Factors associated to low uptake of HIV services in private for profit health facilities in Dar es salaam

The importance of involving private sector in health services provision has increased significantly globally. The current literature clearly informs that there is how uptake of HIV services at private for profit facilities but does not clearly explain reasons behind this state of affaires. This study aimed to examine factors associated to or related to low uptake of HIV services within the private for profit health facilities in Dar es salaam. The study was conducted in 13 private for profit health facilities at Kinondoni and Ubungo councils in Dar es salaam. A conceptual framework demonstrating the influence of facility factors, extent of system factors and relationship of quality of services was used to establish the relationship and interrelation with uptake of HIV services within the private for profit facilities. A cross- sectional design using triangulation of quantitative and qualitative research methodologies was employed. A total number of 160 respondents, who are potential clients seeking for health services at the selected health facilities was sampled in the quantitative component. In the qualitative component 4 Focus Group Discussion of 8-9 HIV-positive participants each, and 9 in- depth interviews with facility in –charges, CTC in- charges, and PMTCT nurses were administered. Quantitative data was analyzed using multinomial logistic regression and qualitative data using the thematic analysis method. Findings show that among the sampled respondents 48.8% prefer to go to public health facilities, 37.5% to private for profit facilities, and 13.8% to private faith-based facilities to access HIV care if they find out that they are HIV positive. Though there is many clients at public facilities, people still opt to go the same than to private for profit facilities, as patient and had almost 0.06 times less odds of opting private for profit because of overcrowding in the public health facilities (AOR =0.066 (0.017-0.254). Some patients deal with overcrowding at one public health facility by moving to another public health facility. Those considering absence of direct payment of money cost are more likely 15 times higher to choose government supported health facilities compared to private for profit (AOR=14.887(2,119-104.58), p-value=0.007) and free services (AOR=13.845 (4.12-46.482)and p-value, 0.001) had higher odds of choosing private for profit facilities. Test and treat all policy, HIV monitoring and retention systems, and proximity of the health facilities to home, human resources for health, provider-patient interactions, waiting time and quality of services offered were reported to be related to the low uptake of services within private for profit facilities. Quantitative findings to these factors showed no statistical significance. The study has revealed that facility factors are associated to low uptake of HIV services at private for profit facilities in Dar es salaam. While patients may not choose the private for profit health facilities for some reasons such as long waiting time and overcrowding and confidentiality, generally patients choose the public health facilities more due to availability of staff and better quality of care. The study recommends that government should collaborate or expand the scope with private for profit health facilities from just regulating the service delivery to integrate and engage them more on vertical program like HIV service toward HIV epidemic control, achieving HIV global goals and sustainability.