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.
Amidst the beautiful tea plantations of Kericho, the Kenya Medical Research Institute (KEMRI)/Walter Reed Program supports research and clinical excellence. This effective Kenyan/U.S. government partnership has brought research training and good jobs for Kenyans and lifesaving clinical care to many. Groundbreaking clinical and vaccine research activities are closely integrated with the HIV prevention, care and treatment activities that are also supported by the Walter Reed program in its role as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) implementing partner in the region.
Current research projects include an evaluation of fluconazole for treatment of cryptococcal meningitis, a major killer of people with HIV infection in sub-Saharan Africa. After hearing about this study, we would later meet with a patient – now an active member of the program’s support group for persons living with HIV – who was hospitalized near death with untreated HIV infection and meningitis who clearly benefited from the research protocol. Studies are also under way to address effective management of tuberculosis (TB)-related immune reconstitution inflammatory syndrome (IRIS) and a study to look at the clinical outcomes of patients who receive routine HIV care and treatment versus those who receive HIV care and treatment plus HIV viral load monitoring. The research portfolio is diverse and includes a surveillance study of high-risk volunteers and preparation for a clinical trial of an HIV vaccine candidate later this year.
Meanwhile the Walter Reed program hosts an active Community Advisory Board with diverse membership including lawyers, religious representatives, persons with disabilities and persons living with HIV; and an HIV support group. We met with both groups who were proud of their involvement and very clear that the United States government had offered them and their community a lifeline through Walter Reed and the PEPFAR program.
There was an emotional greeting of a family of four that had been featured on the cover of an early PEPFAR report to the U.S. Congress (right), who had traveled a great distance on foot from their remote mountainside home to meet with members of the staff of the United States Congress. The father and husband had been very ill with AIDS when he first encountered the program and his wife was pregnant with her second child. Thanks to the clinical intervention, both mother and father are doing well on antiretroviral therapy and both young children are living free of HIV infection. In addition to the expressions of gratitude for the resources to make treatment available, the members of the HIV support group asked us to bring home the message that U.S. assistance and resources were still urgently needed.
Dr. Doug Shaffer, the director of the Walter Reed program, accompanied us to Kericho General Hospital where two dynamic women – Hospital Superintendent Dr. Betty Langat, and the Medical Chief for HIV Services Dr. Eunice Obiero – have worked to provide compassionate and high quality care to adults and children in this catchment area of one million people. The modest, 250-bed facility treats 600 people per day on an outpatient basis and has designed a number of patient-friendly services for their patients with HIV infection. The hospital hosts a Saturday clinic for adolescents to keep them engaged and offers an additional Saturday clinic for the male partners of pregnant women in their prevention of mother-to-child transmission (PMTCT) program. The HIV clinic at the hospital oversees the care of 12,000 adults with HIV infection and manages care for 1,100 children from 7 months to 16 years of age. HIV care is also fully integrated with maternal and child health and family planning services. The hospital has grown to include eight satellite sites, and even runs a small farm to grow fruits and vegetables to allow HIV patients to purchase healthy foods at a subsidized price.