title: Predictors of Patient Dissatisfaction with Services for Prevention of Mother-To-Child Transmission of HIV in Dar es Salaam, Tanzania.
abstract: BACKGROUND
  Mother-to-child transmission (MTCT) of HIV remains a major source of new HIV infections in children. Prevention of mother-to-child transmission of HIV (PMTCT) using lifelong antiretroviral treatment (ART) for all pregnant and breastfeeding women living with HIV (Option B+) is the major strategy for eliminating paediatric HIV. Ensuring that patients are satisfied with PMTCT services is important for optimizing uptake, adherence and retention in treatment.
  
  
  METHODS
  We conducted a facility based quantitative cross-sectional survey in Dar-es-Salaam, Tanzania, between March and April 2014, when the country was transitioning to the implementation of PMTCT Option B+. We interviewed 595 pregnant and breastfeeding women living with HIV, who received PMTCT care in 36 public health facilities. Predictors of overall dissatisfaction with PMTCT services were identified using a multiple logistic regression.
  
  
  RESULTS
  Overall 8% of the patients expressed dissatisfaction with PMTCT services. Patients who perceived health care workers (HCW) communication skills as poor, had a 5-fold (OR 4.9, 95% CI 1.8-13.4) increased risk of dissatisfaction and those who perceived HCW capacity to understand client concerns as poor, had a 6-fold (OR 5.7, 95% CI 2.3-14.0) increased risk. Having a total visit time longer than two hours was associated with a 2-fold increased risk of being dissatisfied (OR 2.3, 95% CI 1.1-4.7). Every 30-minute increment in total visit time was associated with a 10% higher (OR 1.1, 95% CI 1.0-1.2) risk of being dissatisfied. The probability of being dissatisfied ranged from 4% (95% CI 2% - 6%) in the presence of patient-perceived good communication, good understanding of patient concerns, and a total visit time below two hours, to 70% (95% CI 47% - 86%) if HCW failed in all of these aspects.
  
  
  CONCLUSIONS
  Patient dissatisfaction with PMTCT services was generally low; reflecting that quality of care was maintained during Tanzania's transition to Option B+ strategy aiming to increase the number of women initiating life-long ART in PMTCT clinics. Improved HCW communication with clients, their understanding of patient concerns and a reduction of the total visit time would further optimize women's overall satisfaction with PMTCT services in Tanzania.
authors: Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.|Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
authors: Helga
authors: http://orcid.org/0000-0003-1659-5224
authors: H
authors: Naburi
authors: School of Public Health and Social Sciences (SPHSS), Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
authors: Phares
authors: P
authors: Mujinja
authors: Departments of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
authors: Charles
authors: C
authors: Kilewo
authors: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.|Africa Centre for Population Health, Mtubatuba, South Africa.
authors: Till
authors: T
authors: Bärnighausen
authors: Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
authors: Nicola
authors: N
authors: Orsini
authors: Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
authors: Karim
authors: K
authors: Manji
authors: Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
authors: Gunnel
authors: G
authors: Biberfeld
authors: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.|Management and Development for Health (MDH) non-Governmental organization, Dar es Salaam, Tanzania.
authors: David
authors: D
authors: Sando
authors: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
authors: Pascal
authors: P
authors: Geldsetzer
authors: Management and Development for Health (MDH) non-Governmental organization, Dar es Salaam, Tanzania.
authors: Guerino
authors: G
authors: Chalamila
authors: Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.|Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
authors: Anna Mia
authors: AM
authors: Ekström
mesh_terms: D000328:Adult; D001942:Breast Feeding; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D017060:Patient Satisfaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D013636:Tanzania