Abstract:
Civil Society Organizations (CSO) have played a major role in the fight of HIV and
AIDs since its discovery in Kenya in early 1980s. Despite their massive effort to provide
proper health care, adequate nutrition and suitable economic empowerment to people
living with HIV and AIDS, documented data on the impact and value of their
interventions remains very scanty. The main objective of this study was to determine the
effect of CSO interventions on health, nutrition, and economic status on people living
with HIV and AIDS as the target population in Busia County. A quasi-experimental
study design of two hundred and twenty (220) participants from four Sub-Counties of
Busia County (Kenya) was used. A structured and semi-structured questionnaire was
administered to collect baseline and end line data. Qualitative in-depth data were
obtained using focus group discussions (FGDs) and key informant interviews.
Quantitative data analysis was carried out using Statistical Package for Social Scientists
(SPSS) software, version 17. Frequency distributions and percentages were computed to
enable univariable data presentation. In bivariable computations, the Chi-square test was
computed to test for categorical variables associations. In addition, Odds Ratio (OR) was
computed for two by two tables. Net Effect of Intervention (NEI) analysis was used to
determine the impact of interventions at 95% confidence level. Apparent NVIVO (QSR
International Pty Ltd) qualitative software was used to analyze qualitative data. Text,
audio, and video recordings were transcribed verbatim and data categorized into various
themes. Line by line coding was used to manage discrete units of text. Quotes were used
to illustrate perspectives of respondents relating to the different themes. There was no
significant difference in gender, household size, and education level recorded in
intervention and non-intervention sites between baseline and end line. Majority of the
respondents (50%, 42.5% Vs 49.6%, and 39.9%) in intervention and non-intervention
sites at baseline and end line respectively, indicated to have attained primary level of
education. However, a significant difference among those formally employed was
reported at baseline (P=0.03) and end line (P=0.01). The proportion of respondents
recorded as self-employed were high in intervention (75.4% vs 66.1%) and nonintervention sites (62.9% vs 75.4%) at baseline and end line respectively. However,
there was no significant difference recorded at baseline (p=0.83), with a significant
difference recorded at end line (P=0.01). A large proportion of respondents in
intervention (83.1% vs 89.5%) and non-intervention (87.4% vs 73.2%) sites at baseline
and end line respectively accessed HIV/AIDS information. However, Net Effect of
Intervention (NEI) increase (20.6%) was not statistically significant (P=0.16). Main
source of HIV and AIDS information was from MoH in intervention (62.3%) and nonintervention sites (57.5%) at baseline. It was also the main source of HIV and AIDS
information, although others sourced from key opinion leaders, private sector, PLWHA
xix
and line-Ministries. Respondents recorded use of contaminated sharps as a risk factor to
HIV transmission in intervention and non-intervention sites (68.5% vs 62.9%) at
baseline. With 65.7% and 65.2% in intervention and non-intervention at sites at end line.
There was no significant difference in the awareness of HIV risk factors in intervention
and non-intervention sites at baseline and end line (P>0.05). Approximately 16.3% of
respondents reported they smoked and indulged in alcohol despite being aware of the
risks associated with HIV and AIDS. Overall, the differences in change in prevalence of
clinical signs and symptoms were not statistically significant (P>0.05). However, the
5.9% NEI reduction in periodontal diseases illustrated significant difference (P=0.05).
Prevalence of candidiasis dropped at end-line in intervention sites, with 0.7% fewer
cases reported in comparison to the non-intervention sites. No notable significant
difference between intervention arm and non-intervention arm in access to health care
services (P>0.05). Government facilities were the main providers of voluntary
counseling and testing services in both sites. A statistical significant difference was
observed in respondents sourcing ARVs from private facilities in intervention and nonintervention sites at baseline and end line (P=0.05). A large proportion of respondents in
intervention sites (91.5%, 93.7%) and non-intervention sites (88.2%, 80.4%) at baseline
and end line respectively, accessed Anti Retro Viral (ARV) drugs. However, the NEI
increase (10.0%) was not statistically significant (P=0.48) across study sites. Most
respondents in intervention (59.2%, 60.1%) and non-intervention sites (56.7%, 44.2%)
at baseline and end line, accessed health care services from government hospitals.
Despite the NEI (13.4%) increase no significant difference recorded (P=0.24) in all the
study sites. The government was the most common source of Anti Retro Viral in the
intervention sites (42.0%) at baseline. Most respondents at baseline (58.5%, 54.3%) and
at end line (53.8%, 57.9%) in the intervention and non-intervention sites had normal
weight with Body Mass Index (BMI) range of ≥18.5 to 24.9. The NEI (8.3%) decrease
among respondents with normal weight was observed to be statistically insignificant
(P=0.56). More respondents (NEI, 4.8%) in intervention and non-intervention sites at
baseline and end line were recorded as malnourished, and not statistically significant
(P=0.58). There was no significant difference in food intake in intervention sites in
comparison to non-intervention sites between baseline and end line. Respondents did not
take breakfast in the morning in intervention (30.8%) and non-intervention sites
(37.0%,) at baseline. Similarly, at end line in intervention (31.5%) and non-intervention
(34.8%) sites, respondents did not take breakfast in the morning. Ugali or rice
accompanied with green vegetables were the most common foods consumed at lunch
(34.6%) in intervention sites and non-intervention sites 37.0% at baseline. With similar
trend of foods consumed applied for supper at end line. The impact of CSOs on
economic and income generation activities in the study sites was not statistically
significant (P>0.05). Respondents benefited economically from the Chama support
xx
(formal registered group), Merry go round scheme (informal registered group) and
SACCOs initiated by CSOs through regular dialogue with PLWHA. These were the
most common types of economic support for economic growth and development that
supported PLWHA.