Health System-Related Factors that Influence Retention in Care among HIV Infected Pregnant Women in Narok County, Kenya
DOI:
https://doi.org/10.47604/jhmn.2559Keywords:
Health System-Related Factors, Retention in care, HIV Infected Pregnant WomenAbstract
Purpose: The aim of the study was to establish the health system-related factors that influence retention in care among HIV infected pregnant women in Narok County, Kenya.
Methodology: The study adopted a cross-sectional mixed method design. Purposive sampling method was used to sample the required sample size of 117 HIV infected pregnant women, the participants of the Focus Group Discussions (FGD) and Key Informant Interviews (KII). The study was carried out at Narok County Referral and all the sub-county hospitals in Narok County. A structured questionnaire was used to collect quantitative data. Focus group discussion and KII guides were used to collect qualitative data. Quantitative and qualitative data was analyzed using SPSS version 21 and Nvivo version 14 respectively. Chi square test and logistic regression analysis were used to determine the health system-related factors that influence retention in HIV care. Thematic content analysis was done for qualitative data. The mean age of participants was 30 years (SD=6.48). The study results generated were presented in bar graphs and tables for quantitative data. Results were presented as narrations and triangulated with qualitative data.
Findings: This study established that health system-related factors (waiting time, health care workers services and ARV availability) influenced retention in care among HIV infected pregnant women. However, only ARV availability had a significant association with retention in care (P<0.001, OR=0.19). The multiple logistic regression was used to predict the influence of grouped variables. Overall, the model was a significant predictor of retention in care. Health system related factors was found to increase the likelihood of being retained in care (OR=5.14), though not significant predictors of retention in care (P<0.34).
Unique Contribution to Theory, Practice and Policy: Health system-related factors particularly ARV drug stocks, healthcare workers staffing and timely access of services should be strengthened in order to avert stock outs, minimize waiting time and follow up patients who miss clinic appointments to increase retention among pregnant women in HIV care. Advocate for policy reforms aimed at addressing structural barriers to retention in care, including increased investment in healthcare infrastructure, workforce capacity building, and integration of HIV services within maternal and child health programs. By aligning policy initiatives with the unique needs of HIV-infected pregnant women, policymakers can foster an enabling environment for retention in care, ultimately contributing to the achievement of national and global HIV/AIDS targets.
Downloads
References
Alamo, T., Wagner, J., Ouma, J., Sunday, P., Marie, L., Colebunders, R. & Wabwire- Mangen, F. (2013). Strategies for Optimizing Clinic Efficiency in a Community- Based Antiretroviral Treatment Programme in Uganda. AIDS Behavior. 17(1): 274 - 283.
Ebuy H, Yebyo H, Alemayehu M. (2020). Level of adherence and predictors of adherence to the Option B+ PMTCT programme in Tigray, northern Ethiopia. International Journal of Infectious Diseases, 90, 135-141.
Geng, E. H., Odeny, T. A., Lyamuya, R., Nakiwogga-muwanga, A., Diero, L., Bwana, M., "¦ Yiannoutsos, C. (2016). Retention in care and patient-reported reasons for undocumented transfer or stopping care among HIV infected patients on antiretroviral therapy in Eastern Africa : Application of a Sampling-Based Approach. Clinical Infectious Diseases, 62(7): 935-44.
Gichane MW, Sullivan KA, Shayo AM, Mmbaga BT. (2019). The influence of healthcare infrastructure accessibility on the adequacy of antenatal care, HIV testing, and prevention of mother-to-child transmission of HIV in Tanzania. BMC Health Services Research, 19(1), 863.
Gwynn, R. C., Fawzy, A., Viho, I., Wu, Y., Abrams, E. J., & Nash, D. (2015). Risk factors for loss to follow-up prior to ART initiation among patients enrolling in HIV care with CD4+ cell count ≥200 cells/μL in the multi-country MTCT-Plus Initiative Health systems and services in low and middle income settings. BioMed Central Health Services Research, 15(1), 1-10.
