Layering on Non-Communicable Diseases
The AMPATH Chronic Disease Management (CDM) Program
Jemima Kamano, MBChB, MMED
Team Leader, AMPATH CDM Program
Rationale
 High burden of Non-Communicable Diseases (NCDs) in Kenya but
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no working systems to address them.
Both HIV and NCDs are chronic diseases. The AMPATH HIV
program is an example of a successful chronic disease model.
Early diagnosis and sustained care are key to successful
treatment and prevention.
They share the “tip of the iceberg syndrome” (a very small
proportion of the total affected mass are in care at any one time)
Prevention strategies are possible and play a key role.
Treatment is expensive, failure to treat is even more devastating.
Layered Programs Within AMPATH:
Potential for integration
Community-based staff
and their primary role
A
Facility-based
HIV care
Decrease incidence HIV>50%
Mother to Child Transmission
(MTCT) <5% in catchment
Decrease maternal, infant
and under 5 mortality >50%
Traditional
AMPATH
B
PHCT/FLTR
(Find, Link,
Treat ,Retain)
C
Primary
Health Care
(PHC)
D
Level 1-6 care for cancer,
hypertension, diabetes,
lung disease and mental
disorders
NCD
OVC/Community
Health Worker (CHW)
in some locations
Perpetual Home-based
Counseling and Testing
(PHCT): HIV: Find and Link
CBOW: HIV: Retain and
Pregnant: Find and Link
OVC/CHW
PHCT: HIV: Find and Link
CHW: Kenya Essential
Package for Health (KEPH);
Pregnant: Find and Link;
HIV: Retain; OVC
Community Health
Extension Worker
(CHEW): oversight
PHCT: HIV and NCD find
and Link
CHW: as in C plus. Help
with NCD Link and Retain
CHEW: oversight
Program Design and Implementation
 FLTR: case Finding, Linkage,
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Retention and Treatment are the
cornerstones.
Case finding done through
incorporating blood pressure and
random blood sugar test into the
existing PHCT program initially
developed for HIV.
Linkage and retention in care done
through the community strategy
model of PHC.
Treatment systems utilizes the
AMPATH HIV clinics converting
them to chronic disease clinics.
Program Design
 High disease burden, called for
innovation hence the use of level
2 facilities for confirmation of
diagnosis, triage and care for
early disease for NCDs.
 An efficient referral system very
critical for successful NCD
programs, hence additional
effort placed in building Centers
of Excellence (COEs) at the
referral hospital and mini-COEs
at level 4 facilities.
 Multiple stakeholders in this
design with government being a
major partner for sustainability.
Key Innovations
 Change from patient finds Doctor,
to Doctor finds patient.
 Task-shifting – policy is to have
physicians treat NCDs, in this
model nurses and Clinical officers
are key providers.
 Medical records- from paper
forms to electronic medical
records―great opportunity for
quality control and feedback,
summary sheets etc .
 Use of hand held devices- gives
opportunity for real time decision
support, eases work load.
Program Roll Out
Program Roll Out: The Milestones
1. Over 100 nurses and clinical officers
2.
3.
4.
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trained in diabetes and hypertension
care.
Over 1500 adults screened for
diabetes and hypertension so far in
the pilot community units.
Hypertension and diabetes care set up
in 17 dispensaries
Integration of Diabetes, Hypertension
and HIV care operationalized: From
CCCs to Chronic Disease Clinics (CDCs)
in 2 centers.
Training and Piloting of clinical
decision support use ongoing.
Opportunities for Further Partnership
 Opportunity to expand to more AMPATH sites (currently
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limited by funding).
Opportunity for diagnostics support i.e. laboratory and others
especially for COE level.
Staffing challenge- very stretched work force, need to identify
donor partners willing to sponsor some staffing positions for a
given time.
Training opportunities- development of important
competencies such as diabetes educators.
Data transmission- challenge of cost. Looking for partnerships
with mobile providers to give better rates.
Need for partnership in developing efficient staff motivation
strategies - cross cutting.
Thank You For Your Support!