Utilization of ‘prevention with positives’ services by adolescents living with HIV attending comprehensive care clinics in Garissa Town, Kenya

Abstract

Background: Human immune deficiency virus (HIV) infection is associated with significant morbidity and mortality among adolescents. ‗Prevention with Positives services‘ include psychosocial counselling, provision of ART and septrin prophylaxis, family planning, nutrition , screening and treatment of tuberculosis, screening and treatment of sexually transmitted diseases, partner notification, prevention of mother to child transmission, prevention of fungal infections, malaria, vaccination of preventable illnesses, needle – syringe program and opioids substitution which have been shown to reduce HIV associated morbidity and mortality. Assessment of the available services and factors that influence their utilization can assist in guiding policy on improving these services. Objective: To evaluate the utilization of ‗Prevention with Positives services‘ among adolescents living with HIV (ALWHIV) attending Comprehensive Care Clinics in health facilities in Garissa Town. Methods: A mixed method, health facility based, cross sectional study was used. A census involving adolescents living with HIV aged between 10 to 19 years and key informants at the Comprehensive Care Clinics in Garissa County Referral Hospital, Iftin Sub-County Hospital and Police line Hospital. Interviewer administered Questionnaires to the adolescents were used to assess the ‗Prevention with Positives services‘ utilized and what factors influenced their uptake. Focus group discussions with the adolescents were used to assess their knowledge on ART and Family Planning, partner notification, and challenges encountered when accessing preventive services. The key informants gave information on the available services, perceived factors affecting utilization and perception of community about ALWHIV. Descriptive statistics and the corresponding standard deviation were used to summarize continuous variables. All interviews were translated from Somali to English where necessary and thematically analyzed. Results: We recruited 39 adolescents living with HIV and 5 key informants (3 health care providers, one religious leader, and one village elder). Majority were female 22/39 (56.4%).The Prevention with Positives services available at all the three facilities included ART, Septrin prophylaxis and nutritional services, while screening and treatment for both sexually transmitted infections and tuberculosis and psychological counselling were available only at Garissa County Referral Hospital. Three ALHIV were sexually active but none had disclosed their HIV status to their partners. Utilization of ART and Septrin prophylaxis was 39/39(100%), nutritional services 12/39 (30.7%), screening for tuberculosis 11/30 (36.6%), screening for Sexually Transmitted Infections and psychological counselling 1/30 (3.3%).During the Focus Group Discussions adolescents reported that availability of free ART facilitated utilization of the services while Fear of rejection/ stigma, unfriendly health workers, rigid school rules, religious and cultural beliefs were perceived as barriers to utilization of the services. Key informants reported that barriers included shortage of staff and high levels of stigma at the community level. Conclusions: None of the health facilities offered all the ‗Prevention with Positives services‘ in Garissa town. Utilization of services was low. Free ART enhanced the utilization of the services while Stigma, unfriendly health workers, rigid school rules were barriers identified. Recommendations: Efforts should be put in place to ensure that Comprehensive Care Clinics offer all the recommended ‗Prevention with Positives services‘ . There is need to improve adolescents-health care providers‘ relationships and have flexible school rules.