CHAK has a wealth of experience in HIV/AIDS programmes implementation. Over the past year, CHAK has implemented four major HIV programmes:
CHAP-Uzima is a five-year PEPFAR–CDC funded HIV care and treatment project that runs from April 2017 to March 31, 2022. The project is mandated to oversee HIV care and treatment, and orphans and vulnerable children (OVC) services in 79 faith-based and affiliated health facilities spread over 19 counties in Nairobi, Central, Eastern, Coast and Rift Valley regions.
It succeeded the CHAK HIV/AIDS Project (CHAP) which ended on March 31, 2017. The project is implemented by a consortium of five partners:
a) Christian Health Association of Kenya - Prime partner
b) Palladium Group, supporting health information systems, monitoring and evaluation
c) University of Nairobi offering senior clinical technical advisory
d) Mission for Essential Drugs and Supplies (MEDS) for health products and technologies
Purpose of the project
The project's purpose is to contribute to the national effort to halt and reverse HIV incidence and HIV-related morbidity and mortality by providing technical support to a network of targeted, high volume faith based and affiliated health facilities through focused HIV interventions for the general, key, and priority populations. The aim is to ensure expanded provision of sustainable, high quality, integrated HIV prevention, care, and treatment services.
a) Provide comprehensive targeted high-impact interventions to reduce new HIV infections
b) Increase access to comprehensive care and treatment services and improve health outcomes for people living with HIV and AIDS (PLHWA)
c) Improve information generation, management, and use at supported faith based and affiliated health facilities and counties
d) Strengthen capacity of county and facility health systems to deliver sustainable and comprehensive HIV care and treatment services
The project’s achievements in 2017 were as follows:
During the year a total of 35,572 patients were on IPT. Of these, 19,945 were newly initiated on IPT, of whom 19,048 (96 per cent) completed the regimen. The overall IPT coverage under the project was 80 per cent up from 44 per cent in 2016. This was due to a more reliable supply of IPT from national supplies.
The 80 per cent coverage is still suboptimal (The set standard of care is 95 per cent) mainly due to:
a) Patients' reluctance arising from fearsof adverse drug effects and unwillingness to add to pill burden
b) Health care worker related factors (failure to offer IPT, or unwilling to initiate IPT in some groups of patients)
c) Systemic issues such as unavailability of laboratory tests to assess suitability of patients or for monitoring drug adverse events
A total of 7,011 OVC are direct beneficiaries of the CHAP Uzima programme.
HIV Testing Services (HTS): In 2017, 337,977 patients accessed HIV testing and counselling services with a positivity yield of 1.5 per cent. Of those tested, 48,229 (14.26 per cent) were aged below 15 years.
The HTS coverage for pregnant women at the antenatal clinic was 100 per cent. All HIV positive mothers were on antiretroviral therapy as per the national guidelines. Viral suppression in PMTCT mothers was 96 per cent.
The total number of patients on ART by the end of December 2017 was 47,373. Of these, 2.7 per cent were pediatrics aged 0-9 years and 7.7 per cent were adolescents aged 10 -19 years.
The overall 12-month retention in 2017 in CHAP – Uzima was about 90 per cent. The lowest retention rate was recorded among the 20 -24 age category with a retention of 81 per cent.
Screening for tuberculosis was provided to 95 per cent of patient visits at the HIV care and treatment clinics. In the TB clinic, HIV status was established for all (100 per cent) of the identified TB cases (2,765). The proportion of TB/HIV coinfection was 55 per cent (1536 cases), with 397 new HIV cases identified.
In 2017, overall viral suppression was at 91 per cent.
Operation Triple Zero (OTZ): In 2017 the treatment adherence support team implemented OTZ, an adolescent treatment club which has been shown to improve treatment outcomes in adolescents in Kenya. By the end of the reporting year, out of 1528 adolescents aged 10 -19 years in four high volume facilities, 548 had been enrolled into OTZ clubs. Of these, 69 per cent were virally suppressed at baseline. However, after 6 months of OTZ intervention and follow up, over 90 per cent of the adolescents in the OTZ clubs were virally suppressed.
The CHAK HIV and Human Rights project is conceptualized to tackle AIDS-related stigma and discrimination in accordance with the declaration of commitment adopted by the United Nations General Assembly Special Session on HIV/AIDS in June 2011 which states that confronting stigma and discrimination is a prerequisite for effective prevention and care. The declaration also reaffirms that discrimination on the grounds of one's HIV status is a violation of human rights.
The project seeks to educate communities and PLWHA on the rights of those living with the HIV virus to enable PLWHIV to claim their space. Communities are empowered to advocate for and protect those rights within their setting and in healthcare and service delivery.
The overall project goal is to improve HIV and AIDS care and treatment outcomes and quality of life for PLWHIV by increasing protection and realization of human rights and access to justice for PLWHA.
This is achieved through six objectives:
The project achieves its objectives through the following strategies:
Peer educators and health care workers are trained on human rights for people living with HIV/AIDS. The trained peer educators and health care workers sensitize local communities on HIV/AIDS and the rights of PLWHAs during community forums such as chiefs' barazas as well as psycho social support group meetings.
These are pillars to solve disputes stemming from stigma and discrimination against PLWHAs. The Human Rights Councils have seven members as follows: health facility focal point person who is essentially from the HIV clinic, two peer educators, one administrator (chief), respected opinion leaders from the locality, a religious leader and two elders (male and female) from the community. The councils are trained on human rights for PLWHAs and Alternative Dispute Resolution. The councils are introduced to the PLWHIV through psycho social support groups and their mandate explained. Patients needing intervention by the Human Rights Councils are asked to report the matters to the peer educators who also double up as members of the councils.
