ICED OUT: integrated cold-chain eliminating disease outreach. Piloting a motorcycle-enabled laboratory transport system combatting visceral leishmaniasis in rural Kenya

The fight against neglected tropical diseases (NTDs) in sub-Saharan Africa, particularly visceral leishmaniasis (VL) among Kenya's Pokot tribe, exemplifies the need for improved last-mile healthcare delivery systems. The Pokot face high disease burdens due to their pastoral lifestyle, socioeconomic hardship, and comorbidities such as malnutrition and high exposure to communicable diseases. Despite the availability of VL diagnostics and treatments, limited healthcare access in remote Baringo County exacerbates the disease's endemicity. This study describes a motorcycle-based cold chain transport model for VL diagnostics and vaccine transport in East Pokot, Kenya, utilizing phase-change material (PCM)-cooled transport backpacks. A Likert survey of ten key informants from six healthcare facilities identified critical challenges, including laboratory transport costs, interfacility distance, and lack of cold chain services. Three routes connecting these six facilities to more advanced healthcare facilities were established based on identified gaps. Transport schedules were synchronized with village market days to reduce costs and increase accessibility and frequency. Sample collection was further integrated into World Vision and Kenya Red Cross outreach campaigns. Diagnostic care was thereby extended to over 99 Pokot villages during the pilot period. Implementation revealed key insights into barriers to Pokot health-seeking behaviors, including cultural inhibitors and tribal conflict-related challenges. This model demonstrates potential through its linkage of isolated healthcare facilities, creating greater value efficiency and lower barriers for integration into existing community healthcare frameworks. Lessons learned during the pilot phase can guide implementation of similar community-enabled cold chain transport systems in global regions with healthcare fragility.