Destiny Fuqua, Bethsy Harrigan, Lena Lutz, and Leigh Anne Robertson
Yesterday we departed Nairobi and made our way to Kisumu (population 1 million), which is located in the western part of the country and borders Lake Victoria.
On our first day in Kisumu, we traveled to Siaya County, home of President Barack Obama’s grandmother, in western Kenya near the Ugandan lake border. This area is a high incidence region for HIV and TB, and the Centre for Health Solutions – Kenya (CHS) is working to improve health outcomes through infrastructure building and innovative evidence-based solutions. CHS closely partners with the Government of Kenya, on both the national and county levels, to deliver sustainable health services with ambitious 95-95-95 targets for HIV status knowledge (95% of residents with HIV will know their HIV status), antiretroviral therapy delivery(95% of HIV positive will receive ART), and viral suppression measures (95% of HIV positive will reach viral suppression).
Dr. Paul Wekesa, CHS Chief Executive Officer, and the CHS team extended a big welcome to our global health scholars and led us to the Bondo sub-county referral hospital. Clinical Officer Francis Olilo showed us the direct impact of fully electronic medical record systems. The transition from paper to electronic records has increased efficiency via clinical dashboards, automated scheduling, and embedded machine learning to design interventions. This transition has provided important longitudinal data that allows CHS to track outcomes and to show improvements that CHS initiatives are making with the populations they serve.
Since the start of the CHS’s SHINDA project sponsored by PEPFAR and the U.S. Centers for Disease Control and Prevention, the incidence of new HIV positive cases has reduced from ranges of 5-8% to less than 2%. Siaya County was the first county to achieve fewer than 5 in 100 maternal to infant HIV transmissions among mothers who are HIV positive, from a baseline of 18 in 100. In addition, viral suppression rates for the overall population of more than 80,000 patients are 97%, surpassing the target of 95% for both the CHS and United Nations.
These phenomenal outcomes are possible through a differentiated service delivery (DSD) model. DSD allows CHS to meet patients where they are and ensures that healthcare services are accessible to all in Siaya County. One-way CHS utilizes DSD is by having both their own workers and community health workers deliver ART medications and any other necessary medications to the patient household directly.
Reduced clinical waiting times, after implementation of DSD at Bondo Sub-County Referral Hospital
Combining DSD and electronic medical records allows patients to receive lab results and reminders about their next appointments via text messages. These innovations lead to decreased waiting times and overcrowding in health facilities, like the Bondo sub-county referral hospital, also reducing the likelihood of exposure to other illnesses while waiting to be seen by clinicians.
CHS opened Wichlum Beach HIV Prevention Center to bring services closer to the community and to workplaces. We saw a vibrant, bustling fishing center, where boats lined the shores in front of a long line outside this center. Patients served include fisher folk, sex workers, men who have sex with men (MSM), and those who inject drugs. As seen by the numbers of people gathered there, this prevention center is a key health provider within the community, offering a wide variety of services: HIV testing and screening, needle and syringe distribution, TB screening and treatment, condom education, and DREAMS referral (more on DREAMS below). And these are only a portion of the services offered here. Vaccinations are also provided at this center, where we heard an unhappy child receive a life-saving vaccine. This beach is not only a place of economy, but also a place of care and treatment for all connected by the ties of fishing on this shore.
After our visit to the Wichlum Beach HIV Prevention Center, we traveled to the DREAMS Center in Siaya County, where we had the opportunity to witness a powerful community-driven intervention designed to support girls ages 10 to 24 through their transition from girlhood to womanhood. Meeting weekly, the 67 active girls at the center focus on building financial, social, and emotional assets, with strong mentorship and guidance from a board of technical officers and local mentors. The center offers financial literacy education to these girls and women and, through their partnerships with both CHS and other beach-based intervention services, the DREAMS Center even steps in to assist with school fees when possible. One long-time member proudly shared her journey and the meaning behind the acronym, DREAMS: Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe. This safe and educational space is a testament to how local efforts can shape brighter futures, and I hope we can one day adapt this model for girls in the U.S., or even Birmingham—because as Dr. Wekesa, his team, and many other influential people on our trip have reminded us, global changes begin with local solutions. What a powerful way to see Global Health in practice! We are grateful to Dr. Paul Wekesa, the entire CHS team and Saiya County leadership for showing us the impact of policy change as they work together to find and implement lo
