Perceived Patients’ Satisfaction, Barriers and Implications on Engagement in Antiretroviral Treatment Services in Cameroon within the HIV Test and Treat Context

Rogers Ajeh^{1, 2,} , Halle Ekane¹, Egbe O. Thomas¹, Anastase Dzudie² and Assob N. Jules¹

¹Faculty of Health Sciences, University of Buea, Buea, Cameroon

²Clinical Research Education Networking and Consultancy, Yaounde, Cameroon

Cite this paper

Rogers Ajeh, Halle Ekane, Egbe O. Thomas, Anastase Dzudie and Assob N. Jules. Perceived Patients’ Satisfaction, Barriers and Implications on Engagement in Antiretroviral Treatment Services in Cameroon within the HIV Test and Treat Context. American Journal of Public Health Research. 2019; 7(2):73-80. doi: 10.12691/AJPHR-7-2-5

Abstract

Introduction: Patients’ satisfaction has been associated with improved adherence, retention and antiretroviral treatment (ART) outcomes. Sustained engagement in ART is a prerequisite for attaining universal ART coverage. This study describes perceived patients’ satisfaction, barriers and implications on engagement in ART services within the context of the HIV Test &Treat (HIV T&T) strategy. Materials and methods: Between August and September 2018, HIV positive clients who initiated ART and key HIV care providers (HCPs) in three HIV clinics in Cameroon were interviewed. Ethical and administrative clearances for the study were obtained from the appropriate quarters. A thematic approach was used to analyze the data. Results: A total of 45 HIV positive clients and 21 HCPs were interviewed. Patients’ satisfaction varied with HIV service. Patient-reported barriers included: long waiting time, poor reception, delay between time of HIV diagnosis and ART initiation, poor coordination between HIV testing and ART services, poor flexibility in ART delivery system, large tablet size of ARVs/indefinite treatment duration, side effects. Inadequate counselling, overcrowding in the HIV clinics, patients’ non-appreciation of ART benefits were reported by patients and HCPs. Some barriers were linked to the HIV T&T strategy and many of them limited patients’ engagement in ART. Conclusion: Patient satisfaction varied with HIV service. Some of the barriers to patients’ satisfaction were linked with the implementation of the HIV T&T strategy and negatively impacted patients’ engagement in ART services. These views should be considered in evaluating and improving the quality of HIV care.

Keywords

patients’ satisfaction, barriers, antiretroviral treatment, HIV test and treat strategy

