www.aids2014.org

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%

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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 Hospital in Mombasa

• Trained 40 Community Health Workers (CHW)

• Deliver clinic- and community-based programming

• Serve over 6,500 children living with HIV/AIDS

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Healthy Living Initiative• Launched 2011 • Objectives– Improve retention in care

for HIV+ children– Prevent diarrhea and

malaria in HIV+ children– Evaluate program impact

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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%

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Healthy Living Initiative Eligibility Criteria

• HIV positive children• OVC• Linked to CHW

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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

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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

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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

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Evaluation Timeline

Pre-Enrollment

• January 1, 2010- January 31, 2011

• Chart reviews

Enrollment

• February 1, 2011 – August 31, 2011

• Baseline surveys

Intervention

• September 1, 2011 – August 31, 2012

• Bimonthly home visits

• Program monitoring

• Chart reviews

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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

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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)

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Results• Water observed in vessel at

95% of home visits • Subjective evidence of

chlorine use at 85% of home visits

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

Pre-enrollment InterventionTotal visits No of

episodes (%)

Total visits No of episodes (%)

P Value

Overall 3628 118 (3.3%)

3690 44 (1.2%) <0.0001

Age group <5 yo 1022 41 (4.0%) 549 10 (0.8%) 0.074 5-14 2437 72 (3.0%) 2719 23 (1.8%) <0.0001 >15 169 5 (3.0%) 422 11 (2.6%) 0.812

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Results• Overall reported/observed

ITN use: 82% of home visits • Reported/observed ITN use

at all home visits: 48% of households

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

Pre-enrollment InterventionTotal visits No of

episodes (%)

Total visits No of episodes (%)

P Value

Overall 3628 30 (1.0%) 3690 4 (0.1%) <0.0001Age group <5 yo 1022 11 (1.1%) 549 0 (0.0%) 0.015 5-14 2437 27 (1.1%) 2719 4 (0.1%) < 0.0001 >15 169 1 (0.6%) 422 0 (0.0%) 0.114

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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

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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

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AcknowledgementsProject Sunshine

Beatrice Kernan

Caitlin Moses

Mohammed Naem

Jenny Lue

Marieka Walsh

New York UniversitySumathi SivapalasingamMolly Anderson

Benjamin Patterson

CDC, AtlantaRobert QuickKatharine Schilling

Gilead Foundation

Bomu HospitalAabid Ahmed

Dennis Ngui

Asia Abdullah

Rukiya Ali

Hayati Anjarwalla

Mahad Hassan

CHWs

Data Entry Clerks

Children and families who participated in the Healthy Living Initiative

ASANTENI SANA!