Factors associated with initiation of Cotrimoxazole Prophylaxis among people living with HIV in Busia District

Abstract

Introduction: HIV/AIDS remains one of the leading causes of morbidity and mortality and much of this morbidity and mortality is due to opportunistic infections some of which can be prevented using cotrimoxazole. In Busia District, only 28% of all persons who test HIV positive in health facilities start cotrimoxazole prophylaxis, yet every HIV positive person should be on prophylaxis. Objective: To determine factors associated with initiation of cotrimoxazole prophylaxis among people living with HIV in Busia District. Methodology: A case-control study involving 306 people living with HIV (153 cases and 153 controls) was conducted in Busia district in 4 health units of Busia, Masafu, Daban HCIV’s and Lumino HC III. Using probability proportionate to size sampling, the number of respondents from each health unit was determined. These were interviewed consecutively as they presented to the health facility. Results: The mean age of cases was 31.75 years and that for controls was 32.9 years. There was no statistically significant difference observed between the mean ages for cases and controls (student’s t-test = 0.744, p= 0.458). Independent predictors of initiation of cotrimoxazole prophylaxis included: client related, health service and community related factors. The client related factors affecting initiation of cotrimoxazole prophylaxis were subsistence farmer (AOR = 17.82, 95%CI =7.91-40.12) and lack of knowledge on consequences of opportunistic infections (AOR = 4.91, 95%CI = 2.86-8.45). The health service related factors affecting initiation of cotrimoxazole prophylaxis were staying > 5 kms from the nearest health facility (AOR = 2.39, 95%CI = 1.18-4.88) and waiting time for > 1 hour before receiving a service (AOR = 6.44, 95%CI = 3.14-13.21), and the community related factors failure to disclose one’s HIV positive status (AOR = 2.95, 95%CI = 1.40-6.23 and lack of support (AOR = 4.68, 95%CI = 2.37-9.26). Conclusions and recommendations: There is need to decentralize and scale up HIV/AIDS services especially provision of cotrimoxazole prophylaxis to all Health Centre III’s in the district. Community outreaches should also be conducted to take services closer to where majority of the people stay. There is need to strengthen HIV counselling services with emphasis on disclosure and creating awareness on consequences of opportunistic infections. The district should plan for and conduct community mobilization and sensitization on HIV/AIDS so as to create awareness and demand for services. Stigma reduction strategies should be designed to facilitate disclosure in order to improve initiation of cotrimoxazole prophylaxis.