The Practical Side of Comprehensive Care:

ACCOMPLISHMENTS, CHALLENGES AND

LESSONS LEARNED AT KNH

Dr. David BukusiKenyatta National Hospital

VCT and Comprehensive Care Centers

Comprehensive care

Medical and nursing care• OIs/prophylaxis TB, PCP• ARVs• Palliative care

Psychological support• Adherence counselling • Supportive counselling • Post-Test counselling • Post-Disclosure Group

Therapy • Follow-up counselling

PEP Laboratory support

Youth Friendly services Nutritional support Social worker support

tracing defaulters, family support

Spiritual support Referrals for medico-legal

services Networking CCC network Post-test support groups Children’s group therapy/play

Components of Comprehensive care

COMPREHENSIVE CARE

COMPREHENSIVE CARE IS ABOUT

THE PATIENT

The PATIENT may be able to access several services, preferably under one roof, or service provision area as opposed to having services available and having the patient try to track them down

Introduction HIV/AIDS is not just an infection, it is an

emotional, psychological, physical, spiritual and social problem. Thus it requires a multi disciplinary and multi-sectoral approach.

The KNH CCC centre was opened in December 2002.

Initially CC services were provided at Patient Support Centre but this has recently moved to Rahimtulla Wing of KNH.

KNH CCC is one of the largest in the country.

PICTURE OF KNH CCC

Picture to be included later

KNH CCC PARTNERSHIPS

Comprehensive care is about partnerships

KNH CCC Partnerships USAID (PEPFAR) through FHI CDC/UON (PEPFAR) through ACTS MSH (PEPFAR)

Accomplishments Establishment of the CCC which provides;

• Physical care: ART provision, OI diagnosis and treatment, prophylaxis, Laboratory services (CD4, VL, Biochemistry).

• Emotional care: Pre and post test counseling, anxiety relief, support groups (PTC), ongoing care and counselling.

• Spiritual care: In collaboration with the KNH Chaplaincy.

• Social care: community support / outreach, nutritional support, financial dependence/capabilities, networking.

Accomplishments Number of Patients on Comprehensive Care.

( 170 clients per day, including Children)• No. on ARV’s, OI Prophylaxis, PEP• No. / % on Nutritional support / Nutritional

Counselling

Psychosocial support – counselling, social workers• To inpatients • Outpatients – at CCC, Post Test Clubs.

Graphical Representation of Patient load

Cumulative Number of Patients on ART - 2006

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January 920 1392 245

February 972 1456 262

March 1010 1517 280

Male Female Children

Accomplishments

Capacity building • Internal - Health worker training in CC (or

aspects of CC) ART, HBC, CVCT, VCT, DTC, Adherence Counselling .

• External – Technical guidance and supervision to network partners - over 20 VCT / CCC service providers.

• Training of staff from over 10 other large institutions.

• Development and revision of training curricula.

Accomplishments Adherence Monitoring and evaluation. Through;

• Lab;• Follow up – Defaulter tracing. Client assessment;• Data Forms.

Enhanced quality of Care. Has been possible through;• Development of Standard Operating Procedures &

documentation incl. Client Interviews.• Training – CME’s ;• Staff to do ongoing M & E , Quality Assurance and

supervision.

Accomplishments

MIS and IT Services to enhance data collection, data storage, ease drug dispensing and Lab reporting.

Provision of DTC to inpatients.

KNH CCC SERVICES

Referrals forSocial and legal services, wills, inheritance

Peer support, PTC, group therapy

•Spiritual services Homes, community services, hospices

Medical and nursing care

•OIs•ARVs•Palliation

Psychological support•Follow-up counselling•Adherence

Socioeconomic support•Microcredit•Nutrition•OVC

Comprehensive Care for HIV

Challenges High demand for service Lack of adequate Human Resource

to match demand – incl. Child & Adolescent counsellors and care providers.

System challenges • Supplies , complexity of procedures:

Multiple Programmes = different reporting needs / objectives.

• Staff Attitudes

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159

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Average No. of clients per Day

Average per day

Challenges

Inadequate networking to ensure optimal utilisation of resources• Both internal and external networking (with CBO,

NGO, FBOs, Youth Groups)

Provision of “Comprehensive Care” that is not limited to only ARV provision.

Scaling up Home Based Care. Operationalising SOPs in CC

Challenges

Monitoring and evaluation; • of success of treatment, programme

performance.• of Patient Transfers in / transfers out

Provision of CC to children and adolescents – have special needs.

Challenges

Operationalising MIS and IT for clinical services.

Though cost of drugs is low, cost of diagnosis, CD4, VL, Biochemistry, Haematology e.t.c remains high.• Harmonizing data collection (e.g. for

different operational researches) • Use of gathered information to guide

decisions.

Lessons Learned There is a high demand for quality

Comprehensive Care A multidisciplinary team is necessary for the

CCC concept to be effective. Networking is essential because not all client

needs can be met at one location. Clear concise guidelines and standard

operating procedures are useful in standardising the quality of CC especially where it is provided by many people.

Counseling is the foundation of consistent adherence to therapy and to successful comprehensive care.

Lessons learned

The PATIENT must remain the primary focus

A continuum of care needs to be maintained between different members of the multidisciplinary team for CC to be successful.

Consistent data collection is necessary to enable monitoring and evaluation.

Way Forward Coordinated and joint outreach and

defaulter tracing needs to be strengthened to improve adherence to treatment.

Provision of technical support and guidance to new centers beginning CC is important

– To learn from past mistakes and gain from

experiences learnt.

WAY FORWARD

Enhanced Psychosocial Care and support at the community level must be developed further.

Continued provision of quality service to clients and ensuring of the same through – M&E, SOPs must be implimented

Inclusion of other domains of Comprehensive Care remains a challenge- • Counselling of family and care givers• Legal issues of discrimination, unfair dismissal.• Reproductive health issues of HIV couples etc

Way Forward Better linkage between CCC and in-

patient services to ensure continuity of care when these patients are admitted.

Continued staff development to keep abreast with new technology and methodologies in care provision.

ACKNOWLEDGEMENTS

KNH MANAGEMENT USAID/FHI CDC/UON/ACTS MSH MEDS/PHARMACCESS KNH CCC STAFF

Thank you.