Assessment of quality of Antiretroviral therapy care in Iganga District

Abstract

Introduction: The ART program in Uganda was started in an expedited fashion to scale up the ART services and get people on treatment. This rapid scale-up of HIV care and treatment, may have compromised quality of ART care. Information on quality of ART care in view of structural inputs, use of ART guidelines, accessibility, effectiveness, technical competence of health workers and continuity of care is limited. This study established baseline quality of ART care indicators upon which future evaluations of the program could be based.

General objective: To assess the quality of ART care in Iganga district in order to enable health managers and all stakeholders within and outside the district to make appropriate interventions aimed at improving the quality of ART care. Specific objectives: 1) To assess patient satisfaction with ART care; 2) To assess the availability of ART related logistics; 3) To assess the appropriateness of the ART patient management; 4) To assess the follow-up and monitoring of ART clients basing on clinical or laboratory assessments, and 5) To identify institutional factors that influence delivery of quality ART care.

Methodology: A cross-sectional descriptive study was conducted at two ART sites of Kiyunga HC IV and Iganga Hospital in Iganga District. A total of 114 patients were interviewed at exit polls, 230 ART client records were reviewed and 8 key informant interviews were conducted. Systematic and purposive sampling techniques were used to select the respondents.

Results: Overall 76.3% of respondents were satisfied with quality of ART care. Mean waiting time was reported to be 102 minutes.CD4 counts were routinely done as part of ART monitoring for only between 5.7-25.7% of the patients depending on schedule of follow up. Though most patients were on Cotrimoxazole prophylaxis, 85.1% were not receiving the complete doses after prescription. Both facilities had experienced stock-outs of ART related supplies during the 3 months before the assessment. Both facilities had inadequate health workers and space for the ART clinic. Supervision of ART services was irregularly being done by all levels. 16.5% of patients were on a wrong 1st line ARV regimen basing on the body weight.

Conclusions and Recommendations: Generally patients were satisfied with quality of ART care. ART centers suffered stock-outs and have inadequate health workers. Recruitment and training of more staff, acquisition of ART guidelines, ensuring regular and constant supplies for ART and having regular support/ technical supervision to ART sites could improve the quality of ART care.