PATH IS PROUD OF PEPFAR
On this World AIDS Day, members of the GAPP share why they are so proud of PEPFAR’s and what they envision for its future. Below, read why Dr. Edward Kariithi, Regional HIV/TB Service Delivery Technical Advisor at PATH, is proud of PEPFAR.
The work that PEPFAR has funded in Kenya has been a trailblazer in actualizing people-centered and empowered care and advancing community leadership in the HIV response, by both decentralizing service delivery to community settings through differentiated models of care and institutionalizing community-led monitoring (CLM) to provide a voice and platform for clients and community members.
This is the reality of primary health care, meeting the needs of clients where they are and at a cost they can afford, while empowering them in their own care. This implementation of differentiated service delivery and CLM has provided impetus for Kenya’s primary health care reform, which in many aspects is also modeled on the PEPFAR-funded hub-and-spoke approach, with a hub (health facility) and spoke (lower-level health facility and community units) comprising primary care networks.
PEPFAR investments in the digitization of HIV service provision from 2004 to date has catalyzed the development and implementation of an integrated digital health system in Kenya—called Kenya’s digital health superhighway—that aims to digitize all health services. PEPFAR investments in digitization of HIV services began with standalone HIV-specific electronic medical records (EMR). It evolved into standardized data collection tools and the development of a holistic EMR system domiciled within Kenya’s national health information system. Further investments by PEPFAR enabled shifting towards a client-centric, point-of-care EMR system that facilitates clinical care, reporting, and data analytics for decision-making to support optimized and integrated HIV service provision. This point-of-care EMR system was extensively utilized to support continuity of HIV services during the COVID-19 response in Kenya and to support HIV case-based surveillance. Currently, PEPFAR investment supports 2,100 EMR sites (an increase from under 100 sites two decades ago), with client care records for more than 90% (1.2 million) people living with HIV captured electronically and stored within the Kenya National Data Warehouse. This EMR system has now been integrated into Kenya’s digital health superhighway that covers all health areas.
PEPFAR has also been instrumental in strengthening a decentralized laboratory testing system in Kenya by advancing a diagnostic network optimization (DNO) initiative for both static and point-of-care laboratory platforms across the country. These are multi-disease testing platforms, inclusive of molecular testing for HIV (viral load, early infant diagnosis), tuberculosis (GeneXpert and other molecular diagnostics), hepatitis testing, and oncology. This platform was also leveraged for COVID-19 diagnostics. This decentralized system is driven by a sample collection and transportation network, where motorcycle riders carry samples from all HIV service facilities (spokes) for analysis at 12 PEPFAR-supported, multi-disease testing laboratories (hubs). Results are transmitted electronically and in hard copy from hubs back to spoke facilities. PEPFAR support for this system has contributed greatly to the decentralization of integrated, multi-disease diagnostic and monitoring services, with 1.2 million and 120,000 tests performed for viral load and early infant HIV diagnosis in 2023, respectively, with only samples being moved. PEPFAR investments and programming has spurred collective action from national government and other donors, such as the Global Fund, to enhance, accelerate, and shift towards sustaining the gain of the HIV response in the context of integrated, decentralized health services in Kenya.