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 Table of Contents  
Year : 2022  |  Volume : 14  |  Issue : 4  |  Page : 195-199

Satisfaction of the clients attending integrated counseling and testing center in a teaching hospital of North-Eastern India: An observational study

1 Immunization Officer, IGM Hospital, Agartala, Tripura, India
2 Department of Microbiology, Agartala Government Medical College, Agartala, Tripura, India
3 Department of Community Medicine, Agartala Government Medical College, Agartala, Tripura, India

Date of Submission13-Sep-2022
Date of Decision05-Oct-2022
Date of Acceptance13-Oct-2022
Date of Web Publication16-Dec-2022

Correspondence Address:
Himadri Bhattacharjya
Department of Community Medicine, Agartala Government Medical College, P. O. Kunjavan, Agartala - 799 006, Tripura
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajprhc.ajprhc_75_22

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Background: Integrated Counseling and Testing Centers (ICTC) provide counseling and testing for HIV to the clients. Satisfaction of the clients attending an ICTC determines its acceptance among people, and it is crucial for preventing this disease. Objectives: To estimate the level of satisfaction and to determine its association with sociodemographic parameters of the clients attending ICTC in a teaching hospital. Methodology: This hospital-based cross-sectional study was conducted in October 2019 among 213 clients attending ICTC of Agartala Government Medical College, chosen by census technique. An interview schedule containing information regarding age, sex, marital status, education, socioeconomic class, along with a component for evaluating HIV counseling and testing services initially used by UNAIDS, was used for data collection. Results: Among the clients, 54.5% (116) were male, 45.5% were aged between 35 and 80 years, 79.3% were from rural areas, 87.8% were Hindu by religion, 33.8% belonged to scheduled caste community, 63.4% were primary educated, 35.2% belonged to BG Prasad's Class II socioeconomic status, 83.6% were married, and 10.3% attended ICTC by self-initiated approach. Only 39% of the clients were found to be satisfied with the services of this ICTC. Waiting time in queue was found to be significantly associated with client's satisfaction. Conclusion: The client's satisfaction level was found to be low. Reduction in queuing time, caring attitude, and use of the client's own language might improve the scenario.

Keywords: Client, HIV, India, integrated counseling and testing centers, satisfaction, Tripura

How to cite this article:
Debnath A, Roy TK, Bhattacharjya H. Satisfaction of the clients attending integrated counseling and testing center in a teaching hospital of North-Eastern India: An observational study. Asian J Pharm Res Health Care 2022;14:195-9

How to cite this URL:
Debnath A, Roy TK, Bhattacharjya H. Satisfaction of the clients attending integrated counseling and testing center in a teaching hospital of North-Eastern India: An observational study. Asian J Pharm Res Health Care [serial online] 2022 [cited 2023 Jun 8];14:195-9. Available from: http://www.ajprhc.com/text.asp?2022/14/4/195/363944

  Introduction Top

The World Health Organization and Joint United Nations Program on HIV/AIDS (UNAIDS) proposed a strategy in 1994 called: Voluntary Counseling and Testing (VCT) to prevent and control HIV/AIDS. VCT provides an opportunity for both primary prevention by preventing HIV-negative people from contracting the infection as well as secondary prevention by limiting the progression of disease in the infected people through early diagnosis and treatment and also psychosocial support by means of counseling before and after HIV testing. VCT Centers (VCTC) and Prevention of Parent-to-Child Transmission of HIV/AIDS (PPTCT) were started in India in 1997.[1] Later on, the VCTC and facilities providing PPTCT services were remodeled to deliver integrated services to all the clients under one roof and renamed as Integrated Counseling and Testing Center (ICTC). ICTCs are the key entry points for the continuum of care in HIV/AIDS for all sections of the population.[2] Under HIV–TB coordination ICTC also offers services to TB patients through cross-referral activity.

It is a cost-effective entry point to care and support services, which provide people with an opportunity to learn and accept their HIV status in a confidential environment. The aim is to reduce psychosocial stress and provide the client with information and support necessary to make decisions. It is an integral part of the National Aids Control Organization program.[3] pre- and posttest counseling is among the standard components of prevention and addressing to psychological needs.[4] The acceptance of such services, however, depends on the satisfaction of the clients with the services provided. Client satisfaction, in turn, determines client's decisions regarding choices, compliance with regimens, and ultimately the outcome of the management. Carrying out client satisfaction studies provides an opportunity to assess clients' perceptions in an operational setting.[1]

Human satisfaction is a complex concept that is related to a number of factors, including lifestyle, past experiences, future expectations, and the value of both individual and society. Because satisfaction is a derived concept, it is important to find out the sources of dissatisfaction. Thus, in the present-day context, evaluation of services from patient's point of view is becoming increasingly important component of health care delivery.[5] In most of the developed countries, assessing patient satisfaction has been a part of the evaluation of health-care delivery system.

