Assessment of Service Uptake, Monitoring and Evaluation Practices, and Performance of Human Immunodeficiency Virus Projects in Health Facilities in Nairobi County

Abstract

HIV projects play a critical role in mitigating the challenges posed by the epidemic. This study evaluated the progress made by implementing partners in alignment with the global 95-95-95 cascade targets set by UNAIDS, aiming to achieve 95% identification of HIV infections, 95% initiation of treatment for those identified, and 95% viral suppression among individuals on therapy by 2030. The study assesses healthcare workers’ utilization of partner notification services (PNS), test-and-treat services, and routine viral load monitoring services, with monitoring and evaluation (M&E) practices as a moderating variable. A pragmatic paradigm guided the retrospective cross-sectional survey design targeting healthcare workers in 41 comprehensive care clinics. Data were collected from a sample of 226 respondents, drawn from a population of 550 using the Krejcie & Morgan (1970) table for sample size determination, through a self-administered electronic questionnaire, interviews, and focus group discussion schedules. Proportionate stratified sampling$gensured representation across staff cadres. Validity was established through expert opinions and data triangulation, while reliability$was confirmed with a Cronbach’s Alpha coefficient of 0.7. Rich, thick verbatim quotations supported qualitative data analysis. Descriptive statistics; mean and standard deviation, and inferential statistics; Pearson’s Correlation, One-Way ANOVA, and regression analysis were applied, with null hypotheses tested at a 0.05 significance level. Descriptive results showed over 90% agreement across$objectives. Inferentially, PNS (R²=0.126, p<0.05), test-and-treat services (R²=0.28, p<0.05), and routine viral load monitoring services (R²=0.23, p<0.05) were all positively and significantly associated with project performance. Combined service uptake exhibited the highest influence (R²=0.56, p<0.05), underscoring the benefits of integrated interventions. M&E practices were also positively significant (R²=0.13, p<0.05) and moderated the relationship between service uptake and performance (R²=0.18, p<0.05). Although R² values were below 50%, they fall within acceptable ranges for social science research, where the primary aim is to assess the impact of predictors rather than predict human behavior. The findings emphasized the critical role of implementing multifaceted interventions, including PNS, test-and-treat, and routine viral load monitoring services, to enhance HIV project performance. Flexibility, adaptability, and patient-centered approaches were highlighted as essential components for achieving epidemic control. The study contributes to the body of knowledge by demonstrating the synergistic effects of integrated services and the importance of robust M&E frameworks in optimizing HIV project outcomes.