title: Investigating client perception and attitude to decentralization of HIV/AIDS treatment services to primary health centres in three Nigerian states.
abstract: The opinions of consumers in decentralization provide insights into possible levels of improvement in access and uptake of services.
  
  
  
  The study examined clients' perception and attitude towards decentralization of antiretroviral treatment services from central hospitals to primary health centres (PHCs).
  
  
  
  A cross-sectional survey was undertaken in three states in Nigeria. A total of 1265 exit interviews were conducted with HIV/AIDS clients in nine health facilities.
  
  
  
  About a third of all the respondents were not comfortable with receiving ART services in a PHC facility close to where they live. The reasons given by 385 respondents who would not want their treatment centres near were as follows: fear of disclosure, 299 (80.4%); fear of being discriminated against, 278 (74.3%); and satisfaction with care received at current facility, 278 (74.3%). However, more than 90% of respondents in all three states felt that decentralization of ART services to PHCs would be beneficial in controlling HIV/AIDS in Nigeria; the difference in respondents' perception across the three state was found to be statistically significant (P < 0.001).
  
  
  
  The findings imply that scaling-up of treatment services to PHCs would be widely accepted, and probably result in increased uptake. However, this must be accompanied by targeted behaviour change interventions for clients who for the fear of disclosure and stigma would still not access care from proximate facilities.
authors: Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria. obinna.onwujekwe@unn.edu.ng.
authors: Obinna
authors: O
authors: Onwujekwe
authors: Health Policy Research Group, University of Nigeria, Enugu, Nigeria.
authors: Ifeanyi
authors: I
authors: Chikezie
authors: Health Policy Research Group, University of Nigeria, Enugu, Nigeria.
authors: Chinyere
authors: C
authors: Mbachu
authors: FHI360, Abuja, Nigeria.
authors: Robert
authors: R
authors: Chiegil
authors: FHI360, Abuja, Nigeria.
authors: Kwasi
authors: K
authors: Torpey
authors: Health Policy Research Group, University of Nigeria, Enugu, Nigeria.
authors: Benjamin
authors: B
authors: Uzochukwu
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011057:Politics; D011320:Primary Health Care; D011639:Public Opinion; D011795:Surveys and Questionnaires
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV/AIDS; Perception; antiretroviral treatment; attitude; decentralization; primary health centre