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Positive living: success of integrated HIV care in Busia, Kenya
Sitting in his consultation room in SIOPORT district hospital clinical officer Kennedy Ndonga remembers how things used to be for this community in rural Kenya.
“Ten years ago people literally had to be carried to the hospital for treatment, you’d see their family members bringing them on bikes, carrying them on their backs or even in wheelbarrows. The stigma and discrimination surrounding HIV/AIDS was so acute that only the really sick would come to be cared for. The fear was such that even in health facilities you would find HIV positive people had been put in a corner by health workers who were too scared to treat them and they were just lying there, waiting there to die.”
It was at this time, in the absence of any organizations treating HIV, the unavailability of anti-retroviral treatment (ART), and the Ministry of Health unable to cope with the huge burden of treating the disease that MSF started providing HIV/AIDS care in Busia, a rural region in western Kenya. In 2000 the national HIV prevalence in the country was estimated to be 14%. In Busia it was more than double that (30%). Over the last ten years, working closely with the Ministry of Health, MSF’s staff in Busia have treated and cared for over 13,300 people living with the disease, over 4,000 of whom have started taking ART.
Providing integrated HIV care has been key to this success. Outside Kennedy’s consultation room, the waiting area in SIOPORT hospital is packed with men, women and children here for their appointments. On an average day the MSF and Ministry of Health staff at the clinic, who work side by side, will see more than 100 people. Some are HIV positive, some are not. And this is the essence of integrated care, incorporating HIV care into regular primary health care so that people living with HIV/AIDS can access health services just like anyone else.
This approach has had a huge impact on increasing the numbers of HIV positive people seeking treatment in Busia and has also greatly reduced the stigma and discrimination surrounding the disease. “Instead of having to go to different clinics on different days and having to sit in separate waiting areas, people living with HIV come here and visit the doctor just like anyone else,” explains Kennedy. “A pregnant mother with HIV, for example, can come here and receive a regular check up, ante-natal care, prevention of mother to child transmission care, family planning and immunization for her children all on the same day. It’s a one stop service.”
Integrating care is no easy task and MSF had to invest a lot to make this system work. Regular and open dialogue with the Ministry of Health was crucial. In some clinics MSF had to provide extra staff in order to care for the increasing numbers of people coming for treatment. Frequent training and ongoing mentorship for all staff was provided. A number of the clinics had to be renovated and extra rooms built. Yet the investment was worthwhile, as both staff and patients benefit hugely from integrated HIV/AIDS care.
After ten years in Busia, MSF is now able to hand over its activities to another organisation. What was once considered impossible – providing HIV/AIDS care in a rural, resource-poor setting – has been achieved with great success. Challenges remain but providing integrated care can go a long way towards overcoming them.