ADVANCING HIV NURSING PRACTICE IN THE COMMUNITY Presented by Lynette Kosgei, NIMART Nurse, Asayi Dispensary, Kenya

BACKGROUND INFORMATION Asayi Dispensary is located in a rural part of Kenya in Gem Sub-county, Siaya County Asayi Dispensary became operational in 2008 with one nurse. In 2014, another nurse was posted to the dispensary Current Staff: 2 nurses 1 peer educator 1 HTC counselor 1 volunteer

MAP OF GEM SUB-COUNTY

DEMOGRAPHIC PROFILE CATCHMENT POPULATION – 5,061 Male - 2,383 Female – 2,623 Under-one year – 170 Under-five years – 840 Adolescents – 2,253 Women of child bearing age – 1,136

SERVICES OFFERED The facility under management of two nurses offers the following services: HIV care and treatment HIV testing services (HTS) TB treatment PMTCT services Maternity services Cervical cancer screening Voluntary male circumcision General out-patient curative services Maternal child health and family planning

HIV CARE AND TREATMENT SERVICES HIV services started in 2009 with HIV infected pregnant women receiving CTX and single dose NVP and syrup for the baby Other HIV-infected patients were referred for care to higher-level facilities. There was a high defaulter rate due to the distance and funds to facilitate the clients travel to the linked facility 2010-2013 – the dispensary started offering HTS and HIV positive clients were enrolled into care, done initial assessment, WHO staging, collect samples for baseline assessment and send to central lab Clients in stages 3 and 4 and those with CD4 <350 were booked for initiation on ART by a roving clinician every Wednesday

HIV CARE AND TREATMENT SERVICES Clients would wait for long leading to defaulting, stigma and discrimination e.g. clients were nicknamed “members of Anglican church waiting for their pastor’’

Nurse Initiated Management of antiretroviral Treatment (NIMART) In 2014, ICAP introduced NIMART and I was trained as one of the trainers of the National Integrated HIV curriculum. Our role was to continue initiating and managing ART at our facilities as well as train other nurses through the facility based integrated HIV curriculum training Training involves self learning, group discussions and clinical sessions and assessments

NIMART After my training, I have trained and mentored 7 nurses: 1 from our facility and 6 from neighboring facilities. All are competently offering HIV services in their facility Asayi Dispensary is a centre of excellence for mentoring the nurses from neighboring facilities Continuous mentorship and support is constantly provided by ICAP general nursing capacity building and HIV program personnel to ensure provision of high quality HIV services to our clients

NIMART Integrated model of care All outpatient clients undergo HTC and the HIV-infected clients are linked to care immediately All adults and children eligible for ART are initiated as per national guidelines ART for all HIV pregnant and lactating women (Option B+) Follow up visits, community linkage to enhance adherence Routine viral load to monitor viral suppression Routine screening of clients for TB and other opportunistic infections IPT for eligible HIV infected clients

Facility Data on Clients Initiated on ART at Asayi Dispensary (2012 – 2016)

Thank you Lynette Kosgei