The HIV basic care package: where is it available and who receives it? Findings from a mixed methods evaluation in Kenya and Uganda

Abstract

An evidence-based basic care package (BCP) of seven interventions (Family testing, Cotrimoxazole, Condoms, Multivitamins, Access to safe water treatment, Isoniazid preventive therapy (IPT), and Insecticide-treated bednet) has been advocated to prevent infections among people with HIV in low-income settings. We examined the availability and receipt of the BCP in HIV outpatient clinics in Kenya and Uganda. A survey of 120 PEPFAR-funded facilities determined the services offered. At each of the 12 largest facilities, a longitudinal cohort of 100 patients was recruited to examine care received and health status over three months. The full BCP was offered in 14% (n = 17/120) of facilities; interventions most commonly offered were Support for family testing (87%) and Condoms (87%), and least commonly IPT (38%). Patients (n = 1335) most commonly reported receiving Cotrimoxazole (57%) and Multivitamins (36%), and least commonly IPT (4%), directly from the facility attended. The BCP (excluding Isoniazid) was received by 3% of patients directly from the facility and 24% from any location. BCP receipt was associated with using antiretroviral therapy (ART; OR 1.1 (95% CI 1.0–1.1), receipt from any location) but not with patient gender, wealth, education level or health. The BCP should be offered at more HIV care facilities, especially Isoniazid, and to more people irrespective of ART use. Coordinating local BCP suppliers could help improve availability through addressing logistical challenges or reducing costs.

Keywords:

• HIV
• delivery of healthcare
• opportunistic infections
• East Africa

Acknowledgements

The present study benefited from the participation of a wide range of partners, medical professionals, HIV specialists and palliative care researchers. The authors are grateful for the guidance provided by the US Government Palliative Care Technical Working Group and to the Kenyan and Ugandan Country Teams. Finally, we are grateful to the staff and patients at the participating facilities.

Funding

We are grateful to the US Agency for International Development for funding this study under a sub-agreement GPO-A-00-03-00003-00 made under the authority provided to the University of North Carolina.

Additional information

Funding

Funding: We are grateful to the US Agency for International Development for funding this study under a sub-agreement GPO-A-00-03-00003-00 made under the authority provided to the University of North Carolina.