HIV TESTING & COUNSELLING (HTC)

EDARP provides HTC services at the facility and in the community as follows:
CITC – Client Initiated Testing and Counseling
PITC – Provider Initiated Testing and Counseling
HBTC – Home Based Testing and Counseling
Regardless of the approach, the three C’s i.e. (Counseling, Consent and Confidentiality) must be observed. HTC services are offered in all fourteen facilities of EDARP clinics and services are offered for FREE by counselors, nurses, clinical officers and medical officers.

Benefits for HTC:

1. Behavior change for prevention
2. Case finding for care and treatment
3. Reduction of HIV burden in the society/family.
4. Access to care for prevention.
5. Reduction of HIV associated stigma
6. Access of psycho-social support
7. Relieves the burden of living in doubt.
8. Access to other health services including TB screening and treatment, STI screening and treatment, early diagnosis and treatment of cancer.

Knowledge is power therefore Know your HIV status today by visiting any of our clinics near you. Knowing your status is a show of love to your partner and family. It gives you and your loved ones the confidence to face the world with the resolve to overcome challenges and turn them in to stepping stones to success.

ANTENATAL CARE (ANC)

Who should attend ANC Clinic
All pregnant mothers, as soon as a woman confirms she is pregnant she should start ANC clinic. EDARP has 14 Clinics which offer ANC and PMTCT services from Monday – Friday, 7.30am – 4pm excluding weekends and public holidays. ANC services are FREE and are offered by highly qualified clinical staff i.e., Nurses, Clinical officers and Medical officers.

How often should I attend ANC clinic
Minimum four visits

What is offered at the ANC clinic:

• Health talks on pregnancy, nutrition, Infant and young child feeding  (IYCF), birth plan
• Mother-baby booklets are issued
• HIV counseling and testing for all mothers
• Prophylactic treatment;

This includes administering multivite, folic acid, ferrous sulphate, Tetanus toxoid vaccine, and mothers offered mosquitoes nets to prevent malaria,

• Counseling on safe infant feeding practices
• TB/STI screening at every visit
• Assess and treatment for urinary tract infections and Sexual Transmitted Infection’s
• Male involvement activities
• Enrolment of HIV infected pregnant and postnatal mothers in psychosocial support groups
• Nutrition assessment and support
• Care and support for the family

If HIV result is Positive:
Mother is counseled on ways of reducing chances of passing HIV to the baby. The following services are offered;

• Mother is enrolled to HIV care, together with the partner if HIV Positive and encouraged to bring their children (if any) for HIV test and health care services.
• Support and counseling is offered on ways of reducing chances of passing HIV to the baby.
•  Family members are counseled to give support needed by the couple.
• ART prophylaxis is offered to the mother, HAART is given if CD4 is below 350 regardless of WHO stage, AZT prophylaxis is issued to mothers at 14 weeks gestation with CD4 > 350 and in WHO stage 1&2
• Mother is counseled on treatment adherence and baby prophylaxis, safe sex practices is enhanced to reduce chances of passing HIV to the baby and maintaining good health of the mother.
• Mother is encouraged on importance of hospital delivery.
• The HIV exposed infant is offered NVP prophylaxis within 72 hours of birth and continues with NVP for the duration of breastfeeding, this can be discontinued at 6 weeks if the mother is on HAART.
• HIV exposed infants are put on cotrimoxazole prophylaxis to prevent opportunistic infections
• Infants born from HIV infected mothers offered DNA PCR testing at 6 weeks after birth, followed by a HIV antibody test done at 9 and 18 months. If PCR results at 6 weeks are positive, the infant is enrolled into antiretroviral therapy.
• Mothers are educated on importance of exclusive  breastfeeding, exclusive replacement breastfeeding as prevention intervention for the uninfected infant. Mothers are also educated on dangers of mixed feeding to their uninfected infants. 
• Home visits are made regularly to assess mother and baby’s well being
• Mothers are offered postnatal care and immunizations for babies between 0-5 years as scheduled by Kenya Expanded Plan for Immunization (KEPI).
• Nutrition counseling is offered to the mother on every clinic visit and planned home visits
• We refer our ANC/PMTCT mothers for hospital delivery.

NUTRITION DEPARTMENT PROFILE

Nutrition department offers nutrition intervention which forms part of the comprehensive  care and treatment management offered by EDARP. Services offered include; Nutritional Assessment, Diagnosis, Intervention, Monitoring and Evaluation.

Nutrition assessment;
Involves determining the nutrition health of an individual and their dietary needs to suit various clinical conditions.

Nutrition counseling and education:
Aims at empowering patients with information that would assist them make informed health choices and change their attitude and behavior so as to embrace sound nutrition practices.

