Rapid scale-up of PrEP services for HIV serodiscordant couples

a�ending HIV care clinics in KenyaElizabeth M. Irungu, Kenneth Mugwanya, Nelly Mugo, Elizabeth Bukusi, Kenneth Ngure, Josephine Odoyo, Elizabeth Wamoni,

Sarah Masyuko, Jennifer F. Morton, Lara Kidoguchi, Gena Barnabee, Gabrielle O'Malley, Jared Baeten for the Partners Scale Up Team

n In 2016, the Kenya Ministry of Health released guidelines recommending pre-exposure prophylaxis (PrEP) for persons at substan�al risk of acquiring HIV.

n HIV uninfected members of HIV serodiscordant partnerships, where the HIV infected person is not virally suppressed have an on-going risk of acquiring HIV.

Background

Method

Partners Scale Up Project

n As part of the na�onal roll out of PrEP, the Partners Scale Up project, is conduc�ng na�onal scale up of PrEP for HIV uninfected members of HIV serodiscordant couples and other at risk persons.

n PrEP delivery is integrated i n t h e a n � r e t r o v i r a l treatment (ART) clinics in public health facili�es in Central and Western Kenya.

n Between January and July 2017, 24 high volume HIV care clinics were ac�vated to begin PrEP implementa�on

- in a phased manner, using a randomized stepped wedge design

- following the Kenyan na�onal PrEP program measures and training.

n Prior to ac�va�on, we trained the health providers using a 2-day, case-based interac�ve curriculum.

n We obtained program indicators for numbers undergoing CHCT and ini�a�ng PrEP and ART from all clinics.

n We compared the frequency of PrEP ini�a�on prior to and a�er implementa�on, using generalized mixed models adjusted for clustering and �me trends.

Results

PrEP ini�a�ons

Conclusion

n Delivering PrEP at scale for HIV serodiscordant couples in public HIV clinics in Kenya is feasible, with over 2000 PrEP ini�a�ons done in 24 clinics within the first year.

Acknowledgments

n Ministry of Health, NASCOP and county governments in Kenya

n Health providers in all the PSUP clinics

n Partners Scale Up Project Team

n Funders:

• Na�onal Ins�tutes of Health

• Bill and Melinda Gates Founda�on

Poster # 1053

Characteris�cs of PrEP ini�ators at baseline (N = 1758)

n Over the first year of implementa�on the number of at-risk persons ini�a�ng PrEP increased significantly from 146 prior to 2068 (p<0.01) by December 2017.

n The number ini�a�ng PrEP increased each month of this period.

For more informa�on contact: Elizabeth Irungu, Email: eirungu@pipsthika.org

n Overall, 716 health providers working in public health facili�es were trained.

Ÿ Nurses - 33%

Ÿ HIV counsellors - 22%

Ÿ Clinical officers - 20%

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February March April May June July August September October November December January

Central Region Western Region Total Ini�a�ons

Risk factor n (%)

Has a HIV+ partner 1598 (91%)

HIV+ partner on ART <6 moths 480 (30%)

Couple wants to conceive 399 (25%)

Suspected poor ART adherence 224 (14%)

Detectable viral load 176 (11%)

Inconsistent or no condom use 637 (36%)

Sex partner at high risk & HIV status unknown 188 (11%)

Has sex with >1 partner 162 (9%)

Recent sex under influence of alcohol 36 (2%)

Recurrent PEP use 25 (1%)

Recent STI 15 (0.9%)

Transac�onal sex 16 (0.9%)

On going IPV/GBV 9 (0.5%)

Injec�on drug use with shared needles 1 (<0.1%)

Reported HIV risk factors among PrEP ini�ators (N = 1758)

Characteris�c n (%) or median (IQR)

Female sex 930 (53%)

Age, years 32 (26, 39)

Age <30y 796 (45%)

Married or cohabi�ng 1613 (92%)

Number of children in partnership 1 (0-3)

Propor�on repor�ng children in partnership 542 (31%)

Months aware of HIV serodiscordant status 1 (0.25 – 4)