Procedures for TECs and UECs
Efforts to ‘standardise’ assessment of the quality and nature of care in HIV differ from most previously standardised patient or mystery client work in that HIV care is longitudinal as opposed to episodic or acute care. Under these circumstances, the more conventional standardised patient where a single trained actor can present to multiple different care facilities as a simulated patient with a defined set of symptoms or complaints to assess a single episode of care is not feasible. For example, a patient would have to either register as a new patient or have a false ‘file’ introduced into the paper and electronic medical records—which was deemed infeasible and undesirable.Instead of simulated patients, we recruited existing patients already receiving care at a particular facility and then subsequently trained them on the concepts of quality of care according to the MOH manual on Quality Improvement for HCWs in Zambia. To avoid disclosing their trained status, patients were recruited on the day of their visit prior to them entering the triage area (ie, the first point of contact with HCWs). Those who consented underwent single one-on-one training session for 40–60 min where they were sensitised to the study instrument (which was the same for both TECs and UECs), the MOH care standards and strategies on being natural yet observant during their clinic visit for that day according to the standard SP approach. These procedures were meant to ensure patients had a clear and uniform understanding on what they should expect during a high-quality patient visit and were attentive to these critical aspects relative to these standards. Immediately after this training, the TEC presented themselves to their facility and completed their visit as they normally would. After their clinic encounter, participants then completed the exit survey in a private area.For the UEC surveys, we took a systematic (every nFor both TEC and UEC, all interviews and surveys were conducted in either English, Bemba or Nyanja depending on the participant’s preference. Given the extra time commitments required for the training, TEC participants were given K100 (~$5) for the time spent during training as well as a light snack during the survey administration.