Site Contact: Cynthia Binanay
Site Specialties: Cardiology, lung disease, ID, maternal-child health, ethics and policy
- The Moi U. Schools of Medicine (MUSOM) and Public Health (MUSPH) are part of Moi University, and host many trainees from overseas and from within Kenya at any given time.
- 14 Faculties, Schools and Institutes on three campuses in Eldoret. The medical campus includes schools of Medicine, Nursing, Public Health, and Environmental Health. MUSOM contains 24 departments, more than 150 teaching and academic faculty members, 400 medical students, and a problem-based curriculum focusing on the needs of urban and rural communities.
- Academic Model Providing Access To Healthcare (AMPATH) is a network of district hospitals and rural health centers joined with MU and Moi Teaching & Referral Hospital. AMPATH is the largest HIV/AIDS care program in Kenya and one of the largest in all of sub-Saharan Africa.
- AMPATH researchers have published > 160 articles and attracted > $59 million in cumulative funding for AMPATH-related research projects from NIH, Gates Foundation, and other sources.
- To date, ≈100,000 patients have been enrolled in AMPATH and >55,000 are currently receiving care, 33,000 of whom are eligible for and are receiving antiretroviral drugs (ARVs). Duke (as well as Cornell and Vanderbilt) work closely with Indiana U. through the IeDEA network, through which these data can be accessed. Although originally developed to address the HIV epidemic, the program can be expanded to include non-communicable chronic diseases and primary care, including maternal/child health, hypertension, diabetes care, and mental health. Duke is the AMPATH Consortium developed-country partner leading NHLBI CVPD Center of Excellence research/care activities.
- AMPATH Medical Record System (AMRS) which has been made available to the world as OpenMRS: an open-source electronic medical record (EMR). From its beginnings in AMPATH in 2001, OpenMRS is now the most widely used EMR in the developing world, implemented in more than two dozen countries in sub-Saharan Africa, Central-South America, and elsewhere.
- Local laboratory resources available at MTRH and its outpatient clinics include clinical and reference laboratories and radiology facilities. The Cardiac Diagnostic Laboratory contains two electrocardiography machines an echocardiography machine, and an Echo/ECG treadmill. Duke has donated a mobile cardiac catheterization lab to Moi; efforts are underway to build the necessary care platform, including a 6-bed monitored cardiac care unit, to provide safe and effective pre- and post-procedure care. The Pulmonary Diagnostic Laboratory has spirometry, oximetry, and arterial blood gas capabilities. Chest CT scanning is also available through the MTRH Radiology Department, and bronchoscopy and bronchoalveolar lavage can be performed at the MTRH Procedure Suite.
- The AMPATH CVPD COE has already organized an administrative core for CVPD clinical care, training, and research with a senior US cardiologist on location most of the year;
- We have developed and are implementing a competency-based clinical training curriculum;
- We have establish a clinical research training program for foreign trainees that includes a nine month individually mentored (by Duke faculty) on- line clinical research program
- We are enhancing the existing data management and laboratory infrastructure for CVPD; and
- We are actively conducting numerous research programs to address prevalence, prevention, and treatment.
- The Moi Schools of Medicine and Public Health (MUSPH) are part of Moi University, a large liberal arts university established in 1984 by the Kenyan Government. Located in Eldoret, Kenya’s fifth largest city (population 450,000), 200 miles northwest of Nairobi in the Rift Valley Province, MU has 14 Faculties, Schools and Institutes on three campuses in Eldoret. The medical campus includes Schools of Medicine, Nursing, Public Health, and Environmental Health. MUSOM contains 24 departments, more than 150 teaching and academic faculty members, 400 medical students, and a problem-based curriculum focusing on the needs of urban and rural communities. Medical students first matriculated in 1991. MUSPH was established in 1998 and offers MPH degrees in three departments: Community Health Sciences, Population and Family Health, and Health Policy and Planning. Thirty graduates perform research addressing public health problems related to HIV/AIDS, tuberculosis, malaria, alcoholism, and trauma
- Moi University hosts students for clinical research training for an AREP MSc. in International Health Research Ethics. There are typically 10 students in a cohort every year.
