Healthcare provider perceptions on the implementation of the Universal Test-and-Treat policy in South Africa: A qualitative inquiry

Abstract Background The number of people living with HIV (PLHIV) in South Africa was estimated at 7.1 million, accounting for approximately 20% of the 36.9 million PLHIV globally in 2017. In 2015, the World Health Organization (WHO) recommended the universal test and treat (UTT) intervention with UNAIDS 90-90-90 targets. South Africa began implementing the UTT strategy in September 2016. We conducted a qualitative study to understand the impact of implementing the UTT strategy on the patients, healthcare providers, and the health system in uThukela District Municipality (DM) in KwaZulu-Natal province, South Africa. Methods A qualitative study design approach was conducted with one hundred and sixty-one (161) healthcare providers (HCPs) within 18 healthcare facilities in three subdistricts, comprising of Managers (facility managers and PHC manager/supervisors); Nurses (enrolled, auxiliary, and professional nurses) and Lay workers (lay counsellors, community health workers, linkage officers) were included. HCPs were interviewed using open ended-survey questions to gather their experiences with providing HIV care under the UTT strategy. Participants were consented and interviewed in English or Zulu. The HCPs’ responses were recorded on Redcap and exported to Excel for quality checks. All interviews were analysed using ATLAS.ti v.8 software. Results Despite a general acceptance of the UTT policy implementation and delivery, healthcare providers expressed challenges such as work overload, caused by the increased number of service users and the need to meet the 90-90-90 targets. The surge in the workload under conditions of inadequate systems’ capacity and human resources, gave rise to a greater burden on healthcare providers in this study. Conclusions Health system strengthening such as providing more systems’ capacity, and human resources might decrease the already over-burdened system, and thus improve the delivery of the comprehensive UTT services to people living with HIV.