Psycho-social and Care Delivery Challenges of HIV/AIDS in the Dominican Republic: Impairment of Patient Outcomes

Abstract

Objective: The aim of this pilot study was to identify HIV/AIDS care delivery gaps from both caregiver and patient perspectives, in a high risk region of the Dominican Republic. Furthermore, the study hopes to establish baseline data on psychosocial issues of HIV/AIDS in the Dominican Republic. The study further analyzed these factors in the context of current national policies. Methods: The study, conducted at Boca Chica HIV/AIDS Clinic in the Dominican Republic, consisted of two parts: 1) a retrospective review of 300 patient clinical charts and 2) personal interviews with 52 patients, 15 physicians, 7 nurses, 5 social workers and 11 hospital administrators. Results: Major barriers to accessing care identified were patient education, training for healthcare professionals, lack of funds, transportation and inconvenient clinic hours. Over half of patients believed that supernatural means to healing could be utilized as a sole path to disease management. Only 21% indicated they had continuous access to medication. Although patients trusted the clinic in terms of confidentiality, 60% expressed a fear of inappropriate information. Social workers, physicians, and nurses identified stigmatization as a major healthcare barrier, but this view was held by only 17% of patients. Administrators identified documentation and equipment as major areas that need improvement. All 300 records were missing follow-up dates for appointments, medication histories, social histories, income information, or psychiatric histories, and 33% had no record of a physical exam. Only 62% of physicians, nurses, social workers, and medical administrators were aware of national programs that collect HIV/ AIDS information and how they function. Conclusion: Our results warrant new programs and development of a robust and coherent multidisciplinary approach to HIV/AIDS care delivery as a capacity-building national policy. Furthermore, our observations indicate that the lack of effective implementation programs add to the complexity of HIV/AIDS care services.