Abstract:
There are 40 million HIV-infected individuals globally
Experience at MUFHS HIV clinics demonstrated that
[1], the majority of whom live in developing countries
one clinical officer with physician supervision could see
where, until recently, antiretroviral therapy (ART) was
30 HIV patients per day, 150 visits per week, a total of
not available. With the global push to improve access
7000 visits per year. MUFHS serves a catchment area
to drugs in the developing world, ART is becoming a
of 13 million individuals (Fig. 1). Applying a local HIV
reality. The current challenge becomes how to deliver
prevalence of 15%, 980 000 HIV-infected individuals
ART effectively because misuse will have drastic
currently require care. Conservatively, 15% of these
consequences.
patients have a CD4 cell count less than 200 (CD4%
, 15) or an opportunistic infection. These patients
The Moi University Faculty of Health Sciences
require at least 12 visits per year, either to monitor
(MUFHS) is one of two medical schools in Kenya
ART adherence/side-effects or to monitor and treat
(population of 32 million; estimated HIV prevalence
for opportunistic infections in patients without ART
rate 15%) [2]. MUFHS has, since its inception, been
access. The 85% of HIV infected patients with CD4
partnered with US institutions (Indiana University
cell counts greater than 200 (CD4% . 15) will require
School of Medicine and, later, Brown Medical School)
four visits per year to monitor general health and
to foster collaborative medical exchange programmes.
immune function. A total of 5.2 million visits per year
The collaboration responded to the HIV epidemic with
will be needed to provide this routine care. Using these
the formation of the Academic Model for the Preven-
estimates, MUFHS today requires 730 clinicians trained
tion and Treatment of HIV/AIDS (AMPATH). Using
in HIV clinical care to serve their catchment area. This
the AMPATH blueprint, MUFHS opened its first HIV
calculation is not inclusive of the nurses, pharmacists,
treatment clinic with philanthropic donations in De-
nutritionists and outreach workers required to provide
cember 2001, with a modest goal to treat 50 patients.
appropriate multidisciplinary HIV care.
From this beginning, additional programmes devel-
oped: three HIV clinics at affiliated rural health centers,
In response to this educational void, the AMPATH:
a core laboratory (capable of measuring CD4 cell
HIV Clinical Care Training Programme was created.
counts and viral loads), a prevention of mother-to-child
This programme consists of two modules: a didactic
transmission programme leading to a mother-to-child
training programme covering issues such as HIV