Comprehensive HIV/AIDS Programming for Refugee/Mobile

populationsTurkana District Experience

Dr. Dan Koros - IRC

Objectives

• Briefly describe components, structure and implementation of a comprehensive HIV/AIDS program amongst Refugees and pastoralist communities residing in Turkana District.

• Reflect on the lessons learnt, challenges and how they can be adopted in other settings.

Context

Kakuma Refugee Camp– A population of 63,000 people.– Established in 1992. – Diverse cultures with people from 9 different

nationalities.– Free interaction with members of the local

community and across the borders.

Context ctd..

Turkana Community– Covers an area of 477,000 sq. km. and a

population of 517,000 people.– We cover 4 main areas in Turkana District

namely, Lodwar town, Kakuma Division, Kalokol Division and Lokichogio Division (estimated population of 200,000).

– Nomadic pastoralists’ community. – Harsh weather conditions.– Long standing conflict with neighbours.

Unique features of the targeted population

• Highly mobile• Always in some forms of conflict with

neighbouring communities.• High levels of poverty• Adverse weather conditions.• Vast geographical locations.• Poor or absent government infrastructures.

Program Goal

To increase the capacity of the health system, communities and partners to prevent HIV transmission and to provide high quality care and support services for people infected with HIV/AIDS in Turkana District.

Programming areas

• HIV prevention education services• Counselling and Testing• TB/HIV co-infection and STI control services • Blood and injection safety program• Prevention of Mother-to-Child Transmission

(PMTCT) services • Comprehensive HIV/AIDS care including ARV

provision• Home Based Care

Programming strategies – General

• Holistic approach

• Working through local partners and MOH

• Evidence–based approaches through regular assessments, KAP surveys and PRA

Programming strategies - prevention

• IRC BCC strategy

• “Families matter” approach for teenage children.

• HIV prevention activities targeting school and out-of school children.

Programming strategies - CT

Client Initiated Counselling and Testing (CICT)

– Facility –based CICT– Mobile VCT– Home-level VCT

Provider-Initiated Counselling and Testing

Programming strategies - PMTCT

• Integrated in to the routine ANC

• Utilizes the existing MOH protocols (Niverapine single therapy, dual therapy and triple therapy).

• Provision of infant feeding options.

Strategies – Comprehensive Clinical care

• Provision of Basic Care Package (BCP)

• Provision of ARVs

• Procurement and Installation of a CD4 machine to serve the entire district.

Selected results - PMTCT

2004 2005 2006

Women enrolled in ANC (1st consultation)

2,861 3,233 3,585

Number of pregnant women tested

3,867 3,762 3,585

Number of positive tests 60 49 18

HIV prevalence among ANC mothers

1.6% 1.3% 0.52%

VCT data (Jan – July 07)

Number of Persons Accessing Mobile VCTs

Percentage of VCT Clients Reached through Mobile VCTs

Lokichoggio 1,036 78.2% (1,036 of 1,324)

Kalokol 435 66.4% (435 of 655)

STI Cases and HIV Testing - Kakuma Camp Hospital

0

50

100

150

200

250

300

Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07

Month

# of

Per

sons Total STI Cases

STI Cases Tested for HIV

Number of Persons Enrolled in ART - Kakuma Refugee Camp

0

20

40

60

80

100

120

Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07

Month

# of

Per

sons

Conclusion

• It is possible to successfully implement a comprehensive HIV/AIDS programming among mobile and conflict affected populations.

• Need to use evidence-based approaches to yield better results.

• Benefits from partnerships with local organizations.

THANK YOU