Antiretroviral Therapy Service Quality and Associated Factors at Selected Public Hospitals, Addis Ababa, Ethiopia, 2021

Figures & data

Table 1 Sociodemographic Characteristics of Respondents in Client Satisfaction with the Quality of ART Clinical Service in Selected Addis Ababa Public Hospitals, 2021 (n=420)

Variables	Categories	N(%)
Health facilities	Zewditu Memorial Hospital	167(39.8%)
	ALERT Hospital	140(33.3%)
	St Peter Hospital	48(11.4%)
	Yekatit 12 Hospital	65(15.5%)
Sex	Male	282(67.1%)
	Female	138(32.9%)
Age Group	23–33 years	50(11.9%)
	34–44 years	176(41.9%)
	45–55 years	153(36.4%)
	56–66 years	31(7.4%)
	67–77 years	10(2.4%)
Marital status	Single	84(20%)
	Married	184(43.8%)
	Divorced	72(17.2%)
	Widowed	80(19%)
Education status	Unable to read and write	47(11.2%)
	Read and write only	16(3.8%)
	Elementary (1–8)	127(30.2%)
	Secondary (9–12)	134(31.9%)
	College and above	96(22.9%)
Occupation Status	Unemployed	124(29.5%)
	Government employee	67(16%)
	Farmer	6(1.5%)
	Merchant	48(11.4%)
	Daily labourer	74(17.6%)
	Others (Long distance drivers, house wife and students)	101(24%)
Religious	Orthodox	313(74.5%)
	Muslim	54(12.8%)
	Protestant	47(11.2%)
	Catholic	4(1%)
	Others	2(0.5%)
Place of residence	Urban	352(83.8%)
	Rural	68(16.2%)
Travel distance to reach the health facility	Less than 30 minute	27(6.4%)
	30–60 minute	245(58.3%)
	61–120 minute	119(28.3%)
	121 and More	29(6.9%)
Consultation time	≤10 minute	237(56.4%)
	>10 minute	183(43.6%)
Average waiting time	≤30 minute	216(51.4%)
	31–60 minute	149(35.5%)
	61 and More minute	55(13.1%)
Months on ART	Less than 24 Months	29(6.9%)
	>24 Months	391(93.1%)
Estimated monthly income of the respondents	0–500	106(25.2%)
	501–1000	49(11.7%)
	1001–2000	69(16.4%)
	2001–3000	44(10.5%)
	More Than 3000	152(36.2%)

Table 2 Summary of the Structural Quality of ART Clinical Service in Selected Addis Ababa Public Hospitals, 2021

Structural Quality Indicators	Mean Score No (%)
A number of health facilities with at least one trained human resource on ART service.	4(100%)
Number of health facilities where separate ART clinics available with at least one for consultation room, counselling, and on-site pharmacy room	2(50%)
Number of health facilities with available ART program implementation guidelines	1(25%)
Number of health facilities with available ART SOP manual	4(100%)
Number of health facilities with chronic care registers (Pre-ART and ART)	4(100%)
Number of health facilities with data capturing forms at patient level (intake and follow-up forms)	4(100%)
Number of health facilities with activities reporting format	4(100%)
Number of health facilities with available and functional CD4 Machine	4(100%)
Number of health facilities with available and functional chemistry Machine	4(100%)
Number of health facilities with available and functional CBC Machine	4(100%)
Number of health facilities with the available and functional quality committee	1(25%)
Number of health facilities with established HIV/AIDS committee	4(100%)
Number of health facilities with no stock out of at least one required ARV drug in the last twelve months.	2(50%)
Number of health facilities with no stock out of at least one Co-trimoxazole prophylaxis in the last twelve months.	1(25%)
Number of health facilities with no stock out of at least one required Family planning drug in the last twelve months.	1(25%)
The overall quality of ART clinical service for availability dimension	73.3%

Notes: if score is >90% Excellent,80–90% V. Good,70–80% Good,60–70% Fair,< 60% Poor. Score > 85% Acceptable quality, 70–85% Needs Improvement, <70 Needs immediate action for improvement.

Table 3 Quality of ART Clinical Service with Compliance of Service Providers in Selected Addis Ababa Public Hospitals, 2021 (n=357)

Process Quality Indicators	Mean Score N(%)
Proportion of HIV positive clients on ART who were assessed for ART eligibility (using WHO clinical stage or CD4 count) before ART initiation	324(90.8%)
The proportion of clients who have received baseline CD4 count within 2 weeks after the first HIV clinic visit.	282(79%)
The proportion of HIV clients on ART provided ART adherence counselling during clinic visits according to the national guideline	278(77.9%)
The proportion of HIV-positive clients on ART who were assessed for adherence to antiretroviral medicines every clinic visit.	285(79.8%)
The proportion of clients on ART who were received nutritional assessment and counselling every clinic visit.	286(80.1%)
Proportion of clients eligible for CPT who are currently on CPT prophylaxis	254(71.1%)
Proportion of clients who had CD4 count at least once during last six months	215(60.2%)
Proportion of HIV positive clients on ART who were assessed for active TB during each clinical follow-up visit	306(85.7%)
Proportion of HIV clients eligible for ART who get laboratory workup before initiating ART (CBC & Chemistry test)	305(85.4%)
Proportion of clients eligible for ART who are currently on ARV	308(86.3)
Proportion of clients on ART who kept all clinical review appointments in the last 12 months.	200(56%)
Proportion of clients who were lost to follow-up and back to treatment during the last 12 months (n=25)	(80.0%)
The proportion of clients on ART who had at least one HIV clinic visit during the last three months.	299(83.8%)
The proportion of clients with previous ARV regimens is changed for the reason a change in regimen is documented.	302(84.6%)
The proportion of clients who had registered functional status at the start of ART	299(83.8%)
The proportion of clients on ARV who had registered own and contact address	311(87.1%)
The overall quality of ART clinical service for compliance dimension	79.5%

Notes: if score is >90% Excellent, 80–90% V. Good, 70–80% Good, 60–70% Fair, < 60% Poor. Score > 85% Acceptable quality, 70–85% Needs Improvement, <70 Needs immediate action for improvement.

