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Research Article - Volume 1 Issue 1

HIV client’s satisfaction with home delivery of antiretrovirals in Abuja, Federal Capital Territory, Nigeria: A pilot study

Ajagu Nnenna1* ; Offu Ogochukwu1; Oluigbo Emeka Kennedy2, Ani Njideka Ifeoma 3, Okolo Kenneth Obinna3, Nduka Sunday1; Ekwunife Ikechukwu Obinna1,2

1Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria.
2Department of Clinical Pharmacy and Biopharmaceutics, Enugu State University of Science and Technology, Agbani, Nigeria.
3Department of Pharmacology and Toxicology, Enugu State University of Science and Technology, Agbani, Nigeria.

Received Date : Oct 21, 2021
Accepted Date : Nov 23, 2021
Published Date: Dec 12, 2021
Copyright:© Vedat Goral 2021.

*Corresponding Author : r: Ajagu Nnenna, Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka,Nigeria. +234803546093.
Email:ajagunnenna@yahoo.com
DOI: Doi.org/10.55920/2771-019X/1042

Abstract

Background: Human immunodeficiency virus (HIV)-infected patients are faced with the challenge of the frequent visit to an already congested Nigerian hospital for antiretroviral (ARV) refills. Although various decentralization strategies have been adopted to reduce frequent visits to the hospital for antiretroviral (ARV) refills, none has analyzed client satisfaction with the home delivery in Nigeria.

Objective: This study aims to develop and validate a questionnaire for assessing HIV-infected patients’ satisfaction with Home Delivery of antiretrovirals in Nigeria.

Method: The study is a cross-sectional pilot study carried among people living with HIV that are virally suppressed in Abuja Nigeria, between October 2020 to December 2020. Two hundred and ten self-administered questionnaires were distributed conveniently during the regular antiretroviral home refill by the home delivery personnel. Data were analyzed using SPSS version 25. Descriptive statistics were conducted for the demographics. The variables were categorized into domains and analyzed into groups. Cross tabulation was used to show the relationship between variables and among the demographics. Differences in means were analyzed with T-Test and analysis of variance, a p-value of <0.05 was considered to be significant.

Result: All distributed questionnaires were filled and retrieved. All the items in the satisfaction with the home delivery questionnaire showed an internal consistency of ≥ 0.7. Most of the clients were generally satisfied with the antiretroviral delivery model.

Conclusion: The clients that received their antiretroviral refill at home are generally satisfied with the delivery model.

Keywords: Patient satisfaction; home delivery; antiretroviral; HIV.

Introduction

Over the past decades, highly active antiretroviral therapy (HAART), has transformed human immunodeficiency virus (HIV) infection from being a deadly disease to a chronic illness [1]. This is possible because effective management allows an infected individual to survive till old age [2, 3] resulting in a large number of stable patients on HAART with minimal disability life adjusted years. Globally, about a 38.8million people living with HIV infection [5] (WHO 2020 factsheet), but the hardest-hit region in the world is sub-Saharan Africa with more than two-thirds of this population living with HIV [6], Nigeria accounts for 1.9 million people infected with the virus [7].

World Health Organization (WHO) guidelines categorized different decentralization models as (i) partial decentralization, where patients start ART at central hospitals and can be down-referred to PHCs when stable; (ii) full decentralization, where patients start and continue ART at PHCs; and (iii) decentralization beyond health facilities, where trained volunteers deliver antiretrovirals to people in their homes [7], consequently, some countries have adopted the home delivery model as one of the option to scale up access to antiretrovirals. The home delivery model improves patients’ choice for care as well as minimizes interruption to patient’s busy schedules [9]. A study was conducted in Africa in which the home delivery model of antiretroviral was exploited and it was observed that viral suppression in these patients increased from 54% to more than 70% [9-15].

In 2018, Smith et al evaluated patient satisfaction with home delivery of antiretroviral (ARV) medication and reported that patients showed a positive attitude towards the home delivery scheme. At the time of this research, patient satisfaction with this model has not been evaluated in any part of Nigeria [5]. Studies have also shown that the quality of care a patient receives is associated with patient outcomes [16] and one such outcome is patient satisfaction [16]

