140 hospitals picked to care for Kenyans with advanced HIV disease

 At least 140 health facilities have been selected to handle the growing number of Kenyans presenting with advanced HIV disease, previously called Aids.

The National Aids and STIs Control Programme (Nascop) said the centres were selected by the counties with support from the programme.

Dr Lazarus Momanyi, a technical assistant at Nascop, said at least 40 per cent of individuals with new infections are presenting with advanced HIV disease (AHD).

People with AHD are at high risk of death, even after starting treatment.  The most common causes of severe illness and death are tuberculosis, severe bacterial infections and cryptococcal meningitis.

The new centres are hospitals equipped to provide all the care such individuals need.

“They are hospital level facilities where comprehensive packages of AHD care can be implemented with clinical expertise in management of critically unwell AHD patients,” Dr Momanyi said.

He said each centre must have a trained medical officer and proper laboratory capacity to monitor renal function, complete blood count, biochemistry, and other relevant diagnostics.

“They (centres of excellence) will serve as referral sites for spokes and will manage patients in need of hospitalization and regular monitoring, such as in treatment of cryptococcal meningitis,” he said.

Dr Momanyi spoke in Machakos at a meeting organized by the National Empowerment Network of People Living with HIV/Aids in Kenya (Nephak) to engage journalists, technical experts, and communities on ways to amplify the plight of people living with HIV on AHD.

He said men are mostly the people being diagnosed with Advanced HIV Disease (AHD).

Nephak chairperson Nelson Otwoma said the new trend is reversing gains Kenya had made in almost ending advanced HIV.

“HIV related deaths are coming back because we are still seeing people not taking up testing of HIV, delaying testing or doing it when it is too late, particularly men. Men are coming to care too late. By the time they are diagnosed with Advanced HIV Disease, their immune systems are severely compromised. We need to address the barriers that prevent men from accessing care early,” Otwoma said.

Nephak is the umbrella association for Kenyans living with HIV.

The World Health Organization defines advanced HIV disease (AHD) as CD4 cell count below 200 cells or WHO stage 3 or 4 in adults and adolescents.

All children younger than 5 years with HIV are considered to have AHD, given their heightened risk of disease progression and mortality.

WHO recommends offering a package of interventions including screening, treatment and prophylaxis for major opportunistic infections, rapid ART initiation, and intensified adherence support interventions.

Data by the National Syndemic Disease Control Council (NSDCC) shows that 113,000 people interrupted treatment in 2023.

Experts say this places them at higher risk of disease progression, opportunistic infections, and AIDS-related deaths, despite the availability of free HIV testing and treatment services.

Momanyi said Kenya needs to work towards the UNAIDS 95:95:95 targets. He said the focus must shift to engaging men and children in HIV care early and consistently.

Momanyi said there an urgent need to optimize early detection and diagnosis of AHD by implementing effective screening programs.

“Going forward healthcare workers will use CD4 tests to identify AHD while screening all newly diagnosed PLHIV, those returning to care after treatment interruptions and those with suspected treatment failure.”

He said Kenya is working on Advanced HIV Disease (AHD) implementation plan, which is still in its draft stage. The plan aims to guide healthcare workers in ensuring access to common opportunistic infections screening, treatment and prophylaxis and linkages to other healthcare services for all AHD cases.

One participant, Karen Wamboi Omanga, urged policy workers to embrace patient centered, integrated approach of care urging that it can address both stigma and reduce cost of care since one can be attended to in different clinics on the same day.

“If health workers are trained well to integrate services, care seeking behavior will not be associated with stigma and discrimination since someone will not deduce what a client is ailing from since everybody will be seeking care from the same clinics,” she said.

Nephak called on the government to work with communities to understand the needs and priorities of PLHIVs and raise awareness of the emerging issue of Advanced HIV disease and improving access to care.

Patricia Asero, a longtime treatment advocate, praised the combination prevention approach adopted by the government through a biomedical model, where individuals have choices that work best for them.