Booked Appointments System: An evaluation of the acceptability and feasibility of booked appointments in a large HIV clinic in Johannesburg, South Africa

Background Long queues and overcrowding are common in many of South Africa’s public healthcare facilities and may negatively impact on the quality of care provided. In HIV-related services, this problem may also affect retention. Healthcare facilities that rely on a system of patient appointments scheduled by day, and not by time, may exacerbate these issues. This study aims to improve retention and care by understanding the challenges and advantages related to the current system of booking appointments and assessing the potential for alternative systems. Methods The study was conducted in Johannesburg, South Africa at an outpatient HIV treatment clinic set within a large, urban secondary-level teaching hospital. The study is cross-sectional and includes structured interviews with providers and patients. Medical records are linked with patient interviews and observations to determine actual waiting times. Results 245 patients and 6 providers were interviewed. Of the patients interviewed, 64% were female, and 96% were Black African. Nearly a fifth of patients (19%) lost an average of USD 32 in income when attending their appointment. The most common reason for missing an appointment was that they could not be absent from work (40%), but despite this most respondents (65%) do not believe they face any challenges with the current system of booking appointments. Being able to arrive at a time convenient for them was considered a benefit by many (49%), but some (29%) recognized that this may result in overcrowding. The majority of respondents were in favor of appointments offered as a block of time in the morning or afternoon (88%) as well as appointments after work hours (85%). In comparison only just over half (58%) were in favor of booking appointments at a specific time. Most respondents (79%) believe the largest benefit to morning/afternoon block appointments would be the ability to show up at their own convenience during the block of time. Conclusions Patients value convenience highly. This may be explained by the need to be flexible around work schedules and transport options. It might be worth exploring a booking system in which patients are given a morning or afternoon appointment rather than a day. This may improve the distribution of patients throughout the day and as a result retention and care in a high-prevalence HIV setting. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was made possible by the generous support of the American people through the Presidents Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) under the terms of the cooperative agreement 674-1-12-00029 (INROADS) to the Health Economics and Epidemiology Research Office. The content is solely the responsibility of the authors and does not necessarily represent the official views of PEPFAR, USAID, NIH or the United States government. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approval to conduct the study was obtained from the study site and the Human Ethics Research Committee at the University of the Witwatersrand gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors, approval from the Human Research Ethics Committee (University of Witwatersrand) and approval from the study site who owns the clinical data.