ARV Programmes Slowly Recovering From Kenya Post-election Crisis
Photo: Manoocher Deghati/IRIN
|AMPATH has opened a satellite centre in the Nakuru Showground IDP camp where patients can receive ARVs|
ELDORET, 28 April 2008 (PlusNews) – Thousands of Kenyans who dropped out of HIV treatment programmes in January as a result of the country’s post-election violence are gradually returning to clinics and the antiretroviral (ARV) drugs that help prolong their lives.
“Initially more than 90 percent of our patients failed to come for their monthly appointments during which they collect their drugs, but now they are returning slowly,” said Cleophas Chesoli, social work manager for the Academic Model for the Prevention and Treatment of HIV (AMPATH), a research institution linked to Moi University in western Kenya’s Rift Valley town of Eldoret.
At the height of the crisis, AMPATH placed national announcements in the newspapers and on the radio advising clients on the nearest available health facility where they could get ARVs. AMPATH has 67,000 clients, with an estimated 30,000 on treatment; although it is still unclear how many patients missed their doses, Chesoli is hopeful that the chances of patients developing resistance are low.
“We generally give patients as much as six weeks’ worth of medication because many of our patents may not make their monthly consultations due to lack of transport or bus fare, or distance for the nearest centre,” he said.
However, many people affected by the violence left their homes so hurriedly they were unable to pack or grab their medication. “My house was burned to the ground with everything in it; I spent two weeks without taking my drugs,” said Loyce Wambui, a resident of Nakuru camp for internally displaced persons (IDPs) in the Rift Valley. “Many other people just had to run for their lives and leave all their things behind.”
AMPATH has begun to monitor signs of resistance in patients who missed some days of treatment. Chesoli said, however, that it would be months before resistance could be confirmed.
Many patients from the African Medical and Research Foundation (AMREF) community health centre in Kibera, the largest slum in the Kenyan capital, Nairobi, managed to get drugs from nearby health centres when the centre had to close for three weeks during the disturbances.
|Displacement raises risk of drug-resistant TB|
|Jane Wangui: “I don’t know where to get my drugs when the camp closes”|
|Kenya’s post election crisis|
“During the violence two of our staff members were roughed up – one was cut with a machete – so it became unsafe for us to operate,” said Dr Marjory Waweru, the AMREF centre manager. “But we know that many patients who couldn’t get drugs from us got them from MSF [international medical charity Medecins San Frontieres, which also runs HIV clinics in Kibera and never closed during the violence].”
Waweru said most patients had returned to the centre and only a few had reported missing doses. She added that she hoped the patients’ knowledge about the importance of adherence would have ensured that even if they skipped a day or two, they knew that maintaining the regimen was vital to their health and hence they would have sought out the drugs at the nearest alternative health centre.
In the Rift Valley, hardest-hit by the violence, more than 100,000 people remain in IDP camps, unable to return home due to the destruction of their property and continuing tension in the region. AMPATH has had to set up satellite centres to reach its displaced clients.
“We had some staff members displaced from Burnt Forest [a town in the Rift Valley] whom we have now dispatched to Nakuru Showground to ensure our clients who fled towards central Kenya are able to receive treatment,” Chesoli said. “Other camps are using patients as focal points to locate other AMPATH patents and bring them to the centres.”
The organisation has managed to locate at least 110 clients in the Nakuru showground, and in total AMPATH is treating more than 1,000 of its patients in camps across the Rift valley. It has opened a permanent site at the largest camp in Eldoret, which houses 14,000 people, and also runs a mobile clinic operating in several camps around the Rift Valley.
MSF opened a free hotline in January to enable its displaced patients to find their nearest health centre and get advice on treatment. “The hotline has not done as well as we expected – we are getting between 10 and 15 calls a day,” said Ian Van Engelgen, MSF’s medical coordinator. “However, our people on the ground are saying this is likely to be because there is not really a shortage of drugs on the ground and other organisations have filled gaps in treatment.”
He added that nevertheless, MSF would continue to distribute publicity material about the hotline to ensure people had the information they needed.
Van Engelgen also noted that while it was helpful that patients were able to access their medication wherever they were, there was a need for them to return to their original service providers, who were aware of their history and their specific issues.
“People might be receiving care, but is it the appropriate care?” he said. “Many patients have joined new centres and left their patient files behind so issues such as lab monitoring and other issues of chronic illness management are ignored…it is the same for patients on TB medication.”
AMPATH’s Chesoli also said AMPATH’s goal was to get as many patients back under the organisation’s care as early as possible. “Certainly this crisis has taught us some lessons; we need to be better prepared for such an eventuality, and forge a response mechanism in the face of crisis so we are not left in the situation we were this time.”
According to the National AIDS Control Council, at least 15,000 out of the original 600,000 people initially displaced by the violence were HIV-positive. By late February, fewer than half of them had access to treatment, but analysts now say most patients are back on their medication.