Patient and health worker perspectives on quality of HIV care and treatment services in Haiti

BMC Health Services Research

Research

Jean Marcxime Chéry¹  Jean Guy Honoré¹  Witson Dervis¹  Josette Elusdort¹  Jane M. Simoni²  Joseph Adrien Emmanuel Demes³  Elizabeth Haight⁴  Nancy Puttkammer⁴ 

[1] Centre Haïtien de Renforcement du Système Sanitaire (CHARESS), 14, Route de Jacquet, Delmas 95, Port-Au-Prince, Haïti;Department of Psychology, University of Washington, 3921 W Stevens Way NE, Box #351525, 98195-0000, Seattle, WA, USA;Faculté de Médecine et de Pharmacie, Université d’Etat d’Haïti (National University of Haiti), 89, Rue Oswald DURAND, HT6110, Port-Au-Prince, Haïti;International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Box # 359932, 325 Ninth Ave, 98104, Seattle, WA, USA;

关键词: HIV/AIDS;    Haiti;    Antiretroviral therapy;    Adherence;    Retention in care;    Cultural factors in healthcare;   

DOI  :  10.1186/s12913-023-09041-2

 received in 2022-08-26, accepted in 2023-01-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPoor quality of care is a barrier to engagement in HIV care and treatment in low- and middle-income country settings. This study involved focus group discussions (FGD) with patients and health workers in two large urban hospitals to describe quality of patient education and psychosocial support services within Haiti’s national HIV antiretroviral therapy (ART) program. The purpose of this qualitative study was to illuminate key gaps and salient “ingredients” for improving quality of care.MethodsThe study included 8 FGDs with a total of 26 male patients and 32 female patients and 15 smaller FGDs with 57 health workers. The analysis used a directed content analysis method, with the goal of extending existing conceptual frameworks on quality of care through rich description.ResultsDimension of safety, patient-centeredness, accessibility, and equity were most salient. Patients noted risks to privacy with both clinic and community-based services as well as concerns with ART side effects, while health workers described risks to their own safety in providing community-based services. While patients cited examples of positive interactions with health workers that centered their needs and perspectives, they also noted concerns that inhibited trust and satisfaction with services. Health workers described difficult working conditions that challenged their ability to provide patient-centered services. Patients sought favored relationships with health workers to help them navigate the health care system, but this undermined the sense of fairness. Both patients and health workers described frustration with lack of resources to assist patients in dire poverty, and health workers described great pressure to help patients from their “own pockets.”ConclusionsThese concerns reflected the embeddedness of patient – provider interactions within a health system marked by scarcity, power dynamics between patients and health workers, and social stigma related to HIV. Reinforcing a respectful and welcoming atmosphere, timely service, privacy protection, and building patient perception of fairness in access to support could help to build patient satisfaction and care engagement in Haiti. Improving working conditions for health workers is also critical to achieving quality.

【 授权许可】

CC BY   
© The Author(s) 2023