Patient satisfaction is a multidimensional concept that reveals the quality of service provided by healthcare providers as well as the degree to which the expectations of patients are met [17], there are different definitions to patient satisfaction. Schommer and Kucukarslan [18] defined it as an equity-based assessment of a service or product but Gourley et al [19], defined it as a predictive measure of the possibility that a patient will continue to use the service of a particular provider. In a nutshell patient satisfaction is the link between services provided and patients’ needs, it also measures patients’ perspective on a service provided [20]. This study, therefore, aims to develop a questionnaire to evaluate HIV client satisfaction with home delivery of Antiretrovirals

Developing Questionnaire on Satisfaction with Antiretroviral Home Delivery (SAHD)

The questionnaire was developed by reviewing published literature on researches conducted to investigate patient satisfaction with home delivery of health care services. Studies on patient satisfaction with HIV care and treatment services were also reviewed [21-27]. Several instruments identified had about 9 dimensions namely: 1) Technical quality and competence, 2) Facilities and equipment, 3) Interpersonal skills, 4) Communication and Patient education, 5) Financial aspects, 6) Waiting and spending time, 7) Services availability, accessibility, and convenience 8) Confidentiality and privacy 9) General Satisfaction. Four dimensions were identified as relevant to home delivery of antiretroviral and modifications were done to suit this study. Patient education, convenience, confidentiality, general satisfaction was be used as domains in this research.

Lastly, scaling of the items was done such that items are scored on a five-point Likert scale, from,1, strongly disagree, to 5, strongly agree. This Likert scale was used because of the level of literacy of the population of the study, as it will clearly show their opinion about home delivery of antiretroviral. The adaptation of the questionnaire was done by one of the authors who has a lot of experience on the topic and has been involved in counseling and dispensing drugs to HIV clients in ART clinics in Nigeria. We constructed a pooled list of 19 items and then reduced it to 13 items based on relevance. A 13-item questionnaire was designed with four dimensions namely (1) Patient education, (2) Convenience (3) Confidentiality, and (4) General satisfaction. Questions containing patient socio-demographic data were also included.

The items were subjected to face validity by an expert for professional judgment on ambiguity, relevance, and sentence structure. The expert was composed of five lecturers of the Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, three pharmacists trained in the care of HIV-infected patients, and a statistician. Cronbach’s alpha was used to assess the reliability of the instrument and it revealed that the items have an acceptable alpha valve of 0.73. Item –total correlation value of ≥0.3 was retained. The data collected from the pilot study were analyzed as well.

Study design and participant recruitment

The study is a cross-sectional pilot study where questionnaires are distributed to ART clients that enrolled in the decentralization of the home delivery model of ARV in the hospital. From the HIV clinic, 530 clients receive ARV refill at home and come to the hospital for comprehensive care every six months. The pharmacist in the hospital through phone calls contacts the clients conveniently and explained the detail and purpose of the study and asked if they will be willing to participate in the study. Those that were willing to participate received the informed consent forms and the questionnaire at home during the next refill.

Inclusion criteria

The study includes participants between ages18 years to greater than 48years and receives antiretrovirals at home. Children, pregnant women, in-patients, patients receiving ART within the hospital premises, and the very ill patients of other subspecialties were excluded. Those who could not give consent were also excluded from the study.

Study Setting

The study was conducted at St, Mary hospital Gwagwalada area council, Abuja. The hospital has HIV/AIDS comprehensive center, and it provides HAART to HAART care to HIV-positive patients.

Sample size

Using a web-based sample size calculator, the sample size was calculated with a confidence level of 95% and a margin of error at 5% a sample size of 196 respondents from a total sample frame of 530. The attrition rate was set at 5% of the sample size (35), which gave a total sample size of 210. Questionnaires were administered to a total of 210 adults. There was a 100% response rate and written informed consent to participate in the study was obtained from all participants before participation.

Data Analysis

The questionnaire when retrieved was checked for completeness, coded on an excel sheet, and analyzed using the Statistical Package for Social Sciences (SPSS 26, Chicago IL, USA). The retrieved questionnaire was double-checked for consistency with the hard copy by one of the investigators. The demographic data was represented by frequency (percentage) or mean ± standard deviation; cross-tabulation was used to determine the relationship among the demographics. Also, a Chi-test and analysis of variances were used to determine the differences in the mean.

Ethical issues

The research was approved by the hospital management. Informed consent was obtained from those that agreed to participate in the study. Participants’ data will be kept confidential by assigning code instead of using names.

Results

Socio-demographic characteristics

The demographic characteristics of respondents were summarized in (Table 1). Most of the participants are female (70.0%) mostly in the age range of 38-47 years (74.8 %). In the study, the levels of education of the participant are no formal education (0.5%), primary school (1.4%), secondary school education (42.9), and higher institution (54.8). In this study, it was also discovered that most of the respondents were self-employed (37.6%).

