UMB Kenya
ISSUE 2
Jan - Dec 2018
INSIDE THIS ISSUE
Page 6
An annual Newsletter of University of Maryland Baltimore, Kenya Program
Launch of Nairobi Regional Training Centre (RTC)
The National TB Reference Laboratory is finally ISO 15189:2012 accredited
Page 8 Kenya Celebrates World Blood Donor Day
Page 12 Adolescent care should be more patient focused and not doctor focused
Page 14 UMB Kenya supported facilities shine in the best public health facility category
Page 33 Journey towards recovery from drug addiction Stories from people who inject drugs
Page 43 Longitudinal Bio Behavioural Survey (LBBS) in Gem Sub County
UMB UMBKenya KenyaNewsletter Newsletter
Former County Executive Member for Health for Nairobi County Dr Hitan Majevda officially opens the Nairobi Regional Training Centre
O
fficial Opening of the Nairobi Regional Training Centre (RTC) took place on June 13, 2018. UMB Kenya supported the refurbishment of the Nairobi RTC and setting up of technical infrastructure to support an ECHO-based learning collaborative under the Nairobi regional technical working group (RTWG), primarily as a regional hub for continuous medical education (CME), complex case management and data-driven mentorship. ECHO is an e-based learning platform that reaches a large number of clinicians to enhance their knowledge and provide them with support to manage complex cases.
The PACE-K program aims to implement sustainable mentorship models to increase capacity for and access to HIV management knowledge and skills through the RTCs. Dr Hitan Majevda, County Executive Committee (CEC) Member for Health, Nairobi County thanked UMB for their continued support. “UMB has renovated this place into an ultra-modern facility, a sharp contrast to what it was before. Let us utilize this facility well and improve the health outcomes of our people,” he said.
ISSUE ISSUE 22 •• 2018 2018 || Page Page 11
Country Director’s Message accreditation (ISO 15189:2012). These laboratories are Embu level V hospital, Thika Level V Hospital, Consolata Hospital, Kiriaini Mission Hospital, North Kinagop Mission Hospital, St. Francis Mission Hospital and Nyeri Level Hospital. BM has also focused on providing technical support to strengthen electronic data collection and quality management systems at the Regional Blood Transfusion Centres (RBTCs) and haemovigilance at transfusing facilities thereby significantly contributing to access to safe blood and blood products. The Partnership for Advanced Clinical Education Kamilisha (PACE-K) program supported Nairobi City County to renovate one of its facilities, STC Casino thereby establishing the Nairobi Regional Training Centre (RTC) in this facility which uses ECHO (Extension for Community Healthcare Outcomes) to discuss complex Prof. Sylvia Ojoo
HIV cases hence providing a platform for technical support to clinicians in primary health facilities to manage complex HIV cases.
Dear Partners, Friends, Well-wishers and Co-workers,
O
Our Technical Assistance for Public Health Impact in Kenya (TAPHIK) program that is implemented in
n behalf of the University of Maryland Baltimore’s
Siaya and Kisumu counties, remained steadfast in its
(UMB), Kenya Program, I am happy to share our
provision of technical assistance to strengthen and
2018 newsletter with you as we celebrate yet another
harmonize HIV/TB services and its surveillance systems
year of successful implementation of our programs in
and providing quality management for laboratories. The
Kenya.
program completed the Fisher-Folk Bio Behavioural Survey which was conducted on several island beaches
Between October 2017 and September 2018 through
in Lake Victoria. Another round of the Longitudinal Bio
our prevention care and treatment grants PACT Timiza
Behavioural Survey conducted in Gem, Siaya County
and PACT Endeleza, 1,202,761 individuals received
was also completed. The Case Based Surveillance study
HIV Testing Services, following which 14,562 newly
running across several Health Facilities within the Health
diagnosed patients were identified and 13,103 linked to
and Demographic Surveillance System area in Gem, Siaya
HIV treatment services in three counties: Nairobi, Kisii
County is ongoing.
and Migori. Overall these two programs were providing antiretroviral therapy to 90,531 individuals including
As a program, internally, in 2018 we set up a robust
8,735 children and adolescents, with an overall viral
Information Data Management Systems (IDMS) to
suppression rate of over 94% as at 30 September 2018. In
improve the efficiency of our internal operations making
the same period, we provided medically assisted therapy
our institution more responsive to our teams’ and
using methadone to 1,164 people who inject drugs.
partners’ needs.
Our Laboratory Strengthening Program, Boresha
Developmental work globally in most sectors is facing
Maabara (BM), facilitated 7 laboratories to achieve
serious strains as the operating environment both
ISSUE 2 • 2018 | Page 2
UMB Kenya Newsletter
internal and external especially for non-governmental organizations (NGOs) is faced with significant financial strains. Our country programs faced some setbacks that required rapid adjustments following a significant reduction in funding. We were forced to let go some of our very valued staff, a difficult decision for management to make but one that had to be made nonetheless to enable our programs to continue to run optimally. Despite this we remain focused on improving the health care for the populations we serve and look forward to our continued collaborations towards this end, in 2019. I would like to sincerely thank our staff, partners and donors particularly CDC Kenya, for their consistent technical, financial and managerial support throughout the year. We look forward to a yet another fruitful and impactful 2019. With the 2018 Newsletter, we highlight UMB’s work and wish you a nice read. Yours sincerely,
Prof Sylvia Ojoo
UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 3
Editor’s Letter management and the accreditation of the TB laboratory, a huge success in the year. UMB-supported facilities garnered most awards in the Health Services Delivery Award ceremony. Further our teams successfully implemented Viremia Clinics to enhance case management for clients with high viral load, a model that was recognized by PEPFAR as a best practice and shared on the PEPFAR solutions platform for other programs in all countries to learn from. We congratulate the UMB clinical teams for this achievement. We have also featured our work in research in partnership with Kenya Medical Research Institute (KEMRI) featuring two bio-behavioural surveys of residents of Gem in Siaya County, and the fisher-folk communities who have a heightened risk of HIV infection because of their increased propensity to trade fish for sex. In this newsletter, we also share our success stories, best practices, as well as testimonies from our clients whose stories of hope and courage will lift you up and encourage other people who are infected with HIV to be positive, adhere to treatment and be champions in fighting HIV in their communities. Two young people, share their journey Redemtor Atieno
from discovering their HIV status, struggles through school and how they have overcome stigma and discrimination to become role models.
Dear Readers,
I would like to sincerely thank those who contributed to
I
the writing and review of the wonderful and inspiring
second edition of UMB Newsletter, our annual newsletter
You are always welcome to contact the UMB Kenya office
t is indeed a great honour to be the newsletter Editor for the UMB Kenya Newsletter and it is an immense
pleasure to launch this edition for 2018. Welcome to the that showcases our work throughout the year. Inside you will find news, features and regular columns on a wide range of programs supported by UMB in Kenya.
articles.
with questions or comments on UMB’s activities in Kenya. Finally, I wish you all a very happy 2019 and do not hesitate to send me any of your thought or ideas for upcoming editions of the newsletter.
In this issue, we will recount the various projects and activities in which UMB Kenya staff and partners were actively involved in 2018. Some main highlights are: the transition of PACT Endeleza staff to Nairobi City County
ISSUE 2 • 2018 | Page 4
Redemtor Atieno Editor UMB Kenya Newsletter
New Appointments CIHEB gets a new Global Director
CIHEB Kenya gets a Deputy Country Director
Strategic Information gets a new director
Dr. Manhattan E. Charurat, Ph.D,
Dr. Emily Koech has been appointed
Marline
as the first Deputy Country Director
to become the Director of Strategic
Professor of Medicine, Professor of Epidemiology and Public Health, University of Maryland Baltimore
for CIHEB Kenya. Dr. Koech joined
Jumbe
has
been
unit
elevated
Information. She was previously working in the SI Unit as the Strategic Information
CIHEB in 2014 and has more recently
Advisor for the PACT Endeleza Program.
held the position of Program Director
For the last 10 years, Marline has been
Institute of Human Virology (IHV)
for
involved in Monitoring and Evaluation
has
position she will continue to hold.
(UMB), and Director, Division of Epidemiology been
and
appointed
Prevention, the
new
Global Director, of the Center for International Health, Education, and
PACT
Endeleza
program,
a
(M&E) in various donor funded programs including the European Union (MNCH, FP/SRH and Nutrition programs), DFID
Biosecurity (CIHEB), University of
Dr. Koech is a Physician with 15
(MNH programs), USAID (Malaria and
Maryland School of Medicine. He
years experience in leadership and
HIV programs), PEPFAR/CDC (TB and
takes over from Dr. Deus Bazira who
implementation
was the founding Director of CIHEB. Under
Dr.
Charurat’s
leadership,
of
public
health
HIV programs) and GFATM (HIV, TB and Malaria programs), conducted training
programs at national, regional and
in M&E, developed programs’ M&E plans
facility
and logical frameworks, steered program
level
and
in
monitoring
design and new business development
CIHEB will continue to carry on the
and evaluation of these programs.
important CDC service awards to
She
ensure that the care, treatment, and
of the national ART task force
qualitative evaluative research.
developing policies and guidelines
Marline is a holder of a Master of Science
on management of HIV in Kenya and
(MSc.)
programming to those we serve goes uninterrupted.
has
been
a
key
member
Dr. Bazira’s focus and leadership
has participated in the planning and
over the last 8 years together with
roll-out of HIV treatment in Kenya.
the Country leadership, saw him successfully build new partnerships, win new awards and advanced the
execution of rigorous quantitative and
in
Medical
Statistics
(with
substantial coverage in Epidemiology); Holder of a Master of Arts (M.A.) in Population Studies (Demography) and Bachelor of Science (BSc.) degree in
Dr. Koech has spent the last 12
care of African’s living with HIV. As
years managing donor-funded HIV
CIHEB family we are saddened by
programs in the public health sector.
Chemistry
and
Botany.
Professional
training done include: Fundamentals of Implementation Science, Communication of Population and Health Research for Policy, Gender Mainstreaming in Health
his departure but wish him well in his continued professional career.
and has extensively been involved in the
We congratulate her on her new appointment and wish her well.
Programming, Evaluation of Behavior Change Communication (BCC) programs and Measurement for Impact. We
congratulate
her
on
her
new
appointment and wish her well. UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 5
Updates
The National TB Reference Laboratory is finally ISO 15189:2012 accredited
CIHEB Kenya receives new grant for a smoking study
U
MB/CIHEB Kenya with support from the National Institutes
of Health (NIH) will be conducting a 5-year randomized control trial to evaluate the most promising and
accessible
pharmacologic
behavioral treatments
and aimed
at achieving highest efficiency for smoking cessation among people living with HIV (PLWH) who smoke. The study will be conducted in Mathare
and
Ngara
Methadone
clinics in Nairobi and will enroll three hundred HIV positive clients who smoke and are receiving care in
the
program.
methadone Study
maintenance findings
will
provide policymakers, community leaders and clinicians with critical evidence
T
he
National
Tuberculosis
The
dedicated
NTRL
members
Reference Laboratory (NTRL)
of staff have promptly initiated
under the division of National Public
Corrective and Preventive Action
Health
has
(CAPA) upon this NCE, which was
been ISO 15189:2012 accredited by
shared with KENAS within a month
the Kenya National Accreditation
as an evidence of completion to
Systems (KENAS). This is the 3rd
allow
reference laboratory in the division
certificate.
after
Laboratory
National
(NPHL)
HIV
award
of
ISO
The laboratory stands out because, unlike some laboratories which select
(NMRL)
of
only a few tests for assessment, its
quality approval. The milestone was
entire test menu was included in the
achieved
during
this
the
level
assessment
accreditation assessments. Currently
conducted on 4th and 5th June
the laboratory has various main
2018 which yielded only 19 non-
sections within the state-of-the-art
conforming events (NCE).
facility. They include TB Microscopy,
ISSUE 2 • 2018 | Page 6
most
effective
PLWH smokers in the methadone maintenance setting.
Reference
Microbiology Reference Laboratory attain
the
15189:2012
Laboratory (NHRL) and National to
of
smoking cessation treatments for
UMB Kenya Newsletter
Peter Mwangi, a Laboratory Technologist at National TB Reference Laboratory examining slides for bacteria that causes TB (Mycobacterium tuberculosis)
Gene Xpert, Line-Probe Assay (LPA), Culture (LJ; solid
• Review of customer complaints/satisfaction
media and MIGT; liquid media), Drug Susceptibility Testing
• Review of supplies/stock-outs
(DST), Data and Media & reagents preparation.
• Review of equipment downtime • Review of consultant’s/referral laboratories
The laboratory has put in place quality improvement
• Performance reports and remedial action
plans targeting their quality indicators for purposes of
• Advisory services meeting
improving patients results. Management review, document
• Analysis of occurrence review/sample rejection test
review, competency assessments, internal audits, biweekly meetings, quality committee meetings are done once a year with a view to maintain accreditation. KENAS
reports • Bi-weekly/monthly staff meeting to inform management of challenges and successes
conducts surveillance audits to assess compliance to ISO
• Review of competency assessment
15189:2012 standards every six months and annually.