Tripura is a small province of India located in the northeastern corner. It is a resource-constrained zone and differs from the rest of the nation regarding the prevalence of various diseases, ethnicity of the population, sociocultural practices, etc.[6] Although high levels of patient satisfaction are important for the successful implementation of strategies against HIV/AIDS, research in this field of satisfaction with the services of ICTC is very limited in this region. In this context, the present study was designed with the objectives to find out the level of satisfaction of the clients attending ICTC located at Agartala Government Medical College and Govinda Baiiabh Pant Hospital and also to determine the associations of various sociodemographic factors with the level of their satisfaction.

  Methodology Top

This hospital-based cross-sectional study was conducted among 213 clients attending the ICTC of Agartala Government Medical College and GBP hospital from October 1, to October 31, 2019. The minimum sample size requirement for this study was determined using the formula[7] for calculating sample size in prevalence studies using proportion, considering the proportion of clients satisfied with the services of ICTC as 60%[1] at 95% confidence with 10% relative error. It was calculated to be 257.

Probability time sampling was used to choose the study participants. There were twenty working days during October 2019. Out of seven working hours per day, one working hour between 11 AM to 12 PM was chosen by simple random sampling. Thus, 13 participants were planned to be recruited for this study on each working day for 20 days. On every working day from 11 AM to 12 PM, out of all the clients attending this ICTC, 13 were chosen by simple random sampling and approached for participating in this study. In total, 260 clients were selected during the study period. Out of 260 selected clients, 34 participants denied participating in this study and 10 participants had problems in communication. Thus, 44 participants did not meet the inclusion criteria and were excluded from the study. Thus, it was possible to enroll only 213 participants in this study.

Consenting eligible participants were interviewed individually in a face-to-face manner using a predesigned and pretested structured interview schedule, maintaining confidentiality. This interview schedule contained information regarding the age, sex, marital status, education, and socioeconomic class, etc., of the clients. Data regarding the satisfaction of the clients were collected using the tools for evaluating HIV voluntary counseling and testing developed by the Joint UNAIDS,[8] which was translated in local languages. This tool for assessing client's satisfaction contained 12 statements, which were further rated in a 3-point Likert scale (disagree, neutral, and agree). Maximum possible score of all these statements was 24. Satisfaction of a client was finally dichotomized as either satisfied or not-satisfied based upon score percentile. Any score ≥75th percentile was graded as satisfied and <75th percentile as not satisfied. Validity (content and construct validity) and reliability (Internal consistency and test re-test reliability) of this interview schedule was assessed by translating it into local languages (Bengali and Kokborok) by two different translators and re-translating both back to English by another two independent translators and also by piloting upon 10 clients.

Data collected by interviewing the study participants were recorded in the interview schedule and later on entered in computer and analyzed using Statistical Package for Social Sciences-25 for windows.[9] Mean and SD were used to summarize the continuous variables. Chi-square test was performed to test the significance of difference between different proportions. Binary logistic regression model was utilized for predicting satisfaction of the clients attending ICTC using selected predictor variables. P < 0.05 were considered statistically significant. Data were handled with strict confidentiality. Institutional Ethics Committee of Agartala Government Medical College has approved this study vide approval letter no. 4 (6-11)-AGMC/Medical Education/Ethics Com/2018/26764, dated 30th August 2019.

  Results Top

Response rate in this study was 82.87%. Among the study participants 54.5% were male, 54.9% were from joint families, 53.5% were aged <35 years, followed by 31% between 3559 years and only 15.5% were aged either 60 years or above. Regarding religion, 87.8% were Hindu, 7% were Muslim, 4.2% were Christian, and only 1% was Buddhist. Among all, 33.8% belonged to scheduled caste, 27.7% to general caste, 14.1% to scheduled tribes, and 24.4% to other backward communities. Among the clients, 83.6% were married, 12.7% were unmarried, 3.3% were widow, and 0.5% was divorced. Out of all, 79.3% clients were from rural areas and 10.9% came to the ICTC by self-initiated approach. Regarding literacy, 63.4% of the clients were primary educated, 10.3% were secondary educated and 13.1% were either graduate or above. About occupation, 39.8% were self-employed, 15.5% were unemployed, 9.4% were service holders, 33.3% were home makers, and 1.9% were retired employees. Regarding socioeconomic status, 35.2% belonged to upper middle class, 20.7% to lower class, 17.8% to middle class, 14.6% to lower middle class, and 11.7% to upper class as par BG Prasad's socioeconomic classification.[10] High risk behavior was prevalent among 3.3% of the clients and 1.4% spouse, 1.4% had HIV-positive spouse, 24.9% came for antenatal checkup, 30% for preoperative checkup, 0.5% of cases were referred from RNTCP, 1.9% from STD clinic, and 36.6% clients attended the ICTC for various other reasons.