Nutrition support:
This activity focus on clients who are malnourished/ wasted as a result of HIV/TB infection. Clients are taken through a rehabilitation program using certified food supplement to aid them in fast recovery.  Products mainly used are fortified bended flour (FBF) and plumpy nut which is a ready to use therapeutic food (RUTF). These products are therapeutic and their prescription and usage is based on national protocol.

Monitoring/follow up:
Patients who are on supplementation program are constantly and closely monitored through recovery process until they achieve nutritional normalcy and thereafter, a periodic follow up is done in order to avoid relapse cases. Focused home visit is conducted  

Management of various clinical conditions: various clinical conditions are also managed nutritionally. These includes: Diabetes, hypertension, overweight, liver conditions, ulcers, abnormal lab result among others.

Community strategy: CHW have been trained to do screen children at community level and refer them for health facility for nutrition intervention

Training community health care workers (CHCW): The CHW who are a link between the facility and the community

Benefits to the clients
Patients have been able to benefit a great deal through nutrition services offered at EDARP. The benefits have been noted in various levels

• Those with underweight are treated using certified food supplement offered free of charge.
• Improved quality of life and a high self esteem once patients fully recover from malnutrition. ( both underweight and overweight)
• Nutritional interventions offered to clients with various clinical conditions.
•  Nutritional counseling and education provides clients with information which enables them to make informed choices while embracing sound nutrition practices for a sustainable good heath.
• Food drug-drug interaction: clients are educated on food drug interations and how to manage them. They get a food-drug plan and nutritional management of mild drug side effect.
• Nutrition counseling and follow up for ANC clinics (counseling on maternal nutrition, infant feeding)
• Growth monitoring program.

Voluntary medical male circumcision (VMMC)

What VMMC entails:
Voluntary medical male circumcision (VMMC) is a simple, short and painless surgical procedure of removal of the foreskin (prepuce) done as per WHO guidelines by trained providers. EDARP began offering VMMC services in November 2009. Since start of this service, EDARP has  carried  over 12,000 safe male circumcisions. VMMC services offered in EDARP clinics are FREE.
Why get circumcised?

• Hygiene reason – it is easier to keep the penis clean after circumcision
• 60% less chance of becoming infected with HIV
• Reduced risk of urinary tract infections in childhood (12 fold increased risk if uncircumcised)
• Reduced chance of contracting some sexually transmitted infections (syphilis risk is 1.5 to 3 fold if uncircumcised)
• Reduced chance of penile cancer (22 times more frequent in uncircumcised)
• Reduced chance of cancer of the cervix in female sex partners (2 to 5.8 times more frequent in females with uncircumcised partners)

Where can one get circumcised?
FREE voluntary medical male circumcision is provided at the following EDARP FIKIRIA JAMII clinics:on weekdays between 7.30am and 10pm and on Saturdays between 2pm and 8pm.
Located in the areas listed below;

• Donholm clinic: (behind Caltex petrol station)
• Kariobangi (Light industries, behind KCB Bank)
• Dandora Phase 5 (Near Joy Villa bus terminus)
• Soweto ( behind Patanisho maternity and nursing home)
• Babadogo (at  St Joseph’s catholic church)
• Shaurimoyo (at  St Joseph catholic church)
• Eastleigh section 3 - St. Veronica

HIV/TB CARE AND TREATMENT SERVICES

EDARP offers FREE comprehensive HIV/TB care and treatment services to all people living with HIV and AIDS (PLWHA) enabling them to live quality and productive lives. This is in line with the organization’s mission.

WHO CAN ACCESS THESE SERVICES?

All HIV and TB services can be accessed by any person regardless of their status.

BENEFITS OF THESE SERVICES;  

1. You get to know your HIV and TB status.
2. Knowledge on prevention and treatment of Tuberculosis, HIV and opportunistic infections
3. Access to multiple services; For example, a client accessing HIV testing services will also get TB, cervical cancer, and male circumcision screening.
4. Quality service and good experience; Our health workers are trained and have experience in HIV/TB management and therefore you will be offered the best.

OTHER SERVICES OFFERED;

1. Some of the comprehensive HIV/TB services you will be access include;
2. Counseling and testing
3. Clinical assessment
4. HIV screening and treatment
5. Cervical cancer screening All women are at risk of developing cervical cancer specifically those aged 15 – 49 will get access to at least one cervical cancer screening every year.
6. Tuberculosis screening and treatment
7. Sexually transmitted disease screening and treatment
8. Antenatal care
9. Psychosocial support
10. Adherence counseling and support

Post Exposure prophylaxis for sexual assault survivors.

