UTILIZATION OF HIV/AIDS CLINICAL CARE AND SUPPORT SERVICES AMONG HIV-INFECTED ADULTS IN BARINGO COUNTY, KENYA

Abstract

The burden of HIV/AIDS in Baringo County is highest among Adults (>18 years), with over 40% of hospital beds occupied by HIV-related illnesses. Despite the majority of HIV/AIDS clients being enrolled in care programs, care interruptions (dropouts) and loss of follow-up remain major challenges with unclear reasons for defaulting. Therefore, this study aimed to investigate HIV/AIDS care and support service utilization among HIV infected adults in Baringo County, examining the relationship between client uptake, attitudes, accessibility and utilization of services. It also examined the impact of stigma and discrimination on service utilization. The study was conducted in Baringo County among HIV-infected adults enrolled in Comprehensive care centers using an analytical cross-sectional study design. A total of 580 study participants were randomly recruited u ng Fisher et al.'s (1998) formula from four purposefully selected sub-counties. Besides, an interviewer-administered questionnaire was used to collect data. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 27 with Inferential statistics (Univariate and bivariate) analyses conducted at a p = 0.05 significance level. Whereas, qualitative data was transcribed and analyzed thematically. Ethical clearance was sought from the Institutional Scientific and Ethics Review Committee at Masinde Muliro University (Ref No: MMU/COR: 403012 Vol 6 (01), the National Commission for Science, Technology and Innovation (NACOSTI) (Ref No: 963149), the Baringo County Government Department of Health (REF: BCG/HS/RES/01/VOL.1/07), and informed consent from participants. A total of 519 (89.5%) out of a sample size of 580 took part in the study. The Study found 50.7% HIV care uptake, with 80% deterred by a lack of knowledge and high transportation costs (72.3%). The majority of participants (90.6%) had positive attitudes towards HIV care and support services, but utilization was unfavorable due to low knowledge of available services (p = 0.001), fear of ARV drug use when the spouse is watching (p< 0.0001), and long distances to clinics (p 0.0001). Besides, statistically significant factors affecting the accessibility of clinic services were difficulty obtaining services (p < 0.0001), and long distance to clinics (p 0.0001), with clients unlikely to use them. HIV-related stigma and discrimination were found to negatively impact participants' utilization of services, with participants feeling ashamed to attend clinics (p<0.0001) and others judging them when seen attending clinics (p<0.0001), leading to low utilization rates with higher odds found in each case. In conclusion, the study found 50.7% of HIV-infected adults in Baringo County consistently utilize HIV care and support services, with higher education, community support services, counseling, and family support promoting utilization of services. However, factors like low socioeconomic status, long distances, high travel costs, and poor medication perception were associated with poor attitudes towards utilisation of services. Additionally, location optimization and clinic opening on holidays and weekends improve accessibility. Whereas, PLHIV were found to internalize the stigma and bigotry they face, contributing to a negative self-image and lower levels of utilization. The study recommends to the MOH increase HIV/AIDS care utilization through decentralization of services to the community or low-tier facilities, stigma reduction, integration of HIV care with other services, and scaling up services in under-resourced areas.