Ciheb’s work in Kenya continues to make progress in building health systems capacity and in expanding prevention efforts for HIV and tuberculosis (TB). Ciheb is implementing five projects in Kenya funded by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) under the President’s Emergency Plan for AIDS Relief (PEPFAR).
Boresha Maabara. Swahili for “improve laboratory services,” Boresha Maabara has been supporting the Kenya Ministry of Health, the National Public Health Laboratory Services, and the Kenya National Blood Transfusion Services to strengthen laboratory systems and provide national leadership for and coordination of the provision of sustainable high-quality TB/HIV diagnostic services.
The program has provided significant support to the National Public Health Laboratory for its oversight role of other laboratories in the country. It has also contributed to the development of national laboratory-related policy documents and national tools, enhanced inter-laboratory networking, reduced turnaround time for results, and improved the quality of tests. It has also contributed to the accreditation of national HIV and TB reference laboratories and regional laboratories.
Other laboratory-related achievements include strengthening technical working groups in 10 counties supported by the grant, improving the reporting, forecasting and management of lab commodities, entrenching the use of continuous quality improvement principles in lab services, and ensuring quality of rapid HIV testing services.
Partnership for Advanced Care and Treatment (PACT) Timiza and Endeleza. The PACT Timiza (timiza is Swahili for “fulfill” or “accomplish”) and PACT Endeleza (endeleza is Swahili for “sustain” or “continue”) projects collaborate with health management teams from the governments of Kisii, Migori, and Nairobi counties to provide universal, high-quality, comprehensive, and integrated HIV prevention, care, and treatment services across 289 health facilities.
Around 1 million individuals have received HIV testing services in both programs, with more than 105,000 identified as HIV positive and linked to treatment services. PACT Timiza was supporting over 87,000 clients on antiretroviral therapy (ART) (approximately 3,000 children <10 years and 5,700 adolescents 10-19 years) across 241 healthcare facilities within Migori and Kisii counties. Similarly, PACT Endeleza supported nearly 29,000 clients on ART (468 children <10 years, 844 adolescents 10-19 years) in 48 facilities in Nairobi, including 8 in community-based drop-in-clinics that serve key populations (i.e., female sex workers, men who have sex with men, and people who inject drugs).
These counties in rural and urban Kenya serve mobile populations at risk of poor treatment outcomes. The programs have supported the transition of adult populations to more effective antiretroviral regimens and established functional viremia clinics. They have also scaled up differentiated care models for various populations, including multi-month dispensing, institution of robust patient support systems, structured counseling, and patient tracking systems. The programs further provided voluntary male circumcision services—an intervention proven to be effective in HIV prevention—and provided HIV prevention services to female sex workers and men who have sex with men. In two clinics supported by the program in Nairobi, more than 1,100 people who inject drugs are receiving comprehensive harm reduction services, including medically assisted therapy with methadone.
Technical Assistance for Public Health Impact in Kenya (TAPHIK). The CDC-funded TAPHIK Project has collaborated with the Kenya Medical Research Institute (KEMRI) to pilot an HIV case-based surveillance system (CBS) in a region in Western Kenya where CDC has been partnering with KEMRI to support a health and demographic surveillance system (HDSS). The project developed an interactive point-of-registration and linkage system that was used to link the HDSS database to the medical records of HIV-infected individuals seeking care services at 14 pilot health facilities through an interoperability layer running on a Mirth platform.
Dr. Kristen Stafford (left), Associate Director of Ciheb, visits the PACT Endeleza-supported Ngara Health Centre.
Select sentinel events along the HIV continuum of care were extracted into the CBS database and used to monitor implementation and outcomes of HIV treatment. Furthermore, the program is at an advanced level of planning for piloting the use of the CBS system to collect information from facilities with paper-based records using scan forms and an open source software, Open Data Kit, to capture patient information from source records and transmit this to the CBS database for processing.
Tobacco Cessation Study. Ciheb’s first NIH-funded randomized control trial is examining tobacco cessation pharmacotherapy and behavioral interventions among HIV-infected individuals. HIV has been shown to be associated with a greater likelihood of tobacco use, which further aggravates the risk of non-communicable diseases and which are now seen to be causing increasing morbidity and mortality in HIV. Unfortunately, smoking cessation interventions are not included as part of the comprehensive package of services currently provided in HIV treatment clinics. In this second year of implementation, the study conducted formative research, completing 50 participant interviews and three focus group discussions that provided useful information on the study populations and guided the finalization of the study instruments.
Continuous Quality Improvement
Implementing CQI programs in Kenya
News and Impact Stories from Kenya
In 2017, the Government of Kenya adopted a new policy rolling out pre-exposure prophylaxis (PrEP) as part of a national HIV combination prevention strategy. Ciheb in Kenya's PACT Endeleza program then aligned with the government and started offering PrEP that same year to the benefit of thousands of clients in Nairobi.
Ciheb in Kenya, through the PACT Timiza program that worked in the Western Kenyan counties of Kisii and Migori, used differentiated service delivery to support an estimated 90,000 people living with HIV with a variety of health services.
September marked the close of Ciheb in Kenya’s two Partnership for Advanced Care and Treatment (PACT) programs, PACT Timiza and PACT Endeleza. Ciheb held closeout events in the three counties that it worked in – Kisii, Migori, and Nairobi City – to commemorate the two programs' accomplishments.
During the summer, the Nairobi Metropolitan Services (NMS) held its annual Health Service Delivery Awards to recognize best-performing health facilities in Nairobi County. Facilities supported by PACT Endeleza won awards in all categories they participated in. NMS evaluated facilities based on their performance in continuous quality improvement metrics.
In 2016, UMB through Ciheb partnered with the Centers for Disease Control and Prevention to implement a new five-year program called “Technical Assistance for Public Health Impact in Kenya” (TAPHIK), which helped fill a need for HIV research in Western Kenya and Kenya in general.
In Nairobi County, Kenya, health authorities have taken ground-breaking steps toward reducing the spread of HIV among people who inject drugs.
Ciheb in Kenya staff working on the PACT Endeleza project have identified art therapy as a method to help child and adolescent people living with HIV to address psychosocial and emotional issues.
Ciheb in Kenya is leading a five-year smoking cessation study among HIV-infected people in Nairobi, Kenya. The study is examining how combinations of pharmacological and behavioral interventions may improve the chances of maintaining long-term smoking abstinence.
People who inject drugs are a population who are at higher risk of contracting HIV/AIDS. Since 2014, Ciheb has been helping to establish medically assisted therapy (MAT) clinics in Kenya to mitigate the adverse consequences of drug use and protect public health.
Nairobi City County has been an epicenter of Kenya’s COVID-19 outbreak. It is also where Ciheb's PACT Endeleza project supports facilities that provide HIV testing services. Read how we have responded to the pandemic to ensure continued services.
The Boresha Maabara project has been supporting 108 laboratories in 10 Kenyan counties. The support includes facilitating comprehensive planning so that the labs are able to stay on track in meeting their public health objectives. Recently, the project facilitated a laboratory strategic planning meeting for Nairobi City County.
New research examines the prevalence of intimate partner violence and its association with rates of mortality among neonates, infants, and children less than five years of age in the East African countries of Burundi, Kenya, Rwanda, Tanzania, and Uganda.