SCALING UP ART IN KENYA:

Programmatic issues

Mary Wangai MDDeputy Director

National AIDS and STD Programme

Introduction 2.2 m Kenyans estimated to be HIV+ and

200, 000 needing antiretroviral therapy (ART)

Negative impact on all sectors of society Reversed previous health gains: life

expectancy 62 to 46 years 50% to 70% of hospital bed occupancy at

medical wards in many government hospitals are HIV related

Increased death rate: Est. 500 deaths daily

National estimate summary Significant drop in national HIV

prevalence in the last 3 years: 13 to 10% The country experienced high infection

rates in the mid 90’s culminating in peak prevalence in 1998, 1999, 2000.

Initially the prevalence among the young was higher than the older age group but now it is lower or equal in almost all the sites and in the national statistics.

HIV Prevalence in Pregnant Women in Sentinel Surveillance Sites in Kenya

0

2

4

6

8

10

12

14

16

Per

cen

t

HIV Prevalence by Age Group

Prevalence of HIV by 5 year age groups

7.7

10.8 10.611.6

8.57.7

00

2

4

6

8

10

12

14

15-19 20-24 25-29 30-34 35-39 40-44 45-49

Percent

Trends in mortality among children under five years old, 1981-1996

80

85

90

95

100

105

110

1982 1986 1991 1996

ZambiaKenyaCameroon

Working Programme Goal

“Progressively deliver effective ART, reaching 20% by 2005 and 50 – 60% by 2008, so as to increase quality of life and survival by 10 years; reduce HIV-related hospital admissions by 60% and enhance significantly national prevention efforts”

GOK Policy HIV/AIDS Control is top priority for current

government Funds committed in 2002/3 budget

Lab capacity for monitoring patients Assuring drug quality Seed money to purchase ARVs for regional sites

Parallel importation of brand and generic drugs Commitment to private-public sector partnership

Ensure quality, standard care and access Recognition that ARVs are essential drugs

Cost sharing/recovery in the public sector

Program gains Guidelines on ARV use, OI prophylaxis,

home based care and VCT are available Standard regimen determined National

1st and 2nd line ART ARV training of health workers is ongoing Branded and generics ARVs are available Costs are falling, due to increasing

access – generic 1st line cost US$ 35 to $40 /month

Cost of 30 Days of ARV Therapy in Kenya

0

10,000

20,000

30,000

40,000

50,000

Kenyan S

hill

ings

Jan - Feb 2001 Sep - Oct 2001Jan - Feb 2003

National ART regimens

Adults: 1st line: Stavudine + Lamivudine +

Nevirapine/Efavirenz 2nd Line: Zidovudine + Didanosine +

Nelfinavir/Kaletra(Lopinavir/Ritonavir)Children: Zidovudine + Lamivudine + Nevirapine

NASCOP Situational Assessment

Assessment covered: National Central Management Unit and

ART in Kenya generally ( Nov to Dec 2002)

13 sites using JSI modified instrument (May 2003):

7 Provincial Hospitals 4 High volume Districts 2 Teaching Hospitals

Current anti-retroviral therapy ART Activities

Est. 7 to 9,000 patients are on ART in Kenya.

ART available at ~ 20 private companies, numerous private physicians and hospitals

34 / 57 mission hospitals, increased from 600 to 2400 patients in 1 year

5 public health facilities in collaboration with partners; 1500 patients

2 NGO health facilities; 50 patients

Public Sector and partners Currently providing ART

HomabayMSF-F

EldoretMOI

NairobiCDC Amref

MSF -B

NakuruMOH

MombasaFHI

GOK

Partners

Faith based Hospitals Currently providing ART

Kiambu-3

ThikaNyeri-2

Nyandarua

Machakos

Meru-2

Meru-N

Meru-S

Nairobi-4

Kisumu-2

NyandoRachuonyo

Trans Mara

Bomet

KakamegaButere

Bungoma

Issues for Scaling up Public and private sector partnership

Private sector target those who can pay Public sector target this with limited ability

Systems concerns Trained personnel Procurement & Logistics Data management Infrastructure

Quality assurance and Quality Control M& E : HMIS and patient tracking system

Scale up ART

HomabayMSF

EldoretMOI

NairobiCDC/Amref

MSH-F

NakuruMOH

MombasaFHI

GOK

Partners

MombasaGeneral

Kenyatta N.Hosp

New NyanzaHosp

Thika Garissa

EmbuNyeri

Machakos

Kakamega

Mbagathi

Busia

Kitale

Kisii

Kilifi

GOK to support 5-6 Faith based Hosp

CHAK

Nazareth

MauaTenwek

MEWA

Tabaka

Kendu-bay

Catholic

CHAK

Muslim

CHAK

Challenges Inadequate funds and system related

weaknesses Physical infrastructure at health

facilities Policy gaps e.g. equity, waiver system Human resources- numbers, training and

cadre Quality control and assurance

mechanisms Home Based Care Facilities-inadequate

Way Forward Policy Formulation Human resources assessment, planning

and training. Strategic plan formulation Operational planning exercise – upscale

to 13 sites by January 2004. To include communication strategy,

LMIS, M&E Framework, Adherence Strategy