HIV testing is an entry into further prevention interventions and into care and treatment.Evidence suggests that attainment of universal knowledge of correct HIV status and initiation of care and treatment for all those who are HIV infected could eliminate HIV. Linking HIV testing to treatment is primary to LVCT’s work. A three pronged approach to ensure that we link HIV infected individuals to HIV care and treatment programmes includes:

Direct HIV care and treatment services: A cohort of 17,000 HIV infected individuals is provided with HIV management including clinical evaluation, HIV prevention, diagnosis and treatment of opportunistic infections, TB screening, nutritional and psycho-social support as well as regular laboratory monitoring at no financial cost to the client. Of these, 7,200 have been initiated on anti-retroviral therapy (ART) who continuously access adherence counseling and supported disclosure where needed. Integrating reproductive health and HIV as an essential part of care has all clients of reproductive age being offered and provided with contraceptives. LVCT supports 17 facilities including all care and treatment services in the greater Kitui District, a site in Hurlingham in Nairobi, in the Riruta Health centre and family HIV treatment clinics in Nyanza and Embu. The quality of care is ensured through Early Warning Indicator (EWI) monitoring for HIV drug resistance according to WHO standards. LVCT ensures that patients are prescribed the correct ARVs, pick up the correct drugs in time (avoid defaulting) and are retained on the same first line treatment 12 months after initiating therapy. As a quality assurance measure including client feedback interviews are regularly carried out resukting in improved services at all LVCT sites.

Referral tracking for defaulter tracing aims to ensure that all static, home-based and provider initiated testing services attain 80% referral into treatment for those who are HIV infected. Retention rates of 80% have been achieved in the LVCT cohort through a robust and replicable referral and tracking strategy that; a) is anchored on the community based strategy of the GoK and utilizes community health workers to escort those who are tested positive into treatment facilities, index-client follow up for partner and family testing, follow up defaulters and facilitate psycho-social support at household level; b) utilizes mobile technology through bulk sms service and direct phone calls to trace defaulters and those who missed appointments c) relies on the cohesion of support groups to reach out to clients who default. LVCT Inter-departmental continuum of care monthly meetings assess uptake of referrals from testing points within our static, home-based and provider initiated testing services.

Health systems strengthening through laboratory networking for haematology and CD4 counts and quality control sample analysis and feedback, additional human resources, continuous clinical mentorship and medical education are part of LVCT support to decentralized levels (12 sub-district and health centre facilities). Over 15000 laboratory tests are done annually and 200 clinicians and nurses supported. Support supervision visits by clinical and laboratory staff ensure quality of care provided for HIV infected patients, timely requests and returns for drugs, laboratory reagents and commodities and appropriate reporting to the national government level and to LVCT partners. On-going policy engagement ensures effective implementation at local levels and feedback to the national level through active participation in ART policy formulation as members of the NASCOP ART taskforce, ART training, Nutrition/HIV, Nutrition/TB technical working groups, National Quality Assurance Team and Pillar 1 of KNASP III (health sector services/care and treatment sub-sector).