End User Perceptions of Antiretroviral Therapy (ART) Services in Public and Private Health Facilities in Anambra State, Nigeria: Lessons for Scale Up of Quality Private Sector Services Open Access

Abstract

Background

Since the emergence of HIV and AIDS in Nigeria in the early 1980s, the country's health care system has struggled to provide care and support to the growing number of adults and children living with the disease. Government-managed public health facilities serve the vast majority of people seeking HIV and AIDS care and support services. As government resources for health care are stretched to a breaking point by HIV and AIDS and other demands, policy makers and health officials are looking to the private sector to take on more responsibility for providing ART and other HIV and AIDS services for millions of infected Nigerians.

Purpose: This study aimed to examine the perceptions of end-users of ART services provided through programs at private and public health facilities in Anambra State. Anambra State's 8.7% HIV prevalence rate is among the highest of Nigeria's 36 states and the Federal Capital Territory. Anambra State also has one of the country's highest per capita income levels and also has a large number of private healthcare providers. The State provides an important opportunity to understand the perceptions and expectations of people living with ART about services provided by government run and privately operated health facilities.

Methods: A qualitative and descriptive research design was used for the study. Semi-structured focus group discussions were conducted amongst 84 participants in 4 health facilities (2 public and 2 private) in Anambra State. Participants were recruited through purposive sampling of end users receiving ART services in the health facilities. Qualitative data analysis, based in grounded theory, addressed inductive and deductive themes.

Results: The perceived needs of patients affect how they view quality services. Workforce performance stands out as the most important factor influencing end user perceptions of ART services, followed by patient values, health benefits, stigma and support systems.

Conclusion: An understanding of how ART end users evaluate their care may help to identify deficiencies and inform improvements to ART services. This understanding will help render ART services in health facilities more patient centered.

Table of Contents

1.1 Introduction and Rationale...................................................................................................1

1.2 Problem Statement……………………………………………….. …………......….….....2

1.3 Purpose Statement............................................................................................................... 2

1.4 Research Questions............................................................................................................. 3

1.5 Significance Statement ....................................................................................................... 3

1.6 Definition of Terms............................................................................................................. 3

Chapter 2

Review of the Literature

2.1 Introduction……………..................................................................................................... 6

2.2 End User Perceptions.…..................................................................................................... 7

2.3 Chronic Care Model.….................................................................................................... 10

Chapter 3

Methodology

3.1 Introduction……............................................................................................................... 12

3.2 Population and Sample......................................................................................................12

3.3 Research Design................................................................................................................ 14

3.4 Procedures......................................................................................................................... 15

3.5 Instruments........................................................................................................................ 18

3.6 Plans for Data Analysis..................................................................................................... 20

3.7 Ethical Considerations...................................................................................................... 20

3.8 Limitations and Delimitations…....................................................................................... 20

Chapter 4

Results

4.1 Introduction……............................................................................................................... 21

4.2 Demographic data of participants..................................................................................... 22

4.3 Presentation of themes...................................................................................................... 24

4.4 Theme 1: Work force performance................................................................................... 25

4.5 Theme 2: Patient values………….................................................................................... 26

4.6 Theme 3: Health Benefits………..................................................................................... 29

4.7 Theme 4: Stigma…………………................................................................................... 31

4.8 Theme 5: Support Systems………................................................................................... 33

Chapter 5

Discussion of Findings

5.1 Introduction……............................................................................................................... 36

5.2 Discussion………………………..................................................................................... 37

5.3 Participants recommendations………………….............................................................. 41

3.4 Conclusion…………………………................................................................................ 44

5.5 Recommendations…………………................................................................................ 42

5.6 List of References….…………....................................................................................... 43

Annex A: Sociodemographic form................................................................................... 46

Annex B: Focus Group Guide…..................................................................................... 48

Annex C: Key Informant Interview Guide....................................................................... 53

Annex D: Consent Forms………..................................................................................... 56

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Health Care Management
Keyword	Quality of ART services HIV and AIDS management
Committee Chair / Thesis Advisor	Winskell Enger, Kate, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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