- Chronic cardiovascular and pulmonary disease (CVPD) has gone from a relative rarity to a major burden in the developing world and East Africa is at the epicenter of this epidemiological shift. The National Heart, Lung, and Blood Institute has established an overarching network of 11 Centers of Excellence (COE) with an ultimate goal of reducing the burden of non-communicable CVPD in developing nations by enhancing infrastructure and training necessary to conduct innovative and locally-relevant clinical research. Moi University, along with its long-time US medical school partners (Duke University, Indiana University and Brown University) as part of the Academic Model Providing Access To Healthcare (AMPATH) CVPD COE is working to provide a sustainable and ultimately replicable continuous quality improvement environment. Our approach is to build on the existing clinical care and research platform that has successfully responded to the HIV/AIDS epidemic over the past seventeen years to decrease CVPD death and disability so as to quickly impact the current and future lives of East Africans.
- DUKE’s engagement with Moi University (MOI) and Academic Model for Providing Access to Healthcare (AMPATH http://www.ampathkenya.org/) initially began as a student and faculty exchange in medical education and care under the umbrella of the Hubert Yeargan Center for Global Health. With funding from the NHLBI and philanthropic donations, its role rapidly expanded as a significant leader in cardiovascular disease research. In 2009, DUKE and MOI became one of 11 funded centers within the NHLBI Centers of Excellence (COE) program (http://www.nhlbi.nih.gov/about/org/globalhealth/centers/). DUKE was the Developed Country Partner with MOI for the duration of the contract. Dr. Bloomfield’s engagement with AMPATH and Moi University began with the NHLBI program, first as a Cardiology Fellow, subsequently receiving a K award and growing to become a leader in CV research in Eldoret, mentoring many US and Kenyan trainees along the way.
A network of district hospitals and rural health centers joined with MU and MTRH to create the Academic Model Providing Access To Healthcare (AMPATH). The clinical program for AMPATH is based at Moi Teaching and Referral Hospital (MTRH), Kenya’s second national referral hospital, and its multispecialty outpatient clinics. AMPATH began by opening HIV/AIDS clinics in 2001 in MTRH and the Mosoriot Rural Health Centre and now includes 18 HIV/AIDS clinics and more than a dozen satellite clinics (Figure 1) funded by a $60 million, 5-year grant from USAID with additional funding from the CDC, World Food Program, and a number of foundations. The total budget for the 5-year period from 2007-12 is more than $85 million and supports clinical HIV/AIDS care and programs for preventing mother-child HIV transmission, supporting orphans and vulnerable children, providing psychosocial and legal support, feeding more than 30,000 persons a week, screening >25,000 pregnant women annually for HIV, reaching out to communities, tracing patients who are lost to follow-up, enhancing drug adherence and screening for adverse drug effects, providing post-exposure HIV prophylaxis, screening for and treating TB, and developing economic security.
To date, close to 100,000 patients have been enrolled in AMPATH and more than 55,000 are currently receiving care, 33,000 of whom are eligible for and are receiving antiretroviral drugs (ARVs). AMPATH is now the largest HIV/AIDS care program in Kenya and one of the largest in all of sub-Saharan Africa.
Electronic Medical Record System:
To manage this enterprise, AMPATH created the AMPATH Medical Record System (AMRS) which has been made available to the world as OpenMRS: an open-source electronic medical record (EMR). From its beginnings in AMPATH in 2001, OpenMRS is now the most widely used EMR in the developing world, implemented in more than two dozen countries in sub-Saharan Africa, Central-South America, and elsewhere. The AMRS currently contains more than 34 million observations recorded during more than 1.1 million visits made by 100,000 individual AMPATH patients. The AMRS was an expansion of the Mosoriot Medical Record System (MMRS), a primary care EMR implemented in 2000 as sub-Saharan Africa’s first ambulatory EMR. To date, the MMRS contains more than 350,000 visit records for >90,000 enrolled primary care patients and contains and manages primary care for adult and pediatric medicine clinics, antenatal and family planning clinics, and 10 specialty clinics at the Mosoriot Rural Health Centre.
