Paper short abstract:

Adoption of HIV treatment implementation science is promoted by funding donors in resource-limited countries. To some degree this goal is achieved as the number of people taking up services increase, however the success comes at a cost to patients and health workers, an aspect rarely considered.

Paper long abstract:

Although recently adopted global HIV strategies have proven to be effective in expanding uptake of health services in Swaziland, this paper demonstrates that the effort to expand services rapidly and meet donor targets has also undermined patients' therapeutic experiences and overtaxed health workers, both of which are counterproductive to the ultimate goal of treatment scale-up. This paper provides insight on how the adoption of global health promoted policies play out differently when implemented in poor—resourced grassroots health facilities in rural areas of Swaziland. The paper also documents the conflicts and tensions that emanate amongst health workers when these flux policies and strategies are implemented in grassroots facilities. Furthermore, the paper demonstrates the resultant changes in the meaning of care and the shift in arrangement and administration of healthcare as influenced by an influx and permeation of global health policies into national public health systems that are burdened with disease.

The paper argues that the quest to achieve universal early access to treatment, donors must provide support that go beyond enhancing service uptake but also strengthen health systems and take seriously health worker limitations and dynamics that emanate thereof. In conclusion, the adoption of implementation science to scale-up HIV treatment should be applied with caution as it may result to bureaucratization of care delivery which becomes a deterrent and seriously affects the quality of patient experiences.