[01] Philip Towett, Tropical Institute of Community Health and Development, Great Lakes University of Kisumu, Kisumu, Kenya. [02] Margaret Kaseje, Faculty of Arts and Sciences, Great Lakes University of Kisumu, Kisumu, Kenya.

Introduction: Health care systems in sub-Saharan countries bear the greatest burden of disease and face challenges in providing HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency Syndrome) care alongside other health care services. Health systems in these countries experience constraints in ensuring diagnosis facilities, consistent drug supplies and adequate staff and equipment. Comprehensive care and support for People Living with HIV and AIDS (PLWHA) depends on improved health systems consisting of support services and life-saving drugs. This study assessed the capacity of the health facilities to provide standard comprehensive HIV and AIDS care services to PLWHA in Bomet sub-County in Kenya. Method: A cross-sectional descriptive study was conducted where all twenty nine facilities in Bomet sub-County were assessed using a structured questionnaire. The respondents were nurses and clinical officers managing Comprehensive Care Centres. Data was analyzed using SPSS version 20 for Windows while qualitative data was analyzed according to themes that addressed the study objectives. Results: Human resource to offer comprehensive services was a major constraint with only half of the health workforce (48%) trained on HIV and AIDS care. HIV testing and counselling services and antiretroviral drugs were available in the majority (97%) of health facilities. Lower level health facilities lacked capacity to provide basic laboratory investigations due to shortage of trained technicians, inadequate space and infrastructure, lack of essential equipment and occasional stock-outs of supplies. A third of the facilities had the capacity to provide psychosocial services to clients. The sub-County experienced shortage of funds for HIV care and relied on external funding. Conclusions: Despite challenges facing HIV and AIDS care in Bomet sub-County, most of the health facilities across the four level service points consisting of dispensaries, health centres, sub-County and County hospitals had the capacity to provide some care that included HIV testing and counselling services. Constraints to services included inadequate staff trained on HIV and AIDS care, lack of capacity to provide basic laboratory investigations and diminishing funding for HIV and AIDS services. Recommendations: In order to ensure comprehensive care and support for PLWHA, the decentralized sub-County health system needs to increase staffing levels trained on HIV and AIDS care, improve laboratory services and strengthen psychosocial support services. There is need to budget for HIV and AIDs care services at the sub-County level.

