HIV & AIDS PROGRAMS
CHAK Secretariat and the member health network engages in a wide range of services to mitigate the impact of HIV&AIDS in Kenya within the framework of the Kenya National AIDS Strategic Plan (KNASP). CHAK is guided by international and country level policies, guidelines, strategies and best practices in it’s HIV&AIDS response interventions.
CHAK HIV&AIDS response initiatives are evidence based and embrace a comprehensive and wholistic approach addressing the physical, psychological, social, spiritual and economic well-being. The scope of the response include; prevention, diagnosis, care & treatment (ART), PMCT and stigma mitigation. The services include VCT, PITC, PMCT, VMMC, PwP, TB-HIV co-infection, ART, cervical cancer screening, economic empowerment and promotion of legal and human rights of people living with HIV&AIDS.
The CHAK HIV/AIDS programme has worked in the Eastern, Central, Nairobi and Coastal regions of Kenya over the last five years through the USAID-supported APHIA II Western, APHIA plus Kamili and APHIA Jijini (started in late 2015) and the CDC-supported CHAK HIV AIDS Project, (CHAP), covering 21 counties in Kenya and working with over 100 health facilities. Through these projects, CHAK continues to make a significant contribution to national and global efforts to attain zero new infections, AIDS related deaths and discrimination.
The CHAK HIV&AIDS program has 61, 704 active clients on care while 41,059 are on ART, contributing about 9 per cent of the total patients nationally.
CHAK HIV&AIDS Program (CHAP)
CHAK is the prime partner in a 5-year CDC grant funded by PEPFAR for the implementation of a comprehensive high quality HIV care and treatment project in Faith Based Health Facilities in Eastern, Central, Nairobi and Coast regions of Kenya. The consortium partners include MEDS, IHV of University of Maryland, Futures Group and CMMB.
This project is a follow-on to the AIDSRelief project which has implemented high quality comprehensive HIV&AIDS care & treatment services in 29 FBO health facilities and 100 satellite sites. CHAP grant kicked-off on 1st October 2011.
In 2015, the project covered 19 counties spread in the Eastern, Central, Nairobi and Coastal regions of Kenya and supported 55 health facilities. These counties are Nairobi, Kiambu, Murang'a, Kirinyaga, Nyandarua, Laikipia, Nyeri, Embu, Meru, Tharaka, Kitui, Taita-Taveta, Kilifi, Mombasa, Marsabit, Isiolo, Kajiado, Machakos and Nakuru.
The CHAK HIV/AIDS Programme is implemented through a four-pronged strategy which involves:
1) Clinical mentorship and capacity strengthening
2) Health systems strengthening in faith-based affiliated sites
3) Strategic information systems management
4) Integration between faith-based and county-level health systems
This strategy has been instrumental to health systems strengthening efforts and contributed significantly to attainment of project objectives at the facility level.
2015 project statistics
By the end of 2015 the project had enrolled a total of 37,934 active adult patients on care. Of these, 35,245 (93 %) were on antiretroviral therapy (ART). In 2015 alone, the project enrolled 5,191 new adults into HIV care out of who 4,815 were newly started on ART.
By the end of 2015, the project was supporting 3,495 paediatric and 3,220 adolescent patients on care, representing 8.4 per cent and 7.8 per cent of the total patient population on care respectively. Out of the paediatric and adolescent patients on care, 3,216 (92 per cent) and 3,027 (94 per cent) respectively were on ART. In 2015, 4,520 pediatrics were newly enrolled into HIV care while 443 were newly started on ART.
The project also implemented the CDC-funded ACTS initiative to scale up Pediatric HIV care in 25 health facilities within the seven high burden counties of Nairobi, Nakuru, Machakos, Kiambu, Mombasa, Kilifi and Murang’a. Through the ACTS initiative, a total of 223 pediatrics were identified and newly enrolled into care, and 203 newly started on ART in the seven high burden counties.
In the same year, 97 per cent of the new and relapsing TB cases accessed a HIV test in the TB clinics. Antenatal clinic services were available in 52 (94 per cent) of the supported health facilities while maternity services were available in 40 per cent. Integrated HIV/MNCH services were accessible in 67 per cent of the facilities, all of which had an active PMTCT support group for mothers and their babies. In 2015, the project recorded 21,485 new ANC visits within the 55 supported health facilities. Of these, 1,023 were known HIV positive clients, meaning that a total of 20,462 ANC eligible mothers received an HIV test out of who 343 were found to be HIV positive.
In 2015, the project supported HTC in all the 55 facilities. A total of 183,228 patients, across all departments took up HTC out of whom 27,484 (15 per cent) were pediatrics.
The number of adults who turned HIV positive were 4361 or 2.8 per cent while 328 or 1.2 per cent were children. About 90 per cent of these adults and 89 per cent of the pediatrics were linked to care within the supported health facilities and the remaining linked up with other health facilities for HIV care services.
To strengthen the capacity of implementing health facilities, the project carries out trainings in governance and management, supply chain, pharmacy and laboratory, strategic information, financial management, among other areas.
Promoting human rights for people living with HIV/AIDS
Human rights are inextricably linked with the spread and impact of HIV and AIDS on individuals and communities the worldwide. A lack of respect for human rights fuels the spread and exacerbates the impact of the disease.
Discrimination and stigma is a common form of human right violation for PLWHA. The rights of PLWHA violated because of their presumed or known HIV status. This stigmatization and discrimination obstructs their access to health services, affects their employment, housing and other fundaments human rights. Consequently this leads to increase vulnerability to infection, denial or silence and nondisclosure of HIV status which eventually promotes further spread of the infection in the communities. Stigma and discrimination also discourages PLWHA from contacting health and social services, at community level they are denied right to ownership, inheritance, education and other vital social economic rights necessary for them to improve their health and better their quality of life.