• Internal audit • EQA of inter-laboratory
Additionally, the laboratory has an annual work plan with the areas of focus highlighted:
• Review of corrective and preventive action/remedial action
• External Quality Assurance (EQA) program
• Sample transportation and management training
• Review of job descriptions
• Review of maintenance chart
• Review of internal quality control
• Employee satisfaction survey
• Review of contract for serviced equipment’s
• Review of appraisals
• Review of standard operating procedures and quality
• Safety refresher training/fire drill refresher
manual
• Review of staff suggestions
• Continuous medical education
UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 7
Kenya celebrates world blood donor day population donated blood, is a fact that should encourage us to meet this target,” Lillian Ng’ang’a, Machakos First Lady. Dr Johansen Oduor, Kenya’s Chief Government Pathologist said: “As a Ministry, we are supportive of blood donation.
We
urge
everyone
to
donate blood to save a life.” Dr Josephine Githaiga, Head, Kenya National Blood Transfusion Service Stakeholders in the blood transfusion fraternity led by Machakos Governor His Excellency Dr Alfred Mutua (6th left), and the First Lady of Machakos County, Her Excellency Lillian Ng’ang’a, (5th left), on 14th June 2018 during the WORLD BLOOD DONOR DAY 2018 celebrations at Kenyattta Stadium in Machakos County. The theme of the celebration was: “Be there for some else, give blood, share life”.
(KNBTS) speaking during the World Blood
Donor
Day
celebrations
commemorated in Machakos County thanked UMB Kenya for their support in celebrating this day. “Where we
lood is the most precious gift
B
UMB
technical
are is because of you. We owe our
that anyone can give to another
capacity to KNBTS to offer safe and
success to your continued support,”
person, it’s the gift of life! Every
quality blood and blood products and
she said.
year, on 14 June, countries around
supported the overall organization
the world celebrate World Blood
and commodity support for the
“Blood is life. When you donate
Donor Day. The event serves to thank
event.
blood you are saving a life,” Dr Ruth
Kenya
provides
Muthama, Director Health Services,
voluntary, unpaid blood donors for
Machakos County remarked.
their life-saving gifts of blood and
The Machakos Governor Dr Alfred
to raise awareness of the need for
Mutua and First Lady Lillian Ng’ang’a
regular blood donations to ensure
officiated
“Machakos
“As we go through the World Blood
the quality, safety and availability
County is part of the counties that
Donor Day, purpose to donate blood
of blood and blood products for
will implement the ‘big four agendas’
to save a life,” Ababu Namwamba,
patients in need.
in Kenya. We will roll out Universal
Chief Administrative Secretary in the
Health Care and the Machakos First
Ministry of Foreign Affairs and Pledge
celebrations
Lady and I will lead a blood drive
25 Ambassador.
were held in Machakos County. UMB
to ensure that the country leads in
Kenya
blood donations,” Dr Alfred Mutua,
Transfusion
Governor, Machakos County said.
products
This
year’s
national
implements
strengthening
a
laboratory
program
callled
the
event.
of
blood
helps
save
and
blood
millions
of
lives every year. It can help patients
Boresha Maabara which supports the Ministry of Health (MOH) centrally
Lillian Ng’ang’a, Machakos First Lady
suffering
through the National Public Health
urged all people present to become
conditions live longer and with a
Laboratory Services (NPHLS), the
ambassadors and work in partnership
higher quality of life, and supports
Kenya National Blood Transfusion
with all involved to ensure that no
complex
Services (KNBTS), and the Ministry
one loses life due to lack of blood,
procedures. It also has an essential,
of Health Programs on Biosafety/
no mother dies during delivery and
life-saving role in maternal and child
Biosecurity,
other unnecessary deaths.
care
Infection
Prevention
medical
during
life-threatening
and
the
surgical
emergency
response to man-made and natural
Control (IPC), Occupational Safety and Health (OSH), and Health Care
“To note that our blood banks can be
Waste Management (HCWM).
full, if only one percent of the total
ISSUE 2 • 2018 | Page 8
and
from
disasters.
UMB Kenya Newsletter
Quality systems set up in public hospitals to improve service delivery
P
EPFAR has started an innovative initiative called ‘Laboratory African Regional Collaborative (LARC)’ that introduces quality improvement health systems interventions designed to improve service delivery within public health facilities.
In Kenya, the LARC initiative focusses on the ‘viral load cascade’ in selected facilities. Implementing partners and participating facility-based teams were trained in August 2018 on quality improvement techniques that enable rapid identification of health systems problem areas regarding HIV viral load testing services.
Public Health Informatics Institute (PHII) in collaboration with CDC Kenya, and their implementing partners including UMB Kenya introduced LARC formally to health facilities supported by these partners. LARC enhances continuous quality improvement by teaching methodologies to improve any process at work. Katy Yao, Public Health Educator, LARC Faculty said they give tools to health facilities to improve on their work. “We teach them the methodology to improve any process at work with the end goal being for facilitators to learn methodologies to solve any challenges at work,” she stated.
Kate Yao (2nd left), Public Health Educator, leading the LARC team to inspect some of the tools used at the Baraka Health Centre in Nairobi
Blood safety meeting held at CIHEB Kenya
T
he Boresha Maabara program conducted a one day
The hospitals represented in the training included: Mater
haemovigilance technical working group meeting on
Hospital, MP Shah Hospital, Aga Khan Hospital, Nairobi
16 October 2018 in UMB offices in Nairobi. The meeting
Hospital, Mama Lucy Kibaki Hospital, St. Marys Mission
brought together members of the hospital transfusion
Hospital, Embakasi District Hospital, Coptic Mission
committees,
th
laboratory
Hospital, Mbagathi District Hospital, St. Francis Hospital,
coordinators and haemovigilance officers to familiarize
county
and
sub
country
Pumwani Hospital, Mater Hospital, Jamaa Hospital and
them on their roles in ensuring safe blood transfusion in
Eight Sub County Coordinators.
their facilities. The resolutions of this meeting were: use of harmonised haemovigilance tools by all facilities; monthly submission of haemovigilance reports; inclusion of sub county facilities in the haemovigilance framework
and
enhanced
collaboration
between private and public facilities with support from UMB Kenya.. The participants were urged to collect blood from RBTCs and report routinely to KNBTs and UMB to enhance supply of their required quantities of blood. Dr Fatmah Abdallah, Senior Blood Safety Technical Advisor at UMB Kenya making a presentation during the blood safety meeting
UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 9
NPHL Expands automation of laboratories through installation of a laboratory information system
A Laboratory Technologist reviewing results transmitted through LIMS
n a bid to continuously strengthen the laboratory health
I
and also improve reporting to the national reporting
systems, the National Public Health Laboratory (NPHL)
system (DHIS2).
Management System (LIMS) in 19 new health facilities. The
Facilities will also have easy access to the data to utilize
LIMS is expected to facilitate the automation of majority
for decision making. Nationally, the laboratories will also
of the lab processes such as sample handling, result
be linked to a national data center for further analysis
management, commodity and equipment management
and interventions on disease trends across the country.
among others.
The LIMS will also facilitate the move towards ISO 15189
has rolled out installation of a Laboratory Information
accreditation by the various labs. The roll out which began in the last quarter of 2017 has been cascaded to various facilities across the country.
The current implementation is being done in partnership
The selection of the facilities was done on the basis of the
with The Global Fund and AMREF Health Africa, and it
facility workload, HIV, TB and malaria disease burden and
follows the previous successful implementations of LIMS
geographical representation.
to other facilities by NPHL and other partners. Most of the labs are already actively using the system and the LIMS
This LIMS is expected to reduce the amount of paper
implementation is expected to be complete by June 2018.
work required by the clinicians and laboratory personnel through integration of the LIMS and the Hospital
University of Maryland Kenya program through the
Information
reduce
Boresha Maabara program supports the Ministry of Health
transcription errors through interfacing of the LIMS with
(MOH) centrally through the National Public Health
the automated analyzers, improve turn-around-time (TAT)
Laboratory Services (NPHLS).
Management
ISSUE 2 • 2018 | Page 10
systems
(HMIS),
UMB Kenya Newsletter
UMB Kenya hires health care workers for Nairobi County
O
n April 19, 2018, PACT Endeleza program
transitioned
234
Health Care Workers to Nairobi County
Government
to
support
HIV services. The HCW providing HIV services in NCC facilities had previously been hired and managed throguh a sub-grant to Deloitte. Speaking
during
the
transition
ceremony, Dr Emily Koech, Program Director, PACT Endeleza, said it had been an amazing journey working together with Deloitte and Nairobi County.
“As
the
staff
transition
today, UMB Kenya will continue to offer technical support to the Health Care Workforce that have been transitioned to the County,” she stated. “Nairobi
County
Executive
Nairobi City County Public Service Board Chairman Architect Phillip Kungu addressing health care workers during the transition ceremony
Committee Member Health, Dr Hitan Majevda, thanked UMB for their
has employed and trained over 300
this has gone a long way in bridging
continued
Health Care Workers in Nairobi and
the unemployment gap in Kenya,” he
support.
“UMB
Kenya
said.
April 19, 2018 PACT Endeleza program handed over staff to Nairobi County
234
Transitioned Health Care Workers
300
Health Care Workers trained and employed by UMB
NPHL adopts an environment friendly option for medical waste disposal
N
PHL acquired an Auto Clave and Shredder on 26th July 2018. UMB/CIHEB Kenya through the Boresha Maabara program supported a training of Incinerator Operators, Biomedical Engineers, and Biosafety Officers on the operations of the
Auto Clave and Shredder. This is part of UMB’s mandate to capacity build Ministry of Health Institutions towards adopting environmentally friendly and cost effective technologies for treating medical waste.
UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 11
Adolescent care should be more patient focused and not doctor focused Endeleza, and PACT Timiza programs
encouraged the providers to use
and support implementation of UMB
motivation
Kenya Care and treatment programs
adolescents can come up with a
with a focus on adolescent and
solution on their own as this will
pediatric care.
encourage risk reduction. “The care
interviewing
so
that
should be more patient focused and She encouraged youth to use family
not doctor focused,” she said.
planning methods and called on care givers to be more accepting of them.
Dr. Wolf’s visit comprised of site
“How we interact with adolescents is
visits to selected facilities in Nairobi,
important and we should not have
Kisii and Migori; grand rounds at
judgmental beliefs about them. You
Kenyatta National Hospital and an
should keep your door open so that
echo session at NASCOP with the
they can trust you and be truthful
regional technical working groups.
with them and provide them with
Further Dr Wolf conducted training
care,” she stated. She further added
through
that it is important to think outside
sessions to health care workers
hildren and adolescents with
of core care givers and core groups
and UMB on care of HIV infected
HIV face several challenges that
and reach out to family members
adolescents. She at the same time
and community at large.
provided adolescent trainings and
Dr Hillary Wolf, Assistant Professor of Paediatrics, and Medical Director Adolescent and Young Adults Centre at UMB
C
affect their access to HIV services and retention in chronic HIV care. They
are
more
challenging
continous
mentorship
continuous mentorship education to
to
“The important thing is to make
identify than adults since they have
them trust you so that they keep
poor access to HIV testing services
coming back to you,” she said. She
health workers at UMB sites.
despite lowering the age of consent to 15 years and use of effective case finding strategies like partner notification services. Additionally, once children and adolescents are identified as HIV positive, they are less likely to be linked to care, and once in care they are less likely to start and stay on long term treatment. Dr. Hillary Wolf, Assistant Professor of Paediatrics, and Medical Director Adolescent and Young Adults Centre at University of Maryland Baltimore visited Kenya from from the 25th of June to the 6th of July to provide technical assistance on pediatrics and adolescent work with PACT
ISSUE 2 • 2018 | Page 12
PACT Endeleza team pose for a photo with Dr Wolf
UMB Kenya Newsletter
Nairobi Youth celebrate the first Operation Triple Zero fun day
K
enya has made tremendous progress in the HIV response with notable achievements such as the
overall reduction in new HIV infections, increase in the number of people receiving antiretroviral treatment, and enhanced uptake of services. Also, systems for surveillance, commodity management and monitoring and evaluation have been strengthened. However, over the past few years, statistics have shown that young people bear the brunt of HIV infection in the country. An estimate of 300,000 young people are living with HIV in the country contributing to 19% of the total number of PLHIV. New infections among young adults between the ages of 15-24 were recorded at 17,700 out of the total 52,800 in the past year. This accounts for almost 40% of the new infections in the country with prevalence being higher among women compared to men due to the fact that they are disproportionately affected.
Nairobi Youth Celebrate the first OTZ
On Fri Aug 17, PACT Endeleza program celebrated the first Operation Triple Zero (OTZ) fun day. OTZ empowers adolescents to commit to 0 missed appointments, 0 skipped drug doses and 0 viral load. Speaking during the celebration, Janet Mbugua, a Kenyan media personality urged the youth to surround themselves with positivity in order to achieve their dreams. “Whatever you hope and dream for is possible. In this day and age, being HIV positive should not stop you from doing anything you want to do in life,” she advised. OTZ is being implemented in 13 facilities; DREAM, Njiru, Embakasi, Kayole 1, Dandora, SOS, Babadogo, Mathari, Umoja, Riruta HC, loco, Waithaka, Ngara. According to the Dr Emma Momanyi, the Paediatrics and Adolescents Specialist for PACT Endeleza, there are 372 adolescents enrolled in OTZ in Nairobi. She explains that OTZ curriculums have been shared with all health care workers and OTZ activities are incorporated within the psychosocial support groups. Sensitization and capacity building on the same is ongoing.
