessary medication at this facility. On top of that, our health workers needed to be trained on how this new treatment. So, if one client is diagnosed with cryptococcal meningitis, they are sent to the District Hospital on specified dates. (Male HCW, Hub, Nurse Midwife Tech, 27)
Counseling	Because the person has a low CD 4 count, without counseling, it does not work [adherence], but if they can train and explain to us [lay counselors] properly, we would be the ones doing the counseling. (Female LC, Hub, Hospital Attendant, 49) It usually involves telling the patient the ramifications of skipping taking medicine and the benefits of taking medication faithfully; it also involves letting them understand that they need to set their own time for taking the medication without being pressured to follow a particular schedule. We also help counsel our very own AHD patients. (Female HCW, Hub, Clinician (MA/CO/MD), 24).
Mentoring/supervision	[Another main request was] knowledge, continuous mentorship, and supervision. Those who do not know should know; on care, they should monitor our data. (Male HCW, Hub, Lab technician, 35)
Home visits	We need to strengthen our relationship with our AHD clients by at least visiting them [at home] twice a month so that we can know how they are doing or how things are going out for him or them. (Female LC, Spoke, Expert client, 45).