Afya Jijini

Background

OTZ Champions at Paediatric AIDS Treatment for Africa (PATA) Summit

Afya Jijini program was funded by United States Agency for International Development (USAID) and implemented by IMA World Health.

The Afya Jijini program aims to improve the institutional capacity and management of health service delivery through the implementation of HIV programming activities and maternal and child health, nutrition, and water, sanitation, and hygiene services at the county level.

Building on the success of USAID’s APHIAplus program, Afya Jijini has worked to improve health outcomes among target populations in Nairobi County and Kiambu, Nyandarua, Meru, Tharaka Nithi and Embu counties in the Mount Kenya region. Afya Jijini’s mission is to improve and increase access to and the utilization of quality health services.

The program supported the provision of quality services in HIV care and treatment and PMTCT services offered to meet the overall project objective of increasing access to and utilization of HIV health services in Nairobi City County.

AMURT as Afya Jijini sub-grantee worked with facilities to improve upon existing facility- and community-based structures to increase utilization of HIV diagnostic, care, treatment and support services across the continuum of care.

Main objective

The project’s main objective was to support facility-based adherence and psychosocial support groups (PSSGs) for PLHIV in 29 Afya Jijini-supported high and medium volume health facilities in Nairobi County, with the following three sub-objectives: 

  1. SO1: To provide adherence counseling services to 11396 new patients, 9174 non-suppressed patients, 2189 pediatrics clients and 4380 adolescents. 
  • SO2: To ensure more than 95% of ART enrolled clients are retained on treatment at 12 months.
  • SO3: To attain more than 95% viral suppression rates amongst eligible ART Clients attending the 29 target health facilities.
Adolescents’ PSSG
Key Achievements:

  • Formation and strengthening of psychosocial support groups with age cohorts at the 29 health facilities, 11,045 new clients, 8,702 non-suppressed, 2,310 pediatrics and 4,513 adolescents’ clients were reached through PSSGs. This was achieved through alignment of the clinic appointment dates for the different cohorts with the PSSG dates. Provision of refreshments at the inception of the project contributed greatly to the formation of PSSGs. PSSG formation and strengthening was however slowed down due to Covid-19 containment measures restricting social gatherings.
  • AMURT was also able to achieve 81% retention rate in its supported sites which was above general program retention at 76%. This was achieved through client centered appointment management system and defaulter tracing as well as adherence counselling services to the LTFU and defaulters brought back to care. Nairobi county is characterized by a highly mobile population. This created a challenge in achieving retention targets as clients keep on changing contact and locator information hence making it difficult to trace those who have missed appointment.
  • There was a significant improvement in suppression rate in all AMURT supported 29 health facilities. During inception of the project (August 2018) the suppression was at 87% and at the close out of the project (February 2021) it had increased to 96%. 
  • Disclosure of pediatrics and adolescents is a key component towards achieving viral suppression and retention. The project was able to accelerate partial disclosure from 35 to 239 and full disclosure from 43 to 686. Caregivers who could not disclose to the children and adolescents were supported on the same and this has greatly improved retention among pediatrics and adolescents in all the 29 health facilities. Suppression rates among pediatrics and AYP at the inception of the project in August 2018 was as follows: 0-9 (68.69%), 10-19 (65.43) and 20-24 (82.41). An improvement has been noted in February 2021 as follows 0-9 (89%), 10-19 (90%). 20-24 (94%)
  • With implementation of OTZ, more adolescents and young people received adherence counselling services such as facility mentorship programs and PSSG. Through OTZ plus, young mothers were successfully reached with the support of mentor mothers and PMTCT clinicians. Apart from dealing with adherence issues, they are also struggling with motherhood at a young age as well as family issues for the married. Having identified the needs, the project identified other services that they can benefit from such as community based PSSGs by other organizations, family planning services, post GBV services, aPNS among others and conducted referrals accordingly. OTZ implementation has also positively contributed to viral suppression and retention among CALHIV with some facilities achieving 100% suppression rates.
  • Surge implementation strategy played a key role towards achieving the project targets. This was through enhanced adherence counselling services, weekly WIT meetings to identify gaps and having targets of ensuring aPNS for all clients with high viral load, new clients and LTFU clients. The team made deliberate efforts to ensure clients with high viral load are identified in time to initiate interventions. As a result, viremic clients with disclosure issues were able to have amicable solutions with their sexual partners in terms of handling their HIV status for both concordant and discordant couples. New client’s treatment literacy preparation sessions increased in number with TPA counsellors targeting all newly identified positives for adherence support hence improved retention.
  • Viremia clinics were successfully facilitated in all the 29 AMURT supported health facilities. The project team and other partners have ensured re-aligning of clients TCA dates to PSSG dates hence effective implementation.
  • Regular mentorship and support supervision for the facility staff is key to ensure that activities run smoothly at the facilities. During the implementation period, AMURT project officers in collaboration with Afya Jijini technical officers were able to conduct regular mentorship. As a result, quality of work has greatly improved. The CCC team are able to work as a team to ensure clients are not missed out for adherence interventions.
  • Collaboration with other partners for referrals and synergy. The three 95s are very critical in HIV care and treatment. AMURT was able to team up with other partners concerned in order to achieve the programs objectives and ultimately identify, link and ensure viral suppression and retention.
  • AMURT experienced immense support from SCHMT for implementation of activities. This was evidenced in regular joint mentorship sessions, participating in sub-county data review meetings and stakeholders’ planning meetings for planning purpose. As a result, there was a seamless implementation, with minimum conflict of roles and information.