In 2007, AMPATH received a $1.3 million grant from the CDC to transform the primary care MMRS into a primary care module in the AMRS in coordination with AMPATH’s multi-year strategic plan to enhance community- and clinic-based primary health care. AMRS’ primary care module has been implemented at Mosoriot and is being installed in rural health centres at Turbo and Burnt Forest and in the Reproductive Health, Pediatric, and Chest/TB Clinics at MTRH. Computer-based information management, including printing of patient summary reports, and decision support is being implemented to improve the quality and coordination of care between the primary care and specialty clinics at these four sites. Once proven successful, the primary care module will be implemented in all 18 AMPATH sites. To deal with variable availability of electricity, the AMRS relies on paper encounter forms that are the official patient record and from which data are entered into the central AMRS database either on-site or at the 40,000 ft2 AMPATH Centre in Eldoret. These encounter forms are clinic- and population-specific (i.e., different for adults and children) and are printed at the AMPATH Centre so they can easily be changed as needs for clinical data evolve.
The AMRS is being modified to record condition-specific data (e.g., symptoms, physical exam findings, and tests for cardiac and pulmonary diseases). Additional research databases can be established and maintained in the AMPATH Centre and linked with patients’ AMRS records. Located adjacent to MTRH and the Moi University School of Medicine, the AMPATH Centre has an extensive, secure local area network with multiple servers and high-speed (3G) internet connectivity and houses more than 25 data entry technicians, 8 data managers, and 4 full-time technical support staff.
The MMRS and AMRS were established from the beginning to facilitate retrospective and prospective research. For example, the AMRS has been used to demonstrate that both adults and children can be effectively treated for HIV/AIDS in sub-Saharan Africa and identify clinical correlates of better outcomes. AMRS data have shown that USAID’s HIV/AIDS funding can improve patient care and outcomes, and have described the clinical characteristics and outcomes of AMPATH patients admitted to MTRH. The AMRS supports AMPATH’s ability to deliver dry goods and fresh produce to 30,000 persons a week, and AMRS data have shown the impact of HIV/AIDS treatment on labor supply and household finances. AMPATH investigators have also used AMRS data to study psychosocial distress in AMPATH patients, the prevalence of renal disease upon presentation of HIV/AIDS patients, the effects of gender on severity of illness at presentation, and a determination of hypertension and obesity as risk factors among HIV seropositive patients. The Mosoriot EMR was used to assess the outcomes of acute respiratory illness and the geographical epidemiology of injuries.
The AMPATH Data Management and Biostatistics Cores. Data management operations are carried out by a core of data entry technicians, time data managers (two dedicated to research), and information technologists who support the communications and information technology infrastructure at the AMPATH Centre and the expanding number of AMPATH clinic sites with on-site data entry. The core provides data for managing AMPATH and its clinics, reports to the Ministry of Health and other agencies of the Government of Kenya (e.g., National AIDS and STI Control Programme and the National Leprosy and TB Programme), international funding agencies (e.g., USAID and the World Food Program), and all research projects. Data resources include the AMRS and MMRS (soon to be merged) and numerous program and research-specific standalone databases. Data storage and management is secure, being mirrored on two servers and meeting all HIPAA data confidentiality and security requirements with standard operating procedures for daily and weekly backups (onto media removed from the AMPATH Centre) and virus protection. All servers and more than 100 client computers are connected by a secure local area network (LAN) that is connected to the MU and MTRH LAN. Through this LAN, the AMRS connects to the AMPATH Reference Laboratory and MTRH’s digital radiology system that provides coded results for all radiographs (plain films, angiograms, and CT scans) to the AMRS.
The Biostatistics Core is responsible for design and conduct of statistical analyses needed for research that draws on the AMRS. It is staffed by four PhD biostatisticians, three masters-level biostatisticians, and three masters-level data managers. Each project is assigned a PhD statistician and a masters-level analyst, both of whom work collaboratively with the study PI. Personnel in the core are responsible for ensuring that appropriate data are included in a project database, formulating appropriate analyses, carrying out the analyses, and writing up results as part of manuscripts and abstracts. Biostatistics Core members also participate in development of grant proposals. Data for research projects can be extracted from the AMRS and standalone databases by data managers in Kenya. The Data Management Core and Biostatistics Core each meet weekly via international teleconferences.
