Predictors of quality of care among loss to follow-up adults returning to HIV care in Nigeria

Abstract

Background : Loss to Follow-Up (LTFU) remains a major challenge for HIV programmes in sub-Saharan Africa, affecting treatment continuity and health outcomes. Although clinical and structural determinants of retention have been widely studied, limited evidence exists on how defaulted HIV adult patients returning to care perceive the quality of care (QoC) previously received. This study examined predictors of perceived QoC among HIV positive adults returning to HIV treatment in Nigeria after LTFU.

Methods: A secondary analysis was performed on a 2017 cross-sectional survey involving 438 consenting adults who returned to HIV care after LTFU in Nigeria. Data on demographics, stigma, access barriers, healthcare worker (HCW) interactions, and service satisfaction were collected using a structured questionnaire adapted from the Satisfaction with HIV/AIDS Treatment Interview Scale (SATIS). Bivariate analysis and multivariable logistic regression were performed using SPSS version 20, with statistical significance set at p<0.05.

Results: Out of the 438 study participants, 32.2% were diagnosed within 2 years of the study. Most participants (90%) reported good QoC before their most recent LTFU episode. Dissatisfaction with confidentiality, distrust in HCW competence, and poor ART counselling were associated with poor QoC. HCW friendliness (adjusted odds ratio [AOR]=42.04), satisfaction with ART counselling (AOR=141.45), and absence of prior stigma experiences (AOR=7.72) were associated with good QoC.

Conclusion: Healthcare workers and implementing partners in Nigeria and similar settings should strengthen provider–patient communication, improve respectful HIV service delivery, and reduce stigma within health facilities to support sustained retention of adults returning to HIV care after loss to follow-up.