The Perspective of HIV Providers in Western Kenya onProvider-Patient Relationships

Abstract

Kenya, along with other sub-Saharan African countries, hasmade tremendous strides in the delivery of antiretroviral therapy(ART) to HIV-infected persons (Blaizot et al.,2016; Kelly &Wilson,2015; Odhiambo, Kellogg, & Kim,2014). ART cover-age in Kenya increased from 64% in 2008 to 80% in 2013(NACC,2014). Despite this achievement, poor adherence andhigh loss to follow-up (LTFU) rates along the cascade of HIVcare (Hassan et al.,2012; Karcher, Omondi, Odera, Kunz, &Harms,2007; Mann et al.,2013; Mûnene & Ekman,2015;Ochieng-Ooko et al.,2010) reduce the effectiveness of theseefforts. These challenges have been attributed to various indivi-dual, social, and structural factors (Fox & Rosen,2010; Mertenet al.,2010; Ochieng-Ooko et al.,2010; Posse, Meheus, VanAsten, Van Der Ven, & Baltussen,2008; Reda & Biadgilign,2012; Vreeman et al.,2009). Initiating effective adherence dia-logue with HIV patients, and incorporating tailored interventionsalong the continuum of HIV care, are essential to optimize thebenefits of HIV care.Patient engagement in care, which entails patient involve-ment in decisions regarding their treatment, has been shown topromote better HIV medication and clinic adherence (Mûnene &Ekman,2015). For HIV patients to be engaged, high qualityprovider-patient communication and relationship dynamics mustbe fostered and maintained (Flickinger, Saha, Moore, & Beach,2013). In Kenya, poor provider-patient communication and rela-tionship difficulties have been documented as barriers to optimalHIV care (Geng et al.,2015; Gourlay, Birdthistle, Mburu,Iorpenda, & Wringe,2013; Gourlay et al.,2014; Posse et al.,2008; Wachira et al.,2014), yet very few studies in the regionhave focused on the role of provider and patient interactions inpromoting HIV care (Wachira, Middlestadt, Reece, Peng, &Braitstein,2013,2014). These studies do not explore howKenyan providers and patients experience and conceptualizeprovider-patientcommunicationandrelationships.Understanding providers’and patients’expectations during clin-ical encounters is essential to developing appropriate interven-tions to promote better provider-patient interactions in thecontext of HIV care delivery.We therefore used qualitative methods to better understandthese mutual expectations. In this article we examine providers’perspectives on the factors that contribute to poor provider-patient relationships. We focused on the following researchquestions: 1) What are the perceptions of providers about HIVpatients? 2) How do providers perceive and experience provider-patient relationship?in the study and provided written consent. They then conductedthe audio recorded interviews that took approximately 1 hour.Participants were provided with transport reimbursement ofKenya Shillings (KES) 500, equivalent to USD 5