In Kenya, significant strides have been made in the HIV response, leading to reductions in both prevalence and mortality rates. With greater access to HIV testing services and optimized HIV treatment regimens, people living with HIV are living longer.
However, as they age, people living with HIV face increased risk of developing noncommunicable diseases (NCDs), including diabetes, hypertension, and other cardiovascular diseases, and can be more likely to experience mental health conditions.
According to the Kenya AIDS Strategic Framework (2020–2025), more than 1.5 million people are living with HIV in Kenya, with further studies indicating that approximately 62% are living with both HIV and at least one NCD (compared to 51% of people without HIV). The rising prevalence of NCDs threatens to undermine longevity outcomes among people living with HIV, as well as progress made in managing HIV.
This is not any different for 73-year-old Jane* (name has been changed for privacy) who lives in Nyamira County, Kenya. Jane is a farmer and mother to seven children. She was initiated on HIV treatment 16 years ago, and at the time, had just lost her husband due to an HIV-related illness. "When I found out I had HIV, I was in shock. I spent most of my time worrying about my children and their future. I feared I would die too," she recalls.
By continuing her HIV treatment at her local health facility, Jane has been able to successfully manage her health and maintain a suppressed viral load for many years. However, two months ago, she encountered a new health challenge when she was diagnosed with type 2 diabetes.
This condition, caused by elevated blood sugar levels, can result in serious complications, including heart disease, stroke, kidney damage, and nerve issues. “I always felt tired and could not feel my legs. Also, I visited the washroom very often and I was always thirsty. I knew something was wrong, so I went back to the hospital,” she recalled.
During her next clinical check-in at the hospital, the health care provider suspected Jane could be diabetic. The provider followed up with a thorough assessment, confirming a diagnosis of type 2 diabetes, and started Jane on medication to manage her diabetes.
“At the hospital, I received a lot of education and support. Now, I know I should eat healthy, avoid certain foods, and take a walk in the evenings. My family bought a glucometer to help me check my sugar levels. My health has improved.”— Jane
Advancing integrated person-centered HIV-NCD care
Siloing of HIV and other health services has led to fragmented health care delivery that does not fully account for the diversity of health and wellness needs people experience throughout their life course.
Integrated person-centered delivery models offers an efficient solution that facilitates provision of higher quality and holistic health care while addressing service access and utilization barriers.
PATH has been pioneering the advancement of integrated HIV-NCD delivery models across Africa and Asia, ranging from providing NCD screening and referrals for care during clinic visits for people living with HIV to equipping community health workers to conduct household-based HIV-NCD screening and offering NCD screening, diagnosis, and care services at private and/or community-based one-stop shop clinics.
This integrated approach improves quality of life, reduces the burden of disease, and lowers the risk of morbidity from NCDs among people living with HIV. Integrating HIV-NCD care also reduces out-of-pocket costs, which are often catastrophic for people living with NCDs in lower-and-middle income countries.
Through the United States Agency for International Development Nuru Ya Mtoto project, PATH Kenya works closely with the Ministry of Health in Kakamega, Vihiga, Nyamira, and Kisumu counties to promote a comprehensive care model that enables access to high-quality and holistic care services for the more than 92,500 people living with HIV supported by the project.
This model integrates routine NCD screening (hypertension, diabetes, cervical cancer, mental health conditions [including alcohol and substance abuse]) into regular HIV clinical check-ups at project-supported health facilities. By doing so, it minimizes the need for multiple clinic visits, streamlines care delivery for both clients and providers, mitigates stigma and discrimination-related concerns, and enables earlier diagnosis and treatment of NCDs, thus preventing complications and facilitating improved health outcomes for people living with HIV and NCDs.
PATH Kenya also worked with the Ministry of Health to integrate NCD care into differentiated HIV care models, enabling eligible clients to opt into receiving care, refills, and peer support through community groups with quarterly clinic check-ins at health facilities.
To date, the project has screened more than 83,010 and 21,990 people living with HIV for hypertension and diabetes, respectively, with 8,020 people living with HIV and hypertension and 758 people living with HIV and diabetes receiving affordable care to manage both HIV and NCDs.
A provider at a USAID Nuru Ya Mtoto supported facility in western Kenya uses a blood glucose meter to measure a client’s blood sugar level. Photo: PATH/Denise Akun.
While people living with HIV in Kenya can access free HIV treatment, covering the cost of medication for managing NCDs, like diabetes, remains a challenge for most people. To ensure uptake and continuity of holistic HIV-NCD care, USAID Nuru Ya Mtoto encourages people living with HIV to register for Kenya’s Social Health Insurance Fund, a government initiative enabling people to access a wide range of health care services, including outpatient and inpatient care, and treatment for chronic conditions, such as diabetes and HIV, in an affordable way in support of universal health coverage.
Damaris Riechi, a health care provider at Nyamira’s County Referral Hospital supporting people living with HIV, is among the 404 clinical providers trained on HIV-NCD care management by the USAID Nuru Ya Mtoto project.
Equipped with training, essential equipment (such as glucometers and blood pressure monitors), and job aids and tools to provide and monitor care provision, she offers NCD screening and care during routine HIV clinical visits at project-supported health facilities. “We started integrating NCD services in our health facility in 2022. Since then, our patients have been benefiting from this one-stop service," Damaris notes.
“We are able to screen and treat multiple conditions, including NCDs, all from the Comprehensive Care Centre. Based on [screening] results, we support them to manage their health, ensuring they continue to live a healthy life.”— Damaris Riechi, health care provider
