Using a clinic based creativity initiative to reduce HIV related stigma at the Infectious Diseases Institute, Mulago National Referral Hospital, Uganda.

BACKGROUND: Stigma has been associated with chronic health conditions such as HIV/AIDS, leprosy, tuberculosis, Mental illness and Epilepsy. Different forms of stigma have been identified: enacted stigma, perceived stigma, and self stigma. Stigma is increasingly regarded as a key driver of the HIV/AIDS epidemic and has a major impact on public health interventions. OBJECTIVES: The initiative was to provide activities in the clinic while patients waited to be seen by healthcare professionals. It was envisaged this would contribute to reduction of clinic based stigma felt by clients. METHODS: This was a repeated cross-sectional survey (October-November 2005 and March-April 2007) that was conducted at the Infectious Diseases Institute clinic (IDC) at Mulago, the national referral hospital in Uganda. We utilized quantitative (survey) and qualitative (key informants, focus group discussions) methods to collect the data. Data were collected on stigma before the creativity initiative intervention was implemented, and a second phase survey was conducted to assess effectiveness of the interventions. RESULTS: Clients who attended the IDC before the creativity intervention were about twice as likely to fear catching an infection as those who came after the intervention. The proportion that had fears to be seen by a friend or relative at the clinic decreased. Thus during the implementation of the Creativity intervention, HIV related stigma was reduced in this clinic setting. CONCLUSIONS: The creativity intervention helped to build self esteem and improved communication among those attending the clinic; there was observed ambiance at the clinic and clients became empowered, with creative, communication and networking skills. Improved knowledge and communication are key in addressing self stigma among HIV positive individuals.

Assessment of the patient flow at the infectious diseases institute out-patient clinic, Kampala, Uganda.

In order to cope with the increasing patient load, a study was performed to identify bottlenecks in patient flow at the Infectious Diseases out-patient clinic in Kampala, Uganda on 10 January 2005. On a standardised questionnaire we recorded for all patients: the time they presented at reception, waiting times for different services and in- and out times for nursing, counselling and doctor visits. 250 patients visited the clinic the study day: 36 (20 per cent) were asymptomatic; 133 (75 per cent) symptomatic but not critically ill and 8 (4.5 per cent) severely ill; 63 (37.5 per cent) were on antiretroviral treatment. The median time spend at the clinic was 157 minutes (range 22-426). The median time from reception to the triage/vital-signs measuring unit was 34 minutes (range 3-92), from triage nurse to doctor 51 minutes (range 1-205), from doctor to pharmacy 24 minutes (range 5-292). The median waiting time at the pharmacy was 30 minutes (range 10-175). Based on these results, organisational changes were proposed. A similar methodology could be used to evaluate and compare health service delivery systems for persons with HIV infection in Africa in order to identify the most efficient models of care.