The AMPATH Training Institute is located in the AMPATH Centre with classroom and breakout space, internet connectivity, computers, and local copying and printing services. Since 2002, it has trained more than 2500 Kenyans both in- and outside of AMPATH, including 169 physicians, 410 clinical officers, 556 nurses, 74 nutritionists, 117 pharmacists and pharmacy technicians, 7 psychosocial workers, 50 outreach workers, >500 community mobilizers, >100 HIV testing counselors, 21 administrators, 61 lab technicians, 9 MPH students, 115 clinical hospital staff, 104 non-clinical hospital staff, and >100 others. In addition, the AMPATH Training Institute frequently hosts short courses, conferences, and lectures. The AMPATH Training Institute has a large conference room and 4 smaller breakout rooms. They also have slide projector, overhead projectors, flip charts, TVs and VCR facilities which will all be available if needed.
Facilities and Resources:
The AMPATH Center includes conference rooms, adequate space for computer resources and individual office space, and also contains the Medical Informatics Center which houses the AMRS. The Cardiovascular/Pulmonary Diseases Center of Excellence has a dedicated project office in the AMPATH Centre in Eldoret, Kenya.
Institutional Review Ethics Committee (IREC): There is an established Institutional Research Ethics Committee (IREC) for MU/MTRH that has been registered with the US Office for Human Research Protections with its own Federal Wide Assurance Number (FWA 00003128).
Research and Sponsored Projects Office (RSPO): AMPATH’s RSPO provides financial management and regular reporting on all local and international grants. Certified by NIH, the RSPO has SOPs for managing direct and indirect costs for contracts and subcontracts. RSPO is also fully conversant and compliant with Kenyan tax and procurement laws and regulations of all grants in its docket. Beyond the financial management RSPO also provides comprehensive monthly reports to MU/MUFHS, MTRH, U.S. collaborators, the principal investigators of specific grants, and funding agencies. Finally, RSPO is a human resource coordinating agency that ensures harmonization of AMPATH and grant employee terms with those of the MTRH and MUSM. RSPO core staff includes a business manager, assistant manager, human resources manager, purchasing manager and an accountant. It operates on a dual signature checking system requiring the imprimatur of the Dean MUSM, Director MTRH and Field Director of the Indiana University Kenya Program. RSPO maintains accounts in both Kenyan shillings and U.S. dollars at Barclays Bank, Eldoret Branch. The RSPO handles financial transactions totalling 14 (fourteen) million US Dollars per year.
Chronic Diseases Management and Primary Care: In 2008, AMPATH made the strategic decision to engage the AMPATH Consortium’s academic partnership to expand clinical development, teaching, and research to support chronic diseases management and primary health care at all levels from households up through the clinics associated with MTRH. AMPATH will focus mainly on maternal and child health and the prevention of chronic diseases, especially Diabetes, Hypertension, Heart Failure, and COPD.
The most recent step in the expansion of AMPATH into primary health care is home-based counseling and testing (HCT). Supported by >$1 million donated by the PVF and Abbott Foundations, 75 teams of counselors canvassed the Kosirai Division (served by the Mosoriot Rural Health Centre) and Turbo Division (served by the Turbo Rural Health Centre), going house-to-house with hand-held digital devices to perform a census, collect health risk information, offer on-site HIV testing to all persons >13 years old, collect sputum on those screening positive on a TB survey, provide mebendazole to de-worm all children, and provide two insecticide-treated bed nets. To date, >90% of 8999 Kosirai households allowed entry and 35,976 persons were interviewed. Of the 20,047 who met age criteria, 19,034 (95%) were counseled and 18,229 (91% of total) were screened for HIV (2.3% positive – 2.9% of women vs. 1.8% of men, p<0.0001). In Turbo, 95% of the 15,366 households permitted entry, and 28,886 (93%) of 31,107 eligible persons were counseled and tested for HIV (3.9% positive – 4.6% of women vs. 2.4% of men, p>0.0001). In both Kosirai and Turbo Divisions, HCT left behind one counselor for every 4000 persons to act as a Community Care Coordinator (CCC) who will perform HCT for those missed, new residents, and newly pregnant women. The CCCs will also help community members access AMPATH care while facilitating data collection and interventions for AMPATH’s community-based care programs and research initiatives. More than $5 million in funding has been obtained from the Global Business Coalition to extend HCT to all 2 million residents of AMPATH’s catchment area in western Kenya. This home based testing platform is now being expanded to include screening for elevated blood sugar and hypertension.
