Quality of antiretroviral therapy services in Ghana: Implications for the HIV response in resource-constrained settings

Robert Kaba Alhassan; Courage Edem Ketor; Anthony Ashinyo; Mary Eyram Ashinyo; Jerry John Nutor; Conrad Adjadeh; Emmanuel Sarkodie

doi:10.1177/20503121211036142

Quality of antiretroviral therapy services in Ghana: Implications for the HIV response in resource-constrained settings

SAGE Open Med. 2021 Jul 31:9:20503121211036142. doi: 10.1177/20503121211036142. eCollection 2021.

Authors

Robert Kaba Alhassan¹, Courage Edem Ketor², Anthony Ashinyo³, Mary Eyram Ashinyo⁴, Jerry John Nutor⁵, Conrad Adjadeh⁶, Emmanuel Sarkodie⁷

Affiliations

¹ Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana.
² Pharmacy Department, Jasikan District Hospital, Ghana Health Service, Jasikan, Ghana.
³ National AIDS/STI Control Programme, Ghana Health Service, Accra, Ghana.
⁴ Department of Quality Assurance and Safety, Ghana Health Service, Accra, Ghana.
⁵ Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA.
⁶ Pharmacy Department, Margaret Marquart Catholic Hospital Kpando, Kpando, Ghana.
⁷ Pharmacy Department, Kwame Nkrumah University of Science and Technology (KNUST) Hospital, Kumasi, Ghana.

Abstract

Objective: Number of People Living with Human Immune-deficiency Virus in Ghana is over 300,000 and unmet need for antiretroviral therapy is approximately 60%. This study sought to determine the quality of antiretroviral therapy services in selected ART sites in Ghana using the input-process-outcome approach.

Methods: This is a descriptive cross-sectional case study that employed modified normative evaluation to assess quality of antiretroviral therapy services in the Oti and Volta regions of Ghana among People Living with HIV (n = 384) and healthcare providers (n = 16). The study was conducted from 11 March to 9 May 2019.

Results: Resources for managing HIV clients were largely available with the exception of viral load machines, reagents for CD4 counts, and antifungals such as Fluconazole and Cotrimoxazole. Patients enrolled on antiretroviral therapy within 2 weeks was 71% and clients retained in care within 2 weeks of enrolment was 90%. Approximately 26% of enrolled clients recorded viral load suppression; 33% of People Living with HIV who were not insured with the National Health Insurance Scheme paid for some antiretrovirals and cotrimoxazole. Adherence to ART and Cotrimoxazole were 95% and 88%, respectively, using pill count on their last three visits. Time spent with clinical team was among the worst rated (mean = 2.98, standard deviation = 0.54) quality indicators by patients contrary to interpersonal relationship with health provider which was among the best rated (mean = 3.25, standard deviation = 0.41) indicators.

Conclusion: Observed quality care gaps could potentially reverse gains made in HIV prevention and control in Ghana if not addressed timely; an important value addition of this study is the novel application of input-process-outcome approach in the context of antiretroviral therapy services in Ghana. There is also the need for policy dialogue on inclusion of medications for prophylaxis in antiretroviral therapy on the National Health Insurance Scheme to promote adherence and retention.

Keywords: Ghana; Quality healthcare; antiretroviral therapy; human immune-deficiency virus; indicators; input-process-outcome.