Factors influencing the provision of community- based health services for people living with HIV and AIDS in Nakuru Municipality, Kenya

Abstract

HIV and AIDS has become the world's most devastating epidemic in developing countries. More than 25 million people have died has a result of AIDS related illness since the disease was first diagnosed in 1981. A total of 33.2 million people were living with HIV worldwide in 2007. Everyday, over 6800 persons become infected with HIV and over 5700 persons die from AIDS related illnesses, mostly because of inadequate access to HIV prevention, care and support services. The HIV epidemic remains the most serious of infectious disease challenges to public Health. The estimated number of deaths due to AIDS in 2007 was 2.1 million worldwide, of which 76% occurred in sub-Saharan Africa. Bed occupancy in the public health institutions by AIDS related cases averages 60% and AIDS has taken a toll on health professionals as well. Community health workers (CHW) provide basic primary healthcare (PHC) services to the people living with HIV and AIDS (PLHIV) in the community a continuum of care extended from the facilities to the community. This study sought to establish the factors influencing provision of community based health services for the 30,000 PLHIV in Nakuru municipality with the aim of determining the sociodemographic profiles and variety of community based services for PLHIV.This was a descriptive cross-sectional study that mainly targeted PLHIV and CHW in the municipality. Data was collected through questionnaires, focus group discussion, key informant interviews and observation checklists. SPSS was used for analysis and Chisquare tests were used to test the relationship between certain variables. At 95% confidence interval, the study found no significant relationship between age of the CHW and the trend of efficiency in the past one year (k2=12.738: df. p<0.175), though there had been an increase in the proportion of PLHIV. There is a significant relationship between the presence of HBC and the rating of efficiency of CHW. (X2=7.520: df 2: p<0.023). The results further showed that training of CHW directly affects the quality of services they offer to PLHIV (k2=12.355 df=6; p<0.05 ). Other key variables influencing the efficiency of CHW are the presence of HBC programme (43%) referrals (16%) and support (44%). Challenges in provision emerge such as transportation (26.7%), financial support (30%) and stigmatization of PLHIV (13%). The null hypothesis was therefore rejected. This study therefore recommends that interventions be put in place by the government and other stakeholders to address the challenges in order for the PLHIV to attain access to prevention, treatment, care and support services in the community