Referral Network Analysis for Improved HIV Care in Homa Bay County, Kenya: Final Report

Author(s): Agala CB, Xiong K, Thomas JC, Powell R

Year: 2016

Abstract:

This paper reports on a network analysis of healthcare providers in Homa Bay, Kenya. It presents a quantitative description of how these providers coordinate their activities and identifies ways to improve the care they offer to people living with HIV. As part of the analysis, we paid particular attention to referrals linking HIV testing and the provision of antiretroviral therapy (ART), because these are an important element in the achievement of the 90-90-90 goals of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Background
People living with HIV have many clinical, nutritional, and social needs, all of which can seldom be met by a single provider. Providers typically focus on their own services and not the comprehensive needs of the patients. This is often reflected in a lack of coordination among care providers. But in fact, patient care is better when providers are aware of appropriate services at other facilities and refer patients to them. In a county whose HIV prevalence is among the highest in Kenya, we identified the organizations providing some aspect of HIV care and investigated the ways in which they work—or don’t work—together to cover the comprehensive needs of those they serve.

Analysis
We identified 56 organizations and interviewed a representative from each of them about their services and their connections with the other 55. Referral connections among them in the past 30 days were relatively rare, averaging less than two; 13 organizations made no referrals at all. Notably, five facilities that test for HIV did not refer their clients to an ART provider. We found two distinct clusters of connected organizations: one in Homa Bay Township and the other in Rangwe Subcounty. When we convened the organizations and presented our results to them, they expressed interest in establishing better connections and referrals.

Conclusions
Homa Bay has an opportunity to improve care for people with HIV simply by making better use of the services already available, without deploying new ones. This can be achieved by informing each organization of the services provided by each of the others, and by bringing the organizations together to plan and monitor the services’ coordination. These steps could be implemented separately in each of the two organizational clusters.