They are critical to the fight against stigma and discrimination of PLWHAs. The project trains health care workers to be agents of change within their health units, train fellow health care workers on human rights and the rights based approach to health for PLWHA. Health care workers are the project Focal Point People (FPPs) in the facilities. Before assuming the role of FPPs, the health care workers were trained on human rights and Alternative Dispute Resolution.
The health facilities identify and engage a local legal practitioner who offers pro-bono services to needy PLWHA and support to the local council in form of legal advice. The project also supports legal aid clinics held at the health facilities.
Afya Jijini is a three-year USAID-funded contract (with two additional years) designed to strengthen Nairobi City County's institutional and management capacity to deliver quality healthcare services.
Specifically, the project aims to improve access to and uptake of quality health services in Nairobi County for the most pressing health issues, i.e. HIV/AIDS and maternal and neonatal health, with a focus on informal settlements.
AFYA Jijini is implemented by a consortium of five partners.
a) IMA-World Health as the lead recipient and also implementing HIV/AIDS care and treatment
b) Christian Health Association of Kenya (CHAK) implementing HIV/AIDS treatment and care
c) University of Nairobi undertaking the programme for key populations
d) National Organization of Peer educators (NOPE) which leads in community programming in the informal sector
e) Mission for Essential Drugs Supplies (MEDS) which supports health products and technologies.
The project seeks to achieve three main sub-purposes:
1) Increase access and use of quality HIV services
2) Improve access to and uptake of maternal, neonatal and child health (MNCH), family planning (FP) and reproductive health (RH), water, sanitation and hygiene (WASH) and nutrition services
3) Strengthen county and sub-county health systems
During the 2017 project year, AFYA Jijini supported HIV/AIDS care and treatment, maternal and neonatal health, PMTCT and HTC in three sub counties of Nairobi, namely, Westlands, Starehe and Makadara as part of the UHAI team 3 cluster.
The CHAK Jijini programme in 2017 supported 13 health facilities to provide HTS services. During the year, 62,109 clients accessed HTS services out of who 2,514 (4 per cent) tested positive for HIV.
The overall linkage in the year 2017 stood at 90 per cent. The project rolled out Partner Notification Services (PNS) from October 2017 in order to scale up HTS.
In 2017, CHAK Afya Jijini project supported 13,597 clients in care and treatment. The project's 12 month retention rate stood at 80.1 per cent.
In 2017, a total of 10,187 clients had a valid viral load report out of the 13,597 eligible clients. Viral load suppression was at 8379 representing 82 per cent.
A total of 13 health facilities were supported to offer PMTCT services in 2017. The CHAK UHAI cluster team supported testing of 11,942 new ANC clients among who 287 were identified as HIV positive. A total of 293 known positives (KPs) were also identified bringing the total HIV infected pregnant women to 580. A total of 567 out of the 580 (97.7 per cent) of the positive women received antiretroviral therapy to reduce the risk of mother to child transmission. They were also issued with infant prophylaxis.
The APHIA plus KAMILI project is a USAID supported comprehensive HIV and AIDS treatment and care and MNCH/FP project that was launched in 2011. In 2017, the project was in its seventh and final year.
The project started with a consortium of eight partners in year one but by 2017, the partnership had shrunk to two partners, namely; JHPIEGO, the principal recipient, and CHAK.
The CHAK programme in 2017 covered a total of 37 health facilities, of which 22 had active comprehensive clinics for HIV&AIDS while all the 37 offered PMTCT services.
The project was spread in the eight counties of Embu, Tharaka Nithi, Meru, Kirinyaga, Muranga, Kiambu and Nyandarua.
The goal of APHIA Plus KAMILI was to achieve the 90-90-90 strategy along the HTS, client enrollment into treatment and viral load suppression cascade of HIV and AIDS management client pathway.
Project achievements (2017)
Counselling and testing
A total of 37 health facilities have been supported to provide HTS services with 14 provided with 18 sessional counsellors to offer testing.
Health facilities in the APHIA PLUS Kamili project have been taken through a commodity management training covering timely reporting and forecasting in order avoid stock out of kits and commodities. Facilities are supported with commodities and test kits through the national mechanism and redistribution done within counties for sites that run short of the kits.
In 2017, total ANC first visit was 4,625. The number tested was 4506 which translates to 97 per cent. Of those tested, 119 were found to be positive which translated to a positivity of 2.6 per cent. Of the 119 mothers found to be positive, 98 per cent were initiated on ART and their babies issued with prophylaxis. All care and treatment facilities provided post-exposure prophylaxis (PEP). All the 37 supported PMTCT and HIV/AIDS a care and treatment sites provided both occupational and sexual assault/rape-related post exposure prophylaxis as per MoH guidelines.
By September 2017, current clients on ART in the APHIA PLUS Kamili FBO project were 6,155.Out of the targeted 70, a total of 58 health care providers were trained on the new ART/ HTS guidelines in six training sessions to build their capacity on HIV care and treatment.
All APHIA plus care and treatment sites integrated TB/HIV services. Integration of ICF of TB in HIV care and treatment services was achieved and over 95 per cent of patients receiving HIV services were routinely screened for TB at every visit.
All the health care providers in 22 CCCs covered by the project were trained in TB and infection prevention and control established in 70 per cent of the care and treatment sites. Isoniazid preventive therapy (IPT) was initiated in 23 CCCs.
The APHIA PLUS Kamili project had a 12-month retention of over 85 per cent in 2017.
The APHIA PLUS Kamili project came to an end in 2017. Going forward, health facilities under the project will be supported under the Kenya HIV/AIDS activity support cluster 3 programme that is being implemented by JHPIEGO.