Improving the HIV Care Cascade in Kenya through Implementation Science Training

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ABSTRACT The University of Washington (UW) has a 30 year history of collaboration with three Kenyan institutions (University of Nairobi, Kenyatta National Hospital, Kenya Medical Research Institute) and has strong ties to the Kenya Ministry of Health, particularly the National AIDS and STD Control Program (NASCOP). The proposed training grant will focus on building capacity at Kenyatta National Hospital (KNH), the largest teaching and referral hospital in Kenya, to improve HIV testing, linkage to care, antiretroviral initiation, adherence and retention in care, a continuum known as the HIV care cascade. Leadership at KNH and NASCOP has identified addressing "know-do gaps" in this care cascade locally, nationally and regionally in sub- Saharan Africa as a top HIV research priority. To meet this need, the University of Washington, in collaboration with KNH and the University of Nairobi, propose training in implementation science and health metrics, two fields studying delivery challenges and real-world outcomes in order to improve healthcare programs and underlying systems. The program will be led by Dr. Carey Farquhar, Director of the UW AIDS Research and Training Program (AITRP) since 2003, and Dr. John Kinuthia, Deputy Chair, Department of Research at KNH. Two complementary long-term training tracks will be offered: 1) a 3-year MPH/PhD sandwich program in implementation science which will take place in Seattle, USA (year 1) and in Nairobi, Kenya (years 2-3) and 2) a 1-year certificate program which will include 3 months of relevant coursework at the UW followed by completion of two additional UW courses offered by the Institute for Health Metrics and Evaluation (IHME) via distance learning, and completion of a mentored research project. Candidates for the training will have permanent positions at KNH, or at the Ministry of Health with appointments at KNH, and may be from different fields of medicine or public health, including nursing and pharmacy. In addition to the long- term tracks, we will offer short-term training lasting 2 weeks which will reach a larger number of KNH and MOH professional staff (200 individuals short-term vs. 16 long-term), and will include those who may be working in affiliated decentralized public facilities. This kind of short-term training will build broader institutional capacity, promote awareness of key research concepts and practices, and identify the best candidates for future long- term training. Teams including faculty from KNH and UW, as well as from the University of Nairobi Institute of Tropical and Infectious Diseases (UNITID) for those doing their PhD, will provide mentorship within a formal mentoring program. Immediate and long-term outcomes will be monitored externally by the International Training and Education Center for Health (I-TECH) during the 5-year award period. We envision the program will build the KNH research department into a robust program recognized for its expertise in implementation science training and research, and also improve the HIV care cascade at KNH and beyond its walls by influencing national policies and producing high-quality, locally relevant research.