Client and provider preferences for HIV care: Implications for implementing differentiated service delivery in Thailand
Sita LujintanonSorawit AmataveteThanthip SungsingPich SeekaewJitsupa PeelayPravit MingkwanrungruangTanat ChinbunchornSomsong TeeratakulpisarnPornpen MethajittiphanPrattana LeenasirimaAmarin NorchaiwongAmpaipith NilmanatPraphan PhanuphakReshmie RamautarsingNittaya Phanuphak
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Abstract Introduction Differentiated service delivery (DSD) for antiretroviral therapy (ART) maintenance embodies the client‐centred approach to tailor services to support people living with HIV in adhering to treatment and achieving viral suppression. We aimed to assess the preferences for HIV care and attitudes towards DSD for ART maintenance among ART clients and providers at healthcare facilities in Thailand. Methods A cross‐sectional study using self‐administered questionnaires was conducted in September‐November 2018 at five healthcare facilities in four high HIV burden provinces in Thailand. Eligible participants who were ART clients aged ≥18 years and ART providers were recruited by consecutive sampling. Descriptive statistics were used to summarize demographic characteristics, preferences for HIV services and expectations and concerns towards DSD for ART maintenance. Results Five hundred clients and 52 providers completed the questionnaires. Their median ages (interquartile range; IQR) were 38.6 (29.8 to 45.5) and 37.3 (27.3 to 45.1); 48.5% and 78.9% were females, 16.8% and 1.9% were men who have sex with men, and 2.4% and 7.7% were transgender women, respectively. Most clients and providers agreed that ART maintenance tasks, including ART refill, viral load testing, HIV/sexually transmitted infection monitoring, and psychosocial support should be provided at ART clinics (85.2% to 90.8% vs. 76.9% to 84.6%), by physicians (77.0% to 94.6% vs. 71.2% to 100.0%), every three months (26.7% to 40.8% vs. 17.3% to 55.8%) or six months (33.0% to 56.7% vs. 28.9% to 80.8%). Clients agreed that DSD would encourage their autonomy (84.9%) and empower responsibility for their health (87.7%). Some clients and providers disagreed that DSD would lead to poor ART retention (54.0% vs. 40.4%), increased loss to follow‐up (52.5% vs. 42.3%), and delayed detection of treatment failure (48.3% vs. 44.2%), whereas 31.4% to 50.0% of providers were unsure about these expectations and concerns. Conclusions Physician‐led, facility‐based clinical consultation visit spacing in combination with multi‐month ART refill was identified as one promising DSD model in Thailand. However, low preference for decentralization and task shifting may prove challenging to implement other models, especially since many providers were unsure about DSD benefits. This calls for local implementation studies to prove feasibility and governmental and social support to legitimize and normalize DSD in order to gain acceptance among clients and providers.Keywords:
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With an increasing use of cloud services, cloud service providers are forced to professionalize their service delivery. A service desk supports cloud service providers in this challenge. It can support a professional handling of an increasing number of service requests and it addresses the need for a stronger customer orientation as single and reliable point of contact for customers. Despite the growing importance of a service desk for cloud service providers, research and best practices in this area are still limited. The objective of this paper is to propose a set of requirements for a modern service desk for cloud service providers. Through a systematic literature review success factors for cloud service providers are defined. In a further step, a set of functional and non-functional requirements that contribute to the previously mentioned success factors are derived.
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IT service providers typically must comply with service level agreements that are part of their usage contracts with customers. Not only IT infrastructure is subject to service level guarantees such as availability or response time but also service management processes as defined by the IT infrastructure library (ITIL) such as change and incident processes and the fulfillment of service requests. SLAs relating to service management processes typically address metrics such as initial response time and fulfillment time. Large service providers have the choice of which internal service delivery team or external service provider they assign to atomic processs of a service process, each of which having different costs or prices associated with it for different turn-around times at different risk. This choice in QoS of different service providers can be used to manage the trade-off between penalty costs and fulfillment cost. This paper proposes a model as a basis for service provider choice at process request time. This model can be used to reduce total service costs of IT service providers using alternative delivery teams and external service providers.
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As more and more technologies are infused into service delivery, service providers must continuously renegotiate the ways in which they understand service delivery across increasingly high-tech, low-touch modalities. This exploratory qualitative study examines what health care service providers experience when offering separated services in the empirical context of telehealth. In-depth phenomenographic interviews sourced across multiple hospital and health care sites revealed that service providers experience (1) depersonalization, (2) clinical voyeurism, (3) intangibility negotiation, and (4) a need to manage change around identities and roles. These emergent understandings highlight the individual and qualitatively distinct differences in the ways in which service providers experience service separation in telehealth. Our findings address current service science priorities to leverage technology for service delivery as a way to advance separated service design. Further they provide an understanding-based approach toward building new theories from the service provider’s perspective on separation in technology-infused services. Our findings suggest strategies and tactics service providers use to overcome the potential challenges arising from not being physically colocated with their customers during service separation.
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Abstract Introduction HIV viral load testing in resource-limited settings is often centralized, limiting access. Near point-of-care (POC) viral load testing was introduced in Myanmar in 2017. We assessed its uptake and utilization. Methods Routine program data from three HIV clinics of Medical Action Myanmar were used. Annual viral load uptake was cross-sectionally analysed in people living with HIV (PLHIV) on antiretroviral therapy (ART) initiated between July 2009-June 2019. Attrition at two years was assessed between PLHIV with different access to viral load testing with Kaplan-Meier analysis. For those eligible for a first viral load when near POC viral load became available, a viral load cascade was constructed. We used logistic regression to explore predictors of confirmed virological failure after a first high viral load. Results Among 5271 PLHIV who started ART between July 2009-December 2019, annual viral load uptake increased significantly after near POC was introduced. Attrition in the first two years after ART initiation was not different among those eligible for a first viral load before viral load was available, after centralized laboratory-based viral load, and after near POC viral load introduction. After introduction of near POC viral load, 92% (2945/3205) of eligible PLHIV received a first viral load, a median of 2.8 years (IQR: 1.4-4.4) after initiation. The delay was 3.7 years (IQR: 2.8-5.1) and 0.9 years (IQR: 0.6-1.4) in those becoming eligible before and after near POC viral load was available, respectively. Among those with a first viral load, 95% (2796/2945) were ≤1000 copies/ml. Eighty-four % (125/149) of those with a viral load >1000 copies/ml received enhanced adherence counselling and a follow up viral load, a median of 119 days (IQR: 95-167) after the first viral load. Virological failure was confirmed in 67% (84/125), and 82% (69/84) of them were switched to second-line ART. Nine-three % (64/69) among those switched were alive on ART at end of follow-up. Having a first viral load of ≥5000 copies/ml was associated with confirmed virological failure. Conclusion Near POC viral load testing enabled rapid scale-up of viral load testing in Myanmar. PLHIV with a high viral load were adequately managed.
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Organisations are increasingly sourcing services that become part of their value proposition to their (business) customers from external providers. Often, these services are directly delivered by the service provider to the customer. The buying organisation, service provider and customer operate in a triadic service relationship. In these triads, the buying organisation lacks direct control over service delivery and thus completely depends on the service provider for a high-quality performance towards its customers. The question is, therefore, how to ensure that service is delivered in the way the buying organisation wants it to be delivered. This research uses a case-based approach to build propositions on how buying organisations can control service delivery in service triads. The buying organisation is able to control service delivery in service triads by exerting control in other phases than the service delivery phase.
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