Introduction
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Fast-Track Drug Refill (FTDR): People living with HIV (PLHIV) pick up drugs from the ART dispensing points without being attended to by a clinician. However, the facility triage point checks in the patients for a quick assessment of urgent care complaints. Clinicians assess these patients once every 6 months to review adherence and determine eligibility for continuation in the FTDR program.
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Community Client-Led ART Delivery (CCLAD): PLHIV in care form groups within their communities and rotate drug pick-up from the facility or a community drug distribution point.
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Community Drug Distribution Points (CDDP): PLHIV pick up drugs and receive their clinical evaluations from community outreach points closest to them.
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Facility-Based Groups (FBGs): When stable PLHIV in care need peer support, these groups provide such support, as well as drug pick-up, as the leader of the group collects the drugs from the pharmacy for group members and distributes and accounts for them [7].
Methods
Study design and setting
Study population, participants, and sampling
Ethical approval
Data collection
Development and validation of the patient satisfaction instrument
Data management and analysis
Results
Sociodemographic characteristics of the respondents
Variable Name | Categories | FTDR (%) | CCLAD(%) | CDDP (%) | Totals (%) |
---|---|---|---|---|---|
Age (years) | 18–29 | 10(8.3%) | 7 (5.2%) | 7 (1.5%) | 24 (3.3%) |
30–39 | 30 (24.8%) | 15 (11.1%) | 56 (11.8%) | 101 (13.8%) | |
40–59 | 74(61.1%) | 103 (76.3%) | 381 (80.2%) | 558 (76.3%) | |
60+ | 7 (5.8%) | 10 (7.4%) | 31 (6.5%) | 48 (6.6%) | |
Sex | Male | 41 (28.1%) | 56 (33.7%) | 157 (29.6%) | 254 (30.2%) |
Female | 105 (71.9%) | 110 (66.3%) | 373 (70.4%) | 588 (69.8%) | |
Period in HIV care (years) | < 10 | 90 (65.2%) | 71 (43.3%) | 208 (39.7%) | 369 (44.7%) |
≥10 | 48 (34.8%) | 93 (56.7%) | 316 (60.3%) | 457 (55.3%) | |
Period in DSDM (years) | < 3 years | 98 (68.1%) | 25 (15.1%) | 16 (3.0%) | 139 (16.6%) |
≥3 years | 46 (38.9%) | 141 (84.9%) | 513(97.0%) | 700 (83.4%) | |
Distance (km) to health facility | < 10 | 41 (59.4%) | 48 (64.9%) | 229 (75.1%) | 318 (71.0%) |
≥10 km | 28 (40.6%) | 26 (35.1%) | 76 (24.9%) | 130 (29.0%) | |
Employment status | Unemployed | 44 (31.2%) | 47 (28.3%) | 62 (11.7%) | 15,318.3%) |
Employed | 97 (68.8%) | 119 (71.7%) | 468 (88.3%) | 684 (81.7%) | |
Average daily income | < $1.9 | 111 (78.7%) | 139 (16.3%) | 466 (87.9%) | 720 85.5%) |
> $1.9 | 30 (21.3%) | 27 (83.7%) | 64(12.1%) | 122 (14.5%) | |
Education | None | 18 (12.8%) | 12 (7.2%) | 69 (13.0%) | 99 (11.8%) |
Primary | 51 (36.2%) | 111 (66.9%) | 322 (60.8%) | 486 (57.7%) | |
Secondary | 60 (42.6%) | 38 (22.9%) | 177 (22.1%) | 218 (25.9%) | |
Tertiary | 12 (8.5%) | 5 (3.0%) | 22 (4.1%) | 39 (4.6%) | |
Marital status | Married | 92 (65.3%) | 109 (65.7%) | 297 (56.1%) | 498 (59.5%) |
Single | 49 (34.7%) | 57 (34.3%) | 233 (43.9%) | 339 (40.5%) | |
Drinking alcohol | Never | 94 (66.7%) | 133 (80.1%) | 516 (97.4%) | 745 (88.8%) |
At least once a week | 47 (33.3%) | 33 (19.9%) | 14 (2.6%) | 94 (11.2%) | |
Friend/relative at ART delivery point | No | 81 (57.5%) | 97 (58.4%) | 206 (38.9%) | 387 (46.0%) |
Yes | 60 (42.5%) | 69 (91.6%) | 324 (61.1%) | 455 (54.0%) |
