1. The Practical Side of
Comprehensive Care:
ACCOMPLISHMENTS, CHALLENGES AND
LESSONS LEARNED AT KNH
Dr. David Bukusi
Kenyatta National Hospital
VCT and Comprehensive Care
Centers

2. Comprehensive care
 Medical and nursing care
• OIs/prophylaxis TB, PCP
• ARVs
• Palliative care
 Psychological support
• Adherence counselling
• Supportive counselling
• Post-Test counselling
• Post-Disclosure Group
Therapy
• Follow-up counselling
 PEP
 Laboratory support
 Youth Friendly services
 Nutritional support
 Social worker support
tracing defaulters, family
support
 Spiritual support
 Referrals for medico-legal
services
 Networking  CCC network
 Post-test support groups
 Children’s group therapy/play
Components of Comprehensive care

3. COMPREHENSIVE CARE
COMPREHENSIVE CARE IS ABOUT
THE PATIENT
The PATIENT may be able to access several
services, preferably under one roof, or
service provision area as opposed to having
services available and having the patient try
to track them down

4. Introduction
 HIV/AIDS is not just an infection, it is an
emotional, psychological, physical, spiritual
and social problem. Thus it requires a multi
disciplinary and multi-sectoral approach.
 The KNH CCC centre was opened in
December 2002.
 Initially CC services were provided at Patient
Support Centre but this has recently moved
to Rahimtulla Wing of KNH.
 KNH CCC is one of the largest in the country.

5. PICTURE OF KNH CCC
 Picture to be included later

6. KNH CCC PARTNERSHIPS
 Comprehensive care is about
partnerships
KNH CCC Partnerships
 USAID (PEPFAR) through FHI
 CDC/UON (PEPFAR) through ACTS
 MSH (PEPFAR)

7. Accomplishments
 Establishment of the CCC which provides;
• Physical care: ART provision, OI diagnosis
and treatment, prophylaxis, Laboratory
services (CD4, VL, Biochemistry).
• Emotional care: Pre and post test counseling,
anxiety relief, support groups (PTC), ongoing
care and counselling.
• Spiritual care: In collaboration with the KNH
Chaplaincy.
• Social care: community support / outreach,
nutritional support, financial
dependence/capabilities, networking.

8. Accomplishments
 Number of Patients on Comprehensive Care.
( 170 clients per day, including Children)
• No. on ARV’s, OI Prophylaxis, PEP
• No. / % on Nutritional support / Nutritional
Counselling
 Psychosocial support – counselling, social
workers
• To inpatients
• Outpatients – at CCC, Post Test Clubs.

9. Graphical Representation of
Patient load
Cumulative Number of Patients on ART - 2006
0
200
400
600
800
1000
1200
1400
1600
CumulativeNumber
January 920 1392 245
February 972 1456 262
March 1010 1517 280
Male Female Children

10. Accomplishments
 Capacity building
• Internal - Health worker training in CC (or
aspects of CC) ART, HBC, CVCT, VCT,
DTC, Adherence Counselling .
• External – Technical guidance and
supervision to network partners - over 20
VCT / CCC service providers.
• Training of staff from over 10 other large
institutions.
• Development and revision of training
curricula.

11. Accomplishments
 Adherence Monitoring and evaluation.
Through;
• Lab;
• Follow up – Defaulter tracing. Client assessment;
• Data Forms.
 Enhanced quality of Care. Has been possible
through;
• Development of Standard Operating Procedures &
documentation incl. Client Interviews.
• Training – CME’s ;
• Staff to do ongoing M & E , Quality Assurance and
supervision.

12. Accomplishments
 MIS and IT Services to enhance data
collection, data storage, ease drug
dispensing and Lab reporting.
 Provision of DTC to inpatients.

13. KNH CCC SERVICES
Referrals for
Social and legal
services, wills,
inheritance
Peer support,
PTC, group
therapy
•Spiritual services
Homes, community
services, hospices
Medical and
nursing care
•OIs
•ARVs
•Palliation
Psychological
support
•Follow-up
counselling
•Adherence
Socioeconomic
support
•Microcredit
•Nutrition
•OVC
Comprehensive
Care for HIV

14. Challenges
 High demand for service
 Lack of adequate Human Resource
to match demand – incl. Child &
Adolescent counsellors and care
providers.
 System challenges
• Supplies , complexity of procedures:
Multiple Programmes = different reporting
needs / objectives.
• Staff Attitudes
51
64
76
91
86
116
141
159
0
20
40
60
80
100
120
140
160
No.ofClients
2nd
Quarter
2004
3rd
Quarter
2004
4th
Quarter
2004
1st
Quarter
2005
2nd
Quarter
2005
3rd
Quarter
2005
4th
Quarter
2005
1st
Quarter
2006
Quarter
Average No. of clients per Day
Average per day

15. Challenges
 Inadequate networking to ensure optimal
utilisation of resources
• Both internal and external networking (with CBO,
NGO, FBOs, Youth Groups)
 Provision of “Comprehensive Care” that is
not limited to only ARV provision.
 Scaling up Home Based Care.
 Operationalising SOPs in CC

16. Challenges
 Monitoring and evaluation;
• of success of treatment, programme
performance.
• of Patient Transfers in / transfers out
 Provision of CC to children and
adolescents – have special needs.

17. Challenges
 Operationalising MIS and IT for clinical
services.
 Though cost of drugs is low, cost of
diagnosis, CD4, VL, Biochemistry,
Haematology e.t.c remains high.
• Harmonizing data collection (e.g. for
different operational researches)
• Use of gathered information to guide
decisions.

18. Lessons Learned
 There is a high demand for quality
Comprehensive Care
 A multidisciplinary team is necessary for the
CCC concept to be effective.
 Networking is essential because not all client
needs can be met at one location.
 Clear concise guidelines and standard
operating procedures are useful in
standardising the quality of CC especially
where it is provided by many people.
 Counseling is the foundation of consistent
adherence to therapy and to successful
comprehensive care.

19. Lessons learned
 The PATIENT must remain the primary
focus
 A continuum of care needs to be
maintained between different members
of the multidisciplinary team for CC to
be successful.
 Consistent data collection is necessary
to enable monitoring and evaluation.

20. Way Forward
 Coordinated and joint outreach and
defaulter tracing needs to be strengthened
to improve adherence to treatment.
 Provision of technical support and guidance
to new centers beginning CC is important
– To learn from past mistakes and gain
from
experiences learnt.

21. WAY FORWARD
 Enhanced Psychosocial Care and support at
the community level must be developed
further.
 Continued provision of quality service to
clients and ensuring of the same through –
M&E, SOPs must be implimented
 Inclusion of other domains of
Comprehensive Care remains a challenge-
• Counselling of family and care givers
• Legal issues of discrimination, unfair dismissal.
• Reproductive health issues of HIV couples etc

22. Way Forward
 Better linkage between CCC and in-
patient services to ensure continuity of
care when these patients are admitted.
 Continued staff development to keep
abreast with new technology and
methodologies in care provision.

23. ACKNOWLEDGEMENTS
 KNH MANAGEMENT
 USAID/FHI
 CDC/UON/ACTS
 MSH
 MEDS/PHARMACCESS
 KNH CCC STAFF

24. Thank you.