TV personality Janet Mbugua addressing the youth during OTZ fun day
UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 13
UMB Kenya supported facilities shine in the best public health facility category
Staff of Embakasi Health Centre receive an award for being the Best Public Health Facility
Q
uality forms one of the pillars of a viable and
Ms Opiyo says the concept of quality in the health sector
sustainable healthcare system. In line with the Kenya
is not very well understood and is viewed by many health
Health Sector Strategic Plan (KHSSP), the Nairobi City
workers as extra work or a vertical program led by partners.
County Health Department (NCC-HS) has established a
“It is the vision of the Quality Improvement/Quality
Quality Assurance/Quality Improvement Unit to provide
Assurance (QI/QA) unit that quality shall be viewed as an
stewardship in the provision of quality health services in
integral part of service delivery, be the center of service
the County.
delivery and that every department and every health worker will be involved in quality improvement” she states.
UMB Kenya through the PACT Endeleza program supports Nairobi City County health facilities to integrate quality
The quality guru observes that since 2014, the Nairobi City
improvement in service delivery. In 2018 awards, UMB
County (NCC) - HS has, with support from various partners
supported facilities received 3 awards out of the 9 awards
been
given.
guided by the Kenya Quality Model for Health. To date,
implementing
quality
improvement
initiatives
the department has established quality improvement The awards are given on an annual basis to health facilities
structures across all levels of the health system and
in the county, which, in the opinion of assessors and
implementation of these structures is ongoing.
judges, have implemented or enhanced outstanding and innovative projects, programs, and best practices during
The assessment under the HSDAP is based on the Kenya
the year under review.
Quality Model for Health (KQMH) framework which
ISSUE 2 • 2018 | Page 14
UMB Kenya Newsletter
provides a systems perspective by addressing all elements of the World Health Organization (WHO) Building Block. The HSDAP shall feed into the National health sector best practice process as part of the Annual Sector Performance Review (APR) practice.
Highest attainable standard The constitution of Kenya 2010 makes access to the highest attainable standard of health a basic right for every
Best Public Hospital • Mama Lucy Hospital • Mbagathi Hospital • Pumwani Hospital
Kenyan. Kenya’s vision for health is to provide “equitable and affordable health care at the highest affordable standard” to her citizens. Towards the attainment of this vision for the health sector, the Kenya Health Policy (KHP 2014-2030) has spelt out policy commitments and investments aimed at improving quality of care. To ensure quality of service delivery, the Kenya Health Sector Strategic Plan (KHSSP 2014-2018) has identified the Kenya Quality Model for Health (KQMH) as the vehicle for improving care quality in the sector.
Best Public Health Facility • No 1. Embakasi Health Centre (HC) • No 2. Mathari North HC • No 3. Waithaka and Njiru HC
Health Services Delivery Awards (HSDAP) is the county quality award that encourages and engages public and private health facilities to strive for and provide the highest attainable standard of care to Nairobi Citizens.
UMB Kenya Newsletter
Best Faith Based Health Facility • No 1. St Scholastica Uzima • No 2. Brother Andre • No 3. MMM Health Facility
ISSUE 2 • 2018 | Page 15
The First National Best Practices Forum for Regional TWG held in Nakuru
P
ACE-Kamilisha
program
in
treatment as well as demonstrate
Notification Services (PNS) and self-
partnership with the National
how mentorship activities strengthen
testing among other interventions.
Program
health systems towards improving
He emphasized on the need for risk
(NASCOP) held a one-day Best
quality of care, and capacity building
assessment for non-communicable
Practices Forum bringing together
of health care workers on advanced
diseases in management of HIV and
all
case management.
aging. He applauded the recognition
AIDS
&
STI
regional
groups,
on
Control
technical 2nd
August
working 2018
in
and trophy award of the Most
Nakuru. The theme of the forum was
The forum brought together over
Innovative
“Optimizing
outcomes
140 participants who included: HIV
and best poster to be sponsored to
through implementation of regional
regional technical working groups,
attend the HIV Scientific Conference
TWGs and mentorship”
county technical working groups,
that took place in September 2018.
treatment
RTWG
for
2017-2018
lead mentors, facility mentors, senior The forum served as a platform
officials from the Government of
The key note address on ‘Optimizing
for the mentors to showcase best
Kenya, development partners, and
treatment outcomes’ was delivered
practices and impact of mentorship
implementing partners.
by
strategies towards achievement of
Dr.
Marybeth
University
of
Maritim
Nairobi,
from
Unit
of
epidemic control goals 90:90:90 in
Dr. Kigen Bartilol, Head NASCOP,
Clinical and Infectious Diseases. She
the fight against HIV in Kenya and
officially opened the meeting and
highlighted on the importance of
improving HIV outcomes. It also
welcomed participants to the forum.
working beyond HIV and with a focus
provided a forum for learning new
He highlighted the achievements of
on
concepts on HIV prevention, care and
the 1st 90 targets through Partner
by integrating care. There was a
non-communicable
diseases
Lakati RTWG celebrate an award for being the Most Innovative RTWG 2017-2018
ISSUE 2 • 2018 | Page 16
UMB Kenya Newsletter
reflection on the 2016 national guidelines on whether
authors/presenters responding to specific questions
there was achievement of optimal outcomes within the
raised. The selected abstracts for oral presentations were
regions and programs by focusing on the global targets
presented from Nyandarua, Bomet and Vihiga counties.
versus the national targets.
This was followed by best practices presentations from the all the RTWGs.
“Optimizing
the
function
of
the
RTWG
requires
individual commitment, regular TWG attendance, regular
Presentation of awards was facilitated by Dr. Maureen
consultations, self-learning including reading scientific
Kimani, Program Manager Care and Treatment, NASCOP.
papers, regular continuous mentorship education by
Most Innovative RTWG 2017-2018 trophy was awarded to
visiting experts, attendance and presentation during
Lakati RTWG team based on number of posters submitted
scientific conferences, engaging both public and private
and number of mentors who join/log in to the NASCOP
clinicians and joining ECHO platforms for continuous
ECHO sessions. Best Poster was from the lead mentor,
mentorship education and policy updates, said Dr. Maritim.
Turkana County, the poster targeted all the 90-90-90 targets.
The program included poster exhibitions which entailed a poster orientation session by participants with the
Commemorating the 1st Anniversary for Nairobi Regional Technical Working Group
T
he first anniversary of the Nairobi HIV Regional Technical Working group (RTWG) was celebrated
in Nairobi on 17th and 18th October 2018. PACE Kamilisha supported the celebrations which also coincided with the monthly RTWG meeting which brought together the Nairobi CASCO, HIV providers within Nairobi County Health facilities, implementing partners, and private practitioners working in HIV. The main objective of the monthly meeting was ‘Promoting HIV Outcomes that are supported by application of Data Demand and Information Use (DDIU) for policy and strategy formulation’. The two-day meeting served as a platform for the HIV clinical resource persons to showcase their achievements over the past year through oral presentations, and poster displays. It also provided an
opportunity
for
continuous
knowledge
sharing
Members of the Nairobi HIV Regional Technical Working group (RTWG) cut a cake to commemorate the first anniversary of the RTWG
acquirement in managing complex HIV cases and in preparation for the upcoming Annual Mentor’s best
continued support. These included Nairobi CASCO Dr.
practice sharing forum for Nairobi RTWG.
Carol Ngunu, Chair for RTWG- Dr. Duncan Nyukuri, Cochair for RTWG- Dr. Mary Nderitu, Sub-CASCO; Shilla
The PACE-K STA Dr. Linda Misiko led the team in
Mwavua, Lead Mentor Nairobi County; Elizabeth Jaica,
acknowledging the efforts and contribution from Nairobi
and secretariat; Hogla Mwamburi. This was crowned with
secretariat by handing appreciation trophies for their
Cake cutting by the team.
UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 17
NASCOP Reviews HIV training manuals for Health Care Workers
U
MB Kenya through the PACE Kamilisha program supported the Ministry of Health through NASCOP
to review and update the National HIV Integrated Training Manual (NHITC) for Health Care workers first developed and launched in 2012. The manual development process was done through a wide consultative process, with the support and expertise of multiple stakeholders including universities, funding agencies, multilateral organizations and implementing partners. The national program has from September 2017 to August 2018 revised the basic HIV curriculum for Health Care Workers to improve quality of care for the PLHIV as one of the key impetus to achievement of the 90:90:90 strategy and achievement of epidemic control in a rigorous process.
CIHEB Kenya staff pose with the revised NHITC
The information contained is based on the most updated guidelines and policies for HIV care in the country including optimizing HIV prevention and treatment services through introduction of better medicines, diagnostics and patient centered approaches in service delivery. It also contains new units such as the PrEP, Differentiated care; Gender based violence and Positive Health Dignity and Prevention. The competencies acquired through this training model will translate to better quality of care for persons living with HIV in Kenya. The revised curriculum was officially launched by the Ministry of Health during NASCOP’s Annual Joint Scientific HIV Care and Treatment Conference in September 2018. The integrated curriculum has also been translated to an online platform to increase access to the training.
Prof Sylvia Ojoo, Country Director UMB Kenya giving a key note address during the 2018 HIV Prevention, Care and Treatment Scientific Conference
ISSUE 2 • 2018 | Page 18
UMB Kenya Newsletter
PACT Timiza reviews program performance with Kisii County perform,
consolidate
performance
and
see
county how
this
information can be used for decision making. Dr Otumu affirmed the commitment of the county to work and provide leadership. “We have an inclusive technical working group which will set the agenda for stake holders forum. We should be able to have clear issues that we are dealing with,” he stated. He
noted
that
in
light
of
the
dwindling resources there was need for the county to rethink of options to maintain service delivery, achieve high results despite minimal funding. Dr Otumu called for random Data Quality Assuarance (DQA’S) to find out the quality of data that they receive. He said the challenges in the county can be fixed if it strengthens its engagement and systems of communication.
County’s Director of Health Dr Geoffrey Otomu addressing meeting attendees
O
n 8th February 2018, PACT
executive committee. He said such
Timiza
met
engagements will strengthen their
with the Kisii CHMT to review
systems and make them have more
progress made in the first year of
focus and coordination.
program
team
implementation towards the desired goals
and
county
operational
targets.
“We
need
to
strengthen
each
other to achieve county objectives. It is important to have regular
The County’s Director of Health
performance review meetings to
Dr Geoffrey Otomu said it was
ensure that we all reach each other
important
ministerial
on what we agreed on,” he said.
coordinating meeting so that all
to
have
He added that it was important to
partners engage with the county
also look at how individual facilities
UMB Kenya Newsletter
a
We need to work in good faith and address emerging issues
ISSUE 2 • 2018 | Page 19
Ethiopian team visits to learn on KP Integration in Kisii County
Ethiopian team visits to learn on KP Integration in Kisii County
isii County in partnership with UMB Kenya’s PACT
K
The visiting team was happy with the visit and said it was
Timiza program implements a Key Population (KP)
very beneficial to them and will help them improve on their
program through an integrated model providing KP
KP programming. “The visit was good. I learnt so many
friendly services withing three public health facilities. A
things from the county and the facilities we visited in this
team from Ethiopia’s Minisity of Health, CDC Kenya and
joint effort to integrate KP services into MOH facilities,”
Ethiopia accompanied by Kisii County CASCO and UMB
Frie Hailu, Disease Prevention and Control, Sub process
technical support teams visited the three facilities to learn
Owner, Addis Ababa Regional Health Bureau.
on the successes of this model of service delivery. “The visit was very nice. The Kenyan team was welcoming Dr Richard Onkware, CASCO, Kisii County said the county
and we really appreciate. They showed us all the
strives to ensure that the integration of services in the KP
experiences of KPs in Kenya and in different counties and
sites is as smooth as possible with a clear client flow to
I appreciate the involvement of NASCOP, MOH and UMB.
facilitate short waiting time by the KPs when they visit
We plan to replicate integration of KP program in public
the health facilities for health services. “We want to have
facilities in Ethiopia,” Tingo Fantahun, CDC Ethiopia KP
an integrated facility within each sub county so that
Project Coordinator.
eventually all health care workers can get a feel of offering HIV prevention interventions to KPs,” he stated.
