Family AIDS Care and Education Services, Kenya

Fellowship Site: Kisumu, Kenya; US Partner: University of California San Francisco

FACES operates in Nairobi as well as four districts in the western province of Nyanza. There are currently 63 clinic sites supported by FACES (2 in Nairobi, 9 in Kisumu, 20 in Suba, 23 in Migori, and 9 in Rongo). The number of patients currently enrolled in HIV care is 44,890 including 6,610 children. Among those enrolled in HIV care, 16,503 are currently on antiretroviral treatment (ART), including 1,456 children. In addition, 59 sites in Migori and Rongo Districts are providing Prevention of Mother-to-Child Transmission (PMPCT) services. Voluntary Medical Male Circumcision (VMMC) services launched in Migori and Rongo Districts in October 2008 and March 2009, respectively.

The FACES model of care focuses on identifying and enrolling all HIV infected family members to retain and support them in care. This includes: encouraging HIV testing of partners and children; assisting with disclosure to both adults and children; scheduling joint family clinic appointments; facilitating support groups for families and for HIV-positive pregnant women and their husbands. FACES is developing a system to address on-going needs such as home-based care, nutritional support, and economic support (including school fees) through referrals to collaborating community-based organizations.

Research opportunities:

The FACES model of decentralized, comprehensive care provides an excellent environment for collaborative and innovative research. A number of studies are currently underway:

• Integration of HIV care and treatment into MCH in Migori District
• The demand for family planning services among HIV-infected individuals receiving care and treatment in Nyanza Province
• The effects of HIV/AIDS stigma on use of maternity and HIV services by pregnant women in Kenya
• A prospective cohort study of the effect of highly anti-retroviral therapy (HAART) on the recurrence of surgically treated High-Grade Cervical Intraepithelial neoplasia in HIV-infected women in Kisumu, Kenya
• Risk Reduction in HIV serodiscordant couples attempting conception
• Application of weighted time-series to address bias in evaluation of clinic- and community-level research
• An evaluation of isoniazid preventive therapy (IPT) among HIV-infected children within a family-centered HIV care and treatment program in Kenya
• (PrEP) Parallel Comparison of Tenofovir and Emtricitabine/tenofovir Pre-Exposure Prophylaxis to Prevent HIV-1 Acquisition within HIV-1 Discordant Couples

Further information about ongoing and published research can be found on the FACES website.

Housing/Meals/Transportation:

Kisumu is the third largest city in Kenya and capital of Nyanza Province, with a population of approximately 700,000. It is one hour by plane (Kenya Air, Fly540 or East Africa Safari Air) or four to eight hours by bus from Nairobi. Money: There is a Barclay’s Bank downtown on Oginga Odinga Road (and many others nearby). Internet: Cybercafes are plentiful and free internet is available with meal purchases at several local restaurants. Food: There are three large grocery stores in Kisumu that offer a wide range of food and non-food items. There are many places to eat in Kisumu. For the real thing, choose one of the many fish shacks on the shore of the lake, where you can select a fresh-caught tilapia and have it Dholuo style, fried with or without stew, accompanied by ugali or chapatti.

Suba is a rural district on the western edge of Lake Victoria, south of Kisumu, that includes mainland and island sites. Transport: It typically takes about three to four hours to get to nearby Mbita from Kisumu: two hours by FACES van or three hours by matatu (250KSh) plus an hour-long ferry (100KSh). The ferry runs four times a day. A number of Suba staff come to Kisumu for weekends, so it is often possible to travel with them. Money: There is an Equity Bank in Mbita with an ATM. Internet is available at Sindo (bring an ethernet cable – the wireless is substantially slower). Food in the islands can be limited – bring snacks as well as food for meals (bread, eggs, peanut butter, etc.) whenever you go. There are no large grocery stores in Suba; it is advisable to any canned or processed food in Kisumu if possible. There are a number of hotels (food stands) on the main street in Sindo by the hospital selling lunch (as well as chapatti and mandazi for tea).

