Abstract:
Background:
Sub-Saharan Africa is increasingly being challenged in providing care and treatment for chronic
diseases, both communicable and non-communicable. In order to address the challenges of linkage to and
retention in chronic disease management, there is the need to understand the factors that can influence
engagement in care. We conducted a qualitative study to identify barriers and facilitators to linkage and retention
in chronic care for HIV, tuberculosis (TB) and Hypertension (HTN) as part of the Academic Model Providing Access
to Healthcare (AMPATH) program in western Kenya.
Methods:
In-depth interviews and focus group discussions were conducted July 2012-August 2013. Study participants
were purposively sampled from three AMPATH clinics and included patients within the AMPATH program receiving
HIV, TB, and HTN care, as well as caregivers of children with HIV, community leaders, and healthcare providers. A set of
interview guides were developed to explore perceived barriers and facilitators to chronic disease management,
particularly related to linkage to and retention in HIV, TB and HTN care. Data were coded and various themes were
identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health
Services Utilization.
Results:
A total of 235 participants including 110 individuals living with HIV (
n
=50),TB(
n
=39),orHTN(
n
=21);24
caregivers; 10 community leaders; and 62 healthcare providers participated. Barriers and facilitators were categorized as
predisposing characteristics, enabling resources and need factors. Many of the facilitators and barriers reported in this
study were consistently reported across disease categories including personal drive, patient-provider relationships and
the need for social and peer support.
Conclusions:
Our findings provide insight into the individual as well as broader structural factors that can deter or
encourage linkage and retention that are relevant across communicable and non-communicable chronic diseases. The
findings of the present study suggest that interventions should consider the logistical aspects of accessing care in
addition to predisposing and need factors that may affect an individuals
’
decision to seek out and remain in
appropriate care
