Success in Reaching National Pediatric Uptake Targets and Similar Adult Retention Rates in

Pediatric HIV Clinics inthe Rural Southern Rift Valley Province of Kenya

Argwings Miruka, COPediatric Program Manager

Kenya Medical Research Institute/Walter Reed Project HIV ProgramKericho, Kenya

Background• 7,000-10,000 children

HIV infected yearly in Kenya

• National targets 10% HIV clinic patients are

pediatric Often difficult to reach & behind

adult uptake

• Concerns exist regarding retention of children

• Challenges magnified in rural settings due to frequent changes in caregivers, distant pediatric clinics, and extremes in poverty.

KEMRI/WRP HIV Program

• An integrated HIV research, prevention, care, and treatment program

• Located in the southern Rift Valley Province

• Government of Kenya &

PEPFAR Program

• Catchment of ~ 2.5M

• Facilities 11 primary tx centers 80 satellite (rural health)

centers 350 PMTCT facilities 290 VCT & DTC sites

Background & Methods

• President’s Emergency Plan for AIDS Relief (PEPFAR), 2004

• Overarching aims decentralize care clinics closer to rural populations

• Special pediatric initiatives "Mwangalizi" Program Support Groups Treatment Retreats

We describe aggregate program level data results as well as successes, challenges, & opportunities (2004-2011).

Results

HIV Testing• > 17,500• VCT & DTC

Clinic Enrollment, Uptake & Retention

• 57 pediatric clinics • > 5,300 children enrolled

• 10.0 +/- 3.3 years, 50.6% F

• 2.5% 2nd line ART (one on 3rd line ART)

• 2005 = 7.0% children; 2011 = 10.5 children (p < 0.001)

• 2011: adult retention=82.2%; children=81.1%

Started & Currently on ART

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Started ART (Paediatric)Currently on ART (Paediatric)

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24

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527

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Started ART (Adults)Currently on ART (Adults)

n

Paediatric Adult

2011 Retention

81.1%

2011 Retention

82.2%

Successes

• Support “Mwangalizi” Project Support groups

• Training Paediatric retreats Caregivers

• Integration Other clinics Community

Challenges

• Malnutrition• Specialty care• Clinic transport• Caregivers• MCH integration

Opportunities

• Development of specialty care centers• Integration of HIV pediatric clinics in MCH

settings• Training of more pediatric health care workers

(including sub-specialty)

Summary

• National pediatric HIV clinic enrollment goals can be met in rural Kenya with ART retention nearly the same as retention in adults.

• We found “Mwangalizi”, pediatric support groups, and health care team training most helpful.

• Specialty care, integrating services, and additional training of health care workers are opportunities for improvement.

Asanteni Sana!Ministry of HealthEunice ObieroIsack TsikhutsuSheila KorirUSAMRU-KLTC Shon RemichCOL Tom LoganMHRPTiffany HammAnjali KunzKeith Crawford

The President’s Emergency Plan for AIDS Relief (PEPFAR)Pediatric Patients of Kenya’s Southern Rift Valley

KEMRI/WRP Kericho (Authors)Roselida AchiengAppolonia AokoJemutai TarusPeter YegonJonah MaswaiFredrick SaweDouglas Shaffer