“I am so happy and so excited to see all this excellent work. I believe this is a centre of excellence of integrating
According to Edna Gakii, HIV Prevention Specialist – Key
KP services into government facilities. This is a highly
Population at PACT Timiza Program, KP Integration into
developed program, one of the best in Africa particularly
MOH facility creates ownership by the Ministry of Health
in integration,” Afewora Mebratu, CDC Ethiopia and Team
and is the most sustainable model for KP programming
Lead for Ethiopia Visit.
particularly now with reduced donor support towards HIV programming. ISSUE 2 • 2018 | Page 20
UMB Kenya Newsletter
Partners Corner SWOP Celebrates 10 Years Anniversary
S
ex Workers Outreach Program (SWOP),
grantee,
a
UMB
celebrated
Kenya their
sub tenth
anniversary. The event which was marked with pomp and glamour attracted over 1000 participants who included community members, ministry of health and Nairobi county staff, together with other partners. The colourful day saw the female sex workers and men who have sex with men dance the day away in celebration. The climax of the event was the beauty pageant cut walk with an array of beautiful men and women gracing the cut walk adorned in creative attires. It was a day for the community to
Invited guests and SWOP staff cut a cake to celebrate 10 years anniversary
celebrate their milestones in key population programming traversing
service provision for sex workers
&
an era when society abhorred the
and other KPs. She further noted
communities
practice to times when there is more
that many clinics that have since
standard services no matter what
and more tolerance of sex work and
been established have been bench
the situation is. I appreciate the
a collaborative commitment towards
marked on SWOP, not only in Kenya
compassion with which you have
supporting
but regionally and globally.
provides services to sex workers,”
efforts
to
mitigate
spread of HIV. It was also their day
congratulate &
you
for
serving
offering
high
she said. She however observed
to remember their colleagues who
“I can only describe the SWOP
that the road ahead remains tough
lost their lives to HIV/AIDS, violence
family as trend setters, daring to
with funding challenges that hamper
and other reasons associated with
go where others are hesitant, and
service delivery but urged them to
sex work. It was such an emotional
in the process making a difference,
remain resilient because it is this
and tearful moment as names of
changing lives, changing believes,
boldness that has brought them this
hundreds of sex workers who lost
changing systems and supporting
far.
their lives were displayed on the
healthy
family
screen.
healthy
productive,
and
resulting
in
economically
Dr. Koech revealed that to this day,
empowered communities. As UMB,
SWOP continues to receive requests
Dr. Emily Koech, UMB Kenya Deputy
we are honoured to partner with you
from people from all areas in this
Country Director thanked the SWOP
in this venture,” she stated.
globe wanting to come and learn
family for inviting them to be a part of the celebration.
from how these clinics run. “The Mercy Muthui, Deputy Branch Chief,
SWOP clinics have also taught the
HIV Prevention and Treatment said
health community the true meaning
She observed that the SWOP clinics
SWOP is a leader in Africa. “We
of
have set the stage for models of
salute you in your 10
communities
UMB Kenya Newsletter
th
anniversary
meaningful
engagement
through
their
of peer
ISSUE 2 • 2018 | Page 21
SWOP Clinical Director said SWOP was an idea that has been there for 10 years and they would like most of the program to transition to the community as they provide technical assistance. “The challenge is for female sex workers to think out of the box like the male sex workers’ programs,” he advised. models that have successfully been used to reach the
they provide technical assistance. “The challenge is for
target populations with services,” she said and added that
female sex workers to think out of the box like the male
the other area that has stood out in this program is the
sex workers’ programs,” he advised.
evidence based programming which has influenced both global and national policies and guidelines.
John Mathenge, Director HOYMAS said sex workers are role models and not victims any more, but saviours. “By
She further noted that despite the successes that SWOP
using condoms and PrEP, we protect our clients from
had achieved in the last decade, the road ahead remains
HIV/AIDS.” Our rights need to be respected and sex work
tough. “Of particular concern is the structural challenges,
decriminalized. We need to have our fundamental health
that have remained extremely prohibitive and continue
rights,” he said.
to propagate discrimination of KPs resulting in many KPs being unable to access health service particularly
“As we celebrate the 10th anniversary of the existence of
HIV services and therefore HIV incidence among KPs
SWOP clinics, we remember our struggles as a community.
remaining disproportionately high,” she observed.
We have had to break barriers to build bridges. SWOP took us as kids and we salute them with the leadership
Dr. Kimani, SWOP Clinical Director said SWOP was an
of Dr Kimani for this far we have come,” John Mathenge,
idea that has been there for 10 years and they would like
HOYMAS.
most of the program to transition to the community as
Participants at the SWOP 10 year anniversary celebrations light a candle in remembrance of the sex workers who have died in the course of their work
ISSUE 2 • 2018 | Page 22
UMB Kenya Newsletter
Voices from the field Living Your Dream with HIV: One young woman’s story of hope orcas Kawira, a young woman
D
means taking responsibility for our
living with HIV is an epitome
actions. It means owning our actions
of success by all standards. Despite
and being ready to defend them at
her being diagnosed with HIV at a
whatever cost.
very young age, she has surmounted all hurdles to be what she is today:
I congratulate the UMB for choosing
a young, brilliant, outgoing and
to
courageous woman who sees the
people living with HIV through care
sky as her limit. She narrates her
and treatment, and for giving them
story to our editor Redemtor Atieno.
an opportunity to contribute to a
support
children
and
young
HIV free generation through forums My Name is Dorcas Kawira. I just
like these.
turned 26 on 15th July, 2018. So fast how time flies. 13 years ago, if you
I know if we had a choice no one
told me that I would be celebrating
would wish to be HIV+. However,
my 26
birthday in 2018, I would
when it doesn’t turn out as we want
have laughed. I mean that is not
it to, it’s good to know that still we
something someone who’s been
will live life to its fullest because
lying in a hospital bed for months
someone spoke up on their behalf
would believe. But yes 26 years
and organizations like UMB, Kenya
on and am still here. Today, I am a
gave us the platform and opportunity
mother to be and pursuing a career
to do so. I hope that they will look
as a Lawyer.
up to us and know they can make it
th
Well, celebrating birthdays mean
Dorcas Kawira
different things to different people.
because we did. I urge young people to stay focused
For me it’s a moment of gratitude to
to pursue. Knowing I can have any
and purse their dreams despite their
those people who have committed
opportunity that comes on merit and
HIV status. “Remember, HIV is not a
themselves to having an aids free
knowing that I will not be singled out
life sentence. You can live a full life
generation. I treasure these people.
because of my status. Knowing that
when you stay positive and adhere
They are people I hold dear to my
as I look forward to enrolling for my
to
heart and I thank God for them
LLM in Harvard I will be rated on the
Remember you have only one life
every day because they make lives
same scale as everyone else.
to live and live it to the fullest. Aluta
of people like me bearable. I
thank
God
for
life
saving
medication.
continua, together we shall achieve There is a power that comes with
an AIDS free generation for our children and for the future.”
people
speaking out. It is because others
because it is for their efforts that I
living with HIV spoke out that paved
can sleep well knowing it is possible
a clear path for us behind them. It
to have HIV free babies. It is because
is only when we allow more of us
of them that I look forward to being
to speak out that our voice against
a mother of HIV free babies. I wake
stigma will be heard loud and clear.
up every morning ready to work
We will have more strength and we
towards growing the career I wanted
will kick out stigma. Speaking out
UMB Kenya Newsletter
these
your
Globally, women are disproportionally affected by HIV, and constitute more than half of all people living with HIV
ISSUE 2 • 2018 | Page 23
Photo Gallery
Senior staff of CIHEB Kenya at the Annual Global Strategy and Research Meeting 2018 held at the University of Maryland Baltimore in the United States
CIHEB Kenya’s PACT Endeleza staff making merry with Nairobi Outreach Services Trust (NOSET) clients in an early Christmas treat in 2017 at their drop in centre in Ngara
CIHEB Kenya and Nairobi County staff pose for a photo with the US Ambassador to Kenya Robert F. Godec (centre) and CDC Country Director Dr Kevin M. De Cock (4th left) at the Embassy after commemorating World AIDS Day 2017
Rose Nyaboke (left), Clinical Improvement Specialist at CIHEB Kenya doing a demonstration on condom use to the youth at the 2017 World AIDS Day celebrations in Nairobi
Prof Sylvia Ojoo, Country Director CIHEB Kenya at University of Maryland (UMB) making her speech during the World AIDS Day Celebrations at the US Embassy in Nairobi
CIHEB Kenya’s Director of Finance and Administration Matthew Kimani (left) and Boresha Maabara Program Director Dr Christina Mwachari (right) display a memorandum of understanding signed with KEMRI Director Dr Yeri Kombe (centre)
ISSUE 2 • 2018 | Page 24
UMB Kenya Newsletter
Photo Gallery
Prof Sylvia Ojoo (right) Country Director CIHEB Kenya at University of Maryland (UMB) being honoured for her timeless service and dedication to the antiretroviral program in Kenya by the Ministry of Health’s Head of Department of Policy, Planning and Health Financing Dr Peter Kimuu (left)
Members of the HIV Regional Technical Working Groups from Nyawest, Nairobi, South Rift, Bonde la Ufa, Pwani and Mashariki at the annual mentors’ best practice forum in Nakuru held on August 2nd 2018
Kenya National Blood Transfusion Services (KNBTS) and CIHEB Kenya staff display the love sign after the Valentines Blood Donations Campaign in February 2018. The event was dubbed: “show some love this valentine and donate blood to save a life”
CIHEB Kenya Brand Champion of the year 2017 Dr Emma Momanyi, Paediatrics and Adolescents Care Improvement Specialist for PACT Endeleza Program (left), receives an award from Redemtor Atieno, Communications Specialist (right)
CIHEB staff from 7 countries pose for a photo with Dr. Robert C. Gallo, Co-founder and Director, Institute of Human Virology at the University of Maryland School of Medicine (front row, 3rd left) at the Annual Global Strategy and Research Meeting 2018 held in Baltimore, Maryland in the United States
Stakeholders in the blood transfusion fraternity led by Machakos Governor His Excellency Dr Alfred Mutua (6th left), and the First Lady of Machakos County, Her Excellency Lillian Ng’ang’a, (5th left), on 14th June 2018 during the WORLD BLOOD DONOR DAY 2018 celebrations at Kenyattta Stadium in Machakos County. The theme of the celebration was: “Be there for some else, give blood, share life”.
UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 25
Photo Gallery
CIHEB Kenya’s operations team
PACT Endeleza staff led by the Program Director Dr Emily Keter (3rd right) meet Nairobi County Staff led by the Governor Hon Mike Mbuvi Sonko (2nd left) to sign a memorandum of understanding that will enable CIHEB Kenya health care worker working in County Health facilities be transitioned to Nairobi County
Mentor mothers at Migori Teaching and Referral Hospital educate nursing mothers on Prevention of Mother to Child Transfusion (PMTCT). Looking on is Dr Charlote Pahe, (2nd left standing), Senior Technical Advisor, PACT Timiza
ISSUE 2 • 2018 | Page 26
Dr David Riedel, (2nd left), Principal Investigator for Partnership for Advanced Care and Treatment - Kenya (PACE-K) pays a courtesy call to the Chair, Unit of Clinical and Infectious Diseases Prof Titus Munyao (3rd left) and Dr Loice Achieng, Physician and Infectious Diseases Specialist at University of Nairobi. Joining them is the PACE-K Program Manager Elizabeth Gitobu (2nd right) and Dr Vernon Mochache (extreme right)
Nairobi City County Public Service Board Chairman Architect Phillip Kungu issuing a contract to a Health Care Worker during the transition ceremony of University of Maryland (UMB) supported staff under Deloitte to the Nairobi City County. Looking on is the PACT Endeleza Program Director Dr Emily Koech (2nd row, right) and Program Manager Oscar Munyao (2nd row, left)
UMB Kenya Newsletter
Pictorial Page
Laboratory Specialists from the Ministry of Health facilities and CIHEB Kenya Laboratory Mentors after a 3-day training on internal audit which qualified them as Internal Auditors
Dr Linda Misiko, Senior Technical Advisor for Partnership for Advanced Care and Treatment - Kenya (PACE-K) speaking at the annual mentors’ best practice forum held in August 2nd 2018 in Nakuru County
Javies Ngui, Longitudnal Care Advisor at CIHEB Kenya, mobilising young men at their work place to test for HIV during the 2018 Pre-World AIDS Day activity which targeted men
Jennifer Flinn, (extreme right) Executive Director, International Affiliate Support, University of Maryland, Baltimore talking to operations staff in Nairobi during her visit to Kenya in October 2018
Redemtor Atieno, Communications Specialist at CIHEB Kenya taking the PACT Timiza staff in Kisii through the CIHEB Kenya brand guidelines
UMB Kenya and Kenya National Blood Transfusion Staff (KNBTS) pose for a photo during the World AIDS Day 2018
UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 27
Best Practice Viremia Clinics in Kenya: Enhanced Monitoring and Management of HIV-Positive Individuals on Antiretroviral Treatment with High Viral Load WHAT WAS THE PROBLEM?
testing, and delayed switch to 2nd-
adopted the viremia clinic model.
T
line ART.
Sixteen
(VL) monitoring in Kenya has led to
WHAT IS THE SOLUTION?
(PMTCT) sites are also involved.
increasing numbers of people living
The
viremia
These are small maternal and child
with HIV (PLHIV) receiving both
clinics was an initiative to address
health (MCH) facilities providing
life-saving treatment and improved
the gaps and challenges in the
ART for pregnant and breastfeeding
knowledge
monitoring
of
women only. Since the inception
This, in turn, contributes to Kenya
patients with high VL, and function
of the model, an improvement in
achieving The Joint United Nations
as a form of differentiated care for
VL testing of eligible patients and
Programme
AIDS
unstable clients with high VL. Held
VL suppression rates have been
(UNAIDS) global epidemic control
at least one day a month, the viremia
observed.
goal of 73% of all PLHIV being
clinic
virally
team (MDT) model and focuses
he rapid scale-up of antiretroviral therapy (ART) and viral load
of
on
viral
suppression.
