November 24

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Kenya AIDS Vaccine Initiative of Kangemi

The two KAVI sites in Kenya are located in Nairobi and Kangemi.

Kangemi map

The Nairobi site at the Kenyatta National Hospital, where I work, has an up to date lab where we receive blood donors and perform high-throughput assays. The KAVI site in Kangemi is located in the slums. Here the KAVI employees are within the area where many at risk volunteers can be found. A lot of the employees live nearby or have family that live in Kangemi so they are able to build trust within the community.

The Kangemi site does a lot of the initial screening for potential volunteers. They have kits for quick HIV, malaria, and pregnancy screening. They also host informational meetings to explain how the clinical trials work and what is expected from the donor. The doctors also administer the trail medicine. Further blood analysis is sent to the Nairobi site.

Malaria detection kit. (Picture taken by Lisa Kenyan)

Malaria detection kit. (Picture taken by Lisa Kenyan)

I had a free day so I asked to visit the site.

KAVI in Kangemi

KAVI in Kangemi

Kangemi, like most slums, is adjacent to middle class neighborhoods. This is because those that live in the slum might work in the adjacent town. Here there is a main road that splits the sections. Look to the left= slums; turn your head to the right= gated community.

I was introduced to the staff and everyone was eager to explain their role as well as answer my many questions. It was difficult to take pictures since there were clients here. The people in the pictures are KAVI employees.

Clinic Compound

Clinic Compound

I had some questions: (these are summaries put in my words)

Q: What are the volunteer’s top concerns?

Most people have never had blood drawn. Their fear starts with being in a doctor’s office. Then they are afraid of the needles. Finally they worry too much blood is being taken [these are multiple vials, but small quantities].

Q: Clinical trials require both HIV + and – patients. How do you get them to come in since being HIV + can make one an outcast?

Many people don’t know they are HIV + until they are tested here. [It can take weeks or years before showing something that is not a “flu like symptom.” HIV makes people ill, then they feel well again as their body boosts antigen levels].

If they already know, or we find out, then they come in the same way and around the same times as any other volunteer.

[HIV blood vials have a different colored cap. This is so I, as the lab technition, knows to be extra careful. Side note: it is practiced everywhere to treat all bodily fluids as HIV+]. Very few people in the lab knows exactly whose blood this is since patients names are replaced with an identifier number.

Q: Some trials require high-risk, but HIV- patients. How do you find sex workers and men who have sex with men since both practices are illegal?

We have built trust in the community. We have many clinical trials so past volunteers tell their friends that KAVI can be trusted.

Q: Do the clients get compensated?

It is immoral to pay people for blood donations so they get paid as a transportation reemburstment. We used to pay per km, but everyone said they lived at the farthest point to get more money. So payment is set at ~$15 USD per visit.

They suggested I return and go into the residential area and see how the outreach works. I really, really, want to see this first hand. However, I don’t speak Swahili well enough to understand the conversations. Also, in my opinion, a white person in this setting might make people hesitant to participate since I am not a local and could be seen as “overseeing” things.