Links between unit costs for HIV services, perceived service quality and client satisfaction in Ukraine.

Background: Ukraine's HIV prevention and management efforts focus on continuous and sustained scale-up of services. To reach UNAIDS 90–90-90 targets by 2020, Ukraine should increase investments in diagnosing, enrolling and retaining people living with HIV in treatment and care. We evaluated the relationship between expenditure on HIV services and client perception of service quality, as client satisfaction has been linked to retention in the HIV care continuum. Methods: We interviewed 617 clients who received HIV services at 43 healthcare facilities. Perceived service quality was measured across five domains: comprehensiveness of services, accessibility, user-friendliness, confidentiality and privacy, and overall satisfaction. Annual unit costs were estimated for HIV counseling and testing (HCT), antiretroviral treatment (ART), opioid substitution therapy (OST) and the needle and syringe program (NSP). Linkages between perceived service quality scores that were dichotomized at median and unit costs were measured using logistic regressions among subsets of clients who received respective HIV services. Results: Median annual unit costs for HIV services varied from $7.94 to $661.84. Odds of HCT comprehensiveness increased linearly with the unit cost for HCT services (OR = 3.54, 95% CI 1.43–10.27). ART comprehensiveness was not linked to ART costs (OR = 0.46, 95% CI: 0.04–4.53). There was a negative relationship between confidentiality and privacy and OST costs (OR = 0.61, 95% CI: 0.38–0.96). Overall satisfaction was positively linked only to HCT costs (OR = 2.54, 95% CI 1.12–6.29), and no association was found for NSP costs (OR = 2.28, 95% CI 0.47–12.56). Conclusions: Unit costs for HCT services were associated with better perception of service quality and overall satisfaction, whereas other unit costs were negatively linked (OST) or were not associated (ART, NSP). Mixed results suggest that higher unit costs for some HIV services do not necessarily translate into better quality and consequently into improved retention in care. The lack of positive associations between unit costs and perceived quality of some services highlights the need to explore how HIV resource allocations can be improved in Ukraine to achieve better outcomes. [ABSTRACT FROM AUTHOR]

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