Decades of working to strengthen health systems and fighting the HIV/AIDS epidemic in Kenya provided the expertise that informed the COVID-19 response in both western Kenya and in Indiana.
“These are challenging times to be running global health programs,” said Adrian Gardner, MD, MPH, director of the IU Center for Global Health. During a presentation this month about how the Center has responded to the pandemic, he cited stressed health systems, disruption of the global economy, school closures, research interruption and travel restrictions as some of the major challenges experienced around the world. But he also saw reasons to be optimistic for the future of international health collaborations such as IU’s AMPATH partnership in Kenya. “There has never really been a time where the interconnectedness of the global community and need for global cooperation has been more obvious.”
Gardner assumed his new role at the Center and as executive director of the AMPATH Consortium in February 2020. He was previously the executive field director in Eldoret, Kenya, for seven years. IU’s partnership with Moi University and Moi Teaching and Referral Hospital (MTRH) in Kenya and a dozen other universities and academic health centers throughout the world officially began in 1990 when four IU physicians created a partnership with the new Kenyan medical school.
In 2001, AMPATH initiated one of the first HIV care and control programs in sub-Saharan Africa that has grown to now include more than 170,000 people living with HIV who are active in care.
Gardner noted that the growth of AMPATH’s HIV program included Kenyans working with Americans and Canadians to: develop prevention activities; train a new workforce to do testing and counseling; establish protocols for treatment; address poverty, food insecurity and other social determinants of health; create an electronic medical records system to keep track of patients; create reliable supply chains for diagnostics and therapeutics; and work with local and national health authorities while advocating for a global response.
“These actions sound familiar because a lot of the same kind of strategies have been employed here. The parallels between HIV and COVID-19 response are pretty remarkable,” Dr. Gardner said.
Although travel advisories forced IU’s full-time faculty in Kenya to return to the U.S. in mid-March 2020, efforts to aid the COVID-19 response being led by their Kenyan colleagues started immediately. “Kenya was able to gain from the experience of other countries in implementing and quickly putting into place some mitigation strategies and limiting travel and international travel,” said Gardner, who served on a COVID task force established at MTRH.
HIV laboratories supported by U.S. government HIV funding were able to be converted to conduct PCR testing for COVID-19. Philanthropic and corporate support was redirected toward COVID efforts. Indiana University faculty were involved in training, protocol development, and establishing a home-based care effort. Material supplies such as PPE, testing commodities, pulse oximeters and UV machines to sterilize N95 masks were procured for MTRH. In addition to a formal lecture series, Gardner estimates that there were “hundreds of conversations” between AMPATH partners to share knowledge and resources.
At the same time, the expertise of IU’s medical faculty was also needed by the university. In late spring, the IU COVID-19 Restart Committee, chaired by IU School of Medicine Dean Jay Hess, released the Restart Guide which provided a clear outline of the steps that would be needed to allow the university to operate over the ensuing months. A Medical Response Team (MRT) was created with four IU School of Medicine physicians leading efforts in symptomatic testing, mitigation testing, contact tracing and vaccine strategies.
Once again, the parallels between AMPATH’s HIV response and the COVID-19 response were evident, and Dr. Gardner and the IU Center for Global Health were tasked with leading the university’s contact tracing effort. “We had to hire and train a workforce of program managers and contact tracers. We developed scripts and designed an electronic system to track interactions. We established MOUs and communication channels with local health departments and established an internal team to conduct daily case reviews to analyze transmission patterns within our constituents and modify mitigation strategies as appropriate” said Dr. Gardner.
“This is an example of what we mean when we talk about reciprocal innovation, the idea that we can learn lessons from the global work and apply them locally. If we have these true partnership models, we have a bilateral exchange of knowledge and process,” he added.
Dr. Gardner said that the contract tracing effort relies on the knowledge the university has “about our campuses, where our students live, what dorms they are in, what activities they participate in. This has allowed us to augment the efforts of the State and local health departments” he continued.
Working together, the MRT has led IU’s successful fall semester and the return for the spring semester. “Our goal was always to make being part of the IU community safer than not being part of the community,” said Gardner. “Looking back at the fall statistics and fall semester, we were able to do that.” In appreciation for their efforts, President McRobbie awarded all of the leaders of the MRT including assistant directors Bicentennial medals “in recognition of your distinguished leadership and service to Indiana University during an unprecedented period in our University’s history.”
Gardner and other IU faculty involved in the pandemic response in both Kenya and Indianapolis know that their job is not finished as they continue to advocate for equitable access to care and vaccine. “Our definition of global health is about health equity regardless of location,” said Dr. Gardner. “The world over, COVID-19 has disproportionally affected the poor, minorities and other vulnerable populations. Certainly, that has been true in the United States as well,” said Dr. Gardner.
Despite a significant surge in cases when mitigation measures were loosened in the fall, the number of confirmed COVID-19 cases and deaths in Kenya has remained significantly lower than the U.S. However, there is significant concern in Kenya about how COVID-19 is impacting people living with HIV, tuberculosis and chronic, non-communicable diseases as health systems have been disrupted. Delays in diagnosis, treatment initiation and adherence, interruption of public health campaigns and dramatic increases in food insecurity are already being documented.
“The impact of this pandemic will be felt for years to come. We have a lot of work to do to respond to the needs,” concluded Gardner.
The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.