Human Immunodeficiency Virus (HIV) infection remains one of the most significant public health challenges worldwide. The introduction of antiretroviral therapy (ART) has dramatically improved the survival and quality of life of people living with HIV (PLHIV), transforming HIV infection from a fatal disease into a chronic, manageable condition. However, the effectiveness of ART programmes depends not only on the availability of medications but also on the quality of healthcare services and the satisfaction of patients receiving them.¹˒²

Patient satisfaction is recognised as an important indicator of healthcare quality, reflecting the extent to which healthcare services meet patients' expectations and needs. In chronic diseases such as HIV infection, patient satisfaction assumes greater importance because treatment requires lifelong adherence, regular follow-up visits, counselling, and continuous interaction with healthcare providers. Satisfied patients are more likely to maintain adherence to ART, remain engaged in care, and achieve better treatment outcomes.³˒⁴

ART centres provide a wide range of services, including drug dispensing, clinical evaluation, laboratory monitoring, adherence counselling, psychosocial support, and management of opportunistic infections. The quality of these services can significantly influence patients’ experiences and perceptions of care. Factors such as accessibility of services, waiting time, confidentiality, provider–patient communication, staff attitude, availability of medications, and counselling quality have been shown to affect patient satisfaction in HIV care settings.⁵˒⁶

Several studies have demonstrated a positive association between patient satisfaction and retention in HIV care. Improved satisfaction levels contribute to better treatment adherence, increased trust in healthcare providers, and reduced loss to follow-up. Conversely, poor service quality may discourage healthcare utilisation and negatively affect clinical outcomes.⁴˒⁷ As healthcare systems increasingly emphasise patient-centred care, regular assessment of service quality and patient satisfaction has become an essential component of programme evaluation and quality improvement initiatives.

Therefore, evaluating patient satisfaction and service quality at ART centres is crucial for identifying gaps in service delivery and developing strategies to enhance the effectiveness, accessibility, and responsiveness of HIV care services. Such assessments can provide valuable evidence for strengthening ART programmes and improving the overall healthcare experience of people living with HIV.

MATERIALS AND METHODS

Study Design and Setting

A hospital-based cross-sectional study was conducted at the Antiretroviral Therapy (ART) Centre located in Bhopal, Madhya Pradesh. The ART Centre provides comprehensive HIV care services including antiretroviral therapy, adherence counselling, laboratory monitoring, clinical evaluation, and follow-up care for People Living with HIV/AIDS (PLHIV).

Ethical Considerations

The study was conducted after obtaining approval from the Institutional Ethics Committee. Written informed consent was obtained from all participants before enrolment in the study. Participation was voluntary, and confidentiality and anonymity of the collected information were maintained throughout the study.

Study Population and Sampling

The study included HIV-positive patients aged 18 years and above who had been receiving antiretroviral therapy for at least six months and attended the ART Centre during the study period. Patients who were critically ill, unable to communicate effectively, or unwilling to participate were excluded from the study.

The sample size was calculated using the formula n = Z²pq/d², where p represented the expected prevalence of patient satisfaction reported in previous studies. Based on the calculation, a total of 384 participants were required. Eligible participants were recruited consecutively until the desired sample size was achieved.

Data Collection Tool and Procedure

Data were collected using a pre-designed, pre-tested structured questionnaire administered through face-to-face interviews. The questionnaire consisted of socio-demographic and clinical details, along with items assessing patient satisfaction and service quality. Patient satisfaction was measured using a five-point Likert scale ranging from 1 (very dissatisfied) to 5 (very satisfied). The questionnaire assessed multiple domains including accessibility of services, waiting time, availability of antiretroviral medications, counselling services, communication with healthcare providers, staff behaviour, privacy and confidentiality, laboratory services, facility cleanliness, and overall satisfaction with services received at the ART Centre.

Service quality was assessed using five dimensions adapted from the SERVQUAL model, namely tangibility, reliability, responsiveness, assurance, and empathy. For each participant, domain-wise satisfaction scores and an overall patient satisfaction score were calculated by averaging the responses across the respective items. Higher scores indicated greater levels of satisfaction and perceived service quality.

Outcome Measures

The primary outcome measure was the overall patient satisfaction score among ART Centre attendees. Secondary outcomes included domain-specific patient satisfaction scores, perceived service quality scores, and the association of socio-demographic and clinical characteristics with overall patient satisfaction.

Statistical Analysis

Data were entered into Microsoft Excel and analysed using Statistical Package for Social Sciences (SPSS) version 26.0. Descriptive statistics were used to summarise the data. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Mean Patient Satisfaction Questionnaire (PSQ) scores were calculated for individual domains as well as for overall satisfaction. Associations between overall satisfaction scores and selected socio-demographic and clinical variables were assessed using the chi-square test after categorising satisfaction levels. A p-value of less than 0.05 was considered statistically significant.

RESULTS

A total of 384 patients receiving ART services participated in the study. The mean age of the participants was 39.8 ± 10.7 years, and 57.0% were males. The overall mean Patient Satisfaction Questionnaire (PSQ) score was 4.18 ± 0.56 on a five-point scale, indicating a high level of satisfaction with ART Centre services. Higher scores were observed for interpersonal manner, counselling services, and technical quality, whereas accessibility and waiting time received comparatively lower scores.

Table 1. Socio-demographic and Clinical Characteristics of Participants

Most participants were aged 31–50 years, male, and had been receiving ART for more than five years.

Table 2. Mean Patient Satisfaction Questionnaire (PSQ) Scores Across Service Domains

The highest mean satisfaction scores were observed for availability of ART medications (4.56 ± 0.43), interpersonal manner of staff (4.38 ± 0.49), and counselling services (4.34 ± 0.52). The lowest score was reported for waiting time (3.71 ± 0.81). The overall PSQ score of 4.18 ± 0.56 indicates a high level of patient satisfaction with ART Centre services.

