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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Human Immunodeficiency Virus | Research article

HIV/AIDS health services in Manaus, Brazil: patient perception of quality and its influence on adherence to antiretroviral treatment

Authors: Carlued Leon, Tamar Koosed, Bryn Philibert, Cristina Raposo, Adele Schwartz Benzaken

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

Patient satisfaction is an important factor for both assessing the quality of healthcare and predicting positive health outcomes. This study assesses the influence of HIV/AIDS patients’ perception of the quality of health services on adherence to antiretroviral treatment using the decentralized care model in Manaus, Brazil.

Methods

We conducted a non-randomized, cross-sectional analysis to explore the relationship between patient satisfaction and adherence to antiretroviral treatment (ART) in Manaus, Amazonas, Brazil. We also compared patient satisfaction levels at the city’s main hospital with those at smaller health units established to decentralize HIV/AIDS healthcare. Using survey responses from 812 patients and health data from 713 patients, we conducted descriptive and regression analyses to identify health center characteristics associated with higher patient satisfaction and higher adherence to treatment.

Results

We found a clear and positive relationship between patient satisfaction with the quality of health services and adherence to ART. Patients who had better access to their health center and its services –mainly in the form of convenient location, shorter commute times, and shorter wait times— tended to rate the quality of services higher and were also more likely to adhere to ART. We also found higher levels of patient satisfaction and adherence to ART among patients served at decentralized health units than among patients served at the main hospital.

Conclusions

The study’s results emphasize the importance of patients’ experience at the health center for improved health outcomes. While many of the factors that play a role in whether a patient adheres to ART or not are beyond the control of the health center, our findings highlight that health centers can importantly contribute to increased ART adherence by improving such experience. The study also showcases the potential benefits of decentralizing HIV care to increase patient satisfaction and, with it, adherence to ART.
Appendix
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Footnotes
1
Data extracted from databases Sistema de Controle Logístico de Medicamentos (SICLOM) and Sistema de Controle de Exames Laboratoriais (SISCEL).
 
2
Three patients declined to disclose their gender
 
3
Convenience of health center’s location is related to patient’s perception of the location of the health center and not to the actual location of the health center (distance or commute time). Convenience may not necessarily respond to distance or commute time. For example, a health center may not be close to the patient’s home, but it can be convenient if it is on the way between home and work, if there is good public transportation to the health center, or if it is far enough from his/her neighborhood so as to keep the HIV positive status private from others in his/her community.
 
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Metadata
Title
HIV/AIDS health services in Manaus, Brazil: patient perception of quality and its influence on adherence to antiretroviral treatment
Authors
Carlued Leon
Tamar Koosed
Bryn Philibert
Cristina Raposo
Adele Schwartz Benzaken
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4062-9

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