Patient experiences and preferences for antiretroviral therapy service provision: implications for differentiated service delivery in Northwest Ethiopia

Abstract

Background Understanding the experiences, needs, preferences, and behaviors of people living with HIV (PLHIV) are critical to tailor HIV treatment. However, there is limited empirical evidence in Ethiopia on the views of PLHIV regarding their experiences with current antiretroviral therapy (ART) services and preferred models of HIV treatment. Hence, this study aimed to explore the patients’ experiences of taking medications and preferences for ART service provision in Northwest Ethiopia. Methods A phenomenological study design was employed. In this study, stable and 18 years old and above PLHIVs, who had been using ART service at four public hospitals and two health centers in East Gojjam, West Gojjam and Awi zones, and Bahir Dar city administration of Amhara National Regional State, Northwest Ethiopia, were purposively selected. Fifteen in-depth interviews were conducted from July 2021 to September 2021 to collect data. ATLAS.ti version 9 software was used for coding translated transcripts. A thematic analysis approach was employed. Findings Participants in this study had reported positive and negative experiences in receiving ART services and also varied preferences toward ART service features. The study identified five themes on experiences for ART service and 15 attributes of ART service characteristics. The identified themes were stigma, time, availability of drugs and providers, costs for clinic visits, and provider-patient interaction. The fifteen attributes were buddy system, ART refill (individualized or group), ART packaging and labeling, drug formulation and administration, ART room labeling, distance, location of service, preferences on involvement in treatment decision-making, the person providing ART refills, provider’s attitude, spatial arrangement of ART room, time of health facility operation, time spent at clinics, and total cost of the visit. Conclusions The results raise awareness for the positive and negative experiences of patients informing us about barriers and supporting factors in ART service provision. They open up the potential for HIV treatment service improvement. The preferences of PLHIVs toward ART service delivery features were heterogeneous. Policy and program efforts should tailor ART services that suit patients’ needs and priorities in Ethiopia. Future research should further assess the reasons for patients’ distrust of the community ART delivery models.

Dimensions of patient-centred care from the perspective of patients and healthcare workers in hospital settings in sub-Saharan Africa: A qualitative evidence synthesis

“…Both visual and auditory privacy were important [ 27 ]. Expectations or experience of lack of privacy [ 22 , 25 , 26 ] affected the choice of which health facility to visit if one fell ill. One study reported on the possibility of investing in mobile screens and curtains to promote both auditory and visual privacy [ 53 ].…”

“…Many study participants wanted to be actively involved in making decisions about their care [ 25 , 44 , 51 ]. This sometimes included involving family and friends [ 26 ], who were a source of psychosocial and financial support for patients [ 22 , 33 , 38 ].…”

“…Dignity and respect hinged around the behaviour of various healthcare providers towards patients: being shouted at, scared or even slapped in the case of women during childbirth was considered not patient-centred and poor quality of care [ 25 , 27 , 50 ]. Such treatment led to feelings of shame and humiliation.…”

“…Important aspects of access to care reported in the different studies included geographical location (distance to health unit), waiting times, facility opening times, affordability of services, financial transparency, system navigation and availability of sufficient staff [ 21 – 23 , 25 , 28 , 31 , 33 , 34 , 36 , 38 , 43 , 44 , 47 , 54 ]. In some studies, authors reported that long queues at health facilities prompted patients to seek care from herbalists or traditional healers while in others, patients sometimes waited the whole day to see a doctor since some clinics had specific opening times [ 41 ].…”

Efecto de las emociones positivas post ejercicio como terapia complementaria en pacientes VIH/SIDA con tratamiento retroviral

“…La eficacia de los retrovirales (TAR en inglés) con combinaciones modernas de medicamentos para el tratamiento del VIH/SIDA permiten que muchas personas, a pesar de su enfermedad crónica, tengan una esperanza de vida comparable a la de las personas sin la infección (Armoon et al, 2021). De esta manera, se ha confirmado la asociación entre un recuento alto de células CD4, carga viral indetectable, comorbilidades reducidas y alta calidad de vida (Belay et al, 2022). Mejorar las disparidades socioeconómicas, los factores clínicos, la gestión holística del tratamiento y las estrategias de políticas de salud para la prevención, la educación y también la reducción del estigma y la discriminación influyen en los resultados del tratamiento y mejoran la calidad de vida (Bickel et al, 2020).…”