Qualitative exploration of perceived benefits of care and barriers influencing HIV care in trans Nzoia, Kenya

Abstract

Background: Substantial efforts have been made to ensure people living with HIV (PLHIV) are linked to and retained in care but many challenges deter care utilization. We report perceived benefits of seeking HIV care and barriers to HIV care that were identified through a formative assessment conducted to advise the development of an alternative care model to deliver antiretroviral treatment therapy (ART) in Trans Nzoia County, Kenya. Methods: Data were collected in 2015 through key informant interviews (KIIs), in-depth interviews (IDIs), and focus group discussions (FGDs). The study involved 55 participants of whom 53% were female. Ten KIIs provided community contextual information and viewpoints on the HIV epidemic in Trans Nzoia County while 20 PLHIV (10 male and 10 female) participated in IDIs. Twenty-five individuals living with HIV participated in four FGDs-two groups for men and two for women. Key informants were purposively selected, while every third patient above 18 years at the Kitale HIV Clinic was invited to share their HIV care experience through IDIs or FGDs. Trained research assistants moderated all sessions and audio recordings were transcribed and analyzed thematically. Results: Findings showed that PLHIV in Trans Nzoia County used both conventional and complementary alternative care for HIV; however, public health facilities were preferred. Popular perceived benefits of adopting care were relief from symptoms and the chance to live longer. Benefits of care uptake included weight gain, renewed energy, and positive behavior change. Individual-level barriers to HIV care included lack of money and food, use of alternative care, negative side effects of ART, denial, and disclosure difficulties. At the community level, stigma, limited social support for conventional HIV treatment, and poor means of transport were reported. The health system barriers were limited supplies and staff, long distance to conventional HIV care, and unprofessional providers. Conclusions: Diverse individual, community and health system barriers continue to affect HIV care-seeking efforts in Kenya. Appreciation of context and lived experiences allows for development of realistic care models.

‘ARVs are a constant reminder of lost freedom, whereas for others, they are liberating’: understanding the treatment narrative among people living with HIV (PLHIV) in Malawi and Zimbabwe–a qualitative study

“…Patients are not in the right frame of mind to absorb key messages about benefits and the importance of adherence at initial treatment stage. Our findings confirm the health systems barriers such as limited and unprofessional providers at healthcare facilities, unavailability of drugs and long travel distance that have been identified by other researchers 23 28–31…”

Geographical Associations of HIV Prevalence in Female Sex Workers From Nairobi, Kenya (2014–2017)

“…6 Aligning with research from different geographic contexts, 31 our results demonstrate the importance of centering the availability of health care facilities on the preferences of women, by placing facilities in preferred settings, such as closer to their communities or integrating the preferred clinics of women to more specialized HIV care, may form the basis of more comprehensive care for women living with, or vulnerable to, HIV. 18,19,32 The distribution of SWOP clinics in Nairobi is shown in Figure 1, Supplemental Digital Content, http://links.lww.com/QAI/C69; as can be seen, clinics are distributed across Nairobi, with many located in places where HIV prevalence is high, by hotspot constituency.…”

“…17 FSWs are offered a combination HIV prevention and treatment package and provided referrals for non-HIV/ STI-related issues. 16 SWOP clinics employ outreach workers and peer educators, and FSWs are recruited into SWOP using a peer support model; 19 in brief, FSWs were recruited from hotspots, with a certain number of hotspots assigned to a peer leader who facilitates recruitment, retention, and reporting. Services are provided at hotspots and clinics.…”

“…Understanding the interplay between where FSWs work, and the HIV burden in these areas, can further inform the precision, placement, design, and delivery of public health interventions to further reduce HIV transmission. 6,18,19 Therefore, to inform more effective interventions for FSWs, a more comprehensive understanding of the intersection between geography and HIV, about the place of origin, place of residence, and finally, to where FSWs solicit clients, is needed. Using this lens, we analyzed geographic aspects of HIV prevalence distribution in FSWs accessing integrated HIV services through the Sex Worker Outreach Program (SWOP) in Nairobi, Kenya.…”

Understanding the factors that impact effective uptake and maintenance of HIV care programs in South African primary health care clinics

“…Indeed, our informants repeatedly highlighted successes with changes such as the rollout of UTT or CCMDD, which have practical and self-evident benefits. For the patients, these practices make available medications known to improve health and save lives [ 34 ], while reducing inconveniences to accessing care. For the clinic providers and staff, UTT and CCMDD have simplified treatment protocols, facilitating efforts to retain patients [ 25 ] while reducing clinical setting overcrowding, a change that has made it easier to focus on patients with the greatest need.…”