HIV/AIDS health services in Manaus, Brazil: patient perception of quality and its influence on adherence to antiretroviral treatment

Abstract

Background Patient satisfaction is an important factor for both assessing the quality of healthcare and predicting positive health outcomes. This study assesses the influence of HIV/AIDS patients’ perception of the quality of health services on adherence to antiretroviral treatment using the decentralized care model in Manaus, Brazil. Methods We conducted a non-randomized, cross-sectional analysis to explore the relationship between patient satisfaction and adherence to antiretroviral treatment (ART) in Manaus, Amazonas, Brazil. We also compared patient satisfaction levels at the city’s main hospital with those at smaller health units established to decentralize HIV/AIDS healthcare. Using survey responses from 812 patients and health data from 713 patients, we conducted descriptive and regression analyses to identify health center characteristics associated with higher patient satisfaction and higher adherence to treatment. Results We found a clear and positive relationship between patient satisfaction with the quality of health services and adherence to ART. Patients who had better access to their health center and its services –mainly in the form of convenient location, shorter commute times, and shorter wait times— tended to rate the quality of services higher and were also more likely to adhere to ART. We also found higher levels of patient satisfaction and adherence to ART among patients served at decentralized health units than among patients served at the main hospital. Conclusions The study’s results emphasize the importance of patients’ experience at the health center for improved health outcomes. While many of the factors that play a role in whether a patient adheres to ART or not are beyond the control of the health center, our findings highlight that health centers can importantly contribute to increased ART adherence by improving such experience. The study also showcases the potential benefits of decentralizing HIV care to increase patient satisfaction and, with it, adherence to ART. Electronic supplementary material The online version of this article (10.1186/s12913-019-4062-9) contains supplementary material, which is available to authorized users.

Perceived satisfaction with HIV care and its association with adherence to antiretroviral therapy and viral suppression in the African Cohort Study

“…In Manaus, Brazil participants who rated the quality of care highly were approximately two times more likely to adhere to care than those who did not. In this study predictors of satisfaction with care included convenient location of the clinic, waiting time, and respectful treatment from the nurses [ 31 ]. These results are also comparable to the cross sectional study conducted in Houston, Texas where participants with high scores of satisfaction were more likely to adhere to care (p < 0.0001) [ 29 ].…”

Immunologic Biomarkers, Morbidity and Mortality Among HIV Patients Hospitalized in a Tertiary Care Hospital in the Brazilian Amazon

“…Brazil has been successfully combating the HIV/AIDS epidemic by providing state-of-the-art antiretroviral therapy (ART) and a uni ed, universal and free public health system widely disseminated to the population 1,2 . The mortality rate due to HIV/AIDS in Brazil has fallen signi cantly in the last twenty years, especially in the southeastern, southern and mid-western regions.…”

“…Manaus is the capital and the largest city of the state, and the decentralized health units are located in the neighborhoods and semi-urban areas. These are generally more accessible and promote the highly active antiretroviral therapy (HAART) 2 . The Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), located in the middle of the city, is a tertiary care hospital which performs HAART services and admits moderate to severely ill people living with HIV.…”

“…The Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), located in the middle of the city, is a tertiary care hospital which performs HAART services and admits moderate to severely ill people living with HIV. This represents a contingent greater than 85% of all patients receiving ART, as well as concentrating data on incidence levels of AIDS, mortality rates and late diagnosis 2,5 . Studies on the HIV/AIDS epidemic in the region have indicated over time that the trend in the number of cases continues to increase principally in men, that tuberculosis (TB) is still the leading cause of death, and that respiratory failure is the main cause of hospital admission for these patients [5][6][7][8] .…”

Customized blister packaging for patients living with HIV: assessment of patient attitudes and satisfaction

“…6 There is an association between patient satisfaction with health care services and adherence to ART, and using an integrated specialty pharmacy to provide refill reminders, medication delivery, and adherence calls have led to improved immune markers and viral suppression in patients living with HIV. 7,8 Beginning in 2013, the Nebraska Medicine HIV Clinic partnered with Elmwood Pharmacy (a community pharmacy adjacent to the clinic) to develop a Collaborative Care Program (CCP). As part of the CCP, medications are placed in multi-dose adherence blister packaging which is dispensed every two weeks.…”