Viremia Clinics in Kenya: Enhanced Monitoring and Management of HIV-Positive Individuals on ART with High Viral Load

Description/Activities:  The clinic date is established after identifying a day when the clinic has a lower patient volume. Patients with viremia are typically booked in the morning and follow a structured patient flow. Clinics begin with group education on common factors that contribute to viremia, and possible solutions to address these factors.  Patients also receive 1:1 counseling using the nationally developed adherence tools.  During these sessions, patients work jointly with the adherence counselors to identify barriers and potential solutions to adherence.   In between clinic visits, peer educators provide multiple support functions, such as serving as case managers, conducting home visits to enhance support, identifying other factors that could contribute to ART non-adherence, and managing missed appointments. All patients receive one home visit after their first viremia clinic visit. 

What Makes the Intervention Unique/Different:   Held at least one day a month, the viremia clinic utilizes a multidisciplinary team (MDT) model and focuses on enhanced case-management and a patient-centered approach. This model is aimed at identifying patient-specific adherence barriers and tailoring interventions to address the patients’ specific needs.  Patients are empowered to make joint decisions with their providers to improve their ART adherence. The viremia clinic model is easy to introduce to all existing HIV clinics, and requires no significant extra resources.

Impact Data:  Preliminary data show an improvement in the proportion of PLHIV who received enhanced adherence counseling (EAC) sessions, repeat VL testing, and initiate second-line ART. Ongoing implementation of the viremia clinic model with goals of improved EAC and monitoring of the program will hopefully show subsequent improvements in re-suppression rates in individuals with initial high VL.