Patient satisfaction with HIV/AIDS care at private clinics in Dar es Salaam, Tanzania

Abstract

Health system responsiveness (HSR) measures quality of care from the patient's perspective, an important component of ensuring adherence to medication and care among HIV patients. We examined HSR in private clinics serving HIV patients in Dar es Salaam, Tanzania. We surveyed 640 patients, 18 or older receiving care at one of 10 participating clinics, examining socioeconomic factors, HIV regimen, and self-reported experience with access and care at the clinic. Ordered logistic regression, adjusted for clustering of the clinic sites, was used to measure the relationships between age, gender, education, site size, and overall quality of care rating, as well as between the different HSR domains and overall rating. Overall, patients reported high levels of satisfaction with care received. Confidentiality, communication, and respect were particularly highly rated, while timeliness received lower ratings despite relatively short wait times, perhaps indicating high expectations when receiving care at a private clinic. Respect, confidentiality, and promptness were significantly associated with overall rating of health care, while provider skills and communication were not significantly associated. Patients reported that quality of service and confidentiality, rather than convenience of location, were the most important factors in their choice of a clinic. Site size (patient volume) was also positively correlated with patient satisfaction. Our findings suggest that, in the setting of urban private-sector clinics, flexible clinics hours, prompt services, and efforts to improve respect, privacy and confidentiality may prove more helpful in increasing visit adherence than geographic accessibility. While a responsive health system is valuable in its own right, more work is needed to confirm that improvements in HSR in fact lead to improved adherence to care.

Keywords:

• HIV
• patient satisfaction
• private sector
• Tanzania
• quality of care

Acknowledgments

We would like to thank the patients who participated in the exit survey and the health care providers for their dedication to improving quality of care. We also thank all of the Management and Development for Health program staff in Dar es Salaam as well as Gabriela Poles for their assistance.

Funding

This work was funded through the Harvard CFAR grant [grant number P30AI060354] funded from the National Institutes of Health (NIH); the President's Emergency Plan for AIDS Relief through HRSA under the terms of grant number [U51HA02522] through the Harvard School of Public Health.

Additional information

Funding

Funding: This work was funded through the Harvard CFAR grant [grant number P30AI060354] funded from the National Institutes of Health (NIH); the President's Emergency Plan for AIDS Relief through HRSA under the terms of grant number [U51HA02522] through the Harvard School of Public Health.