Provision of ARVs in a resource-poor setting: Kibera Slum, Kenya

Abstract

Kenya is one of Africa’s largest informal settlements. Health indicators are extremely poor and HIV prevalence is estimated at 20%, almost twice the national average. Despite ARV drugs being made available in a pilot programme implemented by African Medical and Research Foundation (AMREF) and Centre for Disease Control (CDC), enrolment rates into the programme have been very low raising questions about strategies for providing ARV in resource-poor settings. Description: Since 1998 AMREF has been implementing a community-based health care project in Kibera slum. In February 2003 AMREF, partnered by CDC launched a pilot programme aiming to test the feasibility of providing ARV drugs within a slum setting. Despite the high HIV prevalence rate in Kibera, the greatest challenge facing the pilot study has been recruitment of patients. To date, under one third of the targeted 300 patients have been identified, screened and enrolled into the programme.

Issues: Kibera slum, Nairobi, Kenya is one of Africa’s largest informal settlements. Health indicators are extremely poor and HIV prevalence is estimated at 20%, almost twice the national average. Despite ARV drugs being made available in a pilot programme implemented by African Medical and Research Foundation (AMREF) and Centre for Disease Control (CDC), enrolment rates into the programme have been very low raising questions about strategies for providing ARV in resource-poor settings.
Description: Since 1998 AMREF has been implementing a community-based health care project in Kibera slum. In February 2003 AMREF, partnered by CDC launched a pilot programme aiming to test the feasibility of providing ARV drugs within a slum setting. Despite the high HIV prevalence rate in Kibera, the greatest challenge facing the pilot study has been recruitment of patients. To date, under one third of the targeted 300 patients have been identified, screened and enrolled into the programme. Challenges preventing a higher rate of uptake include prevailing stigma relating to HIV/AIDS, drug-sharing between clients, competing “alternative therapies” and misconceptions about ARVs.
Lessons Learned: Availability of ARV drugs may assist the reduction of stigma in a resource-poor setting through enabling the realisation that HIV/AIDS is treatable and thus similar to other infectious disease. This study indicates that community acceptance of ARVs in a highly stigmatised resource-poor setting is a slow process and that the provision of ARVs must be accompanied by a targeted awareness campaign.
Recommendations: An intervention aiming to promote take-up of ARVs in such a setting should incorporate a comprehensive community component of community and family support, home-based care and de-stigmatization campaigns.
Despite the above-mentioned challenges, early indications from this programme demonstrate that provision of ARVs in a resource-poor setting is feasible.

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Details

Publication Type paper research
Publisher African Medical and Research Foundation (AMREF)
Year 2004
Author(s) F Ilako, M Kimura
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