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Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Care | Research article

Challenges with seeking HIV care services: perspectives of older adults infected with HIV in western Kenya

Authors: Jepchirchir Kiplagat, Ann Mwangi, Charles Chasela, Susann Huschke

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

While younger adults (15–49 years) form the majority of the population living with HIV, older adults (≥50 years) infected with HIV face multiple challenges related to the aging process and HIV. We explored the experiences of older persons infected with HIV at the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya to understand the challenges faced when seeking HIV care services.

Methods

Between November 2016 and April 2017, a total of 57 adults aged 50 years and above were recruited from two AMPATH facilities – one rural and one urban facility. A total of 25 in-depth interviews and four focus group discussions were conducted, audio-recorded, transcribed and thematic analysis performed.

Results

Study participants raised unique challenges with seeking HIV care that include visits to multiple healthcare providers to manage HIV and comorbidities and as a result impact on their adherence to medication and clinical visits. Challenges with inadequate quality of facilities and poor patient-provider communication were also raised. Participants’ preference for matched gender and older age for care providers that serve older patients were identified.

Conclusion

Results indicate multiple challenges faced by older adults that need attention in ensuring continuous engagement in HIV care. Targeted HIV care for older adults would, therefore, significantly improve their access to and experience of HIV care. Of key importance is the integration of other chronic diseases into HIV care and employing staff that matches the needs of older adults.
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Literature
1.
go back to reference Joint United Nations Programme on HIV/AIDS. Global AIDS update 2016. Geneva: UNAIDS; 2016. Joint United Nations Programme on HIV/AIDS. Global AIDS update 2016. Geneva: UNAIDS; 2016.
2.
go back to reference Joint United Nations Programme on HIV/AIDS. UNAIDS data 2017. Geneva: UNAIDS; 2017. Joint United Nations Programme on HIV/AIDS. UNAIDS data 2017. Geneva: UNAIDS; 2017.
3.
go back to reference Kiplagat J, Mwangi A, Keter A, Braitstein P, Sang E, Negin J, Chasela C. Retention in care among older adults living with HIV in western Kenya: a retrospective observational cohort study. PLoS One. 2018;13(3):e0194047.PubMedPubMedCentralCrossRef Kiplagat J, Mwangi A, Keter A, Braitstein P, Sang E, Negin J, Chasela C. Retention in care among older adults living with HIV in western Kenya: a retrospective observational cohort study. PLoS One. 2018;13(3):e0194047.PubMedPubMedCentralCrossRef
4.
go back to reference Post FA. Managing chronic kidney disease in the older adults living with HIV. Curr Opin Infect Dis. 2017;30(1):4–11.PubMed Post FA. Managing chronic kidney disease in the older adults living with HIV. Curr Opin Infect Dis. 2017;30(1):4–11.PubMed
6.
go back to reference Mutevedzi PC, Lessells RJ, Rodger AJ, Newell M-L. Association of age with mortality and virological and immunological response to antiretroviral therapy in rural south African adults. PLoS One. 2011;6(7):e21795.PubMedPubMedCentralCrossRef Mutevedzi PC, Lessells RJ, Rodger AJ, Newell M-L. Association of age with mortality and virological and immunological response to antiretroviral therapy in rural south African adults. PLoS One. 2011;6(7):e21795.PubMedPubMedCentralCrossRef
7.
