Providing HIV care in the aftermath of Kenya's post-election violence Medecins Sans Frontieres' lessons learned January – March 2008

Abstract

Kenya's post-election violence in early 2008 created considerable problems for health services, and in particular, those providing HIV care. It was feared that the disruptions in services would lead to widespread treatment interruption. MSF had been working in the Kibera slum for 10 years and was providing antiretroviral therapy to 1800 patients when the violence broke out. MSF responded to the crisis in a number of ways and managed to keep HIV services going. Treatment interruption was less than expected, and MSF profited from a number of "lessons learned" that could be applied to similar contexts where a stable situation suddenly deteriorates.

Implementation and outcomes of an active defaulter tracing system for HIV, prevention of mother to child transmission of HIV (PMTCT), and TB patients in Kibera, Nairobi, Kenya

“…Kibera was a site of conflict during the post-election violence that followed the disputed Kenyan presidential election in December 2007; the tracing system greatly facilitated the identification of patients and continuation of treatment as soon as possible. 32 An important feature of the MSF defaulter tracing system is how the data suggest improvements to protocols and project implementation. The system has created an ongoing feedback loop between patients, social workers, clinicians and project staff that fosters discussion of and solutions to the challenges of adherence and retention.…”

Lost to follow up from tuberculosis treatment in an urban informal settlement (Kibera), Nairobi, Kenya: what are the rates and determinants?

“…However MSF managed to keep TB/HIV services going during the post-election violence. 8 One out of the 86 (1%) cases contacted reported being unable to continue treatment due to the violence. Seven out of 27 (26%) controls that missed an appointment and were traced cited the violence as the reason for missing their appointment; all 27 subsequently returned to the clinic and completed their treatment.…”

Providing antiretroviral care in conflict settings

“…MSF's hotline in the Kibera slums of Nairobi reported mixed successes, with staff unprepared to answer non-HIV-related questions from patients and many patients unable to access the telephone number because they subscribed to another mobile provider. MSF concluded that an established hotline, prior to the violence, may have had greater success [46]. One research study team at the University of Nairobi/Manitoba was conducting a randomized trial of cell phone-based messaging to promote cART adherence at the time of the violence.…”