Automated Medication Dispensing System: Are We Meeting Patient Needs? Insights from People Living with HIV’s Perspectives in Eswatini

Introduction While automated medication dispensing systems (ADMS) have been implemented in developed countries for some time to improve efficiency and enhance provider and patient experience, they are relatively a new phenomenon in Sub-Sahara Africa. There is limited evidence to date about how AMDS implementation has improved patient satisfaction in resource limited settings. This study aimed to generate evidence on patient experience by assessing satisfaction of patients living with HIV who adopted the ADMS to access medication for chronic disease care management in Eswatini. Methods A mixed methods study was conducted using an explanatory sequential design to collect data from 717 outpatients aged 18 and above accessing HIV care at five health facilities that implemented the AMDS in Manzini and Lubombo regions of Eswatini. Data was collected between November 1, 2023, through March 31, 2024. In-depth survey data was collected from 100 participants through 20-minute exploratory phone interviews. Descriptive statistics described participants’ demographic characteristics and their use of the AMDS. Thematic analysis was used to examine qualitative interview data, and word frequency analysis was conducted for visualization. Results Most participants (81%) were from the Manzini region, and 99.9% had been on antiretroviral therapy (ART) for at least one year. Most participants found the AMDS easy to use (91.9%), and 94% reported experiencing the shortest waiting times (< 10 minutes). Key advantages cited for using the AMDS included convenience (31.2%), rapid processing (67.4%), reduced queuing time (59.7%), and immediate access to medication (55.9%). Only a small portion of participants (11.2%) expressed dissatisfaction with the AMDS. Thematic analysis revealed AMDS enhanced patient experience through: convenience in accessing ART; optimized adherence to treatment; held potential to benefit more clients if scaled up; and was perceived as less burdensome compared to conventional pharmacy window drug pick up. Conclusion Patients expressed strong user acceptance of the AMDS for medication delivery among people living with HIV receiving chronic care. Participants found the system convenient, easy to use, and supportive of adherence through increased autonomy. While some limitations were raised, the AMDS shows great potential to improve medication access in Eswatini and should be further evaluated for broader implementation.