Addressing the educational void during the antiretroviral therapy rollout

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