1. ADVANCING HIV NURSING PRACTICE IN THE COMMUNITY
Presented by
Lynette Kosgei,
NIMART Nurse,
Asayi Dispensary, Kenya

2. BACKGROUND INFORMATION
Asayi Dispensary is located in a rural part of Kenya in Gem Sub-county, Siaya County
Asayi Dispensary became operational in 2008 with one nurse. In 2014, another nurse was posted to the dispensary
Current Staff: 2 nurses
1 peer educator
1 HTC counselor
1 volunteer

3. MAP OF GEM SUB-COUNTY

4. DEMOGRAPHIC PROFILE CATCHMENT POPULATION – 5,061 Male - 2,383
Female – 2,623
Under-one year – 170
Under-five years – 840
Adolescents – 2,253
Women of child bearing age – 1,136

5. SERVICES OFFERED
The facility under management of two nurses offers the following services:
HIV care and treatment
HIV testing services (HTS)
TB treatment
PMTCT services
Maternity services
Cervical cancer screening
Voluntary male circumcision
General out-patient curative services
Maternal child health and family planning

6. HIV CARE AND TREATMENT SERVICES
HIV services started in 2009 with HIV infected pregnant women receiving CTX and single dose NVP and syrup for the baby
Other HIV-infected patients were referred for care to higher-level facilities. There was a high defaulter rate due to the distance and funds to facilitate the clients travel to the linked facility
– the dispensary started offering HTS and HIV positive clients were enrolled into care, done initial assessment, WHO staging, collect samples for baseline assessment and send to central lab
Clients in stages 3 and 4 and those with CD4 <350 were booked for initiation on ART by a roving clinician every Wednesday

7. HIV CARE AND TREATMENT SERVICES
Clients would wait for long leading to defaulting, stigma and discrimination e.g. clients were nicknamed “members of Anglican church waiting for their pastor’’

8. Nurse Initiated Management of antiretroviral Treatment (NIMART)
In 2014, ICAP introduced NIMART and I was trained as one of the trainers of the National Integrated HIV curriculum.
Our role was to continue initiating and managing ART at our facilities as well as train other nurses through the facility based integrated HIV curriculum training
Training involves self learning, group discussions and clinical sessions and assessments

9. NIMART
After my training, I have trained and mentored 7 nurses: 1 from our facility and 6 from neighboring facilities. All are competently offering HIV services in their facility
Asayi Dispensary is a centre of excellence for mentoring the nurses from neighboring facilities
Continuous mentorship and support is constantly provided by ICAP general nursing capacity building and HIV program personnel to ensure provision of high quality HIV services to our clients

10. NIMART Integrated model of care
All outpatient clients undergo HTC and the HIV-infected clients are linked to care immediately
All adults and children eligible for ART are initiated as per national guidelines
ART for all HIV pregnant and lactating women
(Option B+)
Follow up visits, community linkage to enhance adherence
Routine viral load to monitor viral suppression
Routine screening of clients for TB and other opportunistic infections
IPT for eligible HIV infected clients

11. Facility Data on Clients Initiated on ART at Asayi Dispensary (2012 – 2016)

12. Thank you
Lynette Kosgei