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Health at Home Joseph J. Mamlin, MD
Field Director/Co-founder, AMPATH
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Health at Home
• Began with home-based counseling and testing (HCT) focused predominantly on HIV with some malaria and TB screening
• After ~700,000 tested we decided we needed to improve our approach
• HCT was excellent at “finding” HIV but poor at linking those found into care
• Exposed a secret about preventing mother to child transmission of HIV
• Potential of the FLTR approach became clear
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FLTR
• Find every person with HIV in the community• Link every HIV-infected person into care • Treat the HIV (making the virus undetectable)• Retain in care to sustain viral suppression
If one can FLTR at a high rate one can lower the community viral load dramatically.
This in turn will decrease the incidence of new infections by >50% and essentially stop mother to child transmission---in other words bring the pandemic to its knees
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Health at HomeFinding everyone and rendering them non-contagious by lowering their viral load is now the hottest topic in HIV care worldwide.
It is now known as Treatment as Prevention
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The new Health at Home attack on HIV
• Changed from HCT to Perpetual HCT (PHCT) counselor who stays in the community and links what is found to care instead of moving on to other sites.
• PHCT counselors are now trained and assigned to a catchment of 2,000,000 persons. Retesting everyone every 2-3 years
• This is the world’s first attempt at Treatment as Prevention in a large at-risk population in a Ministry of Health (MOH) care system in sub-Saharan Africa.
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Health at Home has changed everything about AMPATH
• The health of the community is now the target (no more “silo medicine”)
• Finding disease early (in the home) rather than waiting for the sickest patients to come to clinic/hospital (no more “iceberg medicine”)
• If it works for HIV, why not FLTR other threats to health in the homes we serve?
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Three signature Health at Home initiatives
1. FLTR HIV for 2 million people within the AMPATH catchment
2. Layer (integrated into the FLTR catchment) on comprehensive Primary Health Care for >700,000 people (focus on Maternal Child Health - MCH)
3. For this same 700,000 population, layer on a comprehensive non-communicable chronic disease program (focus hypertension, diabetes, cancer, mental health and lung disease due to indoor air pollution)
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Now look what Health at Home has done to us!
• Kenya’s largest and most prominent Ministry of Health (MOH) program (AMPATH) has moved forever toward a home-based rather than clinic-based focus
• USAID has offered a five year non-competitive renewal of our PEPFAR grant
• We are shifting to a Kenyan prime (Kenyan ownership of program with USAID funds flowing directly into Kenya, not through a U.S. institution) with an eye toward long term sustainability
• AMPATH is emerging as the innovative engine of the MOH
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Health at Home
The real work is just beginning!