Patient Satisfaction and Human Immunodeficiency Virus (HIV) Infection in Public Health Facilities in Gauteng, South Africa Open Access

Abstract

Patient satisfaction is a useful tool for evaluating the quality of health programs. Following the Donabedian framework from 1988, patient satisfaction questionnaires should consistently measure the structure, process, and outcomes of healthcare experiences. This information allows for the patient perspective in the assessment of health systems and provides data that can inform systems strengthening. South Africa has high rates of human immunodeficiency virus (HIV) infection yet relatively low rates of adherence to antiretroviral treatment (ART), and facilities that offer services to target the disease need strengthening. Literature shows that patient satisfaction may be a predictor of viral load and HIV treatment adherence outcomes, though further research is needed to assess these relationships. Annual Patient Experience of Care questionnaires are conducted in South Africa by the National Department of Health to assess the public health facilities in each province. This study attempts to better understand the relationship between patient satisfaction and HIV control measures in those facilities. Using data from 2017 Patient Experience of Care questionnaires through the Aurum Institute in Johannesburg, supplemented with PEPFAR quarterly monitoring data on ART adherence, this report uses a multiple linear regression analysis to examine factors that contribute to patient satisfaction. The analysis focused primarily on the City of Ekurhuleni within Gauteng Province and found that higher patient satisfaction was associated with additional Aurum-supported staff, fewer patients lost to HIV care follow-up, and greater facility focus on HIV testing and treatment. This analysis may assist Gauteng Province in improving ART adherence and quality of care in the facilities.

Table of Contents

List of Figures 1

List of Tables 1

Abbreviations 2

Chapter 1: Literature Review.. 3

Introduction. 3

What is Patient Satisfaction?. 4

Patient Surveys as Methods for Evaluation. 7

Measurements in Patient Satisfaction Surveys 8

Patient Satisfaction and Adherence to HIV Treatment 8

PEPFAR and HIV in South Africa. 11

Patient Satisfaction and HIV in Gauteng Province. 13

Chapter 2: Manuscript 15

Abstract. 15

Background. 16

Methods 18

Patient Recruitment 18

Sample. 18

Questionnaire Data Collection. 19

Inclusion/Exclusion Criteria. 20

Statistical Analysis 21

Results 22

Patients 22

Patient Satisfaction. 23

Regression Analysis 24

Discussion. 25

Limitations 26

Recommendations 27

Chapter 3: Conclusion and Recommendations 29

Infrastructure. 29

Collaboration. 30

90-90-90 Goals 31

Conclusion. 32

References 34

Appendix A: Patient Experience of Care (PEC) Questionnaire 38

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Patient satisfaction South Africa linear regression HIV PEPFAR
Committee Chair / Thesis Advisor	Dr. Kenneth Castro, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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