OPTIONSCountrySituationAnalysisInterimFindings:Kenya
FSGinpartnershipwithLVCTHealth
APRI L2 0 1 6
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OPTIONSIntroductionOneoffivecooperativeagreementsawardedbyUSAIDwithPEPFARfundingthroughRoundThreeoftheAnnualProgramStatement(APS)forMicrobicideResearch,Development,andIntroduction.
TheOPTIONSConsortiumobjectiveistoprovidetargetedsupporttohelpexpediteandsustainaccesstonewARV-basedHIVpreventionproductsincountriesandamongpopulationswheremostneeded.
OPTIONSConsortiumMembers
KENYA
SOUTHAFRICA
ZIMBABWE
3APRIL2016
OPTIONS ConsortiumAims
Developevidence-basedbusinesscasesandacoordinatedinvestmentstrategy forARV-basedpreventionproductintroduction toensuretimelyglobal,nationalandprivatesectoractiononpriorityareas
AIM1 AIM2 AIM3 AIM4
Provide technicalassistanceandsupportforhealthsystemsstrengthening(HSS) withrapiduseofdatatoidentifyandaddressimplementationbottlenecksthroughout thevaluechain
Support countrylevel regulatoryapproval,policydevelopment,programplanning,marketingandimplementationstrategiesforARV-basedpreventionproductintroduction
Facilitateandconductimplementationscience (IS)toadvancetheintroduction ofandaccesstomicrobicidesandARV-basedpreventiontechnologies
OPTIONScanprovidetargetedsupportacrossitsfourprojectaims:
4APRIL2016
OPTIONSHowWeWork• OPTIONSisnotaservicedelivery project;weapplysystemsthinkingto
supportandaccelerateproductintroduction
• OursupportisflexibleandisdesignedtoberesponsivetonationalcountryprioritiesandplansandwillbeguidedbynationalleadershipthroughNASCOP
• Wehaveastronglocalpartner,LVCTHealth,withsignificantexperienceworkingonHIVpreventionintheKenyacontext
• InadditiontoLVCT,ourconsortiumisabletobringmulti-disciplinaryexpertisetotheefforttointroducefemale-controlledHIVpreventionproductsinKenya
• Wearetakingsignificantstepstoensurewedonotreplicateexistingorongoingwork– ourmissionistofillgapsandhelpanswerkeyquestionsasoutlinedbythenationalgovernment,theUSAIDcountrymission,andotherkeylocalstakeholders
5APRIL2016
• This document includes interim findings from the OPTIONS situation analysis for Kenya,completed by FSG with significant input and consultation from LVCT Health
• The situation analysis aims to take a comprehensive and robust approach to assessing the“state of the field” for PrEP in Kenya, including opportunities and resources as well as gapsand expected challenges
• The situation analysis serves multiple purposes: it provides a basis for country consultationsand stakeholder engagement, it serves as a tool to clarify the roles, activities and investmentsneeded for the successful roll-out of PrEP, and it will inform the development of the OPTIONSinvestment cases for PrEP
• This document reflects findings from secondary research and in-country consultations withkey stakeholders
• This is designed as a “living document,” to serve as a repository for information regardingthe situation of PrEP in Kenya to be updated on an ongoing basis as additional informationbecomes available and progress ismade towards the roll-out of PrEP
• If you have any updates, additional information, or follow-up questions regarding thissituation analysis, please email Neeraja Bhavaraju at [email protected]
AbouttheSituationAnalysis
6APRIL2016
ExecutiveSummary• Kenyahasmadestridestowardcreatingpositive initialconditions fortheroll-outofPrEP:
– PrEPisincludedinKenya’smostrecentnationalplans forcombatingHIV/AIDSincludingtheKenyaAIDSStrategicFramework(KASF)andthePreventionRevolutionRoadmap
– ThePharmacyandPoisonsBoardhasregisteredTruvada(oralPrEP) forHIVprevention– GovernmententitiessuchasNASCOParetakingaproactiveroleingeneratinglocal-levelbuy-inforPrEP,engaging
diversesectorsinPrEPplanning,andcooperatingwithkeystakeholdersinthedevelopmentofpoliciesandpracticesforPrEP
– Potential targetpopulations havebeen initiallydefined:femalesexworkers(FSW),menhavingsexwithmen(MSM),sero-discordantcouples,adolescentgirlsandyoungwomen(AGYW),amongothers
• Currently, thereisnoofficialimplementation strategyforPrEP.Kenya,throughNASCOPandCDCleadership,isintheprocessoftranslatinghigh-levelWHOpolicyintotreatmentand implementation guidelines,whichareexpected tobecompletedbyJune2016andinvolvemulti-sectorparticipation
• ThecurrentstateofthePrEPdiscussionrevolvesaroundimplementationconsiderations:– Definingpriority targetpopulations forPrEP– FindingkeydeliverychannelsforreachingtargetpopulationswithPrEP(e.g.,comprehensivecarecentersandother
ARTsites,DREAMSdistricts,sexualandreproductivehealth(SHR)sites)– UnderstandingtargetpopulationuserpreferencesandPrEPaccessneeds, anddeployingasuccessful national
communicationscampaignforPrEP– Determiningthecostand impactofaddingPrEP topreventionstrategiesfortargetpopulations– Assessingcapacity-buildingneeds fortheintegrationofPrEPintohealthservicesandotherchannels
• ThemostsignificantcurrentconcernsaboutPrEP include:– Howtoaddressstigmathroughpolicies,communications,andscale-upprocedures– Obtainingdonor commitmenttosustainablyfundscale-upofPrEP
7APRIL2016
GeographyHighlyconcentrated epidemic- 65%ofnewinfectionsoccurringin9outofthe47counties²:
TrendsHIVincidencehassteadilybeendecreasingatalowrate
HIVinKenyaContext• Kenyahastheworld’sfourth largestHIVburden, withanestimated1.63millionpeople livingwithHIV(prevalenceof6%)¹• 100,000newinfectionsoccurannually,with21%ofadult infectionsoccurringamongyoungwomenages15-24²• HighlygeographicallyconcentratedHIVburden, thusGovernmentandPEPFAR’sresponsetoHIVisfocusedatthecounty level
0
20
40
60
80
100
120
140
2009 2010 2011 2012 2013
MaleFemaleTotal
DemographicsKenya’sHIVincidenceisdrivenbyabroadsetofpopulations, includingsignificantcontributionsfromsero-discordantcouplesandadolescentgirlsandyoungwomen(AGYW):
NewadultHIVinfections,2013²
HIVincidenceovertime³(inmillions)
Sources:(1)KenyaAidsStrategicFramework2014/15-2018/19,MinistryofHealth,2014;(2)KenyaPreventionRevolutionRoadmap,MinistryofHealth,2014;(3)KenyaAIDSResponseProgressReport,NationalAidsControlCouncil, 2014
