Barriers and facilitators of care among visceral leishmaniasis patients following the implementation of a decentralized model in Turkana County, Kenya

Turkana County is among the eleven counties in Kenya endemic for Visceral Leishmaniasis (VL). Early diagnosis and management is crucial to improving quality of life, reducing related morbidity and mortality, and disease transmission. In Turkana County, Foundation for Innovative New Diagnostics (FIND) has undertaken significant work in supporting the decentralization of access to VL treatment. Despite this decentralization efforts, barriers to access care for VL still exist. This study sought to investigate the barriers and facilitators to VL care during the implementation of the decentralized model in Turkana County. A descriptive qualitative study was conducted in four health facilities within Turkana County. Data was collected using 13 in-depth interviews (IDIs) with VL patients/caregivers of children below 18 years, and 16 key informants' interviews (KIIs) with health care workers. Data was audio recorded using a digital voice recorder, transcribed verbatim and analyzed using NVivo version 12. Due to low awareness of VL, majority of the patients did not directly associate VL symptoms to the disease. Barriers to seeking care were long distances to healthcare facilities, high transportation and other associated costs, and the initial use of traditional remedies. Facilitators for accessing care included referrals from diagnostic centers, medical camps and outreach programs, and support from community health promoters (CHPs). Notably, there was no reported stigma at either the individual or the community level among the VL patients. Despite patients awareness of the VL diagnosis and treatment centers, there was delay in seeking care due to inaccessibility of the centers. The delay is attributed to the large vast rural nature of the county, and the low socio-economic status of the affected communities. There is need for socio-economic support for the patients to access the treatment centers, and to provide comprehensive management to enable the attainment of the VL elimination goal in Kenya.