Background. Decentralization of care and treatment for HIV infection in Africa makes services available in local health facilities.\nDecentralization has been associated with improved retention and comparable or superior treatment outcomes, but patient\nexperiences are not well understood. Methods.We conducted a qualitative study of patient experiences in decentralized HIV care in\nPlateau State, north central Nigeria. Five decentralized care sites in the Plateau State Decentralization Initiative were purposefully\nselected.Ninety-three patients and 16 providers at these sites participated in individual interviews and focus groups. Data collection\nactivities were audio-recorded and transcribed. Transcripts were inductively content analyzed to derive descriptive categories\nrepresenting patient experiences of decentralized care. Results. Patient participants in this study experienced the transition to\ndecentralized care as a series of ââ?¬Å?trade-offs.ââ?¬Â Advantages cited included saving time and money on travel to clinic visits, avoiding\ndangers on the road, and the ââ?¬Å?family-like atmosphereââ?¬Â found in some decentralized clinics. Disadvantages were loss of access to\nancillary services, reduced opportunities for interaction with providers, and increased risk of disclosure. Participants preferred\ndecentralized services overall. Conclusion. Difficulty and cost of travel remain a fundamental barrier to accessing HIV care outside\nurban centers, suggesting increased availability of community-based services will be enthusiastically received.
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