Understanding client satisfaction with HIV testing and counseling services: a mixed-methods study in four African countries

ABSTRACT

This paper uses mixed methods to provide comparative evidence across four African countries and identify those aspects of the testing experience that are the most important components of clients’ satisfaction with services. We analyze data from three sources: a survey of clients at health facilities that included closed-ended questions about specific services and interactions around testing; responses to open-ended questions about testing experiences that were part of the same survey; and semi-structured interviews with a subsample of respondents who described their experience of testing and being diagnosed with HIV. High levels of reported satisfaction are found in both the survey and interview. The critical factors contributing to client satisfaction included: the three C's of testing-counseling, consent, and confidentiality, client–provider interactions, convenience of location, “good services”, and reliable test results.

KEYWORDS:

• Satisfaction
• HIV testing
• counseling
• Africa
• mixed methods

Acknowledgements

We would like to recognize and thank the many men and women who participated in the study, especially those HIV-positive persons who shared their time and stories with us.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. The study was cleared by the Institutional Review Board of each country, and by the Ethics Review Committee of the World Health Organization (WHO). Details about the testing milieu in each of the four countries, the selection of facilities and respondents, response rates, ethical clearance, and data collection have been previously described (Obermeyer et al., 2012; al., 2013).

2. Interviews were conducted in local languages as well as in French and English, they were recorded, transcribed, and analyzed using NVivo 10. Further details about qualitative data methodology and analyses have been described elsewhere (Hardon et al., 2012; Obermeyer et al., 2014).

3. Open-ended survey questions, which were analyzed for textual analysis included: “Was it hard for you to be tested, why or why not?” (asked about most recent test, and, for those tested more than once, about first test); “Why did you choose to test at this particular facility?”; “How did you find the waiting period for your results?”; “Did clinic staff members help you and if so how?”; “What did the health worker advise you to do?”; “Why have you not received referred care?”

4. The coding was discussed between the lead (Michelle Osborn) and corresponding (Carla Makhlouf Obermeyer) authors and quotes are illustrative of clients’ perspectives.

5. Responses about client consent have been analyzed in detail elsewhere (Hardon et al., 2012; Obermeyer et al., 2014), as well as involuntary disclosure and the ethical dilemmas this poses for health care workers (Bott et al., 2015).

6. This represents a critique levelled at satisfaction studies in general (Brookes & Fenton, 2014; Fenton, Jerant, Bertakis, & Franks, 2012).

Additional information

Funding

This project was supported by a grant from the National Institutes of Health [5 R01 HD053268-05 (PI: Carla Obermeyer)]. This support is gratefully acknowledged.