Integration of HIV Care with Primary Health Care Services: Effect on Patient Satisfaction and Stigma in Rural Kenya

HIV departments within Kenyan health facilities are usually better staffed and equipped than departments offering non-HIV services. Integration of HIV services into primary care may address this issue of skewed resource allocation. Between 2008 and 2010, we piloted a system of integrating HIV services into primary care in rural Kenya. Before integration, we conducted a survey among returning adults ≥18-year old attending the HIV clinic. We then integrated HIV and primary care services. Three and twelve months after integration, we administered the same questionnaires to a sample of returning adults attending the integrated clinic. Changes in patient responses were assessed using truncated linear regression and logistic regression. At 12 months after integration, respondents were more likely to be satisfied with reception services (adjusted odds ratio, aOR 2.71, 95% CI 1.32–5.56), HIV education (aOR 3.28, 95% CI 1.92–6.83), and wait time (aOR 1.97 95% CI 1.03–3.76). Men's comfort with receiving care at an integrated clinic did not change (aOR = 0.46 95% CI 0.06–3.86). Women were more likely to express discomfort after integration (aOR 3.37 95% CI 1.33–8.52). Integration of HIV services into primary care services was associated with significant increases in patient satisfaction in certain domains, with no negative effect on satisfaction. 1. Introduction Funding targeted for HIV care programs in sub-Saharan Africa has produced tremendous results over the past several years, most notably the delivery of antiretroviral therapy to almost 4 million people in sub-Saharan Africa by 2009 [1, 2]. In Kenya, the number of people receiving antiretroviral therapy has increased from about 11,000 in 2003 to more than 138,000 patients in 2007 largely as a result of receiving the President’s Emergency Plan for AIDS Relief (PEPFAR) funds [3, 4]. This kind of directed “vertical” funding (for specific disease areas instead of for general improvements in primary health care) has allowed for specialized staff training, more rapid and efficient program implementation, and better-equipped facilities—including free laboratory services and medications—as HIV programs have been scaled-up [5]. These results may not have been possible in such a short time using an integrated approach to health care delivery. Nevertheless, the HIV epidemic has increased pressure on the Kenyan health care system as a whole by increasing the workload for health personnel—whose numbers have not increased proportionally to the demand [6]—and straining infrastructure capacity and public expenditure.