Integration of HIV Care with Primary Health Care Services: Effect on Patient Satisfaction and Stigma in Rural Kenya

Thomas A Odeny,Jeremy Penner,Hannah H Leslie,Craig R Cohen,Jayne Lewis-Kulzer,Jackson Kioko,Elizabeth A Bukusi,Walter Adero,Starley B Shade

doi:10.1155/2013/485715

Abstract

HIV departments within Kenyan health facilities are usually better staffed and equipped than departments offering non-HIV services. Integration of HIV services into primary care may address this issue of skewed resource allocation. Between 2008 and 2010, we piloted a system of integrating HIV services into primary care in rural Kenya. Before integration, we conducted a survey among returning adults ≥18-year old attending the HIV clinic. We then integrated HIV and primary care services. Three and twelve months after integration, we administered the same questionnaires to a sample of returning adults attending the integrated clinic. Changes in patient responses were assessed using truncated linear regression and logistic regression. At 12 months after integration, respondents were more likely to be satisfied with reception services (adjusted odds ratio, aOR 2.71, 95% CI 1.32–5.56), HIV education (aOR 3.28, 95% CI 1.92–6.83), and wait time (aOR 1.97 95% CI 1.03–3.76). Men's comfort with receiving care at an integrated clinic did not change (aOR = 0.46 95% CI 0.06–3.86). Women were more likely to express discomfort after integration (aOR 3.37 95% CI 1.33–8.52). Integration of HIV services into primary care services was associated with significant increases in patient satisfaction in certain domains, with no negative effect on satisfaction.

Highlights

Funding targeted for HIV care programs in sub-Saharan Africa has produced tremendous results over the past several years, most notably the delivery of antiretroviral therapy to almost 4 million people in sub-Saharan Africa by 2009 [1, 2]
Family AIDS care and education services (FACES) is a collaboration between the Kenya Medical Research Institute (KEMRI) and the University of California, San Francisco (UCSF), funded through the US Centers for Disease Control (CDC)/President’s Emergency Plan for AIDS Relief (PEPFAR) [26]
At baseline 28 (51.9%) were on ART, with this proportion increasing to 61 individuals (58.7%) at three months and 78 (60.9%) at 12-month followup. These consistently high percentages demonstrate that a large proportion of respondents were in HIV care even when the survey was administered to an integrated patient population

Summary

Introduction

Funding targeted for HIV care programs in sub-Saharan Africa has produced tremendous results over the past several years, most notably the delivery of antiretroviral therapy to almost 4 million people in sub-Saharan Africa by 2009 [1, 2]. In Kenya, the number of people receiving antiretroviral therapy has increased from about 11,000 in 2003 to more than 138,000 patients in 2007 largely as a result of receiving the President’s Emergency Plan for AIDS Relief (PEPFAR) funds [3, 4] This kind of directed “vertical” funding (for specific disease areas instead of for general improvements in primary health care) has allowed for specialized staff training, more rapid and efficient program implementation, and betterequipped facilities—including free laboratory services and medications—as HIV programs have been scaled-up [5]. These results may not have been possible in such a short time using an integrated approach to health care delivery. The resulting attrition of personnel from general health services may weaken important primary health care services [8, 9]

Methods

Results

Discussion

Conclusion