Building Healthcare Capacity for Patients in Africa: AMPATH

An important step to enhance global healthcare goals is to strengthen local health systems by equipping local institutions with skilled health workers and critical resources.

To do this, since 1989, Moi University School of Medicine and Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, and a consortium of North American academic health centers led by Indiana University have worked together to deliver health services, conduct health research, and develop leaders in healthcare for both North America and Africa. The institutional partners are collectively named the Academic Model Providing Access to Healthcare (AMPATH). In 2001, in the face of the deadliest pandemic in human history, the partners joined forces to create one of Africa’s largest, most comprehensive and effective HIV/AIDS control systems. Today, in partnership with the Kenyan Ministry of Health and the United States government, AMPATH is expanding from an HIV focus to address the critical needs for primary healthcare, chronic disease care, and specialty care, including cancer. Celgene joined the collaboration in 2011 and has been working to increase access to oncology diagnosis and treatment services for low-income populations in Kenya.

Oncology Update

Celgene’s support, along with that of other partners, has allowed a dramatic expansion of services through the AMPATH-Oncology Institute (AOI). This effort is focused on developing a sustainable and comprehensive academic clinical care cancer program serving the 20 million citizens of western Kenya and neighboring areas.

AMPATH

  • Each year, the AOI receives nearly 20,000 patient visits, treats 8,000 and screens 20,000 – 30,000 women for breast and cervical cancers. To date, more than 120,0004 women have been screened for these two cancers.
  • Celgene’s support of the AOI has helped create a successful multiple myeloma program, the first and only in Kenya. We have extended the program to 16 outreach sites, increasing diagnosis from five new patients per year in 2010 to 60 per year in 2017. The partnership provides MM education to healthcare providers, patients and communities.
  • Recognizing that capacity building is important in cancer care in Kenya at all levels, Celgene provided funding for the Higher National Diploma (HND) in Medical Oncology for Clinical Officers, which was established in 2012 in conjunction with MTRH. Celgene’s support enabled the school to hold stakeholder meetings, develop the training curriculum, help assess the trainees, and develop training manuals and programs.
  • More than 40 Clinical Officers have been trained through the 18-month HND program, and three classes have graduated so far. In 2018, the program received more than 50 applications for the September class, which is limited to 12 trainees per year.
  • Celgene’s funding has enabled the AOI to develop and adopt much-needed oncology nursing and physician assistant oncology training.
  • Celgene support allowed the AOI to develop a Research and Care Laboratory and to purchase supportive care drugs required in oncology.

Pharmacy Update

Through Celgene’s continued support, MTRH has been established as a Center for Clinical Pharmacy Excellence. This is the first institution in Kenya to make a firm, demonstrable commitment to advancing patient outcomes through a more clinically focused pharmacy practice.

In 2017, Celgene’s support helped MTRH’s anticoagulation clinic make great strides in advancing anticoagulation care for patients with venous thromboembolism.

  • The clinic has become one of the largest providers of anticoagulation services in sub-Saharan Africa, having served 2,760 patients and more than 1,800 active patients.
  • The partnership has also extended anticoagulation care to 2,400 patients, developed a tablet-based electronic medical record system, and implemented biopharmaceutical supply chain and inventory control mechanisms, among other programs.

    AMPATH recently introduced its novel Peer Educator Program in rural western Kenya to improve outcomes for patients suffering from chronic diseases, with a focus on higher-risk illnesses like HIV. The program delivers disease and disclosure counseling, medication adherence counseling, and psychosocial support to people living with chronic diseases, with the goal of improving engagement in care.

  • In the outpatient HIV setting, the Peer Educators have become an essential component of the care process for over 200 ever-enrolled patients in a novel HIV Resistance Clinic, which serves patients who are on the last line of HIV treatment. In the inpatient setting, peer educators identify HIV patients, provide counseling, and ensure post-discharge linkage to care.
  • From April 2017 to May 2018, 1,222 people living with HIV were admitted to the adult internal medicine wards. The peers interacted with 80 percent of these patients, providing 2,422 counseling sessions and 520 medication refills.

Support for Provider Education

Celgene’s support has also contributed to the growth of the various clinical pharmacy training programs at Moi University and MTRH (post-graduate diploma in Clinical Pharmacy, and Master’s in Clinical Pharmacy), and AMPATH is now responsible for a large number of trainees seeking advanced education.

Given the success of the program, the government continues to seek training of additional pharmacists across the country to help further promote the transition to a more clinically oriented practice. Celgene’s initial funding for this initiative helped seed the numerous training programs that are now funded and supported by MTRH and Moi University.