8APRIL2016
RemainingChallenges
• Despitegrowinginvestment,Kenyaisstrugglingwithfinancialsustainability forHIVtreatmentandprevention,andhasbeguntodevelopadditionaldomesticfundingsources
• Thecurrenthealthservicesystem faceschallengesinplanning, coordination, and inadequate infrastructureinvestment,leadingtocapacityconstraintsinHIV-AIDSclinicssuchasashortagesofstaffing,insufficientspace/facilityinfrastructure,andshortagesintestingkits
• PLHIV continue tofacehighlevelsofstigma throughout thecountry
• Currentmessaginganddistributionchannelsareinsufficientforreachingkeypopulations; theGoK willneedtocontinuetoadjustcurrentstrategiesinorder toserveat-riskpopulations,andinvestinyouth-friendlyservices/facilities
• Riskperception islowamongcertaintargetpopulations,whichmakespreventionuptakeaconstantchallenge
Context• Throughaheightened levelofinvestmentandafocusoncombinationprevention, thegovernmenthasmadesignificantprogressin
reducingthenumberofnewinfections:44%decreaseamonginfants;7%amongadultsbetween2008and2013¹
• Giventhesmallerreduction inadult infections,Kenya’smostcurrentstrategyhasshiftedtowardsfocusingonprioritygeographieswithhigh-incidence,andintegratingthosewhoaredisproportionately affectedbytheepidemic:girls,womenandkeypopulationssuchasFSW,MSM,peoplewhoinjectdrugs(PWID),andpeopleinprison²
Current Efforts
• HighHIV/AIDStreatmentcoverage²in~2000ARTsites:- Mother tochild(78%)- Men(80%)- Women(77%)- Infants/children(42%)
• HighreachofHIVtestingandcounsellingforhigh-riskpopulations, with lowerratesforgeneralpublic² through~5000testingsites:- FSW(68%)- MSM(74%)- PWID(60%)- Women- general(47.3%)- Men- general(35.8%)
• Varyingpercentofkeypopulations not receivingtargetedinterventions³:- FSW(30%)- MSM(45%)- PWID(76%)
HIVPrevention&TreatmentinKenya
Sources:(1)KenyaAidsStrategicFramework2014/15-2018/19,MinistryofHealth,2014;(2)KenyaPreventionRevolutionRoadmap,MinistryofHealth,2014;(3)KenyaAIDSResponseProgressReport,NationalAidsControlCouncil, 2014
9APRIL2016
KeyConsiderationsforPrEP• Achieving national targets: Kenya has committed to addressing the
HIV/AIDS epidemic by setting a high goal for prevention: a 75% reductionin new infections by 2020.¹ However, the rate of reduction for adult HIVtransmission is slow, seeing only a 7% decrease from 2007-2013.¹ At thisrate, Kenya will not meet its goals. The number of new infections will notdecrease unless Kenya targets at-risk populations who are most severelyaffected: FSW, MSM, sero-discordant couples, PWID, AGYW, people inprison, and other marginalized populations.² PrEP could provide aneffective method for these populations who do not use other preventionoptions.
• Combination prevention: Impact models suggest that PrEP use by keypopulations in combination with the currently available set ofinterventions (behaviour change, early ART, male circumcision) wouldavert the highest number of infections. ²
• Equity and human rights: Kenya’s national plan states that “the success ofthe HIV response is dependent on protecting and promoting the rights ofthose who are socially excluded, marginalised and vulnerable.” ¹ Several ofthe high-risk populations for whom PrEP is most appropriate are alsomost discriminated against by Kenyan society. Currently, demonstrationprojects have shown promising results for the demand for PrEP amongthese populations, particularly among MSM and FSW. ³
• PrEP offers a gender-sensitive option for prevention:Women continue tobe disproportionately affected by HIV/AIDS, in particular AGYW ages 15-24. If implemented effectively, PrEP could give women the choice toprotect themselves against infection, regardless of their partner’spreference for sexual activity.
WhyPrEPisunderconsiderationinKenya ContextandquestionsaroundPrEP• Kenya’snationalplans(KASF,Revolution
Roadmap)includeprovisionofPrEPtokeypopulationsseverelyaffectedbyHIV
• ThePharmacyandPoisonsBoardapprovedPrEPinDecember2015,andnationaltreatmentandimplementationguidelinesexpected inJune2016
• AlthoughnationalplansandpoliciesincludeprovisionsforPrEP,questionsremainonconcreteplanstodeliverPrEPtotargetpopulations,planstoencourageandsupportuptake,andfundingforPrEP
• RemainingquestionsaboutthemosteffectivedeliverychannelsfordistributionofPrEP,aswellasthehealthcaresystemcapacitytoreachkeypopulationsandprovideadditionalPrEP-relatedservices
• FundingforPrEP isstillunclear,yetdonorssuchasGatesandPEPFARhaveshowninitialcommitmentstofundPrEPintroduction inKenya
• PlanningforPrEPwilllikelybeinitiallyfocusedonhigh-priority,high-burdengeographicregionswithinKenya
Sources:(1)KenyaAidsStrategicFramework2014/15-2018/19,MinistryofHealth,2014;(2) KenyaPreventionRevolutionRoadmap,MinistryofHealth,2014;(3)SafetyandAdherencetoIntermittentPre-ExposureProphylaxis(PrEP) forHIV-1inAfricanMenWhoHaveSexwithMenandFemaleSexWorkers,Plos One,2012
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PlandevelopedtoimplementWHOPrEPguidelinesfortargeted
populations
PrEPproduced,purchased,anddistributedin
sufficientquantitytomeetprojecteddemand
PrEPservicesdeliveredbyappropriatechannelswithaccesstotarget
populations
TargetpopulationsseekandareabletoaccessPrEPandbeginuse
TargetpopulationadherestoPrEPatrecommendedfrequencyand forideal
timeperiod
PLANNINGANDBUDGETING
SUPPLYCHAINMANAGEMENT
PREPDELIVERYPLATFORMS
INDIVIDUALUPTAKE
EFFECTIVEUSE&MONITORING
What’sNeededtoIntroducePrEPOPTIONSaimstotakearobustandcomprehensive approachtoanalyzingthesituationaroundPrEP. ThegoalofthisexerciseistoidentifykeybottlenecksandopportunitiestointroduceandscalePrEPeffectively ineachOPTIONScountry.Thisinformationwilleventuallyfeedintotheinvestmentcasesandwillbeusedtoinformandcapturecountryprogress.Toidentifywhat’sneeded forPrEPintroduction, wehaveorganizedtherestofthesituationanalysisalongthePrEPvaluechain,introducedbelow.
