FALLING IN LOVE WITH ‘FLTR’

The AMPATH journey has been one of continually drilling down closer to the source of the HIV pandemic rather than simply staffing clinics. FLTR (Find, Link, Train, Retain) is a coming together of many of the most innovative pieces of AMPATH’s HIV program.

HCT counselors go door-to-door in Western Kenya communities to counsel and test for HIV.

Since 2008 we have been finding HIV-positive people in the community who otherwise might have been very sick by the time they knew they were HIV-positive; by the time they presented for care, they might have transmitted the virus to many other people, sold their land or other assets to pay for traditional medicine or other types of healthcare, or become widowed from losing their spouse. Many of these people would have been so sick by the time they came for HIV care that they might not have survived the early phases of treatment which are the highest risk in terms of mortality – resulting in more orphans, more loss, more devastated people and lives left behind. By finding them early through programs such as AMPATH’s Perpetual Home-based Counseling and Testing Program (PHCT), where counselors go door-to- door in communities to counsel and test for HIV, we are reaching them before they get too sick.

Linking them to care has been a key follow-up piece of the finding strategy – finding without linking is not a success from a clinical perspective. In PHCT, counselors remain in the community in which they test for HIV. As a consequence, the PHCT counselor can revisit patients hesitant to link to care and play a powerful role in limiting the frequency of failure to seek care.

HIV treatment is on-going and expanding in ever-new innovative ways – getting more people into care and on treatment is a major challenge but one that AMPATH has risen to through its High Risk and Low Risk Express Care programs, and trying to deliver more care to more people in the community through decentralization and provision of community-based services.

Getting people into care isn’t enough – keeping them there is the real challenge. With about 25% of patients lost to follow-up since the start of the program, more energy is going into creative ways of keeping patients retained in care. In addition to the innovative treatment programs that result in less time spent in the clinic for patients, moving the outreach program to the community brings services to the people.

Evidence is convincing that if a program can find everyone infected with HIV, link them to care, treat aggressively, and retain them in care, the resultant decrease in that community’s viral load holds the potential to markedly decrease the incidence of new HIV infections and bring the HIV epidemic to its knees in these areas. Demonstrating proof of concept is our next big challenge, and one that the AMPATH Monitoring and Evaluation team is eager to sink its teeth into.