What We Do
FACES works in concert with national and global efforts to achieve universal access to HIV prevention, care and treatment services. To achieve this, FACES focuses on
- Rapid scale-up of HIV services through decentralization to health facilities in remote location – Over 130 health facilities are now supported, in 2005 they were two.
- Comprehensive, family-centered HIV service provision in Nyanza Province, specifically Kisumu East, Suba, Mbita, Migori, Nyatike, and Rongo districts and at two sites in Nairobi.
- Laboratory networking between smaller facilities and district hubs to facilitate quick turnaround and enhanced patient management.
- Task-shifting to improve workflow and the efficiency of quality patient care.
- Integrated services – one point of care for multiple patient services whenever possible.
- Capacity-building and technical assistance for long-term sustainability.
Health and Support Services
HIV Care and Treatment
FACES provides HIV care and treatment technical support to government health facilities and other local partners who provide direct patient HIV care and treatment. HIV patient management includes prevention, screening, diagnosis, treatment, and management of opportunistic infections and sexually transmitted infections, reproductive health services, cotrimoxazole prophylaxis and multi-vitamins, Prevention with Positives (PwP), and close monitoring of HIV disease progression through physical exams, WHO staging, CD4 cell count taking, and other laboratory investigations. Patients meeting antiretroviral therapy (ART) criteria are initiated on ART following adherence counseling sessions. Laboratory networking between remote sites and district laboratory hubs is in place to facilitate quick turnaround time for samples and enhance patient care. Integrated services, where patients receive all services at one point of care,are provided where possible. All HIV services are provided in compliance with Kenya National Guidelines and best practices. Technical support in clinical service provision is aimed at strengthening sustainable government health facility management of HIV services.
Family Model of Care
A family-centered approach guides HIV care and treatment services program-wide. The family model of care is based on the linkage between HIV-infected patients (index patients) and their family members at risk. It was designed to identify, engage and care for all HIV-positive family members, prevent new infections among family members at risk, and raise family support and awareness. Providers guide index patients through the steps of identifying family members at HIV risk, address disclosure, facilitate family testing, and work to enroll all HIV-positive family members and prevent new infections. Family members are booked for joint appointments, their files are kept together, couples and family counseling is provided, family treatment buddies and partner involvement are encouraged, and PwP services are provided. Supporting the family unit helps reach individuals and families in need of HIV services.
Task-shifting is a major program strategy that enables health facilities with very few staff members and high patient volumes to effectively manage their workload and workflow. Nurses take on more clinical responsibility and lay health care workers conduct the non-clinical activities, allowing providers to focus on patient care. When HIV services are introduced to a site, the ongoing work level increases substantially, yet the number of staff typically does not change. Task-shifting enables sites to meet the workload demands and to continue to provide quality patient care.
Open Medical Record System (OpenMRS)
HIV care and treatment requires efficient information management to monitor patient clinical care. In 2007, FACES implemented the electronic medical record (EMR) system called Open Medical Records System (OpenMRS; http://openmrs.org) at four sites in Kisumu. It is an open source medical record system designed for developing countries and the HIV arena. OpenMRS is now in use at 19 FACES supported sites in Nyanza and Nairobi. Its flexible and friendly design enables the program to track and link patients in care, assess patient care and their health outcomes, evaluate care approaches, and report findings for ongoing review and program improvement.
Tuberculosis (TB) and HIV have a high co-infection rate, therefore TB services within the framework of HIV care is a key priority. As part of FACES’ comprehensive care approach and in accordance with Kenya and WHO guidelines, TB screening and management is conducted at every patient visit. TB/HIV co-infected patients are also prioritized for Highly Active Antiretroviral Treatment (HAART)initiation to improve their health outcomes.Efforts to strengthen TB diagnostic and treatment sites, sputum coverage and Multi-Drug Resistant TB (MDR TB) surveillance are underway. TB/HIV training and mentorship is conducted to build local capacity. TB infection control, intensive case management, and TB policy and implementation are also prioritized at the site level. Collectively these efforts are working to reduce the dual burden of TB and HIV.
