Investigating client perception and attitude to decentralization of HIV/AIDS treatment services to primary health centres in three Nigerian states

Abstract

BackgroundThe opinions of consumers in decentralization provide insights into possible levels of improvement in access and uptake of services.ObjectivesThe study examined clients' perception and attitude towards decentralization of antiretroviral treatment services from central hospitals to primary health centres (PHCs).MethodologyA cross‐sectional survey was undertaken in three states in Nigeria. A total of 1265 exit interviews were conducted with HIV/AIDS clients in nine health facilities.FindingsAbout a third of all the respondents were not comfortable with receiving ART services in a PHC facility close to where they live. The reasons given by 385 respondents who would not want their treatment centres near were as follows: fear of disclosure, 299 (80.4%); fear of being discriminated against, 278 (74.3%); and satisfaction with care received at current facility, 278 (74.3%). However, more than 90% of respondents in all three states felt that decentralization of ART services to PHCs would be beneficial in controlling HIV/AIDS in Nigeria; the difference in respondents' perception across the three state was found to be statistically significant (P < 0.001).ConclusionThe findings imply that scaling‐up of treatment services to PHCs would be widely accepted, and probably result in increased uptake. However, this must be accompanied by targeted behaviour change interventions for clients who for the fear of disclosure and stigma would still not access care from proximate facilities.

How ready is the system to deliver primary healthcare? Results of a primary health facility assessment in Enugu State, Nigeria

“…In the communicable disease components, our study showed that while HIV testing services were available in 68% of PHC centres sampled, only 25% offered HIV treatment. This may indicate that community members prefer secondary or tertiary institutions for care ( Onwujekwe et al , 2016 ) and that seeking care in their communities is not appealing due to stigma. This may adversely affect the realization of the 90–90–90 UNAIDS targets in the country ( Levi et al , 2016 ).…”

Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya

“…The findings differs with those of [16] reported that dissatisfaction of the patients towards integrated services is related to increased workload for the staffs which led to reduction in quality of care, his findings reflected failure of the staffs to rule out opportunistic infections and some defaulting on their treatment schedule leading to deterioration of their health status. [17] found that in a total of 185 (93.7%) of the respondents reported that their health status had improved since starting antiretroviral treatment. Most of the respondents during the interview reported improvement in health status since they started using the facility but others said that they did not see any change in their health status but they still utilize the facility because of convenience in relation to time and distance.…”

HIV-related stigma and discrimination among health care workers during early program decentralization in rural district Gunungkidul, Indonesia: a cross-sectional study

“…Investigations into decentralized programming indicate fear of discrimination and unwarranted disclosure of HIV status as two areas of SAD that PLHIV feel strongly concerned about or commonly experienced during health care delivery [ 32 , 33 ]. Firstly, these concerns may signal an early progress in organizational learning as primary health centres (PHCs), now an emerging model of HIV care provision in the health system, rearrange resource allocations in adapting to the imperative of HIV service provision.…”