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Horberg MA, Hurley LB, Silverberg MJ, Klein DB, Quesenberry CP, Mugavero MJ. Missed Office Visits and Risk of Mortality Among HIV-Infected Subjects in a Large Healthcare System in the United States. AIDS Patient Care STDs. 2013 Aug; 27[8]: 442-9.
[2]	Mugavero MJ, Lin H-Y, Willig JH, Westfall AO, Ulett KB, Routman JS, et al. Missed Visits and Mortality in Patients Establishing Initial Outpatient HIV Treatment. Clin Infect Dis Off Publ Infect Dis Soc Am. 2009 Jan 15; 48[2]: 248-56.
[3]	Park WB, Choe PG, Kim S-H, Jo JH, Bang JH, Kim HB, et al. One-year adherence to clinic visits after highly active antiretroviral therapy: a predictor of clinical progress in HIV patients. J Intern Med. 261[3]: 268-75.
[4]	Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007-2009: systematic review. Trop Med Int Health TM IH. 2010 Jun; 15 Suppl 1: 1-15.
[5]	Gill VS, Lima VD, Zhang W, Wynhoven B, Yip B, Hogg RS, et al. Improved Virological Outcomes in British Columbia Concomitant with Decreasing Incidence of HIV Type 1 Drug Resistance Detection. Clin Infect Dis Off Publ Infect Dis Soc Am. 2010 Jan 1; 50[1]: 98-105.
[6]	Das M, Chu PL, Santos G-M, Scheer S, Vittinghoff E, McFarland W, et al. Decreases in Community Viral Load Are Accompanied by Reductions in New HIV Infections in San Francisco. PLOS ONE. 2010 Jun 10; 5[6]: e11068.
[7]	Axelrad JE, Mimiaga MJ, Grasso C, Mayer KH. Trends in the Spectrum of Engagement in HIV Care and Subsequent Clinical Outcomes Among Men Who Have Sex with Men [MSM] at a Boston Community Health Center. AIDS Patient Care STDs. 2013 May; 27[5]: 287-96.
[8]	Gardner EM, McLees MP, Steiner JF, del Rio C, Burman WJ. The Spectrum of Engagement in HIV Care and its Relevance to Test-and-Treat Strategies for Prevention of HIV Infection. Clin Infect Dis Off Publ Infect Dis Soc Am. 2011 Mar 15; 52[6]: 793-800.
[9]	Bemelmans M, Baert S, Goemaere E, Wilkinson L, Vandendyck M, van Cutsem G, et al. Community-supported models of care for people on HIV treatment in sub-Saharan Africa. Trop Med Int Health TM IH. 2014 Aug; 19[8]: 968-77.
[10]	Rosen S, Fox MP, Gill CJ. Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic Review. PLOS Med. 2007 Oct 16; 4[10]: e298.
[11]	World Health Organisation. TTR-TaskShifting.pdf [Internet]. 2008 [cited 2018 Jul 15]. Available from: http: //www.who.int/healthsystems/TTR-TaskShifting.pdf.
[12]	Babatunde OA, Ojo OJ, Atoyebi OA, Ekpo DS, Ogundana AO, Olaniyan TO, et al. Seven year review of retention in HIV care and treatment in federal medical centre Ido-Ekiti. Pan Afr Med J [Internet]. 2015 14 [cited 2018 Jul 15]; 22. Available from: http: //www.panafrican-med-journal.com/content/article/22/139/full/
[13]	Wouters E, Heunis C, van Rensburg D, Meulemans H. Patient satisfaction with antiretroviral services at primary health-care facilities in the Free State, South Africa--a two-year study using four waves of cross-sectional data. BMC Health Serv Res. 2008 Oct 9; 8: 210.
[14]	de Jager GA, Crowley T, Esterhuizen TM. Patient satisfaction and treatment adherence of stable human immunodeficiency virus-positive patients in antiretroviral adherence clubs and clinics. Afr J Prim Health Care Fam Med [Internet]. 2018 Jun 18 [cited 2018 Jul 15]; 10[1]. Available from: https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6018455/.
[15]	Miller JS, Mhalu A, Chalamilla G, Siril H, Kaaya S, Tito J, et al. Patient satisfaction with HIV/AIDS care at private clinics in Dar es Salaam, Tanzania. AIDS Care. 2014; 26[9]: 1150-4.
[16]	Asfaw E, Dominis S, Palen JGH, Wong W, Bekele A, Kebede A, et al. Patient satisfaction with task shifting of antiretroviral services in Ethiopia: implications for universal health coverage. Health Policy Plan. 2014 Sep; 29[Suppl 2]: ii50-8.
[17]	Flickinger TE, Saha S, Moore RD, Beach MC. Higher Quality Communication and Relationships are Associated with Improved Patient Engagement in HIV Care. J Acquir Immune Defic Syndr 1999. 2013 Jul 1; 63[3]: 362-6.
[18]	Poles G, Li M, Siril H, Mhalu A, Hawkins C, Kaaya S, et al. Factors associated with different patterns of non-adherence to HIV care in Dar es Salaam, Tanzania. J Int Assoc Provid AIDS Care. 2014; 13[1]: 78-84.
[19]	Ford RC, Bach SA, Fottler MD. Methods of Measuring Patient Satisfaction in Health Care Organizations. Health Care Manage Rev. 1997 Apr; 22[2]: 74.
