Table 3.

Perceptions of quality and acceptability of ART initiation process by patient type from SLATE II

Quality element	Standard arm	Intervention arm eligible for same-day initiation	Intervention arm not eligible for same-day initiation
Choice
Positive	Most perceived choice of when to start treatment: patients are given option of whether to initiate treatment the same day or wait for CD4 results	Patients are asked about readiness to start treatment Study staff stressed not forcing patients to do anything they do not want to	No themes emerged
Negative	Few perceived not having a choice for same-day initiation	No themes emerged	No themes emerged
Information
Positive	Patients perceived counselling as acceptable: received information about HIV, test results, medication, side effects, and lifestyle changes such as stopping smoking and drinking, eating well Counselling helped patients accept their status	Found counselling helpful to understand medication time, side effects, no CD4 count threshold, using condoms Counselling helped patients overcome fear and gain comfort and courage Felt encouraged to ask questions	Learned same-day initiation was a possibility Counselled about starting/taking ART
Negative	Perceived inadequate counselling Confusion around same-day initiation	Lacked understanding of tests
Patient perception of provider’s technical competence
Positive	Generally met patient expectations Patients thought counsellors were very good and well trained	Met patient expectations, got correct tests, medication Patients felt better treatment by the SLATE study staff than the clinic staff Patients surprised and satisfied they could initiate ART the same day Patient grateful to receive a shopping voucher	Still report receiving medication promptly (medication for other illness) High quality of care
Negative	Few had expectations of same-day initiation; thought providers were wasting time by not initiating them on treatment Some patients reported lost test results, lost files, incorrect information, wrong medication	Felt poor quality of service at the clinic (not being checked by the doctor, not assisted, lost file, asked to come back later)
Interpersonal relations
Positive	Generally positive interaction with counsellors and nurses; friendly, professional, comfortable, supportive, treated patient well, non-judgmental	Study staff were welcoming and comforting: allowed patients to be open and feel respected, did not feel rushed Liked the privacy of study staff not being from their own community	Treated well, staff caring and patient
Negative	Some reported negative interaction with providers; provider did not show any concern or cannot speak to patients properly	Some expressed concern that clinic staff will be rude/treat them disrespectfully because of their status	No themes emerged
Mechanisms to encourage continuity
Positive	Believed patients were more likely to initiate and continue taking ART if perceived good service at clinic Referred to hospital or followed up at clinic for TB care and other health problems Referred to pharmacy for medication pick up	Perceived that same-day initiation facilitates ART initiation Patients liked not having to be referred Requesting pills for three months at a time	Patients referred to the clinic side for treatment of various illnesses (TB, shingles, headache)
Negative	Believed patients were less likely to continue if long queue/wait time Patients sent from one place to another at clinic—too many places; few were not able to initiate same day	None	None
Appropriate constellation of services
Positive	Perceived process as acceptable Same-day initiation unexpected Medication pick up is easier, more options for pick up location; it was fast, did not take long—used to long wait Given specific time to pick up medication	Same-day treatment is easier for people who work or are unmotivated to come back to start treatment; SLATE treatment was faster than the clinic is usually	Pleased with short wait time, felt process was easy
Negative	No privacy when collecting medication Cards and files are different colours for HIV patients at the clinic	Clinic is full and less organised, patients feel they wait too long in the queues, sometimes do not receive medication and have to come back Cards are different colours for HIV patients at the clinic	Long wait, even just to receive treatment at the clinic

ART antiretroviral therapy, SLATE Simplified Algorithm for Treatment Eligibility, TB tuberculosis