1. 1 Increasing health system efficiency: Use of motorcycles for patient outreach in Kisumu, Nyanza Province D. O’Farrell 1, K. Nichols 1, K. Harrison 1, M. Lutukai 1, J. Lewis-Kulzer 2,3, G. Agengo 2, P. Oyaro 2, I. Sakura 1 1 Riders for Health, 2 FACES/KEMRI, 3 UCSF

2. What is Riders for Health? Riders is a not-for-profit social enterprise that manages transport operating in African health systems. ♦Focused on providing reliable, scalable, cost-efficient and appropriate transport solutions ♦Emphasis on rural access and experts in difficult terrain ♦Partner with ministries of health (MoHs) and other health partners in 7 countries

3. Background/program description ♦Expertise: −FACES: comprehensive HIV prevention, care, & treatment program −Riders: motorcycle management through preventive maintenance and rider training to increase reliability −FACES & Riders partnership: in Oct. 2009, 9 outreach workers trained to use 6 motorcycles for defaulter tracing at 5 FACES supported health facilities in Kisumu District, in addition to usual tracing means

4. HIV care and treatment challenges ♦Challenging for outreach health workers to traverse difficult terrain and long distances to trace HIV- infected patients who default on care ♦Outreach workers used public transport, walked, and had infrequent access to motorcycles ♦Motorcycles were not preventively maintained and were not reliable

5. Study Objective This study examined whether mobilising outreach workers using accessible motorcycles maintained preventively and routinely affected patient tracing and return rates.

6. Methods ♦Evaluation: retrospective study at five health facilities ♦Data collection: existing aggregated program data on monthly patient defaulter tracing rates were abstracted and compared at: −Baseline: Jan – Sep 2009 −Follow-up 1: Jan – Sep 2010 −Follow-up 2: Jan – Sep 2011 ♦Analysis: Student’s t-test

7. Objective and methods ♦Objective: Study examined whether mobilising outreach workers using accessible motorcycles maintained preventively/routinely affected patient tracing and return rates. ♦Methods: −Retrospective study conducted at 5 health facilities in Kisumu District −Aggregated programme data on monthly patient defaulter tracing rates to the facility were utilized. −Baseline data (Jan.-Sept. 2009) were compared to data from the same time period in 2010 and 2011 following implementation using paired Student’s t-tests. Joy Judy FACES outreach health worker

8. Results across 2009 - 2011 ♦10,334 patients defaulted between 2009-2011. ♦63.9% (n=6,603) were traced, among which 55.6% (n=3,669) returned.

9. Result #1: Tracing rates The average monthly percentage of defaulters who were traced increased significantly (2009-2011). * Indicates significant change from previous period (p=.0001) ** Indicates slightly insignificant change from previous period (p=.055)

10. Result #2: Return rates The average monthly percentage of traced defaulters who returned increased significantly (2009-2011). * Indicates significant change from previous period (p=.0216) ** Indicates significant change from previous period (p=.0393)

11. Conclusions ♦Substantial increases in tracing and return rates were found after managed motorcycles were introduced. ♦Increases could be potentially attributed to: −Facility staff numbers −Use of phone tracing and other tracing means −Motorcycle functionality ♦Providing outreach workers with managed motorcycles may be a viable approach to increase tracing and other outreach services in Kenya.

12. Further research/partnerships ♦Potential research to examine comparison facilities and GPS mapping results to improve understanding of motorcycle impact ♦Additional analysis of other Riders partnerships, where outreach health workers are mobilised on motorcycles to deliver health education, host support groups, monitor water and sanitation programmes, etc. ♦Open to further partnerships to manage transport used in health care delivery, such as a motorcycle courier system to transport samples between clinics and labs

13. Thank you ♦To our partners at FACES, KEMRI and UCSF, who have strongly supported this programme and enabled its success. See www.faces-kenya.org.www.faces-kenya.org ♦To our teams here in Kenya for their dedication For more information, please contact partnerships@riders.org or visit: www.riders.org