After a fortnight of political violence during which an estimated 250,000 Kenyans were displaced, health workers are scrambling to ensure that HIV-positive people on life-prolonging anti-retroviral (ARV) therapy continue to receive their drugs and adequate food supplies.
"As of last week, only about 5 percent of our patients on ARVs had reported to refill their ARV prescriptions," Sylvester Kimaiyo, programme manager of the Rift Valley-based Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH), told IRIN/PlusNews. "We have 58,000 HIV-positive people under our care, 24,000 of whom are on ARVs."
Kimaiyo said AMPATH's 19 sites across the northern Rift Valley, Western and Nyanza provinces usually gave patients one month's supply of drugs, but habitually also a few days' extra in case patients failed to make it to the dispensaries in time.
"However, staff at our sites say many patients who have begun to report this week had missed some days of their medication," he said, noting that the Burnt Forest and Eldoret areas of the Rift Valley had been worst affected.
Interruption of ARV therapy risks patients developing resistance to the drugs. According to the UN World Health Organization, "The consequences of drug resistance include treatment failure, increased direct and indirect health costs associated with the need to start more costly second-line treatment for patients, the spread of resistant strains of HIV and the need to develop new anti-HIV drugs."
As tentative calm returns to the country, patients have begun making their way to the sites, Kimaiyo said, and by 15 January, only patients in IDP camps had not reported.
"We have sent our staff into the camps in the Rift Valley and they are tracing patients and delivering drugs to them," he added. "And for those patients able to make it to our clinics, we are providing food supplies from our stores, whether or not they were receiving food before the election."
In Nyanza Province, the Ministry of Health's provincial ART coordinator, Lennah Nyabiage, said it had been difficult to gauge the situation because the local population was extremely hostile to the government and its officials.
Nyanza, with an HIV prevalence rate of 12 percent, has an estimated 45,000 people on ARV treatment. Home to Raila Odinga, the opposition candidate contesting President Mwai Kibaki's December election victory, it has witnessed some of the worst violence in the country.
"Our officials have reported being harassed when they show up in GoK [Government of Kenya] vehicles and they are too scared to go to many areas because they are known to work for the government," she told IRIN/PlusNews. "I am in touch with our people at government hospitals, and they are reporting that most people have not run out of drugs yet."
She said her office was working with the local police to ensure that people were aware they could get treatment from any health centre, even if it was not their regular one, as long as they provided medical records that showed they were on ARVs. The ministry has also placed notices in national newspapers advising people on ARVs and tuberculosis medication to report to their nearest health centre for free treatment.
Seeking out missing patients
Across the country, NGOs are developing new ways to trace patients. The international medical charity, Médecins Sans Frontières (MSF), is setting up a toll-free national hotline, due to begin on 21 January.
"The hotline will run for six weeks and will be advertised in the national English and Kiswahili newspapers," said MSF's Anouk Delafortrie, who is coordinating the project. "We are asking patients to call for advice about the closest centre if they have had to relocate, and letting them know what their options are if they are no longer near an MSF health facility."
MSF has three centres in Nairobi's Kibera slum, scene of much of the violence, as well as a TB clinic in the city's Mathare slum and HIV projects in the western Kenyan towns of Homa Bay and Busia; the organisation has 12,000 patients on HIV treatment and care.
"When the unrest broke out after the election, many of our patients were displaced, so we have set up this mobile clinic in Jamhuri Park [in Nairobi, where 2,400 IDPs are living] to try and trace them and alert them to our presence - since we have been here, about 50 of our own patients have come to refill their ARV prescriptions," said Mohamed Hamid, coordinator of the mobile clinic. "We are not turning away patients from other health providers - if they have their medical records with them then we are providing them with drugs."
The Ministry of Health and several other health NGOs have also set up satellite centres at Jamhuri Park and in IDP camps in the Rift Valley to trace their patients, with particular emphasis on tracing those on ARVs and TB medication.
Uganda's New Vision Newspaper has reported that HIV-positive Kenyan refugees fleeing across the border will be able to get ARVs at camps through local NGOs.
Health workers have commended the speed with which emergency mechanisms have kicked in to locate patients nationally and keep them on their medication, but have also warned that only time will reveal the impact of interrupted treatment on thousands of patients across the country. More than 160,000 Kenyans receive free government ARVs.