Health facility challenges to the provision of Option B+ in western Kenya: a qualitative study
Open accessAbstract
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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Health system challenges to implementing Option B+ include health facility resource limitations such as shortage of staff and drugs.
“There are also multiple health system challenges to implementing Option B+. The most common among them are health facility resource limitations such as shortage of staff and drugs [10,20,21].”
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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)
- ORCID
- Venue
- Health Policy and Planning
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-09-10
- Volume
- 32
- Issue
- 2
- Pages
- czw122
- ISSN
- 0268-1080 (ISSN-L)
- 1460-2237
- PMC
- PMC5886182
- 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
- bronze
- doi.org
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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