Investigating client perception and attitude to decentralization of HIV/AIDS treatment services to primary health centres in three Nigerian states

BACKGROUND The opinions of consumers in decentralization provide insights into possible levels of improvement in access and uptake of services. OBJECTIVES The study examined clients' perception and attitude towards decentralization of antiretroviral treatment services from central hospitals to primary health centres (PHCs). METHODOLOGY A cross-sectional survey was undertaken in three states in Nigeria. A total of 1265 exit interviews were conducted with HIV/AIDS clients in nine health facilities. FINDINGS About a third of all the respondents were not comfortable with receiving ART services in a PHC facility close to where they live. The reasons given by 385 respondents who would not want their treatment centres near were as follows: fear of disclosure, 299 (80.4%); fear of being discriminated against, 278 (74.3%); and satisfaction with care received at current facility, 278 (74.3%). However, more than 90% of respondents in all three states felt that decentralization of ART services to PHCs would be beneficial in controlling HIV/AIDS in Nigeria; the difference in respondents' perception across the three state was found to be statistically significant (P < 0.001). CONCLUSION The findings imply that scaling-up of treatment services to PHCs would be widely accepted, and probably result in increased uptake. However, this must be accompanied by targeted behaviour change interventions for clients who for the fear of disclosure and stigma would still not access care from proximate facilities.