ICAP Kenya Programming

1
ICAP- Kenya Programming
International Center for AIDS Care and Treatment
Programs Annual Meeting, March 2006 Dar Es
Salaam, Tanzania

• David Hoos, MD, MPH
• March 2006

2
ICAP-Kenya

• Through 2005, ICAP-Kenya programming has been as
  a collaboration between Indiana University, Moi
  Referral and Teaching Hospital and Moi University
  College of Health Sciences (AMPATH Program), in
  Western Kenya
• COP 06 funds were added by CDC-Kenya for Columbia
  University to implement direct programming at
  clinical sites in Central Province
• Over the next few years, ICAP can expect
  significant growth in funds in Kenya, all focused
  on this direct implementation.

3
Columbia University Supported Sites - 2004/2005
and 2005/2006

• 2004/2005 Sites
• Mosoriot
• Turbo
• Chulaimbo
• Naitiri
• Burnt Forest
• Amukuru
• Webuye
• Teso

• 2005/2006 Sites
• Thika District Hospital
• Jomo Kenyatta University Agricultural at Thika
  (JKUAT)
• Gitundu sub District Hospital
• Kiambu sub District Hospital

4
ICAP- Kenya

• Clinical support at CU supported AMPATH sites in
  western Kenya
• Large and dispersed HIV care program, in mix of
  urban, periurban and rural sites
• Clinical staff virtually all public sector
  employees
• Roll out of primary care model, with referral
  center and peripheral clinics has worked well for
  adults
• Care for children in the primary care network has
  not been sufficiently addressed.

5
Western Kenya Provide HIV care and ART with
7,700 and 3,700 patients, respectively
6
Western Kenya Enhance patient information
systems and data collection

• Extensive and expansive data collection system
  significantly beyond national guidelines
  currently entered by data managers
• Moving towards electronic medical record with
  VSAT communication
• Significant investment in systems

7
W. Kenya Enhancement of laboratory

• Establishment of reference regional laboratory
• Triage of lab testing for primary health care
  level and reference lab
• Assessment that motor vehicle transport of
  samples more efficient and assures quality rather
  than expanding laboratory
• Laboratory results distributed by same system of
  vehicles

8
Enhance nutritional support services for HIV
infected patients

• Food security remains an issue for many people
  with HIV infection.
• World Food Program, USAID and privately raised
  funds will likely meet most nutritional needs
  but
• the need for infrastructure to deliver the food
  and to monitor and evaluate outcomes, and
• need for rapid expansion of the Family
  Preservation Initiative (micro-enterprise
  initiative) to transition the patients from food
  support towards productive employment.

9
Expansion of Pediatric Programming in Kenya

• A new model of pediatric clinical support is
  being piloted
• Lack of systems for provision of pediatric HIV
  care in context of family focused care
• Lack of tools for tracking of HIV exposed
  children
• Limited guidelines and tools for pediatric HIV
  care
• Provision of pediatric HIV clinical and
  programmatic expert, Dr. Steve Arpadi to AMPATH
  system to develop these tools
• These tools for pediatric program support will be
  shared with all ICAP programs

10
Lessons learned in Western Kenya

• Sites located at a distance from paved roads can
  expect slow start up in enrollment
• It is possible to integrate innovative health
  systems within existing MOH care systems
• Great attention needs to be paid to nutrition,
  micro-enterprise initiatives and orphan services
• Attention to various forms of provider
  recognition is critical to avoiding provider
  fatigue or burn out
• Attention to medical records and information
  management is critical to success
• Multidisciplinary teams are essential to provide
  high quality HIV care
• Once HIV services are available, patient
  recruitment is brisk
• Need for expanded space to deliver services and
  develop innovative models of care delivery

11
Lessons learned in Western Kenya working with an
implementing partner

• Current projects in western Kenya have tension
  between identity as implementing partner or as
  collaborator
• Divergence from national and ICAP approaches
• Potentially over-emphasis on technology
• Identification of comparative advantage permits
  intersection of funding and implementing partner

12
ICAP Kenya Expansion

• Acknowledgement by CDC Atlanta and Kenya that
  Columbia University operates best as a direct
  implementing partner
• CDC suggested CU provide support to ART care
  sites in Central Province
• Rapid support gained from National AIDS Control
  Program (NASCOP)
• Central Province Sites - identified
• Thika District Hospital
• Gatundu Sub District Hospital
• Kiambu District Hospital
• Jomo Kenyatta University of Agriculture and
  Technology at Thika

13
ICAP-Ke Expansion

• Goal Enroll 1,200 patients in care and
  treatment services by September 2006 (including
  800 patients on ART). Of these 1,200, 10 (120
  enrolled in care and 80 on ART) will be children
  lt 15 years of age
• Strengthen and expand HIV/AIDS care and
  treatment services (TDH,GSDH, KDH, JKUAT)
• Strengthen TB/HIV collaborative activities (TDH,
  GSDH, KDH
• Enhance and promote VCT services (TDH, GSDH, KDH,
  JKUAT)

14
ICAP-Kenya Expansion

• Develop and strengthen linkages and collaboration
  between key stakeholders in the District
• Provincial ART Officer (PARTO) leads partnerships
  within provinces and is key link to National AIDS
  Control Program (NASCOP)
• Key part of workplan is to provide support,
  including funds, to functioning of the PARTO
• Multiple partners within each province, move away
  from different partners supporting VCT, pMTCT,
  Care and treatment, to one partner providing
  support to package of care within same facility

15
ICAP-Kenya Expansion

• Perspective of ICAP country programs IT HAS ONLY
  BEEN TWO YEARS is helpful
• Registration
• Work permits
• Banking
• Negotiations (!!) with other partners and
  rationalization of overlap is ongoing
• Staffing country director, desk officer
• M and E officer, clinical program manager
  identified
• See You Next Year!!!