go back to reference Rodriguez-Penney AT, Iudicello JE, Riggs PK, Doyle K, Ellis RJ, Letendre SL, Grant I, Woods SP, The HIV Neurobehavioral Research Program Group. Co-morbidities in persons infected with HIV: increased burden with older age and negative effects on health-related quality of life. AIDS Patient Care STDs. 2013;27(1):5–16.PubMedPubMedCentralCrossRef Rodriguez-Penney AT, Iudicello JE, Riggs PK, Doyle K, Ellis RJ, Letendre SL, Grant I, Woods SP, The HIV Neurobehavioral Research Program Group. Co-morbidities in persons infected with HIV: increased burden with older age and negative effects on health-related quality of life. AIDS Patient Care STDs. 2013;27(1):5–16.PubMedPubMedCentralCrossRef
8.
go back to reference Greene M, Steinman MA, McNicholl IR, Valcour V. Polypharmacy, drug–drug interactions, and potentially inappropriate medications in older adults with human immunodeficiency virus infection. J Am Geriatr Soc. 2014;62(3):447–53.PubMedPubMedCentralCrossRef Greene M, Steinman MA, McNicholl IR, Valcour V. Polypharmacy, drug–drug interactions, and potentially inappropriate medications in older adults with human immunodeficiency virus infection. J Am Geriatr Soc. 2014;62(3):447–53.PubMedPubMedCentralCrossRef
9.
go back to reference Tseng A, Szadkowski L, Walmsley S, Salit I, Raboud J. Association of age with polypharmacy and risk of drug interactions with antiretroviral medications in HIV-positive patients. Ann Pharmacother. 2013;47(11):1429–39.PubMedCrossRef Tseng A, Szadkowski L, Walmsley S, Salit I, Raboud J. Association of age with polypharmacy and risk of drug interactions with antiretroviral medications in HIV-positive patients. Ann Pharmacother. 2013;47(11):1429–39.PubMedCrossRef
10.
go back to reference Quinn K, Sanders C, Petroll AE. “HIV is not going to kill me, old age is!”: the intersection of aging and HIV for older HIV-infected adults in rural communities. AIDS Educ Prev. 2017;29(1):62–76.PubMedPubMedCentralCrossRef Quinn K, Sanders C, Petroll AE. “HIV is not going to kill me, old age is!”: the intersection of aging and HIV for older HIV-infected adults in rural communities. AIDS Educ Prev. 2017;29(1):62–76.PubMedPubMedCentralCrossRef
11.
go back to reference Heckman TG, Heckman B, Kochman A, Sikkema KJ, Suhr J, Goodkin K. Psychological symptoms among persons 50 years of age and older living with HIV disease. Aging Ment Health. 2002;6(2):121–8.PubMedCrossRef Heckman TG, Heckman B, Kochman A, Sikkema KJ, Suhr J, Goodkin K. Psychological symptoms among persons 50 years of age and older living with HIV disease. Aging Ment Health. 2002;6(2):121–8.PubMedCrossRef
12.
go back to reference Kuteesa MO, Wright S, Seeley J, Mugisha J, Kinyanda E, Kakembo F, Mwesigwa R, Scholten F. Experiences of HIV-related stigma among HIV-positive older persons in Uganda–a mixed methods analysis. SAHARA-J. 2014;11(1):126–37.PubMedPubMedCentralCrossRef Kuteesa MO, Wright S, Seeley J, Mugisha J, Kinyanda E, Kakembo F, Mwesigwa R, Scholten F. Experiences of HIV-related stigma among HIV-positive older persons in Uganda–a mixed methods analysis. SAHARA-J. 2014;11(1):126–37.PubMedPubMedCentralCrossRef
13.
go back to reference Emlet CA. “You're awfully old to have this disease”: experiences of stigma and ageism in adults 50 years and older living with HIV/AIDS. Gerontologist. 2006;46(6):781–90.PubMedCrossRef Emlet CA. “You're awfully old to have this disease”: experiences of stigma and ageism in adults 50 years and older living with HIV/AIDS. Gerontologist. 2006;46(6):781–90.PubMedCrossRef
14.
go back to reference Emlet CA, Poindexter CC. Unserved, unseen, and unheard: integrating programs for HIV-infected and HIV-affected older adults. Health Soc Work. 2004;29(2):86–96.PubMedCrossRef Emlet CA, Poindexter CC. Unserved, unseen, and unheard: integrating programs for HIV-infected and HIV-affected older adults. Health Soc Work. 2004;29(2):86–96.PubMedCrossRef
15.