Cardiac Diagnostic Laboratory:
This laboratory contains two electrocardiography machine [9620Nihon Kohben and Kena ECG108] and an echocardiography machine [HP Sonus 2500]. This also includes an echo/ecg treadmill. The Cardiology Diagnostic Laboratory is capable of providing resting and exercise electro- and echocardiography. In 2009, a Philips PAX digital archiving system and CX50 digital portable echocardiography machine were added to the CVPD Center of Excellence. The MTRH Radiology Department is also capable of performing diagnostic cardiac catheterizations but not percutaneous coronary interventions.
Cardiology Clinic: The cardiology clinic at MTRH meets each Tuesday. It is staffed by two faculty and 2 to 4 internal medicine registrars (residents). This clinic sees ~40 to 70 patients per session. While this clinic hosts occasional medical students, training primarily focuses on cardiology subspecialty experience for medicine registrars. The Paediatric Cardiology clinic meets every Friday in the main hospital and is staffed by 1 consultant and two registrars and sees about 15 patients. We have three experienced echo-techs.
Chest Clinic: The chest clinic is located at MTRH. It is a combination TB and Pulmonary clinic. The TB component is open five days a week but the Pulmonary Clinic meets each Thursday. The Pulmonary clinic is staffed by one faculty and one or two clinical officers. They see ~ 20 patients per session. Like the primary care clinic, the pulmonary clinic may host medical students and registrars during their ambulatory rotations.
Pulmonary Diagnostic Laboratory: A spirometer is available in the Pulmonary Diagnostic Laboratory. Finger pulse oximetry is available in this laboratory as well as at all AMPATH sites: oxygen saturation is measured at each AMPATH and Chest/TB Clinic visit. Exercise oximetry is also available using the treadmill in the Cardiac Diagnostic Lab. Arterial blood gas measurements (providing PO2, PCO2, pH results) are also available at MTRH through its intensive care units. Chest CT scanning is available through the MTRH Radiology Department. There is a Procedure Suite at MTRH in which bronchoscopy and bronchoalveolar lavage can be performed.
Primary Care Clinic: The Adult primary care clinic in MTRH meets two times per week. It is staffed by 5 physicians (combination of faculty and registrars). Each session sees ~50 patients. This clinic follows the full range of primary care internal medicine. Patients are self-referred, referred from nearby health centers or represent follow up from hospitalization or emergency room visits. The only training occurring in this clinic is hosting of medical students and registrars during their medicine rotations. There are also two paediatric clinics in MTRH which are staffed by 2 consultants and two registrars and see 20 to 35 children per session.
Rural Health Center Clinics: In nearby rural health centers such as Mosoriot, Turbo and Burnt Forest, all clinics [other than AMPATH] are run by clinical officers and nurses [3-5] and function mainly as primary care walk in clinics for anyone over 5 years of age. These “general” clinics meet daily and see 75-100 adults per day.
Local laboratory resources available at Moi Teaching and Referral Hospital and its outpatient clinics consist of clinical and reference laboratories, radiology facilities, and special Pulmonary and Cardiac Diagnostic Laboratories. Each of these are described below.
Clinical and reference laboratories: MTRH maintains clinical laboratories in three sites: MTRH, the AMPATH Centre, and a satellite laboratory in the Busia District Hospital. (Busia performs tests for nearby AMPATH clinics.) These laboratories do routine hematology and chemistry tests including serum lipids. An assay for brain naturietic peptide was added in 2009. A commercial laboratory management information system (LIMS) is being implemented in all three sites that will manage specimen processing and results reporting, interfacing directly with automated analyzers. Importantly, the LIMS will use the same universal AMPATH patient identification number (with check digit) and port data directly in to patients’ AMRS records at all three sites. All three laboratories have established Standard Operating Procedures which have been reviewed by a site assessment team from Pharmaceutical Product Development Ltd. The AMPATH Centre reference laboratory (ARL) not only occupies one entire wing of the second floor of the AMPATH HIV Care Center but has a routine lab located at the ground floor of the AMPATH Centre. This laboratory employs >45 technologists, technicians, clerical and data entry personnel. The ARL routinely processes approximately 3,500 samples per month providing Chemistry, Hematology, Immunology and HIV DNA and viral load testing as needed. The laboratory also supports research projects that require serologic diagnosis of HIV, Hepatitis B & C, and Herpes Simplex Virus. The laboratory has a state-of-the-art molecular biology and TB diagnostics sections. The ARL is certified by the Kenyan Medical Laboratory Technologists and Technician Board, and is certified by Safety Monitoring and International Laboratories Evaluation (SMILE) on behalf of NIH Division of AIDS.
