HIV diagnosis and treatment at Moi University

1
HIV diagnosis and treatment at Moi University

• AMPATH

2
Acknowledgements

• AMPATH clinical working group
• Collaborating, funding and supporting
  institutions and individuals
• Conference hosts

3
AMPATH Academic Model for Prevention and
Treatment of HIV/AIDS

• Collaborating Institutions
• Moi University School of Medicine (MUSoM)
• Moi Referral Hospital (MTRH)
• Indiana University School of Medicine (IUSoM)
• GoK health facilities

• Funding Agencies
• PEPFAR
• Ministry of Health/NASCOP
• USAID/CDC/WFP
• Bill and Melinda Gates
• Rockefeller/NIH/PVF

4
Mt. Elgon
Kapenguria
Kitale
Naitiri
Teso
Kabarnet
Iten
Turbo
Webuye
Eldoret
Amakura
Mosoriot
Busia
Burnt Forest
Port Victoria Chulaimbo
5
HIV diagnosis

• Diagnosis at the health facilities
• Moi Referral Hospital (VCT)
• AMPATH
• Provider initiated counseling and testing
  (PITC/DTC)
• Antenatal clinic (ANC) and Labor ward (pMTCT)
• Paediatric diagnosis
• Diagnosis in the community
• Community mobilization
• Home Counseling and Testing

6
MTRH VCT

• VCT clinic initiated at MTRH in 2001
• Supported by NASCOP/MoH
• 45 60 minutes/client
• Test between 250 and 350 people/month
• 7 test positive

7
AMPATH PITC/DTC

• Since May 2005
• Initially confined to general Medical wards at
  MTRH
• Now covers entire MTRH
• Service being spread out to all affiliate AMPATH
  health facilities
• 15 minutes/client

• 31,700 adult patients tested
• 60 female
• 25 have tested ve
• 1,430 children tested
• 12 have tested ve
• Note 50 of medical ward patients have tested ve

8
pMTCT

• Inception March 2002
• In 2006
• 70,00 pregnant women attended ANC
• 43,000 counseled
• 30,200 consented tested
• 7 positive

9
Paediatric diagnosis

• 983 babies tested before 12 months
• 115 ( 10) had positive PCR
• 6 SD NVP formula
• 8 ART formula
• 9.5 ART breast milk
• 17 no drug formula
• 25 SD NVP breast milk
• 28 no drug mixed feeding

10
Community Mobilization

• CM team set up in March 06
• Started activities in June 06
• Group counseling, individual testing
• 44,400 tested
• 60 men
• 5.4 tested HIV positive

11
Home Counseling and Testing

• Pilot program to do home-based testing
• One administrative Division
• Population 40,000
• Advance team to sensitize the community
• Testing team trails
• Education on prevention in negatives and
  positives
• Lateral expansion
• Safe water (waterguard), mosquito nets,
  de-worming, cough monitoring and TB screening,
  reproductive health

12
Testing protocols

• Serial testing (Determine)
• If positive 2nd test (Bioline)
• pMTCT do parallel testing
• Tie breaker Unigold
• Long method Elisa for indeterminate results
• Blood from every 10th test taken for long Elisa

13
Quality of tests Gold standard - long Elisa

• Determine (N146)
• Sensitivity 85
• Specificity 95
• Unigold (N190)
• Sensitivity 70
• Specificity 90

• Bioline (N27)
• Sensitivity 100
• Specificity 77

14
Challenges in diagnosis

• Demand far outstrips manpower capacity
• Unrealistic community and community leaders
  expectations
• Handouts
• Clinic establishments
• Employment
• Mobile phones
• Kits shortages
• Quality control

15
ART

• History of AMPATH
• ART programs
• Pilot
• MTCT plus
• TpMTCT
• PEP

16
PatientsAs at 31st May 2007

• 54,500 patients enrolled
• 2,800 died
• 3,300 lost/transferred
• 390 discontinued
• 48,000 active patients
• 40,500 adults
• 70 females
• 19,600 on ART
• 7,500 children
• 52 female
• 1,800 on ART

17
Cumulative Patients Enrolled Nov 01June 06
18
Lost to follow-up

• Active absconder tracing
• Tracer information on all patients
• Search for patients missing appointments
• If on ART - activated in 3 days
• All other - activation is within 1 month
• Statistics for patients on ART
• Missed appointment 3 months 1.7
• Missed appointment 6 months 1.2

19
ART support services

• Routine lab Hematology, Chemistries
• Reference lab
• Immunology
• Molecular diagnostics
• TB lab
• Microscopy, culture (LJ and MIGT), PCR
• Planning for Microbiology, Nutrition and
  Pharmacology labs in progress

20
ART support services

• Nutrition
• Food prescription
• HAART n Harvest Initiative (HHI)
• Food distribution
• WFP

21
ART support services

• Family Preservation Initiative (FPI)
• Small business enterprise
• Eradication of poverty
• Promotion of self reliance

22
ART support services

• Pharmacy
• Psychosocial and Adherence support
• Social services
• Humanitarian, Safe houses
• OVC
• AMPATH Medical Records
• Electronic database
• 500,000 patient visit records
• Used for care and research

23
(No Transcript)
24
Thank you

• Dr A. M. Siika
• Department of Medicine
• Moi University School of Medicine
• P. O. Box 4606 30100 Eldoret, Kenya
• Tel [phone]
• Email amsiika_at_africaonline .co.ke