ValueChainforPrEP
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ValueChainAnalysesThefollowing slidesholdthreeanalysesalongthevaluechain
• Resourcesthatexistin-countrytosupport andacceleratePrEPintroduction
• GapsinresourcesthatcouldactasbarrierstoeffectivePrEPintroduction
• Keyconsiderations toinformcomprehensive in-countryplanning forPrEPintroduction
• Alistofspecificfactorsthatneedtobein-placetoeffectivelyintroducePrEPforeachcomponent ofthevaluechainalongwithprogressto-dateforeachfactor
• Detailsoncurrentsituation,keyactors,responsibilities,timelinesandprogresstowardseachactivityareincluded intheappendix
• Remainingquestions toinformin-countrydiscussionsandplanning
• Remainingquestions toinformongoingmodelling,researchandanalysisefforts
• OpportunitiesforotherpartnerstosupportaccelerationofPrEPintroduction
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ResourcesandGapsforPrEPinKenya
PLANNING&BUDGETING
SUPPLYCHAINMANAGEMENT
PREPDELIVERYPLATFORMS
INDIVIDUALUPTAKE
EFFECTIVEUSE&MONITORING
ExpectedStrengths
EmergingKeyConsiderations
•PrEPcoulduseexistingsupply chainsystemsforARVs,butnewdeliverychannelswould requireadditional planning•County coordination andtargetingwillrequireconsideration
•Healthsystemwillneedadditional capacity(e.g.,staff,equipment) todeliverPrEP
•Channels forPrEP willneedtobeidentified fortargetpopulationsincluding AGYW
•Ongoingtesting forPrEPusersmayputadditionalstrainonhealthsystemcapacity• Strategiesareneededtoencourageeffective useforeachtargetpopulation
• StigmaisamajorconcernforuptakeinAGYWandsero-discordant couples
• Awareness/demand forPrEPisunknown;willrequire investmentindemandgeneration
• NeedcommunicationscampaignforPrEP
• Implications ofPrEPforAGYWremainuncertain;demonstration projectswillprovideadditionaldataandinsights
• Sourcesoffinancing forPrEPareuncertain
• National plans callforusingPrEPwithin currentcombination preventionforFSW,MSMandserodiscordant couplesinhigh-burden counties
•Truvadaisnowregisteredforprevention•PrEP national guidelinesexpected inJune2016•Procurement processeshaveeffectivelysuppliedARVswithout shortagesthrough astronge-system
•Current distributionchannelsforHIVtestingandcounsellingarewidespread anddiverse•Healthsystemhas highreachofsomeat-riskgroupssuchasFSWandMSM
•NationalHIVM&Eplantomeasureprogressisinplace.NASCOPandpartners plantodevelopanationalPrEPM&Eplan•Demoprojects aregeneratinginsightsoneffectiveuseconcerns
• HighreachandusageofHIVtesting/counsellingservicesforat-riskpopulations
• Demonstration projectswillprovideinsight onuserneedsandpreferencesforPrEP
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Impact, costandcost-effectiveness analysesforPrEP aspartofcomprehensive HIVprevention portfolio
Identification andquantification oftargetpopulations forPrEP
InclusionofPrEPandfemale-controlledmethodsincurrent orupcoming national HIVprevention plans
Timeline andplan forPrEPintroduction andscale-up
Abudget forPrEProll-out totargetpopulations
Sufficient funding toachievetargets
Regulatoryapprovalofform(s)oforalPrEPbyauthorities
Effectivedemandandsupply forecastingmechanismsforPrEP
Manufactureridentification andcontract negotiation topurchasePrEP
Product andpackagingdesigntomeettargetpopulation needsandpreferences
Developmentofdistribution plan forPrEPtoreachtargetpopulations
Effectivedistributionmechanisms toavoidPrEPstock-outsinpriority facilities
Issuanceofstandardclinical guidelines forprescription anduseofPrEP
Sufficientinfrastructure andhumanresourcestoconduct initial HIVtestsandprescribePrEPinprioritychannelsPlantoengagehealthcareworkers onPrEPanddeliverytotargetpopulations (includingmitigatingstigma)
Toolstohelppotentialclients andHCWunderstandwhoshould usePrEP havebeencreated
Sufficient resourcestoroll-out plansforhealthcare workerengagement
Clearandinformativecommunications onPrEPforgeneralpublicaudiences
Developmentofdemandgenerationstrategiestargetedtounique needsofdifferent populations
Linkages betweenHTC,PrEPprescription, andPrEPaccesstoenablePrEPuptake
Information forclientsonhowtoeffectivelyusePrEPforalltargetpopulations
Establishedplanstosupport effectiveuseandregularHIV,creatinine testing thatreflect theuniqueneedsoftargetpopulations
Capacity toprovideongoingHIV andcreatinine level testingforPrEPusersaccessibletotargetpopulations
Monitoring systemtosupport datacollectionforongoinglearning(e.g.,rateofpatientsreturning for2ndvisit,non-HIVSTIrates)
PLANNING&BUDGETING
SUPPLYCHAINMANAGEMENT
PREPDELIVERYPLATFORMS
INDIVIDUALUPTAKE
EFFECTIVEUSE&MONITORING
TowardsIntroductionofPrEPinKenya
Significantprogressand/ormomentum
Earlyprogress
Initialconversationsongoing
COLORKEY
14APRIL2016
KeyQuestionsforPrEPinKenya
• WhatistheincrementalcostandimpactofaddingPrEPtocombinationpreventionfortargetpopulationsintargetgeographies?
• Towhatextentaretargetpopulationswillingandabletopay forPrEP?
• HowwilltheintroductionofPrEPbefinanced?
• WhowillmanufacturePrEP?Howwillitbepriced/packaged?Whatalternativescouldbeused?
• HowwillPrEPprocurementanddistributionbemanagedbetweenthenationalandcountylevels,particularlyforpotentialchannelsthatarenotdeliveringARVs?
• Whatwillbeconsidered“effectiveuse”foreachpopulationandhowwillitbeencouraged?
• TowhatextentwillongoingtestingneedsforPrEPusersfurtherstrainhealthsystemscapacity?
• Howwillongoingmonitoringbemanaged?
• Whatarethemosteffective channelstoreachtargetpopulationswithPrEP(e.g., healthfacilities,communitychannels)?
• Howwillhealthcareworkers,includingcommunityhealthworkers,beengagedandsupportedtodeliverPrEP?
• WhatisthecurrentdemandgenerationstrategyforPrEP?
• HowwillstigmabeaddressedbothtoensuretargetpopulationscaneffectivelyaccessPrEPandtoensurethatusebysome(e.g.,FSW)doesnotstigmatize PrEPforothers(e.g.,AGYW)?
