An estimated 1.5 million Kenyans are living with HIV, of whom 1,136,000 were on antiretroviral therapy by December 2017. The 2018 Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV Infection in Kenya further indicate that every effort should be made to ensure patients with confirmed HIV infection are linked to treatment and prevention expeditiously. Unfortunately, many patients are still lost at linkage to care, a crucial early step in successful HIV treatment.
Through the United States Agency for International Development (USAID) Health Communication and Marketing (HCM) program, PS Kenya works with private sector through three franchises: the Tunza Family Health Network, Gold Star Network (GSN) Kenya and Huduma Poa to implement an array of HIV services. Of the three franchises, some offer the full array of services; Treatment and Prevention of Mother-to-Child Transmission of HIV (PMTCT); while others are non-testing sites, offering testing and linkage.
“USAID has unequivocally continued to insist on innovative ways to recognize these providers and their services towards the HIV program. Therefore, every year, HCM holds an awards ceremony to reward providers who have performed well. Each year, we see clinics increasingly improve their performance and there is a competitive nature among the providers,” remarked PS Kenya Senior Technical Manager HIV, Dr. Catherine Kanari, during the 2018 HCM provider awards.
She noted the 2nd 90; by 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, as the biggest challenge, adding in all the award categories, linkage, viral load suppression and viral load coverage were key because the ultimate goal of a HIV patient is to achieve viral suppression.
These sentiments were reiterated by Mr. Kenneth Ireri, the Director of Ukunda Medical Centre, who stated that retaining adolescents in care (who are almost a third of PLHIV in Kenya and contribute more than half of all new infections each year) is a hurdle that the country must surmount to achieve the 2nd 90. The reasons behind this problem are multi-layered and includes a lack of psychosocial community support and disclosure.
“For some adolescents, their parents do not disclose to them in good time. I have had a very sad case of two sibling adolescents where disclosure was made quite late and because of this shock, the siblings say they felt cheated because they got the virus from their parents and completely refused to take drugs,” Mr. Ireri said.
The HCM program provides two roving HTS counsellors (in Mombasa and Greater Nairobi) who strengthen service delivery in the facilities, including linkage and retention. According to Ms. Teresia Mirera, the Gold Star coach and roving counsellor, this capacity building has helped get more clients into treatment.
“In May 2016, I was assigned to the Huruma Nursing Home to support HTS services and linkages. The facility had an issue of linkage and client defaulting. I had to go through almost 200 files to trace the clients that had defaulted; some of the contacts were not going through, some would pick up and say that I had called the wrong number, and unfortunately, some had died. In the end, I managed to get around 150 active clients,” recounted Ms. Mirera.
In line with HCM regulations, the facility is also advised to employ their own HTS counsellors. “Gold Star supports a lot of facilities, I was there temporarily, to motivate the staff, identify the gaps and give recommendations for implementation. By the time I was leaving after five months, the clients had started to consistently trickle in for their medical check-ups and drugs. My impact at Huruma Nursing led them to hiring Teresia.”
Teresia Yula, the current HTS counsellor at Huruma Nursing Home confirms that she found a good foundation and support system. “Teresa mentored me. She gave me all the information on the client CCC. After one month, she left. When tests would turn out positive, I did my best to educate the client on the importance of starting on ART. Some would say they are stable, they will go and come back but I would repeat to them the benefits of starting the medication early and eventually they would be convinced.”
Ensuring complete engagement of patients along the care cascade can help change the trajectory of the HIV epidemic. While delayed linkage to care remains a major barrier to the potential for “treatment as prevention”, programs such as the HCM HIV provide hope in private sector contribution to realize the UN AIDS 90–90–90 goal; by 2020, 90% of all people living with HIV will know their HIV status, by 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy by 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.
About the authors
Joyous A.L. Begisen is PS Kenya’s Corporate Communications Manager. Follow Joyous on Twitter: @JoyousBegisen. Andrew Juma is the Communications Manager HIV/TB at PS Kenya.Follow him on Twitter: @andrewjuma