The laboratory participates in external proficiency programs which include America Proficiency Institute, (API), United Kingdom National External Quality Assessment Service (UKNEQAS), Royal College of Pathologists of Australia (RPCA), South African-REQAS (Regional External Quality Assurance Scheme) among others in order to guarantee the highest quality results for use in patient care and disease management. Current laboratory equipment includes: Roche Hitachi Chemistry Analyzer (Eldoret), Cobas Intergra Chemistry Analyzer X 2 (1- Busia, 1-Eldoret), FACS Calibure x 3 (1- Busia, 2-Eldoret), Refrigerators X 8, Aplitron 11 Thermolyne, Nihon Kohden Hematology Analyzer (Busia), Coulter Hematology Analyzer (Eldoret), and an -80C Freezer. Redundant backup power is available for the AMPATH Centre and the laboratory separately.
Radiology: MTRH has a radiology facility capable of a full range of routine x-ray tests, including flat films and angiograms. It contains a CT scanner capable of routine head, chest, abdominal, and pelvic examinations. Each AMPATH site has an x-ray machine capable of flat films only. In collaboration with the Indiana University Department of Radiology, MTRH has a system for producing digitized images of all x-rays and storing them and all radiology reports on a central server that is connected to the MTRH-AMPATH local area network. MTRH and most AMPATH clinic sites also perform pelvic ultrasound examinations for patients visiting their Antenatal and Gynecology Clinics.
5R01AI110478-02 (Wendy Prudhomme-O’Meara PI)
Innovative Partnership to Target antimalarial Subsidies in the Retail Sector
Evaluation of a public-private partnership between community health workers and retail medicine shops to improve access to malaria diagnosis in order to improve targeting of subsidized antimalarials and reduce overuse and over-treatment.
4U01HL114200-05 (Valentin Fuster PI)
Optimizing Linkage and Retention to Hypertension Care in Rural Kenya
Development and evaluation of an innovative community-based strategies to and initiatives to address the challenge of linking and retaining hypertensive individuals to a hypertensive management program with the support of mobile technology.
4R01MH096633-05 (Kathryn Whetten PI)
Improving Health Outcomes for Orphans by Preventing HIV/STD Risk
This RCT will test the effectiveness of Trauma-focused Cognitive Behavioral Therapy for traumatic grief and traumatic stress compared to receipt of usual care orphan services in TZ and KE. Using a task-shifting approach, in which lay individuals are trained as counselors, we will train nine counselors in each country, who deliver 20 groups in each site (10 rural, 10 urban), resulting in 320 children and adolescents (ages 7-13) who receive TF-CBT and 320 who receive usual care. Outcomes for children are assessed at 12-14 weeks (i.e., corresponding with the end of TF-CBT), 6-months post-treatment, and 12-months post-treatment.
5R03HD078600-02 (Wendy Prudhomme-O’Meara PI)
Impact of Spatial Distribution of Health Services on Child Morbidity and Mortality
The objective of the proposed work is to use innovative spatial techniques to quantify the contribution of access to health services in reducing childhood morbidity and mortality. We will use large, existing datasets to describe the relationship between health outcomes and geographic distribution of health services at different spatial scales. Ultimately, the goal of such an approach is to provide evidence regarding the impact of health systems infrastructure on disease burden, independent of disease-specific interventions.
1167 (Eve Puffer PI)
Developing a direct observational measure of family functioning for low-resource settings
Establishing reliability and validity in a Kenyan sample (D), assessment of criterion of direct observational tool to assess family interaction patterns by comparing its results with results of in-depth interviews with the families.