PLANNINGANDBUDGETING
SUPPLYCHAINMANAGEMENT
PREPDELIVERYPLATFORMS
INDIVIDUALUPTAKE
EFFECTIVEUSE&MONITORING
15APRIL2016
Natio
nalstakeho
lders
KenyaMinistryofHealth- createsnationalplans/priorities,andoverseesthefollowingHIV-specificdivisions
NACC- implementsstrategicplans,coordinatesstakeholders,leveragesresources,andprovidescareforPLHIV
NASCOP- oversees policyandguidelines,coordinatestechnicalHIVprogramming,managessupplychainsandcapacity-building,performsM&E
Nationaltechnicalworkinggroups-provideleadershipandstrategicguidanceforimplementation
CDC- involvedinguidelinecreation
CDC- supplies laboratorycapacitysupport
Professionalregulators- (MedicalPract.&DentistsBoard,NursingCouncil)- giveslicensureto healthproviders,andmonitorsethicalpracticeofhealthworkers
PharmacyandPoisonsBoard-approvesallnewmedications
Gilead- registeredTruvada forprevention inKenya
KenyaMedicalSuppliesAuthority- centralprocurementagency
NationalHIVReferenceLaboratory- improvescountry’sHIV labcapacity
Implem
enters
County-levelgovernments-makedecisionsregardingplanning,funding,procurement/distribution,andhealthfacilitycapacity-buildingforPrEP
Healthcarefacilities(community-basedclinics,SWOPclinics,comprehensivecareclinics,mobileclinics,HTCsites)-provideARVSandotherHIV/AIDS-relatedservices
Communitybasedorganizations(non-profit, faith-based,advocacygroups)- trustedorganizationsthatcanreachtargetpopulationswithPrEPandgeneratedemand
Dono
rs Currentdonors(PEPFAR,GatesFoundation,andNikeFoundationaspartof DREAMS)CHAI,GlobalFund,UNAIDSandWHO
Otherpotentialdonors(HNWIs,local philanthropicorganizations,UKAID,UNITAID)
KeyStakeholdersforPrEP
Specificorganizationswillbedetermineduponnationallevel
implementationplans
Currently involved
Potential/futureinvolvement
PLANNING&BUDGETING
SUPPLYCHAINMANAGEMENT
PREPDELIVERYPLATFORMS
INDIVIDUALUPTAKE
EFFECTIVEUSE&MONITORING
16APRIL2016
County-levelHIVstructuresinKenyaCounty governmentsareresponsible fordevelopingHIVpreventionbudgetsandimplementationplans atthelocallevel,andthereforewillbecriticalpartnersinanyeffortstointroducePrEP inKenya.
County-level governancestructures forHIV
CountyExecutiveCommitteeoversees effective deliveryoftheHIVresponse atthecountylevel
CountyGovernment(Governor)implementsnationalpolicyandensuresresourceallocationfor
HIVprograms
CountyHIVCommitteeensures effective deliveryoftheHIVresponse atthecountylevel
CountyHIVCoordinationUnit(NACC)coordinates
implementationofthe KASF
CountyHIVInter-agencyCoordinatingCommittee
comprisedofstakeholderWorkingGroupsrepresentingthevariousconstituenciese.g.,CSO,FBOs,Youth,PWID,PLHIVcoordinatesandoversees implementationof
globalfundprojects
CountyKASFMonitoringCommittee
countymonitoringofKASFactivitiesacrossfive
StrategicDirectionareasofPrevention,Treatment,HumanRights,Systems
StrengtheningandResearch
Sub-County/ConstituencyHIVCommittees
membersoftheCountyHIVCommittee,responsiblefortheeffective deliveryoftheHIVresponse atthesub-
countylevel
CountyHealthManagementTeam
responsibleforensuringintegrationofHIVservices
atthecounty level
NationalGovernmentcoordinatesfunctionsof
ministriesandgovernmentdepartmentstoreinforceNACC’srole;coordinatesallocationof
fundingtodistricts
NACCSecretariatfacilitatesdeliveryof
KASF,includingaccountabilityofsectorsandpartnersinvolved
andsustainablefinancing
Sources:KenyaAidsStrategicFramework2014/15-2018/19,MinistryofHealth,2014
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APPENDIXA.ValueChainDetailB.TimelineforPrEPC.References
18APRIL2016
AppendixA:ValueChainDetail
Thefollowing slidesprovideadditionaldetailoneachsectionofthePrEP valuechaininKenya
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PlanningKeyStakeholders• MoH - createsnationalplans/priorities,andoverseesthefollowingHIV-
specificdivisions:• NACC- helpsimplementstrategicplans,coordinatesstakeholders,and
providescareforPLHIV• NASCOP- hasoversightonpolicyandguidelines,coordinatestechnical
HIVprogramming,managescapacity-building,andperformsM&E• Nationaltechnicalworkinggroups- runbyNASCOPandNACC,provide
leadershipandstrategicguidanceforimplementation
KeyStrengthsandOpportunities• Targetpopulationsandtargetgeographies forPrEP aredefined• Governmentisleadingeffortstofurtherdisaggregatedatatosegment
youthpopulation,includingAGYW• PreventionRevolutionRoadmapmakesthecaseforgeographic
targetingandcombinationpreventionincludingPrEP fortargetpopulations
• NASCOPisengagingkeystakeholderssuchascounty-levelgovernments,civilsocietyandadvocacygroups
• CostmodelsexistandarebeingrefinedfordeliveringandscalingPrEPtoFSWandMSM
KeyEmergingConsiderations• Moreprep-specificinformationisneededfortargetpopulations:
preferences, needsforaccessandsupport,effectiveuse(somewillbeavailablethroughdemoprojectandPopulationCouncilresearch)
• Translatinganationalstrategyintocounty-levelactionwillrequiresignificantguidanceandincentives(financialandtechnicalsupport,leadershipofothercounties)
• Nationalfundingisinsufficient forprovidingandsustainingPrEP;Kenyawillneeddonorstoscale-upPrEP
ReadinessforPrEPIntroductionReadinessFactor ProgressImpact, costandcost-effectivenessanalyses forPrEP aspartofcomprehensiveHIVpreventionportfolio
• Modellingstudiesunderwaytorefineimpactandcost-effectivenessestimates (HealthPolicyProject,Avenir)
• Costingstudiesunderway (CHAI/LVCTHealth);expectedQ42016
Identification andquantification oftargetpopulations forPrEP
• TargetpopulationsinRevolutionRoadmapincludeFSW,MSM,PWID,sero-discordantcouples,variedbycounty
• PlansforAGYWremainuncertain
InclusionofPrEPandfemale-controlledmethodsincurrent orupcoming nationalHIVprevention plans
• PrEP ismentionedintheKASFandincludedinRevolutionRoadmap aspartofrecommendedpreventioninterventions
Timeline andplan forPrEPintroduction andscale-up
• Earlyconsiderations articulated• NASCOPhasaskedLVCTHealthtosupportdevelopmentofanimplementationplan
Abudget forPrEProll-out totargetpopulations
• Earlybudgetconsiderationsandthinking happeningaspartofbroaderPrEPplanning
Sufficient funding toachievetargets
• DREAMShasresourcesdedicatedtoPrEPforAGYW
• GatesFoundationhasexpressedinterestinPrEPscale-up.
