integration of hiv AND aids services: THE AMREF KENYA EXPERIENCE

1. integration of hiv AND aids services: THE AMREF KENYA EXPERIENCE By Dr Koki Kinagwi, Mr. Walter Kibet

2. Outline • Background • Problem Statement • Methodology • Results • Discussion • Conclusion and Recommendations

3. Background • Kibera is one of the largest slums in sub-Saharan Africa • Estimated population of over 177,000 • Lacks basic infrastructure • High disease burden, estimated HIV prevalence of 15% • AMREF has been implementing an Integrated Community Based Health program in Kibera since 1998

4. Background • The CDC funded Kibera HIV Prevention, Care and Treatment Project started in 2003 • Goal • Improving the Health and Quality of Life of HIV Infected Adults and Children in Kibera • The project covers 4 facilities • Project Partners – Ministry of Health, community

5. Problem Statement Most HIV and AIDS services are located at stand-alone facilities - Comprehensive Care Centers (CCCs) Integration if present, is often partial - separate rooms within the facility Lack of integration leads to low enrolment, poor adherence and stigma

6. The AMREF Model • Between 2003 and 2006- partial integration • From 2007 to 2010- full integration • HIV care and treatment is integrated with other routine clinical activities • No specific service areas designated for HIV • HTC is done at the service delivery points

7. AMREF Model Triage • Outpatient clinic/ TB clinic/ MCH/ Maternity • General clinical care • HIV care and treatment • PITC • PMTCT • EID • PEP • Nutrition • Nutritional counseling • HIV counseling • Pharmacy • Drug dispensing • ARV dispensing • Adherence check • Counseling • Laboratory • Lab tests • HIV testing

8. Study Objective To determine the effect of integration of HIV services on enrolment of patients into care and treatment

9. Study Design • Retrospective data of all clients enrolled between 2003 and 2010 in the Kibera Health Centre • Descriptive statistics were used in the analysis with the aid of SPSS Version 16

10. Results Phase 1: 2003 - 2006 1,157 (354 males and 803 females) enrolled Phase 2: 2007 - 2010 2,583 (893 males and 1690 females) enrolled 2003 – 2010 A total of 3,740 (1,247 male and 2,493 female) clients had enrolled into the HIV project The results were divided into two phases:

12. Enrolment by sex 2003- 2010

13. Discussion • Increased enrolment over the later years - 123% • Possible other contributing factors- • community-facility linkages • increased awareness of HIV • increased staff capacity • PITC became the main entry point into care as compared to VCT • Quality of service was not affected - all staff trained in HIV care • Integration provided a secure environment for patients - less stigma

14. Conclusion and Recommendations • Integration fosters higher enrolment of patients • Need to promote integration by providing training on ART at the pre-service level • Integration provides opportunities to screen for other diseases • Further studies to look at • provider and client perspectives on integration • other factors associated with increased enrolment

15. Acknowledgement • Centers for Disease Control (CDC) • Ministry of Health • AMREF • Kibera community

16. THANK YOU