HIV
suppressed.
and
One
barrier
of establishment
and
utilizes
a
management
multidisciplinary
mother-to-child
Preliminary
data
improvement
in
transmission
show
the
an
proportion
on
limited responses when responding
and a patient-centered approach.
to PLHIV with viremia. Viremia is
This model is aimed at identifying
generally defined as the presence
patient-specific adherence barriers
of viruses in the bloodstream. An
and
HIV-positive person is considered to
address the patients’ specific needs.
have viremia when they have greater
Patients are empowered to make
than or equal to 1,000 copies of HIV
joint decisions with their providers
per 1 milliliter of blood in their body
to improve their ART adherence.
of the viremia clinic model with goals
providing rapid and comprehensive
WHAT WAS THE IMPACT?
of the program will hopefully show
care to patients with high VL has
All 24 HIV clinics in Nairobi County,
led to poor optimization of ART
with
adherence,
infected
delayed
repeat
VL
tailoring
case-management
prevention
to realizing this goal, is poor or
(≥ 1,000 copies/mL). Challenges in
enhanced
of
stand-alone
interventions
approximately clients
to
have
1000
counseling repeat
(EAC)
VL
testing,
and initiate second-line ART (in despite
optimized
adherence
(Figure 1)). Ongoing implementation
subsequent improvements in re-
ART,
1135
sessions,
of improved EAC and monitoring
HIV-
1200
adherence
individuals with persistent viremia
22,000
on
of PLHIV who received enhanced
suppression rates in individuals with initial high VL.
1039 (92%) 855 (82%)
809
800 600
453 (56%)
524 (61%)
521 (115%)
400
237 (45%)
200 0
331 (39%)
284 (55%)
424 (81%)
88 (31%)
Jan 15 to Mar 16 (Pre-Viremia Clinic) Number with high VL Number with repeat VL Number with persistent viremia
Oct-Dec 16 (Post-Viremia Clinic) Number who received at least 3 adherence counselling sesions Number who re-suppressed Number switched to 2nd line ART
Figure 1: Comparison of high VL cascade before and after viremia clinic introduction
ISSUE 2 • 2018 | Page 28
UMB Kenya Newsletter
HOW DOES IT WORK?
one-on-one counseling using the
ART non-adherence, and managing
nationally
adherence
missed appointments. All patients
tools (see below). During these
receive one home visit after their first
established
sessions, patients work jointly with
viremia clinic visit. Additional visits
after identifying a day (usually a
the adherence counselors to identify
may be made for those requiring
fixed day every month) when the
barriers and potential solutions to
more support.
clinic has a lower patient volume.
adherence.
INDIVIDUAL LEVEL The
clinic
date
is
Patients with viremia are typically booked in the morning and follow a structured patient flow. Clinics begin with group education on common factors that contribute to viremia, and possible solutions to address these factors. Patients also receive
In
developed
between
SYSTEMS & SERVICES LEVEL clinic
visits,
peer
The structure and operationalization
educators provide multiple support
of the viremia clinics encompasses
functions, such as serving as case
key aspects for service delivery.
managers, conducting home visits to
These include clinic reorganization,
enhance support, identifying other
case management, and a robust
factors that could contribute to
system for patient follow-up (Figure 2).
• Dedicated clinic days
Clinic Reorganization
• Multidisciplinary team of providers • Common patient challenges addressed in group meetings • UMB TA/participation in viremia clinic days/MDTs
• Individualized patient care, identification of challenges/barriers to adherence
Case Management
• Identified case managers who provide care navigation and appointment support • Counselling by qualified adherence counsellors
• Monthly (or more frequently as necessary) clinic visits with case management • MDT case discussions
Robust Follow-up System
• Home visit by adherence team/peer educators • Use of viral load register to track interventions given at every clinic • Timely repeat VL tests following enhanced adherence counselling • Prompt 2nd line ART initiation
Figure 2: Structure and operationalization of Viremia Clinics
UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 29
SCALABILITY
the Viremia Registers for service
The viremia clinic model is easy
delivery
to introduce to all existing HIV
quality
clinics, and requires no significant
reviewed include time between EAC
extra resources. While the model
sessions, time to repeat VL, and
described includes an MDT of various
time to switch to 2nd or 3rd-line ART.
background providers, clinics with
After ART regimen switch, patients
fewer providers have still benefited
continue to receive individualized
from the model by establishing a
adherence support during their clinic
dedicated clinic day for patients with
visits and have repeat VL testing 6
viremia, and following the general
months after the medication switch.
organizational structure and patient
Patients with VL suppression are
flow as outlined. Low-volume clinics
subsequently transitioned back to
can choose to incorporate the model
attend regular clinics.
quality
assurance
improvement.
and
Indicators
within their current clinic structure. In Nairobi County, where multiple partners support ART sites, the strategy
has
received
immense
support from the county following repeated strategy
dissemination in
best
improvement
of
this
practice/quality
meetings.
The
county’s recommendation for broad scale-up of this model to all facilities has led to more facilities establishing viremia clinics. MANAGEMENT & OVERSIGHT Monitoring:
UMB
developed
a
Viremia Register (attached), which collects regular data for high VL clients. This information allows for the monitoring of compliance with, and timeliness of, interventions. The clinician is responsible for reviewing the Viremia Register at the beginning and end of each clinic. This allows the clinician to monitor the provision of services, and initiate corrective actions when necessary. Through performance review and quality
management
approaches,
viremia clinics have increased the efficiency and quality of the MDT approach to high VL patient case management.
During
visits
to
the facilities, UMB teams review ISSUE 2 • 2018 | Page 30
UMB Kenya Newsletter
UMB Kenya provides treatment to reduce injecting drug use and its health risks
A clinician in a viremia clinic explaining to a client how to use a male condom
T
he Medically Assisted Therapy
In the two clinics supported by UMB,
officers all trained and equipped
(MAT) Program at the Mathari
Methadone is administered daily
with skills to provide quality services.
National
Teaching
Referral
as an outpatient service. Medically
Hospital (MNTRH) was established
Assisted Therapy (MAT) helps PWID
The program is a collaborative effort
with support from the University of
to reduce or stop injecting, decrease
between the health facilities, CIHEB
Maryland, Baltimore (UMB) program
risks to their health, and return to
Kenya who provide technical and
in
funding
productive lives. The treatment also
financial resources to facilitate the
through Centers for Disease Control
helps to address health and social
day to day running of the clinic and
and Prevention (CDC).
consequences of opioid use.
three Civil Society Organizations
The MNTRH MAT clinic opened its
Methadone is a synthetic opioid
(NOSET),
doors for the first intravenous drug
that blocks the effects of heroin and
- Kenya (MdM) and Support for
user (IDU) on 14th December 2014
other prescription drugs containing
Addictions Prevention and Treatment
and
opiates. Used successfully for more
in Africa (SAPTA) in Nairobi who run
than 40 years, methadone has shown
drop-in-centers in the community
by
the ability to eliminate withdrawal
and support community outreach
World Health Organization (WHO).
symptoms and relieve drug cravings
activities to drug dens, recruitment
These are HIV Testing, Antiretroviral
from heroin and prescription opiate
and preparation of PWID for OST
therapy, TB screening and treatment,
medications.
and subsequent community follow-
Kenya
with
and
PEPFAR
Nairobi
provides
package
of
interventions
STI
screening
a
comprehensive
harm
reduction
recommended
and
treatment,
Outreach
Services
Medecins
du
Trust Monde
up of clients enrolled in the clinics.
Hepatitis B and C screening and
The services are provided by a
treatment, condom demonstration
multidisciplinary team of health care
The goal of this program is to assist
and
Information
providers including clinicians, nurses,
People Who Inject Drugs (PWID) to
Education and Communication and
addiction counsellors, pharmacists,
stop or reduce this harmful practice
Opioid Substitution Therapy using
Laboratory technologists and data
and to eliminate risks associated with
distribution,
Methadone. UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 31
illicit injecting practices including
The United Nations Office of Drug
opiates. Used successfully for more
HIV acquisition and transmission.
and Crime (UNODC) estimates that
than 40 years, methadone has shown
Since
there may be close to 10 million
the ability to eliminate withdrawal
established a second MAT clinic in
of
in
symptoms and relieve drug cravings
Ngara Health Centre in January 2017
Kenya
shows
from heroin and prescription opiate
in collaboration with Nairobi City
HIV prevalence among people who
County. Both MAT clinics have been
inject drugs in Kenya is significantly
established in Nairobi within public
higher (18.3%) than for the general
Program Successes
health facilities and are serving more
population
Since inception of the clinics, 731
than 500 PWIDs daily.
inject drugs are disproportionately
PWID
affected
majority
then,
UMB
Kenya
has
risky
injections
annually.
practiced
Evidence
(6%).
(44.5%
Females HIV
who
prevalence
medications.
have
been
84%
enrolled,
being
males.
the At
The Burden of IDU in Kenya
versus 16% for male peers). In
enrolment, 17% of clients had HIV,
Use of IDU has increased significantly
addition,
1.6% Hepatitis B and 16% Hepatitis
in Kenya over the last decade. It is
heroine users is 6-20 times higher
C.
estimated that at least 18,327 people
than among the general population.
antiretroviral therapy have achieved
risk
of
death
among
in Kenya are currently addicted to
The
HIV-infected
client
on
a remarkably high viral suppression
heroin and other opiates according
Harm reduction interventions have
of 98% and this is attributed to
to
Control
significantly led to reduction in the
the
intense
Program (NACC). The use of these
the
number of new HIV infections among
by
competent
illicit drugs, and particularly IDU
people who inject with drugs. The
addiction counselors and use of
is associated with adverse public
needle and syringe exchange and
directly observed therapy (DOT) to
health consequences that include:
MAT using methadone are part of
support ART administration.
risk of disease transmission (HIV,
the harm reduction interventions
tuberculosis, viral hepatitis, sexually
recommended
transmitted infections - STIs), and
Organization.
other
National
physical
AIDS
and
by
World
Health
The
support
provided
clinicians,
retention
amongst
trained
clients
enrolled is 88% at 3 months, 82% at
psychosocial
6 months, 77% at 12 months and 70%
problems, premature death, liver
In the two clinics supported by UMB,
at 24 months, which is significantly
disease from alcohol abuse and
Methadone is administered daily
higher than that reported in other
other physical and mental health
as an outpatient service. Medically
countries
problems.
Assisted Therapy (MAT) helps PWID
Further the program has been able
to reduce or stop injecting, decrease
to support re-integration of PWID
The HIV prevalence rate for PWIDs
risks to their health, and return to
with their families with up to 70% of
in
18%-30%
productive lives. The treatment also
the female PWIDs successfully re-
compared to only 5.6% in the
helps to address health and social
integrated. Further the clinics have
general population. This is attributed
consequences of opioid use.
reported
Kenya
ranges
from
to high risk injecting behavior such
with
similar
significant
programs.
decrease
in
crimes committed by drug users and
as needle sharing and blood flushing
Methadone is a synthetic opioid
instead engagement in meaningful
and unsafe sexual behavior and
that blocks the effects of heroin and
lifestyle activities.
practices among this population.
other prescription drugs containing
1628 PWIDs enrolled
ISSUE 2 • 2018 | Page 32
1457 Male PWIDs
148 Clients with HIV
1608 Clients with Hepatitis B
1577 Clients with Hepatitis C
UMB Kenya Newsletter
Success Stories Journey towards recovery from drug addiction stories from people who inject drugs
J
eff Atonga (not his real name) is one of its founding members. Jeff
is a 38-year-old male who battled with heroin addiction for over a decade and is finally on his path to recovery. He is married and lives with his family in Kosovo, Mathari. Jeff currently works as a Peer Educator at MdM and also considers himself a ‘hustler’ -one who does various odd jobs to earn a living. His initiation to heroin use began in 1997 while he was still high school. “I always had friends who were older than me and as such I became more mature for my age,” he narrates. One day one of his friends came with heroin from Mombasa which he tasted and vomited as he did not like the taste. “I later came to know that the heroin they gave me was known as ‘brown’ which left the drug market in the late 90’s and was replaced by ‘white crest’,” he explains. Jeff
finished
his
high
lost trust in him. He eventually lost
a comprehensive package for HIV
his job due to the drug use. As a
prevention,
result of the injecting drug use, he
in order to eliminate withdrawals
contracted HIV. He lost hope in life
and reduce craving for heroin. The
and his health deteriorated fast.
treatment he and other methadone
He first heard about the Medically
clients receive address health and
Assisted Therapy using methadone
social consequences of opioid use.
care
and
treatment
from a friend. school
education in 1998 and went to driving school. He got a job in the public transportation industry as a driver. The job set him firmly on the path to heroin addiction. “A lot of my colleagues took drugs so my drug use became worse, and I began to inject to get a faster high. Eventually I started stealing to get drugs as my income could not sustain my drug use. My wife could not persevere the pain I put her through and left with our child,” he tearfully recounts. His addiction to heroin ruined his relationship with his family as they
UMB Kenya Newsletter
Health Cabinet Secretary Cecily Kariuki talking to people who inject drugs during the 1st East African Harm Reduction Conference
Among
the
services
where he was provided with Needle
testing and counseling, HIV care
and Syringe Program (NSP) kits to
and
promote safer injecting practices,
and treatment, Hepatitis B & C
HIV testing and once diagnosed
screening, condom demonstration
as HIV+ he was initiated on anti-
and distribution, and psychosocial
retroviral
and
counseling and support among other
provided with adherence support. He
services. Family reintegration is one
was then provided with information
of the key interventions conducted
on methadone treatment for heroin
by the psychosocial departments.
