摘要：The Academic Model Providing Access to Healthcare (AMPATH) is a partnership between Moi Teaching and Referral Hospital, Moi University School of Medicine, and a consortium of universities led by Indiana University. AMPATH has over 50 000 patients in active care in 17 main clinics around western Kenya. Despite antiretroviral therapy, many patients were not recovering their health because of food insecurity. AMPATH therefore established partnerships with the World Food Program and United States Agency for International Development and began high-production farms to complement food support. Today, nutritionists assess all AMPATH patients and dependents for food security and refer those in need to the food program. We describe the implementation, challenges, and successes of this program. THERE IS A COMPELLING monotony to the maps of sub-Saharan Africa that delineate high-prevalence areas of HIV, poverty, and food insecurity—each map might literally be superimposed on the others. This overlap is not a coincidence. The interplay between HIV, poverty, and food insecurity is increasingly recognized as a major contributor to the devastation now challenging much of sub-Saharan Africa. 1 – 3 It is unlikely that any scientific evidence can depict the actual human and economic costs to societies burdened by the disability and death of young adults, endless numbers of widows, unparalleled numbers of orphans, and falling school attendance by an expanding number of malnourished, vulnerable children. Responses targeting only the rapid scale up of antiretroviral therapy are unlikely to meet the needs of many of the patients they serve. To those on the front lines of HIV care in sub-Saharan Africa, it is clear that food security and poverty reduction are essential components of a meaningful response to the havoc wrought by the HIV pandemic. 1 , 4 , 5 Medical care is necessary but insufficient, whereas health care attends to all these sectors. In 2001, Kenya's second national referral hospital, Moi Teaching and Referral Hospital; its second medical school, Moi University School of Medicine; and a consortium of medical schools from the United States led by Indiana University School of Medicine initiated a bold response to the HIV pandemic in western Kenya. They launched the Academic Model for the Prevention and Treatment of HIV/AIDS now known as the Academic Model Providing Access to Healthcare (AMPATH), which has grown into one of Africa's largest and most rapidly growing HIV care programs. 6 , 7 AMPATH is currently working in a network of 17 Ministry of Health facilities in western Kenya, including a national referral hospital, several district hospitals, subdistrict hospitals, and many rural health centers ( Figure 1 , Table 1 ). AMPATH is currently serving over 50 000 HIV-infected patients, half of whom are receiving combination antiretroviral treatment. Each month, approximately 2000 new patients are enrolled, roughly 40% to 50% of whom begin antiretroviral treatment. Open in a separate window FIGURE 1 Map of western Kenya showing locations of Academic Model Providing Access to Healthcare (AMPATH) clinics. Note. Eldoret is the location of the program headquarters. TABLE 1 Proportion of Patients Identified as Food Insecure by AMPATH Clinics: Western Kenya, 2007 Clinic Site Type of Center No. of Patients Enrolleda Food Insecure, % MTRH National referral hospital 17 781 39 Mosoriot Rural health center 5329 40 Turbo Rural health center 4103 30 Burnt Forest Rural health center 2654 20 Chulaimbo Rural health center 8105 40 Webuye Subdistrict hospital 4508 20 Naitiri Rural health center 1447 25 Amukura Rural health center 1769 30 Kapenguria District hospital 1168 44 Kitale District hospital 5943 20 Teso District hospital 1855 29 Mount Elgon District hospital 708 28 Iten District hospital 683 35 Kabarnet District hospital 1083 40 Busia District hospital 5814 30 Port Victoria Subdistrict hospital 2257 50 Khunyangu Subdistrict hospital 1831 50 Total 67 038 33.5b Open in a separate window Note. Academic Model Providing Access to Healthcare = AMPATH; MTRH = Moi Teaching and Referral Hospital. aAs of January 1, 2008. bMean percentage. Early on, AMPATH care providers became acutely aware of the impact hunger and poverty were having on patients presenting for care and on the vulnerable members of their households, most notably children. AMPATH leaders decided to provide nutritional support for all food-insecure patients and dependents within their homes. That decision alone initiated a series of challenges for AMPATH that have proven just as complex as scaling up Kenya's largest antiretroviral delivery program. AMPATH is one of the first HIV care programs in sub-Saharan Africa to roll out comprehensive HIV treatment combined with extensive nutritional support for food-insecure patients and their dependents. We provide an overview of the program, including challenges, successes, and lessons learned, so others might be assisted in building their own food support programs.
