Discussion
HIV care retention, viral suppression
Disengaged patients often express a disconnect between their care expectations and the provider’s style; hence, experience is bound to vary across facilities.Improving HIV health outcomes requires new strategies that minimise methodological biases and includes everyone the patient encounters during their visit, including clinical officers, doctors, nurses, data clerks and lay HCWs. Our TEC approach could contribute to getting a true reflection of how much value patients place on things such as effective communication, being greeted appropriately, or being treated with care and respect at all these different touch points. Involving patients in their own care and design of health services has been linked to improved HIV care retention and patient outcomes, such as higher viral suppression rates.Because HIV care is longitudinal, SPs, who are often used to evaluate episodic care, require highly skilled people to pose as a simulated patient making one visit to multiple clinics, posing practical implementation challenges in our setting.Our findings are consistent with a study done in South Africa which found that non-clinical dimensions of care play a bigger role in determining an overall satisfactory experience for SPs when compared with untrained patients.Female TECs were generally more critical about the care they received and would likely provide a more accurate reflection of the health system, possibly because they have better health-seeking behaviour than men, which may be strongly influenced by local gender norms and health service structures designed to engage women of reproductive age.The observed effect of training on patient experience is likely multifaceted potentially stemming from increased attention and recall to the exit survey items which solicited a feeling of empowerment to be more critical of the care received. In future studies, patient activation should be measured as an outcome to see how training changes the patient’s engagement with their care over time.