Relationship between stage of HIV disease and family functioning at initiation of care at Kangundo Sub-County Hospital, Kenya

Abstract

Background: About 40% of all new patients initiated on HIV/AIDS care globally come late with advanced disease – World Health Organization stage 3 or 4 and or CD4 count less than 200/mm3. The family is the basic social unit of society and the first point of care for sick members and thus the quality of healthcare decisions at this level are greatly influenced by family functioning. Objectives: To determine the relationship between the stage of HIV/AIDS disease and family functioning at the time of initiation of care. Methodology: This was a hospital based cross sectional study done in the comprehensive care clinic at Kangundo Sub-County Hospital, Machakos County in Kenya. The socio-demographic characteristics of all new patients were recorded and levels of satisfaction with family support was measured using the family Adaptation Partnership Growth Affection and Resolve scale. Results: A total of 188 clients participated in the study, 115(61.2%) were female, 89(47.3%) were married. The mean age was 40(SD 10.3) years, 84(44.7%) had at least secondary level of education. 132(70.2%) were tested through PITC and 36(19.1%) through VCT, mean number of children per respondent was 2(range 0-8) and mean household size 4(range 2-11). Those employed were 36.7%, 86.7% had disclosed their HIV status and 34(18.1%) were using alcohol. Among the 152 who reported to have partners, 51(33.6%) were reported to be HIV concordant, 13.2% HIV discordant while 53.3% did not know the serostatus of their spouse. Respondents’ distribution by WHO staging: I 14.9%, II 35.1%, III 39.4% and IV 10.6%. More than half of the respondents 116(61.7%) had CD4<200 cells/μl. Among the early entry group (WHO I & II) 66% had functional families compared to 69.1% of the late entry group (WHO III & IV) and 52 (72.2%) of those with CD4 ≥200/μl had functional families compared to 75 (64.7%) of those with CD4 <200/μl. Conclusion: Most of the people living with HIV and AIDS had normal functioning families. There was no significant difference in family functioning scores between respondents in early and those in advanced HIV disease at the time of initiation of care. Recommendations: More local studies on the determinants of late presentation for HIV care. Secondly, a study to assess and compare the baseline family functioning of the general population and that of PLWHA. A study to validate the family APGAR scale in the African population is recommended.