Perceived quality of HIV care and client satisfaction across different service providers in Ukraine

"We need to talk about it, test it, prevent it, and that is our job": qualitative report on the awareness of primary care physicians regarding HIV in Ukraine

Introduction

Approximately 240,000 people in Ukraine are living with HIV. Recent changes in medical legislation have significantly strengthened the role of family doctors and primary care pediatricians in the prevention, early detection and follow-up of patients with HIV. Thus, the purpose of the study was to examine the experience of primary care physicians in testing and providing care to patients with HIV.

Methods

Qualitative semi-structured in-depth interviews with typical representatives of the target audience from different regions of Ukraine were conducted. Inductive thematic content analysis was used to analyze the data upon standardized research protocols using the Theoretical Domain System.

Results

The results identify knowledge, skills, motivation, barriers, and opportunities in the context of HIV testing among family doctors in Ukraine. Primary health care providers consider HIV testing of patients to be an important part of their professional activities. In most cases, HIV testing is initiated upon detection of clinical indicators or when a person is identified as a key population. Preventive testing at the request of the patient is less common. Although most family doctors believe that they are sufficiently informed to conduct testing, there is a certain knowledge gap regarding communication with the patient and further treatment in case of a positive HIV result. The main obstacle to regular HIV testing is the reluctance and resistance of patients, as well as in some cases insufficient or non-existent tests in primary health care facilities. In order to improve the situation with HIV testing among the population, family doctors believe that it is necessary to organize regular trainings and courses to improve the skills of doctors on HIV, provide primary health care facilities with sufficient tests and establish high-quality information support.

Conclusions

The obtained results clearly outline the main problems that concern family doctors in Ukraine regarding work with key vulnerable groups and persons living with HIV.

Individual satisfaction with HIV/AIDS care in Belo Horizonte, Brazil

Individual satisfaction is associated with increased retention in HIV/AIDS care services and adherence to treatment. This study assessed factors associated with individual satisfaction at the initiation of antiretroviral therapy and compared the proportions of satisfaction at the initiation of antiretroviral therapy and after three months of follow-up. Face-to-face interviews were carried out among 398 individuals of three HIV/ AIDS healthcare services in Belo Horizonte, Brazil. Variables included sociodemographic and clinical characteristics, perception about healthcare services, and domains of quality of life. Individuals that rated the quality of healthcare services as good or very good were classified as satisfied. A logistic regression analysis of the association between independent variables and individual satisfaction was performed. The proportion of individual satisfaction with healthcare services was 95.5% at the initiation of antiretroviral therapy and 96.7% after three months and these changes were not statistically significant (p = 0.472). The physical domain of quality of life was found to be associated with satisfaction at the initiation of antiretroviral therapy (OR = 1.38; CI = 1.11-1.71; p = 0.003). Training and supervision of health professionals for addressing the needs of individuals with lower levels of physical domain of quality of life may improve satisfaction with HIV/ AIDS care.

Quality of Nursing Care Perceived by People With HIV in Brazil: A Cross-Sectional Study

ABSTRACT

We evaluated the quality of care provided by the nursing team within specialized care services (SCS) from the perspective of persons with HIV (PWH). A cross-sectional study was conducted in 25 SCS selected by a single-stage cluster sampling in 21 municipalities in Brazil. Systematic sampling was performed between October 2019 and March 2020 in the reception areas of SCS locations to choose the study population ( N = 377). The adapted and validated Quality of Care Through the Patient's Eyes-HIV (QUOTE-HIV) questionnaire was used to measure the quality of perceived care, and the Mann-Whitney test to compare the scores between men and women. Of the 377 PWH, most were women (57.71%), Black or Brown (85.9%), heterosexual (67.1%), and cisgendered (96.0%); the mean age was ≥30 years (76.1%). Users' evaluation of the care provided by SCS according to scores of importance and performance of the QUOTE-HIV instrument ranged from 5.60 to 8.95 and 0.03 to 0.76, respectively. The perception of PWH about the quality of care provided by the nursing team in SCS suggests that there are opportunities to improve.

How Do People Living With HIV (PLHIV) and AIDS Feel About the Quality of Care They Received Amid the COVID-19 Pandemic in Lagos, Nigeria?

