Comparative assessment of structures and treatment processes in public and private hiv treatment centres in port harcourt, rivers state

Abstract

Background: HIV treatment centres use the WHO standard policies and guidelines to conduct HIV testing services, and anti-retroviral treatment to people living with HIV. The purpose of the study was to assess and compare structures and treatment processes in public and private HIV treatment centres in Port Harcourt, Rivers State.

Materials and Methods: This was a comparative cross-sectional study carried out in both public and private HIV treatment centres in Port Harcourt, Rivers State. The sample size of 10 public and 10 private HIV treatment centres were used for this study. A stratified sampling method was used to randomly select ten public and ten private HIV treatment centres from existing forty-six (46) public and forty (40) private ART facilities in Port Harcourt metropolis, Rivers State. Public and private HIV treatment centres included in the study were all that had existed for 6 months, still functional and render HIV treatment to a minimum of 5 patients per week. Other treatment facilities that did not meet this criteria were excluded. The study tool was pretested in other HIV treatment centres that were not selected for the main study. The tool was validated by performing Cronbach’s alpha (α) using 24 items tool for measuring the structure and 10 items tool for measuring the process; hence 0.902 and 0.736 were obtained for structure and treatment process respectively. A semi-structured interviewer checklist was used to assess structures of the treatment centres and evaluate the treatment process. The assessment the structure and evaluation of HIV treatment process was completed in a period of eight (8) weeks. Data was entered into the Statistical Package for Social Sciences (SPSS) software version 21 in numeric codes and analyzed using SPSS version 21. Comparative analysis for public and private HIV treatment centres were done. Ethical clearance for the study was obtained from the Research and Ethics Committee of the University of Port-Harcourt. Written permission from Rivers State Primary Health Management Board, Department of Planning, Research and Statistics (DPRS) and Rivers state Ministry of Health was obtained to cover the various health facilities used. Verbal permission/ consent were obtained from the directors of the private treatment centres.

Result: A total of 20 facility assessment checklists were used to assess the public and private HIV treatment centres. The result indicated that public versus private structures of facilities had median scores of 11 versus 6.5 for utilities, 30.5 versus 22.5 for equipment, 24 versus 18.5 for commodities and the overall structural score of 65 versus 46. There was a statistically significant difference between the various structural domains and the health facility type: Utilities (5.60; p=0.02); Equipment (10.08; p=0.002); Commodities (6.27; p=0.01); Overall Structural scores (7.02; p=0.01). Also, (public versus private facilities) had median scores of (39 versus 34.5) with interquartile range of 39-46 for public facilities and (30-37) for private facilities. A statistically significant association was observed between HIV treatment process in public and private facilities (10.87; p=0.001).The HIV treatment process in public versus private facilities had median scores of (39 versus 34.5) with interquartile range of 39-46 for public facilities and (30-37) for private facilities.

Conclusion: Based on findings in this study, the researchers conclude that the public HIV treatment centres had good structures in offering HIV service delivery. The public HIV treatment centers had a better HIV treatment process than the private HIV treatment centres. The non-governmental organizations should be encouraged to take responsibility of equipping private facilities with the needed structure which in turn will enhance HIV treatment process.