Cited by 52HIV/AIDS Research and InterventionsGlobal Maternal and Child HealthReproductive Health and Contraception

Health facility challenges to the provision of Option B+ in western Kenya: a qualitative study

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Helova, Anna, Akama, Eliud, Bukusi, Elizabeth A., Musoke, Pamela, Nalwa, Wafula Z., Odeny, Thomas A., Onono, Maricianah, Spangler, Sydney A. +3 more·2016·Health Policy and Planning

Abstract

Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty individual gender-matched in-depth interviews with HIV-positive pregnant/postpartum women and their male partners, and four focus groups with thirty health care providers at four health facilities in western Kenya between September-November 2014. Transcripts were coded with the Dedoose software using a coding framework based on the literature, topics from interview guides, and emerging themes from transcripts. Excerpts from broad codes were then fine-coded using an inductive approach. Three major themes emerged: 1) Option B+ specific challenges (same-day initiation into treatment, health care providers unconvinced of the benefits of Option B+, insufficient training); 2) facility resource constraints (staff and drug shortages, long queues, space limitations); and 3) lack of client-friendly services (scolding of patients, inconvenient operating hours, lack of integration of services, administrative requirements). This study highlights important challenges at the health facility level related to Option B+ rollout in western Kenya. Addressing these specific challenges may increase linkage, retention and adherence to life-long ART treatment for pregnant HIV-positive women in Kenya, contribute towards elimination of mother-to-child HIV transmission, and improve maternal and child outcomes.

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  1. Chan AK, Bedell RA, Mayuni E, et al. M Same day integration of HIV diagno- sis and treatment with antenatal care affects retention in Option Bþ PMTCT services in Zomba District, Malawi. 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; Vancouver, Canada. July 19 -22, 2015.
  2. Fowler MQ, Fiscus SA, Currier JS, et al. PROMISE: Efficacy and Safety of 2 Strategies to Prevent Perinatal HIV Transmission. Conference on Retroviruses and Opportunistic Infections. Seattle, Washington, United States. February 23-26, 2015.
  3. Ministry of Health. National AIDS and STI Control Programme and National AIDS Control Council. Kenya HIV Estimates 2014. http://healthservices. uonbi.ac.ke/sites/default/files/centraladmin/healthservices/ HIV%20estimates%20report%20Kenya%202014.pdf, accessed 20 August 2015. Ministry of Medical Services, Republic of Kenya. National AIDS/STI Control Program (NASCOP), Kenya. 2011. Guidelines for antiretroviral therapy in Kenya. 4th Edition. Nairobi, Kenya. http://healthservices. uonbi.ac.ke/sites/default/files/centraladmin/healthservices/Kenya%20 Treatment%20Guidelines%202011.pdf, accessed 12 May 2015.
  4. Williams BG. Optimizing control of HIV in Kenya. http://arxiv.org/ftp/arxiv/ papers/1407/ 1407.7801.pdf. 2014, accessed 10 August 2015.
  5. World Health Organization. WHO Guidelines Approved by the Guidelines Review Committee. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. Geneva: World Health Organization. 2013.

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Authors
Helova, A., Akama, E., Bukusi, E. A., Musoke, P., Nalwa, W. Z., Odeny, T. A., Onono, M., Spangler, S. A., Turan, J. M., Wanga, I., & Abuogi, L. L.
Affiliations
  • Kenya Medical Research Institute (KE)
  • University of Alabama at Birmingham (US)
  • Ministry of Health (KE)
  • University of Washington (US)
  • Emory University (US)
  • University of Colorado Denver (US)
Venue
Health Policy and Planning
Published
2016-09-10
Volume
32
Issue
2
Pages
czw122
ISSN
  • 0268-1080 (ISSN-L)
  • 1460-2237
OpenAlex
W2511728840
Cited by
52
References
28
Citations by year
2026: 1 · 2025: 3 · 2024: 3 · 2023: 7 · 2022: 5 · 2021: 2 · 2020: 9 · 2019: 6 · 2018: 7 · 2017: 9
FWCI
6.77
Type
journal article
Language
en
Open access
Locations
  • Health Policy and Planning (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • University of California, San Francisco
  • National Institute of Child Health and Human Development
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD080477)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
Option B+, lifelong antiretroviral therapy, HIV in pregnancy, postpartum women, medication adherence, retention in care, clinician attitudes, service integration, mother-to-child HIV transmission, Western Kenya
MeSH terms
Workforce, Attitude of Health Personnel, Breast Feeding, Female, Health Facilities, Health Services Research, Humans, Kenya, Male, Pregnancy, HIV Infections, Qualitative Research, Anti-Retroviral Agents, Health Facility Administration

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