Patient satisfaction with integrated HIV and antenatal care services in rural Kenya

Abstract

A cluster randomized controlled trial was initiated in Kenya to determine if full integration (FI) of HIV care, including HAART, into antenatal care (ANC) clinics improves health outcomes among HIV-infected women and exposed infants, compared to a non-integrated (NI) model. This article examines ANC clients' satisfaction with and preferences regarding HIV-integrated services. In this cross-sectional study, pregnant women attending five FI clinics (n=185) and four NI clinics (n=141) completed an interviewer-administered questionnaire following an ANC visit. By self-report, 55 women (17%) were HIV(+), 230 (71%) were HIV(−), and 40 (12%) did not know their HIV status. Among HIV-infected women, 79% attending FI clinics were very satisfied with their clinic visit compared to 54% of women attending NI clinics (P=0.044); no such difference was found among HIV-uninfected women. In multivariate analysis, overall satisfaction was also independently associated with satisfaction with administrative staff, satisfaction with health care providers, positive evaluation of wait time, and having encountered a receptionist. Full integration of HIV care into antenatal clinics can significantly increase overall satisfaction with care for HIV-infected women, with no significant decrease in satisfaction for HIV-uninfected women served in the same clinics.

Keywords:

• patient satisfaction
• HIV
• antenatal care
• service integration
• Kenya

Acknowledgements

We would like to thank the Kenyan women who participated in the study and shared their experiences with us. We acknowledge the support of FACES and Research, Care and Training Program at KEMRI. We thank the trilingual research assistants, Salome Ogola Amuom and Samuel Otieno, for their diligent work in collecting the data. We gratefully acknowledge the Director KEMRI and the Director of KEMRI's Centre for Microbiology Research for their support in conducting this research. We also thank Janet Myers, Ph.D., MPH and David Glidden, Ph.D. for study design and analysis advice. The project received IRB approval from both UCSF and KEMRI. This publication was supported by NIH/NCRR/OD UCSF-CTSI Grant Number TL1 RR024129, UCSF Quarterly Research Fellowship, UCSF SBS/PTD Student Research Fund, and UCSF Pathway Project Fund. Janet Turan's work on this study was supported by grant #5K01MH81777 from the US National Institute of Mental Health (NIMH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NIMH.

Notes

Preliminary findings were presented at the 7th annual Global Health and Innovations Conference, Connecticut, USA, on 17–18 April 2010.