Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Aug 8:16:741.
doi: 10.1186/s12889-016-3462-6.

Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya

Beth Rachlis  1   2   3 , Violet Naanyu  4   5 , Juddy Wachira  4 , Becky Genberg  6 , Beatrice Koech  4 , Regina Kamene  4 , Jackie Akinyi  4 , Paula Braitstein  4   7   8
Affiliations

Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya

Beth Rachlis et al. BMC Public Health. .

Erratum in

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), or HTN (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.

Keywords: Barriers; Facilitators; HIV; Hypertension; Kenya; Linkage; Retention; Tuberculosis.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Map of Study Sites: This figure presents a map of all AMPATH sites in western Kenya and specifically highlights the three study sites: Chulaimbo, Teso and Turbo
See this image and copyright information in PMC

References

    1. Venkat Narayan KM, Miotti PG, Anand NP, Kline LM, Harmston C, Gulakowski R, Vermun SH. HIV and noncommunicable disease comorbidities in the era of antiretroviral therapy: a vital agenda for research in low- and middle-income country settings. J Acquir Immune Defic Syndr. 2014;67:S2–7. doi: 10.1097/QAI.0000000000000267. - DOI - PubMed
    1. Geneau R, Hallen G. Toward a systematic research agenda for addressing the joint epidemics of HIV/AIDS and noncommunicable diseases. AIDS. 2012;26(suppl 1):S7–10. doi: 10.1097/QAD.0b013e328355cf60. - DOI - PubMed
    1. Levitt NS, Steyn K, Dave J, Bradshaw D. Chronic noncommunicable diseases and HIV-AIDS on a collision course: relevance for health care delivery, particularly in low-resource settings-insights from South Africa. Am J Clin Nutr. 2011;94:1690S–6. doi: 10.3945/ajcn.111.019075. - DOI - PMC - PubMed
    1. de Graft AA, Unwin N, Agyemang C, Allotey P, Campbell C, Arhinful D. Tackling Africa’s chronic disease burden: from the local to the global. Global Health. 2010;6:5. doi: 10.1186/1744-8603-6-5. - DOI - PMC - PubMed
    1. Kenyan National Bureau of Statistics. Kenya Integrated Household Budget Survey (KIHBS) 2005/2006. Nairobi: http://statistics.knbs.or.ke/nada/index.php/catalog/8.