Quality of antiretroviral therapy in public health facilities in Nigeria and the perceptions of the end users

Abstract

The health care industry in Nigeria is increasingly grappling with challenges of meeting end users’ requirements and expectations for quality antiretroviral therapy (ART) service provision. This study sought to explore and describe the quality of antiretroviral therapy in public health facilities in Nigeria and the perceptions of the end users. A descriptive qualitative research design was used in the study in order to generate ideas from end users for improving quality of ART service provision, and prompt additional research activities. Unstructured focus group discussions were conducted with end users (n=64) in 6 locations across the 6 geopolitical zones of Nigeria. Data was analysed using the framework approach because it reflects the original accounts and observations of the end users and the Weft QDA version 1.0.1 software to validate the results. Findings revealed that end users were satisfied with uninterrupted antiretroviral drug supplies, courtesy treatment, volunteerism of support group members and quality counselling services. End users expect public health facilities to accept diagnostic results from collaborating facilities, implement continuous quality improvement (CQI), maintain clean and adequate health infrastructure, reduce end user waiting time, reduce stigma, comprehensively assess end users during each clinic visit and ensure uninterrupted ART services. They also expect effective collaboration between healthcare providers and support group members, to enhance the quality of life of people living with HIV (PLHIV). End users identified the following as quality gaps in ART service provision: weak health facility leadership, non-attractive ART service infrastructure, frequently interrupted laboratory services, demotivated and inadequate health care workers, long waiting time, interrupted medicine supplies and inadequate procedure for complaints management. In conclusion, the following recommendations were proffered: deploy and train additional health care workers, integrate ART into regular health services, improve supply chain management of health commodities, and reduce end user overload in clinics. Finally, a best practice guideline for the provision of end user focused ART service provision was developed.