Community antiretroviral therapy dispensation in Cameroon associated with improved perceived service quality: a national evaluation


BACKGROUND: The USAID- and PEPFAR-funded Meeting Targets and Maintaining Epidemic Control (EpiC) project and the Government of Cameroon developed and evaluated a model in which some health facilities providing antiretroviral therapy offered clients the option to receive antiretroviral (ARV) drug refills at community-based organizations (CBOs). We describe the impact of the model on clients' perceived quality of HIV services.
METHODS: The evaluation was conducted from October to December 2020 in10 regions of Cameroon. We compared measured wait time for HIV services and perceived client satisfaction with services as proxies for service quality between clients receiving ARV refills at health facilities (n=557 clients) vs. at 50 CBO pick-up sites (n=293 clients). Wait time and satisfaction among clients were also assessed at three matched pairs of health facilities: three facilities offering the CBO pick-up option ('offering facilities') (n=170 clients) and three facilities that did not offer the CBO option ('non-offering facilities') (n=170 clients). Perceived satisfaction and wait time were collected through a client survey and a time log. Descriptive and inferential analyses were conducted.
RESULTS: CBO dispensation was associated with shorter wait times. Mean difference in wait time for clients receiving ARV refills from CBOs was 37.5 minutes less (CI:29.05'45.95, p-value=0.000) than at health facilities. Between the matched pairs, wait time for clients receiving refills at offering facilities was 12.9 minutes less than at non-offering facilities (CI:26.29'44.31, p-value<0.000). Clients receiving refills at CBOs were 4.5 times more likely to report satisfaction with services than those at offering facilities (97.3% vs. 89.1%, CI:2.12-9.42, p-value '¤0.000). Similarly, clients receiving refills at offering facilities were 6.26 times more likely to report satisfaction with services than those at non-offering facilities (94.4% vs. 73.1%, CI: 3.13 - 12.54, p-value <0.000).
CONCLUSIONS: Community ARV dispensation through CBOs was associated with shorter wait times for HIV services and higher client satisfaction than in offering facilities, and higher client satisfaction in offering facilities than non-offering facilities. ARV dispensation through CBOs has the potential to improve perceived service quality both for clients who receive ARV refills at CBOs and those who continue to obtain refills at the offering facilities.

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