Keywords: quality of care, ART, expectations, perception, privacy, PLHIV, patient satisfaction.

ABSTRACT

Objective: To determine the perception of the care provided to people diagnosed with HIV in the Integral Care Clinics of the Department of Matagalpa-Nicaragua in January 2023. Design: A quantitative and cross-sectional study was conducted, with a universe of 165 people in withdrawal of ART in the different clinics and with a convenience sample of 49 respondents. A data collection form was used, which was carried out through an individual survey with closed questions to answer the objectives to be developed, such as gender, age, origin, sexual identity, schooling, etc. Results: Of 49 respondents it was found that the highest percentage were male, that the highest age groups were between 20 to 29 years with 18 (36.7%) patients; 40 (82%) were heterosexual and homosexual 7 (14%), that 47 (96%) respected their privacy, that 47 (95%) value as good and excellent the attention of the clinics. Conclusions: Of the 49 respondents, the highest percentage are male, from the urban area, with complete high school and university education, heterosexual, and with occupation of housewife and shopkeeper. The attention is valued with good satisfaction since 95% is obtained, there is a high percentage of not applicable in the admission and pharmacy attention since the attention staff performs the procedures of those areas mentioned above, and the nursing attention is better valued for having greater empathy.

INTRODUCTION

To guarantee the quality of health services in Latin American and Caribbean countries, the Pan American Health Organization (PAHO) and the World Health Organization (WHO) have been developing efforts to increase the quality and efficiency of health services since the 1980s. (Suarez, 2013).

Lack of quality can manifest itself in multiple ways including ineffective health services, inefficient services, and limited accessibility, which ultimately generates dissatisfaction of users and health service providers. (Gonzalez, 2012, p.5).

The higher the quality and warmth of care provided in integral care clinics, the better adherence to treatment will be achieved in people with HIV.

HIV is currently considered a public health problem because it is one of the most deadly diseases. Worldwide, 28.2 million people had access to antiretroviral therapy at the end of June 2021; 37.7 million people were living with HIV; 36.3 million people have died from HIV-related illnesses since the beginning of the epidemic (World Health Organization, 2022).

The objective of the study is to know the degree of perception of people diagnosed with HIV in the Integral Care Clinics of the Department of Matagalpa-Nicaragua in January 2023, this study was conducted through the application of a survey with closed questions.

MATERIAL AND METHODS

The study has a quantitative approach, with a descriptive cross-sectional study type. The study area will be carried out in the Department of Matagalpa in the four municipalities that have five HIV clinics: La Dalia, Matiguas, Policlínico, Sebaco, and Hospital Regional. The study was conducted with PLHIV who will attend their antiretroviral treatment withdrawal in January 2023 with a universe that consists of all people who are on antiretroviral treatment and who will be treated in the HIV/AIDS program in the Department of Matagalpa, The total number of people with HIV on antiretroviral treatment is 165 and the sample is a selection of 30% by convenience of out of those active in antiretroviral treatment, in which users who are deprived of liberty, new cases and who have appointments scheduled every 2 months are discarded and their unit of analysis is in the Clinics of Integral Attention directed to people with HIV.

The selection criteria are people over 18 years of age, diagnosed with HIV/AIDS, admitted to the HIV/AIDS program in the Department’s Integral Care Clinics, with more than 4 treatment withdrawals during the year, patients classified as dropouts or non-attendees during the year, and the study variables are sociodemographic data, expectations regarding health care, perception of the care provided.

The sources of information will be clinical records, daily consultation record reports, antiretroviral treatment reports, record books, the Health Surveillance System, and surveys conducted on individuals.

Data collection techniques: a data collection form will be prepared to collect general information on the persons under study, and collect information on their treatment withdrawals, performance of tests, and their current status in the program.

With the data collection instruments, a survey-type instrument with closed questions will be constructed to facilitate the execution of individual interviews directed to HIV persons who withdraw treatment in the Integral Care Clinics.

The data analysis plan will be carried out with the SPSS program. Both qualitative data will be analyzed according to the criteria and objectives of the study, in addition, Excel was used to facilitate the entry of data that will facilitate the creation of graphs and the processing of the information, a data table will be created in Excel with the information obtained from the interviews to cross and perform an analysis of statistical validity. This procedure will be carried out using SPSS.

Informed consent was obtained to collect the information through the surveys.

RESULTS

Figure 2. Ages of people diagnosed with HIV who were treated in the Integral Care Clinics of the Department of Matagalpa-Nicaragua, in January 2023.

Source: Data collection form

Regarding age, the age group with the highest percentage is 20 to 39 years old, 59% (29) being the most affected ages, being a young age group. By established groups, the age group 20 to 29 years obtained a percentage of 36.7% (18), followed by the group 30 to 29 years with 22.4% (11), in this age group the most prevalent are 28 and 29 years of age, followed by the group 40 to 49 years with 20.4% (10), and the groups 50 to 59 years, 16.3% (8), less than 19 years and 60 to 69 years 2% (1). Díaz Jirón (2021), describes in his results, that the age group obtained from 20 to 29 years with 38%. Torres Sánchez (2021) reflects that the 18 to 30 years age group was the predominant one, with 28.6%, followed by the 41 to 50 years age group with 27%. Castellón Sequeira, concerning age, the age group from 50 to 59 years obtained a percentage of 34.3% (78), followed by the group from 60 to 69 years with 24.2% (55), followed by the group from 40 to 49 years with 20.7% (47), and the groups from 30 to 39 years, 10.1% (23), from 20 to 29 years 5.7% (13) and from 70 years and older with 5% (11), which are in agreement with this study since the most affected groups are young people.

