Patient satisfaction feedback (PSF) for ART services in Cambodia

Background: Cambodian ART services have been successful in identifying and initiating HIV+ clients on ART, but the country still faces challenges in meeting the UNAIDS 90-90-90 targets. In 2018, 3,734 new HIV cases were diagnosed and 59,164 PLHIV were on ART (83% of all estimated PLHIV). However, 118 (3.2%) of the newly diagnosed PLHIV were lost to follow-up after 6 months of ART, representing 6% of the total ART cohort of 1,877 dropping out of care. To better understand these losses, the PSF survey of ART services was implemented to assess patients'' perceptions and possible service-related reasons for dissatisfaction and drop-out.
Methods: The National Center for HIV AIDS Dermatology and Sexually Transmitted Infections selected 8 ART facilities to assess the feasibility and acceptability of the PSF tool. A pad-based tool was developed based on the USAID- and PEPFAR-supported LINKAGES project''s electronic client feedback system employed in other countries. It was designed to be self-administered by ART clients to elicit perceptions and experiences regarding all aspects of care and perceived stigma. Steps included pre-testing tablet use; monthly monitoring for feedback from facility staff; data review meetings with ART sites to support interpretation of findings and discuss challenges and solution of implementation
Results: 3,062 ART service clients completed the questionnaires from July- December 2018. Low literacy made self-completion difficult for some (10%) requiring staff time to assist, possibly influencing client comments. 86% were satisfied with HIV clinic services, felt their information was kept confidential; needs were met. However, 37% reported long waits and repeat visits were bothersome. During survey results discussions, staff were responsive to client comments and addressed modifications of clinic SOPs to reduce wait times and repeat visits which were thought to contribute to drop-out rates.
Conclusions: The PSF tool enabled PLHIV to provide feedback on their perceived quality of the HIV-related services they received. The data were used to improve service delivery aimed at increasing satisfaction, reducing loss to follow-up and increasing the number of PLHIV achieving viral load suppression. PSF provides NCHADS information to inform policy and guidelines to address the needs of clients and improving service delivery systems.

P.S. Ly1, S. Phal2, S. Samreth1, B. Ngauv1, V. Khol1, S.M. Sau1, D. Nhim2, S. Seng2, B. Eveslage2, C. Rang2, C. Im2, S. Sokhan2, C. Rin2
1NCHADS, Phnom Penh, Cambodia, 2FHI 360, LINKAGES, Phnom Penh, Cambodia