UMB Kenya Newsletter

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