Table 4 Summary Clients Satisfaction (Outcome Quality) of ART Clinical Service in Selected Addis Ababa Public Hospitals, 2021 (n=420)

Satisfaction Variables	Mean Score No (%)
The proportion of clients satisfied with the ARV drugs availability always when needed	368(87.6%)
The proportion of clients satisfied with the availability of the non-ARVs drug always when needed	221(52.6%)
The proportion of clients satisfied with the laboratory services availability always when needed	236(56.2%)
The proportion of clients satisfied with opening hours of ART clinic	344(81.9%)
The proportion of clients satisfied with the easy accessibility of ART clinic when needed	366(87.1%)
The proportion of clients satisfied with respect shown by health care providers	391(93.1%)
The proportion of clients satisfied with counselling service given by HCPs	391(93.1%)
The proportion of clients satisfied with a chance given to ask and talk about what they feel	350(83.3%)
The proportion of clients who satisfied with their medical information confidentiality kept by HCPs	391(93.1%)
The proportion of clients who were satisfied with the information provided by health care providers	394(93.8)
The proportion of clients who satisfied with the competency of health care providers to treat them	394(93.8)
The proportion of clients satisfied with service received from the facility today	406(96.7%)
The proportion of clients who are satisfied with the privacy of exam/treatment/counselling room (not to be seen or heard by others)	389(92.6%)
The proportion of clients who were satisfied with the cleanliness and attractiveness of the waiting area	397(94.5%)
The proportion of clients who satisfied with the appropriate waiting time to get service	281(66.9%)
The proportion of clients who were satisfied with the time spent with health care providers during the consultation	401(95.5%)
The proportion of clients who satisfied with the appropriateness of the prescribed therapy for their illness	406(96.7%)
The proportion of clients who are satisfied with the overall quality service they get at this health facility	409(97.4%)
The overall quality of ART clinical service for satisfaction dimension	86.4%

Notes: if score is >90% Excellent, 80–90% V. Good, 70–80% Good, 60–70% Fair,< 60% Poor. Score > 85% Acceptable quality, 70–85% Needs Improvement, <70 Needs immediate action for improvement.

Table 5 Bivariate and Multivariate Analysis of Satisfaction Rate of Clients on the Overall Quality of ART Clinical Service in Selected Addis Ababa Public Hospitals, 2021

Variables		Satisfaction		COR (95%)	AOR (95%)	P-value
		Satisfied N (%)	Dissatisfied N(%)
Education	Unable to read and write	43(83.7%)	4(16.3%)	1.536(0.254–9.303)	0.7(0.19–2.5)	0.58
	Read and write only	14(87.5%)	2(12.5%)	2.466(0.81–7.503)	1.23(0.22–6.76)	0.804
	Elementary (1–8)	113(89%)	14(11%)	1.33(0.415–4.271)	0.89(0.35–2.3)	0.815
	Secondary (9–12)	109(81.3%)	25(18.7%)	1.536(0.467–5.047)	1.73(0.77–3.85)	0.18
	College and above	84(87.5%)	12(12.5%)	1	1	1
Occupation	Unemployed	109(87.9%)	15(12.1%)	0.502(0.175–1.437)	0.586(0.266–1.29)	0.185
	Government employee	59(88.1%)	8(11.9%)	2.158(0.368–12.659)	0.534(0.212–1.34)	0.182
	Merchant	43(89.6%)	5(10.4%)	0.6(0.285–1.239)	1.99(0.318–12.506)	0.461
	Daily laborer	66(89.2%)	8(10.8%)	0.585(0.24–1.427)	0.395(0.133–1.173)	0.094
	Farmer	4(66.7%)	2(33.3%)	0.523(0.215–1.271)	0.608(0.229–1.618)	0.319
	Others(long distance drivers, house wife and students)	82(81.2%)	19(18.8%)	1	1	1
Patients who know partner’s HIV status	Yes	317(85.7%)	53(14.3%)	1.923(0.665–5.562)	2.328(0.78–6.943)	0.130
	No	46(92%)	4(8%)	1	1	1
Consultation time	≤ 10 minutes	193(81.4%)	44(18.6%)	1	1	1
	>10 minutes	169(92.3%)	14(7.7%)	2.752(1.457–5.2)	3.5(1.6–7.35)	0.001*
Disclosure of HIV status	Yes	317(91.9%)	28(8.1%)	7.55(4.13–13.8)	10.7(5.2–22)	0.000*
	No	45(60%)	30(40%)	1	1	1
Month on ART	Less than 24 months	14(48.3%)	15(51.7%)	1	1	1
	> 24 months	348(89%)	43(11%)	8.67(3.92–19.2)	10.4(3.89–27.8)	0.000*
Age group	23–33 years	47(94%)	3(6%)	1	1	1
	34–44 years	159(87.8%)	22(12.2%)	4.5(1.01–19.6)	5.1(1.2–22)	0.028*
	45–55 years	132(83.5%)	26(16.5%)	5.8(1.08–30.6)	8.1(1.9–35.5)	0.006*
	56–76 years	23(76.7%)	7(23.3%)	4.9(1.2–20.6)	5(2.97–9.44)	0.001*

Note: P-value≤0.05 is considered statistically significant*.

Abbreviations: COR, crude odds ratio; AOR, adjusted odds ratio.