The findings revealed a high overall level of patient satisfaction among ART Centre attendees. Patients reported excellent satisfaction with medication availability, staff behaviour, counselling services, and communication with healthcare providers. However, waiting time and accessibility of services received relatively lower ratings, suggesting areas for improvement. Overall, the ART Centre demonstrated good service quality and patient-centred care.

DISCUSSION

The present study assessed patient satisfaction and perceived service quality among People Living with HIV/AIDS attending the ART Centre. The findings revealed a high overall level of patient satisfaction, with a mean Patient Satisfaction Questionnaire (PSQ) score of 4.18 ± 0.56, indicating that the majority of participants were satisfied with the healthcare services provided. These findings suggest that the ART Centre is effectively delivering patient-centred HIV care and maintaining satisfactory standards of service delivery.

The highest satisfaction score in the present study was observed for the availability of ART medications (4.56 ± 0.43). Continuous availability of antiretroviral drugs is essential for ensuring treatment adherence and preventing treatment interruptions. Similar findings were reported by Nikitha et al., who observed high satisfaction among ART beneficiaries regarding medication availability and emphasised its importance in maintaining continuity of care.¹⁰ Adequate drug supply strengthens patient confidence in healthcare services and contributes to long-term treatment compliance.

High satisfaction scores were also observed for the interpersonal manner of staff (4.38 ± 0.49) and counselling services (4.34 ± 0.52). These findings indicate that participants perceived healthcare providers as supportive, respectful, and approachable. Counselling services are a crucial component of HIV care as they enhance treatment adherence, address psychosocial concerns, and improve understanding of disease management. Similar observations were reported by Vahab et al., who found that courteous staff behaviour and effective counselling significantly influenced patient satisfaction among PLHIV attending an HIV clinic in southern India.¹² Sood et al. also reported that positive interactions with healthcare personnel contributed substantially to overall satisfaction among patients attending ART centres.⁹

The domains of communication with healthcare providers (4.26 ± 0.57) and privacy and confidentiality (4.22 ± 0.60) received high satisfaction scores in the present study. Effective communication promotes patient trust, improves understanding of treatment plans, and encourages long-term engagement in care. Confidentiality is particularly important in HIV care because stigma and discrimination continue to affect many individuals living with HIV. Dang et al. identified provider communication and patient-provider relationships as major determinants of overall satisfaction among HIV patients receiving care.¹¹ Similarly, Beach et al. demonstrated that a strong patient-provider relationship was associated with improved adherence to treatment and better health outcomes among HIV-positive individuals.¹⁶

The mean score for technical quality of care (4.29 ± 0.54) indicated a high level of confidence in the competence and professionalism of healthcare providers. Patients receiving lifelong ART frequently interact with healthcare personnel, making trust in clinical expertise an important aspect of satisfaction. The findings of the present study support previous evidence suggesting that perceived technical competence positively influences healthcare experiences and patient retention in HIV care programmes.¹¹˒¹⁶

Among all domains, the lowest satisfaction score was observed for waiting time (3.71 ± 0.81), followed by accessibility and convenience of services (3.89 ± 0.72). Although these scores remained within the satisfactory range, they were lower than those observed for other service domains. Increased patient load, limited manpower, and administrative procedures may contribute to prolonged waiting times in ART clinics. Similar findings were reported by Wanyenze et al., who observed that delays in service delivery and clinic congestion adversely affected patient experiences in HIV treatment facilities.¹⁴ Long waiting periods have consistently been identified as one of the common causes of dissatisfaction in healthcare settings and represent an important area for quality improvement.

The overall high satisfaction score observed in the present study is consistent with findings reported from ART centres in different regions of India. Sood et al. reported high satisfaction among patients attending an ART centre in North-West India, particularly with healthcare provider behaviour and quality of services.⁹ Likewise, Nikitha et al. observed favourable satisfaction levels across multiple service domains, highlighting the effectiveness of structured ART service delivery systems.¹⁰ These similarities suggest that standardized ART services implemented under the national HIV programme have contributed to improving patient experiences across different healthcare settings.

Patient satisfaction is increasingly recognised as an important indicator of healthcare quality. Batbaatar et al., in their systematic review, concluded that factors such as provider communication, accessibility, responsiveness, and interpersonal behaviour significantly influence patient satisfaction across healthcare settings.¹³ The findings of the present study support these observations, as domains related to communication, counselling, staff behaviour, and medication availability demonstrated the highest satisfaction scores.

Overall, the results indicate that the ART Centre provides satisfactory and patient-centred services to PLHIV. High levels of satisfaction were observed with medication availability, counselling services, healthcare provider communication, and staff behaviour. However, improvements in waiting time and accessibility may further enhance patient experiences and service quality. Regular assessment of patient satisfaction can help identify service gaps and support continuous quality improvement initiatives to strengthen HIV care delivery.

CONCLUSION

The present study demonstrated a high level of patient satisfaction with the services provided at the ART Centre, with an overall mean PSQ score indicating positive perceptions of care among People Living with HIV/AIDS. The highest satisfaction levels were observed for availability of antiretroviral medications, counselling services, staff behaviour, and communication with healthcare providers, reflecting the effectiveness of the ART programme in delivering patient-centred care. However, comparatively lower scores for waiting time and accessibility of services suggest areas that require further improvement. Regular assessment of patient satisfaction and service quality can help identify gaps in healthcare delivery and support continuous quality improvement initiatives, ultimately enhancing treatment adherence, patient retention, and overall quality of HIV care.

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