People-Centered Metrics to Support HIV Service Delivery: Perceptions of Clients and Providers in Tete Province, Mozambique

Achieving the global HIV/AIDS 95-95-95 targets requires monitoring clinical outcomes as well as the experience of people living with HIV (PLHIV). A qualitative exploratory study was conducted with program staff, providers, PLHIV and PLHIV advocates at two government HIV clinics in Tete Province, Mozambique. The purpose was to explore how newly developed, people-centered outcome metrics for HIV could be used in monitoring and improving the management and provision of care. Focus group discussions and 40 semi-structured interviews explored respondents’ perceptions of the acceptability, feasibility, integrability and relevance of the indicators. Respondents noted the importance of issues raised by these indicators—such as physical symptoms, mental and emotional problems, discrimination, lack of family support, financial burden, and satisfaction with HIV services—for improving the patient experience and health outcomes. PLHIV generally said they would share information on these issues with their clinician if asked, especially if it would help improve their care. Program staff and providers shared ideas about how they might use data on these issues to improve delivery of care, though they recognized that the capacity of program staff and existing clinic systems to address the broad range of individual and social issues recorded by these metrics was a major challenge. Results of this study point to the importance of continuing to pursue efforts to examine how integration of one or more of the people-centered metrics in routine HIV care and monitoring could lead to improved clinical outcomes and client quality of life.