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Argwings Miruka, CO Pediatric Program Manager

Success in Reaching N ational P ediatric U ptake T argets and Similar Adult Retention Rates in Pediatric HIV Clinics in the Rural Southern Rift Valley Province of Kenya. Argwings Miruka, CO Pediatric Program Manager

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Argwings Miruka, CO Pediatric Program Manager

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  1. Success in Reaching National Pediatric Uptake Targets and Similar Adult Retention Rates in Pediatric HIV Clinics inthe Rural Southern Rift Valley Province of Kenya Argwings Miruka, CO Pediatric Program Manager Kenya Medical Research Institute/Walter Reed Project HIV Program Kericho, Kenya

  2. Background • 7,000-10,000 children HIV infected yearly in Kenya • National targets • 10% HIV clinic patients are pediatric • Often difficult to reach & behind adult uptake • Concerns exist regarding retention of children • Challenges magnified in rural settings due to frequent changes in caregivers, distant pediatric clinics, and extremes in poverty.

  3. KEMRI/WRP HIV Program • An integrated HIV research, prevention, care, and treatment program • Located in the southern Rift Valley Province • Government of Kenya & PEPFAR Program • Catchment of ~ 2.5M • Facilities • 11 primary tx centers • 80 satellite (rural health) centers • 350 PMTCT facilities • 290 VCT & DTC sites

  4. Background & Methods • President’s Emergency Plan for AIDS Relief (PEPFAR), 2004 • Overarching aims • decentralize care • clinics closer to rural populations • Special pediatric initiatives • "Mwangalizi" Program • Support Groups • Treatment Retreats We describe aggregate program level data results as well as successes, challenges, & opportunities (2004-2011).

  5. Results HIV Testing • > 17,500 • VCT & DTC Clinic Enrollment, Uptake& Retention • 57 pediatric clinics • > 5,300 children enrolled • 10.0 +/- 3.3 years, 50.6% F • 2.5% 2nd line ART (one on 3rd line ART) • 2005 = 7.0% children; 2011 = 10.5 children (p < 0.001) • 2011: adult retention=82.2%; children=81.1%

  6. Started & Currently on ART Paediatric Adult 2011 Retention 81.1% 2011 Retention 82.2% n

  7. Successes • Support • “Mwangalizi” Project • Support groups • Training • Paediatric retreats • Caregivers • Integration • Other clinics • Community

  8. Challenges • Malnutrition • Specialty care • Clinic transport • Caregivers • MCH integration

  9. Opportunities • Development of specialty care centers • Integration of HIV pediatric clinics in MCH settings • Training of more pediatric health care workers (including sub-specialty)

  10. Summary • National pediatric HIV clinic enrollment goals can be met in rural Kenya with ART retention nearly the same as retention in adults. • We found “Mwangalizi”, pediatric support groups, and health care team training most helpful. • Specialty care, integrating services, and additional training of health care workers are opportunities for improvement.

  11. Asanteni Sana! KEMRI/WRP Kericho (Authors) Roselida Achieng Appolonia Aoko Jemutai Tarus Peter Yegon Jonah Maswai Fredrick Sawe Douglas Shaffer Ministry of Health Eunice Obiero Isack Tsikhutsu Sheila Korir USAMRU-K LTC Shon Remich COL Tom Logan MHRP Tiffany Hamm Anjali Kunz Keith Crawford The President’s Emergency Plan for AIDS Relief (PEPFAR) Pediatric Patients of Kenya’s Southern Rift Valley

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