(ART)
treatment,
clinics TB
are
in
the
therapy
methadone
offered
He was linked to a drop-in-centre
HIV
screening
abuse. On joining the MAT clinic, he was able to continue with his ART
Jeff says that the treatment has
treatment as a directly observed
helped him to stabilize and he no
therapy.
longer
experiences
withdrawals.
He has since been able to get a job The methadone treatment Jeff is
and support his family. He no longer
on is administered daily as part of
engages in crime and his health has
ISSUE 2 • 2018 | Page 33
also improved. He has continued
Her
journey
with
heroin
abuse
she has continued to receive at the
to take his ART. His adherence to
began 19 years ago when she was
methadone clinic. She has reconciled
ART has since led to him achieving
21 years old. She was introduced to
with her family who are proud of her.
undetectable viral load, something
heroin by friends and was told it was
She has since rented a house where
he is so proud of.
‘ndom ya Pakistan yenye imesagwa’
she lives with her children and is
(ground cannabis from Pakistan).
currently volunteering as a peer
Following pyscho-social sessions at
Her drug use escalated quickly and
educator in the methadone clinic.
the MAT clinic in Mathari, Jeff and
her clothes business began to suffer.
The main challenge she continues to
other clients formed the Triumph
She began to steal from home and
face is lack of a stable income which
Self Help Group. On inception their
lie to obtain drugs, she neglected
sometimes affects her ability to
aim was to sensitize clients and
her child and eventually ran away
come to the clinic daily due to lack
active drug users on the importance
from home to be closer to where the
of transport.
of methadone treatment, to assist
drugs were sold.
the service providers in maintaining
She however remains hopeful that
order amongst clients in the MAT
Her
first
encounter
harm
Triumph Group which she has been
clinic, and to improve their financial
reduction
standing through initiation of various
through
a member of will be the vehicle that
outreach by one of the Nairobi based
can help her earn a stable income,
projects and monthly contributions.
drop-in-centres SAPTA. She was
perhaps even start a business. She
provided with NSP kits, condoms
is also happy with the commitment
Triumph Self-Help Group is working
and linked to a drop-in-centre for
made by Triumph Self Help Group
to provide an alternative financing
health support. She later moved
to one day help other clients with
option for methadone patients in
to a drop-in-centre at a different
transport and housing assistance
Nairobi. It is a self-group started by
location to avoid drug using peers.
just as she was helped by the social
patients on Methadone in Mathari
What appealed to her in with the
work department when she joined
MAT clinic.
new drop-in-centre was the fact that
the clinic. Triumph has helped her
services
with
was
they were given toiletries in addition
think about what more she would
As one of the founding members
to other health services. In April
like to do with her life. Her dream is
of Triumph Group, Jeff says that
2015 she was enrolled in the Mathari
to help other female heroin users like
the
Methadone clinic and was among
herself come out of this addiction.
self-help
group
has
been
instrumental in helping him improve
the first women in the program.
his self-confidence, and organization
Triumph Group is a self-help group
skills. He sees the self-help group
At the beginning of the treatment
was
as a motivator to recover from the
she was impressed by the strong
by a group of 30 MAT clients who
ravages of heroin abuse. He has
support given by the social work
included Jeff and Jennifer, who
also benefitted financially from the
department. She and other clients
were all beneficiaries of methadone
group’s monthly merry go round
received clean clothes, grooming
treatment
which he has used to meet some of
items and there was even housing
clients
his monthly financial obligations.
assistance arranged for those in
including business, law, chefs and
need.
various artists with skills in creating
His story is not very different from
formed
in
December
services.
with
It
different
2015
attracted skillsets
art and designing crafts.
Jennifer Wambera* (not her real
After 3 years in the program she
name). Jennifer is a 40-year-old
has many positive things to share
The group was officially registered
woman who lives in the Bahati
regarding her treatment. She has
in April 2018 and has to date spread
Area of Jogoo Road. She is a single
stopped using heroin, she is HIV
awareness on heroin abuse through
mother of two children, one aged 23
negative
skits,
and another aged 9.
the quarterly HIV retesting and
performances with a focus on drug
education on safe sex practices that
abuse and prevention. The group is
ISSUE 2 • 2018 | Page 34
and
attributes
this
to
poetry
recitals
and
play
UMB Kenya Newsletter
responsible for the art work on the
One major challenge that hinders
The group members however remain
methadone clinic walls and this year
Triumph Self-Help Group’s goals is
optimistic and are looking towards
repainted the clinic walls. They have
the lack of adequate finances. The
building
also initiated monthly contributions
group currently has a short term
with
amongst members as a bid to
project to design, sew and sell bags.
through the National AIDS and STI
provide financial support to the
This initiative has however been
Control
members.
slowed down by the high start-up
well as exploring other non-profit
strategic
the
partnerships
Ministry
Program
of
Health
(NASCOP)
as
costs. A minimum of $2,300 (ksh
partnerships in order to achieve its
thematic
230,000) is required to purchase
goals.
support groups, they have created
one machine for making bags as well
safe spaces for HIV/HCV clients,
as raw materials. Triumph further
Self-help groups such as Triumph
women’s support groups as well as
lacks a consistent office space to
provide an alternative option for
support groups for all their members
conduct its operations.
sustainable
Through
their
varied
livelihoods
amongst
PWID on MAT.
How methadone has transformed my life
T
he methadone clinic has done wonders to our lives and I cannot imagine where I would be without this clinic A personal testimony from a recovering drug addict during the 1st East African Harm Reduction Conference I always like to mention to anyone I meet and get a chance to speak with that if it were not for the Harm Reduction Program, I would not be here. Many of us would not be here. We would have died a long time ago. So the first thing I need to say today is, thank you for saving our lives. It is indeed an honour to be standing in front of you today. When we were preparing for this 1st East African Harm Reduction Conference, we were asked a simple question. Are you quick on your feet? Because you will be moving around quite a bit. And in my head I thought to myself, of course I am quick on my feet, some of us are so used to running away from the police
UMB Kenya Newsletter
over the years, of course we are quick on our feet. But again, thanks to the Harm Reduction Program, the same police we used to run from, we now run to, they have become our friends. This is why it pains me to hear that in some countries like Burundi, our brothers run from the police to avoid being arrested for giving clean needles to injecting drug users who need them. That medically assisted therapy using methadone is still outlawed in that country because some people in power think it will bring a greater addiction to the region. This is pure ignorance! Before the Harm Reduction Program was rolled out in East Africa, we were hopeless, desperate and drug addicts who had no way out. You were either a criminal or a conman - no in-between. We did things that we are not proud of. Most of us have served at least a year in a maximum security prisons. We lost our jobs, our livelihoods, our families, our children, our self-worth, our dignity
Rita Nyaguthii, a recovering drug addict
as human beings. Anybody can be a drug addict, whether you are a pilot, a doctor, a nurse, a teacher, a police man, a lawyer, a businessman, a hustler, children of government officials, doctors, you name it. Drug use does not spare anybody. Drug use does not know rich or poor. It brought us all down to the lowest possible level of human indignity. Nobody wanted to be around us. Nobody understood that what ISSUE 2 • 2018 | Page 35
Having been addicted to drugs together, we have forged bonds of brotherhood with people we otherwise would never have met. We are a community of people from all kinds of backgrounds, both rich and poor. But the friendships, the clear perspectives on life, and the brotherhood we have formed in the heat of the flames of drug addiction, are so strong that they can hardly be broken.
Director of Medical Services Dr Jackson Kioko (3rd left) and Health Cabinet Secretary Cecily Kariuki (2nd right) pose for a photo with people who inject drugs during the 1st East African Harm Reduction Conference
we were experiencing was beyond our control. We understood that we had no control over our bodies, but we could neither express it nor change it, because we had no control over our brains, either. Every night we went to bed without knowing whether we would wake up the next morning. Death was always just around the corner. If overdose did not kill us, HIV that we acquired from sharing needles would. If AIDS did not kill us, crime would. If crime did not kill us, suicide would and If suicide did not kill us, depression would. Then you came with your Civil Society Organisations, NGOs, your statistics, and your science. You saw us as human beings and reached out to us. You understood us, you understood that our issues were Mental Health issues and gave us treatment. Even with all this caring, love and support, what did we do as addicts? We stole from you, we insulted you, and made your work very difficult but you did not leave us. You decided that you will not wait for our governments to initiate programs to help us. You took it upon yourselves to lift us out of the hole we were in. Through the support of NGOs, we are stronger, we are wiser and are more knowledgeable and yearning for so much more. We know the value of life and we are dying to live it to the fullest. Drug addicts don’t fight over small things. We don’t know tribalism; we don’t know hate. We don’t know division. We only know how to build. These days, we only know humanitarian life. ISSUE 2 • 2018 | Page 36
You have also vaccinated us against, and treated us for Hepatitis B and C. Naloxone, a drug for overdose, has brought us back from the dead, quite literally. You have prevented us from catching TB and treated those of us who have it. And as if that was not enough, you finally brought us our saviour, the much awaited methadone, the drug of choice for heroin addiction. For sure, without methadone 80 percent of us here would still be on the streets, dying a slow and painful deaths. You have trained many people: psychiatrists, psychologists, social workers to provide us with psychosocial support. Without psycho-social support, the harm reduction program is self-defeating. Without psycho-social support, there is no harm reduction program. But we still struggle. We still struggle with the wider effects that drugs have left with us. We still get angry. We are easily irritated. We may sometimes bite the hand that feeds us. We still engage in high-risk behavior. We have lost many good people along the way. We may relapse, we get frustrated, we get depressed and loose hope in life, we disappoint ourselves and our loved ones. But after all is said and done, we are still hopeful that better days are yet to come. We are working hard every minute of every day to get better. We thank all the partners working on harm reduction in this country and will forever be grateful to you for giving us a second chance. We are very hopeful that the future is promising and are hoping to see continued research in the field of drug addiction and harm reduction; increased awareness all over Africa; increased sensitivity training across our societies and expanded capacity among the relevant professionals and lastly have more people trained and involved in psycho-social support including the recovery addicts.
Re-integration into the society One of the biggest issues affecting recovering addicts is how to re-integrate into the society, and how to fend for ourselves economically. Our societies are still full of UMB Kenya Newsletter
stigma towards drug users. It is also a challenge that many of our countries are struggling financially with a lot of budgetary constraints for core and essential services making it increasingly difficult for us to find a portion of the overstretched budget. It is important that all partners begin to think of strategies to improve domestic financing for harm reduction programs as donor funding for HIV is shrinking day by day. This is something we need to address urgently in order to advance and strengthen the harm reduction programs. We need to develop a legal framework; we need to advocate for legal reforms in regard to how drug users are treated; and most importantly, we need access to legal services. In most times, our crimes are not deliberate and locking us in prison cells is not the answer. The Coast region has already began advocacy efforts to create an enabling environment for people who use drugs and have started seeing positive results. In Nairobi, the officers at Muthaiga Police station which is closest to our rehabilitation centre at Mathare, are fully sensitized, and extremely supportive to us recovering drug users.
Thank you: • For coming to look for us on the streets where we sleep, dirty and dangerous, Thank you. • For pestering us, tolerating us, understanding us until we realized that you are only out to help us, Thank you. • For never giving up on us; For believing in us, Thank you.
UMB Kenya Newsletter
The future
Thank you
Even as we look ahead and are hopeful of a better future, we need to be cognisant of new and emerging challenges in the drug war. New drugs are about to come into Africa as we are a big stopover for drug trafficking. Greater mental health issues are coming. The increased effects of capitalism; joblessness, despair, always lead to drug trade, drug use and crime. Now that we know better, let us not be caught off-guard.
On behalf of all PWUDs and recovering addicts, to all the CSOs and NGOs and Government Ministries involved in this project we thank you so much. There is really no way to thank you enough and all we can do is work with you to assist others as you have assisted us.
In conclusion, let me say this: Harm Reduction has gone above and beyond its mandate of simply reducing the dangers associated with drug use. Harm reduction, because of its practical nature, is hands on, and has opened up a space for there to be a collective wisdom in the handling of matters affecting us as Africans. Harm reduction is the greatest weapon in the war on drugs. It allows you to choose, but steers you in the right direction. Harm reduction has turned the negative peer pressure that pushed us to use drugs into positive peer pressure that is pushing us to stop using drugs, or at the very least use drugs in the safest possible way. Harm reduction, is bigger than any one of us can imagine.
• For setting the standard for a united Africa ready to tackle our social problems head on, thank you. • For going out of your way to engage our families, our communities, that they can now know us and understand us, Thank you so much.
