Table 1 Responding to Population Health Needs: AMPATH Accomplishments in Service Delivery

Institutional Partnership Building 1989–2001

• Moi University School of Medicine curriculum is developed, with a focus on rural and community-based health care, embodied in their Community-Based Education and Service (COBES) program

• Indiana University (IU) initially commits to supporting Moi University in primary health care, COBES, and curriculum development. IU embodies this commitment with a full-time faculty member on ground in Kenya at Moi University every year

• With support from Indiana University, new surgical suites and surgical care capacity is built at Moi Teaching and Referral Hospital

• The platform for bilateral exchange is created; IU and other North American students, residents and faculty rotate in Kenya, and Moi students, residents (registrars), and faculty rotate and train at AMPATH institutions in North America

• In response to population health needs and health system challenges, new North American academic partners join the consortium; by 2018, there are a total of 14 North American academic partners involved

HIV Era 2001 – present

• In 2001, the first patient at MTRH is treated with anti-retroviral therapy, launching AMPATH (The Academic Model for the Prevention and Treatment of HIV/AIDS). Over the years, AMPATH has received three cycles of USAID-PEPFAR funding for HIV care, with over 150,000 patients enrolled and 85,000 active on anti-retroviral therapy delivered at nearly 500 MOH-supported clinics across western Kenya. Moi University is the first African institution to be the prime grantee recipient of this type of funding

• With support from Brown University, community and hospital-based programs for tuberculosis (TB) care, training, and research is developed

• AMPATH partners with the World Food Program to support nutrition for patients with HIV

• Kenya’s first EMR, the AMPATH Medical Record System (AMRS) is developed at a single HIV clinic, scaled to all clinics across the catchment area, and developed into OpenMRS which is now in use in over 60 countries worldwide

• AMPATH launches home-based counseling and testing “HCT” to go door-to-door testing for HIV at every home in the catchment area, eventually reaching nearly 2 million households

• Programs to support orphans and vulnerable children (OVCs) and address food and income security are developed alongside the HIV care program

• The Legal Aid Centre of Eldoret (LACE), a human rights law center for HIV-infected patients is developed

Population Health Era 2010 – Present

• AMPATH changes its name to reflect its broader population health mission, now called The Academic Model Providing Access to Healthcare

• Hypertension and diabetes screening are layered onto the HIV home-based counseling and testing program

• The chronic disease management program is launched, focusing on hypertension and diabetes, providing care for nearly 15,000 patients at 69 MOH-supported facilities

• With support from Indiana University, pharmaceutical industry partners, and the NIH, the Center of Excellence in Oncology was created, providing clinical care, training, and research for cancer

• With support from Duke University, philanthropic partners, and the NIH, the Center of Excellence for Cardiovascular and Pulmonary Disease Research was created, along with the cardiac care unit (CCU) at MTRH, Kenya’s first in the public sector, providing clinical care, training, and research for cardiovascular diseases

• With support from the University of Toronto, Indiana University, philanthropic partners, and Grand Challenges Canada, a community-based, maternal-child health program is developed. In addition, Riley Mother Baby Hospital at MTRH is built, dedicated to clinical care, training, and research for pregnant mothers and newborns

• Purdue University commits full-time faculty members on the ground in Kenya, who, working with Moi University faculty, develop innovative and financially sustainable supply chain models for chronic disease medicines, and have pioneered the training of a new pharmacy workforce in Kenya

• With support from the Regenstrief Institute at Indiana University, and faculty at Brown University, informatics and data science capacity is created, creating robust data infrastructure, biostatistics training, and expanded functionality of the AMRS EMR

• With partnership from Dow AgroSciences and Purdue University, agricultural training and farm development support nutrition and income generation for Kenyan families, and in turn become a food distributor to the World Food Program

• GISE (Group Integrated Savings for Empowerment), a community-based savings and loan program is launched. Following this, BIGPIC (Bridging Income Generation with Group Integrated Care) is created, coupling chronic disease management for hypertension and diabetes, to these microfinance GISE groups. AMPATH investigators subsequently received NIH-funding to evaluate this model of care delivery

• The Chandaria Cancer and Chronic Disease Center is opened at MTRH, Kenya’s first dedicated center in the public sector to support clinical care, teaching and research for cancer and chronic disease

• AMPATH, working within the Kenyan MOH, is working to secure a partnership with Kenya’s National Hospital Insurance Fund (NHIF) to be a principal service provider for primary care in the public sector in western Kenya.

• AMPATH’s vision for Population Health is spread with the Learning Map® tool, and work ramps up towards a comprehensive, integrated, community-centered, and financially sustainable health care delivery system responsive to the needs of an entire population