Perceived quality of pharmaceutical HIV services in a post-conflict setting: structural equation modelling in Tigray, Ethiopia

Background The HIV care services in Tigray have been severely impacted during and after the infamous Tigray conflict, which took place from November 2020 to November 2022. The present study assessed the perception of care through people living with HIV satisfaction towards pharmaceutical services in the post-conflict Tigray, North Ethiopia. Methods A cross-sectional survey using exit interviews was conducted, with data captured via Qualtrics XM Software. The study assessed overall satisfaction using 31 indicators across five latent dimensions: provider communication, commitment and respect, medication use information, solving drug problems, and pharmacy environment. Second-order structural equation modeling quantified how these interrelated factors collectively predict satisfaction. Model robustness was verified through fit indices, ensuring the reliability and validity of the findings. Results The study reveals low overall satisfaction (57.2%) among people living with HIV, with significant gaps in medication use information (49% satisfied) and solving drug problems (50.2%). Structural equation modeling identifies that improving medication use information has the highest impact on satisfaction (68.2% increase per quality unit, β = 0.682), followed closely by solving drug-related problems (64.4%, β = 0.644), provider communication skills (59.4%, β = 0.594), and commitment & respect (37.7%, β = 0.377), all statistically significant (p < 0.05). Facility type significantly influenced satisfaction, with health centers outperforming referral hospitals by 128% (β = 1.281, p < 0.001), while primary hospitals showed a drastic 83% decrease in satisfaction (β = -1.789, p = 0.003). Extending refill intervals beyond 3 months increased satisfaction odds 5.6-fold (β = 1.732, p < 0.001). Interestingly, non-Mekelle residents reported 79% higher satisfaction than Mekelle residents (β = 0.794, p = 0.028). The model explained 84.4% variance, with minimal demographic effects (p > 0.05). Conclusions Satisfaction with pharmaceutical services among people living with HIV in Tigray is significantly lower than the national benchmark of 85%, raising concerns about HIV outcomes. Enhancing drug therapy management and optimizing appointment spacing are essential strategies for improving satisfaction during post-conflict rehabilitation. Targeted interventions should prioritize addressing gaps in the provision of medication use information and drug related problem-solving capabilities, particularly in primary hospitals, where satisfaction levels are critically low.