Table 1: Demographic characteristics of respondents.

The demographic characteristics of the respondents (Table 1) show that the majority of the clients are female (70%) and most of them were within the age range of 38-47(74.4%). While more than half of them are employed in the private sector. Most of the participants are married as well as most of them have a form of tertiary education. It is worthy to note that most of the respondents reside at Abaji (31.0%).

The majority of the clients responded that they receive a form of health education from the home delivery personnel when the ARV medication is been delivered to them through a few respondents (3.2%), responded that the HDP does not count the leftover pill (if any). About 84.2% of the respondents affirmed they refill their medication easily from the HDP. While only 3.6% said refill from the HDP and the hospital makes no difference to them. The level of advice they receive from the HDP has a percentage mean health education score of 3.3. Most of the respondents (82.8%) found it easy to contact the HDP for any health issues at any time. In the confidentiality domain, most of the respondents responded that they trust the health personnel with their health issues. General satisfaction of 82.8% was seen among the respondents (see table 2).

It was also observed that most of the respondents are female from the Abaji council (17%). About 24% of the respondents are with an age range of 38-47yrs from Abaji council (24.8%). However, most of the respondents are self-employed from Abaji and Kwali council respectively (See table 3). As shown in the table it was seen that the t-test was done the demographic characteristic against location showed statistical differences in the mean with the P value<0.01* SD 2.1 SEM = 0.2for all the area council.

Table 2: Responses of respondents on satisfaction with antiretroviral home delivery services (SAHDS).

Table 3: Relationships between Socioeconomics factors and Location.

*t-test, ^post hoc, (mean difference is significant at 0.05), SD, Standard Deviation SEM standard error of mean.

 

Table 4: HIV Clients responses based on Location.

*P-value t-test(mean difference significant at 0.05). C-Confident, NS-Not sure, VC-Very confident, Cf -Confident, VCf –Very Confident, NSt- Not Satisfied St- Satisfied.

 

Table 5: Relationship between clients’ demographics and occupation.

*t-test, ^post hoc. (the mean difference is significant at 0.05),

 

Most of the respondents agreed that the HDP explains the side effect of the medication (if any) to them with significant differences in their mean at a p-value <0.01. There were also significant differences in the mean at p-value <0.01 where 15.7% of the respondents from the Abaji area council disagreed that they preferred to refill their medication at the hospital. Most of the respondents from the Abaji area council (25.5%) also responded that they find the refill system very convenient for them at a p-value of <0.05.

Discussion

This study assessed HIV Clients’ Satisfaction Questionnaire with Home Delivery of Antiretroviral in Abuja, Nigeria. The clients were perceived to have received a good knowledge about their health condition during refill. They find the delivery model highly convenient and very confidential. The general satisfaction was seen to be very high this is also seen in the study done by Smith et al.

Conclusion

The client living with HIV in Abuja Nigeria that engaged in receiving their medication through the Home delivery of Antiretroviral received a good health education during refill. Generally, the clients find this system of refill very confidential and convenient for them.

Acknowledgments: We wish to acknowledge St. Mary Missionary Hospital, Gwagwalada for their approval to use their hospital for the study site.

Availability of data material: The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request.

Author’s Contributions: NA conceived of the study NA, SN and OI initiated the study design. All authors contributed to the refinement of the study protocol and approved the final manuscript.

Limitations of this study: The study is conducted only in one state in Nigeria and thus this may not allow for the generalization of the study findings.

Funding: This research did not receive whatsoever funding from government, private or cooperative institutions.

Author’s information: AN is a Ph.D. student in Nnamdi Azikiwe University, Awka, Nigeria. She is also a lecturer in the Department of Clinical Pharmacy and Biopharmaceutics. Enugu State University of Science and Technology, Enugu. OO is a Lecturer in the Department of Clinical Pharmacy and Biopharmaceutics, Enugu State University of Science and Technology, Enugu. SN is a senior lecturer in the Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria. OIE is an Associate Professor in Nnamdi Azikiwe University, Awka, Nigeria.

Ethics approval: The hospital management/ethics committee approve for the study to be conducted. The trial will be conducted as per the principles outlined in the Declaration of Helsinki. All identifiable data will be handled with the strictest confidentiality. Participants will be informed that they are free to withdraw at any time during any phase of the trial.

Consent for publication: Not Applicable.

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