Deloitte Consulting LLP, Atlanta, GA, USA.
Independent Research Consultant, Kyiv, Ukraine.
Eur J Public Health. 2020 Feb 1;30(1):23-30. doi: 10.1093/eurpub/ckz124.
Prior studies have shown that high client satisfaction and quality of services are important drivers of uptake and retention in human immunodeficiency virus (HIV) care. Study objectives were to assess the perceived quality of HIV services, satisfaction and associated factors across different types of health facilities in Ukraine.
We conducted a cross-sectional study among 649 individuals receiving HIV services across 47 health facilities in three regions of Ukraine. Primary outcomes were satisfaction and perceived quality of services measured along five dimensions: accessibility, user-friendliness, privacy and confidentiality, comprehensiveness (separately for testing and treatment services). Quality dimensions were constructed by confirmatory factor analysis. Links between quality dimensions, satisfaction and related factors were measured by structural equation modelling.
Median scores for accessibility, user-friendliness, privacy and confidentiality, comprehensiveness of services and overall satisfaction ranged from 0.75 to 1 out of 1. User-friendliness was the main determinant associated with satisfaction (total effect: β = 0.515, P < 0.001). Satisfaction was higher at primary healthcare centres (direct effect: β = 0.145, P < 0.001; indirect effect through accessibility: β = 0.060, P < 0.001), narcological/tuberculosis dispensaries (direct effect: β = 0.105, P = 0.006; indirect effect through accessibility: β = 0.060, P < 0.001) and hospitals (indirect effects through user-friendliness and accessibility: β = 0.180, P < 0.001) when compared to acquired immune deficiency syndrome centres.
User-friendliness is a key driver of client satisfaction with HIV services in Ukraine. Decentralization of services, together with improved training and supervision for provider-client interactions may provide important levers to improve client satisfaction with HIV services and enrolment and retention in the cascade of HIV services.
先前的研究表明，较高的客户满意度和服务质量是促进艾滋病毒（HIV）护理服务的重要驱动力。本研究旨在评估乌克兰不同类型卫生机构的 HIV 服务质量、满意度及其相关因素。
我们在乌克兰三个地区的 47 个卫生机构中，对 649 名接受 HIV 服务的人员进行了横断面研究。主要结局是通过五个维度评估满意度和服务质量感知：可及性、用户友好性、隐私和保密性、全面性（分别针对检测和治疗服务）。质量维度通过验证性因子分析构建。通过结构方程模型测量质量维度、满意度和相关因素之间的联系。
可及性、用户友好性、隐私和保密性、服务全面性和总体满意度的中位数评分范围为 0.75 至 1 分（满分 1 分）。用户友好性是与满意度相关的主要决定因素（总效应：β=0.515，P<0.001）。在初级保健中心（直接效应：β=0.145，P<0.001；通过可及性的间接效应：β=0.060，P<0.001）、麻风和结核病诊所（直接效应：β=0.105，P=0.006；通过可及性的间接效应：β=0.060，P<0.001）和医院（通过用户友好性和可及性的间接效应：β=0.180，P<0.001），与艾滋病中心相比，客户对 HIV 服务的满意度更高。
在乌克兰，用户友好性是客户对 HIV 服务满意度的关键驱动因素。服务的去中心化，以及改善提供者与客户互动的培训和监督，可能是提高客户对 HIV 服务满意度以及艾滋病毒服务级联中参与和保留率的重要手段。