Cervical Cancer Screening and Prevention (CCSP)
HIV-infected women are at increased risk for developing cervical cancer. Low-cost screening methods can detect the earliest stages of precancer, which can be treated safely in the clinic to prevent progression to invasive cancer. Since 2007, FACES has offered clients at Lumumba and Kisumu District Hospital cervical cancer screening with Visual Inspection with Acetic Acid and treatment in clinic with LEEP. In 2012, FACES began offering screening to sites in all districts in partnership with the Kenya Ministry of Health. As of early 2013, over 8000 women have been screened at FACES-supported facilities.
Family Planning Services (FP)
To address the large unmet need for contraception among HIV-infected women in Africa, FACES and the Ministry of Health (MOH) strive to integrate family planning (FP) into HIV care and treatment services, giving women and their partners the opportunity to make reproductive choices in the HIV care setting. Currently 93% of HIV care and treatment sites provide integrated FP services. At these sites, during routine HIV care appointments, nurses and clinicians assess family planning needs and provide appropriate counseling and education with the job aids (eg. boards with the FP commodities displayed) and FP commodities are provided to clients as needed. FP counseling and education is also provided in patient waiting bays for broader reach. Injectables are the most commonly used method (60%), followed by implants (30%)*. Approximately 46% of reproductive age women use modern contraception at FACES supported district hubs*. Ninet
*Data from 2013 at 8 sites utilizing the electronic medical record system OpenMRS
Prevention of Mother-to-Child Transmission (PMTCT)
Accessible high quality Prevention of Mother-to-Child Transmission (PMTCT) services are provided to women and their family members to reduce the risk of HIV transmission. Within maternal child health services (MCH), patients receive the core components of PMTCT centered on primary prevention; family planning; universal access to HIV counseling and testing for women, partners, and infants; a standard package for prevention and care (eg. antiretroviral prophylaxis to reduce transmission risk during birth, cotrimoxazole, counseling on feeding options and risk reduction); close HIV exposed infant monitoring; and HIV care and treatment for women and families as needed. Integrated services, where women and their family members receive their MCH and HIV services at one point of care is conducted where possible. FACES technical support is provided by a PMTCT Technical Advisor, District Coordinators, and Program Officers in collaboration with the Ministry of Health (MOH) District Health Management Team (DHMT) to strengthen local capacity for quality PMTCT provision. All services are provided in compliance with Kenya National Guidelines and best practices
HIV Testing and Counseling (HTC)
Patient HIV status knowledge is critical to providing the appropriate HIV prevention, care, and/or treatment services. HIV counseling and testing is provided at FACES supported sites in the context of Provider Initiated Testing and Counseling (PITC). PITC involves health care providers taking the initiative to counsel and test patients for HIV during routine visits to the outpatient, TB, inpatient, and other relevant departments at a health facility. Within the HIV care department and as part of the family model of care, patients are encouraged to bring their family members in for testing and counseling and PITC would be offered in that context as well. Providers explain the need and purpose of testing, clarify their role in the process, assure confidentiality, assess previous testing status, and counsel and test accordingly. Those found HIV positive are provided with post-test counseling, disclosure support, and encouraged to enroll in care. Patients who are HIV negative are encouraged to return for repeat testing in three months’ time and counseled on HIV prevention. . FACES provides technical support for quality HTC/PITC in collaboration with MOH in the form of training, support supervision, mentoring, logistics support, and quality improvement assessment.
Voluntary Medical Male Circumcision (VMMC)
Voluntary Medical Male Circumcision (VMMC) services are provided for HIV prevention; research has shown that VMMCreduces male risk of acquiring HIV by 60% (Bailey 2007).VMMC services are targeted for males 15 to 49 years of age. Parental consent is required for VMMC patients under the age of 18. VMMC services encompass counseling and education on the procedures; HIV testing and counseling;STI screening,diagnosis and treatment;and circumcision surgery and follow-up. VMMC patients who test HIV positive are encouraged to enroll in HIV care and are referred accordingly. VMMC patients who test HIV negative are encouraged to return to the health facility for repeat testing in three months’ time. To increase VMMC awareness and services, community mobilization is carried out in schools and communities periodically. VMMC services are provided at district and sub-district hospitals in all of the FACES-supported districts in Nyanza Province and all services are provided in compliance with Kenya National Guidelines.
