title: Health facility barriers to HIV linkage and retention in Western Kenya.
abstract: BACKGROUND
  HIV linkage and retention rates in sub-Saharan Africa remain low. The objective of this study was to explore perceived health facility barriers to linkage and retention in an HIV care program in western Kenya.
  
  
  METHODS
  This qualitative study was conducted July 2012-August 2013. A total of 150 participants including; 59 patients diagnosed with HIV, TB, or hypertension; 16 caregivers; 10 community leaders; and 65 healthcare workers, were purposively sampled from three Academic Model Providing Access to Healthcare (AMPATH) sites. We conducted 16 in-depth interviews and 17 focus group discussions (FGDs) in either, English, Swahili, Kalenjin, Teso, or Luo. All data were audio recorded, transcribed, translated to English, and a content analysis performed. Demographic data was only available for those who participated in the FGDs.
  
  
  RESULTS
  The mean age of participants in the FGDs was 36 years (SD = 9.24). The majority (87%) were married, (62.7%) had secondary education level and above, and (77.6%) had a source of income. Salient barriers identified reflected on patients' satisfaction with HIV care. Barriers unique to linkage were reported as quality of post-test counseling and coordination between HIV testing and care. Those unique to retention were frequency of clinic appointments, different appointments for mother and child, lack of HIV care for institutionalized populations including students and prisoners, lack of food support, and inconsistent linkage data. Barriers common to both linkage and retention included access to health facilities, stigma associated with health facilities, service efficiency, poor provider-patient interactions, and lack of patient incentives.
  
  
  CONCLUSIONS
  Our findings revealed that there were similarities and differences between perceived barriers to linkage and retention. The cited barriers reflected on the need for a more patient-centered approach to HIV care. Addressing health facility barriers may ultimately be more efficient and effective than addressing patient related barriers.
authors.affiliation: Moi University School of Medicine, P.O Box 4604-30100, Eldoret, Kenya. wachirajuddy@gmail.com.|Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O Box 4604-30100, Eldoret, Kenya. wachirajuddy@gmail.com.
authors.forename: Juddy
authors.initials: J
authors.lastname: Wachira
authors.affiliation: Moi University School of Medicine, P.O Box 4604-30100, Eldoret, Kenya. vnaanyu@gmail.com.|Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O Box 4604-30100, Eldoret, Kenya. vnaanyu@gmail.com.
authors.forename: Violet
authors.initials: V
authors.lastname: Naanyu
authors.affiliation: Department of Health Services, Policy & Practice, Brown University, Box G-S121-7, 121 South Main Street, Providence, RI, 02912, USA. becky_genberg@brown.edu.
authors.forename: Becky
authors.initials: B
authors.lastname: Genberg
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O Box 4604-30100, Eldoret, Kenya. beatyjelagat@yahoo.com.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Koech
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O Box 4604-30100, Eldoret, Kenya. jackiezulu2007@yahoo.com.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Akinyi
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O Box 4604-30100, Eldoret, Kenya. rkamene70@gmail.com.
authors.forename: Regina
authors.initials: R
authors.lastname: Kamene
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O Box 4604-30100, Eldoret, Kenya. ndegekip@yahoo.com.|Moi University School of Public Health, P.O Box 4604-30100, Eldoret, Kenya. ndegekip@yahoo.com.
authors.forename: Samson
authors.initials: S
authors.lastname: Ndege
authors.affiliation: Moi University School of Medicine, P.O Box 4604-30100, Eldoret, Kenya. amsiika@africaonline.co.ke.|Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O Box 4604-30100, Eldoret, Kenya. amsiika@africaonline.co.ke.
authors.forename: Abraham M
authors.initials: AM
authors.lastname: Siika
authors.affiliation: Moi University School of Medicine, P.O Box 4604-30100, Eldoret, Kenya. skimaiyo@ampathplus.or.ke.|Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O Box 4604-30100, Eldoret, Kenya. skimaiyo@ampathplus.or.ke.
authors.forename: Sylvester
authors.initials: S
authors.lastname: Kimayo
authors.affiliation: Moi University School of Medicine, P.O Box 4604-30100, Eldoret, Kenya. pbraitstein@yahoo.com.|Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O Box 4604-30100, Eldoret, Kenya. pbraitstein@yahoo.com.|Indiana University School of Medicine, 1110 W Michigan St, Indianapolis, IN, 46202, USA. pbraitstein@yahoo.com.|University of Toronto, Dalla Lana School of Public Health, 155 College St, Toronto, ON, M5T 3 M7, Canada. pbraitstein@yahoo.com.
authors.forename: Paula
authors.initials: P
authors.lastname: Braitstein
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001071:Appointments and Schedules; D017028:Caregivers; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009035:Mothers; D010349:Patient Compliance; D036301:Qualitative Research; D057545:Social Stigma