Background: This study aimed to assess the perception of quality of care among people living with HIV (PLHIV) in Lagos, Nigeria, and identify factors influencing their perceptions. Methodology: The study was a descriptive cross-sectional survey conducted between December 2020 and March 2021 among 578 PLHIVs drawn from various healthcare facilities in Lagos where HIV care and treatment services were provided. Data were collected through pretested questionnaires and analyzed using Stata SE 12. Results: About 83% of the respondents had a good attitude toward their HIV medication, and 95.5% had a good perception of the quality of care they received. PLHIVs with higher education, skilled or professional occupations and higher monthly income had a significantly higher perception of quality of care compared to others (P < .05). Conclusion: The PLHIV in Lagos had a positive attitude toward their medication and a good perception of the quality of care they received during the COVID-19 pandemic. All stakeholders' efforts should be sustained for continuous quality improvement in HIV care in Lagos.

Antiretroviral Therapy Service Quality and Associated Factors at Selected Public Hospitals, Addis Ababa, Ethiopia, 2021

Background

It is important to offer high-quality HIV/AIDS treatment and antiretroviral medication to people living with the disease to improve health outcomes. The quality of health services has become a public health issue.

Objective

To assess ART service quality and associated factors at a selected public hospital, Addis Ababa, Ethiopia, in 2021.

Methods

A mixed study design was used from April to May 2021. Donabedian’s structure–process–outcome model of health care quality was employed as a framework. A total of 420 clients were interviewed to obtain quantitative data, and 08 key informant interviews and 357 program documents were reviewed. Quantitative data were checked, coded, and entered into Epi Info version 7.2 and exported into SPSS windows version 25.0. In the multivariable logistic regression analysis, variables with p-values < 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to identify factors associated with client satisfaction. Qualitative data were transcribed and analysed using the ATLAS.ti version 8 software program and used to complement the quantitative findings.

Results

The overall quality of ART services was 73.3% for the availability of resources, 79.5% for healthcare providers’ compliance with the national guidelines, and 86.4% for client satisfaction with the quality of ART clinical services. Patients who disclosed their HIV status [AOR 10.7, 95% CI: 5.2–22], months of ART [AOR 10.4, 95% CI: 3.89–27.8], age group 34–44, 45–55, and 56–76 years were found to be 5.1, 8.1, and 5 [AOR 5.1,95% CI:1.2–22, AOR 8.1,95% CI:1.9–35.5, AOR 5,95% CI:2.97–9.44], respectively, and consultation time [AOR 3.5, 95% CI: 1.6–7.35] were associated with client satisfaction on the quality of ART clinical services.

Conclusion

This study revealed that the overall quality of ART services in selected Addis Ababa public hospitals was good, although with the availability of resources and compliance health care providers need improvement.

Quality Perceptions and Choice of Public Health Facilities: A Mediation Effect Analysis of Outpatient Experience in Rural China

PURPOSE

Outpatients have choices of providers in the hierarchical health service delivery system of China. Understanding how quality perceptions and outpatient experience affect the choice of health facility would help inform decisions about priorities for action aimed at guiding the use of primary care. This study examines how quality perceptions of outpatient service affect the facility level choice in rural China.

METHODS

Household surveys were conducted in 2011, 2012 and 2015 in Ningxia Hui Autonomous Region, China. We selected 968 respondents as the study sample, who had at least two outpatient visits to the public health facilities during each survey period. Prior quality perceptions of the outpatient service at the village clinics, township centers, and county hospitals were reported on an 8-item Quality Indicator questionnaire. Experienced quality perception from the first outpatient visit was also reported. The outcome of interest was outpatients' facility level choices. We used regression and mediation analysis to explore whether and how outpatient experience at a specific health facility would mediate the relationship between prior quality perceptions and the facility level choice.

RESULTS

Overall, the quality perception was positively and significantly associated with outpatients' staying at the same or lower levels of care (β=0.265, P=0.007). This effect was fully mediated by experienced quality perception (z=2.985, P=0.003). The indirect effect was significant for three particular dimensions, including quality perceptions of the environment (β=0.075, P=0.025), doctor-patient communication (β=0.065, P=0.022), and physician ability (β=0.062, P=0.021).

CONCLUSION

Outpatient quality perceptions-especially positive perceptions regarding environment, doctor-patient communication, and physician ability-could contribute to minimizing upward referral via improvement in outpatient experience. Policymakers and health care providers may need to therefore optimize outpatient experience as they push to develop a more locally responsive primary care system.