Migori is a large rural district located in southern Nyanza; it tends to be cooler and wetter than the other districts. The town of Migori itself sits on the main road to Tanzania, about half an hour from the border. Money: There are several banks in Migori, including a Barclay’s on the main road past the bridge. There is a KCB with ATM down the road from the hospital. Internet: It is possible to use the internet within the PSC office at Migori when staff do not need the computers. It also may be possible to connect your own laptop to the network. In addition, there are several cyber cafes along the main road. Food: MDH features a canteen and a Coke stand with the typical lunch time offerings. The Al Jazeera Hotel on the main street by the road leading to the flat offers excellent tea. Small grocery stores abound, and two large grocery stores are located on main road on the far side of the bridge. Small shops on the main road past the bridge show movies and TV shows – look for chalkboards with upcoming shows along the sidewalk.

Rongo is even cooler and wetter than Migori! You should have some sturdy shoes for walking that can also handle getting very muddy. Rongo is about 3 hours from Kisumu by matatu (200KSh). Kisii is the closest major town and you can also reach it by matatu (100KSh). Money: There are no ATMs available in Rongo. The closest ATM is in Kisii. It is recommended to obtain cash on the weekends. Internet: There is wireless internet access in the clinic so it is best to have your own laptop while you are there. Internet cafes are available, but since the flat is removed from the main town, there is not much opportunity to use them. Food: Most basics can be purchased in the small kiosks (bread, pasta, flour). Fruits and vegetables can be bought from the street vendors. However, there are no supermarkets in Rongo, so it is recommend to buy non-perishable items at a supermarket in Kisii or Kisumu.

Nairobi is the capital of Kenya, an urban center with a population of more than two million people. FACES operates in two sites within Nairobi: the main clinic on the grounds of the Kenyatta National Hospital (KNH) at the KEMRI Centre for Respiratory Disease Research (CRDR) and a peripheral clinic in Mimosa, a fifteen-minute drive away. Money: There is a Visa-compatible ATM on the hospital grounds. There are several banks located at Prestige Plaza and at nearby Yaya Center. Internet: To access internet at the main FACES clinic from your own laptop, you will be asked to fill out a form with basic information in order to obtain a temporary IP address. With that you will be able to connect from the office whenever an Ethernet cable is available. Food: Like any major city, there are plenty of restaurant options and nightlife in Nairobi. There are also two large grocery stores, an open-air market, and small food stands near KNH.

Health Issues:

Though the water at most sites has been treated, it is advisable to buy bottled water or boil all water before drinking. Most of the FACES flats have a sufficient number of mosquito nets already there. If not, they are available for purchase in Kisumu for ~ 800 KSh at any large grocery store. Post-exposure prophylaxis is typically kept stocked at the Kisumu flat.

Beyond malaria, health concerns in the region include schistosomiasis in Lake Victoria and sporadic cholera outbreaks. Traffic accidents also pose a risk at all sites.

For non-urgent health concerns, contact one of the medical officers at FACES (see site-specific contacts). For urgent health concerns, the best hospital to go to in Kisumu is Aga Khan Hospital. The best hospital to go to in Nairobi is Nairobi Hospital, as it is located close to the clinic and provides rapid care.

See the U.S. Centers for Disease Control and Prevention website and The Yellow Book: Health Information for International Travel fro additional information. The NIH/FICRS program mandates that all Scholars see a physician prior to their assignment abroad.

Safety Issues:

Be sure you have registered with the U.S. Embassy in Nairobi in case of emergency of any kind, and leave copies of your essential documents with an emergency contact. Bring copies of the same documents on paper and also accessible via email.

In the case of theft or other emergency, contact FACES staff and, if they are not available to assist you, the police. It is helpful to deal with any crises under the aegis of KEMRI and/or FACES to facilitate this assistance.

See the U.S. State Department Web site for additional information.

Language Requirements:

Though all staff speak English and all clinic records are kept in English, any projects involving clients will require translation into Kiswahili and Dholuo. People appreciate it when you try to speak Swahili or Luo, so be open to having people teach you.