Quality of care for people with HIV infection and AIDS receiving antiretroviral therapy in Bamrasnaradura Infectious Diseases Institute

Abstract

This descriptive research aimed to study the quality of process and outcome of care for people with HIV infection and AIDS (PHA) receiving antiretroviral therapy (ART) in Bamrasnaradura Infectious Diseases Institute, Nonthaburi Province, Thailand. The 249 medical records were selected with simple random sampling method from the records of PHA who were new cases starting ART during October 2014 – September 2016. Research instruments included patient information form, care-process quality record form, and care-outcome quality record form. Data were collected from the medical records and were analyzed by descriptive statistics, Friedman test and Wilcoxon-signed rank test. Research results related to the quality of care-process revealed that 85.7% of PHA received ARV knowledge and 100% of PHA counseling to prepare for starting ART. They were advised to disclose their infection to their partners and to have family–planning for 53.0% and 39.4% respectively. The quality of care-process during ART was as follows: 95.2% of the PHA were followed up for drug adherence and 78.8% received information about taking antiretroviral drugs (ARV). They were regularly screened for opportunistic infections, comorbidity and sexually transmitted diseases (STDs) for 98.0%, 97.6% and 95.2% of them respectively. 94.8% were assessed for sexual risk behaviors of STDs and 94.0% were advised to have safe sex. They were also assessed for risk behaviors such as alcohol consumption/smoking and drug addiction for 53.8% and 0.8% of them respectively. Most of them (90.8%) were regularly assessed for health problems and those who had health problems were sent to specialist for consultations. Regularity of investigation on CD4 every 6 months and viral load once a year was observed in 90.0% and 35.7% of cases respectively. For the quality of care-outcomes, it was found that drug adherence rate was 91.2%, while 55.8% of the PHA were consistently assessed as good drug adherence (≥95%), 47.0% had regular follow-up and 8.4% were founded to have ARV drug resistance. CD4 levels after ART were significantly higher than those prior to the therapy and viral load levels significantly decreased after ART. The study recommends the development of the care system to increase follow up rate and increase assessment of ART effectiveness as indicated.