[20]	Gunning CS. Striving for quality in health care: An inquiry into policy and practice: By R. Heather Palmer, Avedis Donabedian, and Gail J. Povar. Ann Arbor, MI, Health Administration Press, 1991, 177 pages. J Prof Nurs. 1994 Mar 1; 10[2]: 120-1.
[21]	Peltzer K. Patient experiences and health system responsiveness in South Africa. BMC Health Serv Res. 2009 Jul 14; 9: 117.
[22]	University of Buea Faculty of Health Sciences Institutional Review Board [Internet]. [cited 2019 Mar 9]. Available from: http: //www.irb.fhs.ubuea.cm/index.php/contact-us
[23]	Dang BN, Westbrook RA, Hartman CM, Giordano TP. Retaining HIV Patients in Care: The Role of Initial Patient Care Experiences. AIDS Behav. 2016 Oct 1; 20[10]: 2477-87.
[24]	Wung BA, Peter NF, Atashili J. Clients’ satisfaction with HIV treatment services in Bamenda, Cameroon: a cross-sectional study. BMC Health Serv Res [Internet]. 2016 Jul 19 [cited 2019 Feb 14]; 16. Available from: https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC4950718/
[25]	Tessema SB, Adane MM. Assessment of antiretroviral treatment [ART] care service provision in Tigray Region health centers, North Ethiopia. BMC Health Serv Res [Internet]. 2015 Sep 10 [cited 2019 Feb 14]; 15. Available from: https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC4566360/.
[26]	Dixit S, Verma N, Shrivastava N, Sharma M, Pradhan SK, Agarwal S. Patient satisfaction with ART centre services among people living with HIV: a cross sectional study in a tertiary care hospital, Chhattisgarh, India. Int J Community Med Public Health. 2018 May 22; 5[6]: 2564-71.
[27]	Tran BX, Nguyen NPT. Patient Satisfaction with HIV/AIDS Care and Treatment in the Decentralization of Services Delivery in Vietnam. PLOS ONE. 2012 Oct 5; 7[10]: e46680.
[28]	CHAN BT, TSAI AC. Trends in HIV-related Stigma in the General Population During the Era of Antiretroviral Treatment Expansion: An Analysis of 31 Sub-Saharan African Countries. J Acquir Immune Defic Syndr 1999. 2016 Aug 15; 72[5]: 558-64.
[29]	Universal test and treat greatly improves retention in care [Internet]. [cited 2019 Feb 15]. Available from: http: //www.aidsmap.com/Universal-test-and-treat-greatly-improves-retention-in-care/page/3313714.
[30]	Xiao H, Barber JP. The effect of perceived health status on patient satisfaction. Value Health J Int Soc Pharmacoeconomics Outcomes Res. 2008 Aug; 11[4]: 719-25.
[31]	WHO | How does satisfaction with the health-care system relate to patient experience? [Internet]. WHO. [cited 2019 Mar 8]. Available from: https: //www.who.int/bulletin/volumes/87/4/07-050401/en/.
[32]	Xesfingi S, Vozikis A. Patient satisfaction with the healthcare system: Assessing the impact of socio-economic and healthcare provision factors. BMC Health Serv Res [Internet]. 2016 Mar 15 [cited 2019 Mar 8]; 16. Available from: https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC4793546/.
[33]	Ankomah A, Ganle JK, Lartey MY, Kwara A, Nortey PA, Okyerefo MPK, et al. ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: a mixed method study. BMC Infect Dis [Internet]. 2016 Dec 7 [cited 2019 Feb 15]; 16. Available from: https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC5142337/.
[34]	Colvin CJ, Konopka S, Chalker JC, Jonas E, Albertini J, Amzel A, et al. A Systematic Review of Health System Barriers and Enablers for Antiretroviral Therapy [ART] for HIV-Infected Pregnant and Postpartum Women. PLOS ONE. 2014 Oct 10; 9[10]: e108150.
[35]	Dombrowski JC, Simoni JM, Katz DA, Golden MR. Barriers to HIV Care and Treatment Among Participants in a Public Health HIV Care Relinkage Program. AIDS Patient Care STDs. 2015 May 1; 29[5]: 279-87.
[36]	Rougemont M, Stoll BE, Elia N, Ngang P. Antiretroviral treatment adherence and its determinants in Sub-Saharan Africa: a prospective study at Yaounde Central Hospital, Cameroon. AIDS Res Ther. 2009 Oct 12; 6: 21.
[37]	Koole O, Tsui S, Wabwire-Mangen F, Kwesigabo G, Menten J, Mulenga M, et al. Retention and risk factors for attrition among adults in antiretroviral treatment programmes in Tanzania, Uganda and Zambia. Trop Med Int Health TM IH. 2014 Dec; 19[12]: 1397-410.
[38]	Boyer S, Iwuji C, Gosset A, Protopopescu C, Okesola N, Plazy M, et al. Factors associated with antiretroviral treatment initiation amongst HIV-positive individuals linked to care within a universal test and treat programme: early findings of the ANRS 12249 TasP trial in rural South Africa. AIDS Care. 2016; 28[Suppl 3]: 39-51.