Catherine Wawira, a clinician at the CHS supported Muumandu Health Facility in Machakos County, believes the reason a huge percentage of men living with HIV continue to record poor health outcomes is due to failure of involving them in identifying innovative solutions that address their barriers to adherence.
“Involving men in the identification of challenges and development of solutions that work for them is paramount in improving the uptake of prevention and treatment services among them,” she said. “We need to implement patient-centred solutions. This requires us to understand the patients’ needs before we rush into developing and implementing strategies.”
Since Wawira joined the facility in November 2017, the reduction in the number of men retained in care and the shooting viral load rates among men enrolled at the CCC concerned her. She had tried having longer counselling sessions and one on one discussions with them in a bid to identify the cause of their treatment failure and non-adherence, to no avail. “Something had to be done and I just wanted to come up with an innovative way to address this issue,” said Wawira.
Viral load refers to the amount of HIV virus in the blood of a HIV positive individual. A high viral load in a person on treatment indicates either that the medication is not being taken properly, or that the virus is becoming resistant to the medication. Causes of a high viral load should be identified and addressed immediately in order to protect the patients’ immune system and help reduce the risk of transmission of HIV to others this was, however, proving to be an uphill task for Wawira and health care workers serving at the CCC in the facility.
As is routine every morning, a peer educator and a health care worker hold treatment literacy sessions at the waiting bay, as patients await their turn to see the clinician for their monthly appointments. During these sessions, the patients raise and discuss issues they face in their treatment journey and share their experiences for psychosocial support.
It was during one of those sessions that an idea hit her after observing how men were interacting among themselves. “Men were usually very reserved during the treatment literacy sessions they barely spoke and always seemed disengaged however, as soon the meeting ends you would see them having discussions by themselves,” remembered Wawira.
After extensive conversations with the CHS technical team and patients during their routine appointments, she decided to set aside a clinic day dedicated to men only with the aim of empowering men to take charge of their health outcomes as well as create a safe space for them to openly discuss the issues they experience during their treatment journey.
The men only clinic kicked off in February 2019. Before the one on one monthly appointment with the clinician, the men together with the health care workers discuss various health topics and openly ask questions.
They have a schedule of topics to discuss during each of their meetings which take place the third week of every month. The men are further encouraged to bring a friend to the clinic this includes the known positives and those who do not know their status for services such as HIV testing and counselling, screening for sexually transmitted infections and tuberculosis.
“Although the men only clinic days have just been going on for a few months there has been a change in appointment keeping, very few men are missing their monthly appointments, we are really looking forward to carrying out the routine viral load test after six months,” said Wawira. The men are very keen to identify their peers who miss their appointments and even conduct home visits.
In a bid to bring their peers back to care, they identify barriers to adherence among themselves and report these to the clinician who is then able to provide targeted clinical support such as counselling, information and referrals where necessary. These clinic day meetings have helped Wawira identify reasons behind men’s reluctance to access health care services including psychosocial, economic and infrastructural issues.
CHS is committed towards the development and implementation of innovative patient-centered approaches towards ensuring patients receive quality health services taking into consideration that patients have a variety of needs.
With support from US President’s Emergency Fund for AIDS Relief (PEPFAR) through the US Centers for Disease Control and Prevention (CDC) CHS trains and builds the capacity of its staff to identify and develop innovative solutions and has implemented the use of the men only clinic concept across various supported facilities in Lower Eastern (Machakos, Makueni and Kitui) through its NAISHI project and in Siaya County through the Shinda Project.