Patient and Provider Experiences on Differentiated Antiretroviral Therapy Service Delivery Models in Addis Ababa Health Fa cilities: A Mixed-Methods Study
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Date
2024-10
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Addis Ababa University
Abstract
Background: Following the World Health Organization's (WHO) recommendation of the
Differentiated Service Delivery (DSD) models as a client-centered approach in 2016, Ethiopia
has been implementing these models since 2017. However, there is paucity of information on the
impact of the DSD model implementation in Ethiopia.
Objective: To assess patient and provider experiences with the implementation of Antiretroviral
therapy (ART) DSD models in selected health facilities of Addis Ababa, Ethiopia.
Methods: A mixed-methods sequential explanatory study design was undertaken among People
Living with HIV (PLWH) and healthcare professionals at 10 selected health facilities of Addis
Ababa. For the quantitative study, convenient sampling was employed, while purposive sampling
method was used for the qualitative study. Mann-Whitney U and Kruskal Wallis tests were
performed to determine the difference in the patient satisfaction among subgroups of patients.
Multivariable Tobit regression was performed to identify factors associated with patient
satisfaction. Thematic analysis was used to interpret the qualitative data.
Results: Four hundred fifteen PLWH were included in the final analysis. The majority (266,
64.1%) were female and 185 (44.6%) were enrolled in Appointment Spacing Model (ASM). The
median score of patient satisfaction was 76.5. Viral load count of <1000 copies/ml, high
adherence level and being on first line regimen were significantly positively associated with high
patient satisfaction. There was no satisfaction difference among the DSD models. The qualitative
analysis documented patients’ and professionals’ perspectives in the areas of service efficiency,
perceived patient outcomes, and integration with other chronic patient care services.
Conclusion and recommendation: The study found that patients expressed a high level of
satisfaction with DSD models. Factors such as the type of regimen, patient adherence status, and
viral load amount significantly influenced satisfaction. Perceived stigma with community DSD
models, low awareness on DSD models, fear of detachment from the health facility, and supply
chain inconsistency were the reported barriers with ART DSD models. Majority of the study
participants believed that the integration of HIV care with other chronic condition was beneficial.
Policy makers, federal ministry of health, and health care providers should consider addressing
the barriers associated with DSD models.
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Keywords
DSD models, ART, Patient satisfaction, PLWH, integration, Ethiopia