Patient Support Service
To raise patient and family HIV awareness and knowledge, trained Persons Living with HIV/AIDS (PLWHA) lead group HIV and general health education sessions daily as a part of routine patient care. Sessions are focused on facts, misconceptions, and risk reduction behaviors. General health education is also provided to patients in the patient waiting rooms.Topics include family planning, nutrition, hygiene, maternal child health, and malaria, among other health topics.
To improve well-being and healthy behaviors, a wide range of counseling is provided to patients, partners, and family members. Counseling topics span: adherence, nutrition, couples, child, trauma, psychosocial, and Prevention with Positives (PwP) which encompasses risk reduction, preconception, family planning, assisted disclosure, and discordant couples counseling.
Patient Support Groups
Patient support groups are a vital source of social and emotional support and strengthfor HIV-infected and affected individuals. The groups provide an opportunity for sharing information, knowledge, ideas, and experiences in a confidential manner. Members also benefit from the coping skills gained, insight into the issues affecting others, and bonds made with others going through a similar experience.HIV positive people living positively and thriving also serveas role models and inspiration to others and encouragecare and treatment adherence. Most of the supported health facilities have patient support groups, including some tailored to specific needs such as maternal child health.
To enhance the well-being of HIV-infected and affected children and their siblings, children’s clubs are in place at many FACES-supported health facilities. The clubs meet monthly and the children engage in art, song, movement, and play. Meanwhile, parents or caregivers attend workshops on child care and education. The children’s clubs are managed by lay health care workers and nurses who have been trained as child counselors.
As the rate of adolescents newly diagnosed with HIV rises and to address their unique barriers to HIV services, FACES has made a valiant effort to support and provide services for this population. In some clinics, FACES has established a teen only day so that adolescents feel more comfortable waiting with their peers and also enabling short wait times. During clinic visits peer leaders provide adolescents with support and adherence counseling. Adolescent peer support groups have been established at hubs across the districts. FACES partnered with Sunburst, a California-based NGO, to expand and strengthen peer support and leadership. Read more on Sunburst below.
Sunburst Adolescent Collaboration
FACES and Sunburst, a California-based NGO, are working collaboratively to strengthen support services for adolescents living with HIV. Motivated HIV positive adolescent peer leaders are recruited and hired by FACES. Sunburst then leads an intensive two-week training to build their leadership and support group facilitation skills. The training sessions cover non-violent communication, public speaking, computer skills, and HIV education on risk reduction, treatment adherence, and positive living. Peer leaders are responsible for forming and facilitating adolescent support groups at the designated health facility, conducting school outreach, and coordinating occasional social events. The support groups consist of small group gatherings (10 per group) centered on open discussions, educational lessons, artistic activities, games, and role playing. Separate support groups are also held for parents and guardians of adolescent patients. This youth-focused collaboration and interactive initiative is aimed at engaging adolescents in HIV care and maintaining health behaviors.
FACES partners with Tuungane, an organization providing health and community services in Kisumu East exclusively for youth including youth friendly HIV prevention, care, and treatment services. This program enables youth to seek and obtain services in a setting tailored to their peers and comfort level. In addition to health services, there are recreational activities, computers, and a library.
Community Strengthening Persons Living with HIV/AIDS (PLWHA) Involvement
Recruiting and training Persons Living with HIV/AIDS (PLWHA) from the community to be peer educators goes a long way toward building their skills and improving patient knowledge and care. Garnering peer support, reducing HIV-related stigma, and providing essential clinic support are core responsibilities for the highly motivated peer educators supported by FACES. In Nyanza, the Peer Internship Program selects and trains PLWHA for a nine-month internship as a peer educator involving non-medical work in the clinic. They provide HIV education to patients, conduct home visits, trace patients who have missed appointments, facilitate support groups, provide clinical assistance, perform clerical work, encourage pregnant women and their partners to be tested for HIV, and promote pediatric services. In Nairobi, peer educators are recruited for community mobilization and patient defaulter tracing. The skills PLWHA learn often to lead to gainful employment within FACES-supported facilities or with other organizations. PLWHA have been an important source of inspiration and understanding for patients and staff.
