Health facility barriers to HIV linkage and retention in Western KenyaReport as inadecuate

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BMC Health Services Research

, 14:646

Health systems and services in low and middle income settings


BackgroundHIV 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.

MethodsThis 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.

ResultsThe 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.

ConclusionOur 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.

KeywordsHIV Linkage Retention Healthcare Barriers Social ecological model Kenya Electronic supplementary materialThe online version of this article doi:10.1186-s12913-014-0646-6 contains supplementary material, which is available to authorized users.

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Author: Juddy Wachira - Violet Naanyu - Becky Genberg - Beatrice Koech - Jacqueline Akinyi - Regina Kamene - Samson Ndege - Abraham


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