April 2-4, 2020 • Hyatt Regency • Lexington, KY
Intersectionality and Interdisciplinarity in Health Communication Research
Abstract: Understanding Barriers to Retention in HIV Treatment among HIV Positive Members of Key Population Groups
◆ Ruth A. Osoro, Michigan State University
In the last several years in Kenya, significant progress has been seen in the implementation of programs meant to substantially push forward HIV prevention, care and treatment in key populations – men who have sex with men, sex workers, and people who inject drugs. However, despite this progress, recent reports reveal a gap in retaining HIV positive members of these populations in HIV treatment services. Recent data show that key population programs are doing a good job in reaching and testing these populations, but these programs are lagging in retaining in treatment key populations who test positive for HIV 1. Lack of retention in HIV treatment not only ensures that HIV incidence rates increase 2,3,4, it also increases mortality rates from AIDS related illnesses and malignancies 5,6,7.
To understand what barriers contribute to lack of retention among HIV positive members of key population groups, and to understand what has been done to encourage retention, interviews with 20 program workers, health care workers and HIV positive members of key population in Kenya were done. Their perceptions of the contributors to the attrition of HIV positive members of key population groups from the HIV treatment continuum were assessed. Participants were recruited from three key population organizations and two healthcare facilities in Kenya. Participants were paid $10 (KSH 1,000) for their time.
Themes that emerged from the interviews focused on barriers. Individual barriers such as substance abuse, hopelessness, stigma, disclosure issues, faith-based healing, migration and complacency; and structural barriers such as the location of the comprehensive care center in linking facilities, mishandling by health care workers after missed appointments, under-staffing at health care facilities, and impersonalized care emerged in the interviews. Systemic barriers emerged, most notably, health care facilities had no way of knowing whether a person living with HIV had dropped out of care or had started treatment elsewhere after migration unless the person called to ask that their name be transferred from one facility to the other. A centralized computerized system that could be used to follow up on or monitor patients would facilitate tracking patients across Kenya.
Innovative ways to improve retention include, the use of peer navigators to follow up with HIV positive individuals that have defaulted from treatment, social support groups held by health facilities and key population organizations, storage of medication in key population organizations drop-in centers for HIV positive patients who have not disclosed their status to family members, and having antiretroviral therapy dispensing sites within key population organizations.
Finally, when asked what should be done to improve retention, key population organizations program workers suggested that peer navigators who work in the capacity of volunteers should be made full time employees of the organization and all key population organizations should be made antiretroviral sites because members of key population groups viewed the organizations’ drop-in centers as safe spaces.
This pilot work demonstrated the need for programs in Kenya to work on reducing stigma and facilitating access to treatment for key populations.