title: Performance of HIV care decentralization from the patient's perspective: health-related quality of life and perceived quality of services in Cameroon.
abstract: OBJECTIVE
  (i) To assess HIV care decentralization in Cameroon from the patients' point of view, in terms of health-related quality of life (HRQL) and perceived quality of services; (ii) to identify patient- and hospital-related factors undermining HRQL.
  
  
  METHODS
  Perceived quality of services was compared among 1985 HIV-infected patients treated with antiretroviral therapy (ART) for at least 6 months in 27 treatment centres at different levels of health care delivery (central, provincial and district) (EVAL-ANRS 12-116 survey, 2007) using chi-square and non-parametric tests. Correlates of the SF-12 physical (PCS) and mental (MCS) HRQL scores were identified using two-level linear models.
  
  
  RESULTS
  Patients followed-up at central and district levels had similar physical HRQL, while those followed-up at the more decentralized district level reported significantly better mental HRQL. Patients at district level also expressed better relationships with caregivers, easier access to consultations and more reliable drug supply. Financial barriers to access to HIV care and self-reported side-effects were independently associated with both lower PCS and lower MCS. Caregivers' heavy workload tended to impair both PCS and MCS, while availability of counselling by social workers in the hospital was independently associated with higher MCS.
  
  
  CONCLUSIONS
  Despite limited resources, the decentralization of ART delivery can improve quality of care, providing a positive impact on HIV-infected patients' well-being. The development of psychosocial support interventions is necessary but not sufficient for improving quality of care in ART scaling-up programmes, and should be related to global strengthening of health human resources.
authors.affiliation: INSERM UMR 912/ORS PACA, 23 rue Stanislas Torrents, 13006 Marseille, France. sylvie.boyer@inserm.fr
authors.forename: Sylvie
authors.initials: S
authors.lastname: Boyer
authors.forename: Camelia
authors.initials: C
authors.lastname: Protopopescu
authors.forename: Fabienne
authors.initials: F
authors.lastname: Marcellin
authors.forename: Maria Patrizia
authors.initials: MP
authors.lastname: Carrieri
authors.forename: Sinata
authors.initials: S
authors.lastname: Koulla-Shiro
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Moatti
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
mesh_terms: D000328:Adult; D002163:Cameroon; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011057:Politics; D011787:Quality of Health Care; D011788:Quality of Life