Perceived quality of HIV care and client satisfaction across different service providers in Ukraine

Background: 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. Methods: 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. Results: 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: beta = 0.515, P < 0.001). Satisfaction was higher at primary healthcare centres (direct effect: beta = 0.145, P < 0.001; indirect effect through accessibility: beta = 0.060, P < 0.001), narcological/tuberculosis dispensaries (direct effect: beta = 0.105, P = 0.006; indirect effect through accessibility: beta = 0.060, P < 0.001) and hospitals (indirect effects through user-friendliness and accessibility: beta = 0.180, P < 0.001) when compared to acquired immune deficiency syndrome centres. Conclusions: 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.