Team formed to help introduce more services in HIV clinics

The Ministry of Health has formed a team to help integrate new health services in the standalone HIV clinics.

The move is informed by evidence that combining HIV treatment and other health services is good for patients and the health system. It is also cheaper.

On paper, this integration should have started five years ago but was hampered by a lack of proper infrastructure in health facilities and training of staff.

Testing and dispensing of HIV drugs and other services are still conducted at separate clinics, known as comprehensive care clinics.

Dr Rose Wafula, head of the division of the National Aids and STIs Control Programme at the ministry, said the new team will develop the roadmap Kenya will follow in ending the standalone clinics.

The team includes officials from Nascop, researchers, donors and representatives of Health CECs.

“Currently, in terms of location, we have standalone comprehensive care clinics (CCCs) or places that are labelled for HIV-positive clients and then the rest of the health facility," Wafula said.

"So, the future would look like this, we do not need to see a standalone place that is labeled HIV, which is stigmatising. We will move to an integrated place where somebody has just come for a service and that service is provided without necessarily labeling the person.” 

More than 65 per cent of the 1.4 million Kenyans living with HIV are aged above 35 years.

As one ages, they become more susceptible to non-communicable diseases such as heart problems, cervical cancer, depression and diabetes.

“Now, that combination tells you that beyond HIV, they have other health needs,” she said.

“And so, to be responsive as a programme, you need to redesign your services to respond to the multiple needs that the person requires beyond HIV services. So, the service delivery integration is really a focus on the person rather than just the virus.” 

Standalone HIV clinics in many facilities were started by donors and some staff are still paid by donors such as Usaid.

There are currently 3,752 standalone HIV treatment sites in public, private and faith-based health facilities in the country, according to the MoH.

Integration means all the HIV-trained health workers will also see non-HIV patients. 

Other medics will also need training to handle HIV services. This training is yet to happen.

The doctor said currently, NCDs developed as a result of the virus are killing elderly people living with HIV.

“You have a 50-year-old who is virally suppressed. In other words, viral load is undetectable. But that same person has hypertension, diabetes that is not controlled. So, the person will walk out of your CCC with no HIV but will be killed or will die because of uncontrolled hypertension and diabetes,” she said.

“The future of a successful intervention or integration would be the virus is controlled, the hypertension is controlled and the diabetes is controlled as they walk out of that facility.”

Several studies have extolled the benefits of integration, but also the pitfalls.

In April, Unaids and Friends of the Global Fight Against Aids, Tuberculosis and Malaria published a report showing great gains from Colombia, Côte D’Ivoire, Jamaica, South Africa, Thailand and Uganda, which have integrated their services.

“The integration of HIV and non-HIV specific services is increasing access to holistic, comprehensive health services needed for people living with and affected by HIV,” says the report.

The report titled 'Expanding the HIV response to drive broad-based health gains' added that whereas there is good evidence that integration can have such positive effects, there can even be counterproductive results.

“Deeper integration can be difficult in poorly resourced health systems. Facilities may lack staff with sufficient training to provide integrated care and they may not be equipped to provide the prompt tuberculosis screening and testing that is required,” the Unaids said.