An integrative model of patients' perceived value of healthcare service quality in North Cyprus

Background

Improving healthcare quality has become an essential objective for all health institutions worldwide to address the need to improve services, manage costs and satisfy patient expectations about the quality of care. As health is one of the leading service sectors of the North Cyprus economy, analysing patients’ perceived value of healthcare service quality is crucial. In this research, a comparative analysis of existing models revealed affordability, acceptability and accessibility as the leading modern service quality indicators affecting patients’ perceived value of healthcare service quality. The quality of services is a leading factor impacting business competition and retention dictated by the current market. This study aimed to investigate the factors that influence patient perceptions of healthcare service quality in North Cyprus.

Methods

A self-administered questionnaire was carried out among 388 patients of public and private hospitals in North Cyprus, and the data were analysed using partial least squares-structural equation modelling.

Results

Empirical results highlight that the acceptability of healthcare services is a prerequisite for perceiving a high value of service quality. The affordability and accessibility of services, respectively, were less effective. Results concerning mediating effects confirm that acceptability could fully mediate the relationship between affordability and perceived value and could partially mediate the impact of accessibility on the perceived quality of healthcare services.

Conclusion

This study contributes to healthcare theory and practice by developing a conceptual framework to provide policymakers and managers with a practical understanding of factors that affect healthcare service quality.

Stigma and quality of co-located care for HIV-positive people in addiction treatment in Ukraine: a cross-sectional study

INTRODUCTION

Co-located treatment for HIV and opioid use disorder has been shown to improve care outcomes for HIV-positive people who inject drugs (PWID) in Ukraine. However, patients continue to be stigmatized for both HIV and substance use. This study aimed to assess whether co-located care for HIV-positive PWID receiving opioid agonist treatment (OAT) services in Ukraine is associated with less stigma and better perceived quality of HIV services.

METHODS

This cross-sectional study enrolled 191 HIV-positive PWID who received OAT services at three healthcare facilities providing substance use treatment (OAT only) and at four facilities that provided co-located care (both OAT and HIV treatment) in six regions in Ukraine during July-September, 2017. Primary outcomes were HIV stigma (Berger scale), substance use stigma (Substance Abuse Stigma Scale) and intersectional stigma (both stigma forms above 75th percentile). Secondary outcome was quality of HIV care, a composite score based on a package of received services. Linear and ordinal regressions were used to assess the predictors of selected outcomes.

RESULTS

Study participants were 75% male, mean age 40 ± 7 years; 47% received co-located care, and 10.5% had both high HIV and substance use stigma. Co-located care was neither associated with HIV nor substance use stigma but it was linked to better quality of HIV care (adjusted odds ratio: 4.13; 95% CI: 2.31, 7.54). HIV stigma was associated with suicide attempts (adjusted beta (aβ): 5.90; 95% CI: 2.05, 9.75), and substance use stigma was linked to poor mental health (aβ: -0.26; 95% CI: -0.44, -0.08) and lower likelihood of receipt of services from non-governmental organization (NGO; aβ: -6.40; 95% CI: -10.23, -2.57).

CONCLUSION

One in ten people with HIV in this cohort who received OAT services experienced high levels of both HIV and substance use stigma, which was associated with poorer mental health and less NGO support. Co-located HIV and OAT services were linked to better perceived quality of HIV care, but did not seem to reduce stigma for this key population. Stigma interventions for PWID, possibly delivered involving NGOs, may be an approach to mitigate this challenge.

Opening the horizons of clinical reasoning to qualitative research

Clinical Reasoning (CR) is an important aspect of health professional education and effective practice. It is a complex series of factors and cognitive functions, involving higher-level thinking to define problems, examine the evidence and then making decisions and choices to improve the patient's physiological and psycho-social state.CR consists of 3 interconnected and interdependent sub-processes: clinical experience and clinical context and Evidence-Based Practice. This essay focuses on the opportunities that Qualitative Research offers during the CR process when the doctor finds the evidence to address a patient's health problem. Clinicians are often faced with questions that randomized clinical trials or systematic reviews of efficacy studies cannot answer. For this reason, we considered it necessary to offer an expanded view of the process of interpretation of the scientific literature used in daily clinical practice through the complex process of Clinical Reasoning, through the use of studies conducted with qualitative methods, which are able to respond to a different range of clinical questions, and to support studies based on the effectiveness of treatments.