Quality of Antiretroviral Treatment Services in Woliso Town, South West Shoa Zone, Central Ethiopia

Abstract

Background: - Quality of clinical care is fundamental to achieve the goal of antiretroviral treatment services. But it is not known due to different factors especially in developing countries like Ethiopia. The objective of this study is to assess quality of antiretroviral treatment services by using Donabedian quality model in Woliso Town Health Facilities, South West Shoa Zone, Central Ethiopia. Methods: - Facility based cross sectional study by using both quantitative and qualitative methods of data collection were undertaken from 1-30 March/2011. A total of 324 clients on antiretroviral treatment from two health facilities were included in the study by using consecutive sampling technique in Woliso town health facilities. Total sample size was proportionally allocated to each health facility. Pre-tested instruments were used for data collection and data were analyzed by using SPSS version 16. Factor score was computed for the items identified to represent perception scale by Varimax rotation methods. Factor mean score was used to describe overall satisfaction level of client‘s on quality of ART services, and multiple linear regressions with stepwise method was used to identify independent predictors of overall satisfaction. Binary logistic regression with forward likelyhood method was undertaken to predict independent variable for adherence to ARV drugs. 50% of quantitative study for record review and observation of consultation session with health providers were carried out with additional in-depth interview with clients and health providers after informed written consent was taken from participants. Result: - Minimum package requirements for provision of antiretroviral treatment were fulfilled as guideline except some limitation. A total of 314 (96.7%) participants were willing to response the questionnaire. The mean score level of overall client satisfaction was found to be 12.92±2 (86.1%). Perceived technical competence (β=0.127), perceived availability of basic resources for provision of antiretroviral treatment service (β=0.125), perception and knowledge of clients on ARV drugs (β=0.192) and perceived confidentiality of medical record (β=0.222) were the main positive independent predictors of overall satisfaction of client on quality of ART services at p-value less than 0.05. Adherence rate at 95% in past seven days was 93%. On the others hand perceived technical competence [OR, 1.285, 95% CL, 1.079-1.531] and convenience of opening hours [OR, 1.561, 95% CI, 1.061-2.293] were the main independent predictors of adherence to ARV drugs at p-value<0.05. Conclusion and Recommendation; - Gaps exists on some structural requirement for provision of ART service differently in both health facilities. Perceived technical competence, perceived availability of basic resources for ART provision, perception and knowledge of clients on ARV drugs, perceived convenient of opening hours, perceived confidentiality of medical record were the main findings that need special attention for sustainability of quality of ART service. Continous health education, waiting area, separated room, and nutritional support should avail for clients.