Effect of Civil Society Organization Intervention on Health, Nutrition, and Economic Status of People Living with HIV and AIDS in Busia County, Kenya

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 non-intervention 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 non-intervention 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 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 non-intervention 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 (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.