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