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PotentialTargetPopulationsforPrEPAdolescentgirlsandyoungwomen(AGYW)
Sero-discordantcouples FemaleSexWorkers(FSW)
PeopleWho InjectDrugs(PWID)
Menwhohavesexwithmen(MSM)
KeyIndica
tors
• ~4.1MtotalAGYW(ages 15-24)inKenya,basedon2009Census¹
• 21%ofnewadultinfectionsperyearareamongAGYW³
• 4.5%prevalence;byage24therateforAGYWisalmost4timeshigherthanforyoungboys²
• ~90%ofyoungwomentestforHIVatleastoncebythetimetheyareage 24²
• ~260,000couples³or5-6%⁴ofcouplesareHIVsero-discordant
• 44.1% ofnewadultinfectionsfromsero-discordantcouples³
• UnknownlevelofaccesstotestingandtargetedHIV/AIDSinterventionservices
• Lowawarenessofpartnerstatus(48%forwomen;61%formen)⁵
• Unknownnumber,butestimatedat~1000,000⁴*
• 29.3%HIVprevalence⁴• 14.1% ofnewadultinfectionsperyearareamongsexworkersandtheirclients³
• 68%testedforHIVinthepastyear andknowtheirstatus⁶
• 70% receivetargetedinterventionservices³
• UnknownnumberoftotalPWID*
• 18.3% prevalence³• 3.8% ofnewadultinfectionsperyear³
• 60%testedforHIVinpastyearandknowtheirstatus⁶
• 24% receivetargetedinterventionservices³
• UnknownnumberoftotalMSM*
• 18.2%prevalence³• 15.2% ofnewadultinfectionsperyearfromMSMandprison³
• 74% testedforHIVinthepastyearandknowtheirstatus⁶
• 55%receivetargetedinterventionservices³
Prioritiza
tion
• NationalplansdefineAGYWasaprioritypopulationforprevention;sometimesmentionedastargetsforPrEP
• Demonstrationprojects:ConfidenceProject,MP3-Youth,POWER,IPCP
• Includedinnationalplansasprioritypopulationforprevention
• MentionedastargetsforPrEP
• Demonstrationprojects:Fem-PrEP,PartnersPrEPOle
• NationalplansdefineFSWasaprioritypopulationforprevention;mentionedastargetsforPrEP
• Demonstrationproject:IPCP
• ExistingstudyoncostofPrEPscale-upforFSW
• NationalplansdefinePWIDasaprioritypopulationforprevention
• MentionedastargetsforPrEP
• NationalplansdefineMSMasaprioritypopulationforprevention
• MSMmentionedastargetsforPrEP
• Demonstrationproject:IPCP
Questio
ns
• WhatmessageswillbeappropriateforencouraginguseofPrEP withoutstigma?
• WhichchannelswillbeeffectiveforPrEP delivery?
• WhatadditionalcommunitysupportmechanismsneedtobeinplaceforPrEP’s effective use?
• HowmuchdemandwilltherebeforPrEP,especiallyrelativetootherpreventionoptionsinthepipeline?
Sources:1-KenyaPopulationandHousingCensus, KenyaNationalBureauofStatistics,2009;2-KenyaFastTrackPlantoendHIV/AIDSinAdolescentsandYoungPeople,MinistryofHealth,2009;3-KenyaPreventionRevolutionRoadmap,MinistryofHealth,2014;4-KenyaHIVResponseandmodesoftransmissionanalysis,MinistryofHealth,2009;5-KenyaAidsStrategicFramework2014/15-2018/19,MinistryofHealth,2014;6-KenyaAIDSResponseProgressReport,NationalAidsControlCouncil,2014
21APRIL2016
Budgeting
Current Funding• PEPFAR,GatesFoundation, andNike
currentlyfundPrEP-relatedefforts($39.5mallocatedtoDREAMS)¹
• PrEP researchhasbeenfundedbyBMGF,USAID,andNMHI/NIH
• MainfundsourcesforHIV/AIDS²:• >62%Bilateralfunds(PEPFAR,UK)• >15%PublicFunds(GoK)• >4%Internationalnonprofits(CHAI)
• Current fundinggoestoward³:
RemainingGapsandChallenges• ItislikelythatPrEP willnotbefunded
byGoK,spellingtheneedforadditionalfundingfromexternaldonors suchasPEPFAR
• TheoverallHIV/AIDS fundinggap (in$USDM)willcontinueuntil2019³:
PotentialNewFundingSources• FunderssuchastheGatesFoundation
haveshowninitialcommitmentstofurther fundPrEP throughcurrentrequestsforproposals
• TheNationalHospitalInsuranceFund(NHIF)willfinancetheKenyangovernment’suniversalhealthcare.Kenyaseekstoincreasethenumberofcontributors tothisfundtocovercostsofART,andpotentiallyfundadditionalHIVservices
• KenyaHIVTrust/InvestmentFundwillraisenational/countyresourcesthatwillsubsidizegovernmentHIVcosts
• DeterminingtheabilityandwillingnesstopayforPrEP inaprivatehealthcaresettingmightenablesomecost-recovery
Summary• Kenya’sHIV/AIDStotalexpenditureshaverisenovertime,accountingfor2%oftotal
countryGDP.Over68% offundingcomingfromexternalsources³• Thecountryhasprojected fundinggapstoimplementthenewstrategicplan(KASF)• Kenyawillstrivetoclosefundinggapsbymaximizingprogramefficiencytoreduce
costs,andincreasingdomesticfinancingby50%by2019
Nationalbudget
$956.2McostsforHIV$210.3Mofwhichisprevention$0M ofwhichiscommittedtoPrEP
Treatment& Care 52%
Prevention 21%
Socialinclusion,humanrights&gender 13%
Leadership&governance 7%
Healthsystems 4%
Year 2015 2017 2019
Baselinefunding $829M $797M $724M
Proposedfunding $829M $852M $940M
Resourceneeds $956M $948M $833M
Gap -13% -10% +13%
Sources:1- “ProjecttocutnewHIVcasesingirls,womenlaunched”,SciDevNet,2015;2- KenyaNationalAidsSpendingAssessment,ReportfortheFinancialYears2009/10-2011/12,NACC,MOH,andUNAIDSKenya,2014;3-KenyaAidsStrategicFramework2014/15-2018/19,MinistryofHealth,2014
22APRIL2016
Procurement&DistributionKeyStakeholders• Gileadlicenses Truvadamanufacturing globally.Itsregionalbusiness
partnerinKenya iscurrentlyPhillipsPharmaceuticalsLimited• Pharmacy andPoisons Board- approves allnewmedications• KenyaMedicalSuppliesAuthority- centralprocurement agency
undertheMoH; partnerswithdonors,countygovernments andcommunity-based organizations (CBOs) toestablish effective supplychains
