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Differentiated HIV Care in Kenya: A Student’s Perspective on Informing Antiretroviral Treatment Provision for Stable HIV-infected Individuals in Kenya

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Differentiated HIV Care in Kenya: A Student’s Perspective on Informing Antiretroviral Treatment for Stable HIV-Infected Individuals in Kenya

Jill M Hagey MPH1, Xuan Li2, Jill Barr-Walker3, Craig R Cohen MD MPH4,5

1School of Medicine, 3Zuckerberg San Francisco General Hospital, 4Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco, CA

2School of Medicine, Rush University, Chicago, IL

5Family AIDS Care and Education Services, Kisumu, Kenya 

 

Introduction:

•Medical student participation in global health experiences has increased in the last decade; necessitating increased consideration of professional and ethical implications of medical student involvement in projects abroad1,2
•Working within the structure of an existing implementing partner such as the Family AIDS Care & Education Services (FACES) and collaborating with local governments, students can engage with the long-term challenge of administrating novel antiretroviral therapy (ART) delivery models to reach the growing number of individuals needing treatment3

Methods:

•To increase coverage of patients on HIV treatment, the Kenyan National AIDS and STI Control Programme (NASCOP) has started to implement differentiated HIV care – a responsive, client-centered approach that adapts HIV services across the care cascade to serve individual needs and reduce burdens on the health system4,5
•Students working with FACES have been providing support to NASCOP in implementing differentiated HIV care through: (1) participating in updating the national HIV care and treatment guidelines and related toolkits, (2) supporting pilot differentiated care models and evaluating those models, and (3) completing a scoping review of differentiated care models

Results:

•Policy
•Aided in background research for the publication of national “Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV Infection in Kenya” including a large section on differentiated HIV care for patients stable on ART7
•Aided in creation of toolkits and training modules for healthcare workers on implementation of differentiated HIV care
•Implementation Science
•Championing facility-based ART group differentiated care model in Kisumu, Kenya
•Executing monitoring and evaluation strategies for differentiated care models, including investigating HIV+ patients preferences around models of HIV care delivery
•Research
•Conducting scoping review of models of differentiated HIV care to determine which models have positive health impacts for stable HIV-positive adult patients
 

Conclusions:

Differentiated HIV care restructures ART delivery appropriately to ensure patient-centered care, non-inferior health outcomes, and reduced burden on overworked health facilities. Kenya has started to scale up these differentiated care models with the help of different implementing partners. Continued collaboration between implementing partners such as FACES and NASCOP should focus more research efforts in this area, and can provide students with the opportunity to engage in long-term solutions to health system challenges.

Selected References:

1.Shah S, Wu T. 2008. The medical student global health experience: professionalism and ethical implications. J Med Ethics; 34:375-378.
2.Crump JA, Sugarman J. 2008. Ethical Considerations for Short-term Experiences by Trainees in Global Health. JAMA; 300(12):1456-1458.
3.Kulzer JL, Penner JA, Marima R et al. 2012. Family model of HIV care and treatment: a retrospective study in Kenya. J Int AIDS Soc; 15:8.
4.International AIDS Society (IAS). Differentiated Care. www.differentiatedcare.org.
5.World Health Organization. 2015. HIV Treatment and Care: What’s New in Service Delivery. Geneva, Switzerland: WHO.
6.Duncombe C, Rosenblum S, Hellmann N et al. 2015. Reframing HIV care: putting people at the centre of antiretroviral delivery. Trop Med Int Health; 20(4):430-47.
7.National AIDS and STI Control Programme, Ministry of Health Kenya. 2016. Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV Infection in Kenya. Nairobi, Kenya: NASCOP.
 

Collaborators:

We would like to thank the FACES Differentiated Care Team: Dr. Lisa Abuogi, Dr. Maurice Aluda, Cinthia Blat, Dr. Elvin Geng, Mary Guze, Dr. Julie Kadima, Dr. Charles Kibaara, Jayne Lewis-Kulzer, Edwin Mulwa, Dr. Thomas Odeny, and Dr. Patrick Oyaro, Dr. Rena Patel, and Dr. Jeremy Penner.

Support in part by grants from the UCSF Global Health SOM Research Fellowship and the UCSF RAPTr Pathways Grant.

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