Integrated People-Centred Health Services (IPCHS) is NEPHAK’s call for KASF II.
NEPHAK Board members during the 2019 AGM in Mombasa county.
Integrated People-Centred Health Services (IPCHS), defined as the delivery of comprehensive, high quality and coordinated care across the different levels and sites of care according to specific needs throughout the life course is what NEPHAK membership and the entire PLHIV community in Kenya want to see in the Kenya AIDS Strategic Framework II. This is the key outcome from the consolidated input derived from NEPHAK members after they were asked to share on their priorities to inform the development of the KASF II. NEPHAK members were reached out through email and social media: WhatsApp; Twitter and Facebook.
In semblance to the GIPA Principle, the integrated people-centered health services approach also requires that communities and especially patients have the education and support they need to make decisions and participate in their own care and that carers are able to attain maximal function within a supportive working environment. Going forward, the NEPHAK membership wants the government and partners working to improve the health and wellbeing of communities to ensure that they are meaningfully engaged in the design, planning, and delivery of the interventions targeting them.
The Ministry of Health through the National AIDS Control Council (NACC) is working on the Kenya AIDS Strategic Framework II and has reached out to partners to come up with recommendations and priorities to be included in the framework. In response to the call by the NACC, the NEPHAK membership has stated that making progress towards the United Nations’ Sustainable Development Goal 3 (ensure healthy lives and promote well-being for all at all ages), including target 3.8 on Universal Health Coverage (UHC) and target 3.3 on communicable diseases, require the government and especially the Ministry of Health to move towards ensuring that all people and communities have access to health services that are high quality, safe and acceptable.
Developing and implementing more integrated people-centred health services has the potential to help accelerate progress towards SDG and UHC by generating significant benefits to the health and care of all people, including: improved access to care; better health and clinical outcomes; health literacy and self-care; increased satisfaction of service users with care as well as job satisfaction for health workers; improved efficiency of services; and reduced overall costs. This is what the Kenya PLHIV is hoping for.
The NEPHAK membership also want the proposed KASF II to have a clear vision and come with strategies for implementation, namely: engage and empower people and communities; strengthen governance and accountability; reorient the model of care; strengthen the coordination of care and create an enabling environment. For this to happen, the KASF should only focus on HIV as an entry point but purpose to foster the integration of HIV, TB and malaria services and other non-communicable diseases.
Noting the high and rising cases of other conditions and diseases among PLHIV, the NEPHAK membership want a framework that will remind health service providers to ensure that people living with, at risk of and affected by HIV access integrated services, including for HIV, tuberculosis, sexual and reproductive health, maternal, new-born and child health, hepatitis, drug dependence, food and nutrition support and noncommunicable diseases, especially at the community level. In short, the NEPHAK membership is calling for HIV-sensitive universal health coverage.
The NEPHAK membership is also aware that stigma and discrimination still constitute huge barriers to the uptake of HIV and health services. They, therefore, want KASF II to include strategies to help ensure that HIV-related stigma and discrimination is eliminated among service providers in health-care, workplace and educational settings and that laws, policies, and programmes work to prevent and address violence against PLHIV and especially adolescents and young people living with HIV. When it comes to human rights and health justice, the PLHIV community want KASF to prioritize the repeal of punitive laws, policies, practices, stigma and discrimination that block effective responses to HIV and uptake of health services.
NEPHAK and Partners to Convene National Consultative Forum on Men & HIV.
Following on the Men & HIV Forum organized by the International AIDS Society (IAS) and partners at the 2019 AIDS Conference in Mexico, NEPHAK and partners will be convening a national consultative meeting on HIV and Men in Kenya. The forum is expected to bring together a diverse civil society and community on targeted advocacy and HIV for men and boys. The national forum is timely for Kenya because the country is making good progress towards the delivery of the UNAIDS 90.90.90 targets but the latest estimates and data show that men and boys are being left behind.
Bishop James Okombo at the Men and HIV Forum during the AIDS 2019 in Mexico.
Borrowing from the IAS Conference forum, the national forum in Kenya will be informed by a number of high level policy pronouncements such as the 2017 UNAIDS report, Blindspot: Reaching out to men and boys, which acknowledged that men are disproportionately less likely than women to know their HIV status, less likely to access and adhere to HIV treatment and more likely to die as a result of AIDS-related illnesses and the more recent Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020) by the , the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) which emphasized the need for an “acceleration of optimized HIV testing and treatment strategies particularly to reach men under age 35”.
So far, a planning team has been put together for the national forum mainly starting with those who attended the IAS forum in Mexico from Kenya comprising of representatives from the NEPHAK, the Movement of Men Against AIDS in Kenya (MMAAK) and NECLETA and a host of people drawn from agencies working with men and boys. Starting this week, this team will be reaching out to other stakeholders, including those from the government agencies such as the NACC and the NASCOP to join the planning team.
In the planned forum to be held before the World AIDS Day 2019, participants will deliberate on approaches and strategies that need to be put in place to ensure boys taking up and utilizing HIV and health services. The forum will also debate and discuss what the next steps are to ensure greater uptake and access to HIV services among men as the deadline for the delivery of the 90.90.90 targets approaches. The other goal will be to bring the conversation about men and HIV to the forefront ahead of ICASA 2019. The forum shall generate advocacy and communications strategies and messages to be presented with a continental-wide audience at the ICASA scheduled for the 1st – 7th December in Kigali, Rwanda.
Study confirms that Kidney disease is more prevalent in PLHIV.
In general, kidney problems are more common in people over the age of 50. They are also more common in people of black or Asian ethnicity. Conditions that make kidney problems more likely include diabetes, high blood pressure, raised cholesterol, drug use, heavy drinking, hepatitis B and hepatitis C. In people living with HIV, a low CD4 count or a high viral load raise the risk. But the Danish researchers were particularly interested in looking at the risk of impaired kidney function in people with HIV who were generally at low risk. Their study only included people who were white, had an undetectable viral load, did not have hepatitis C and had never injected drugs. Each person living with HIV was compared with four people of the same age and sex in the general population.
They found that 3.7% of people with HIV had impaired kidney function (a glomerular filtration rate – GFR – below 60). This compared with 1.7% of people in the general population. The researchers say that the increased risk of kidney disease in people living with HIV was comparable to that of people living with diabetes.
The risk of kidney disease increases as you get older. But it seemed to do so to a greater extent in people with HIV in this cohort. But no specific HIV-related factor was associated with a higher risk of kidney problems. This includes taking the anti-HIV medication tenofovir disoproxil fumarate, which other studies have found to be associated with kidney problems.
We all know that Injury or disease, including HIV infection, can damage the kidneys and lead to kidney disease. High blood pressure and diabetes are the leading causes of kidney disease. In people living with HIV, poorly controlled HIV infection and coinfection with the hepatitis C virus (HCV) also increase the risk of kidney disease. NEPHAK, therefore, works to sensitize PLHIV to demand for kidney disease screening services and where a disease is detected to demand treatment. The challenge encountered by the NEPHAK membership has been the high cost of kidney disease treatment.
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