Feasibility and acceptability of a compassion-focused program to support staff, improve workflows and enhance the clinic environment in South African primary health clinics with low ART retention

South Africa has the largest HIV epidemic globally. Despite improvement, retention on antiretroviral therapy (ART) remains challenging. We used a positive deviance (PD) approach to develop a program called Connect designed to increase retention in HIV care by improving the staff and patient experience. PD consists of discovering ways in which high-performing outliers succeed despite sizable barriers and then sharing successful strategies with lower performers. Connect consists of strategies in three domains: (1) engaging, encouraging, supporting staff; (2) expediting and augmenting workflow; (3) creating a welcoming environment. In a pilot study to determine feasibility and acceptability, we conducted interviews or focus groups with leadership (N = 8) and staff (N = 12) and administered acceptability surveys (N = 20) and compassion training satisfaction surveys (N = 67) in three public health clinics in Cape Town. We reviewed implementation logs to assess feasibility and analyzed surveys and qualitative perspectives to determine acceptability. Huddles and compassion training was highly acceptable, but attendance in huddles was low, and they were not delivered as intended. Aesthetic improvements were not feasible, and workflow improvements were already implemented. A larger study is needed to test the effectiveness of huddles and compassion training on ART retention.