Assessment of referral practices and facilitation activities of HIV testing and counseling sites in Nairobi city county, Kenya.

ABSTRACT

Knowledge of one’s HIV status through HIV Testing and Counselling remains the first step towards HIV prevention, appropriate care, support and treatment services. The knowledge needs to be coupled with means of accessing and obtaining essential post test services including appropriate care and treatment for all individuals who test HIV positive. Through linkages with care, treatment and support programs, HTC is expected to contribute to lessening the impact of the HIV epidemic on children, adults, families and communities only if all clients who test HIV positive are offered and/or linkedto all the requisite prevention, care and treatment services. Therefore the aim of the study was to identify frequency of referrals, referral practices and facilitation activities of HTC providers in Nairobi County for individuals who test HIV positive.The objectives of the study were to determine the frequency of referrals for HIV positive clients by type of HTC site, identify the referral practices by HTC type and establish referral facilitation activities for clients to test HIV positive by type of HTC type in Nairobi County. A cross-sectional comparative study design was employed. The study took a census approach and a total of 92 sites participated in the study.A structured questionnaire was administered to 92 authorized personnel at the HTC sites. The Statistical Package for Social Sciences version 22.0 was used for quantitative data analysis. Key variables of the study were cross tabulated with the main institutional variables and aggregates computed. The relationship between the HTC site type and thevaried referral practices and facilitation activities was assessed using the chi square test of association. The results were presented in form of tables, bar charts, and pie charts.Findings showed that 94% the sites referred all the clients who tested HIV positive. However, there was no association between type of HTC site and referrals (X 2 = 0.0039, P =0.95). Majority of the sites had a documented referral system. Nevertheless, there was no relationship between the type of HTC site and a documented referral system (X 2 = 0.432, P =1). Only 44% of the sites had conducted referrals for HIV positive clients considered to be emergency cases, with 45% reporting accompanying clients. None of the referral facilitation activities studied had an association with the type of HTC site. The study concluded that there are gaps in the frequency of referrals, referral practices and facilitation activities of HTC providers for clients who test HIV positive in Nairobi County. The study recommends actions for both policy and practice modifications. Inorder to increase frequency of referrals, NASCOP should institute compliance measures to ensure HTC providers adhere to policy requirements for referral and linkage of all individuals who test HIV positive. The HTC sites should institute review of frequency of referrals and institute corrective measures to ensure linkage of all individuals who test HIV positive. Inorder to enhance referral practices, the National AIDS and STIs Control Program should refine and disseminate standardized guidance on referral practices for HTC sites. HTC sites should adhere to standard documentation for referrals, institute formal collaborative relationships with referral network partners and designate staff to manage referrals and folow ups. Inorder to improve referral facilitation activities, NASCOP should refine and disseminate standard guidance on referral facilitation activities related to accompaniment, transportation and follow up for clients who test HIV positive. On the other hand HTC sites should establish site specific activities that will ensure accompaniment, provision of transport and/or bus fare and follow up to intensify linkage of individuals who test HIV positive and are regarded as emergency cases, into requisite HIV care and treatment services.