Overall, 39% of the study participants were found to be satisfied with the services of this ICTC. Majority, i.e., 61.2% of the male clients, were not satisfied in comparison with females with the services of ICTC, though statistically it was not significant. Similarly, 69.7% of the participants aged either 60 years or more, 65.9% of the participants from urban areas, 71.4% of the illiterate participants, 65.7% of the participants living singly, 63.5% of participants belonging to nuclear families and 72.7% of participants belonging to lower socioeconomic class were not satisfied with the services of ICTC, but none of these attained the level of statistical significance (P > 0.05) [Table 1].
Table 1: Satisfaction of the clients by their sociodemographic profile

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While taking the opinion of the clients regarding services of this ICTC, 86.9% of the study participants opined that the ICTC was easily accessible, 58.7% said that the queue for counseling and testing was not too long, 76.5% opined that the testing procedure was explained to them, 77.5% said that the testing procedure was not much painful, 70.9% opined that the counselor used simple and easily understandable words, 48.8% agreed with the fact that the counselor showed interest in explaining issues pertaining to HIV, 67.1% opined that during the session they were given the opportunity to ask questions and clarify their doubts, 52.1% said that the counseling very useful, 48.4% opined that their perspective regarding HIV/AIDS has been changed by the counseling and 43.2% did not agree with the statement that the counseling sessions could have not been better [Table 2].
Table 2: Opinion of the clients regarding services of the Integrated Counseling and Testing Centers

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Binary logistic regression analysis showed that with 1 year increment in age, a client attending the ICTC will have 5.7% higher chance of being satisfied (odds ratio [OR] = 2.057, 95% confidence interval [CI] = 1.0442.089, P = 0.000), similarly with one unit increment in the waiting time, a client attending the ICTC will have 57.4% lesser chance of being satisfied (OR = 0.574, 95% CI = 0.1560.893, P = 0.001). Likewise, increment in the literacy level of the clients and failing to maintain cleanliness in the ICTC showed significant effect in reducing the level of satisfaction. On the other hand, good explanation by the counselor and maintaining good privacy showed significant effect in improving the level of satisfaction of the clients (P < 0.05) [Table 3].
Table 3: Result of binary logistic regression analysis

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  Discussion Top

The present study found that, self-initiated approach was only 10.9% which was much lower than the study of Kabbash et al. (27%).[11] Majority of the participants came being referred from the various clinical departments. This could be due to the fact that the ICTC was located at a tertiary care hospital and was also near to the ART center. The present study revealed that only 39% of the clients were satisfied with the services provided by this ICTC. Haque et al.[12] found overall satisfaction of the clients attending ICTC as 59%, which was contrary to the findings of the present study. Proportion of female clients attending ICTC in this study was 45.5%. Similar studies conducted by Dinesh et al.[13] reported it to be 44.94% and Chelliyan et al.[14] reported to be 32%. In the present study, 53.5% of the clients were found to be aged <35 years. In a similar study by Haque et al.,[12] 88.75% of clients were found to be aged between 18 and 45 years, i.e., sexually active age group and it was also contrary to the findings of the present study.

The present study revealed that 78.3% of the clients were dissatisfied with the long queuing time, which was contrary to the findings of Chourasiya et al.[15] where only 35.30% were dissatisfied with the waiting time. Devnani et al.[16] also found that clients spending more time in ICTC were less satisfied and the total time spent in ICTC was also found to be significantly associated with the level of satisfaction of the clients (P = 0.03). The attitude of counselors emerged as a significant factor, as it was associated with client satisfaction level. Among all, 51% of the clients were significantly satisfied as the counselors used easy language. About 67.1% agreed that they were given opportunity to ask questions and clarified their doubts which was higher than the findings of Devnani et al.[16] where only 54% of the study participants said that the counselor encouraged them to ask questions. The present study could not find much difference between the satisfaction level of general clients and that of women coming for antenatal checkup (ANC). On the contrary, Papanna et al.[1] and Haque et al.[12] found ANC clients to be more satisfied with the services of ICTC. In this study, the satisfaction level of the male and higher educated clients was found to be low, which was contrary to the findings of Kabbash et al.,[11] where male sex and higher literacy were associated with higher satisfaction levels.

