Journal Article Ahead of print
PubMed: 42657599 DOI: 10.1080/09540121.2026.2718806
Feasibility and acceptability of a compassion-focused program to support staff, improve workflows and enhance the clinic environment in South African primary health clinics with low ART retention.
AIDS Care
Authors: Allison J Ober, Donald H Skinner, Laura M Bogart, Leletu Busakwe, Hassan Mahomed, Debbie Ling, Virginia Zweigenthal
Affiliations
- Department of Behavioral and Policy Sciences, RAND, Santa Monica, CA, USA.
- Department of Public Health, Stellenbosch University, Cape Town, South Africa.
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
- Western Cape Department of Health and Wellness, Cape Town, South Africa.
- Department of Social Work, Monash University, Melbourne, Australia.
- School of Public Health, University of Cape Town, Cape Town, South Africa.
Abstract
South Africa has the largest HIV epidemic globally. Despite improvement, retention on antiretroviral therapy (ART) remains challenging. We used a positive deviance (PD) approach to develop a program called Connect designed to increase retention in HIV care by improving the staff and patient experience. PD consists of discovering ways in which high-performing outliers succeed despite sizable barriers and then sharing successful strategies with lower performers. Connect consists of strategies in three domains: (1) engaging, encouraging, supporting staff; (2) expediting and augmenting workflow; (3) creating a welcoming environment. In a pilot study to determine feasibility and acceptability, we conducted interviews or focus groups with leadership (N = 8) and staff (N = 12) and administered acceptability surveys (N = 20) and compassion training satisfaction surveys (N = 67) in three public health clinics in Cape Town. We reviewed implementation logs to assess feasibility and analyzed surveys and qualitative perspectives to determine acceptability. Huddles and compassion training was highly acceptable, but attendance in huddles was low, and they were not delivered as intended. Aesthetic improvements were not feasible, and workflow improvements were already implemented. A larger study is needed to test the effectiveness of huddles and compassion training on ART retention.
MeSH
Workflow, Acquired Immunodeficiency Syndrome, Surveys And Questionnaires, Retention, Psychology, Environment