ORPHAN VUNERABLE CHILD SERVICES

Who is an OVC?

An orphan or vulnerable child (OVC) is a child who has lost one or both parents.

EDARP began offering OVC services in 2006.

OVC services offered in EDARP clinics are FREE.

What are the benefits?

1.   Health care

We provide OVCs with medical care regardless of their HIV status until they are 18yrs.

2.   Shelter

We link them to institutions or rescue centers temporary or permanently and continue to follow them up.

3.   Psycho social support

We provide this support monthly and during  school holidays.

• Counseling
• Immunizations
• Play therapy
• Disclosure
• Life skills, self esteem and career goals
• Sexuality and relationships.

4. Legal civic support

We offer help to OVC’s whose rights are violated

5.   Nutritional support.

Where can one get OVC services?

OVC services are provided at all EDARP FIKIRIA JAMII clinics. On weekdays between 7.30am and 4.00pm and they are FREE.

PHARMACY

EDARP pharmacy has grown over time in terms of variety of medicines and the quantity of products stocked for dispensing. Medicine dispensing involves educating our clients on how the drug is to be used before dispensing. The pharmacy departments dispense anti tuberculosis, antiretroviral (ARVs) and other drugs used in treatment of opportunistic infections. All drugs are prescribed and dispensed as per the Kenya National guidelines.

Our goal;

1. Reduce the detectable viral load of HIV RNA as low as possible,
2. Maintain this level of suppression for as long as possible.
3. Prevent opportunistic infections occurring, improve the quality to prolong the life of HIV infected person

To achieve the above goals the department ensures the following are addressed during and before dispensing medicine to our clients;

• Patient education and instructions of use
• Dosing instructions
• Adherence counseling
• Nutrition counseling
• Precautions and contraindications
• Side effects and adverse drug reactions
• Safe storage of drugs.

A pharmacy staff is not limited to the above services but works as a team with all other professionals to ensure that our patients get the best care possible.

HMIS DEPARTMENT

BACKGROUND

The department aims to establish a reliable, efficient and functional Hospital Medical Information System (HMIS) that enables easy patient information management within all EDARP clinics.

EDARP’s HMIS system has been designed to capture the minimum standard requirements of Ministry of Health (MoH) health indicators.

The system was 1^st introduced in 2009 at our Kayole clinic and currently all our 14 facilities are running on the system.

HOW WILL YOU BENEFIT FROM OUR SERVICES?

CLIENT

• Better service delivery by reducing client waiting time  
• Facilitates efficient patient clinical assessment and data recording by clinicians
• Facilitates easy client referral as client information can be accessed within all EDARP clinics
• Clients get accurate records, and have a documented audit trail of their medical history

EDARP

• Coordinate and guide program data collection activities
• Promote and support data quality improvement through Routine Data Assessment (RDQA)
• Monitor and evaluate all care and treatment program activities
• Facilitate a feedback system to the management and staff to facilitate informed decision-making in all levels of the program.

DONORS

• Provide timely, accurate and reliable care and treatment program activity reports
• Easy assessment of activities funded

GOVERNMENT AND OTHER STAKEHOLDERS

• Provide timely, accurate and reliable care and treatment reports as per sites covered by EDARP. For example, Monthly MOH 731 and MOH 711 reports.
• Technical support.

Laboratory Services

The laboratory provides diagnostic services for patients accessing EDARP services. The laboratory operates on a network system where client samples from all EDARP clinics are collected and transported to the lab for testing. This approach is cost effective to our clients as it enables all clients’ access laboratory services from whichever clinic they are getting care and treatment from without having to come to the laboratory.

The main services being offered include; TB screening, organ function tests specifically kidney/liver and immune monitoring tests. TB screening involves identifying M.tuberculosis from sputum of clients suspected to be infected of TB and those on treatment. Immune monitoring tests are offered to newly diagnosed HIV clients and those on treatment. EDARP follows the laboratory testing protocol as recommended by the National Aids and STI Control Programme (NASCOP).

The laboratory partners with the TB Central Reference Laboratory which assists in carrying sputum culture, drug sensitivity and testing for patients on TB treatment and those suspected of developing Multidrug resistance TB. The laboratory outsources PCR testing from KEMRI HIV-P3 laboratory to enable early infant HIV diagnosis is accessible to all clients within EDARP clinics.

As a measure of improving the laboratory services, the laboratory is enrolled and participates in external quality assurance programs. These include; Human Quality Assessment Services (HUQAS), United Kingdom National External Quality Assessment Service (UKNEQAS), and Quality Assurance System International (QASI).
All laboratory services offered are free to all clients accessing care and treatment under Eastern Deanery Aids Relief Program from Monday to Friday.