Kenya: Integrating HIV Care With Broader Maternal and Child Health

In the three years since it integrated routine services with HIV diagnosis and care, the Maternal and Child Healthcare Clinic at Kakamega Provincial General Hospital has seen an 80 percent increase in uptake of its services to prevent mother-to-child HIV transmission. This, observers say, bodes well for similar efforts throughout the nation's health care system, where the walls between routine care and HIV treatment are coming down.

When the Kakamega clinic's services were separated, "Stigma was found to be the major cause of dropouts, since it was common knowledge that anybody being referred to the comprehensive care center was HIV-positive," said Khadija Nalinya, nursing officer in charge.

The dramatic improvement since the integration confirms the results of a Family Health International study conducted in Rwanda. Researchers in that examination of 30 health care centers found that ending the segregation of primary health care and HIV services boosted the uptake of both.

Now Kenya's government is enacting the change across its health care system. Special rooms for counseling and testing, specific pharmacies for people with HIV, and other separate accommodations will be phased out nationwide by the end of next year. So far, three other health care facilities are following in Kakamega's example, said Dr. Sirengo Martin, manager of the Prevention of Mother to Child Transmission (PMTCT) program at the National AIDS/STD Control Program.

"These services will be offered in the same room where MCH [maternal child health] and family planning services are offered," Martin said. "For effective integration, the government is cross-training MCH and HIV service providers so that they can offer antenatal and PMTCT services in the same visit."

In Western Kenya, four public health clinics have taken the process a step further by integrating HIV care with outpatient services.

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