Factors that influence the satisfaction of people living with HIV with differentiated antiretroviral therapy delivery models in East Central Uganda: a cross-sectional study
Abstract Background The World Health Organization (WHO) and the Uganda Ministry of Health recommend differentiated service delivery models (DSDMs) as patient-centered antiretroviral therapy (ART) mechanisms for people living with HIV/AIDS (PLHIV) with undetectable viral loads. We studied patient sat...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-023-09114-2 |
| _version_ | 1811166032802349056 |
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| author | Keith Baleeta Augustin Muhwezi Nathan Tumwesigye Betty Nsangi Kintu Sara Riese Dathan Byonanebye Martin Mbonye Daniel Mwehire Robert Iriso Bernard Ayebazibwe Lauren Bailey Deborah Lopez Laura McGough Michael Etukoit Dyogo Nantamu Louisa Nakitende Baker Tibengana Jacob Wasswa |
| author_facet | Keith Baleeta Augustin Muhwezi Nathan Tumwesigye Betty Nsangi Kintu Sara Riese Dathan Byonanebye Martin Mbonye Daniel Mwehire Robert Iriso Bernard Ayebazibwe Lauren Bailey Deborah Lopez Laura McGough Michael Etukoit Dyogo Nantamu Louisa Nakitende Baker Tibengana Jacob Wasswa |
| author_sort | Keith Baleeta |
| collection | DOAJ |
| description | Abstract Background The World Health Organization (WHO) and the Uganda Ministry of Health recommend differentiated service delivery models (DSDMs) as patient-centered antiretroviral therapy (ART) mechanisms for people living with HIV/AIDS (PLHIV) with undetectable viral loads. We studied patient satisfaction with ART services, and its associated factors amongst PLHIV enrolled in DSDMs in Uganda. Methods This cross-sectional study involved a random sample of PLHIV accessing DSDM-related ART at nine facilities in East Central Uganda. Eligible patients were adult PLHIV (≥18 years), on ART, and enrolled for at least 12 months in one of three DSDMs: Community Client-Led ART Delivery (CCLAD), Community Drug Distribution Points (CDDP), or Fast-Track Drug Refill (FTDR). We collected data from June to July 2019. A validated tool measured satisfaction. General Estimating Equations with modified Poisson regression and exchangeable correlation structures accounted for clustering at health facilities and identified DSDM-related satisfaction factors. Results Of 842 participants enrolled, 530 (63.5%) accessed HIV care through CDDP, 166 (20.1%) through CCLAD, and 146 (16.3%) through FTDR; 541 (64.2%) were satisfied with DSDM services: 78.7% in CDDP, 42.8% in CCLAD, and 36.3% in FTDR. The delivery and treatment factors positively associated with satisfaction included: being enrolled on CDDP [adjusted prevalence ratio (aPR) = 1.51, 95% CI:1.47–1.56] or FTDR [aPR = 1.47, 95% CI:1.26–1.71] relative to CCLAD and being enrolled in a DSDM for more than 3 years [aPR = 1.28, 95% CI:1.11–1.48]. Poor ART adherence [aPR = 0.33, 95% CI:0.19–0.56] and having a baseline WHO HIV stage of 3 or 4 [aPR = 0.36, 95% CI:0.20–0.64] relative to stages 1 and 2 were negatively associated. Among socioeconomic factors, having lower transport costs (< $1.35) per clinic visit [aPR = 1.34, 95% CI:1.17–1.53], being employed [aPR = 1.61, 95% CI:1.38–1.87], and being single [aPR = 1.10, 95% CI:1.08–1.13] were positively associated with satisfaction; drinking alcohol at least once a week [aPR = 0.77, 95% CI:0.63–0.93] was negatively associated with patient satisfaction. Conclusions Results showed that 64.2% of patients were satisfied with DSDM services. HIV service delivery and treatment factors (DSDM type, time in DSDM, WHO stage, ART adherence), plus social factors (employment and marital status, transport costs, alcohol consumption), were associated with patient satisfaction. DSDM implementers should tailor services to address these factors to improve patient satisfaction. |
| first_indexed | 2024-04-10T15:45:51Z |
| format | Article |
| id | doaj.art-eddf9631f0364d6b9493b400d8e842a9 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-10T15:45:51Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-eddf9631f0364d6b9493b400d8e842a92023-02-12T12:07:45ZengBMCBMC Health Services Research1472-69632023-02-0123111110.1186/s12913-023-09114-2Factors that influence the satisfaction of people living with HIV with differentiated antiretroviral therapy delivery models in East Central Uganda: a cross-sectional studyKeith Baleeta0Augustin Muhwezi1Nathan Tumwesigye2Betty Nsangi Kintu3Sara Riese4Dathan Byonanebye5Martin Mbonye6Daniel Mwehire7Robert Iriso8Bernard Ayebazibwe9Lauren Bailey10Deborah Lopez11Laura McGough12Michael Etukoit13Dyogo Nantamu14Louisa Nakitende15Baker Tibengana16Jacob Wasswa17University Research Co., LLCUniversity Research Co., LLCFamily Health International 360University Research Co., LLCUniversity Research Co., LLCCollege of Health Sciences, Makerere UniversityUniversity Research Co., LLCUniversity Research Co., LLCUniversity Research Co., LLCUniversity Research Co., LLCUnited States Agency for International DevelopmentUniversity Research Co., LLCUniversity Research