Satisfaction of HIV patients with task-shifted primary care service versus routine hospital service in northern Thailand

Abstract

Introduction: Shifting the task of HIV care to primary care providers is an important strategy to sustain expanding access to antiretroviral therapy (ART) in high HIV burden countries like Thailand. In a pilot project, the task of following up ART-receiving patients was shifted from a physician-led HIV clinic team based at district level community hospital, to a nurse-led primary healthcare team of seven primary care centers, based at sub-district level in a district of Chiang Mai in northern Thailand. This study aimed to evaluate the task-shifted ART service in a patient-centered approach. Methodology: Patients' satisfaction level was assessed cross-sectionally in a sample of 198 patients, which included 66 people living with HIV (PLHIV) receiving task-shifted ART service and matched controls in a ratio of 1:2. HIV immunological outcome was compared in a retrospective cohort of a year follow-up. Transculturally translated patient satisfaction questionnaire short form (PSQ-18) was used. Multivariate analysis of variance compared seven domains of patients' satisfaction levels. Results: Community hospital patients expressed significantly higher levels of satisfaction with the technical quality, communication, and time spent by the service provider, whereas the task-shifted model patients experienced significantly better accessibility and convenience of the service. At the one-year follow up, CD4 counts of the two groups were not significantly different. Conclusion: Future research and training programs should aim to improve the technical quality and communication skills of nurse-led ART service teams to shift the task of HIV care and sustain expansion of ART access in primary care settings.

Organisation of primary health care systems in low- and middle-income countries: review of evidence on what works and why in the Asia-Pacific region

“…However, a systematic review on barriers and facilitators to lay health worker programmes found that while the community often had high levels of trust in lay workers, they also saw the care delivered by these workers as ‘insufficient’, particularly when they lacked access to medicines and equipment 47. Similarly, one Thai study reported that the community felt nurses based in local facilities delivered lower-quality care while also appreciating the benefit of not having to travel to hospital to receive treatment 68…”

Patient and Provider Satisfaction With a Comprehensive Strategy to Improve Prevention of Mother-to-Child HIV Transmission Services in Rural Nigeria

“…In Thailand, HIV-infected patients exposed to a nurse-led primary care service reported greater satisfaction with services than their counterparts who continued to be seen by physicians. 22 Iwu and Holzemer 23 reviewed studies of physician-to-nurse task shifting in HIV settings in Sub-Saharan Africa; they reported increased levels of job satisfaction, as indicated by feelings of stature, achievement, and morale among nurses in 3 studies. In Malawi, patients rated HIV prevention services more positively after the hospital workers (including physicians) received training in delivering peer-led HIV prevention interventions.…”

“…17,19–21 Fewer studies have focused on the impact of task shifting on patient satisfaction with clinical services and the satisfaction of the lower-cadre workers with their new positions. 13,22,23 …”

Perceived stigma of HIV patients receiving task-shifted primary care service and its relation to satisfaction with health service

“…Task-shifting HIV services to primary healthcare is an important strategy within this expansion of access to ART. [11], with a recent study in northern Thailand reporting greater accessibility and convenience for PLHIV receiving a task-shifted service at primary health care centers [12]. However, anecdotal evidence among healthcare professionals and policy makers has led to concern about the existence of HIV stigma in the communities where PLHIV reside.…”