go back to reference dos Santos MM, Kruger P, Mellors SE, Wolvaardt G, van der Ryst E. An exploratory survey measuring stigma and discrimination experienced by people living with HIV/AIDS in South Africa: the people living with HIV stigma index. BMC Public Health. 2014;14(1):80.PubMedPubMedCentralCrossRef dos Santos MM, Kruger P, Mellors SE, Wolvaardt G, van der Ryst E. An exploratory survey measuring stigma and discrimination experienced by people living with HIV/AIDS in South Africa: the people living with HIV stigma index. BMC Public Health. 2014;14(1):80.PubMedPubMedCentralCrossRef
16.
go back to reference Pindani M, Nkondo M, Maluwa A, Muheriwa S. Stigma and discrimination against people living with HIV and AIDS in Malawi. World J AIDS. 2014;4:123–32.CrossRef Pindani M, Nkondo M, Maluwa A, Muheriwa S. Stigma and discrimination against people living with HIV and AIDS in Malawi. World J AIDS. 2014;4:123–32.CrossRef
17.
go back to reference Emlet CA, Brennan DJ, Brennenstuhl S, Rueda S, Hart TA, Rourke SB. The impact of HIV-related stigma on older and younger adults living with HIV disease: does age matter? AIDS Care. 2015;27(4):520–8.PubMedCrossRef Emlet CA, Brennan DJ, Brennenstuhl S, Rueda S, Hart TA, Rourke SB. The impact of HIV-related stigma on older and younger adults living with HIV disease: does age matter? AIDS Care. 2015;27(4):520–8.PubMedCrossRef
18.
go back to reference Zukoski AP, Thorburn S. Experiences of stigma and discrimination among adults living with HIV in a low HIV-prevalence context: a qualitative analysis. AIDS Patient Care STDs. 2009;23(4):267–76.PubMedCrossRef Zukoski AP, Thorburn S. Experiences of stigma and discrimination among adults living with HIV in a low HIV-prevalence context: a qualitative analysis. AIDS Patient Care STDs. 2009;23(4):267–76.PubMedCrossRef
19.
go back to reference Shippy RA, Karpiak SE. Perceptions of support among older adults with HIV. Res Aging. 2005;27(3):290–306.CrossRef Shippy RA, Karpiak SE. Perceptions of support among older adults with HIV. Res Aging. 2005;27(3):290–306.CrossRef
20.
go back to reference Asante KO. Social support and the psychological wellbeing of people living with HIV/AIDS in Ghana. Afr J Psychiatry. 2012;15(5):340–5.CrossRef Asante KO. Social support and the psychological wellbeing of people living with HIV/AIDS in Ghana. Afr J Psychiatry. 2012;15(5):340–5.CrossRef
21.
go back to reference Rueda S, Law S, Rourke SB. Psychosocial, mental health, and behavioral issues of aging with HIV. Curr Opin HIV AIDS. 2014;9(4):325–31.PubMedCrossRef Rueda S, Law S, Rourke SB. Psychosocial, mental health, and behavioral issues of aging with HIV. Curr Opin HIV AIDS. 2014;9(4):325–31.PubMedCrossRef
22.
go back to reference Schrimshaw EW, Siegel K. Perceived barriers to social support from family and friends among older adults with HIV/AIDS. J Health Psychol. 2003;8(6):738–52.PubMedCrossRef Schrimshaw EW, Siegel K. Perceived barriers to social support from family and friends among older adults with HIV/AIDS. J Health Psychol. 2003;8(6):738–52.PubMedCrossRef
23.
go back to reference Ozbay F, Johnson DC, Dimoulas E, Morgan C III, Charney D, Southwick S. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont). 2007;4(5):35. Ozbay F, Johnson DC, Dimoulas E, Morgan C III, Charney D, Southwick S. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont). 2007;4(5):35.
25.
go back to reference Einterz RM, Kimaiyo S, Mengech HN, Khwa-Otsyula BO, Esamai F, Quigley F, Mamlin JJ. Responding to the HIV pandemic: the power of an academic medical partnership. Acad Med. 2007;82(8):812–8.PubMedCrossRef Einterz RM, Kimaiyo S, Mengech HN, Khwa-Otsyula BO, Esamai F, Quigley F, Mamlin JJ. Responding to the HIV pandemic: the power of an academic medical partnership. Acad Med. 2007;82(8):812–8.PubMedCrossRef
26.