World’s AIDS Day, World TB Day, Chief Barazas (chief’s meeting with community), the Ministry of Health Community Strategy, and Rapid Results Initiatives for Prevention of Parent-to-Child Transmission (PPCT), HIV Testing and Counseling (HTC), and Voluntary Male Medical Circumcision (VMMC) are a few of the community events that FACES engages in to promote AIDS awareness, improve HIV knowledge, and increase HIV testing uptake and the uptake of other prevention and care services. Many FACES patients and staff members compete annually in the World AIDS Day Marathon and Children’s Club members participate in the World AIDS Day Fun Run. Peer educators help with race planning and coordination. FACES, in partnership with other HIV and VCT centers, conducts a “Moonlight VCT”.
The Community Strategy is aimed at improving the health of communities surrounding health facilities. FACES works closely with the Community Units and Community Health Workers in the Community Strategy structure to connect with the communities with a goal of increasing linkage to the health facility for priority HIV services. Rapid Results Initiatives encompass an upsurge of mobilization to spark sharp increases in targeted service areas. For instance, twice annual month-long VMMC Rapid Results Initiatives typically increase surgeries four-fold and involve drama, singing, dancing, and radio spots to promote services.
Shamba Maisha is an agricultural program aimed at promoting sustainable healthier lives. The program was piloted in Kisumu as an income-generating project. Shamba Maisha enables HIV-infected persons to grow crops for food and sale through the provision of a hand pump, supplies, and vegetable seeds. Participants are active patient support group members, have access to land and a consistent water source. The enterprising patient farmers now have a small income to help with transport, school fees, and other necessary expenses. A study of Shamba Maisha is underway in Rongo District to examine the feasibility of expanding the program.
Each groups starts with approximately 10 local female goats and one donated purebred Saanen buck (generous donation by Marie MacKay). Each group builds their own structures for the animals and then receives three days of training by the area Livestock Officer, Veterinary Officer and the Officer of Culture and Social Affairs on goat care, feeding, treatment, pregnancy, the importance of goat milk, and other advantages of goat ownership and breeding.
Each women’s group maintains a high quality purebred buck which stays in one place. Then different female goats are brought to the buck for approximately one week at a time for breeding. The offspring are given to other support group members. The groups are responsible for the care and feeding of the goats, and a FACES Clinic and Community Health Assistant (CCHA) visits the groups every month to oversee the project and provide support as needed. In order to participate in this project, a group must have both a small farm and a shelter for the buck approved by the District Livestock Officer.
Football Program (soccer)
clubs for youth and young adults are supported to foster healthy, positive living and toutilize as an avenue to promote HIV prevention, care and treatment. FACES has joined Kicking AIDS Out! Network Network, a peer-driven program that engages thousands of youth across the African continent in football. The program allows young people to explore serious and sensitive issues in an environment where they feel comfortable
FACES invests its in staff, patients, and community by offering:
- Training for health care providers on adult and pediatric ART, HIV palliative care, voluntary male medical circumcision, PMTCT, HIV testing and counseling and other relevant clinical services are provided in compliance with Kenya National Guidelines. Lay health care worker and systems-related trainings are also carried out to strengthen program services and delivery.
- Weekly CME (continuing medical education) for FACES staff and peer educators
- Bi-monthly intensive CME for staff
- Daily HIV education for new patients
- Clinical mentorship of FACES staff
- Clinical attachments of Ministry of Health employees
- Training from affiliated institutions such as ASPIRE from the University of California, San Francisco
- Student Training Elective Program (STEP): FACES has an electives program for medical students and residents from affiliated universities including the University of Nairobi, the University of California, San Francisco, and the University of British Columbia.
Uliza! Clinicians’ HIV Hotline
FACES has created a toll-free, 24/7 telephone consultation service called Uliza! to give support to the health care workers who provide HIV care. The rapid scale-up of HIV care in Kenya has lead to many clinicians, some with limited experience and training, working in isolation.
Uliza! seeks to provide accessible expert HIV advice to care providers, 24 hours a day, 7 days a week. It utilizes the widespread cellular phone coverage as an appropriate, low cost technology to expand the reach of HIV experts and the range and depth of care. The hotline is staffed by volunteer doctors with experience in HIV care. The hope is to develop a hotline/referral model to expand to other regions within Kenya and other countries.