• CBOs andcountylevelgovernments - willberesponsible forthe localsupplychainofPrEP
KeyStrengths andOpportunities
• Strong supply chainfor ARVs,withlimitedinstances ofshortages
• Strong E- MedicalRecordSystem (EMR) toensure ART coordinationandqualitymanagement system inplace
• Althoughthe detailsonwhowillprocurePrEPare stillunclear,theGoK has committedtosupporting procurementforPrEP tomake itavailablewherever needed (pharmacies, HIVclinics)
KeyEmerging Considerations• Need foradditionaldata ontargetpopulations demand estimates
anduser preferences toinformdemand forecasts
• Lackofclarityonwhowillmanufacture and distributePrEP– likelynotachallengewhen handledbycurrentARV channels butquestionsremain aboutadditionaldelivery channels notadministeringART
• HighpriceofTruvada – couldshiftwithemergence ofalternativesoralPrEPdrugs
ReadinessforPrEPIntroductionReadinessFactor ProgressRegulatoryapprovalofform(s)oforalPrEPbyauthorities
• Truvada approvedforpreventionbythePharmacyandPoisonsBoard
• OtherformsoforalPrEPinpipeline
EffectivedemandandsupplyforecastingmechanismsforPrEP
• StrongsupplychainmanagementinplaceforARVs,whichwilllikelytranslatetoPrEPreadiness
Manufactureridentification andcontract negotiationtopurchasePrEP
• Notoutsideofdemonstrationprojects
Product andpackagingdesigntomeettargetpopulation needsandpreferences
• Currently aplasticpillbottle,toberefilledmonthly;unknownifformatwillbeconsistentforotherformsoforalPrEP
Developmentofdistribution plan forPrEPtoreachtargetpopulations
• NACCandotherentitiesdeterminingmosteffectivechannelsandaccompanyingdistributionplans
• NASCOP’s RFPsforimplementationofPreventionRevolutionRoadmapwillprovideinsightondistribution
Effectivedistributionmechanisms toavoidPrEPstock-outsinpriority facilities
• KenyahashistoricallymaintainedastrongsupplychainforARVs,withlimitedinstancesofshortages.LikelytotranslatetoPrEP
23APRIL2016
PrEPDeliveryPlatformsKeyStakeholders• PrEPTWG– informidentificationandplanningfordeliverychannels• Comprehensivecareclinics(currentARVchannels)- coulddistributePrEP
alongsideHIVtestingandtreatment• Community-basedorganizations- cansupportdemandgeneration,distribution,
andprovidesupportforPrEPatthelocallevel• County-levelgovernments– createcounty-levelHIVplansaspartofKASF
deliverythatwouldneedtoincorporatePrEP• Keypopulationclinics-provideHIVservicestokeypopulationsdirectly
KeyStrengthsandOpportunities• ARVclinicshaveawidereachthrough~2000sitessuchascomprehensivecare
centersandCBO-runclinics.ThesecouldbeleveragedforPrEPdelivery• AdditionaldistributionplansarecurrentlybeingdevelopedbyNACC, takinginto
accountthevoiceofcommunities(viafocusgroups) toidentifyaccessneeds,preferences, andsupportmechanismsnecessaryforeffective distributionofPrEPtotargetpopulations
• ConsidertheabilityandwillingnesstopayforPrEPthroughprivatehealthchannels,somealreadyreachingkeypopulations(e.g.,FHI’sGoldStarNetwork)
KeyEmergingConsiderations• HealthworkersinmanysettingsarenotequippedtodistributePrEPtotarget
populations,oraddressstigma• HIVtestingkitshortagescouldimpedePrEPprescription/access• NeedbetterunderstandingoffulllandscapeofpotentialPrEPdistribution
channels inordertomosteffectivelyreachtargetpopulations• Capacity-buildingwillbeneededinordertoequipnon-ARVdeliverychannelsas
PrEPdelivery/referralsites,includingcapacitytointegratewithothercareoutlets(e.g.,hospitals)toprovideliverandkidneytestingneededalongsidePrEP
• Noear-markedfundingforPrEPisavailableforcapacity-building
ReadinessforPrEPIntroductionReadinessFactor ProgressIssuanceofstandardclinicalguidelines forprescription anduseofPrEP
• CDCcurrentlydraftingstandardtreatmentguidelines;NASCOPexpected toissueguidelines inJune2016
Sufficientinfrastructure andhumanresourcestoconduct initial HIVtestsandprescribePrEPinprioritychannels
• HighreachofHTC forhigh-riskpopulations,withlowerratesforgeneralpublic,through~5000testingsites.
• Humanresourcesneedslikelytobedetermined tomeetPrEPguidelines
Plantoengagehealth careworkersonPrEPanddeliverytotargetpopulations(includingmitigatingstigma)
• No planinplace,butconsiderationsarebeginningtoemerge inrelationtotheneedsspecifictoPrEPdeliveryandthetargetpopulationslikelytoaccessPrEP.
Toolstohelppotential clientsandHCWunderstandwhoshould usePrEPhavebeencreated
• Somematerialsalreadyexistfromdemonstrationprojects
• LVCTHealthdevelopingariskassessment toolforPrEPuse
Sufficient resourcestoroll-out plansforhealthcare workerengagement
• Resources notyetsecured.
24APRIL2016
CurrentPrEPDeliveryChannelsDemonstrationProjectsandOpenLabelExtensions DREAMS
Background
• PrEPdemonstrationprojectsthroughoutKenyahavedeliveredPrEPthroughanumberofprojects.Theseprojectsinclude:ConfidenceProject;Fem-PrEPwithadultwomen;LVCTandSWOPIPCPdemoprojectwithFSW,youngwomen,andMSM;MP3-Youthwithyouth15-24yearsold;PartnersPrEPdemoprojectandOLEwithsero-discordantcouples.
• TheDREAMS initiative(Determined, Resilient, Empowered,AIDS-free,Mentored,and Safewomen)willprovidePrEPtoyoungwomeninthedistrictsofHoma Bay,Siaya,KisumuandNairobibeginningin2016/2017. ItislikelythatoralPrEPintheformofTruvadawillbedonatedbyGileadforusebyDREAMS.