  Conclusion Top

This study revealed client's perspective regarding ICTC services and various factors that influenced the level of their satisfaction. Overall satisfaction of the clients attending ICTC of Agartala Government Medical College was found to be low. Reduction in queuing time, good explanation by the counselor, improving cleanliness, and enhancing privacy may improve the scenario.


The present study had some limitations like lower literacy level of the clients might have affected their ability to understand the testing procedure and other explanations and such clients might not answer correctly during their exit interview which reflected their level of satisfaction.


The authors are indebted and thankful to the authority of Agartala Govt. Medical College for permitting to conduct this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Papanna MK, Kumar P, Shetty A, Kamath A, Bhaskaran U, Saddichha S. Client satisfaction with HIV counseling services: A cross-sectional study from south India. J Int Assoc Provid AIDS Care 2013;12:169-72.  Back to cited text no. 1
Chauhan T, Bhardwaj AK, Parashar A, Kanga AK. A study on profiles of clients attending an Integrated Counselling & Testing Centre of tertiary care hospital in a Northern Hilly State, India. Glob J Res Rev 2014;1:018-26.  Back to cited text no. 2
Mathur A, Sharma B, Bithu R. Socio-demographic characteristics of clients visiting Integrated Counselling and Testing Centre (ICTC) at SMS Medical College, Jaipur (Rajasthan) India. Int Multispecialty J Health 2016;1:27.  Back to cited text no. 3
HHS/CDC Global AIDS Program (GAP) in India. The GAP India Fact Sheet. Available from: http://www.Cdc.gov/nchstp/od/gap/countries/India.htm. [Last accessed on 2020 Jan 01].  Back to cited text no. 4
Verma A, Sarma RK. Evaluation of the “Exit Proformas” in use at special wards of a public sector tertiary care hospital. J Acad Hosp Adm 2000;12:23-7.  Back to cited text no. 5
International Institute for Population Sciences. National Family Health Survey – 5, 2019–20. State Fact Sheet for Tripura. Ministry of Health and Family Welfare, Government of India. Available from: http://rchiips.org/nfhs/NFHS-5_FCTS/Tripura.pdf. [Last accessed on 2021 Dec 18].  Back to cited text no. 6
Daniel WW, editor. Biostatistics: A Foundation for Analysis in the Health Sciences. 7th ed. New York: John Wiley & Sons; 1999.  Back to cited text no. 7
Joint United Nations Program on HIV/AIDS (UNAIDS). Tools for Evaluating HIV Voluntary Counseling and Testing; 2000. Available from: https://data.unaids.org/publications/irc-pub02/jc685-tools-for-eval_en.pdf. [Last accessed on 2020 Feb 07].  Back to cited text no. 8
IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.  Back to cited text no. 9
Majhi MM, Bhatnagar N. Updated B.G Prasad's classification for the year 2021: Consideration for new base year 2016. J Family Med Prim Care 2021;10:4318-9.  Back to cited text no. 10
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Kabbash IA, Hassan NM, Al-Nawawy AN, Attalla AA, Mekheimer SI. Evaluation of HIV voluntary counselling and testing services in Egypt. Part 1: Client satisfaction. East Mediterr Health J 2010;16:481-90.  Back to cited text no. 11
Haque SM, Hedayetullah S, Aslami AN, Fazal K, Singh PK. Client satisfaction attending ICTC of a tertiary care hospital of Bihar: A cross-sectional study. Int J Health Clin Res 2021;4:65-6.  Back to cited text no. 12
Dinesh PV, Namratha KG. Kulkarni AG. Socio-demographic profile of HIV seropositive clients attending Integrated Counselling and Testing Centres of Sullia taluk, Karnataka. J App Med Sci 2015;3:1173-77.  Back to cited text no. 13
Chellaiyan VG, Raut DK, Khokhar A, Singh S. Profile and client satisfaction among clients of Integrated Counseling and Testing Centre for human immunodeficiency virus in Delhi. Int J Med Public Health 2014;4:380-4.  Back to cited text no. 14
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Devnani M, Gupta AK, Wanchu A, Sharma RK. Factors associated with Integrated Counseling and Testing Center (ICTC) service satisfaction: Experience from Chandigarh, India. JCMS Nepal 2017;13:229-34.  Back to cited text no. 16


  [Table 1], [Table 2], [Table 3]


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