Factors influencing access to anti-retroviral drugs: a case of Nairobi Kibera slums
Oluoch, Anne Achieng
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At the end of 2009, there were 33.3 million people living with HIV. In 2009, there were an estimated 2.6 million people who became newly infected with HIV. The number of annual AIDS-related deaths worldwide is steadily decreasing from the peak of 2.1 million in 2004 to an estimated 1.8 million in 2009. Sub-Saharan Africa still bears an inordinate share of the global HIV burden. In Kenya, the number of people living with HIV in 2009 was 1,500,000. The number of people receiving ART in December 2009 was 336,980. Anti-retroviral therapy (ART) coverage in Kenya according to 2010 World Health Organization's guidelines stands at 50%. In the last one year, Kenya has lost 20% of patients enrolled to HIV / AIDS treatment programs raising serious concerns about access to ARVs medication. The study therefore aimed to determine the factors influencing access to ARVs in Nairobi's Kibera slums. A descriptive cross-sectional study was conducted with a desired sample size of 384 study participants. Purposive sampling was used to sample seven of the busiest sites offering ART services. The sample was then distributed proportionate to size in each selected site. Systematic random sampling was then used to select the individual study participant. Data were collected using structured interview schedule and key informant interviews. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 11.5. The findings showed 54.9% of the respondents accessing ARVs. Several factors were established to hinder access to ARVs. These included the gender of the respondent (OR=0.632, 95% CI 0.421- 0.950, p=0.028), the distance to the ARVs delivery points (OR=5.921, 95% CI 3.710-9.447, p=O.OOOI), attitude towards the open ARVs access program (OR=0.642, 95% CI 0.427- 0.964, p=0.033) and knowledge to the free ARVs provision (OR=0.590, 95% CI 0.390-0.891, p=0.012). Several challenges to the open access ARVs program highlighted in the study were distance and transport difficulties, stigma, poor drug adherence, lack of funds, staff shortages, lack of drugs to treat opportunistic infections, cultural beliefs, illiteracy among patients, patient migration, lack of proper nutrition, long waiting time and transfer of counsellors. It is evident that that there were eminent factors and challenges affecting access to ARVs by HIV/AIDS patients in Kibera slum. The study therefore recommends devolvement of ARVs delivery points to increase physical access, education of the pubic about the free provision of ARV s to increase awareness and the review of the free open access program to make it more patient friendly.