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Abstract
The aim of this study was to explore the perspectives of healthcare providers on the advantages and disadvantages of integrating HIV care services, including highly active antiretroviral therapy (HAART), into antenatal care (ANC) clinics in rural Kenya. We conducted a qualitative study using in-depth interviews and thematic analysis; 36 healthcare providers from six health centres in Nyanza Province, Kenya participated. Effects on service providers included increased workload due to the incorporation of specialised HIV services into ANC clinics. Providers observed that integration results in decreased patient time spent at the health facility, increased efficiency and closer provider-patient relationships; all leading to increased patient satisfaction. Providers also said that women would be more likely to receive HAART and adhere to their treatment as a result of improved confidentiality and decreased stigma. However, a minority of providers noted that integration could result in longer appointment times for HIV-positive women at ANC clinics leading to inadvertent disclosure. Integration could lead to strengthened ANC, postpartum care, prevention of mother-to-child transmission and HIV care for women and their families. However, integration efforts need to take into account potential negative effects on ANC provider workload, disclosure and the quality of care.
Acknowledgements
The authors thank Michaela Kiernan, Yvonne Maldonado, Jayne Kulzer, Anna Leddy, Douglas Okelloh, Katherine Doolan, Rachel True and Kimberly Bale. We gratefully acknowledge the Directors of KEMRI, the KEMRI-UCSF Collaborative Group and especially FACES for their support in conducting this research. Lena Winestone's work on this study was supported the Stanford Medical Scholars Programme. Janet M. Turan's work on this study was supported by NIH grant #5K01MH81777.