HIV Care clinic Services in Post-Conflict Tigray, North Ethiopia: Client Perceptions and Health System Challenges

Abstract Background Patient satisfaction serves as a vital metric to evaluate care quality and guide recovery efforts. This study assessed perceived HIV clinic service quality in Tigray using satisfaction as a proxy, aiming to identify systemic barriers and inform post-conflict care improvements. Methods A facility-based cross-sectional study was carried out from October to November 2024 in Mekelle City, Tigray, Ethiopia. The study was conducted in eleven health facilities, including eight public facilities and three operated by non-governmental organizations. Eligible participants were adults aged ≥ 18 years who had been on antiretroviral therapy (ART) for at least 12 months. Client satisfaction was measured using a 21-item Likert-scale questionnaire. Four quality domains were modeled as latent constructs to capture systemic service gaps, while overall satisfaction served as the primary outcome and domain-specific satisfaction as secondary outcomes. Structural equation modeling (SEM) with 1,000 bootstrapped samples was employed to assess relationships between latent variables and overall satisfaction. Additionally, logistic regression models were used to identify predictors of satisfaction.. Results Of 631 eligible patients, 569 consented (90.17%), with 521 included after exclusions. Among the 521 participants (mean age 42.4 years, 60.7% female), 62.96% reported overall satisfaction with HIV clinical laboratory services. Satisfaction varied across domains: 64.5% with provider–client relationships, 31.5% with care availability, 57.2% with quality of care, and 57.4% with facility environment. Structural equation modeling showed strong, significant positive associations between overall satisfaction and all four latent constructs (PRC β = 0.920, AAC β = 0.963, QCS β = 0.925, FSE β = 0.985; all p < 0.001). Of the exogenous predictors, only the level of care was significantly associated with satisfaction (β = −0.167, p < 0.001). Clients at tertiary-level and public facilities had significantly lower odds of being satisfied (OR = 0.50 and OR = 0.64, respectively; p < 0.001). Conclusions The study found that HIV care satisfaction in Tigray fell below the national benchmark of 85%, underscoring the disproportionate impact of conflict on structural determinants of care quality. Future research should adopt longitudinal and mixed-methods approaches to track satisfaction trends, integrate patient experiences, and inform equitable, conflict-resilient HIV service delivery frameworks.