Assessing the preparedness of primary healthcare facilities for the implementation of universal test and treat in uThukela District, South Africa: a cross-sectional study

Abstract

BACKGROUND: The availability of HIV guidelines, infrastructure, essential medicines and diagnostic tests for HIV services is a prerequisite to effective universal test-and-treat (UTT) services. However, evidence on public facility readiness for UTT services in rural, high HIV prevalence areas remain limited. This study provides a snapshot of facility readiness for UTT services in selected public health facilities within the uThukela district, KwaZulu-Natal, South Africa. METHODS: A cross-sectional survey was conducted at 15 healthcare facilities in the uThukela district, KwaZulu-Natal Province, South Africa. Data were collected from public primary healthcare points, including three mobile clinics, three gateway clinics and nine Outpatient Departments, Community Health Centres and Hospitals (OPD-CHC-H). Questionnaires were programmed into Research Electronic Data Capture. Analysis was performed using STATA Software V.18, and results were summarised in percentages (%) and presented in tables and graph. RESULTS: The study highlights gaps in UTT services in uThukela district, with variability in infrastructure availability across health facility types. Mean readiness was 86% (95% CI: 77.6% to 92.1%) for OPD-CHC-H; 70% (95% CI: 60.0% to 78.7) for gateway clinics and 67% (95% CI: 56.8% to 76.0%) for mobile clinics. Mean availability of indicators for basic amenities was 61% (95% CI: 50.7% to 70.5%); 90.4% (95% CI: 82.3% to 95.0%); and 80.9% (95% CI: 70.8% to 87.3%) in mobile clinics, gateway clinics, and OPD-CHC-H, respectively. HIV test kits, palliative care guidelines and improved water sources was limited across all facility types. Overall, facility readiness was 74% (95% CI: 64.2% to 82.2%), which was deemed satisfactory according to WHO-Service Availability and Readiness Assessment criteria. CONCLUSIONS: Persistent shortages in antiretrovirals, HIV test kits, palliative care guidance and logistics/operations hinder care; integrating HIV testing into routine screenings, expanding self-testing and adopting digital and personalised care models can ease burdens and improve outcomesCite Now.