HIV/AIDS
1. Summary
The area in proximity to Lake Victoria in western Kenya is the most heavily affected area by HIV in Kenya. Of 529 villagers tested in Lwala in August, 2006, 32% were HIV positive. Within this group, 24% of men and 40% of women were HIV positive. Although this was a self-selected sample, data from the nearby town of Homa Bay suggest that this 30% prevalence may represent the Lwala population as a whole. If that is the case, over 90% of deaths in Lwala are likely due to AIDS. This has a predictable effect on children in Lwala; of the 408 pupils at Lwala Primary School, 29% have lost one or both parents.
HIV/AIDS was the primary motivation for starting the clinic and remains an enormous priority. However, it is important to be able to provide consistent service including a reliable drug supply and well-trained clinicians to provide antiretroviral therapy for AIDS, which can be detrimental without scrupulous adherence to the medication. Consequently, we are focusing in our first year on developing and refining our most basic systems, including financial accounting and reporting, pharmacy inventory and patient records. As these systems are consolidated, we are planning new programs to better address HIV/AIDS. In the meantime we have partnered with Tabaka Mission Hospital to provide comprehensive medical care for people with HIV/AIDS. We have also helped organize several HIV testing outreaches and education events for people in Lwala.
During the two years we have done ethnographic research about AIDS in the Lwala area. In particular, we have developed strong relationships with the women’s group in Lwala and an HIV/AIDS support group across the river from Lwala. These groups have participated integrally in designing the program outlined below.
2. Testing and Counseling
Voluntary counseling and testing (VCT) will be offered at the health center, employing two counselors from outside the village for reasons of confidentiality. The health center will offer stand-alone VCT services, but it will work to integrate these services with other clinical services. Over time, we will evaluate the possibility of instituting routine opt-out testing at the health center.
3. Treatment
The health center will provide comprehensive medical care for people with HIV/AIDS including anti-retroviral therapy. We are working to develop partnerships with other institutions and the Ministry of Health to get antiretroviral therapy (ART) for free. We are also developing partnerships for free CD4 testing and other necessary basic blood work, whereby we will send blood samples to an outside lab for analysis. At present, we are working towards an agreement with Tabaka Mission Hospital to integrate the Lwala health center into their AIDS program, which is designed and funded by AIDS Relief.
4. Community Health Worker Observed Therapy and In-home Follow-up Network
The cornerstone of our proposed HIV/AIDS program is a network of trained community health workers (CHWs). These CHWs will be recruited from local HIV/AIDS support groups and women’s groups. Already three CHWs have been hired to follow up with patients on ART through partnership with Tabaka Mission Hospital. They will be trained at the health center in home-based care, ART adherence, and social support for people with HIV/AIDS, using a curriculum designed by Partners in Health. The health center will equip each CHW with a bicycle and basic supplies such as gloves, and will pay each a small monthly stipend, intended to augment their normal daily activities rather than replace them. Each CHW will be assigned to no more than 4 patients near their home. Every patient on ART from the health center living within a 10km radius will receive daily in-home follow-up and directly observed therapy from a CHW. The CHWs will provide important follow-up to identify drug side effects and reactions, to ensure regular clinic attendance, and to help address threats to patient success as they arise. They will also act as a referral network for new patients.
5. Agricultural Outreach and Assistance
Poor nutrition is perhaps the chief threat to successful treatment of people with AIDS in resource-poor settings. The LCA will create a demonstration garden at the clinic to train people living with AIDS on innovative gardening techniques that can be done with less strength, including bag gardens and drip irrigation. The demonstration garden will be tended by an agricultural extension officer employed by the LCA. The produce of the garden will be given to severely ill patients. As these patients’ condition improves, the agricultural extension officer will visit them at home to help them develop new farming and gardening techniques. These patients will also receive fertilizer supplements and plowing assistance. Many people living with AIDS in this area have lost the productive members of their household, so plowing assistance will allow them to cultivate a larger area and produce more food. This program has been developed through focus group discussions with local HIV/AIDS support groups.
6. Community-based Education
The health center has been working with one local HIV/AIDS support group since its inception in 2006, and started a second HIV/AIDS support group in January 2007. These groups will be trained and equipped to provide HIV/AIDS education in the area. Young people reaching adolescence are at extremely high risk due to early sexual initiation, sometimes on a transactional basis, coupled with a lack of knowledge about AIDS and protective measures. The health center will train and equip students who have graduated from local primary schools to provide AIDS education there. The health center will also continue its program of using soccer matches as a platform for providing AIDS education, building on the Grassroots Soccer model. It will provide further training to the local soccer teams, which are highly admired by young people in the area, to provide AIDS education. This program has been developed through focus group discussions with local HIV/AIDS support groups.
7. Equipment and Supplies
Antiretroviral medications (ART) will be obtained through partnership with AIDS Relief, the Ministry of Health, or other NGOs. However, ART is only a part of AIDS treatment. Other medications will be needed for prophylaxis and treatment. HIV tests must be purchased, as well as basic furniture to equip a VCT office. The VCT will require hiring two full time counselors. We will also need to hire another full time nurse to handle the increased patient load. The CHW and agricultural outreach will be managed by a community health coordinator, who will be a full time employee of the LCA. The CHWs will require gloves and other basic protective equipment, as well as bicycles and small monthly stipends. Various educational materials will be needed for CHW training and community-group trainings, and funds will be needed to supply food and other necessities for community AIDS education events.
8. Facility
At present, the health center has no unused space to develop the proposed HIV/AIDS program. We plan to construct a building with private rooms for VCT and training space to house this program. This building would also house the proposed maternity program.