Figure 3. Gender of people diagnosed with HIV who were treated in the Integral Care Clinics of the Department of Matagalpa-Nicaragua, in January 2023.

Source: Data collection form

With the percentage of age, 63% (31) were male, followed by 37% (18) female. Castellón Sequeira describes in his results that 54.6% (124) of the study subjects were female and 45.4% were male. The results obtained show that men had the highest percentage due to the increase in the key and vulnerable population, which is not assimilated to the present study because there are gender differences. Castellón Sequeira describes in his results that 54.6% (124) of the study subjects were women and 45.4% were men. The results obtained show that men had the highest percentage due to the increase in the key and vulnerable population.

Figure 4. Sexual orientation of people diagnosed with HIV who were treated in the Integral Care Clinics of the Department of Matagalpa-Nicaragua, in January 2023.

Source: Data collection sheet.

For the sexual orientation of the respondents, 82% (40) are heterosexual, 14% (7) are homosexual, and 4% (2) are transsexual. Díaz Jirón (2021), narrates in his results that the highest percentage of users are homosexual at 57% (12) and heterosexual at 29% (6), followed by bisexual at 9% (2), which does not agree with the results obtained. Concerning the sexual identity of the respondents, the heterosexual orientation was 82% (40), homosexual 14% (7), and transsexual 4% (2). Díaz Jirón (2021), narrates in his results that the highest percentage of users are homosexual at 57% (12) and heterosexual at 29% (6), followed by bisexual at 9% (2), which does not agree with the results obtained, analyzing the results obtained from the present study, they do not agree with those obtained from Díaz Jirón since there is a difference in heterosexuals.

Figure 10. Counseling about their special at the time of care to people diagnosed with HIV who were treated in the Integral Care Clinics of the Department of Matagalpa-Nicaragua, in January 2023.

Source: Data collection sheet.

The results obtained from the respondents show that 90% (44) received counseling about the performance of special examinations, and 10.2% (5) did not receive counseling for special examinations. Castellón Sequeira describes in his results that 89.3% (124) received a quick response for the sending and performance of examinations. In the results obtained, the respondents rated 96% (47) respected their privacy and 4% (2) did not respect their privacy. Castellón Sequeira obtained 94% about privacy.

The participants in the study rated attention at 65% (32), good attention, at 30% (15), and regular attention at 4% (2). According to the results obtained, the care provided in the integral care clinics is acceptable for the people in the Program.

Figure 15. Perception by areas of care of people diagnosed with HIV who were attended at the Integral Care Clinics in the Department of Matagalpa-Nicaragua, in January 2023.

Source: Data collection form.

Satisfaction with the attention in the areas of admission is rated as Good at 2% (1), excellent at 4% (2), not applicable at 94% (46), and regular at 0%. In the pharmacy, 29% (14) rated the attention as good, 44% (22) excellent, 20% (10) not applicable, and 6% (3) regular. In the laboratory, 42% (21) rated the attention as good, 54% (23) excellent, 0% not applicable and 4% (2) regular. Castellón Sequeira, according to his study, rated laboratory treatment as 89.3%. This is similar to the percentages obtained in the present study.

The cleanliness of the clinics was rated as excellent 59.2% (29), good 36.7% (18), bad 2% (1), regular 2% (1). In the study, Castillo Juarez obtained 38.8% of hygiene in the care areas.

Figure 18. Persons diagnosed with HIV who were seen in the Integral Care Clinics of the Department of Matagalpa-Nicaragua, in January 2023,023 received the date of their next appointment and instructions for their medication.

Source: Data collection form.

In the results, 88% (43) of the respondents received their next appointment at the end of their consultation; 12% (6) did not receive their appointment. With the variable do they receive medication instructions 47% (23), if they receive instructions for their medication 27% (13) and does not apply 27% (13). In Castellón Sequeira’s study, there are different data, since in his study it is evaluated with 95% that they receive instructions for taking their medication.

Figure 19. Satisfaction with the waiting time of people diagnosed with HIV who were attended at the Integral Care Clinics of the Department of Matagalpa-Nicaragua, in January 2023.

Source: Data collection form.

Regarding the waiting time in the integral care clinics, they evaluated it with 61% (30), and little time 39% (19). Regarding the duration of the consultation time, 80% (39) rated it as acceptable, a short time of 20% (9). The Castillo Juárez study did not obtain similar data, since they evaluated the waiting time as 35% and the duration of the consultation as 35.9%.

In the duration of the consultation, 9 respondents have a perception that the duration is very short.

CONCLUSIONS

1. Regarding sociodemographic characteristics, they reflected that the highest percentage in the age group of 20 to 49 years, being the young population.

2. In relation to the expectations evaluated by the respondents, they received indications of important tests for the follow-up of their health, they respected their privacy, the health personnel provided counseling at the time of care and they understood the recommendations and counseling. The highest percentage was Empathy, where patients rated good care and would return again to the integral care clinic to be seen again by the same resource.

3. Regarding the perceptions indicated by the respondents, the highest percentage was in satisfaction with the care received in the different integral care clinics, in the treatment of care in the pharmacy there is a higher percentage in the option of not applicable because the health personnel is in charge of taking the medicine to the patients, a percentage of regular treatment is obtained by the pharmacy and laboratory area.

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