Tobias Oloo

Julius Okinyi

"PEPFAR gives quality assurance"

PEPFAR Kenya gives hope and quality assurance through....

strengthening whole health systems

As PEPFAR celebrates 20 years in Kenya, we are proud of the achievements and measures that have been put in place to assure high quality HIV testing and linkage to comprehensive care clinics, where patients are quickly initiated on antiretroviral therapy and monitored for viral suppression. PEPFAR has strengthened TB/HIV laboratory service at all levels of health facilities. By leveraging the existing integrated specimen referral network, PEPFAR is helping provide effective, efficient, accessible, equitable, and affordable TB/HIV lab services to ensure that HIV/TB patients and their healthcare providers have increased access to timely viral load information to support follow-up care.

PARTS OF A WHOLE

An integrated sample referral system relies on a three-part system:  a spoke, hub, and reference testing laboratory. Samples are collected from various locations, or “spokes,” and then transported to a “hub” lab for processing and short-term storage, and finally transferred to the reference lab for testing. Then the results are returned to the patients. Samples are transported to the hubs through motorcycle riders like Julius, who has done this important work for the last 14 years.  All health workers within the chain – from staff at the ‘spoke’ collection points, to sample riders, to ‘hub’ laboratory staff – are trained on ethics, biosafety, biosecurity, and approved standard operating procedures (SOPs), which include specimen request forms, manifests, and tracking logs. When samples reach the hub lab, they are processed and then transported to Kenya Medical Research Institute – Center for Global Health Research (KEMRI-CGHR) Laboratory, in Kisumu, where they are then tested by molecular laboratory scientists like Tobias.

JULIUS

Julius Okinyi has worked for different PEPFAR-funded programs since 2009 as a sample rider, he and has attended a number of trainings to enable him to do his important work with safety and accuracy - including biosafety and biosecurity training. The specimen chain of custody ensures that all the specimens collected by sample riders like Julius are properly handled and tracked from the spoke to the hub and on to the testing laboratory.

Julius has always enjoyed driving bodas (motorcycles), but he is particularly proud that he has been able to provide for his family through meaningful work that helps others. “On a personal level, working with PEPFAR over the last 14 years has also built me up and enabled me to succeed in various aspects of my life,” he reflects.” I have been able to educate all my children and I have bought a plot and built a home; this has uplifted me and my family.’’

Through the role of sample riders like Julius, scientists like Tobias are able to receive specimens transported quickly and with proper cold chain and handling, and as a result, people can get reliable test results in a safe, timely manner – enabling them to make informed decisions for their health and life.

TOBIAS

Providing high-quality laboratory services is a critical component of the PEPFAR HIV service delivery program. For over a decade, Tobias Oloo has been on the front line, every day, providing lifesaving diagnostic services for people living with HIV (PLHIV). He is a dedicated clinical laboratory scientist who oversees the PEPFAR-supported HIV viral load and early infant diagnosis molecular laboratory within KEMRI-CGHR. Tobias and has also provided mentorship and training in other PEPFAR-supported HIV laboratories, helping to strengthen technical capacity throughout Kenya.

The laboratory services provided by KEMRI-CGHR and all PEPFAR-supported facilities are critical in determining if PLHIV are receiving the appropriate antiretroviral therapy and have a suppressed HIV viral load. Undetectable viral load means that the person cannot transmit HIV infection to others. Laboratory testing is also needed to determine the HIV status of children born to mothers infected with HIV. Each year, PEPFAR, in collaboration with Kenya’s Ministry of Health (MOH), supports over 1 million HIV viral load (VL) tests and 80,000 early infant diagnosis (EID) tests across Kenya. In 2022 alone, KEMRI-CGHR was able to perform over 150,000 HIV VL tests and nearly 14,000 HIV EID tests.

“Through PEPFAR's support in the last 20 years, people living with HIV are assured of quality HIV care and quality of life,” Tobias notes with pride. “Now that we are talking sustainability and ownership, we are hoping that the national and county government will be able to maintain the gains in HIV/TB.”

A STRONGER WHOLE

Through our partnership, each part of the sample referral and testing system in Kenya has been strengthened – from spoke collection points, to transport, to hub laboratories, to reference laboratories.

Thanks to PEPFAR support, Ministry of Health laboratories throughout Kenya are well equipped with state of the art, high throughput molecular platforms, safety equipment and other essential instruments needed to conduct testing safely and accurately. This investment enabled Kenya to rapidly introduce SAR COV 2 testing during the recent COVID-19 pandemic.

In addition to the HIV viral load and early infant diagnosis services, PEPFAR also supports numerous surveillance activities that leverage the KEMRI-CGHR HIV molecular laboratory. Examples include HIV mortality surveillance and evaluation of novel laboratory testing methods that may be used postmortem, studies to help identify recent HIV infections within well-defined patient populations, and activities with focus on comorbidities such as HIV and COVID-19.

Moreover, the majority of hub labs in Kenya now implement laboratory quality management systems (QMS), and most have acquired and sustained the ISO 15189 accreditation. All health care providers are trained on standard laboratory procedures, registers and tracking logs, quality assurance standards for specimen handling, testing and storage, and biosafety and biosecurity.

“PEPFAR supported this whole infrastructure,” notes Kimberly McCarthy, Senior TB/HIV Laboratory Technical Advisor for CDC, Western Kenya. “PEPFAR not only invests in the health system infrastructure and equipment, but also in building local capacity.” This includes human resource capacity, such as laboratory scientists like Tobias and sample riders like Julius. By strengthening different parts of the sample referral system, with differentiated and targeted support across the spectrum, PEPFAR has played a pivotal role in strengthening whole health systems in Kenya. As the laboratory scientists at KEMRI-CGHR have seen, PEPFAR's unwavering support and dedication have saved lives and bolstered Kenya's resilience in the fight against HIV/AIDS, leaving a lasting impact on the country's public health landscape.