Client perceptions and satisfaction with HIV care clinic services in post-conflict Tigray, Ethiopia: a cross-sectional study

BACKGROUND: The 2020-2022 Tigray conflict affected health infrastructure, antiretroviral therapy (ART) supply chains, and continuity of HIV care. Assessing patient satisfaction during the recovery period is important to monitor service quality and inform service improvement. This study aimed to (i) measure the level of patient satisfaction among people living with HIV (PLHIV) receiving ART in post-conflict Mekelle City, (ii) model the relationships between four service-quality dimensions and overall satisfaction, and (iii) identify determinants of overall satisfaction with HIV care clinic services. METHODS: The study was conducted from October to November 2024 in Mekelle City, Tigray (eight public facilities and three operated by non-governmental organizations (NGOs)). Eligible participants were adults (≥ 18 years) on ART for at least 12 months. Patient satisfaction was measured using a 21-item, 5-point Likert-scale questionnaire covering four domains: provider-client relationship (PCR), availability and accessibility of care (AAC), quality of care services (QCS), and facility and service environment (FSE). Confirmatory factor analysis (CFA) was used to validate the four-factor measurement model, a second-order structural equation model (SEM) examined associations between the four domains and overall satisfaction, and binomial logistic regression identified determinants of dichotomised overall satisfaction (mean composite score > 3.69 = satisfied). RESULTS: Of 631 eligible patients, 569 consented (90.17%); 521 were retained after exclusions. Mean age was 42.4 years and 60.7% female. Overall, 62.4% reported satisfaction with HIV care clinic services. Domain-level satisfaction was: 64.5% for PCR, 31.5% for AAC, 57.2% for QCS, and 57.4% for FSE. The second-order SEM showed strong, statistically significant standardised associations between overall satisfaction and each domain (PCR β = 0.920; AAC β = 0.963; QCS β = 0.925; FSE β = 0.985; all p < 0.001). In multivariable logistic regression, clients at tertiary-level facilities (OR = 0.50, 95% CI 0.37-0.67) and at public facilities (OR = 0.64, 00195% CI 0.54-0.76) had significantly lower odds of satisfaction; sociodemographic and clinical variables were not independently associated with satisfaction. CONCLUSIONS: Overall satisfaction with HIV care clinic services in post-conflict Mekelle City was 62.4%, below Ethiopia's Health Sector Transformation Plan-II (HSTP-II) target of 80% and at the lower end of the Ethiopian pooled estimate of 69.7% (95% CI 63.8-75.5%). All four service-quality domains were strongly associated with overall satisfaction, and tertiary-level and public facilities had lower odds of satisfaction. Targeted quality improvement is warranted across access, environment and quality-of-care dimensions, particularly at tertiary and public facilities. Whether changes in satisfaction translate into ART interruption, virologic failure, or drug resistance was outside the scope of this cross-sectional analysis and should be examined in longitudinal research.