Perpetual Home-Based Counseling and Testing Program in Kenya

Partnership objectives

  1. Expand and increase access to health care services to create a model of population health serving one million people living in remote areas of Kenya.
  2. Reduce mortality and improve health in a focused catchment area by turning a previously HIV-focused Perpetual Home-Based Counseling and Testing (PHCT) program into a sustainable Ministry of Health population-based program.

An AMPATH Counselor Conducts a Blood Pressure Test During a Home-Based Visit in Western Kenya An AMPATH Counselor Conducts a Blood Pressure Test During a Home-Based Visit in Western Kenya Copyright AbbVie and AbbVie Foundation.

What are the health needs and challenges?

In 2007, 85% of people in AMPATH’s catchment area of then 1.8 million people did not know their HIV status. In remote areas programs needed to find less expensive and more effective means of keeping those who were HIV-positive from progressing to advanced disease and death as well as work “upstream” to provide intervention before HIV-positive patients became gravely ill. Testing people before they are obviously ill—and before they have infected their partners—will move more infected people into treatment earlier, when the treatment can be most effective and prevent thousands of people from becoming HIV-positive in the first place. The UNAIDS “90-90-90” strategy (i.e. >90% of those with HIV found; >90% on ART; >90% with viral suppression) requires a shift to a rapid testing strategy where counselors can cover targeted, high prevalence communities within months rather than years, testing and finding all HIV positive individuals as soon as possible.

Additionally, to better meet the health needs of people in their catchment area, AMPATH has been transforming its HIV care system into an integrated health care system inclusive of the treatment and control of HIV but also addressing issues of maternal, newborn, and child health as well as chronic diseases such as cancer, diabetes, cardiovascular disease, and mental health. 

Description of partnership activities and how they address needs and challenges:

AMPATH has developed a Perpetual Home-based Counseling and Testing (PHCT) program which allows PHCT counselors to offer door-to-door counseling and testing and linkage to care and treatment. The model reduces loss to follow up, leads to less expensive, more effective treatment and reduces the level of community viral load to markedly diminish HIV transmission within the community. With PHCT, AMPATH has better knowledge of HIV prevalence, can monitor the impact of its interventions, help reduce the loss to follow up and can ensure care and treatment for the long term.  The use of simple technologies including solar power and cell phones with GPS systems brings health care directly to people’s homes rather than requiring them to go to a hospital or clinic – often a hardship for those without access to transportation. AMPATH brought Africa’s first operational model of care structured to halt the HIV pandemic comprehensively. Evidence underlines that aggressive efforts to Find, Link, Treat and Retain (FLTR) all HIV-infected persons in a population holds the promise of lowering the prevalence of HIV/AIDS substantially.

As of 2016 the partnership has reached over 1,500,000 people.  The percentage of individuals already in care among those who know their HIV status increased from 93.8% in 2014 to 99.3% in 2016.

PHCT counselors can also screen for tuberculosis, test for diabetes and blood pressure, treat children for intestinal worms, screen for cervical cancer, provide nutritional counseling and record household data in a handheld device which is then synced with the AMPATH electronic medical records system (AMRS), linking patients to care.

AMPATH’s electronic medical record system now holds the largest clinical data repository in Africa and is active in over 40 countries worldwide. The system has become one of the electronic record systems of choice in a number of African countries, including Kenya. AMPATH is now poised to fully deploy the electronic medical record system throughout its model of population-based primary care. Key new features enable it to:

  • Capture all clinical encounters into a single repository (e.g. in home or clinic; nutritionist or clinician)
  • Transition to a paperless point-of-care capture of clinical encounters
  • Assure point-of-care clinical decision support for clinical providers to enhance best practices
  • Assure Ministry of Health access and ownership of data at each major clinic.

Intensive outreach by counselors also seeks to reduce mother-to-child transmission of HIV, address food and income insecurity and build self-sufficiency through skills training and health education workshops. Critical maternal neonatal child health services and chronic disease management are supported by a network of speciality care extending from County Hospital to National Referral Hospital.  Income and food security are strengthened by an extensive network of village based groups capable of a full range of small loans and micro-enterprise training. Kenya’s National Hospital Insurance Fund (NHIF) will utilize this care system as a demonstration of health insurance for the informal (unemployed) segment of society.

The partnership has also helped:

  • Launch Kenya’s first primary care insurance coverage for individuals who are employed in the informal sector (e.g. subsistence farmers, small independent shop owners, etc.). AMPATH will serve as the delivery network for a capitated insurance product sponsored by the NHIF. This product will be scaled, as needed, to keep pace with the entire catchment served by this evolving model of population-based primary care.
  • Certify Advanced Practice Clinical Officers (APCO): These non-physician providers have demonstrated the capacity to manage high volume clinics with very complex patients in remote resource limited settings. In the HIV component of the AMPATH/MOH program, APCOs provide more than 95 percent of the care. Now, these same clinical officers are adding to their responsibilities the care of non-communicable chronic diseases. AMPATH is working with the Government of Kenya and national certifying agencies to recognize the advanced capacities of these clinical officers and to establish national curricula and more appropriate compensation packages and career advancement opportunities for them. 

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Partnership information

Company(ies) AbbVie

Partner(s) Academic Model Providing Access to Healthcare (AMPATH), Indiana University, University of Toronto, US Agency for International Development (USAID)

Type of Partner(s) Academia / Hospitals, Government

Therapeutic Focus Women and Children's Health, Non-Communicable Diseases, Neglected Tropical Diseases, Infectious Diseases

Disease(s) Cancer, Cardiovascular Diseases, Children's Health, Diabetes, HIV/AIDS, Hypertension, Malnutrition, Soil-Transmitted Helminthiasis, Tuberculosis, Women's Health

Program Type(s) Availability of Treatment - Financial Support, Health System Infrastructure - Development of Physical Infrastructure, Health System Infrastructure - mHealth, Health System Infrastructure - Outreach & Medical Services, Prevention Programs - Awareness & Outreach

Targeted Population(s) Children, Elderly, Marginalised / Indigenous People, Men, Mothers, Patients in needs of treatment, People with low income, Women, Youth

Region(s) Sub-Saharan Africa

Number of Countries 1

Country(ies) Kenya

Research Country(ies) Kenya

Start Date 2009

More information AbbVie

Anticipated completion date Ongoing

« Kenya's most comprehensive initiative to combat HIV and a working model of urban and rural HIV preventive and treatment services. »

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