But even as we celebrate the milestones we have achieved so far, let us remember that children as young as 9 years old in Burundi, in Kenya, and elsewhere are quickly becoming one of the major consumers of drugs; losing their lives before they even have a chance to know life. There is still so much more work to be done. Let it not end here. Let it not be that we had a conference, ate food and drank water. Let the effort that has gone into creating this gathering translate into a much greater impact on the ground and in our communities. Let us be even stronger in our resolve for Harm Reduction all over Africa. To All Harm Reduction stakeholders; may God Bless you, protect you and advance your cause to heights you have not yet imagined.
• For giving hope to the hopeless, Thank you • For fighting for us, against a world that was ready to let us die, Thank you. • For restoring our dignity as human beings, Thank you • For giving us a second chance at life, giving us a future, Thank you.
ISSUE 2 • 2018 | Page 37
Success Stories Successes of PMTC interventions in PACT Timiza program
A clinician at Migori Teaching and Referral Hospital explaining to Penina Naftali (right) how to take her ARVs
Penina Naftali,
the baby for 6 months as I was told to do in the clinic. The
Penina Naftali, is a 26-year-old woman married with one
baby was tested at 1 year and 6 months and also tested
child who is two years old. She narrates how PMTCT clinic
negative. My husband is also HIV negative.
helped her deliver a HIV negative baby. The clinic has helped me because my baby is HIV negative In 2016, I was pregnant and came to the clinic and found
and I appreciate the donors for supporting this program
I was HIV positive. I was put on anti-retroviral treatment
and urge those on care to continue with their medication.
to protect my baby from acquiring HIV. I started taking my medication every day at 9.00 pm and on 31st Aug
Beatrice Achieng
2016 I delivered an HIV negative baby. I was overjoyed
Beatrice Achieng is a 24-year-old woman married with
that my baby tested HIV negative and vowed to follow all
2 children aged 4 and I year. In 2005, she came to the
instructions I was given in the clinic. I exclusively breastfed
clinic as she felt sick, had rashes and was itching all over
ISSUE 2 • 2018 | Page 38
UMB Kenya Newsletter
her body. She was tested and told about her status then
was given ARV medication for six weeks. After the six
given health education and told the importance of anti-
weeks the baby was tested and he was found to be HIV
retroviral medication. She agreed to start treatment and
negative and this made her very happy. Her baby was
after 2 months her rashes disappeared.
continued on septrin medication and a reapeat HIV test at 9 and 18 months confirmed HIV negative status.
Beatrice narrates that she contracted HIV from a boyfriend who did not disclose his status. She was so pained and
She advised pregnant women not to fear being tested for
bitter after this experience and vowed never to have
HIV. Even if you test positive for HIV do not fear because
a boyfriend in her life again but after six years, she met
you will be put on medication and will live a normal life,”
a man who agreed to marry her. She disclosed her HIV
she states. She has been adhering to ARVs ever since she
status to him and persuaded him to go to the clinic for
started taking them.
a test where he tested HIV negative. Her viral load was however undetected but they were advised to use
She advises pregnant women not to deliver at a traditional
condoms consistently and correctly.
birth attendant because of the risks associated with it. She has committed her life to helping young girls on HIV
When they were ready to conceive, her husband was
prevention measures. “I have disclosed my status in my
given pre-exposure prophylaxis and advised to visit the
village and I give advice to girls in school to stop early sex
clinic every month with his wife. She managed to conceive
and avoid pregnancy and HIV. I make an effort to bring
and attended ante-natal clinics. She delivered at Migori
defaulters to the facility to continue with treatment,” she
Teaching and Refferral Hospital and the baby was given
states.
Success Stories How a young man has used his life experiences to support HIV positive adolescents ACT Timiza Program has strived to reach out to HIV
P
to accept his status. He was hurt and disappointed with
positive adolescents and the results so far achieved
his parents.
his unpleasant experiences to support other adolescents
“We had been taught in school that HIV was a killer
living with HIV.
disease and acquired through sex and it was shocking for
have been impressive. Here is a success story how he used
me that I had it when I had not had sex,” he recounts. He We speak to Michael Oluoch, a 24-year-old adolescent
started using drugs because of depression and his uncles
who was born with HIV. He got to know about his status
and aunties counselled him.
when he was in class 7 when his aunty quarrelled with his mother and told him about it and he was so shocked. He
He remembers when he was younger in class 4 and 5 he
was only 12 years old then and it was very difficult for him
wondered why he used to take medicine every day and
UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 39
Success Stories
his other siblings were not. “It was a big challenge for me to adhere as a child and I out rightly refused to take the medicine. At times my mum was forced to give my older brother Panadol so that I can agree to also take my medication,” he recounts.
High School Life While in high school, there is a day a teacher inspected his box and refused to accept the medicine in school. His mother had to take away the medicine and he stayed without medication for a whole term. He was forced to devise clever tactics to hide his medicine from his teachers and his peers. He would take his medicine every morning with porridge. While in form 3 he contracted TB and was put on TB medication for three months. When he cleared high school he moved to Migori County to live with his grandmother and enrolled at Migori County Referral Hospital (MCRH) for his medication. While at MCRH, jobs for HIV Testing Services (HTS) were advertised and he applied and managed to get a job as a HTS Linkage Tracker where he prepared clients for medication. He worked as an HTS Linkage Trackor for four months before PACT Timiza program took over the management of the facility and engaged him as an adolescent Peer Educator. In this role, he screens adolescents and escorts them for HIV testing services. He also supports those who are HIV infected to adhere to the medication and counsels them on issues that they may be going through. In his new
Michael Oluoch
role, he is involved in screening for eligible clients to be
Life beyond HIV
tested and works with adolescents to get to know how
Michael sees life in a broad perspective. “I don’t have
they adhere to medication and also counsel them in case
regrets over my life anymore. Initially I thought that God
of any social issues.
had favourites and I was not one of them but not anymore. My dream is to be an entrepreneur but for now I spend all
Working with the youth has been fun for Michael however
the time with my peers educating and advising them on
he experiences challenges talking to youth who are not
HIV and staying healthy,” he explains.
ready to talk to him. “Most of the youth don’t believe that I am positive because I look health and say that I claim to
He looks at the horizon and see a great future ahead, of a
be positive because of my job,” he explains.
life beyond HIV. “I have accepted my status and continue with my life unperturbed. HIV cannot hinder me from
He also conducts daily outreaches and visits youth who
achieving my dreams. I live my life as I have it, one step at
have high viral load and ensure that they take their
a time, taking my drugs in the right way and at the right
medication.
time.
ISSUE 2 • 2018 | Page 40
UMB Kenya Newsletter
Best Practice Operation Triple Zero: Empowering Adolescents and Young People Living with HIV to Take Control of Their Health in Kenya WHAT WAS THE PROBLEM?
I
WHAT WAS THE IMPACT?
n Kenya, Adolescents and Young
Self-reported adherence has improved significantly across programs increasing
People Living with HIV (AYPLHIV)
from 88% in October 2017 to 96% in February 2018 (Figure 1).
account
for
approximately
(303,700)
of
with
(Spectrum
HIV
all
20%
people
living
Estimates,
Attended clinic
Self reported adherence >95%
98%
2015; Kenya HIV Estimates 2015 Report).
AYPLHIV
(aged
10-24)
face especially complex challenges dealing
with
a
chronic
psychological development changes of transitioning from childhood to adulthood. The HIV epidemic among Adolescents
and
Young
4057
4000
96% 94%
3456
92% 92%
92% 90%
2000
88% 88%
1000
86%
87%
84%
0
People
treatment outcomes, including a
96%
3000
Oct-17
(AYP) is characterized by relatively high HIV incidence and sub-optimal
4060
3726
illness
amidst the physical, emotional, and
Percent
4856
5000
Nov-17
Dec-17
Jan-18
Feb-18
Figure 1: Tracking Adherence among Adolescents Enrolled in OTZ in High HIV- Burden Counties in Western Kenya.
relatively high loss to follow-up, low adherence to treatment, and low
Preliminary data for clients aged 10-24 years old from six PEPFAR/CDC
viral suppression.
supported implementing partners (IPs) show a substantial improvement in viral suppression (Figure 2). Of 2742 AYPLHIV, viral suppression increased from 71%
WHAT IS THE SOLUTION?
(range 67%-82%) to 82% (range 71%-96%) after 6 months of enrollment in OTZ.
Operation Triple Zero (OTZ) engages AYPLHIV as active stakeholders and
July-Sep 2017
partners in their health by promoting
90%
a
80%
responsive
service
delivery
model. AYPLHIV joining OTZ clubs are offered a comprehensive HIV treatment
are empowered to be self-health
30%
managers. Further, they commit to
20%
a simple treatment goal of achieving
10%
zero
missed
appointment, zero missed drugs/ medications, and zero viral load (VL).
Apr-June 2018
71% 65%
78% 66%
84%
65%
58%
50% 40%
zeroes”:
package,
Jan-Mar 2018
80%
60%
and
“three
literacy
70%
Oct-Dec 2017
0% 10 - 14 years
15 - 19 years
Figure 2: Overall Viral Suppression among Adolescents in Siaya County (OTZ activities initiated in June 2017).
OTZ empowers participants to take charge of their health, take control of
HOW DOES IT WORK?
their decisions, receive support from fellow peers, and identify with peers
INDIVIDUAL LEVEL
who are doing well.
The target population is AYPLHIV aged 10-24 years old. The intervention is tailored to nurture both intrinsic and extrinsic developmental assets to promote positive behaviors resulting in better health outcomes. Intrinsic assets among
UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 41
AYPLHIV are enhanced through providing comprehensive
SCALABILITY
treatment literacy and goal setting, promoting resilience,
OTZ has been rapidly scaled up, moving from one facility
and enabling positive peer interactions, independence,
with 70 OTZ members in 2016 to over 400 facilities
and connectedness.
with over 40,000 members by March 2018. The main proponents of OTZ have been PEPFAR, civil society, and
Comprehensive HIV treatment literacy training ensures
the Kenyan government.
in-depth understanding of body changes as a result of HIV infection, HIV prevention, and antiretrovirals (ARVs).
OTZ is a facility-based initiative driven by partners in
The training also clarifies desired ARVs treatment goals,
collaboration with county and facility leads. To bring the
including improved quality of life, per national guidelines.
initiative to scale, partners engage with counties, identify
Extrinsic assets are nurtured by providing knowledge and
facilities ready to implement, and carry out individualized
skills to healthcare workers (HCWs) and caregivers to
or joint sensitization meetings.
support AYPLHIV. The combination of both intrinsic and extrinsic assets ultimately results in empowered, confident
At the facility-level, sites are sensitized and begin
AYPLHIV who are self-health mangers.
enrolment of AYPLHIV into OTZ. Both group and individual enrolment is encouraged. The overall goal at the facility-
AYPLHIV were engaged in designing numerous aspects
level is to enrol all, or nearly all, AYPLHIV into OTZ.
of the OTZ initiative, including defining the mandate of OTZ clubs; designing the OTZ logo, motto and pledge;
MANAGEMENT & OVERSIGHT
translating the OTZ pledge and motto into local languages;
Monitoring: The team developed a logic model to guide
developing content for OTZ modules; and participating
implementation and performance measurement of OTZ
in OTZ talent shows and activities. At the facility-level,
goals (Figure 3). To track processes and outcomes of OTZ,
AYPLHIV identified as OTZ graduates (referred to as
an M&E plan was developed. Indicators were designed
“champions”) enroll new members, provide psychosocial
to track completion of processes, and measurement of
support to newly identified HIV-positive AYP, provide
inputs and outputs, along with short-term, intermediate,
support to AYPLHIV with high viral loads (VL >1000c/
and long-term outcomes. Documenting implementation
ml) through pairing, coordinate OTZ clubs, and oversee
activities, processes, and outcomes was done in an M&E
various OTZ activities, including social media.
template and reviewed regularly to inform progress.
LOCAL ENVIRONMENT The OTZ initiative supports AYPLHIV and civil society in HIV programming. In the PEPFAR Regional Planning Meeting for the Fiscal Year 2019 Country Operational Plans, one of the key recommendations from civil society representatives was the nationwide scale up of OTZ, indicating their buy-in and continued engagement.
Inputs • Train HCW • Train AYPHHIV • Train caregivers • Start WhatsApp group for motivation • Asset mapping and mobilization
Short term outcomes • Increase the number of AYPHHIV enroled in OTZ • Increase number of HCW trained • Increase number of AYPHHIV who receive motivational messages
Intermediate outcomes • Improve adherence to appointments • Improve adherence to antiretroviral treatment • Implement asset based approach • Improve AYPLHIV participation • Improve case management of AYPLHIV failing treatment
Long term outcomes • Increase proportion of virally suppreseed AYPLHIV by 20% • Increase retention on ART among AYPLHIV to >90% • Reduce mortality among AYPLHIV by 25%
NATIONAL ENVIRONMENT The OTZ initiative builds on the existing APOC without additional policy changes to date. However, PEPFAR
Figure 3: Operation Triple Zero Logic Model.
will be supporting the national program to review and revise APOC and caregiver literacy trainings. We envision incorporating
asset-based
programming
into
these
Source: PEPFAR Solutions: https://www.pepfarsolutions.org/ solutions/2018/10/30/operation-triple-zero-empowering-adolescents-andyoung-people-living-with-hiv-to-take-control-of-their-own-health
activities.
