Abstract:
Kenya, like other African countries, has been affected significantly by the
HIV/AIDS epidemic. Kenya has been a leader in rapidly expanding access to
HIV prevention, care and treatment, and great effort has been invested in
developing national to facility-level systems to deliver prevention, care, and
treatment services for HIV patients. In December 30, 2007; civil unrest broke
out in several parts of the country after the presidential election results were
announced. People fled their homes and health care services were disrupted.
The effects of the post-election violence on HIV infected individuals and those
on antiretroviral therapy (ART) are not clearly understood.
A cross-sectional study was carried out to determine the effects of post-election
violence on HIV patients care and treatment in selected districts in Central,
Nyanza, and Rift Valley provinces, Kenya. A total of 35 health facilities from
18 districts were selected using person proportion to size method. HIV patients
were interviewed and facility records reviewed to asses the effects of the postelection violence. A standardized questionnaire was administered to the study
participants. Odds Ratio (OR) was used to assess the strength of association
between various risk factors and missing ART and chi square to test for
statistical significance.
A total of 947 participants were interviewed. On analysis of factors that could
have lead to patients missing treatment, there was significant increased risk of
missing ART therapy among those who reported to have moved into different
districts since December 30, 2007 (OR=2.6, p=0.002), unable to access health
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care during the post-election violence period (OR=9.5, p<0.0001), having
experienced physical violence personally (OR=2.7, p=0.0055) and having
witnessed acts of physical violence (OR=2.0, p=0.02). For participants who
had remained at the hospital of normal care they were less likely to miss ART
(OR=0.3, p=0.002).
A Logistic regression model of factors that lead to patients missing treatment
showed two factors that remained independent. There was an increased risk of
missing ART among those participants who were unable to access routine
health care (OR=5.25, p<0.0001) and care when ill (OR=3.81 p<0.0001).
The post-election violence had an effect on patients who were on ART.
Inability to access health care and experiencing physical violence were
important factors leading to participants missing ART treatment. This may
have implications on ARV drug resistance and further research is needed.
