Bringing Communities Closer to Care: Strengthening HIV and TB Treatment in Kenya

Astellas Global Health Foundation Grant Helps PATH Improve Delivery and Access to Essential Health Services

When Mr. Mathew Abuto first started working for the Nyamira County Government as a Monitoring and Evaluation Officer over 14 years ago, he saw worrisome trends in county health data that were impossible to ignore. Limited coverage of essential services such as HIV testing among pregnant women and low adherence rates for HIV and tuberculosis (TB) treatment meant a large proportion of county residents were not getting the care they needed to stay healthy and thrive.

Even today, Nyamira County is among the highest HIV burden counties in Kenya, with an estimated HIV prevalence rate of 3.5% (2.2% among males and 4.8% among females). Rising HIV infection rates, especially among children and adolescents, coupled with a high TB-HIV coinfection rate of 25%, continue to point to missed opportunities to provide HIV and TB testing and treatment. People living with HIV and TB also face challenges such as stigma and lack of health education, leading to limited health-seeking behavior, late diagnosis, poor adherence to treatment, and ultimately poor health outcomes.

A desire to tackle these challenges led Mathew to take on the role of Community Health Services Coordinator in Borabu subcounty, the largest subcounty in Nyamira. In this role, he began working directly with community health promoters (CHPs) to improve access to health services within communities and linkages to services at heath facilities and provided leadership to establish seven community health units (the lowest levels of care, which have coverage areas of approximately 5,000 people each). His early work with CHPs focused on improving their ability to: deliver health education, locate and re-engage people who had discontinued or interrupted their treatment, refer community members to health facilities, and report on health indicators. The results of this work have inspired Mathew, who has since risen through the ranks to become Nyamira County Community Health Services Coordinator.

Since Mathew first began working in Nyamira County, the strategy around community health services in Kenya has evolved as the recognition of the crucial role community health plays in prevention and care for HIV, TB, and other diseases has increased. Community health services are a key pillar of primary health care, which focuses on health promotion, preventive care, and management of common diseases. Since the early 1980s, although they provided valuable health services, CHPs have been engaged on a voluntary basis. Through recent policy changes, including an amendment to the county’s Community Health Services Act of 2022, the Nyamira County government has developed a policy framework to recognize, professionalize, and incentivize CHPs including provision of monthly stipends from the county’s health budget.

However, CHPs continue to face many challenges in delivering high-quality services. The number of CHPs adequately trained to deliver high quality HIV and TB services is unacceptably low, and many lack the equipment and skills needed to record, monitor, and report on their work using Kenya’s new electronic Community Health Information System (e-CHIS).

The support provided through the Astellas Global Health Foundation (AGHF) to strengthen community health services for HIV and TB, therefore, has been catalytic for overall government efforts in Nyamira County, and has rekindled Mathew’s hope to improve health outcomes for the county’s population of approximately 700,000. 

Earlier this year, AGHF support allowed one of Mathew’s colleagues to participate in a workshop to review the national HIV and TB training curriculum for CHPs. In Nyamira, PATH and partners will use this curriculum to equip 1,440 CHPs with the skills and knowledge to provide integrated HIV and TB services in the community through AGHF-supported training courses.

AGHF support has also enabled PATH to procure 207 new tablets and smart phones for the community health units to fill gaps in essential equipment. These devices are crucial to digitize community health reporting through the national e-CHIS platform. They will enhance real-time reporting and empower community health teams to make timely and informed decisions for key activities and interventions—which goes hand-in-hand with an upcoming AGHF-supported e-CHIS training for the 1,440 CHPs and their supervisors.

Within the Nyamira County government, Mathew has championed these efforts as well as other AGHF-supported initiatives including the establishment of e-CHIS help desks to provide service support to users and trouble-shoot in real time, and a county asset management system which lists and tracks all IT devices.

Mathew Abuto is elated as he reflects on the progress that AGHF has enabled. “This AGHF support came at a time when the county was intentional in revamping community level HIV and TB service delivery to complement care and treatment work in health facilities,” he says.

With PATH’s approach to strengthening community health systems to provide integrated HIV and TB services in Nyamira, Mathew foresees a future in which individuals living with HIV and TB have access to a wide range of health care services, ultimately resulting in happier and healthier lives. The AGHF’s support to incorporate community level HIV and TB services into the county’s primary health care system is a transformative and sustainable approach, aligning with Kenya’s universal health coverage agenda.

About PATH
PATH is a global non-profit dedicated to achieving health equity. With more than 40 years of experience in forging multisector partnerships, and with expertise in science, economics, technology, advocacy and dozens of other specialties, PATH develops and scales up innovative solutions to the world’s most pressing health challenges. Its mission is to advance health equity through innovation and partnerships with three areas of focus: 1) increase health system capacity and resilience, 2) improve lives with science and technology, and 3) prepare for and respond to emerging health threats. PATH advances equity through co-creating projects that challenge social and structural inequities, developing guidance for and incorporating measures of equity into all projects and programs, prioritizing programs designed to improve the health and well-being of populations that have been historically marginalized and underserved by health systems, and investing in an internal culture of learning and improvement.