Use of semi-mobile clinics in HIV/AIDS treatment in rural Kenya

Purpose: The HIV/AIDS burden has grown in rural communities in Africa, but care and treatment services are still more accessible in urban areas or at referral hospitals. Doctors of the World (DOW) is partnering with Indiana and Moi Universities' Academic Model for Prevention and Treatment of HIV/AIDS (AMPATH) and Kenya's Ministry of Health (MOH) in the West Pokot District to provide comprehensive HIV/AIDS services in this rural District, where HIV prevalence is estimated to be 8%. DOW has adapted AMPATH's model for West Pokot's dispersed, semi-nomadic population.

Methods: Since November 2005, DOW, with AMPATH and MOH, has enrolled about 700 patients in treatment centered at a District Hospital clinic. Care is delivered by MOH clinicians and DOW psychosocial staff, trained in AMPATH protocols and supervised by DOW. However, reaching rural populations remains a challenge because of distance from hospitals and limited roads. To reach HIV-positive individuals without access to the District Hospital, DOW initiated semi-mobile clinics. A team of clinicians and social workers from the Kapenguria District Hospital visits one of four rural health centers each week, to provide ARVs, monitoring, and psychosocial support. Clinicians take blood samples that are brought to AMPATH's reference laboratory; social workers visit patients at-risk of non-adherence and convene support groups.

Program results: Since instituting semi-mobile clinics, DOW has observed a rise in the number of HIV-positive patients who live far from the Hospital. The number of patients defaulting on follow-up visits has decreased. In addition to patient benefits, semi-mobile clinics have enabled on-site mentorship in HIV/AIDS care for health center clinicians. Data will be presented on patients at the Hospital and semi-mobile clinics. The presentation will describe and compare, among these groups, distance traveled and time required for patients to reach services, care-seeking behaviors, adherence, and satisfaction. For patients who began treatment at the Hospital and moved to semi-mobile sites, results will include comparative analysis.

Recommendations: A hospital-based treatment site and reference laboratory can provide a foundation for semi-mobile sites that increase the reach of HIV/AIDS services. With supportive policy structures and collaboration between MOH and NGOs, this model can be replicated by others delivering rural HIV/AIDS treatment, expanding community access while maintaining quality.