Perceptions of patients and clinicians on integration of human immunodeficiency virus and non- communicable diseases care in Jarmogi Oginga Odinga teaching and referral hospital, Kisumu- Kenya

Abstract

The rising prevalence of non-communicable diseases (NCDs) among patients with HIV has led to the need to re-think of how best to manage the patient with both conditions in the HIV clinic. Despite the evidence suggesting system-wide and nation-wide benefits to integration, the patient and service level effects are undocumented. This study aimed to investigate patients and clinicians’ perception of challenges of NCDs-HIV care service integration. A descriptive crosssectional study was carried out in the Jaramogi Oginga Odinga Teaching and Referral Hospital HIV and MOPC clinics, involving 480 respondents from 2 groups; adult HIV patients and clinicians providing care for HIV patients and NCDs. The two groups of respondents were randomly and purposively sampled respectively. A structured questionnaire designed with a 4point Likert scale was used for data collection. A score of 1 was awarded for strongly disagree, 2 for disagree, 3 for agree and 4 for strongly agree. All scores were added to give an aggregate score for each domain and overall. The study found that most respondents strongly agreed that combining HIV and NCDs Clinic would improve care, decrease frequency of clinic visits be cost effective as resources are shared for HIV and NCDs, and integration could capitalize on the good foundations built for HIV to improve NCDs Care. 49.8% of patients strongly agreed the integration of HIV and NCDs care services improve HIV and NCDs care in the HIV outpatient clinics. 87% of clinicians strongly agreed that the integration of HIV and NCDs care services improve care in the HIV outpatient clinics. Concerns on funding and lack of policies and strategies on integration were expressed as possible problems to the implementation of an integrated approach. The study also confirmed the clinicians’ and patients’ willingness to work and be seen in the integrated clinic respectively. 83.6% of the patients agreed they would visit HIV and NCDs integrated outpatient clinics for HIV and NCDs care. On the other hand, all clinicians agreed they would attend and work in integrated outpatient clinics to provide care for HIV and NCDs patients. Most respondents perceived that the integration of HIV and NCDs care services would lower frequency of visiting clinics, improve care for both HIV and NCDs in the HIV outpatient clinic, and enhance cost effectiveness of accessing quality health care. On the challenges, it was apparent that the integration of HIV and NCDs care services would lead to crowding and workload for patients and clinicians respectively. Regardless of the challenges, both patients and clinicians were overwhelmingly interested in being seen and working in integrated HIV and NCDs outpatient clinics respectively