Improving Retention of Male Clients Through Peer Support
Kenya is one of the most affected countries by the HIV/AIDS epidemic; as of 2015, 5.9% of all adults in the country lived with HIV. In Kisii, one of 47 counties in Kenya, HIV/AIDS poses a risk to not only community health, but also to the county’s economy and food supply. Mitigating and eliminating HIV/AIDS is crucial in all affected areas, and Kisii County exemplifies how dangerous the epidemic is beyond its immediate health risks.
The continuous quality improvement (CQI) staff at Isecha Health Centre in Kisii County works to combat risks posed by HIV/AIDS and was faced with a difficult challenge: in 2017, male patients had a 37% missed appointment rate. Root cause analysis revealed that most men who miss appointments do so because of consuming alcohol, forgetting to pick up their drugs, or visiting the center outside of their scheduled appointments. Eleven of the facility’s 31 male clients (35%) reported drinking and poor adherence.
“I either forget or remember [appointments] late,” one patient said. “And it is not advisable to come to the clinic when I am not sober.”
To assist this male client population, the Isecha Health Centre staff, supported by Ciheb, created a clinic just for men on a specific day each week.
CQI staff structured the package of care to improve accountability. A case manager was assigned to each patient, and the clinic would not dispense medication until all patients were accounted for on “Men-Only” days.
Clinic practices were also adjusted to better serve these patients. Instead of only remaining open during the day, the clinic began opening at 2 a.m. on “Men-Only” days. Support group meetings are also held three times each month on “Men-Only” days, and those support groups are patient-led.
The clinic operated as a prototype between October 2017 and September 2018, and it has since become a facility antiretroviral therapy distribution group for men only.
The newly structured package of care positively affected male patients, their wives, and ultimately informed best practices for clinics across Kenya.
Nine of the 11 men with high viral load became re-suppressed, and three of those men remain on follow-up support for alcohol abuse. Surveyed spouses reported that their husbands’ abilities to function productively had improved, and spouses also reported being happier.
Because this solution was effective — appointment keeping improved from 62% to 100% — the methods used were presented at a national forum during Kenya’s annual HIV best practices meeting.
Lessons Learned and Future Actions
This case demonstrates that using CQI approaches for analyzing problems and identifying solutions is effective in chronic care.
To successfully solve issues that first appear difficult to health providers, designing patient-centered care approaches, and involving patients in designing their care, is crucial. Isechan men, in this case, are held accountable not only by the clinic, but by each other: they lead some of their own support groups, and their presence affects whether their fellow patients can obtain their medications. The patients rely on and support each other.
This case also demonstrates that better understanding patients, achieved through characterizing clients with specific gaps, ensures appropriate intervention.