Patient experiences and preferences for antiretroviral therapy service provision characteristics: implications for implementing differentiated service delivery in Northwest Ethiopia

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Abstract BackgroundUnderstanding the experiences, needs, preferences, and behaviors of people living with HIV (PLHIV) are critical to tailor HIV treatment. However, there is limited research evidence in Ethiopia on the views of PLHIV regarding their positive and negative experiences on current antiretroviral therapy (ART) service and their preferred models of HIV treatment. Hence, this study aimed to explore patients’ experiences of taking medications and preferences for ART service provision characteristics in Northwest Ethiopia.MethodsThis study with a phenomenological approach was conducted as part of the larger discrete choice experiment study. Purposive selection of stable and 18 years old and above PLHIVs using ART service at health facilities implementing four differentiated service delivery (DSD) models in East Gojjam, West Gojjam, Awi, and Bahir Dar special zones was done. Data were collected between July and September 2021. About 15 in-depth interviews with differentiated ART eligible patients were conducted. ATLAS.ti version 9 software was used for coding translated transcripts. A thematic analysis approach was employed.FindingsParticipants in this study had reported both positive and negative experiences in receiving ART. Five themes: stigma, time, availability of drug and provider, costs per clinic visit, provider-patient interaction were identified. Participants also reported varied preferences towards ART service features. Fifteen attributes: buddy system, ART refill (individualized or group), ART packaging and labeling, drug formulation and administration, ART room labeling, distance, location of service, preferences on involvement in treatment decision-making, person providing ART refills, provider’s attitude, spatial arrangement of ART room, time of health facility operation, time spent at clinics and total cost of visit were identified.ConclusionsParticipants provided both positive and negative experiences with the aspects of current ART service. The preferences of PLHIVs towards ART service delivery features were heterogeneous. Policy and program efforts should tailor ART services that suit patients’ needs and priorities in Ethiopia. Future research should also focus on understanding the satisfaction of patients enrolled among the four DSD models now under implementation in the country to get insights for optimizing each model implementation and to ensuring the strong quality of ART service provision for stable PLHIV.

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