Table 3.

Influencing factors for monitoring of ART services in decentralized settings

First author, year	Reported implementing issues/barriers for ART services under decentralized care from system perspective	Acceptability and reported quality of decentralized care from service provider and patient perspectives
Assefa, 2012 [30]	Policy: lack of regulation framework enabling nurse to perform tasks such as ARV prescription, monitoring of patients on ART Finance: high cost associated with training and monitoring quality of services Human resource: additional workload for nurse without increased remuneration/compensation; Community health workers were not permanent employee/formal health system	Patient’s perspective: Nurse led ART services was well accepted, help to reduce waiting time; provide appropriate counseling; combat stigma and discrimination in society and can help to provide opportunity for employment
Georgeu, 2012 [28]	Workload, including paperwork increased significantly for nurses and other team members through broader human resource shortage and lack of capacity (e.g. data capturers performed basic nurse duties when nurse too busy, nurse dispensed when pharmacist not available) Increased number of patients on treatment further strained scare/inadequate human and physical resources of health system: insufficiently staff and resources; fragmented information, poor patient transport/referral system; unreliable drug supplies due to poor communication, transport between pharmacy/central dispensing unit and clinics	Nurses were comfortable, motivated, enthusiastic about opportunity to be directly involve in providing life-saving ART treatment Physicians reported mix attitude: majority support decentralization and nurse initiated ART but significant minority reported uncertainty about the ability of nurses to manage and refer complicate cases Patients were supportive of decentralization as it improved access to care, reduced travel time/cost but some wanting ART to remain a separate services and expressed preference toward physician services because of higher clinical status and only doctor can medically certify social grant—key source of income for people living with HIV/AIDS in South Africa
Humphreys, 2010 [27]		Among patients interviewed in intervention group (received nurse led/primary care based ART services) 81% (25/31) were very satisfied 13% (4/31) were satisfied 3% (1/31) dissatisfied and 3% (1/31) very dissatisfied as compared to services at main hospital Reasons for satisfaction includes: reduced cost, services provided nearer to home, shorter queue and being treated better by staff. Reasons for dissatisfaction were lack of doctor and delay of service because team from hospital arrive late
Labhardt, 2012 [29]	CD4, VL and biochemistry were not available on site at decentralized settings Hemoglobin was available in 2/5 and 2/7 health centers of two studied districts