School of Medicine and Health Sciences
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Item Factors Influencing Patients’ Retention in HIV Chronic Care Health Facilities in Nakuru County(KeMU, 2023-09) Abagudo, Qabale NuraHuman Immunodeficiency Virus /Acquired Immunodeficiency Syndrome (HIV/AIDS) has remained a threat to global public health. WHO says that globally, 39 million people were living with HIV, with 1.3 million newly infected in 2022 and another 40.4 million having succumbed to it since then (World Health Organization [WHO], 2023). Sub-Saharan Africa is home to 54% of HIV-positive people, and Kenya was ranked third in Africa in 2019. Nakuru is one of the four counties in Kenya with the highest number of new infections, with 15% Elimination of Mother-to-Child Transmission (EMTCT) rates in 2022. Antiretroviral Therapy (ART) greatly decreased mortality and morbidity among people living with HIV; however, patients are not kept on care to achieve viral suppression. This study therefore sought to determine the factors influencing patients’ retention in HIV chronic and care health facilities in Nakuru County. The study adopted a descriptive cross-sectional design to investigate the effect of socioeconomic, patient health condition, service delivery, and psychosocial factors on retention in Nakuru County health facilities. The target population was 2,963 people who had been booked for care during the study period. The sample size was 341 based on Morgan’s table. The non-probability method was used to select clients as they arrived for their clinical appointments. For the defaulters, simple random sampling was used, where patients were selected from clinical appointments diaries. Patients at the health facility filled out the questionnaires, while the defaulters with valid phone contacts were interviewed over the phone. Descriptive statistics and binary logistic regression were the main methods of analysis. SPSS version 26 was used to analyse quantitative data. The results established significant relationships between study variables and care retention in Nakuru County facilities. For socioeconomical factors, male patients were 1.2561 times more likely to miss appointments than females, and those living with their sexual partners had a higher chance of missing appointments than singles. Being 40-49 years old or a casual labourer was 0.779 and 0.998 times less likely to miss appointments, respectively. The odds of missing appointments decreased as one's education level increased. For health conditions, the odds of missing an appointment reduce as patients progress to the next stage of HIV-related illness. For service delivery factors, patients were 2.452 times more likely to miss appointments in facilities where health workers were unfriendly; chances of missing appointments increased as time taken in and out of the facility increased; and those with difficulties getting off days to seek medical care were 1.111 times more likely to miss appointments. For psychological reasons, those who never disclosed their HIV status were 1.787 times more likely to miss appointments compared to those who disclosed their status. The study recommends that HIV prevention and care programs should take a multifaceted approach. The concentration should be on service providers' attitudes towards PLHIV, service accessibility, and quality in chronic care facilities. County governments should ensure full implementation of policies prohibiting stigmatisation of HIV patients seeking care in health facilities. Future research should consider targeting other tiers and counties.Item Factors Influencing Hiv/Aids Client Satisfaction at Comprehensive Care Centres in Wajir County, Kenya(KeMu, 2021-09) Mohamed, Ibrahim AbdiService delivery is a key pillar of the health systems building blocks and client satisfaction is one of the parameters that is used to assess the status of services offered in an institution. Client satisfaction is a customer related tool that is applied to identify the gaps and improve the quality of services while focusing on the retention of clients. Most institutions do not understand the importance of client satisfaction and assume that clients are satisfied with the service while at the end the quality of care is compromised especially in the areas of HIV/AIDS service provision. This study arose to investigate the factors that influence HIV/AIDS Client satisfaction at the Comprehensive Care Centre’s in Wajir County. Specifically, the study assessed availability of HIV/AIDS testing services, availability of HIV drugs, availability of care and support system and the availability of the institutional support towards HIV/AIDS at the Comprehensive Care Centres. In order to accomplish these research objectives, a descriptive cross-sectional study was employed where both quantitative and qualitative data were gathered through survey questionnaires for the HIV/AIDS Clients. In addition, key informant interviews and facility-based observation guide was used to collect qualitative data. The study targeted clients in the Clinic who were on antiretroviral therapy for more than six months at the sub- County referral hospitals and the County referral hospital Comprehensive Care Centre of Wajir County. The researcher targeted a sample of 157 clients out of a population of 265 clients. The study managed to gather information from 147 clients using semi-structured questionnaires; representing a 93.6 per cent response rate. Pretest was done to improve reliability and validity of the research instruments. Statistical Package for Social Sciences (SPSS) version 24 was used to code and analyze the collected data. Chi-square, Fisher’s exact test, Pearson correlation coefficient and Logistic regression analysis was done to determine the relationship between and among the variables. The data was analyzed using descriptive statistics (percentages, frequencies, means, and standard deviations) and inferential statistics (regression coefficients, F-statistics, t-statistics and Chi-square statistics). Results from bivariate analysis revealed a significant relationship between client satisfaction (1= Satisfied, 0=Not satisfied) and predictor variables. The researcher therefore did a multivariate analysis using logistic regression, where availability of HIV testing services (sig. 0.010) and availability of HIV care and social support (sig. 0.005) were significant predictors of client satisfaction. Availability of institutional support (sig. 0.263) and availability of drugs (sig. 0.480) were not found to be significant predictors of client satisfaction. The results indicated the likelihood of being satisfied with services in the Comprehensive Care Centre’s was 51.3 per cent (sig. 0.010) higher for people who reported availability of HIV testing services and 56.9 per cent (sig. 0.005) higher for people who reported accessibility of HIV care and social support. The study concluded that availability of HIV testing services and availability of HIV care and social support were significant factors influencing client satisfaction. Based on the findings from the study the researcher recommended that focus and priority should be given to HIV/AIDS services, the hospitals management need to ensure sufficient HIV testing services and drugs are available and accessible to patients. In addition, stakeholders in the fight against HIV/AIDs in collaboration with hospitals management need to provide social and welfare support as well as institutional support through budgetary allocation to the HIV/AIDS programs in the County. The study also suggested further that, studies can be conducted to identify quality of services and client retention.