Factors influencing the implementation of provider-initiated testing and counselling services at the Provincial General Hospital Nyeri, Central Province, Kenya

Abstract

Much effort has been put by Nations world wide to curb the spread of HIV/AIDS. Most of these efforts have been geared towards providing opportunities for people to know their HIV status, and for a good reason. It has been established through studies done that people who know their HIV status tend to change their sexual behavior; to prevent themselves from being infected or if already infected, to avoid infecting their partners or even increasing their viral load. Voluntary counseling and Testing (VCT) has been one initiative where by people voluntarily visit the VCT sites to request for an HIV test. But even with all these efforts, only about 22% of the people living in Sub-Saharan Africa for example know their HIV status. The implication of this is that 78% of the population in this region is not aware of their HIV status.

PITC is one such effort aimed at providing an early entry point to HIV prevention care and support to the infected and affected people. The government of Kenya targets for PITC coverage at the outpatient is 50% and 80% for the inpatient in each facility. At the Provincial Hospital Nyeri, outpatient uptake for PITC stands at 2.6% while that of the inpatient is at 11.2% with gaps of 47.4% and 68.2% respectively. The study undertaken investigated the influence of staff levels, training, staff attitude towards HIV and availability of resources on implementation of PITC at the Provincial General Hospital Nyeri. The study adopted a cross sectional descriptive study design and stratified simple random sampling method was used to draw the sample from a population of 266 health care providers. Out of 169 respondents targeted in the sample 119 accepted to be included in the study and questionnaires administered to them.114 returned the filled questionnaires out of the 119 questionnaires administered.

Documents from the hospital on staffing levels were reviewed to determine the staffing levels at the facility. Data was analyzed by use of the statistical package for social sciences (SPSS) programme and presented by use of frequency table and bar graghs.Staffing levels emerged the number one factor that affects the implementation of PITC at the hospital in that the inadequate number of staff translates to high workload making it difficult to provide PITC services to a large number (76%) ofpatients/clients who visit the hospital each day. Provider training and consistency in availability of material resources were other important factors affecting implementation ofPITC to a great extent. Inadequate staffing, inadequate provider training and update affect implementation of IPTC services at the Provincial General Hospital Nyeri to a great extent and as a result many patients miss the opportunity of knowing their HN status increasing the overall percentage of missed opportunities. The staff is willing to provide the services and appreciate the importance of PITC. Provider related stigma needs to be investigated further.