No differences in recipients of care perceived quality of care between differentiated service delivery models and conventional care in South Africa


BACKGROUND: Differentiated service delivery (DSD) models aim to increase the responsiveness of HIV treatment programs to individual needs of recipients of care (RoC) to improve treatment outcomes and quality of life. Little is known about how care experiences in DSD models differ from conventional care.
METHODS: From May-November 2021 we interviewed adult RoC at 12 primary clinics in four districts of South Africa. Participants, selected consecutively at routine visits and stratified by DSD model, were asked about perceived quality of care (QOC) including provider attitudes, trust in provider, and time spent with the provider using questions with Likert-scale responses (Cronbach's alpha = 0.70). Mean scores were categorized as "low' QOC (score <=3) or 'high' QOC (score>3). We used logistic regression to assess differences and report crude and adjusted odds ratios (AORs). Qualitatively, participants explained their overall satisfaction; themes were identified through content analysis.
RESULTS: 767 RoC (70.4% female, median age 39) were surveyed: 23.9% enrolled in facility pick-up-points; 26.2% in out-of-facility pick-up-points; the remainder in conventional care. Participants reported high QOC regardless of model. (Figure.1). Those in facility-based models perceived no differences in QOC compared to those in conventional care; fewer RoC in out-of-facility models reported low QOC. Participants who missed more visits, had more expected healthcare interactions and/or more out-of-facility interactions perceived lower QOC, as did those receiving longer dispensing intervals (non-significant differences). Qualitatively, participants receiving conventional care perceived providers as helpful, respectful, and friendly; they were satisfied with care despite long queues. Those in DSD models frequently spoke about ease and convenience, particularly not having to queue.

CONCLUSIONS: RoC enrolled in DSD models in South Africa did not perceive differences in QOC compared to those in conventional care. Existing DSD models (facility and external pick-up-points) and dispensing intervals do not appear to affect self-reported QOC but are perceived as more convenient.

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