KeyS
trengths
• DemoprojectsalreadyreachingtargetpopulationsathighriskofcontractingHIV• ExistingaccesstoPrEPandassociatedtesting,monitoring,andcounsellingservices• ExperiencedstaffhighlyknowledgeableaboutPrEP• Valuableinsightsfromrecruitmentandretentioneffortsthusfar• LowlevelsofstigmaamongstaffworkingwithPrEPusers
• Targetedprogramreachinghigh-risk(asidentifiedbycommunity-ledcriteria)adolescentgirlstostart2016/17• PrEPdeliverycoupledwithbehaviorchangeactivitiesandextensivecounseling• FundingforPrEPsecured(TruvadadonatedbyGilead,programcostsfromDREAMSfunding)• PotentialtoexpandPrEPthroughout thesedistrictsgivenother investmentstomakePrEPavailabletoDREAMSparticipants,includinglogistics,procurement,demandgeneration,andcommunitybuy-inefforts
Key
Challenges • PerceptionofPrEPaspartofan“experiment”deterspotential
usersfearingpoorsafetyandefficacyofdrug• Highercostsofdelivery indemonstrationprojectcontext
• DREAMS’PrEPcomponent toreachonlyadolescentgirlsincommunitieswheremanyotherpopulationscouldbenefitfromPrEP• ReachlimitedtoHoma Bay,Siaya,KisumuandNairobi
25APRIL2016
ComprehensiveCareCenters &otherARTsites SexualandReproductiveHealth(SRH)careproviders
Background
Public (Gov’t) NGO Private
• Publichospitals,clinics,andotherhealthcarecenters
• NGO-runclinics,carecenters,otherHIV serviceprogramsincludingthosespecificallyforkeypopulations(e.g.,SWOP,LVCTHealth,FHI,PSI)
• Private fee-for-serviceproviders(e.g.,FHI’sGoldStarNetwork)
• ArangeofSRHcareincludingfamilyplanning,post-abortioncareclinics,pre-natalcare&otherSRHproviders
KeyS
trengths
• Mostvisibletogeneralpopulation
• Systemsguidedandlinkedwithcountyandnationalstandards/agendas
• Canprovidegreateraccesstokeypopulations(FSW,MSM,PWID)
• Effectivelyreachhigh-riskindividualswithlow/nostigmapresentincentersoramongstaff
• Frequentuseofpeer-educatorprograms,whichmightbecriticaltoeffectiveuseandincreaseddemandgeneration
• Opportunitiestodeliverthroughprivatechannelsaccessingkeypopulationssuchas FHI’sGoldStarNetworkclinicsinNairobi,thecoastalregion,andRiffValley
• DiscreteaccesstoPrEPwithoutstigmaforthosewhocanaffordit
• Notdependentonaid
• Providegreateraccesstosero-discordantwomenandAGYWinfemale-friendlyandtrustedsettings
• StaffhavelowerlevelsofstigmaagainstAGYWwhoseek familyplanningandHTCservices
• Post-abortioncareclinicshavethepotentialtoreachwomenatveryhighriskofHIVinfection
• LowcostofdemandgenerationsincewomenarealreadyvisitingSRHservices
• Over2000ARTsitesthroughoutKenya• Well-integratedprocurementanddeliverysystems• LaboratorycapacityfornecessaryPrEPmonitoringinplace• HTC-trainedstaff
Key
Challenges • HCWstigmaagainsttargetpopulationsdetersmanyfromaccessingcarethroughthesechannels
• Staffandresourcesperceivedtobestretchedthin,resultinginsuboptimalcare• Maynoteffectivelyreachtargetpopulationsathighestrisk
• PotentiallylimitedexperienceandtraininginHTClinkages
• Limited/nolaboratorycapacityfornecessary PrEPmonitoring
• AGYWmayhavetroubleaccessing
PotentialPrEPDeliveryChannelsThisisanareaoffocus
forOPTIONS.Additionaldetailsexpectedbythe
endof2016
26APRIL2016
IndividualUptakeKeyStakeholders• DREAMS-willpotentiallyhaveresearchandimplementationpracticefor
AGYWusingPrEPthatcanbeusedtoinformfurtherscale-up(managedbyGlobalCommunitiesinKenya)
• Community-basedandfaith-basedorganizations- willplayakeyroleinreachingtargetpopulationslocallyandinfluencingcommunitybuy-inforPrEP
• Localandnationalmedia- tohelpaccuratemessagingonPrEPasaneffective andsafe preventionoption
KeyStrengthsandOpportunities• SomeresearchexistsonuserpreferencesforPrEPinkeypopulations
(FSW,MSM,andsero-discordantcouples),including:dosagepatterns;willingnesstoconsiderusingPrEP;potentialdemandforPrEP
• NASCOPhasplansforadditionalresearchspecificallyondeliverychannelsandaccesspointsforPrEP
• ImplementationstakeholdersacknowledgetheimportanceofaddressingstigmainordertoreachAGYWandsero-discordantcouples
KeyEmergingConsiderations• Stigmaisamajorconcernforuptake.Thisincludesboththestigma
associatedwithHIVandthosenormallythoughtofas“highrisk”populations,aswellasstigmaagainstyoungwomenwhomightbesexuallyactiveandseekingSRHcare.ThereisastrongneedtonormalizePrEPandcreateasupportivecommunicationstrategyforitsuse
• Awareness/demand forPrEPisunknown;willrequireinvestmentindemandgeneration(CHAIiscurrentlydoinginitialdemandgenerationresearchtobecompletedbyQ4/16)
ReadinessforPrEPIntroductionReadinessFactor Progress
Clearandinformativecommunications onPrEPforgeneralpublic audiences
• Nocommunication strategyyetexists.
Developmentofdemandgenerationstrategiestargetedtounique needsofdifferent populations
• Whileearlyconsiderationsfordemandgenerationare beingdiscussed,strategies arenotyetbeingcreated
Linkages betweenHTC,PrEPprescription, andPrEPaccesstoenablePrEPuptake
• Necessary linkageswillbeunknownuntilPrEPguidelines(outliningchannels,populations,andprescriptiondetails)arecompleted.IfPrEPisdeliveredthroughARVchannels,thelinkagesare likelytoenablePrEPuptake
Information forclients onhowtoeffectivelyusePrEPforalltargetpopulations
• Informationexistsforthoseparticipatingindemoprojects.Generalinformationforalltargetpopulationswillneedtobedeveloped.
27APRIL2016
KeyConsiderations
Stigma
• Earlystigmalingers:makingPrEPwidelyavailablebeyondkeypopulationswouldhelpmitigatepreconceptionsofPrEPasanoptiononlyforFSWandMSM.Thisisimportantbecausemostdemoprojectshavebeendonewithkeypopulations.AnyPrEPcommunicationscampaignwillneedtodirectlyaddressthestigmaassociatedwiththosepopulations.
• Amonghealthworkers:thechallengesaretwofold- healthcareworkershavetheirownbiasesaboutwhoshouldbeaccessingbirthcontroloptionsandHIVpreventionservices,andtheyoftenlacktheappropriateinformationandtrainingtoeffectivelyprovidearangeofoptionsforindividualstomakeinformeddecisions.
• Youthandfemale-friendlyspacesarecriticalandneeded:centersthatarestigma-free,youthandfemale-friendlywillfacilitateuptake,butchangestofacilitieshavebeenslowandinsufficient.
DrugPreconceptions
• There arefearsaboutdevelopingresistancetoARVswhileonPrEP,anddevelopingphysicalsideeffectsassociatedwithARVs.
• PeoplerecognizeTruvadaasanARVanddonotwanttobeseentakingitiftheyareHIVnegative.
Messengers• Messages aroundPrEPneedtobeproactive,consistent,andcomefrommultipledirections.Importantmessengersinclude:nationalandcountygovernments,ministries,CBOs,celebrities,religiousleaders,healthcareworkers,peersandvariousformsofmedia(e.g.print,radio,online).