ISSUE 2 • 2018 | Page 42
UMB Kenya Newsletter
Research Longitudinal Bio Behavioural Survey (LBBS) in Gem Sub County
Winnie Esther (2nd right) an LBBS Research Assistant/HTS Counsellor testing a study participant (3rd right) for HIV in Gem during a data collection exercise that also involved HIV testing through Home Based Testing and Counselling (HBTC) program. Looking on is the Study Coordinator Vivienne Kamire (right) and Study Supervisor Samuel Oyoo (left)
K
EMRI CDC with support from the University of Maryland has been conducting a Longitudinal Bio Behavioural Survey (LBBS) for residents of Gem sub county in Siaya County from 2010. LBBS is an Open-cohort of individuals aged 13 years and above, living in approximately 6000 randomlyselected compounds in the demographic surveillance area of Gem. It is a cross-sectional biobehavioral survey of HIV and AIDS risk behavior, sero-status, and the impact evaluation of HIV prevention interventions. It involves door-todoor HIV Counseling and testing.
UMB Kenya Newsletter
The study aims at assessing the impact of HIV prevention, care, and treatment services on HIV prevalence, incidence, and risk behaviors in the KEMRI/CDC HDSS area in Western Kenya. The goal of the study is to determine trends in behavioral risk factors, incidence and prevalence of HIV, and evaluate the level of coverage of HIV interventions, and associated enabling, predisposing and reinforcing factors (over time). According to the Study Coordinator Vivienne Kamire, LBBS study findings will inform policy formulation among the communities. “We collect information at household level following consent
by head of household. LBBS has over the years been implemented within the Demographic Health Surveillance Site (HDSS) in Siaya County,” explains Ms Kamire. She explains that the focus on Gem was because the HDSS platform started working there in 1996 which allows for ease of information collection from residents. The KEMRI/CDC HDSS, with approximately 250 000 inhabitants, has been the foundation for a variety of studies. The HDSS provides general demographic and health information (such as population, age, structure and density, fertility rates, birth and death rates, in and ISSUE 2 • 2018 | Page 43
out migrations, patterns of health care access and utilization and the local economics of health care as well as disease or interventionspecific information. The HDSS also collects verbal autopsy information on all deaths.
Study Settings
Households targeted for the survey are those that have participated in the previous rounds of the survey which occured in 2010 – 2011 (round 1), 2012 – 2013 (round 2), 2016 (round 3), and 2018 (round 4), which included approximately 15,000 individuals in each round. The study makes attempts to have as much as possible, the same individuals participating and normally interviews both residents and nonresidents found in the households. Also, the HIV testing and other diagnostic services are offered to all individuals in the study households regardless of whether they are participating in the study or not. Participation in the survey is voluntary and requires explicit consenting. “We provide HIV tests as part of community-based HIV testing services, and all positive individuals are linked to HIV care and treatment services of their choice,” Ms Kamire states and adds that cases of distress especially sexual violence, which are not related to the study or services offered by KEMRI, are referred for management in appropriate listed service-delivery points. In round 4 Dry Blood Samples (DBS) was collected from every positive participant to know the viral load and 30% of the total sample collected with viral load >1000 will be tested for ARV Metabolites (drug resistance). DBS is also collected from newly diagnosed HIV participant to distinguish between new and old infections through recency assays. For those who have refused to be tested, DBS was
ISSUE 2 • 2018 | Page 44
collected for ELISA testing. For HIV exposed infants <18 months, DBS was collected for DNA -PCR.
off possible errors that might arise while collecting it,” he explains and adds that study summaries are done
Ms Kamire explains that before DBS samples are collected, the Study interviewers first confirms that a client is on care with a Comprehensive Care Clinic (CCC) number and is on antiretroviral medication. “The DBS is done after confirming that one is on care and this will help to know whether the intervention of care and treatment is working or not,” she explains.
that inform the data collection and identify questions which are not answered well which are then sent back to study interviewers to take back to the respondents to correct the mistakes.
Ms Kamire notes that participation in the survey is improved by being flexible with the timing and location of interviews in order to accommodate working men, women, and youths in school. Ms Herine Atieno Winda, a study participants says the study is good and beneficial to the community. “They have explained the objective of the study which is to know our status and reduce the number of HIV infected people in Gem, Keremo and Asembo. I am grateful to have known my status and appreciate the soap they bring to me,” she said.
Data Collection and Analysis
Data collection is done in all the sampled compounds after the team has moved through the villages to do mobilisation and household listing. The study uses the services of village reporters, who are residents of the village, to assist the interviewers in physically locating households. Information collected from participants is entered in electronic forms within tablet computers then transferred to a protected server in near real-time. According to the Data Analysts Moses Otieno, the team has full access of the study data from the server. “We download data daily, generate errors and do data cleaning to flag
During data collection, quality assurance/control is done quarterly using a tool which is administered by the Study interviewer, Study Supervisor and Study Cordinator to ascertain that the study is following protocol. The data is then analysed by the Data Analyst, Data Manager and Senior Statistician who focus on cleaning the data and generation of weekly summary reports. Adhoc reports are generated every monday and on month end. Data management and cleaning and support supervision is done by MOH staff especially for HIV Testing and Counselling.
Mobile-based Technology
The study teams uses android based devices which uses the Commcare Open Data Kit software, an application for mobile based surveys. The LBBS Study Software Developer Martin Mutuku explains that data is collected using android based tablets, which save data in the local disk and submits it later when there is an internet connection. A special software is installed to block other functionalities and reduce power consumption. “We convert the hard copy questionnaire to an electronic questionnaire which allows you to key in information in the tablet. The questionnaire uses skip pattern and in built logic which allows it to ask relevant questions related to the person based on gender, age etc” he explains. The field staff are then
UMB Kenya Newsletter
Christine Apondi, (right) an LBBS Research Assistant/HIV Testing Services (HTS) Counsellor with a study participant (left) in Central Gem during a data collection exercise
trained on using the devices for about 2 weeks, perform a pilot, get feedback and then improve on the questionnaire The android based devices have since reduced costs of paper, saved time and space used to store the hardcopy questionnaires. â&#x20AC;&#x153;This technology has also reduced the time the data is collected before it reaches the data analyst. It has improved efficiency and real time monitoring and improved data quality by eliminating errors during data collection,â&#x20AC;? explains Mutuku. The Software Developer says the technology improved performance as supervisors can now know who UMB Kenya Newsletter
is not working and address the problem immediately. The system also does quality assurance and can tell if the interviews were really done since there is GPS to determine the location of the interviewer. Despite the otherwise very good outcomes of the system, it does not function 100 percent without bugs necessitating the need to work on a rolling basis to identify and solve problems and continuous maintenance till the end of the study. The system is also prone to some challenges as the application can crash and continuous maintenance is done to reduce the chance of this happening. There is also a chance of the devices being stolen as they
are portable and internet may be intermittent. The Systems Developer has also devised some solutions to deal with technological challenges such as installing anti-virus and special softwares to block other sites and media consuming applications. He advises the Study interviewers to switch off the tablets everyday after work to limit chances of overworking the tablets and making them crash and also to help reduce battery consumption. The Study interviewers have also been provided with powerbanks due to the frequent power black outs in Gem sub county.
ISSUE 2 â&#x20AC;˘ 2018 | Page 45
Staffing Levels
The study employed 70 interviewers in the 2018 round. There were also 2 Counsellor Supervisors; 1 Assistant Study Coordinator; 1 Study Coordinator and 1 Principal Investigator.
Study Findings
Preliminary findings of the study indicate that HIV prevalence is not as high as reported and incidence is also not as high as people think. A large majority of HIV positive individuals are aware of their status and enrolled into care. The coverage of male circumcision is especially high among adolescent boys and young men. Early marriage and school drop-out is high among girls. Additionally, cases of early pregnancies remain high. Other risky sexual behaviours remain prevalent; these include inconsistent use of condoms, transactional sex, transgenerational sex, sexual multiplicity and concurrency, and non-consensual sex. The study also found out that majority of the study participants are aware of various HIV prevention interventions that they get to know of through schools, media, word of mouth, community health volunteers, or health facilities but hardly seek them.
Challenges
The Study Supervisor Samuel Oyoo says the study has some challenges such as difficulties in tracing people who have out migrated as well as maneuvering the hilly and mountainous terrain. Another limitation to the study is the reliance on self-reporting because participants may provide answers that are socially desirable. Other challlenges include participant fatigue of doing home based testing since 2010 in the same locality; in
ISSUE 2 • 2018 | Page 46
very rare cases, some individuals refuse to participate in the study and chase away the study team from their homes. There is also some difficulties in getting kits from the Ministry of Health (MOH) facilities. “We collect our test kits from the local MOH facilities and they feel that we are taking too many kits,” he notes.
Inclusion Criteria
To be eligible for inclusion in the study, all the participants must: • Be a permanent or temporary resident of an HDSS compound • Have spent the night or eaten in the selected compound the night before the interview OR consider the selected compound to be their home • Be > 13 years of age, willing to participate in the study • Be able to provide informed consent for both study participation and HIV test and: • if > 18 years of age, OR • if >13 years and <18 years of age and a mature minor (married, pregnant, or a parent), • If >13 and <18 years of age and not a mature minor, be able to assent to study participation after a parent or legal guardian has given consent.
Study process 1. County sensitisation to discuss the objectives of the study with the county 2. Community mobilisation with stakeholders withing Gem subcounty – County Health Management Team (CHMT) and partners on the ground for referral purposes 3. Recruitment of staff 4. 10 day intensive training of Study interviewers/ HTS Counsellors that incorporates all that is required – NASCOP Training of Trainers (TOT ); Laboratory training on sample collection; training on interviewing skills - data collection , study protocal ; training on Commcare and data collection using an android based mobile device/tablet 5. Study piloting then corrections from the pilot are done 6. Recruitment of study participants through household listings 7. Data collection is done in all the sampled compound (administer research questionnaire and take blood sample for HIV test and DBS)
UMB Kenya Newsletter
Selling fish for sex A fisherman’s story of the transactional sex that takes place on the shores of Lake Victoria
The government should support KEMRI CDC to reach to all beaches and teach people how to live in this era – not a life of unprotected sex with multiple sexual partners.
A fisherman trading fish with a female fish trader
y name is Kennedy Onyango,
M
That is what I have been doing all my
we not only depend on fishing alone.
37 years old and a resident
life as a fisherman until the KEMRI
Everyone is now responsible and the
of Mageta Island. I am a jaboya
staff came and taught us how to
women are empowered now since
(fisherman) and married with 4
live responsibly. The KEMRI staff
they now have started alternative
children. I bring fish from the lake
also tested us for HIV and my results
sources of income and are not at the
and give to women to take to the
were positive. They advised me to
mercy of Jaboya’s anymore.
market and the women give me
stop having reckless sex and to use
some small money for my survival
condoms every time I have sex.
and sex.
We
request
KEMRI
to
continue
teaching the fisher folk community Right now my life has changed and I
since there are some that have not
“After fishing, I give the fish to my
have re-united with my family which
been
girlfriends at the lake who go and
I had abandoned when I lived a
should support KEMRI CDC to reach
sell the fish at the market and bring
reckless life. “Now I am working hard
to all beaches and teach people
me some small money. I only give
and educating my children thanks to
how to live in this era – not a life of
fish to my girlfriends who in turn pay
the education I received from IMC.” I
unprotected sex with multiple sexual
me and give me sex.”
would like to urge KEMRI to continue
partners. This area has people from
giving us health education and show
various countries such as Uganda
us the right path of life.
and Tanzania, who have not come
The money from the fish I use for drinking and buying sex. “That is
reached.
The
government
with their wives and live in the
what we do because we know that
We have now formed groups for
abila (meaning: hut) ; therefore HIV
even if we squander all the money
both male and female and we are
transmission is high because of cross
we will get more money the next
taught how to do table banking and
border fish trade.
day.”
UMB Kenya Newsletter
ISSUE 2 • 2018 | Page 47
Advisory Team Prof. Sylvia Ojoo
Editorial Team Members Ms Redemtor Atieno, Communications Specialist Dr Charlote Pahe, Senior Technical Advisor, PACT Timiza Dr Rebecca Wangusi, Senior Technical Advisor, PACT Endeleza Dr Linda Tindi Misiko, Senior Technical Advisor, PACE Kamilisha Susan Musau, Quality Management Services Coordinator, Boresha Maabara
Editor Ms Redemtor Atieno
Photography Ms Redemtor Atieno
Contributors Dr Linda Misiko Susan Musau Joseph Oduor Nelson Akenga Tina Wakukha Masai Jeff Kerika
Wambua Kongo Vivienne Kamire Anne Adega Kelly Khabala Nellie Mukiri Joseph Osoga
UMB Kenya Locations Nairobi Office
Kisumu Office
6th Floor, K-REP Center Wood Avenue, Kilimani, Nairobi Tel: +254-20-2327640
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Kisii Office
Migori Office
Dakianga Building Hospital road
Kadika road opposite St. Josephâ&#x20AC;&#x2122;s Ombo staff quarters
