Article Text
Abstract
Introduction HIV services at the community level in Kenya are currently delivered largely through vertical programmes. The funding for these programmes is declining at the same time as the tasks of delivering HIV services are being shifted to the community. While integrating HIV into existing community health services creates a platform for increasing coverage, normalising HIV and making services more sustainable in high-prevalence settings, little is known about the feasibility of moving to a more integrated approach or about how acceptable such a move would be to the affected parties.
Methods We used qualitative methods to explore perceptions of integrating HIV services in two counties in Kenya, interviewing national and county policymakers, county-level implementers and community-level actors. Data were recorded digitally, translated, transcribed and coded in NVivo10 prior to a framework analysis.
Results We found that a range of HIV-related roles such as counselling, testing, linkage, adherence support and home-based care were already being performed in the community in an ad hoc manner. However, respondents expressed a desire for a more coordinated approach and for decentralising the integration of HIV services to the community level as parallel programming had resulted in gaps in HIV service and planning. In particular, integrating home-based testing and counselling within government community health structures was considered timely.
Conclusions Integration can normalise HIV testing in Kenyan communities, integrate lay counsellors into the health system and address community desires for a household-led approach.
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Footnotes
Handling editor Stephanie Topp.
Twitter Follow Lilian Otiso @taiso29 and Miriam Taegtmeyer @MiriamTaegtmeye
Contributors LO and MT and KK conceptualised the study and this article and LO oversaw a team of data collectors. MM was involved in data collection and provided input on the results and Kenyan community context. The analysis was performed by RM, LO, MM, KdK and MT. MT prepared the final draft, with contributions and revisions made by LO, RM, KdK and RK. All authors have read and approved the final version.
Funding This research forms part of a multicountry context analysis for REACHOUT, a 5-year multicountry research consortium aiming to maximise the equity, effectiveness and efficiency of close-to-community services in rural areas and urban slums in six countries (Bangladesh, Ethiopia, Indonesia, Kenya, Malawi and Mozambique). The REACHOUT Consortium is funded by the European Union FP7 grant (number 306090). This document reflects only the authors' views and the European Union is not liable for any use that may be made of the information contained therein.
Competing interests None declared.
Ethics approval Kenya Medical Research Institute Ethics and Review Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.