Itoua, C., Nsongola, M., Koulimaya, C. G., Moutounou, G.M., & Koko, P.S. (2015). Adherence to anti-retroviral drugs in pregnant and lactating HIV positive women in Brazzaville. East Africa medical Journal. 92(10):495.
Kenya AIDS response progress report (KARP) (2016). National AIDS Control Council of Kenya.
Koto, M. V., & Maharaj, P. (2016). Difficulties facing healthcare workers in the era of AIDS treatment in Lesotho. Sahara journal, 13(1): 53-59.
Layer, E. H., Kennedy, C. E., Beckham, S. W., Mbwambo, J. K., Likindikoki, S., Davis, W. W., "¦Brahmbhatt, H. (2014). Multi-Level Factors Affecting Entry into and Engagement in the HIV Continuum of Care in Iringa, Tanzania. Public Library of Science ONE 9(8).
Ministry of health (2016). Statistical review of progress towards the midterm targets of Kenya health sector strategic plan 2014-2018.
Mugavero, M. J., Westfall, A. O., Zinski, A., Drainoni, M., Gardner, L. I., Keruly, J. C., "¦ Giordano, T. P. (2012). Measuring retention in HIV care: The elusive Gold Standard. National Institute of Health, 61(5), 574-580.
Muhumuza, S., Akello, E., KyomugishaNuwagaba, C., Baryamutuma, R., Sebuliba, I., Lutalo, I. M., "¦ Lindan, C. (2017). Retention in care among HIV infected pregnant and breastfeeding women on lifelong antiretroviral therapy in Uganda: A retrospective cohort study. Public Library of Science ONE 12(12).
Nachega JB, Uthman OA, Anderson J, Peltzer K, Wampold S, Cotton MF, Mills EJ, Ho YS, Stringer JS, McIntyre JA, Mofenson LM. (2014). Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis. AIDS, 28(Suppl 2), S105-18.
Oetzel, J., Wilcox, B., Avila, M., Hill, R., Archiopoli, A., & Ginossar, T. (2015). Patient-provider interaction, patient satisfaction, and health outcomes: testing explanatory models for people living with HIV/AIDS. Journal of AIDS care, 27(8):972.
Omonaiye, O., Kusljic, S., Nicholson, P., & Manias, E. (2018). Medication adherence in pregnant women with human immunodeficiency virus receiving antiretroviral therapy in sub-Saharan Africa. Biomed central public health, 18(1), 805.
Rachlis, B., Bakoyannis, G., Easterbrook, P., Genberg, B., Braithwaite, R. S., Cohen, C. R., ... Geng, E. H. (2016). Facility-level factors influencing retention of patients in HIV care in East Africa. Public Library of Science ONE, 11(8).
Rosenberg NE, Mtande TK, Saidi F, Stanley C, Jere E, Paile L, & Hosseinipour MC. (2017). Recruiting male partners for couple HIV testing and counselling in Malawi's option B+ programme: An unblinded randomised controlled trial. The Lancet HIV, 4(10), e482-e491.
Shigdel, R., Klouman, E., Bhandari, A., & Ahmed, L. (2014). Factors associated with adherence to antiretroviral therapy in HIV-infected patients in Kathmandu District, Nepal. HIV AIDS (Auckl), 6:109-116.
Wachira, J., Naanyu, V., Genberg, B., Koech, B., Akinyi, J., Kamene, R., "¦ Braitstein, P. (2014). Health facility barriers to HIV linkage and retention in Western Kenya. Biomed central health services research, 14:646.
World Health Organization (2011). Retention in HIV Programmes; defining the challenges and identifying solutions; Meeting Report 13 (15): 3-4.
World Health Organization (2018). Mother to child transmission of HIV.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Jackline Gakii , Dr. Nelson Menza, PhD., Dr. Winfreda Nyamota Maoga, PhD.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