go back to reference Kiplagat J, Huschke S. HIV testing and counselling experiences: a qualitative study of older adults living with HIV in western Kenya. BMC Geriatr. 2018;18(1):257.PubMedPubMedCentralCrossRef Kiplagat J, Huschke S. HIV testing and counselling experiences: a qualitative study of older adults living with HIV in western Kenya. BMC Geriatr. 2018;18(1):257.PubMedPubMedCentralCrossRef
27.
go back to reference Berger LK, Otto-Salaj LL, Stoffel VC, Hernandez-Meier J, Gromoske AN. Barriers and facilitators of transferring research to practice: an exploratory case study of motivational interviewing. J Soc Work Pract Addict. 2009;9(2):145–62.CrossRef Berger LK, Otto-Salaj LL, Stoffel VC, Hernandez-Meier J, Gromoske AN. Barriers and facilitators of transferring research to practice: an exploratory case study of motivational interviewing. J Soc Work Pract Addict. 2009;9(2):145–62.CrossRef
29.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
30.
go back to reference Miles MB, Huberman AM, Huberman MA, Huberman M. Qualitative data analysis: an expanded sourcebook: Sage; 1994. Miles MB, Huberman AM, Huberman MA, Huberman M. Qualitative data analysis: an expanded sourcebook: Sage; 1994.
31.
go back to reference Cloete A, Strebel A, Simbayi L, van Wyk B, Henda N, Nqeketo A. Challenges faced by people living with HIV/AIDS in Cape Town, South Africa: Issues for group risk reduction interventions. AIDS Res Treat. 2010;2010:420270.CrossRef Cloete A, Strebel A, Simbayi L, van Wyk B, Henda N, Nqeketo A. Challenges faced by people living with HIV/AIDS in Cape Town, South Africa: Issues for group risk reduction interventions. AIDS Res Treat. 2010;2010:420270.CrossRef
32.
go back to reference Jesus GJ, Oliveira LB, Caliari JS, Queiroz AAFL, Gir E, Reis RK. Difficulties of living with HIV/Aids: obstacles to quality of life. Acta Paulista de Enfermagem. 2017;30(3):301–7.CrossRef Jesus GJ, Oliveira LB, Caliari JS, Queiroz AAFL, Gir E, Reis RK. Difficulties of living with HIV/Aids: obstacles to quality of life. Acta Paulista de Enfermagem. 2017;30(3):301–7.CrossRef
33.
go back to reference Karpiak SE, Havlik R. Are HIV-Infected Older Adults Aging Differently? In: HIV and Aging. Volume 42. Karger Publishers; 2017. p. 11–27. Karpiak SE, Havlik R. Are HIV-Infected Older Adults Aging Differently? In: HIV and Aging. Volume 42. Karger Publishers; 2017. p. 11–27.
34.
go back to reference Halkitis PN, Krause KD, Vieira DL. Mental Health, Psychosocial Challenges and Resilience in Older Adults Living with HIV. In: HIV and Aging. Volume 42. Karger Publishers; 2017. p. 187–203. Halkitis PN, Krause KD, Vieira DL. Mental Health, Psychosocial Challenges and Resilience in Older Adults Living with HIV. In: HIV and Aging. Volume 42. Karger Publishers; 2017. p. 187–203.
35.
go back to reference Schatz E, Seeley J, Negin J, Weiss HA, Tumwekwase G, Kabunga E, Nalubega P, Mugisha J. “For us here, we remind ourselves”: strategies and barriers to ART access and adherence among older Ugandans. BMC Public Health. 2019;19(1):131.PubMedPubMedCentralCrossRef Schatz E, Seeley J, Negin J, Weiss HA, Tumwekwase G, Kabunga E, Nalubega P, Mugisha J. “For us here, we remind ourselves”: strategies and barriers to ART access and adherence among older Ugandans. BMC Public Health. 2019;19(1):131.PubMedPubMedCentralCrossRef
36.
go back to reference Schatz E, Seeley J, Negin J, Mugisha J. They ‘don't cure old age’: older Ugandans’ delays to health-care access. Ageing Soc. 2018;38(11):2197–217.CrossRef Schatz E, Seeley J, Negin J, Mugisha J. They ‘don't cure old age’: older Ugandans’ delays to health-care access. Ageing Soc. 2018;38(11):2197–217.CrossRef
37.
38.
