Health facility barriers to HIV linkage and retention in Western Kenya

BMC Health Services Research

Paula Braitstein³  Sylvester Kimayo²  Abraham M Siika²  Samson Ndege¹  Regina Kamene²  Jacqueline Akinyi²  Beatrice Koech²  Becky Genberg⁴  Violet Naanyu²  Juddy Wachira² 

[1] Moi University School of Public Health, Eldoret, Kenya;Academic Model Providing Access to Healthcare (AMPATH) Partnership, Eldoret, Kenya;University of Toronto, Dalla Lana School of Public Health, 155 College St, Toronto M5T 3 M7, ON, Canada;Department of Health Services, Policy & Practice, Brown University, 121 South Main Street, Providence 02912, RI, USA

关键词: Kenya;    Social ecological model;    Barriers;    Healthcare;    Retention;    Linkage;    HIV;   

Others  :  1089974
DOI  :  10.1186/s12913-014-0646-6

 received in 2014-07-21, accepted in 2014-12-10,  发布年份 2014

【 摘 要 】

Background

HIV linkage and retention rates in sub-Saharan Africa remain low. The objective of this study was to explore perceived health facility barriers to linkage and retention in an HIV care program in western Kenya.

Methods

This qualitative study was conducted July 2012-August 2013. A total of 150 participants including; 59 patients diagnosed with HIV, TB, or hypertension; 16 caregivers; 10 community leaders; and 65 healthcare workers, were purposively sampled from three Academic Model Providing Access to Healthcare (AMPATH) sites. We conducted 16 in-depth interviews and 17 focus group discussions (FGDs) in either, English, Swahili, Kalenjin, Teso, or Luo. All data were audio recorded, transcribed, translated to English, and a content analysis performed. Demographic data was only available for those who participated in the FGDs.

Results

The mean age of participants in the FGDs was 36 years (SD = 9.24). The majority (87%) were married, (62.7%) had secondary education level and above, and (77.6%) had a source of income. Salient barriers identified reflected on patients’ satisfaction with HIV care. Barriers unique to linkage were reported as quality of post-test counseling and coordination between HIV testing and care. Those unique to retention were frequency of clinic appointments, different appointments for mother and child, lack of HIV care for institutionalized populations including students and prisoners, lack of food support, and inconsistent linkage data. Barriers common to both linkage and retention included access to health facilities, stigma associated with health facilities, service efficiency, poor provider-patient interactions, and lack of patient incentives.

Conclusion

Our findings revealed that there were similarities and differences between perceived barriers to linkage and retention. The cited barriers reflected on the need for a more patient-centered approach to HIV care. Addressing health facility barriers may ultimately be more efficient and effective than addressing patient related barriers.

【 授权许可】

   
2014 Wachira et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Kimaiyo S, Were MC, Shen C, Ndege S, Braitstein P, Sidle J, Mamlin J: Home-based HIV counselling and testing in Western Kenya.East African Medical Journal 2010, 87(3):100–107.
• [2]Negin J, Wariero J, Mutuo P, Jan S, Pronyk P: Feasibility, acceptability and cost of home-based HIV testing in rural Kenya. Tropical Med Int Health 2009, 14(8):849-855.
• [3]WHO: Global Update on HIV Treatment 2013: Results, Impact and Opportunities. 2013.
• [4]Wachira J, Kimaiyo S, Ndege S, Mamlin J, Braitstein P: What is the impact of home-based HIV counseling and testing on the clinical status of newly enrolled adults in a large HIV care program in western Kenya? Clin Infect Dis 2012, 54(2):275-281.
• [5]Losina E, Bassett IV, Giddy J, Chetty S, Regan S, Walensky RP, Ross D, Scott CA, Uhler LM, Katz JN, Holst H, Freedberg KA: The “ART” of linkage: Pre-treatment loss to care after HIV diagnosis at Two PEPFAR sites in Durban, south Africa. PLoS One 2010, 5(3):e9538.
• [6]Ferguson L, Grant AD, Watson-Jones D, Kahawita T, Ong’ech JO, Ross DA: Linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services: a systematic review. Tropical Med Int Health 2012, 17(5):564-580.
• [7]Rosen S, Fox MP: Retention in HIV care between testing and treatment in Sub-Saharan Africa: a systematic review. PLoS Med 2011, 8(7):e1001056.
• [8]Fox MP, Rosen S: Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007–2009: systematic review. Tropical Med Int Health 2010, 15:1-15.
• [9]MacPherson P, MacPherson EE, Mwale D, Squire SB, Makombe SD, Corbett EL, Lalloo DG, Desmond N: Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi. J Int AIDS Soc 2012, 15(2):18020.
• [10]Wachira J, Middlestadt SE, Vreeman R, Braitstein P: Factors underlying taking a child to HIV care: implications for reducing loss to follow-up among HIV-infected and -exposed children. SAHARA J 2012, 9(1):20-29.
• [11]Gourlay A, Birdthistle I, Mburu G, Iorpenda K, Wringe A: Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc 2013, 16(1):18588.
• [12]Mugavero MJ, Norton WE, Saag MS: Health care system and policy factors influencing engagement in HIV medical care: piecing together the fragments of a fractured health care delivery system. Clin Infect Dis 2011, 52(suppl 2):S238-S246.
• [13]Inui T, Nyandiko W, Kimaiyo S, Frankel R, Muriuki T, Mamlin J, Einterz R, Sidle J: AMPATH: living proof that No One Has to Die from HIV. J Gen Intern Med 2007, 22(12):1745-1750.
• [14]Obermeyer CM, Osborn M: The utilization of testing and counseling for HIV: a review of the social and behavioral evidence. Am J Public Health 2007, 97(10):1762-1774.
• [15]Bradford JB, Coleman S, Cunningham W: HIV system navigation: an emerging model to improve HIV care access. AIDS Patient Care and STDs 2007, 21(1):49-58.
• [16]Bemelmans M, Van Den Akker T, Ford N, Philips M, Zachariah R, Harries A, Schouten E, Hermann K, Mwagomba B, Massaquoi M: Providing universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care. Tropical Med Int Health 2010, 15(12):1413-1420.
• [17]Pfeiffer J, Montoya P, Baptista A, Karagianis M, Pugas MdM, Micek M, Johnson W, Sherr K, Gimbel S, Baird S, Lambdin B, Gloyd S: Integration of HIV/AIDS services into African primary health care: lessons learned for health system strengthening in Mozambique - a case study.Journal of the International AIDS Society 2010, 13(1):3.
• [18]Odeny TA, Penner J, Lewis-Kulzer J, Leslie HH, Shade SB, Adero W, Kioko J, Cohen CR, Bukusi EA: Integration of HIV care with primary health care services: effect on patient satisfaction and stigma in rural Kenya. AIDS Res Treat 2013, 2013:10.