Patients’ perceptions of a rural decentralised anti-retroviral therapy  management and its impact on direct out-of-pocket spending.

Monique Lines1, Fatima Suleman
1. Postgraduate Student, Discipline of Pharmaceutical Sciences, School of Health Sciences, University of
KwaZulu-Natal,
2. Prof Fatima Suleman, Associate Professor, Discipline of Pharmaceutical Sciences, School of Health
Sciences, Westville Campus, University of KwaZulu-Natal

Abstract
Background: Geographical and financial barriers hamper accessibility to HIV services for rural communities. The government  has introduced the nurse initiated management of anti-retroviral therapy at primary health care level, in an effort to improve  patient access and reduce patient loads on facilities further up the system.

Objectives:To ascertain the perceptions and satisfaction of patients in terms of the decentralised anti-retroviral policy and the  direct out-of-pocket expenses of patients accessing this care in a rural setting.

Method:Using a cross-sectional study design, 117 patients from five different primary health care collection points and a hospital anti-retroviral clinic were interviewed using a standard questionnaire.

Results:More clinic patients walked to their clinic to collect their medicines as compared to hospital patients (71.2% versus  14.6%). Hospital patients spent more than clinic patients on monthly transport costs (ZAR71.92 versus ZAR25.81, Anova  F=12.42, p=0.0009). All clinic patients listed their respective clinic as their preferred medicine collection point despite recording  lower levels of satisfaction with anti-retroviral services (89% compared to 95.5%).

Conclusion:Patients seem to indicate that they preferred decentralisation of HIV care to PHC level and that this might minimise out-of-pocket spending. Further studies are required to confirm these findings.

Keywords: HIV, patients perception, decentralised care, South Africa.