title: Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya.
abstract: Sub-Saharan Africa is increasingly being challenged in providing care and treatment for chronic diseases, both communicable and non-communicable. In order to address the challenges of linkage to and retention in chronic disease management, there is the need to understand the factors that can influence engagement in care. We conducted a qualitative study to identify barriers and facilitators to linkage and retention in chronic care for HIV, tuberculosis (TB) and Hypertension (HTN) as part of the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya.
  
  
  
  In-depth interviews and focus group discussions were conducted July 2012-August 2013. Study participants were purposively sampled from three AMPATH clinics and included patients within the AMPATH program receiving HIV, TB, and HTN care, as well as caregivers of children with HIV, community leaders, and healthcare providers. A set of interview guides were developed to explore perceived barriers and facilitators to chronic disease management, particularly related to linkage to and retention in HIV, TB and HTN care. Data were coded and various themes were identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health Services Utilization.
  
  
  
  A total of 235 participants including 110 individuals living with HIV (n = 50), TB (n = 39), or HTN (n = 21); 24 caregivers; 10 community leaders; and 62 healthcare providers participated. Barriers and facilitators were categorized as predisposing characteristics, enabling resources and need factors. Many of the facilitators and barriers reported in this study were consistently reported across disease categories including personal drive, patient-provider relationships and the need for social and peer support.
  
  
  
  Our findings provide insight into the individual as well as broader structural factors that can deter or encourage linkage and retention that are relevant across communicable and non-communicable chronic diseases. The findings of the present study suggest that interventions should consider the logistical aspects of accessing care in addition to predisposing and need factors that may affect an individuals' decision to seek out and remain in appropriate care.
authors: Academic Model Providing Access to Healthcare (AMPATH), PO-Box 4606, Eldoret, 30100, Kenya. brachlis@gmail.com.|University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada. brachlis@gmail.com.|Ontario HIV Treatment Network, Toronto, ON, Canada. brachlis@gmail.com.
authors: Beth
authors: B
authors: Rachlis
authors: Academic Model Providing Access to Healthcare (AMPATH), PO-Box 4606, Eldoret, 30100, Kenya.|Department of Behavioral Sciences, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.
authors: Violet
authors: V
authors: Naanyu
authors: Academic Model Providing Access to Healthcare (AMPATH), PO-Box 4606, Eldoret, 30100, Kenya.
authors: Juddy
authors: J
authors: Wachira
authors: Department of Health Services, Policy and Practice, Program in Public Health, Brown University, Providence, RI, USA.
authors: Becky
authors: B
authors: Genberg
authors: Academic Model Providing Access to Healthcare (AMPATH), PO-Box 4606, Eldoret, 30100, Kenya.
authors: Beatrice
authors: B
authors: Koech
authors: Academic Model Providing Access to Healthcare (AMPATH), PO-Box 4606, Eldoret, 30100, Kenya.
authors: Regina
authors: R
authors: Kamene
authors: Academic Model Providing Access to Healthcare (AMPATH), PO-Box 4606, Eldoret, 30100, Kenya.
authors: Jackie
authors: J
authors: Akinyi
authors: Academic Model Providing Access to Healthcare (AMPATH), PO-Box 4606, Eldoret, 30100, Kenya.|University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada.|Department of Medicine, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.
authors: Paula
authors: P
authors: Braitstein
mesh_terms: D000328:Adult; D002648:Child; D002908:Chronic Disease / Q000628:therapy*; D005260:Female; D015658:HIV Infections / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000628:therapy; D007630:Kenya; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation / Q000706:statistics & numerical data*; D036301:Qualitative Research; D014376:Tuberculosis / Q000628:therapy
keywords: Barriers; Facilitators; HIV; Hypertension; Kenya; Linkage; Retention; Tuberculosis