Health System, Health Facilities, HIV and AIDS, Antiretroviral Drugs

[01] Barker, C., Mulaki, A., Mwai, D., & Dutta, A. (2014). Devolution of Kenya Health Care: Assessing County Health Systems Readiness in Kenya: A Review of Selected Inputs. Washington, DC.: Health Policy Project. [02] Bomet County. (2013). Bomet county Development Profile. Bomet County. [03] Castellin, F., Pietra, V., Diallo, I., Schumacher, F., & Simpore, J. (2010). Antiretroviral Therapy in Resource Poor Countries: What Do We Need in Real Life? Open AIDS Journal, Volume 4, pages 28-32. [04] Cherutich, P., Imwani, I., Nduati, R., & Mbori-Ngacha, D. (2008). Optimizing Paediatric Care in Kenya: Challenges in early infant diagnosis. Bulletin of the World Health Organization, Volume 86, No 2. [05] IntraHealth International. (2010). Health Resources and Services Administration. IntraHealth. [06] Jesicca, E., Stephania, K., Amilcah, T., Allison, G., Felipe, L., & Charon, G. (2009). Developing Laboratory Systems and Infrastructure for HIV Scale-up: A Tool for Health Systems Strengthenin in Resource Limited Settings. Journal of Acquired ImmuneDeficiency Syndromes, Volume 52 pages 30-33. [07] Kenya Ministry of Devolution and Planning. (2013). Bomet County Development Profile. Nairobi: Government Printer. [08] Kenya Ministry of Health. (2007). Primary-level Handbook for Comprehensive Management of HIV Infection. Nairobi: Government Printers. [09] Kenya Ministry of Health. (2011). Guidelines for Antiretroviral Therapy in Kenya, 4th Edition. Nairobi: Government of Kenya. [10] Kenya Population News. (2006). Kenya Health Services Battle AIDS. Kenya Population News, pp. Volume 1, No 4, page 1. [11] Kimalu, K., Nafula, N., Manda, K., Bedi, A., Mwabu, G., & Kimenyi, S. (2004). A Review of the Health Sector in Kenya. Nairobi: Kenya Institure of Public Policy Research and Analysis. [12] Kiragu, K., Schenk, K., Murugi, J., & Sarna, A. (2008). "If You Build It Will They Come?" A Diagnostic Study Investigating Barriers to HIV Treatment and Care Among Children. Washington DC: Population Council. [13] Liambila, W., Askew, I., Mwangi, J., Ayis, R., Kibaru, J., & Mullick, S. (2009). Feasibility and Effectiveness of Integrating Provider-Initiated Testing and Counselling with Family Planning Services in Kenya. Journal of the International AIDS Society, Volume 23, pages 115-121. [14] Lowrance, D., & et.al. (2007). Lower Early Mortality Rates Among Patients Receiving Antiretroviral Treatment at Clinics Offering Cotrimoxazole Prophylaxis in Malawi. Journal of International AIDS Society, Volume 46, pages 56-61. [15] Lubega, M., Nsabagasani, X., Tumwesigye, N., Wabwire-Mangen, F., Ekstrom, A., Pariyo, G., et al. (2009). Policy and Lost in Transition: Reasons for High Drop-Out from Pre-antiretroviral Care in Resource-Poor Settings of Eastern Uganda. Health Policy Journal, 153-158. [16] Machingura, F., Rusike, I., Mutasa, E., Sharara, E., & Kaim, B. (2011). Strengthening Community Health System for HIV Treatment, Support and Care in Goromonzi District, Zimbabwe. Harare: Training and Research Centre. [17] Muriuki, J., Thuku, M., Njoroge, D., Mulwa, A., Kathambara, M., Kiema, J., Annette, A., Asfaw, Y. and Doll, K. (2015). Case Study on Human Resource Commitment: Kenya. Chapel Hill, North Carolina, USA: IntraHealth International. [18] National AIDS Control Council. (2014). Kenya AIDS Strategic Framework 2014/2015-2018/2019. Nairobi: Ministry of Health Kenya. [19] National AIDS Control Council. (2012). The Kenya AIDS Epidemic Update 2011. Nairobi: Government of Kenya. [20] Njagi, E., Matoke, J., Kanyara, L., Waruingi, M., Kamau, T., Kiare, J., et al. (2003). Health Facilities Preparedness for AIDS Care and Treatment in Kenya. Nairobi. [21] Nkengason, N., Birx, D., & Sankale, J. (2009). Challenges in Developing Laboratory Capacity and Infrastructure to Support HIV/AIDS Care Programs. Centers for Disease Control and Prevention, Global AIDS Program, USA. [22] Odindo, M., & Mwanthi, M. (2008). Role of Non-governmental Organizations in Mitigation of Stigma and Discrimination Among HIV/AIDS Persons in Kebera, Kenya. East African Journal of Public Health, Vol 5, No 5, pages 1-5. [23] Shisana, O. (2003). The Impact of HIV/AIDS on the Health Sector: A National Survey of Health Personnel, Ambulatory and Hospitalized Patients and Health Facilities. South Africa: National Department of Health. [24] UNAIDS. (2001). HIV and AIDS Care and Support. Geneva: UNAIDS. [25] UNAIDS. (2009). Kenya National AIDS Spending Report for the Financial Years 2006/07 and 2007/08. Geneva: UNAIDS. [26] UNAIDS. (2012). Report on the Global Epidemic. Geneva: UNAIDS. [27] Wasti, P., Simkhada, J., & Teijlingen, E. (2009). Issues and Challenges of HIV/AIDS Prevention and Treatment Programme in Nepal. Global Journal of Health Science, Vol 1 pages 62-72. [28] Wasti, P., Simkhada, J., & Teijlingen, E. (2009). Issues and Challenges of HIV/AIDS Prevention and Treatment Programmes in Nepal. Global Journal of Health Science, Volume 1 pages 62-72. [29] WHO. (2004). HIV/AIDS Care and Treatment: Guide for Implementation. Geneva: WHO. [30] WHO. (2000). The World Health Report 2000: Health Systems - Improving Performance. Geneva: World Health Organisation. [31] Zerfu, A., Yaya, Y., Dagne, S., Deribe, K., & Biadgirlign, S. (2012). Home and Community Based Care Program Assessment for People Living with HIV/AIDS in Araba Minch, Southern Ethiopia..BMC Palliative Care, Volume 11.