• It is a collaboration between KEMRI and the University if California in San Francisco (UCSF) and is funded through the US President€™s Emergency Plan for AIDS Relief (PEPFAR).  FACES-Nyanza started in March 2005 with the program in Kisumu and has since expanded to work in Suba district.  FACES is committed to providing high quality HIV care, treatment and support to HIV infected persons and their families.

The FACES family model of care focuses on concerted efforts to identify and enrol all HIV infected family members and to retain and support them in care.  The model includes: encouraging HIV testing of partners and children; assisting with disclosure to both adults and children; and joint family clinic appointments. The staff hold weekly team meetings to discuss the needs of particular patients and how families can be involved in care.  We facilitate a family support group, and also have a support group for pregnant women with HIV, and their husbands.  We are starting a "kids club" for children who are HIV infected and their siblings.  Family members often attend education sessions and clinic appointments, and are encouraged to be treatment buddies for patients on ARVs.  We are also piloting a "Family Empowerment" education curriculum which is designed to strengthen family support systems to improve the well being of patients.  Ongoing needs such as home-based care, nutritional support, and economic support including school fees are addressed through referrals to collaborating community-based organizations. 

FACES-Kisumu

The clinic in Kisumu is based at the Lumumba health center which is Kisumu€™s largest and busiest municipal health center. Services are provided free of charge to the general population. After our first year of operations we had enrolled 1700 people into care (170 children), with 480 on ARVs (20 children).

FACES-Suba

In partnership with the Kenyan government, FACES is coordinating facility-based HIV care and treatment for the district in an effort to create a functional model of decentralised HIV care.  This includes supporting programs at all of the government health facilities, as well as some of the islands that do not have health centers, through the use of stationary and mobile services.  We are also taking a lead in strengthening the collaborative efforts of community, government, and NGOs, in developing a unified HIV prevention and treatment program for the district.

Services offered at FACES

• Prevention, diagnosis and treatment of opportunistic infections
• Provision of antiretroviral therapy to both adults and children
• Laboratory investigations including CD4, liver and renal function tests, hematocrit, serum cryptococcal antigen, syphilis testing. Others include malaria smear, pregnancy testing and urinalysis
• Diagnostic counseling and testing- This is offered to family members of persons enrolled at the clinic
• Counseling- Patients and their families are prepared for ARVs via adherence counseling. Nutritional and psychosocial counseling is also offered at the clinic. Assisted disclosure is also available.

• Support groups- These groups meet regularly and are open to patients of FACES and their family members.  They serve as a forum for emotional and peer support.

• Peer educator network- FACES has involved peer volunteers who are involved in patient education and some counseling.  Sharing of testimonies has been encouraging to other patients. Peer volunteers will also be involved in tracing of patients who miss appointments.
• Antenatal women€™s support group- this group aims to offer peer support to expectant HIV infected women.  Education on infant feeding options and important considerations  during the peri-natal period is provided.

• Inpatient care
• Investigations- Patients are referred for all radiologic and some laboratory tests including HIV PCR for diagnosis of HIV in children. In Suba laboratory tests will be coordinated at a district level, whereby all sites refer samples to the district laboratory and receive results at their site.
• Home based care- Eligible patients are referred for home based care to collaborating CBOs.
• Nutritional support- We have very limited spaces for nutritional support through collaboration with CBOs.

 Education

FACES invests in education of its staff and patients and community.  This it does in the following ways:

• Weekly CME for FACES staff and peer educators
• Bi-monthly intensive CME for staff
• Daily HIV education for new patients
• Training in relevant fields for each department such as Rational use of ART, paediatric training, peer educator treatment literacy
• Clinical mentorship of FACES staff
• Clinical attachments of Ministry of Health employees
• Training from affiliated institutions such as ASPIRE from the University of California in San Francisco
• Electives: FACES has recently begun an electives program for medical students and residents from affiliated universities including the University of Nairobi, the University of California in San Francisco, and the University of British Columbia.

Youth HIV Service

Starting November 2005, FACES has collaborated with Tuungane (a youth organization that aims at promoting HIV prevention and improving uptake of VCT and STI services) in the provision of youth friendly and youth specific HIV services. Tuungane has one central clinic and 5 satellite sites that are open daily until 7:00 PM, where youth receive VCT and STI services, and participate in a variety of recreational activities. Approximately 400 youth visit the clinics every month.FACES and Tuungane have partnered to provide free, youth-specific HIV care services at Tuungane€™s central clinic, with FACES providing technical supervision, training, medications (including ARVs), and laboratory services.  As of March 2006, the number of youth enrolled in this program number 80 and those on antiretrovirals are 10.

Uliza! Clinicians€™ HIV Hotline

In April 2006, FACES launched a consultation service for HIV care providers.  Whenever health care workers have a question, they can call toll-free and discuss clinical issues with an HIV expert. During the pilot phase, HIV providers from selected clinics in Suba, Migori and Kisumu districts have access to the service. We hope to be able to expand the service to all of Nyanza after the pilot phase.

Progress, April 2006

• Increase the number of partners and children who are tested
• Decrease delays in initiating children on ARVs
• Integrate services with Lumumba Health Center's TB and antenatal clinic
• Increase Lumumba staff's capacity to provide HIV care
• Continue to expand youth HIV services in Kisumu
• Continue to strengthen collaborative links with Kisumu PSCs and CBOs
• Decentralize services to an addition MOH facility in Kisumu

• Increase the number of partners and children who are tested
• Decrease delays in initiating children on ARVs
• Strengthen the existing ART sites in the district
• Assist in the establishment of PSCs at every MOH facility in the district, down to the Health Center level (and including one dispensary)
• Support PSCs to expand services to include ARVs, through supervision, technical assistance, mentoring, training, and the use of mobile teams
• Put in place a specimen transport system so all patients in the district have access to CD4 testing and baseline bloodwork
• Strengthen the link between PSCs and CT services, TB services, antenatal services, and community services
• Continue to strengthen the collaborative effort of partners, government, and community
• Assist in the coordination of HIV services for the island/beach communities