The following is a post from Center for Global Health Policy Director Christine Lubinski, who recently traveled to Kenya with a group of Capitol Hill staff from key Congressional offices with jurisdiction over global health funding or programs.
Joe Mamlin, MD, and his team of able Kenyan healthcare professionals have transformed health care delivery in western Kenya. Dr. Mamlin identifies the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) as the catalyst and inspiration.
AMPATH – Academic Model Providing Access to Healthcare – is a consortium of partners including the Moi Teaching and Referral Hospital, the Moi University School of Medicine, the Kenyan Ministry of Health and a host of American academic institutions led by Indiana and Brown Universities. “PEPFAR taught us anything was possible in Africa,” Malmin said, and the art of the possible has led to AMPATH’s creation of a broad range of health care services and programs with strong community engagement. These range from community health care workers serving as “cough monitors” to do active tuberculosis (TB) case finding, to community based care and treatment for multidrug-resistant (MDR)-TB, to a program that acknowledges the link between TB and diabetes and screens both patient populations for both diseases.
AMPATH cares for more than 137,000 adults and children with HIV infection and receives its funding for HIV care from the U.S. Agency for International Development. This resourceful organization has developed an electronic medical record system that has become a model in Africa and has built a comprehensive primary care model on infrastructure funded by PEPFAR. They also conduct important operational research on key questions such as factors that sustain HIV medication adherence and factors that contribute to patient loss-to-follow-up. AMPATH’s innovative work on tuberculosis includes taking a mobile X-ray machine right into the community to do chest X-rays on TB suspects. AMPATH is also a pilot site for rifabutin roll-out—a drug intended to replace rifampin for HIV-infected TB patients. (Rifampin adversely affects drug absorption for some critical HIV antiretrovirals.) AMPATH is also doing cutting edge work in oncology including providing community-based chemotherapy. They will have radiation therapy capacity soon as well.
AMPATH goals in the HIV context remain incredibly ambitious, even as they move aggressively to integrate care for reproductive health, TB and non-communicable diseases with HIV care and treatment. The goal is to decrease the incidence of new HIV cases by more than 50 percent. Mamlin and others argued that this was the wrong time to withdraw federal funding from HIV and other global health programs just as lessons are accruing about how best to meet the health care needs of poor, rural Kenyans plagued by both of these infectious and chronic diseases.
After a tour of their facilities and a series of presentations from impressive Kenyan health care professionals, there was little doubt that AMPATH is up to the task.