Background: Healthcare worker (HCW) attitudes towards and interaction with patients may be important barriers to patient retention in HIV services, particularly for pregnant women in prevention of mother-to-child transmission programs.
Methods: We collected feedback from women attending antenatal care (ANC) services at seven health facilities in eSwatini over three months. All pregnant women attending ANC were eligible and those providing verbal consent completed anonymous tablet-based audio assisted computer self-interview (ACASI) surveys with symbolic responses (agree/happy, neutral, disagree/sad). The 24-question survey asked about women''s interactions with facility staff (nurses, peer supporters, receptionists and lab workers) including whether women felt respected and if nurses spent enough time and answered questions. Women self-reported HIV status and age. Monthly quality improvement sessions with HCW were held to review feedback data and used to identify strategies to improve patient-provider relationships. Chi-square tests of proportions reporting the different response options were performed to compare surveys from month 1 and 3, and between HIV-positive and HIV-negative pregnant women.
Results: From October to December 2017, 1,483 surveys were completed; 508 (34.3%) women self-reported to be HIV-positive, 710 (47.9%) HIV-negative status and 265 (17.9%) declined to report HIV status. Median age was 25 years (interquartile range 21-30), 35.0% completed the survey at their first ANC visit for the current pregnancy. The questions with the highest proportion of “agree” responses overall were whether peer supporters treated woman with respect (97.4%), whether the nurse cared about the woman (96.3%) and whether nurses answered all questions (96.2%). The question with the highest disagreement was whether the woman was satisfied with her wait time (26.0% disagreed). The only significant change in responses was for whether nurses listened for which agreement increased from 88.3% to 94.8% (p< 0.01) from month 1 to month 3. HIV-positive women had significantly higher agreement with most questions compared to HIV-negative women. However 43.9% of HIV-positive women reported feeling that HCW treat HIV-positive women worse than HIV-negative women compared to 24.5% of HIV-negative women (p< 0.0001).
Conclusions: Women reported overall high rates of favorable patient-provider interactions, HIV-positive women felt more strongly that HCW treat HIV-positive women worse than HIV-negative women.

Download the e-Poster