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Comparison of health system responsiveness between HIV and non-HIV patients at infectious disease clinics in Yunnan, China

Authors Li J, Chongsuvivatwong V, Assanangkornchai S, McNeil EB, Cai L

Received 22 January 2018

Accepted for publication 28 March 2018

Published 29 June 2018 Volume 2018:12 Pages 1129—1137

DOI https://doi.org/10.2147/PPA.S163416

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Naifeng Liu


Jing Li,1 Virasakdi Chongsuvivatwong,2 Sawitri Assanangkornchai,2 Edward B McNeil,2 Le Cai1

1School of Public Health, Kunming Medical University, Kunming, Yunnan Province, China; 2Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand

Background: China is in an epidemiologic transition period. Health system responsiveness (HSR) has become an increasing concern in China. With the burden of increasing human immunodeficiency virus (HIV) infection/acquired immune deficiency syndrome, responsiveness of HIV care is urgently needed. We aimed at comparing the experience of HSR between HIV-positive and non-HIV patients.
Methods: A cross-sectional study was carried out in Yunnan, China, from January to February 2015 among two consecutive groups of HIV and non-HIV patients in two hospitals with the largest HIV admissions. Patients’ experience and expectation of HSR were measured using a self-reported questionnaire containing items of seven domains and 35 vignettes (five per domain). Each of the items and vignettes was ranked from 1 “very good” to 5 “very bad.” For each domain, B-scales were built based on the difference between experience and the vignettes. Ordered probit and censored ordered probit regression models were constructed to compare HSR experience between the two groups adjusted for socioeconomic status (SES) factors.
Results: The majority of HIV patients were at clinical stage 1, were infected via unprotected sexual contact, and had a CD4 count <500 cells/µL. After adjustment by SES factors, HIV patients had better experiences of HSR in six of the seven HSR domains, prompt attention being the only domain that non-HIV patients had better experiences.
Conclusion: Perceptions of HSR experience were better among HIV patients except for prompt attention, which could not be explained by SES factors and difference in expectations. A reform is needed not to neglect the needs of non-HIV patients in the study area.

Keywords:
health system responsiveness, anchoring vignettes, HIV care, China

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