title: Health facility challenges to the provision of Option B+ in western Kenya: a qualitative study.
abstract: Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty individual gender-matched in-depth interviews with HIV-positive pregnant/postpartum women and their male partners, and four focus groups with thirty health care providers at four health facilities in western Kenya between September-November 2014. Transcripts were coded with the Dedoose software using a coding framework based on the literature, topics from interview guides, and emerging themes from transcripts. Excerpts from broad codes were then fine-coded using an inductive approach. Three major themes emerged: 1) Option B+ specific challenges (same-day initiation into treatment, health care providers unconvinced of the benefits of Option B+, insufficient training); 2) facility resource constraints (staff and drug shortages, long queues, space limitations); and 3) lack of client-friendly services (scolding of patients, inconvenient operating hours, lack of integration of services, administrative requirements). This study highlights important challenges at the health facility level related to Option B+ rollout in western Kenya. Addressing these specific challenges may increase linkage, retention and adherence to life-long ART treatment for pregnant HIV-positive women in Kenya, contribute towards elimination of mother-to-child HIV transmission, and improve maternal and child outcomes.
authors.affiliation: Department of Health Care Organization and Policy School of Public Health, University of Alabama at Birmingham, Birmingham, Birmingham, Alabama, US.
authors.forename: Anna
authors.initials: A
authors.lastname: Helova
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Eliud
authors.initials: E
authors.lastname: Akama
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.affiliation: Department of Health Care Organization and Policy School of Public Health, University of Alabama at Birmingham, Birmingham, Birmingham, Alabama, US.
authors.forename: Pamela
authors.initials: P
authors.lastname: Musoke
authors.affiliation: Migori County Referral Hospital, Kenya Ministry of Health, Migori, Kenya.
authors.forename: Wafula Z
authors.initials: WZ
authors.lastname: Nalwa
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.|Department of Epidemiology, University of Washington, Seattle, US
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Odeny
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Maricianah
authors.initials: M
authors.lastname: Onono
authors.affiliation: Nell Hodgson Woodruff School of Nursing and Department of Global Health, Emory University, Atlanta, Georgia, US.
authors.forename: Sydney A
authors.initials: SA
authors.lastname: Spangler
authors.affiliation: Department of Health Care Organization and Policy School of Public Health, University of Alabama at Birmingham, Birmingham, Birmingham, Alabama, US.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Turan
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Iris
authors.initials: I
authors.lastname: Wanga
authors.affiliation: Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, US.
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Abuogi
mesh_terms: D044966:Anti-Retroviral Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001942:Breast Feeding; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control; D006268:Health Facilities / Q000592:standards*; D058016:Health Facility Administration / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D007630:Kenya; D008297:Male; D011247:Pregnancy; D036301:Qualitative Research; D000078329:Workforce
chemical_list: D044966:Anti-Retroviral Agents