Factors associated with delay in receiving health care services at Luwero District Hospital HIV/AIDS Clinic, Uganda

Abstract

Background: There is still high proportion of delays in accessing and receiving adequate HIV care and treatment which contributes to poor client satisfaction, retention, poor adherence to lifelong HAART that increases the infectivity in the community and the high risk of death. Objective: To determine the proportion of clients who delay to receive health care and the contributing factors that influence delay in receiving health care services among patients at HIV/AIDS clinic of Luwero district hospital, Uganda. Method: A cross-sectional study using the time motion approach with a pretested structured exit questionnaire and six focus group discussions of twelve participants were conducted to achieve the objectives of this study. The primary data was collected from 358 clients who attended HIV/AIDS clinic at Luwero district hospital for a period of two months. Data was analyzed using STATA version 15 and qualitatively using grounded theory. Factors associated with delay in receiving health care services were identified using chi square analysis and logistic regression. Results: 94.7% of the respondents delayed to receive the health services they needed. Most of the patients delayed at consultation (n = 323, 93.1%), pharmacy section (n = 297, 87.1%), counseling (n = 127, 68.3%), and registration (n = 195, 54.5%) waiting areas. The factors that were found to be significantly associated with increased delay include ; less than one year duration of stay in HIV care at the facility[AOR=5.88, (CI: 1.27-16,10), p = 0.018], and factors that were associated with reduced delay included; patient being on an appointment [AOR=0.24, (CI: 0.01-0.92), p = 0.041],enough privacy at the facility[AOR=0.71, (CI:0.08-0.93), p = 0.021], health workers informing patients about service protocols[AOR=0.86, (CI:0.71-3.15), p = 0.062] and the patients volume being commensurate with the number of clinical health workers[AOR=0.20, (CI: 0.09-0.84), p = 0.039].Most FGDs indicated that: few doctors, few serving drug outlets and consultation rooms with insufficient privacy and jumping queues were the major factors associated with increased delay to receive health care. Conclusion: There was high proportion of patients who delayed to receive HIV services mostly at consultation and pharmacy sections. Increased likelihood of delaying patients who were less than one year in care and not familiar with the clinic protocol, while reduced likelihood among patients on appointment with enough privacy and patient load commensurate with the number of clinical staff. Recommendation: Orientation of new clients about clinic protocol, proper allocation and keeping of client appointment, recruitment of more clinical staff and redesigning of the consultation rooms to ensure privacy may ultimately reduce client delays to receive health services.