Delivery of HIV care during the 2007 post-election crisis in Kenya: a case study analyzing the response of the Academic Model Providing Access to Healthcare (AMPATH) program

Abstract

BackgroundWidespread violence followed the 2007 presidential elections in Kenya resulting in the deaths of a reported 1,133 people and the displacement of approximately 660,000 others. At the time of the crisis the United States Agency for International Development-Academic Model Providing Access to Healthcare (USAID-AMPATH) Partnership was operating 17 primary HIV clinics in western Kenya and treating 59,437 HIV positive patients (23,437 on antiretroviral therapy (ART)).MethodsThis case study examines AMPATH’s provision of care and maintenance of patients on ART throughout the period of disruption. This was accomplished by implementing immediate interventions including rapid information dissemination through the media, emergency hotlines and community liaisons; organization of a Crisis Response leadership team; the prompt assembly of multidisciplinary teams to address patient care, including psychological support staff (in clinics and in camps for internally displaced persons (IDP)); and the use of the AMPATH Medical Records System to identify patients on ART who had missed clinic appointments.ResultsThese interventions resulted in the opening of all AMPATH clinics within five days of their scheduled post-holiday opening dates, 23,949 patient visits in January 2008 (23,259 previously scheduled), uninterrupted availability of antiretrovirals at all clinics, treatment of 1,420 HIV patients in IDP camps, distribution of basic provisions, mobilization of outreach services to locate missing AMPATH patients and delivery of psychosocial support to 300 staff members and 632 patients in IDP camps.ConclusionKey lessons learned in maintaining the delivery of HIV care in a crisis situation include the importance of advance planning to develop programs that can function during a crisis, an emphasis on a rapid programmatic response, the ability of clinics to function autonomously, patient knowledge of their disease, the use of community and patient networks, addressing staff needs and developing effective patient tracking systems.

A long way to go: a systematic review to assess the utilisation of sexual and reproductive health services during humanitarian crises

“…The first, a pre-post study conducted in a camp setting during postelection violence in Kenya, evaluated a disaster response plan that included rapid information dissemination through the media, HIV outreach activities and a medical record system helping to track missed appointments among HIV-positive patients. 19 Using clinic attendance as the primary outcome, the study reported that the majority of clinics (60.0%, n=12) had more visits during their opening week, and that there was an overall increase in patient volume by 105% compared with the baseline. The number of unscheduled visits also increased from 27.2% pre-intervention to 42.4% three months after clinics were opened.…”

Essential healthcare services provided to conflict-affected internallydisplaced populations in low and middle-income countries: A systematicreview

“…41 The study by Kim et al 47 showed significant associations between recent STI symptoms and conflict-related sexual violence among IDP women compared to non-IDPs (aOR=3.9 and 4.2; P value <0.01 and =0.05, respectively). This indicated HIV care was of high priority in conflict settings and possible if planned effectively as shown in the study by Goodrich et al 42 which documented the experiences of offering HIV care in active conflict settings. Goodrich et al 42 advised for the inclusion of rapid case tracking, availability of resources, staff support and promotion of patient and community networks in HIV programs.…”

“…This indicated HIV care was of high priority in conflict settings and possible if planned effectively as shown in the study by Goodrich et al 42 which documented the experiences of offering HIV care in active conflict settings. Goodrich et al 42 advised for the inclusion of rapid case tracking, availability of resources, staff support and promotion of patient and community networks in HIV programs. Findings from the TB and HIV studies illustrated the impact of conflict and migration on treatment uptake.…”

“…All HIV studies focused on HIV management and adherence. 41,42,47 Adherence to treatment was generally high, with one study reporting mean adherence of 99.6% and no significant difference when compared to non-IDPs. 41 Key factors that influenced non-adherence among IDPs were being at the first stages of treatment and condemning attitudes of health staff.…”

Addressing chronic diseases in protracted emergencies: Lessons from HIV for a new health imperative

“…There are promising data on the use of mobile phones and text reminders to support retention in HIV treatment (Horvath, Azman, Kennedy, & Rutherford, 2012) and on the use of mobile clinics and electronic medical records to support displaced HIV patients during emergencies (Goodrich et al, 2013). In the case of forced migrants, cloud-based health records accessed via mobile phone applications could mitigate the challenges of maintaining medical information and test results while in transit, although it will be important to identify and address issues of privacy and security.…”