HIV/AIDS in Kenya

1. HIV/AIDS in Kenya • Population – 43 million • HIV prevalence: 6.1% • 1.6 million infected • 1.1 million children orphaned by AIDS • 190,000 children living with HIV • 58,000 AIDS related deaths • HIV prevalence in Mombasa: 11.1%

2. Project Sunshine Kenya • Nonprofit providing free educational, recreational and social service programming to children and families living with medical challenges • Launched in Kenya in 2006 at Bomu Hospitalin Mombasa • Trained 40 Community Health Workers (CHW) • Deliver clinic- and community-based programming • Serve over 6,500 children living with HIV/AIDS

3. Healthy Living Initiative • Launched 2011 • Objectives • Improve retention in care for HIV+ children • Prevent diarrhea and malaria in HIV+ children • Evaluate program impact

4. Diarrhea and Malaria in PLHIV • Diarrheal diseases • Disease rates are 2 to 6 times higher • Water and hygiene (WASH) interventions reduce risk by 25 – 48% • Malaria • Higher incidence and severity • Insecticide-treated bednets (ITN) reduce risk by 50%

5. Healthy Living Initiative Eligibility Criteria • HIV positive children • OVC • Linked to CHW

6. Program Enrollment • February – August, 2011 • Baseline Survey • Demographic and SES characteristics • Water handling practices • ITN use • Hand washing behavior • Distribution of Free Healthy Living Package (HLP) • 20 L storage vessel with lid and spigot • WaterGuard disinfectant solution • Soap • ITN • Educational Guide

7. Intervention Phase • September, 2011 – August, 2012 • CHWs conducted bimonthly home visits • Program monitoring: interim surveys on usage of WaterGuard, Soap and ITNs • WaterGuard and soap refills provided at each home visit

8. Program Evaluation • Analysis of baseline survey and program monitoring data • Assess clinical data • Hospital chart reviews for illness • Compare 1 year pre-enrollment to 1 year intervention phase

9. Evaluation Timeline

10. Data Analysis • Demographic data • Observations of water handling and ITN use • Comparison of illness data from pre-enrollment period to intervention phase • Chi-Square Test

11. Results • 500 enrolled at baseline • 70 (14%) lost to follow-up • 31 (6.2 %) transferred out • 24 (4.8 %) lost to follow-up • 15 (3.0 %) died • 430 children in evaluation • <5 years old: 13.5% • 5-14 years old: 75.4% • ≥ 15 years old: 11.2% • Median # of home visits: 4 (range 1-11)

12. Results • Water observed in vessel at 95% of home visits • Subjective evidence of chlorine use at 85% of home visits

13. Diarrhea Episodes per Person-Visit, Overall and by Age Group

14. Results • Overall reported/observed ITN use: 82% of home visits • Reported/observed ITN use at all home visits: 48% of households

15. Confirmed Malaria per Person-Visit, Overall and by Age Group

16. Limitations • Announced home visits may have influenced use of interventions – courtesy bias vs. Hawthorne Effect • CTX can reduce malaria and diarrhea incidence • Limited sample of children – not necessarily representative of Kenya

17. Healthy Living Initiative - Conclusions • Significantly fewer hospital visits for diarrhea and malaria • High retention in care: 86% • High adherence to water handling and ITN interventions

18. Acknowledgements Bomu Hospital Aabid Ahmed Dennis Ngui Asia Abdullah Rukiya Ali HayatiAnjarwalla Mahad Hassan CHWs Data Entry Clerks Project Sunshine Beatrice Kernan Caitlin Moses Mohammed Naem Jenny Lue Marieka Walsh New York University SumathiSivapalasingam Molly Anderson Benjamin Patterson CDC, Atlanta Robert Quick Katharine Schilling Gilead Foundation Children and families who participated in the Healthy Living Initiative ASANTENI SANA!