New Tool, Better HIV Treatment in Kenya

“I still don’t fully accept my status,” says Vivian Achieng , who has been living with HIV for almost four years. Vivian is one of 200 people waiting for antiretroviral therapy outside Kisumu’s HIV Patient Support Centre on a brisk, Wednesday morning. 
Seeking treatment for HIV is not just a decision; it’s a commitment – one that many people are reluctant to make. Antiretroviral drugs (ARV’s) work to boost the immunity of HIV patients and reduce the risk of opportunistic infections – it’s a complex, life-long treatment that must be strictly adhered to. 

Vivian understands how the drugs help to manage the virus, but she is concerned the side effects of the drugs will make her HIV status easily identifiable. There are rumors that once you are on antiretroviral drugs “your legs become darker, your tummy swells and your lips become reddish,” she says.

The HIV Patient Support Centre is located at Kisumu East District Hospital and dispenses antiretroviral drugs on Mondays, Tuesdays and Wednesdays.  Many Kenyans seek treatment far away from their homes to escape the stigma that can be associated with being HIV-positive – and when they arrive in Kisumu they are not disappointed.

They come because "we never run out of drugs," says Caroline Audi, Head Clinician at the support center.  She’s referring to the centre’s full-stock of antiretroviral drugs, which is not commonplace in all dispensaries. The Antiretroviral Therapy Dispensing Tool (ADT) – an easy-to-use electronic pharmacy management software, has made effectively managing HIV medications much easier. The tool was provided to the centre and 319 other health facilities in Kenya through USAID’s Health Commodities and Services Management Program implemented by Management Sciences for Health.

The dispensing tool is a valuable resource that allows pharmacy staff to keep track of patient information, and records on the antiretroviral drugs prescribed and dispensed. There are over 600,000 Kenyans on antiretroviral treatment – approximately 83% of these patients are treated in sites that use the dispensing tool.

Keeping track of medication consumption allows staff to accurately forecast the amount of medicines needed. In order to effectively treat the virus, health providers must maintain an uninterrupted supply of antiretroviral drugs and medicines to treat related opportunistic infections. As of December 2012, Over 600,000 patients in Kenya were on ARV treatment – 83% of these patients are treated at sites that use the dispensing tool.

How antiretroviral therapy works
Vivian consented to antiretroviral therapy one month ago.  At this time, she worked with her doctor to ascertain a course of treatment that blended into her normal daily activity. Strict adherence was reviewed and encouraged by her doctor – this means that Vivian is responsible for taking her medicines at the same time each day to “ensure an effective concentration of medicine is maintained in the body,” explains Emmah Obegi, Kisumu East District Pharmacist.

Every month, Vivian arrives at the support centre and presents her card and prescription at the pharmacy window.  Dispensary workers confirm her biographical information and match the drugs on her prescription, with her drug history stored in the dispensing software.  Vivian’s next appointment is entered and dispensary workers input the drug name and batch number dispensed. 

The Beauty of the Antiretroviral Therapy Dispensing Tool
The dispensing tool improves the quality of patient care, it catches errors in prescriptions or patient information, and immediately flags health workers when patients have missed their appointment or are in danger of running out of drugs.

Once social service workers run the daily report, patients who missed their appointments, or may be running out of medications are immediately identified and contacted.  If they can`t be reached on the phone community health workers are dispatched to their homes. 

When a patient misses a routine doctor`s appointment, or fails to adhere to the treatment plan, it can impact both the individual and the community. 

Incorrect dosing or missing as little as one dose puts the patient at-risk for developing drug resistance, which means the virus becomes resistant to certain antiretroviral drugs. If detected early, most types of drug resistance can be managed by changing drugs. If it is not detected early, the drug-resistant virus will continue to multiply, thereby causing a patient’s health to fail and increasing the risk of infection to others.

Before the antiretroviral dispensing tool, the support centre used a Daily Activity Register – a thick book in which workers would log dispensing information.  With the register there was no way to keep track of patients who had missed their appointments or were at-risk of running out of medicine.  Monthly reports would take hours, instead of minutes – as they do using the dispensing tool.  “The registers simply don’t have the capability to detect important issues in a patient’s treatment,” adds Obegi.

Persons living with HIV are not alone
Vivian isn’t sure she will stay on antiretroviral therapy if the side effects are noticeable.  Her immunity is too low to continue on other treatments and her health care providers have assured her they will work with her to minimize side effects. 

She believes she cannot have any more children, because her husband is HIV-negative and they have to use protection.  “When you’re sick you belong in another world, and it’s lonely,” says Vivian.  “No one understands how it feels to be HIV-positive . . . there is no one at home to remind me to take my medicine," she adds. 

Vivian’s story rings true for many people living with HIV. But, small improvements in health care systems mean that Vivian, and the other 579,038 Kenyans on HIV treatment are not fighting this lonely disease alone.

* Vivian's name has been changed for privacy purposes

Story by Ranelle E. Sykes