ДЕЦЕНТРАЛИЗАЦИЯ СИСТЕМЫ ОКАЗАНИЯ МЕДИЦИНСКОЙ ПОМОЩИ ПРИ ВИЧ-ИНФЕКЦИИ КАК ФАКТОР УДОВЛЕТВОРЕННОСТИ ПАЦИЕНТОВ

The current HIV epidemic in Russia represents a serious public health concern. However, associations between structure of health care delivery and psychosocial, behavioral and other characteristics of people living with HIV/AIDS have not been sufficiently studied. The purpose of the research is to examine the effect of decentralization of HIV care on patients’ satisfaction with care in clinics of St. Petersburg, Russia. We conducted a cross-sectional study with 418 HIV-positive patients receiving care at the St. Petersburg AIDS Center or at District Infectious Disease Departments (centralized and decentralized models, respectively). Face-to-face interviews included questions about psychosocial characteristics, patient’s satisfaction with care, and clinic-related patient experience. Our finding showed that patients of District Infectious Disease Departments spent significantly less time in lines and traveling to reach the clinic, and they had stronger relationships with their doctor. The overall satisfaction with care was high, with 86% of the sample reporting high level of satisfaction. Nevertheless, satisfaction with care was strongly and positively associated with the decentralized model of care and Patient-Doctor Relationship Score. Patient experience elements such as waiting time, travel time, and number of services used were not significant factors related to satisfaction. Given the positive association of satisfaction with decentralized service delivery, it is worth exploring decentralization as one way of improving health care services for people living with HIV/AIDS.