go back to reference Negin J, Martiniuk A, Cumming RG, Naidoo N, Phaswana-Mafuya N, Madurai L, Williams S, Kowal P. Prevalence of HIV and chronic comorbidities among older adults. AIDS. 2012;26:S55–63.PubMedPubMedCentralCrossRef Negin J, Martiniuk A, Cumming RG, Naidoo N, Phaswana-Mafuya N, Madurai L, Williams S, Kowal P. Prevalence of HIV and chronic comorbidities among older adults. AIDS. 2012;26:S55–63.PubMedPubMedCentralCrossRef
39.
go back to reference Ball SC. Increased longevity in HIV: caring for older HIV-infected adults. Care Manag J. 2014;15(2):76.PubMedCrossRef Ball SC. Increased longevity in HIV: caring for older HIV-infected adults. Care Manag J. 2014;15(2):76.PubMedCrossRef
40.
go back to reference Rachlis B, Naanyu V, Wachira J, Genberg B, Koech B, Kamene R, Akinyi J, Braitstein P. Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya. BMC Public Health. 2016;16(1):741.PubMedPubMedCentralCrossRef Rachlis B, Naanyu V, Wachira J, Genberg B, Koech B, Kamene R, Akinyi J, Braitstein P. Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya. BMC Public Health. 2016;16(1):741.PubMedPubMedCentralCrossRef
41.
go back to reference Labhardt ND, Balo JR, Ndam M, Manga E, Stoll B. Improved retention rates with low-cost interventions in hypertension and diabetes management in a rural African environment of nurse-led care: a cluster-randomised trial. Tropical Med Int Health. 2011;16(10):1276–84.CrossRef Labhardt ND, Balo JR, Ndam M, Manga E, Stoll B. Improved retention rates with low-cost interventions in hypertension and diabetes management in a rural African environment of nurse-led care: a cluster-randomised trial. Tropical Med Int Health. 2011;16(10):1276–84.CrossRef
42.
go back to reference Knight L, Schatz E, Mukumbang FC. “I attend at Vanguard and I attend here as well”: barriers to accessing healthcare services among older South Africans with HIV and non-communicable diseases. Int J Equity Health. 2018;17(1):147.PubMedPubMedCentralCrossRef Knight L, Schatz E, Mukumbang FC. “I attend at Vanguard and I attend here as well”: barriers to accessing healthcare services among older South Africans with HIV and non-communicable diseases. Int J Equity Health. 2018;17(1):147.PubMedPubMedCentralCrossRef
43.
go back to reference Zakumumpa H, Rujumba J, Kwiringira J, Kiplagat J, Namulema E, Muganzi A. Understanding the persistence of vertical (stand-alone) HIV clinics in the health system in Uganda: a qualitative synthesis of patient and provider perspectives. BMC Health Serv Res. 2018;18(1):690.PubMedPubMedCentralCrossRef Zakumumpa H, Rujumba J, Kwiringira J, Kiplagat J, Namulema E, Muganzi A. Understanding the persistence of vertical (stand-alone) HIV clinics in the health system in Uganda: a qualitative synthesis of patient and provider perspectives. BMC Health Serv Res. 2018;18(1):690.PubMedPubMedCentralCrossRef
45.
go back to reference Emlet CA. Understanding the impact of stigma on older adults with HIV. Psychol AIDS Exchange Newslet. 2014. Emlet CA. Understanding the impact of stigma on older adults with HIV. Psychol AIDS Exchange Newslet. 2014.
46.
go back to reference French H, Greeff M, Watson MJ, Doak CM. HIV stigma and disclosure experiences of people living with HIV in an urban and a rural setting. AIDS Care. 2015;27(8):1042–6.PubMedCrossRef French H, Greeff M, Watson MJ, Doak CM. HIV stigma and disclosure experiences of people living with HIV in an urban and a rural setting. AIDS Care. 2015;27(8):1042–6.PubMedCrossRef
47.
go back to reference Earnshaw VA, Lang SM, Lippitt M, Jin H, Chaudoir SR. HIV stigma and physical health symptoms: do social support, adaptive coping, and/or identity centrality act as resilience resources? AIDS Behav. 2015;19(1):41–9.CrossRef Earnshaw VA, Lang SM, Lippitt M, Jin H, Chaudoir SR. HIV stigma and physical health symptoms: do social support, adaptive coping, and/or identity centrality act as resilience resources? AIDS Behav. 2015;19(1):41–9.CrossRef
48.
