2021 Full of Challenges and Accomplishments
Dr. Adrian Gardner, executive director of the AMPATH Consortium, reflects on the last year.
So long 2021—what a year! This has been such a challenging year for so many around the world and no one has gone unscathed by the pandemic in one way or another. COVID has drawn more attention to existing inequalities in the US and on a global level, and indeed the pandemic has exacerbated these inequalities as well.
As I reflect on AMPATH’s accomplishments in 2021, there are so many stories that reflect the power of this long-term institutional partnership and the dedication and commitment of Kenyans and members of the AMPATH Consortium alike. There is no way to describe all the hard work and achievements, but I would like to share a few highlights.
Responding to COVID-19 and improving care for patients with infectious diseases
“The impact of the pandemic on supply chains, clinical service delivery and economic well-being has left many of AMPATH’s most vulnerable patients hurting. Yet, the ability of our partnership to rise to these new challenges is notable.”
Kenya has not been spared by the pandemic and while there is still debate about the various factors that may contribute to the relatively small number of deaths formally attributed to COVID-19 in Kenya (limited testing capacity, under-reporting, relative youth of population as a whole, possible partial immunity from exposure to other coronaviruses), we unfortunately don’t need to look beyond the AMPATH family to recognize the devastating impact this virus has had. Dr. Chege, Dr. Ashraf and Mr. Kamanda are among the leaders AMPATH lost and they are already dearly missed. The impact of the pandemic on supply chains, clinical service delivery and economic well-being has left many of AMPATH’s most vulnerable patients hurting. Yet, the ability of our partnership to rise to these new challenges is notable: AMPATH’s HIV care laboratory and MTRH’s laboratory rapidly re-tooled their PCR platforms and became COVID testing centers for the region; new high-acuity isolation ward space was created at Moi Teaching and Referral Hospital (MTRH) and a new oxygen plant was installed; and a home-based isolation and care program was successfully implemented for those who didn’t require hospitalization. In the surrounding communities, AMPATH supported County governments to equip isolation facilities, provided personal protective equipment (PPE) to frontline workers, and made direct cash transfers to microfinance groups and into the pockets of the most vulnerable individual patients. Indiana University led the AMPATH Consortium support as faculty staffed the wards and COVID unit in Eldoret, participated in COVID response planning, provided financial support for needy medical students, and participated in virtual continuous medical education sessions, sharing lessons in both directions.
COVID vaccinations rates are low, but rising.
Clinical service delivery at MTRH and AMPATH-supported ambulatory clinics has continued throughout the pandemic with a few pauses at various times. The research program has continued in-person activities for the most part as well. Educational programs have been hard hit by institutional closures and more recently, a clinical faculty strike. Some students at Moi University College of Health Sciences are nearly a year behind in their training but others in MMED programs have managed to complete their training and graduate. While uncertainty remains about the future, we are hopeful. Testing numbers and anecdotal reports suggest the worst of the omicron surge is behind us and vaccination rates, while still too low, are rising. I am excited to see that in December the Government of Kenya set up the Kenya BioVax Institute Limited, a company that in the future will oversee manufacture of COVID, childhood and other vaccines plus other health products.
In addition to establishing infrastructure to mitigate the effects of highly communicable diseases, faculty and staff from MTRH, MU, IU, and IU Health have been working closely together to improve care for infectious diseases more broadly. An analysis published recently in Lancet suggests that bacterial anti-microbial resistance (AMR) is a major cause of death around the world. By expanding diagnostic capacity, implementing antibiotic stewardship activities, and improving infection prevention and control measures, AMPATH and partners are working hard to establish a multi-disciplinary model addressing AMR.
Radiotherapy at MTRH
Radiotherapy and brachytherapy began at MTRH this year.
The Chandaria Cancer and Chronic Diseases Centre at MTRH has served as a medical home for a growing number of individuals with cancer and chronic, noncommunicable diseases for several years, but available care expanded greatly with the installation of a linear accelerator for radiation therapy in 2021. Now, patients with cancer in western Kenya, and the broader East African region served by MTRH, have access to both external beam radiotherapy and brachytherapy services in a timely way that is profoundly life-changing for those that need it. Already, more than 500 individuals have benefitted from radiotherapy and brachytherapy and patient appointments are booked for the next several months. A second Linac bunker is under construction to meet growing demand. Recently, a small child from a nearby county was treated with chemotherapy, then surgical resection of her Wilms’ tumor and she just completed her radiation therapy (a feat that would not have been possible until recently as her family lacked the resources to afford the long trip and stay to Nairobi even though the radiotherapy service itself is covered by the National Health Insurance Fund (NHIF)). She and twenty other children like her with Wilms’ tumor have already benefited from radiotherapy in Eldoret. AMPATH’s oncology efforts include education and awareness, early screening, surgical and medical chemotherapy. The addition of radiotherapy capacity affords oncology care providers another important tool to use in their efforts to combat cancer and will create new opportunities for education and research as well.
