Patient Experiences of Decentralized HIV Treatment and Care in Plateau State, North Central Nigeria: A Qualitative Study.

Grace O Kolawole,Nancin Y Dadem,Becky L Genberg,Norma C Ware,Patricia A Agaba,Oche O Agbaji,Hannah N Gilbert,Prosper Okonkwo

doi:10.1155/2017/2838059

Abstract

Background. Decentralization of care and treatment for HIV infection in Africa makes services available in local health facilities. Decentralization has been associated with improved retention and comparable or superior treatment outcomes, but patient experiences are not well understood. Methods. We conducted a qualitative study of patient experiences in decentralized HIV care in Plateau State, north central Nigeria. Five decentralized care sites in the Plateau State Decentralization Initiative were purposefully selected. Ninety-three patients and 16 providers at these sites participated in individual interviews and focus groups. Data collection activities were audio-recorded and transcribed. Transcripts were inductively content analyzed to derive descriptive categories representing patient experiences of decentralized care. Results. Patient participants in this study experienced the transition to decentralized care as a series of “trade-offs.” Advantages cited included saving time and money on travel to clinic visits, avoiding dangers on the road, and the “family-like atmosphere” found in some decentralized clinics. Disadvantages were loss of access to ancillary services, reduced opportunities for interaction with providers, and increased risk of disclosure. Participants preferred decentralized services overall. Conclusion. Difficulty and cost of travel remain a fundamental barrier to accessing HIV care outside urban centers, suggesting increased availability of community-based services will be enthusiastically received.

Highlights

Immediate treatment of all persons found to be HIVinfected—the “test-and-treat” approach to HIV service delivery [1]—requires rethinking traditional, clinic-based models of HIV care, in resource-scarce settings
To simplify care experiences for patients, services based on differentiated care models are increasingly located in communities, rather than large HIV-specialty clinics
To understand how the delivery of decentralized HIV care is responding to the needs and priorities of patients in north central Nigeria, our research captured a set of advantages and disadvantages that represent patients’ key experiences with the decentralization of their own care services

Summary

Introduction

Immediate treatment of all persons found to be HIVinfected—the “test-and-treat” approach to HIV service delivery [1]—requires rethinking traditional, clinic-based models of HIV care, in resource-scarce settings. To simplify care experiences for patients, services based on differentiated care models are increasingly located in communities, rather than large HIV-specialty clinics. New community-based services, such as home and mobile van HIV testing and counseling, point-of-care CD4 and viral load testing, ART refill groups, and community drug distribution points (CDDPs) [3,4,5,6,7,8,9,10,11,12], have their roots in the movement to decentralize ART initiation and follow-up care. We conducted a qualitative study of patient experiences in decentralized HIV care in Plateau State, north central Nigeria. Difficulty and cost of travel remain a fundamental barrier to accessing HIV care outside urban centers, suggesting increased availability of community-based services will be enthusiastically received

Methods

Discussion

Conclusion