Co., LLCThe AIDS Support OrganizationJinja District Local GovernmentUniversity Research Co., LLCThe AIDS Support OrganizationUniversity Research Co., LLCAbstract Background The World Health Organization (WHO) and the Uganda Ministry of Health recommend differentiated service delivery models (DSDMs) as patient-centered antiretroviral therapy (ART) mechanisms for people living with HIV/AIDS (PLHIV) with undetectable viral loads. We studied patient satisfaction with ART services, and its associated factors amongst PLHIV enrolled in DSDMs in Uganda. Methods This cross-sectional study involved a random sample of PLHIV accessing DSDM-related ART at nine facilities in East Central Uganda. Eligible patients were adult PLHIV (≥18 years), on ART, and enrolled for at least 12 months in one of three DSDMs: Community Client-Led ART Delivery (CCLAD), Community Drug Distribution Points (CDDP), or Fast-Track Drug Refill (FTDR). We collected data from June to July 2019. A validated tool measured satisfaction. General Estimating Equations with modified Poisson regression and exchangeable correlation structures accounted for clustering at health facilities and identified DSDM-related satisfaction factors. Results Of 842 participants enrolled, 530 (63.5%) accessed HIV care through CDDP, 166 (20.1%) through CCLAD, and 146 (16.3%) through FTDR; 541 (64.2%) were satisfied with DSDM services: 78.7% in CDDP, 42.8% in CCLAD, and 36.3% in FTDR. The delivery and treatment factors positively associated with satisfaction included: being enrolled on CDDP [adjusted prevalence ratio (aPR) = 1.51, 95% CI:1.47–1.56] or FTDR [aPR = 1.47, 95% CI:1.26–1.71] relative to CCLAD and being enrolled in a DSDM for more than 3 years [aPR = 1.28, 95% CI:1.11–1.48]. Poor ART adherence [aPR = 0.33, 95% CI:0.19–0.56] and having a baseline WHO HIV stage of 3 or 4 [aPR = 0.36, 95% CI:0.20–0.64] relative to stages 1 and 2 were negatively associated. Among socioeconomic factors, having lower transport costs (< $1.35) per clinic visit [aPR = 1.34, 95% CI:1.17–1.53], being employed [aPR = 1.61, 95% CI:1.38–1.87], and being single [aPR = 1.10, 95% CI:1.08–1.13] were positively associated with satisfaction; drinking alcohol at least once a week [aPR = 0.77, 95% CI:0.63–0.93] was negatively associated with patient satisfaction. Conclusions Results showed that 64.2% of patients were satisfied with DSDM services. HIV service delivery and treatment factors (DSDM type, time in DSDM, WHO stage, ART adherence), plus social factors (employment and marital status, transport costs, alcohol consumption), were associated with patient satisfaction. DSDM implementers should tailor services to address these factors to improve patient satisfaction.https://doi.org/10.1186/s12913-023-09114-2Differentiated service delivery model (DSDM)HIV carePatient satisfactionCommunity client-led ART delivery (CCLAD)Community drug distribution points (CDDP)Fast-track drug refill (FTDR) |
| spellingShingle | Keith Baleeta Augustin Muhwezi Nathan Tumwesigye Betty Nsangi Kintu Sara Riese Dathan Byonanebye Martin Mbonye Daniel Mwehire Robert Iriso Bernard Ayebazibwe Lauren Bailey Deborah Lopez Laura McGough Michael Etukoit Dyogo Nantamu Louisa Nakitende Baker Tibengana Jacob Wasswa Factors that influence the satisfaction of people living with HIV with differentiated antiretroviral therapy delivery models in East Central Uganda: a cross-sectional study BMC Health Services Research Differentiated service delivery model (DSDM) HIV care Patient satisfaction Community client-led ART delivery (CCLAD) Community drug distribution points (CDDP) Fast-track drug refill (FTDR) |
| title | Factors that influence the satisfaction of people living with HIV with differentiated antiretroviral therapy delivery models in East Central Uganda: a cross-sectional study |
| title_full | Factors that influence the satisfaction of people living with HIV with differentiated antiretroviral therapy delivery models in East Central Uganda: a cross-sectional study |
| title_fullStr | Factors that influence the satisfaction of people living with HIV with differentiated antiretroviral therapy delivery models in East Central Uganda: a cross-sectional study |
| title_full_unstemmed | Factors that influence the satisfaction of people living with HIV with differentiated antiretroviral therapy delivery models in East Central Uganda: a cross-sectional study |
| title_short | Factors that influence the satisfaction of people living with HIV with differentiated antiretroviral therapy delivery models in East Central Uganda: a cross-sectional study |
| title_sort | factors that influence the satisfaction of people living with hiv with differentiated antiretroviral therapy delivery models in east central uganda a cross sectional study |
| topic | Differentiated service delivery model (DSDM) HIV care Patient satisfaction Community client-led ART delivery (CCLAD) Community drug distribution points (CDDP) Fast-track drug refill (FTDR) |
| url | https://doi.org/10.1186/s12913-023-09114-2 |
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