Health at Home Joseph J. Mamlin, MD

Field Director/Co-founder, AMPATH

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

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

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

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.

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?

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)

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

Health at Home

The real work is just beginning!