Messages
• Riskperception:youngwomeninKenyagenerallydonotseethemselvesathighriskforHIVtransmission.Theyaremorefocusedoneconomicopportunityandeducation
• PrEPaspower: PrEPcouldbeframedasanoptiontoprotectoneself and thecommunity. Alsoassomethingthatisempoweringandpositiveasopposedtoshamefulandincriminating.Ideasformessagingincluded statementssuchas:“Ourownchoice,ourownpower”
• “MpangoWa Kando”:potentialtobuild-offofpreviousnationalcampaign abouttheconsequencesof extramaritalaffairstoappealtopotentialPrEPusersbyhighlightingtheriskassociatedwith theirown/theirpartners’conduct
• PrEPforall: ideasfor inclusivemessaging includedstatementssuchas“PrEPisforyou,PrEPisforme”and“PrEPisforallofus”
KeyEndUserThemesforPrEP
28APRIL2016
EffectiveUse&MonitoringKeyStakeholders• NACC- holdscountry-wideresponsibilitytotrackKASFprogressandHIV-related
programsuccess• CDC- workscloselywithGOKandimplementingpartnerstosupportlabsystems
andnetworksstrengthening• NationalHIVReferenceLaboratory(NHRL)- leadspolicyandguidelines
formulationonHIV-relatedlabservicestostrengthencountry’slaboratorycapacity
KeyEmergingConsiderations• MechanismsforgatheringlocaldataonPrEPimpactarenotestablished• Planstoincreaseeffectiveusedonotexist;noroleshavebeenassignedfor
generatingthesupportsystemsneeded tofostereffective useatlarge• Interventionsusedtoencourageeffective useamongdemoprojectparticipants
wouldlikelybetoocostlyinmanyreal-lifesettings(e.g.extensivecounselling,useofpeereducators)
• Frequent,ongoingmonitoringneedsyettobedeterminedandlikelytobothdriveupcostsofdeliveryanddiscourageongoinguseofPrEP
ReadinessforPrEPIntroductionReadinessFactor Progress
Establishedplanstosupport effectiveuseandregularHIV,creatinine testing thatreflect theuniqueneedsoftargetpopulations
• Effectiveuseyettobedefined• Whileearlyconsiderationsforencouragingandsupportingeffective useandadherencetoregulartestingarebeingdiscussed,specificstrategies fortargetpopulationsarenotyetbeingcreated.
Capacity toprovideongoingHIV andcreatinine level testingforPrEPusersaccessibletotargetpopulations
• While thereisincreasingHTCcapacityforcurrentefforts,gapsremainparticularlyforreachingtargetpopulations.Additionally,exacttestingneedsforPrEPareyettobedetermined.
Monitoring systemtosupport datacollection forongoinglearning(e.g.,rateofpatientsreturning for2ndvisit,non-HIVSTIrates)
• ThenationalMonitoringandEvaluationFramework2014/15-2018/19isthefoundationformonitoringprogresstowardHIVnationalgoals (keyindicatorsincludereducingstigmarelatedtoHIV-AIDS,andreducinginfectionswithinkeypopulations).
KeyStrengthsandOpportunities• Nationalmonitoringandevaluationframework includesprioritiestoincrease
fundingtowardhealthcarecapacity-building,reducingstigma,andtargeting/prioritizingkeypopulationssuchasMSM,FSW,youth
• VarioussurveysexisttocollectnationaldataontheHIVepidemic,includingthesituationroomtoolwhichwillshowlive,localupdatesonHIVincidenceandmortality
• NASCOPleadingthedevelopmentPrEPM&Eplans• Lessonsoneffectiveusefromdemoprojectstolearnfromandbuildoninclude
consistentregimens,structuredfollow-up,andcounselling/communitysupport
29APRIL2016
AppendixB:TimelinesforPrEPQ1, 16 Q2, 16 Q3, 16 Q4, 16 Q1, 17 Q2, 17 Q3, 17 Q4, 17 2018 2019 2020
Research
IPCPKenya(LVCTHealthandSWOPKenya)studyonPrEPforAGYW,MSM,andFSW
PartnersDemonstration ProjectonPrEPforsero-discordantcouples
MP3-Youthstudy toevaluatecombinationpreventionforadolescentboysandgirls
POWERdemonstrationprojectsforadherence/deliverysupportforwomen
EMOTIONandGEMSstudies
ConfidenceProjectstudy (LVCTHealthandLSHTM)onPrEPacceptabilityreports
DevelopmentofanationalresearchagendaforHIV
Planning/
Implem
entation
WHOPrEPImplementation Guidelinesexpected
KenyaPrEPtreatmentguidelinesandimplementationplanexpected
DREAMSprogrammingimplementedinHoma Bay,Siaya, Kisumu, andNairobi
Policy NextNationalAIDSStrategicFramework
(KASF)developed
Financing
NASCOP RFPsforPreventionRevolutionRoadmapimplementation,includingPrEP
KenyaGlobal
Exacttimelinestobeclarified
30APRIL2016
AppendixC:References• KenyaAidsStrategicFramework2014/15-2018/19,MinistryofHealth,2014• KenyaPreventionRevolutionRoadmap,MinistryofHealth,2014• KenyaAIDSResponseProgressReport,NationalAidsControlCouncil,2014• KenyaMonitoringandEvaluationFramework 2014/15-2018/19,MinistryofHealth,2014• NationalguidelinesonHIVtestingandcounselling,MinistryofHealth,2008• GuidelinesonUseofAntiretroviralDrugsforTreatingandPreventingHIVInfection:Arapidadvice,MinistryofHealth,2014• KenyaAidsIndicatorSurvey,MinistryofHealthandothers,2012• KenyaHIVResponseandmodesoftransmissionanalysis,MinistryofHealth,2009• KenyaFastTrackPlantoendHIV/AIDSinAdolescentsandYoungPeople,MinistryofHealth,2009• KenyaPopulationandHousingCensus,KenyaNationalBureauofStatistics,2009• KenyaNationalAidsSpendingAssessment,ReportfortheFinancialYears2009/10-2011/12,NACC,MOH,andUNAIDSKenya,
2014• Costofprovidingpre-exposureprophylaxistopreventHIVinfectionamongsexworkersinKenya,HealthPolicyProjectand
MinistryofHealth,2014• ConsiderationsforRollingOutOralPrEP toTargetPopulationsthroughSocialMarketing,FHI360andIRDO,2013• Barriersandfacilitatorstopre-exposureprophylaxis(PrEP)eligibilityscreeningandongoingHIVtestingamongtarget
populationsinBondo andRarieda,Kenya:Resultsofaconsultationwithcommunity stakeholders,BMCHealthServicesResearch,2014
• SafetyandAdherencetoIntermittentPre-ExposureProphylaxis(PrEP)forHIV-1inAfricanMenWhoHaveSexwithMenandFemaleSexWorkers,Plos One,2012
• PreferencesforandWillingnesstoUseAntiretroviralBasedHIV-1PreventionStrategiesamongKenyanHIV-1SerodiscordantCouples,NCBI,2012
• “ProjecttocutnewHIVcasesingirls,womenlaunched”,SciDevNet,2015• SouthAfricaandKenyaApprovalofOralPrEP ShouldSpurRollout,AVACblog,2015• http://www.prepwatch.org/,AVAC,2015