At least 85,000 Kenyans living with HIV will miss treatment this year simply because of the attitude of workers in health facilities, a new study suggests.
The study shows 5.7 per cent of patients enroled on the life-prolonging antiretroviral therapy are usually lost to follow up, but no sufficient effort is made to locate them.
Others die a few months after being put on ARVs.
The study found health facilities with a proactive culture report fewer deaths and less cases of patients lost to follow up. “Factors such as long waiting times for clients, using staff who do not have specialised training in HIV care, failure to contact individuals who do not attend clinic, and lack of communication between pharmacy and clinic staff if ART drugs are not collected lead to patients being lost to follow-up,” says the study conducted in Nairobi.
Patients lost to follow-up are those who enrol for HIV care but abandon clinic visits and cannot be traced for more than three months.
Findings published last week by the Plos One journal also suggest many of the early HIV-related deaths are avoidable and have less to do with patient and disease factors.
“The health system capacity to improve service delivery depends not only on having a health workforce equipped with the necessary skills and equipment, but also having an organisational culture that is able to use rewards and incentives to promote the right service delivery values,” Dr Richard Ayah, the University of Nairobi public health lecturer who authored the paper, said.
He recommended an adhocracy type of culture, which is associated with adaptation and innovation, and proactive workers. “This was found to be associated with low early mortality and low levels of lost to follow-up of patients,” he said.
His study – Scaling up implementation of ART: Organisational culture and early mortality of patients initiated on ART in Nairobi – is the first to explore organisational culture and HIV care outcomes in Kenya.
Kenya has about 1.5 million people living with HIV but 500,000 are not on treatment. Ayah explained expanding ARV coverage will require a proactive organisational culture.
“The required organisational culture would therefore be one able to adapt to the increase in workload in maintaining large numbers of patients on ART,” he said.
In the study, participants from 31 health facilities were given descriptions of the four types of organisational cultures and ticked which ones applied to their facility.