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

Abstract

BackgroundUnderstanding the experiences, needs, preferences, and behaviors of people living with HIV (PLHIV) are critical to tailor HIV treatment. However, there is limited research evidence in Ethiopia on the views of PLHIV regarding their positive and negative experiences on current antiretroviral therapy (ART) service and their preferred models of HIV treatment. Hence, this study aimed to explore patients’ experiences of taking medications and preferences for ART service provision characteristics in Northwest Ethiopia.MethodsThis study with a phenomenological approach was conducted as part of the larger discrete choice experiment study. Purposive selection of stable and 18 years old and above PLHIVs using ART service at health facilities implementing four differentiated service delivery (DSD) models in East Gojjam, West Gojjam, Awi, and Bahir Dar special zones was done. Data were collected between July and September 2021. About 15 in-depth interviews with differentiated ART eligible patients were conducted. ATLAS.ti version 9 software was used for coding translated transcripts. A thematic analysis approach was employed.FindingsParticipants in this study had reported both positive and negative experiences in receiving ART. Five themes: stigma, time, availability of drug and provider, costs per clinic visit, provider-patient interaction were identified. Participants also reported varied preferences towards ART service features. Fifteen attributes: 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, 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 visit were identified.ConclusionsParticipants provided both positive and negative experiences with the aspects of current ART service. The preferences of PLHIVs towards 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 also focus on understanding the satisfaction of patients enrolled among the four DSD models now under implementation in the country to get insights for optimizing each model implementation and to ensuring the strong quality of ART service provision for stable PLHIV.

Differentiated service delivery models for antiretroviral treatment refills in Northern Nigeria: Experiences of people living with HIV and health care providers–A qualitative study

“…Our findings regarding cost of care corroborate those of previous studies in the region [26,[39][40][41][42][43], with PLHIV on MMD and receiving treatment through community-based models reporting reduced transportation costs and other out-of-pocket expenses due to infrequent clinic visits. Patients who preferred facility-based ART refill perceived this model to provide greater anonymity, and thus safety, and to offer quality of care.…”

“…Most patients in the study reported satisfaction with 6-month ART refills, with others preferring and recommending longer intervals between medication refills. Similar findings have been noted in Ethiopia and Thailand, with patients preferring longer (up to 1 year) ART refills [26,37].…”

“…IDI participants were PLHIV with a median age of 39 years (IQR [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. Of the 40 participants, 22 (55%) were male, 23 (58%) were currently married or co-habiting, and 25 (63%) were accessing care at secondary facilities (e.g., district hospitals).…”

“…In South Africa, patients receiving MMD at 6-month intervals reported saving time and money due to shorter waiting times and the need for fewer visits to clinics [2,17,23,24]. In light of health care worker shortages, DSD models have also given providers the opportunity to focus on PLHIV with advanced disease [17,[25][26][27].…”

People Living with HIV and AIDS: Experiences towards Antiretroviral Therapy, Paradigm Changes, Coping, Stigma, and Discrimination—A Grounded Theory Study

“…The association among a high CD4 cell count, undetectable viral load, reduced comorbidities, and high quality of life has been confirmed [ 3 ]. Improving socioeconomic disparities, clinical factors, holistic treatment management, and health policy strategies for prevention, education, and also reducing stigma and discrimination influence treatment outcomes and improve quality of life [ 4 ].…”