- a 20-year pediatric ART, PMTCT, and clinical research story -

Back in that time, my relatives were just waiting for me to die, and every story seemed closed already... so I cannot imagine life without ARVs - I could not be here testifying; they saved my life.

For people living with HIV, ARVs are life.

(Joyline Chelangat)

"PEPFAR gives life"

PEPFAR Kenya gives hope and life through....

providing life-saving antiretroviral drugs to HIV positive children

Few stories exemplify the purpose and the promise of PEPFAR as clearly as that of Joyline, whose encounter with the program has caused ripples through her life that have grown to touch her family and community.


With the inception of the PEPFAR Program in Kenya in 2004, there was an infusion of hope as thousands of people were put on life-saving antiretroviral medications (ARVs). However, the number of HIV positive children put on ARVs was disproportionately smaller compared to adults. This was because of the complexity of deciding which child required ARVs, and the complex pediatric regimens and dosing schedules which were based on the child’s weight and sometimes body surface area. Yet although the dosing regimen proved vastly complicated for children, they needed the life-saving antiretroviral therapy every bit as much as their adult counterparts, and without it, many HIV positive children in Kenya were failing to thrive.


Joyline became infected with HIV perinatally, through 'vertical transmission,' and was orphaned when her parents, a teacher and a nurse, died of AIDS without access to treatment. Joyline’s grandmothers took over her care, but her declining health forced her to drop out of school in third grade. 


Dr. Fred Sawe, Director of Kenya Medical Research Institute/Walter Reed Project-Kenya (KEMRI/WRP-K), recalls that when he first met Joyline in 2004, she was 10 years old and weighed less than 25 pounds, so weak she could not support her own head. Joyline was admitted in hospital for a long-time suffering from TB and other opportunistic infections arising from HIV. "Back in that time, my relatives were just waiting for me to die, and every story seemed closed already... so I cannot imagine life without ARVs - I could not be here testifying; they saved my life. For people living with HIV, ARVs are life." Kericho District Hospital was the only facility that was offering antiretroviral therapy (ART) to children in the South Rift Region in the early days of PEPFAR, and so Joyline became the first pediatric patient to receive treatment through PEPFAR-supported services.


After being discharged from the hospital, Joyline had to return monthly to get the next dose of her life-giving ARVs. Due to rough terrain and poor road conditions, she and her grandmothers would travel two days to Kericho to pick up her antiretroviral drugs, and another two days to return to their village. MOH, with the help of PEPFAR, was able to develop a curriculum for pediatric ART training and helped in training many health care providers on ART. Because of these trainings, pediatric ART services were decentralized even to the dispensary level, and children like Joyline did not have to travel 2 days to get their drugs; they could get them right at their nearest dispensary. 


Until that breakthrough in pediatric HIV treatment came about, Joyline would return monthly to Kericho District Hospital to collect her ARVs; each time, she came wearing the same blue and white dress that she was photographed in upon intake at the hospital. At the time of the photo, Joyline's lovely dress - although age-appropriate in size - was positively huge on her, because she was so severely under weight and size for her age due to the effects of the HIV in her little body. However, as Dr. Sawe recalls with pride: “Over the years, with every month that passed, we gradually saw her dress get shorter and tighter between visits as she grew bigger and healthier.”


Joyline was eventually able to return to school and graduate from high school. She earned a college certificate in community health work and was employed as a peer educator at one of the faith-based facilities supported by PEPFAR, to offer psychosocial and adherence counseling to adolescents and young people on ART. Later on, Joyline transitioned to working at the KEMRI/Walter Reed Project, Kericho Research Site - for the very same PEPFAR program that saved her own life.


At age 26, Joyline and her husband welcomed a son who was born HIV-free. With the help of PEPFAR, Joyline’s diagnosis and ongoing access and adherence to treatment enabled her to break a cycle of illness and orphanhood to help usher in a new HIV-free generation. “It used to be that an HIV diagnosis was a death sentence that created a lot of despair,” said Dr. Sawe. “PEPFAR has been able to turn that problem upside down, so now a positive diagnosis is a mark of life, enabling people to get help and treatment. It has transformed lives and communities in Africa.”


Today, Joyline works for the PEPFAR-funded KEMRI/Walter Reed Project-Kenya, doing community outreach for clinical research aimed at getting better drugs for HIV patients. She is so grateful she gets to share the gift of hope and life that she has experienced so profoundly, thanks to PEPFAR's support.


- a pepfar Kenya story of hope -