Scaling Up Community Differentiated Service Delivery To Improve Access To Health Care Among People Living With Hiv in Kakamega County, Kenya

Abstract

Access to health services encourages early treatment seeking leading to better health outcomes and significant social and economic benefits. Without adequate access, the impact of HIV treatment and care services is severely diminished. This study aimed to address the existing challenges in healthcare access by scaling up community differentiated service delivery and evaluating its effectiveness in improving health outcomes among people living with HIV in Kakamega County. Two public facilities (cluster) in two sub counties (Butere and Kakamega) were randomly assigned (1:1) to provide community differentiated service delivery model (intervention group) and standard care (control group) to people living with HIV who are established on antiretroviral therapy. Exclusion criteria included patients on transit, those with comorbidities, pregnant and breastfeeding and those unable to give informed consent. At intervention clinic patients were assigned a lay health worker, attended monthly group meetings, received health education, peer counseling, symptom screening and ART refill. The primary outcome was the proportion of patients who had two clinic visits in twelve months. Baseline data was collected through questionnaires, in-depth interviews, and end line data collected through document reviews. Ethical clearance was obtained from relevant authorities. This trial is registered with National Council of Science and Technology clinical trial registry, number Nascosti/P/21/12623.At enrollment, 402 participants (201 in each group) were included, with 295 aged below 35 years and 107 above 35 years. Males comprised 116, and females 286. Baseline assessment established low level of readiness (p=0.007, OR=1.362), low demand (p=0.032, OR=1.78), non-comprehensive package of services (p=0.009, OR=1.134) and poor support (p=0.009, OR=1.20) At end line scaling up community differentiated service delivery was successful in improving accessibility to health services among people living with HIV odds ratio 1.494 (p-value 0.001). Community differentiated service delivery can substantially improve and should be scaled up to improve health outcomes among people living with HIV. Future research should investigate enhancing visibility and accessibility of community differentiated service delivery for chronic diseases.