1194 (Eric Greene PI)
A pilot study to estimate the impact of mPango on contraceptive use
A digital marketplace will educate callers about family planning, offer free automated counseling, recommend suitable methods, and make referrals to local providers. Pilot study will estimate the impact of mPango on the uptake of contraception among women with an unmet need for family planning.
USAID-AMPATH Partnership; Controlling and Preventing HIV-AIDS in Western AfricaThe Academic Model Providing Access to Healthcare (AMPATH) has demonstrated a successful model of HIV/AIDS control and prevention in western Kenya covering a population of nearly 2 million persons. The USAID-AMPATH partnership aims to demonstrate how a similar model can serve as a resource to the Government of Kenya (GOK) for the delivery of the Kenya essential package of health and the development of cost-effective strategies for the delivery of primary care services.
AMPATH Global Health Activities in Developing Countries to Combat Non-Communicable Chronic and Cardiovascular and Pulmonary Diseases- Centers of Excellence in Eldoret, Kenya
The mission of the Cardiovascular and Pulmonary Center of Excellence is to establish a unique and sustainable continuous quality improvement environment in Western Kenya to cyclically evaluate how to diagnose, characterize, treat, and ultimately prevent chronic cardiovascular and pulmonary diseases. The objectives are to organize an administrative core for CVPD clinical care, training, and research; develop and implement a competency-based clinical training curriculum; establish a clinical research training program; adopt and enhance existing data management and laboratory infrastructure for CVPD; and implement research programs to address prevalence, prevention, and treatment.
CVPD COE Supplements (Menya)
Indoor Air Pollution and Its Resultant Health Effects in Kenya and Bangladesh
Feasibility intervention trial of two types of improved cook stoves
The major goal of these projects is to investigate the relationship of exposure to indoor air pollution to isolated right heart failure and pulmonary function abnormalities in women in Western Kenya.
Implementation Science to Optimize Malaria Vector Control and Disease Management
The major goal of this project is to improve malaria control outcomes through an implementation science approach that integrates health delivery experiments and decision support modeling to promote joint optimization of vector control and disease management strategies.
The AMPATH Program has a long history of hosting visiting trainees. All logistical issues are handled through a central administrative mechanism. There is an extensive orientation manual, safe and secure housing, and language training available on site. Our project house presently consists of 6 houses in a gated community that is a 10 minute walk to the medical center. Living is communal. The second floors of all the houses are sleeping quarters. The first floors are common rooms- dining area, living rooms with a general library as well as a medical library, and the administrative offices of the program. Wireless internet is available on compound if an individual has a personal laptop; otherwise, there are two desktop computers with internet access for general use. Laundry facilities are available on site (washing machines, clothes lines, or the option of laundry services). Meals are provided: breakfast is self service as is weekend dining. Lunch and dinner during the week are provided in a cafeteria style, cooked by our catering staff. The water supply of the local area is not safe; all water on site is boiled and filtered for consumption. Although there are automobiles on site for faculty use, they are not available to students or visiting scholars; when students or scholars need to travel to an off site for work, transportation is provided through the AMPATH transport pool. A list of reliable drivers and car access is provided if a scholar wishes to travel on weekends. The hospital and medical school is a 10 minute walk from the housing facility and the center of town is a ten minute walk beyond the medical school. Motor vehicle accidents are the major health risk in Kenya due to poor road infrastructure and a lack of emergency transport system (ambulances); thus, the program has strict rules about motor vehicle safety issues. If an individual is unwilling to abide by the overall program safety guidelines, the individual would be repatriated and released from the program. This applies to all our safety standards outlined in the next section. Living on site at any time are the following persons: Team leader (usually accompanied by his/her family), US leader of the AMPATH program and his wife, US head of the pharmacy exchange with Perdue University, US head of the associated micro economics program, plus all medical exchange participants- faculty, residents and students (number varies per month but averages 10-15), plus any associated researchers from related institutions. Number of persons living at the house at any time averages 18-25 but may in peak months go up to 50. The full time US field coordinators live in Eldoret but not in the project house.
Paul Park, MD, MS
Tecla Mtui-Temu, MD, PhD
Lindsay Boole, MD, PhD
Sugut Wilson, MBChB, MMed