go back to reference Kuteesa MO, Seeley J, Cumming RG, Negin J. Older people living with HIV in Uganda: understanding their experience and needs. Afr J AIDS Res. 2012;11(4):295–305.PubMedCrossRef Kuteesa MO, Seeley J, Cumming RG, Negin J. Older people living with HIV in Uganda: understanding their experience and needs. Afr J AIDS Res. 2012;11(4):295–305.PubMedCrossRef
49.
go back to reference MacPherson P, MacPherson EE, Mwale D, Squire SB, Makombe SD, Corbett EL, Lalloo DG, Desmond N. Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi. J Int AIDS Soc. 2012;15(2):18020. MacPherson P, MacPherson EE, Mwale D, Squire SB, Makombe SD, Corbett EL, Lalloo DG, Desmond N. Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi. J Int AIDS Soc. 2012;15(2):18020.
50.
go back to reference Kearney F, Moore AR, Donegan CF, Lambert J. The ageing of HIV: implications for geriatric medicine. Age and Ageing. 2010;39(5):536–41.PubMedCrossRef Kearney F, Moore AR, Donegan CF, Lambert J. The ageing of HIV: implications for geriatric medicine. Age and Ageing. 2010;39(5):536–41.PubMedCrossRef
51.
go back to reference Hurley EA, Harvey SA, Keita M, Kennedy CE, Roter D, Dao S, Doumbia S, Winch PJ. Patient-provider communication styles in HIV treatment programs in Bamako, Mali: a mixed-methods study to define dimensions and measure patient preferences. SSM-Popul Health. 2017;3:539–48.PubMedPubMedCentralCrossRef Hurley EA, Harvey SA, Keita M, Kennedy CE, Roter D, Dao S, Doumbia S, Winch PJ. Patient-provider communication styles in HIV treatment programs in Bamako, Mali: a mixed-methods study to define dimensions and measure patient preferences. SSM-Popul Health. 2017;3:539–48.PubMedPubMedCentralCrossRef
52.
go back to reference Wachira J, Middlestadt S, Reece M, Peng C-YJ, Braitstein P. Physician communication behaviors from the perspective of adult HIV patients in Kenya. Int J Qual Health Care. 2014;26(2):190–7.PubMedCrossRef Wachira J, Middlestadt S, Reece M, Peng C-YJ, Braitstein P. Physician communication behaviors from the perspective of adult HIV patients in Kenya. Int J Qual Health Care. 2014;26(2):190–7.PubMedCrossRef
53.
go back to reference Mutevedzi PC, Newell M-L. A missing piece in the puzzle: HIV in mature adults in sub-Saharan Africa. Futur Virol. 2011;6(6):755–67.CrossRef Mutevedzi PC, Newell M-L. A missing piece in the puzzle: HIV in mature adults in sub-Saharan Africa. Futur Virol. 2011;6(6):755–67.CrossRef
54.
go back to reference Negin J, Cumming RG. HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. Bull World Health Organ. 2010;88(11):847–53.PubMedPubMedCentralCrossRef Negin J, Cumming RG. HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. Bull World Health Organ. 2010;88(11):847–53.PubMedPubMedCentralCrossRef
55.
go back to reference Gebo KA. Epidemiology of HIV and response to antiretroviral therapy in the middle aged and elderly; 2008.CrossRef Gebo KA. Epidemiology of HIV and response to antiretroviral therapy in the middle aged and elderly; 2008.CrossRef
56.
go back to reference Kyobutungi C, Ezeh AC, Zulu E, Falkingham J. HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey. BMC Public Health. 2009;9(1):153.PubMedPubMedCentralCrossRef Kyobutungi C, Ezeh AC, Zulu E, Falkingham J. HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey. BMC Public Health. 2009;9(1):153.PubMedPubMedCentralCrossRef
57.
go back to reference Mall F. The impact of HIV/AIDS on older people. Human Exchange Mag. 2005;5:29–31. Mall F. The impact of HIV/AIDS on older people. Human Exchange Mag. 2005;5:29–31.
Metadata
Title
Challenges with seeking HIV care services: perspectives of older adults infected with HIV in western Kenya
Authors
Jepchirchir Kiplagat
Ann Mwangi
Charles Chasela
Susann Huschke
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7283-2

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