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      Patient satisfaction with HIV services in Vietnam: Status, service models and association with treatment outcome

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          Abstract

          This study assessed the satisfaction of patients receiving antiretroviral treatment (ART) in Vietnam and its multilevel predictors. Cross-sectional data were collected from January to September 2013 in eight outpatient clinics in Hanoi and Nam Dinh provinces. Patient satisfaction was evaluated using the Satisfaction with HIV/AIDS Treatment Interview Scale. Multivariable Tobit regression was utilized to measure the associations between these factors and satisfaction with treatment services. Generalized Mixed-effect Regression model was used to estimate the effect of satisfaction with the quality of service on the change between the initial and the latest CD4 cell count. Among 1133 patients, most of them were completely satisfied with the 10 domains measured (65.5% to 82.5%). “Service quality and convenience” domain which was attributed by the waiting time and administrative procedure had the lowest score of complete satisfaction. Compared to central clinics, provincial clinics were negatively associated with the overall satisfaction (Coef = -0.58; 95%CI = -0.95; -0.21). Patients rating higher score in “Consultation, explanation, and guidance of health care workers”, “Responsiveness of health care workers to patients’ questions and requests” and “Perceived overall satisfaction with the quality of service” were related to improvement in immunological treatment outcomes. Our results revealed the high level of satisfaction among ART patients towards HIV care and treatment services, and this had a high correlation to treatment outcomes. Interventions should focus on reducing administrative procedures, providing sufficient guidance and comprehensive services which integrate physical with psychological care for improving the health outcome of the ART program.

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          Most cited references32

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          Towards an improved investment approach for an effective response to HIV/AIDS.

          Substantial changes are needed to achieve a more targeted and strategic approach to investment in the response to the HIV/AIDS epidemic that will yield long-term dividends. Until now, advocacy for resources has been done on the basis of a commodity approach that encouraged scaling up of numerous strategies in parallel, irrespective of their relative effects. We propose a strategic investment framework that is intended to support better management of national and international HIV/AIDS responses than exists with the present system. Our framework incorporates major efficiency gains through community mobilisation, synergies between programme elements, and benefits of the extension of antiretroviral therapy for prevention of HIV transmission. It proposes three categories of investment, consisting of six basic programmatic activities, interventions that create an enabling environment to achieve maximum effectiveness, and programmatic efforts in other health and development sectors related to HIV/AIDS. The yearly cost of achievement of universal access to HIV prevention, treatment, care, and support by 2015 is estimated at no less than US$22 billion. Implementation of the new investment framework would avert 12·2 million new HIV infections and 7·4 million deaths from AIDS between 2011 and 2020 compared with continuation of present approaches, and result in 29·4 million life-years gained. The framework is cost effective at $1060 per life-year gained, and the additional investment proposed would be largely offset from savings in treatment costs alone. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Quality of life profile and psychometric properties of the EQ-5D-5L in HIV/AIDS patients

            Objectives We assessed health-related quality of life (HRQOL), its associated factors, and examined measurement properties of the EuroQol - 5 Dimensions - 5 Levels (EQ-5D-5L) in HIV/AIDS patients. Methods A cross-sectional multi-site survey was conducted in 1016 patients (age: 35.4 ± 7.0 years; 63.8% male) in three epicenters of Vietnam. Internal consistency reliability, convergent validity, and discriminative validity of the EQ-5D-5L and a visual analogue scale (VAS) were evaluated. Tobit censored regression models were used to identify predictors of HRQOL in HIV/AIDS patients. Results The mean EQ-5D-5L single index and VAS were 0.65 (95% Confidence Interval (CI) = 0.63; 0.67) and 70.3 (95% CI = 69.2; 71.5). Cronbach’s alpha of five dimensions was 0.85. EQ-5D-5L has a good convergent validity with VAS (0.73). It discriminated patients at different HIV/AIDS stages, duration of ART, and CD4 cell count. Predictors of poorer HRQOL included being female, lower education level, unemployment, alcohol and drug use, CD4<200 cells/mL, and advanced HIV/AIDS stages. Conclusion The EQ-5D-5L has good measurement properties in HIV/AIDS patients and holds potentials for monitoring ART outcomes. Integration of HRQOL measurement using EQ-5D-5L in HIV/AIDS clinical practice could be helpful for economic evaluation of HIV/AIDS interventions.
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              Higher quality communication and relationships are associated with improved patient engagement in HIV care.

              Patient retention in HIV care may be influenced by patient-provider interactions. In an urban, academic HIV clinic, 1363 patients rated the quality of communication and relationships with their providers on 5 domains. We used linear regressions to investigate associations between these 5 domains and appointment adherence. In multivariate analysis, patients kept more appointments if providers treated them with dignity and respect, listened carefully to them, explained in ways they could understand, and knew them as persons. Being involved in decisions was not significantly associated with appointment adherence. Enhancing providers' skills in effective communication and relationship building may improve patient retention in HIV care.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: ResourcesRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: ResourcesRole: SoftwareRole: Writing – original draft
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SoftwareRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: InvestigationRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                8 November 2019
                2019
                : 14
                : 11
                : e0223723
                Affiliations
                [1 ] Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
                [2 ] Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
                [3 ] Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
                [4 ] Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
                [5 ] Department of Psychological Medicine, National University Hospital, Singapore, Singapore
                [6 ] Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
                [7 ] Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
                [8 ] Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
                University of Ghana College of Health Sciences, GHANA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-5741-383X
                Article
                PONE-D-19-17622
                10.1371/journal.pone.0223723
                6839840
                31703089
                2d8e9c47-ff4c-402f-9926-5c82506739d0
                © 2019 Tran et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 21 June 2019
                : 26 September 2019
                Page count
                Figures: 0, Tables: 5, Pages: 13
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Biology and Life Sciences
                Organisms
                Viruses
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
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                Viruses
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                Retroviruses
                Lentivirus
                HIV
                Biology and Life Sciences
                Microbiology
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                Microbial Pathogens
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                Organisms
                Viruses
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                HIV
                Medicine and Health Sciences
                Health Care
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                People and Places
                Geographical Locations
                Asia
                Vietnam
                Biology and Life Sciences
                Immunology
                Vaccination and Immunization
                Antiviral Therapy
                Antiretroviral Therapy
                Medicine and Health Sciences
                Immunology
                Vaccination and Immunization
                Antiviral Therapy
                Antiretroviral Therapy
                Medicine and Health Sciences
                Public and Occupational Health
                Preventive Medicine
                Vaccination and Immunization
                Antiviral Therapy
                Antiretroviral Therapy
                Medicine and Health Sciences
                Infectious Diseases
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                Diagnostic medicine
                HIV diagnosis and management
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                Custom metadata
                Data collected for this study is legally restricted. HIV-related information is protected by Vietnam law and cannot be made publicly available. Interested researchers may send requests for data to Dr. Phan Thi Thu Huong, Deputy Director General of the Vietnam Authority of HIV/AIDS Control (email: huongphanmoh@ 123456gmail.com ).

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