Health facility challenges to the provision of Option B+ in western Kenya: A qualitative study

Anna Helova, Eliud Akama, Elizabeth A. Bukusi, Pamela Musoke, Wafula Z. Nalwa, Thomas A. Odeny, Maricianah Onono, Sydney A. Spangler, Janet M. Turan, Iris Wanga, Lisa L. Abuogi

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty individual gender-matched in-depth interviews with HIV-positive pregnant/postpartum women and their male partners, and four focus groups with thirty health care providers at four health facilities in western Kenya between September-November 2014. Transcripts were coded with the Dedoose software using a coding framework based on the literature, topics from interview guides, and emerging themes from transcripts. Excerpts from broad codes were then fine-coded using an inductive approach. Three major themes emerged: 1) Option B+ specific challenges (same-day initiation into treatment, health care providers unconvinced of the benefits of Option B+, insufficient training); 2) facility resource constraints (staff and drug shortages, long queues, space limitations); and 3) lack of client-friendly services (scolding of patients, inconvenient operating hours, lack of integration of services, administrative requirements). This study highlights important challenges at the health facility level related to Option B+ rollout in western Kenya. Addressing these specific challenges may increase linkage, retention and adherence to life-long ART treatment for pregnant HIV-positive women in Kenya, contribute towards elimination of mother-to-child HIV transmission, and improve maternal and child outcomes.

Original languageEnglish
Pages (from-to)283-291
Number of pages9
JournalHealth Policy and Planning
Issue number2
StatePublished - 2017


  • Adherence and retention
  • Health facilities
  • Kenya
  • Option B+
  • Prevention of mother-to-child transmission of HIV
  • Treatment


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