Levels of satisfaction with DSDM services
DSDM type | N | Satisfied (n = 541) | Not satisfied (n = 301) |
---|---|---|---|
CCLAD | 166 | 71 (42.8%) | 95 (57.2%) |
CDDP | 530 | 417 (78.7%) | 113 (21.3%) |
FTDR | 146 | 53 (36.3%) | 93 (63.7%) |
Overall | 842 | 541 (64.2%) | 301(35.8%) |
Correlates of patient satisfaction
Variable | Category | Patients on DSDM | Bivariate Analysis | Multivariate Analysis | |||
---|---|---|---|---|---|---|---|
Total (N = 842) | Satisfied n (%) (N = 541) | Unadjusted (Crude) Prevalence Ratio [95% CI] | p-value | aPR [95% CI] | p-value | ||
DSDM | CCLAD | 166 | 71 (42.8%) | Ref | Ref | ||
CDDP | 530 | 417 (78.7%) | 1.98 [1.65–2.39] | < 0.001a | 1.51 [1.47–1.56] | < 0.001a | |
FTDR | 146 | 53 (36.3%) | 1.80 [1.47–2.20] | < 0.001a | 1.47 [1.26–1.71] | < 0.001a | |
Gender | Female | 588 | 366 (62.2%) | Ref | Ref | ||
Male | 254 | 175 (68.9%) | 1.10 [1.03–1.16] | 0.003a | 1.10 [0.98–1.24] | 0.106 | |
Age category | 18–29 years | 24 | 12 (50.0%) | Ref | |||
30–39 years | 101 | 70 (69.3%) | 1.20 [0.95–1.53] | 0.125 | |||
40–59 years | 560 | 391 (69.8%) | 1.13 [0.91–1.41] | 0.28 | |||
≥60 years | 48 | 33 (68.8%) | 1.10 [0.98–1.23] | 0.092 | |||
Period in HIV care (Years) | < 10 Years | 369 | 232 (62.9%) | Ref | Ref | ||
≥10 Years | 457 | 296 (64.8%) | 0.91 [0.90–0.93] | < 0.001a | 1.00 [0.96–1.03] | 0.923 | |
Period in DSDM (Years) | 1–2 years | 139 | 46 (33.1%) | Ref | Ref | ||
3+ years | 700 | 494 (70.6%) | 1.44 [1.08–1.92] | 0.014a | 1.28 [1.11–1.48] | 0.001a | |
Poor adherence to ART (Last 3 days) | No | 732 | 523 (71.5%) | Ref | |||
Yes | 110 | 18 (16.4%) | 0.57 [0.48–0.67] | < 0.001a | 0.33 [0.19–0.56] | < 0.001a | |
Baseline WHO stage | Stage 1 or 2 | 796 | 532 (66.8%) | Ref | Ref | ||
Stage 3 or 4 | 35 | 7 (20.0%) | 0.49 [0.33–0.73] | < 0.001a | 0.36 [0.20–0.64] | < 0.001a | |
HIV viral load suppression | Detectable HIV viral load | 130 | 79 (60.8%) | Ref | |||
Undetectable HIV viral load | 666 | 436 (65.5%) | 0.95 [0.82–1.09] | 0.857 | |||
Employment status | Unemployed | 153 | 50 (32.6%) | Ref | Ref | ||
Employed | 684 | 491 (71.8%) | 2.00 [1.73–2.31] | < 0.001a | 1.61 [1.38–1.87] | < 0.001a | |
Average income/day | < $1.90/ day | 720 | 470 (65.3%) | Ref | Ref | ||
> $1.90/ day | 122 | 71 (58.2%) | 1.02 [0.98–1.06] | 0.395 | |||
Education level | No education | 99 | 66 (66.7%) | Ref | |||
Primary education | 486 | 324 (66.7%) | 1.02 [0.93–1.12] | 0.687 | |||
Secondary education | 218 | 129 (59.2%) | 1.05 [0.99–1.12] | 0.069 | |||
Tertiary education | 39 | 22 (56.4%) | 1.02 [0.82–1.29] | 0.835 | |||
Marital status | Married | 499 | 307 (61.5%) | Ref | Ref | ||
Single | 114 | 81 (71.1%) | 1.12 [1.07–1.18] | < 0.001a | 1.10 [1.08–1.13] | < 0.001a | |
Transport costs to facility | ≥5000 UGX ($1.35) | 231 | 106 (45.9%) | Ref | Ref | ||
< 5000 UGX ($1.35) | 611 | 435 (71.2%) | 1.39 [1.32–1.46] | < 0.001a | 1.34 [1.17–1.53] | < 0.001a | |
Estimated distance to health facility | < 10 KM | 318 | 249 (78.3%) | Ref | Ref | ||
≥10KM | 130 | 72 (55.4%) | 0.71 [0.66–0.76] | < 0.001a | 0.98 [0.87–1.10] | 0.735 | |
Friend/relative at ART point | No | 387 | 206 (53.2%) | Ref | Ref | Ref | |
Yes | 455 | 335 (73.6%) | 1.36 [1.24–1.49] | < 0.001a | 1.01 [0.99–1.02] | 0.292 | |
Alcohol consumption | Fewer than once a week | 745 | 517 (69.4%) | Ref | Ref | ||
At least once a week | 97 | 24 (24.7%) | 0.55 [0.36–0.85] | 0.008a | 0.77 [0.63–0.93] | 0.008a |