Background: Transitioning HIV care toward a client-centered model is a key strategy for improving treatment outcomes and controlling the spread of HIV infection. Evaluating service accessibility, quality, and client satisfaction is essential for improving strategic planning and strengthening health service delivery. Aim: To assess the accessibility and quality of client-centered health services among people living with HIV. Materials and methods: A facility-based cross-sectional study was conducted. Data were collected using structured questionnaires from 50 clients and 30 health managers who participated voluntarily. The reliability of the questionnaire, measured using Cronbach’s alpha, ranged from 0.673 to 0.783. Data were analyzed using SPSS version 23.0 with both descriptive and analytical statistical methods. Quantitative variables were summarized using means and standard deviations, and statistical significance was determined at p < 0.05. Results: HIV-related services were found to be highly centralized at the NCCD, particularly for blood testing (96.8%) and inpatient care (71.4%). Overall, 84% of clients reported the need to access services outside NCCD, with the highest demand for internal medicine (32%), dental services (14%), and surgical services (14%). Among the barriers to accessing care, 75% were related to stigma and discrimination associated with HIV status, while 18% were linked to healthcare workers’ attitudes. In addition, 56.7% of healthcare facilities had not conducted HIV-related training, and only 40% had dedicated rooms ensuring confidentiality. Client satisfaction was strongly correlated with healthcare providers’ attitudes and communication (R = 0.614) and confidentiality (R = 0.578), both showing significant associations (p = 0.000). Conclusion HIV services remain highly centralized at NCCD, while the readiness of primary and referral healthcare facilities remains insufficient. Strengthening a client-centered care approach requires improving healthcare workers’ attitudes and communication, ensuring confidentiality, and implementing continuous HIV-related training for healthcare providers.

Background. Low back pain is a frequently encountered symptom. Although 70-80% of the entirepopulation have low back pain complaints in their lives, only 2-4% of them require surgical intervention.’Department of Neurosurgery, Shastin 3rd Central Hospital about 200 patients who undergo back surgery,while 90% of patients who have prolapsed lumbar disc surgery from 2010 to 2012. There are variousstudies indicating that exercise improves pain and disability in chronic low back pain and in those whohave had surgery. The main objectives of the postoperative rehabilitation programmes are to accelerateand maximize function recovery as much as possible, and to prevent further injury by restricting theprogression of degenerative changes. We evaluated the effectiveness of rehabilitation treatments thatare used in our department which is the first time in our country.Goal. To evaluate the effectiveness of rehabilitation after lumbar discectomy.Materials and Method. We examined 83 patients were included the Shastin central hospital, Departmentof neurosurgery and rehabilitation after lumbar discectomy at a single level and operated in the periodfrom May 15, 2013 to September 15, 2014. All patients were evaluated at the beginning and at theend of treatment by Oswestry Disability Index which is a specific functional questionnaire for back pain.Pretreatment values are one month after surgery and posttreatment values three months after surgery.All patients received the intensity specific exercise and back school education programme 3 days aweek for eight weeks.Results. All patients pain intensity are reduced after treatment evaluated by VAS (p<0.000). Functionalability had significantly increased after treatment which is evaluated by Oswestry Disability Index in allpatients (p<0.000). 46 from all patients had minimal disability before treatment and this number wasincreased in to 79 after treatment. The number of moderate and severe disabled patients ability wasincreased after treatment.Conclusion: Back school education and specific exercise programme should be one of the parts oftreatment after lumbar discectomy. After treatment was increased functional ability and early painrelief.