In Kenya, the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai focuses on adolescent health, particularly youth with HIV/AIDS. We work as a member of the Academic Model Providing Access to Healthcare (AMPATH) Consortium. The Consortium is a partnership among Moi University, Moi Teaching and Referral Hospital, North American universities, and the Kenyan Government, to perform research and help operate the Rafiki Center for Excellence in Adolescent Health, in the town of Eldoret as well as in smaller clinics in more rural areas.
AMPATH aims to foster long-term, equitable partnerships with health centers and universities in low-income countries. Each institution brings their own perspective and provides opportunities for medical trainee exchange programs and hands-on education, both in Kenya and North America.
The AMPATH-Mount Sinai working group continues to focus on expanding Mount Sinai engagement in the AMPATH Consortium. Current members include faculty from the Departments of Health System Design and Global Health, Pediatrics, Medical Education, Internal Medicine (Palliative Care), and Population Health, with expertise in adolescent medicine, infectious diseases, and health services research.
We serve as the lead for adolescent medicine within the AMPATH Consortium in Kenya. As such, we strive to advance care, research, and training opportunities focused on adolescent health in western Kenya. Mount Sinai convenes an AMPATH Adolescent Medicine Interest Group and collaborates closely with Kenyan pediatricians to improve the health of adolescents in Kenya.
The Moi Teaching and Referral Hospital Rafiki Center is a combined adolescent medicine, adolescent HIV care and research clinic. It provides services for high-risk adolescents with an emphasis on street-connected children and youth. This ‘one stop shop’ for adolescents offers reproductive health, mental health, management of chronic diseases, HIV prevention and treatment services, and life skills training for nearly 1,400 adolescents in Eldoret. The newly renovated facility also serves as a training center for future OB/GYNS, pediatricians, nurses, social workers and counselors focused on adolescent-friendly care. AMPATH also serves more than 5,000 adolescents living with HIV across their large HIV clinical system in western Kenya.
Research
Our implementation research in Kenya focuses on improving health care services, particularly for children and adolescents living with HIV. We operate out of the Rafiki Center for Excellence in Adolescent Health in Eldoret. Our goal is to help children, adolescents and their families sustain successful HIV treatment for their entire lives. Our work falls within four key areas: medication adherence and viral suppression, adolescent health challenges, HIV/AIDS stigma, and mobile education and peer support.
We have several areas of focus:
Maintaining Medication Adherence and Viral Suppression: With medicines to keep HIV suppressed, children can live–and thrive–with HIV, all the way into adulthood. This requires that children and adolescents have excellent adherence to their therapy, meaning that they take HIV medicines almost perfectly, every day, and that they remain engaged in health care. It also requires that their HIV virus does not become resistant to their medicine options. Our team has pioneered global research in understanding the challenges families are having with children’s adherence to HIV medicines, detecting problems with adherence, knowing how drug resistance evolves and can be prevented, and testing strategies to provide counseling and peer support to improve adherence in settings like Kenya, including via mobile health monitoring.
Tackling Adolescents’ Health Challenges: HIV is still the leading cause of death for adolescents in Sub-Saharan Africa. Adolescents growing up with HIV face a host of challenges. They are coming to understand that if HIV is part of their life story, they must cope with HIV stigma throughout their community, and they may face both mental health and physical health issues. Our research includes understanding the social determinants shaping adolescents’ health, evaluating novel care models to connect adolescents to HIV care services focused on their specific needs, and generating evidence for offering mental health care and support to adolescents in Kenya. We also lead a global research cohort that follows adolescents living with HIV from across more than 40 countries to assess their physical, mental, social, and emotional challenges and health.
Addressing HIV/AIDS Stigma in Schools and Communities: Even in places where many people are living with HIV, stigma still leads to discrimination and fear. One of our efforts to combat HIV/AIDS stigma resulted in creating short films in collaboration with film and media students and faculty at Moi University. These films show the stories of adolescents coping with HIV stigma in their homes, neighborhoods, churches, and schools. They have been featured at international film festivals and used in communities to try to reframe how people respond to those living with HIV. Knowing that children and adolescents spend much of their time in schools, we partnered with HIV and education experts across Kenya to develop a novel, multi-media teacher training module to help Kenyan teachers better understand HIV and avoid encouraging or introducing stigma into their teaching. Ongoing research is evaluating the effectiveness of this approach through interviews with teachers, education officials, and students.
Mobile Education and Peer Support: Our research shows that many adolescents living with HIV feel alone and wrestle with isolation, depression, and coping with trauma and stigma. To respond to these needs, we are championing training and funding for peer support and mental health within the AMPATH clinics. We have also developed various mobile mental health monitoring and support interventions for adolescents, with a focus on delivering counseling, education and peer support across virtual platforms. In rural settings and places with few trained mental health professionals, mobile and telehealth options are urgently needed. For example, one of our studies uses text messaging within anonymous groups to check in with adolescents, offer regularly scheduled education sessions, maintain a structured group chat for peer support, and deliver one-on-one counseling via phone. Participating youth receive phones so they can join without economic stumbling blocks.
Education
Working with AMPATH, we are helping to train the next generation of health care workers, both in Kenya and the United States. Our physicians provide one-on-one mentorship of trainees and junior faculty in clinical research in both Kenya and the United States. This includes year-long opportunities such as the Fogarty Scholar awards, and other supervised research internships.
In addition, we bring students together for medical education. Under this program, more than 2,200 Kenyan and North American students and residents have trained alongside each other in Kenya, the United States, and Canada, with more joining every year. The Icahn School of Medicine at Mount Sinai hosts Kenyan medical students as part of this consortium, and Mount Sinai pediatric residents have also joined this exchange.
The North American-Kenyan partnership enables AMPATH Consortium students and residents to take one- to two-month electives in Eldoret under the supervision of the AMPATH Consortium team leaders. While at Moi University, the residents are responsible for patient care, teaching, research and public health activities in the Moi Teaching and Referral Hospital and urban and rural health centers. To promote bilateral exchange, the AMPATH Consortium, including Mount Sinai, provides full scholarship support each year for selected MUSM students to participate in six- to eight-week electives in North America.