Perceived satisfaction with HIV care and its association with adherence to antiretroviral therapy and viral suppression in the African Cohort Study
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
AIDS research and therapy
Abstract
Increased availability of HIV care over the past decade has dramatically reduced morbidity and mortality
among people living with HIV (PLWH) in sub-Saharan Africa. However, perceived and experienced barriers to care,
including dissatisfaction with services, may impact adherence and viral suppression. We examined the associations
between satisfaction with HIV care and antiretroviral therapy (ART) adherence and viral load suppression.
Methods: The African Cohort Study (AFRICOS) is a prospective observational study conducted at PEPFAR-supported
clinics in four African countries. At enrollment and twice-yearly study visits, participants received a clinical assessment
and a socio-behavioral questionnaire was administered. Participants were classified as dissatisfied with care if they
reported dissatisfaction with any of the following: waiting time, health care worker skills, health care worker attitudes,
quality of clinic building, or overall quality of care received. Robust Poisson regression was used to estimate prevalence
ratios and 95% confidence intervals (CIs) for associations between satisfaction with care and ART adherence and
between satisfaction with care and viral suppression (viral load < 1000 copies/mL).
Results: As of 1 March 2020, 2928 PLWH were enrolled and 2311 had a year of follow-up visits. At the first annual
follow-up visit, 2309 participants responded to questions regarding satisfaction with quality of care, and 2069 (89.6%)
reported satisfaction with care. Dissatisfaction with waiting time was reported by 177 (7.6%), building quality by 59
(2.6%), overall quality of care by 18 (0.8%), health care worker attitudes by 16 (0.7%), and health care worker skills by
15 (0.7%). After adjusting for age and site, there was no significant difference in viral suppression between those who
were satisfied with care and those who were dissatisfied (aPR: 1.03, 95% CI 0.97–1.09). Satisfaction with HIV care was
moderately associated with ART adherence among AFRICOS participants (aPR: 1.09; 95% CI 1.00–1.16).
Conclusions: While patient satisfaction in AFRICOS was high and the association between perceived quality of care
and adherence to ART was marginal, we did identify potential target areas for HIV care improvement, including reducing
clinic waiting times.
Description
Keywords
HIV/AIDS, Quality of care, Viral load
Citation
Somi, N., Dear, N., Reed, D., Parikh, A., Lwilla, A., Bahemana, E., ... & Esber, A. (2021). Perceived satisfaction with HIV care and its association with adherence to antiretroviral therapy and viral suppression in the African Cohort Study. AIDS research and therapy, 18(1), 1-8. https://doi.org/10.1186/s12981-021-00414-3