HIV program
AMPATH partners received three new USAID awards.
AMPATH’s HIV care program continued to support Kenya’s efforts to improve care for those living with HIV in western Kenya. The USAID-AMPATH Plus award (2012-2021) formally came to an end, but under the leadership of Professor Sylvester Kimaiyo and team, AMPATH was awarded three new multi-year USAID awards for HIV care and treatment, and care of orphans and vulnerable children. Together, these awards total over $120 million over the next five years and support service delivery to over 110,000 individuals living in nine counties in western Kenya. AMPATH has continued to achieve targets set by the Government of Kenya (GOK) and United States President’s Emergency Plan for AIDS Relief (PEPFAR) program and is committed to a process of transition to even more County ownership of HIV service delivery. However, global supply chain issues have affected the availability of certain antiretroviral medications and lab commodities necessary for routine monitoring and I remain concerned that we are yet to fully realize the impact of the pandemic on individuals suffering from tuberculosis, HIV, and noncommunicable diseases including mental illnesses. A large number of Kenya’s most vulnerable citizens have lost jobs and income in the last two years, and what little resources they had to cushion themselves against health shocks and unexpected needs have evaporated. Only time will tell what impact this has on rates of adherence to care.
IeDEA and Data Science
AMPATH’s strong HIV care program and informatics infrastructure have long served as an important resource for research that informs innovations in policy and practice throughout the world. In 2021, the National Institutes of Health (NIH) awarded principal investigators at IU and the Infectious Disease Institute in Uganda support to continue to lead the East Africa region of the International epidemiology Databases to Evaluate AIDS (IeDEA). The five-year award, totaling $16.5 million, will continue to support collaborations with clinical sites to identify and define key variables, harmonize data to generate large datasets, and effectively analyze data to inform policy decisions. Last month, the NIH awarded Brown University and Moi University investigators $4.6 million to support both training and the use of machine learning to improve outcomes for patients with HIV. Using data science to better understand the HIV care cascade, the team will ultimately design a predictive modeling system that will alert clinicians when their patients are at high risk of negative outcomes so that they can work together to avoid them.
Mental health program
The MTRH Nawiri Recovery and Skills Centre began welcoming people with mental health challenges.
In August 2021, MTRH began welcoming residents to the Nawiri Recovery and Skills Center, a transitional home for patients struggling with addiction and mental illness. Faculty from IU and a number of other AMPATH Consortium institutions have worked closely with Kenyan leadership at MTRH and MU to design and implement this innovative clinical service. Across the globe, many health systems provide inadequate care for individuals suffering from mental illness and certainly this is a neglected area when it comes to funding for health at a global level. The MTRH Nawiri Center will be a rehabilitation option that simply never existed before, but it is just one component of AMPATH’s broader mental health strategy that includes supporting community-based groups for more than 1000 individuals with substance abuse challenges, and engaging with law enforcement personnel to equip them with skills for interacting with individuals with mental illness.
Innovative Educational programs
AMPATH colleagues meet to discuss advances in oncology care.
COVID-19 has certainly limited faculty travel to and from Kenya over the last two years, but through the dedication of AMPATH Consortium faculty and their Kenyan counterparts, cutting edge educational programs have thrived. Moi University post-graduate fellowships in pediatric oncology, cardiology, maternal/fetal medicine have launched, continued and graduated fellows, and a medical oncology fellowship will soon be recruiting! A new palliative care training program for nurses and clinical officers has begun at the MTRH training college. A grant from Project ECHO is supporting the establishment of new infrastructure and curriculums for tele-mentoring and education. And a new platform for tele-dermatology now supports remote consultation which will improve access to care and be an important component of a post-graduate training program in dermatology.
Looking forward in 2022
I am so proud of these and many other accomplishments achieved through AMPATH teamwork. As we embark on a new year, there are several exciting programs and partnerships in various stages of development: dermatology, informatics, anesthesia, child development, plastic surgery and burn care, orthopedics, cardiothoracic surgery, neurology, and emergency medicine. And AMPATH’s efforts to improve population health, address social determinants, and implement a model of ensuring high quality health service delivery through domestic health financing will remain critical to the sustainability of all our efforts.
I look forward to seeing and connecting with you in 2022, whether in Eldoret or at our Global Gathering in Indianapolis on October 8!