Progress or just promises? HIV patients reflect on the new HIV care system at PGH

More than two months have passed since Mtaa Wangu published an exclusive report on the distress experienced by patients living with HIV as they navigate the new care systems (the integration of services) at Nakuru PGH.

The initial report, published on May 5, 2025, revealed that integrating HIV services into general outpatient care had left many patients feeling exposed and inadequately supported.

Now, patients and county officials confirm that several of the issues raised in the article have been addressed, though some have different views.

John* who uses the facility's services says they no longer have to go to the hospital in person to collect their medication.

"They send the drugs to where you are," he said, describing this as a more convenient option than queuing for hours at the referral hospital.

Although the drug delivery system had begun early in the year, it had slowed down. This most patients presumed was due to the USAID funding crisis. 

"The delivery service is OK. It’s more convenient than going to PGH and queuing. Also, we receive phone calls as reminders to test our viral load, which often depends on other factors, including age,” he said.

However, Frida shares a different experience, saying that they still have to queue at Gilgil sub-county hospital and have not noticed any meaningful changes since the integration.

She expressed concern about being placed in the same waiting areas as other patients, noting an increased risk of exposure to other infections.

"We still line up at the hospital since the integration happened, and nothing has changed. It’s even riskier now, sharing the same space with people who have other conditions,” she says.

The Department of Health maintains that the integration of services is intended to replace disjointed care with a single service point, thereby ensuring improved continuity of care.

Dr Joy Mugambi, Director of Health Planning and Administration, says that, globally, the system has been used to enhance confidentiality and reduce stigma.

"For us, the goal was to promote equity and universality by offering services at a single point. We also wanted to make better use of all available human resources and ensure that staff are familiar with the different service points within the facility. This improves care and enhances their market value. At the same time, we had to adapt to the withdrawal of donor funding," Dr Mugambi says.

According to Dr Mugambi all service providers stationed across all facilities in the county have now undergone thorough training, that USAID-seconded staff have been reinstated and integrated into service delivery, and that the only remaining challenge is ensuring continuity of care.

"While there have been challenges, we have also had several successes," she says.

When asked about the continued use of identification cards for patients in emergency areas of other facilities following the integration, something some clients say compromises their privacy, Dr Mugambi acknowledges the concern, saying the department is actively working on a solution.

"We’re trying to transition from the card system to a digital platform where patients are identified by name through the system, not by a card,' she says.

"It's a work in progress. As we continue to digitise the health system, the use of physical cards will be phased out, improving both confidentiality and the quality of care at the first point of contact."

The electronic medical records system she says is already in use at Nakuru PGH and will be rolled out to more facilities.

Regarding patients defaulting on medication due to the changes, Dr Joy says that adherence is an individual choice. However, there has been no alarming rise in defaulters since the integration compared to when the CCCs existed.

"We have a drug delivery system for those who may not be able to reach their nearest service point, which is either near a health facility or pharmacy, on time. This system has worked successfully for us," she says, adding that, unlike the former CCCs, care is now available at any time, including weekends, and patients can seek services on Saturdays or Sundays, during the day or at night.

Regarding service points and the risk of contracting other conditions, Dr Mugambi says that maintaining hygiene is an individual responsibility. The hospital has also done its part to ensure that the spaces are hygienic and well-ventilated to accommodate patients and provide care.

“All our level four facilities have a digital health system enabling one to just use their ID card for name purposes and then a unique number is generated. if an individual feels at risk of cross infection while in hospital its advisable to wear a mask and maintain hygiene," she explains.

However, according to the Nakuru County deputy AIDS and STI coordinator, Martha Kahura, HIV management is digitised in 88 facilities in Nakuru out of the 172 facilities that are offering HIV services. 93 are still using Electronic Medical Records (EMR).