Discrimination and stigmatization meted toward vulnerable groups such as adolescents PLWHA, injecting drug users and sex workers drives these communities underground. This reduces programmatic capacity to reach out to these populations with health care and social services. Denial of education and information about HIV treatment, and care and support services to PLWHA impacts negatively on effective responses to HIV and AIDS which slowing down the efforts to stop new infections and improve the health and livelihood of those who are infected.
The goal of the CHAK HIV and human rights project is to increase the protection of human rights and improve access to justice for PLWHAS in Kenya.
The objectives of the project include:
- To empower PLWHIV to demand and defend their human rights and better quality health care services in order to achieve better treatment and care outcomes and improved quality of life.
- To build the capacity of Health Care Workers to enable them offer quality and humane health services as a result of integrating human rights into treatment and care of PLWHA.
- To effectively link Health Care Workers to the community mechanisms for reporting and registering client human right abuses and disputes reported to them in the course of their work while respecting the confidentiality of the client’s information.
- To build the capacity of the community social structures and systems to ensure that the community plays a pivotal role in effective response to and resolution of disputes involving PLWHIV.
- To build effective, accessible, affordable and sustainable linkage mechanisms between the community and collaborating legal practitioners and agencies for aiding legal and human rights disputes irresolvable at the community level.
- To improve the socio – economic status of PLWHA in order to reduce the impact of HIV and AIDS thus improving access to treatment and care and the outcomes therein.
The project is implemented under four strategies which include:
1) Community mobilization.
2) Capacity building
3) Net-working & collaboration
4) Economic empowerment of PLWHAs
The project is structured to work in three key pillars in the society.
The first is the health facility pillar which is composed of the health facility, the health care workers and the PLWHA and their psychosocial support groups. This pillar is responsible for the care and treatment services, human rights education to PLWHA and support and education to the psychosocial support groups. The health facility is also responsible for conducting community based outreach clinic in conjunction with the community pillar in order to educate the communities about the rights of PLWHA and to offer legal clinics in conjunction with the technical pillar.
The second is the community pillar that is composed of a group of community opinion leaders forming a council of five persons. Their work is to offer alternative dispute resolution for human right cases brought to them either directly by the PLWHA or communities or referred to them by the health facility or even by the legal pillar.
The third is the legal Technical pillar which is composed of local legal support either from a lawyer or from a local non-governmental organization with legal capacity. Some health facilities have their own lawyers and they form this part of the structure.
The human rights program has created significant impact in the knowledge and practices within the targeted communities. CHAK and the partner have been inspired by the results and decided to document the achievements in a documentary to facilitate sharing best practices and lessons learnt.
CHAK Documentary - Fixing The Broken Link (Click to view Video)
CHAK is an implementing partner in the 5-year USAID funded APHIAPlus Kamili project serving in the region of Eastern and Central Kenya. The APHIAPlus Kamili project is led by JHPIEGO and has 9 consortium members. It supports the Ministries of Health, FBOs and communities to improve the capacity of health institutions to deliver integrated and comprehensive HIV/AIDS, TB and Reproductive Health services.
CHAK has a team of health workers in the project whose mandate is to build capacity of 73 faith based health institutions to deliver comprehensive HIV/AIDS & TB care and treatment, PMCT, HCT, Reproductive Health and Family Planning services in Central and Eastern regions. They also facilitate linkages and integration with the District Health Management Teams.
Afya Jijini project
CHAK is a consortium member in the new USAID-funded Afya Jijini project led by IMA World Health. The project will provide support for HIV, maternal health, child health, nutrition and water and sanitation (WASH) activities in Nairobi County with the exception of Kibera sub-county.
CHAK has been assigned the two sub-counties of Westlands and Dagoreti. We shall work with county and sub-county Health Management Teams and health facilities and Community Health Workers to address poor health indicators in the city. This will involve reaching out to the slums and informal settlements.
Pre-service HIV training
CHAK is a partner in the CDC funded project on strengthening HIV pre-service training in Medical Training Colleges. The project partners are; JHPIEGO (prime), CHAK, KMTC and Danya. CHAK mandate is to coordinate project implementation in 26 Faith Based Medical Training Colleges from the whole country. The project purpose is to produce pre-service MTC graduates who are competent to provide quality HIV&AIDS prevention, treatment, care and support services. The specific objectives include;
- Review and update the HIV content in the training curricula
- Improve training skills for lecturers/tutors
- Facilitate delivery of the HIV content
- Develop systems for quality assurance in training and follow-up
- Develop and implement e-learning modules
CHAK has facilitated capacity building of FBO MTC Tutors in Effective Teaching Skills, Students Performance Assessment and IT skills. Routine regular supervision is done to provide feedback to tutors on their teaching performance and offer on-site mentorship.
HIV prevention, treatment, care and support modules have been developed in the thematic areas recommended by the National AIDS and STIs Control Program (NASCOP). Regional MTCs Resource Centres have been established and well equipped starting with 3 FBO MTCs at Maseno, Mathari and Kyeni. In addition Laptop computer and LCD have been provided to all MTCs to facilitate delivery of lectures. The project has identified the need to invest in ICT infrastructure and resources to facilitate access to information and learning for faculty and students.
Global Fund support
CHAK had also implemented comprehensive HIV care and treatment through funding from Global Fund Round 2 and 7 HIV grants.