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PrEP Roll-out in Kenya Michael Kiragu 20 July 2016

PrEP Roll-out in Kenya Michael Kiragu 20 July 2016. Outline. Why prevention? Kenya context Oral PrEP policy in Kenya What is the evidence? Requirements for scale up? What’s next?. www.lvcthealth.org. The need for HIV Prevention. www.lvcthealth.org. Kenya Context.

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PrEP Roll-out in Kenya Michael Kiragu 20 July 2016

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  1. PrEP Roll-out in Kenya Michael Kiragu 20 July 2016

  2. Outline • Why prevention? • Kenya context • Oral PrEP policy in Kenya • What is the evidence? • Requirements for scale up? • What’s next? Building Partnerships, transforming lives www.lvcthealth.org

  3. The need for HIV Prevention Building Partnerships, transforming lives www.lvcthealth.org

  4. Kenya Context • Population: 46 million • 1.5 Million people living with HIV (UNAIDS, 2015) • 71,000 new adult infections every year (UNAIDS, 2015) • Mixed epidemic (generalized and concentrated) • Concentrated among key populations • Wide variation in prevalence and incidence in geographical locations • Engendered epidemic (women > men) Building Partnerships, transforming lives www.lvcthealth.org

  5. Kenya HIV Prevention Revolution Approach Revolutionary approaches to HIV prevention: • Combination prevention approach • Shift focus from interventions to populations • Leverage synergies across sectors • Align of the HIV prevention to the geographical disparities in the epidemic Oral PrEP recommended for: • Key populations (MSM, sex workers, PWID) • Adolescent girls and young women • Discordant couples Building Partnerships, transforming lives www.lvcthealth.org

  6. Policy for oral PrEP Implementation • Registration of Truvada for HIV Prevention by regulators • PrEP included in the newly in new “national guidelinesfor test, treat & prevent” launch: • Describes situations of HIV risk • Outlines clinical and laboratory evaluation for initiation and monitoring • Underlying principle is to increase access and minimize barriers • Allowing innovation in service delivery (community and facility approaches can be used) • Accompanying documents under developmen • Data tools • Job aids • SOPs • IEC materials Building Partnerships, transforming lives www.lvcthealth.org

  7. Evidence for action! http://www.prepwatch.org/kenya/ Building Partnerships, transforming lives www.lvcthealth.org

  8. Plans for scale up Building Partnerships, transforming lives www.lvcthealth.org

  9. Make oral PrEP the norm! Advocacy and Education for Health Providers • Address potential stigma (PrEP & users) • Willingness to recommend/prescribe PrEP influenced by personal values and level of knowledge Community education and demand creation • Educate communities and create demand • Change unuseful paradigms of communicating Prevention • deemphasize risk • Should we use self esteem and intimacy? Microbicide communication materials Borrowed from FHI 360 Building Partnerships, transforming lives www.lvcthealth.org

  10. What do we need for public health scale-up of PrEP Simplification of procedures and decision making • Evaluation for eligibility (What’s Substantial risk?) • Risk assessment (Caution: Stigma!) • Identification and management of adverse events • Goals of adherence? Monitoring of adherence? • Referral criteria and pathways • Discontinuation of PrEP Building Partnerships, transforming lives www.lvcthealth.org

  11. What lessons/systems can we leverage from ART scale up? • Commodity management systems • Integrate PrEP in surveillance systems for ARV resistance • Integrate data collection & reporting into existing HIV service tools • Identify alternative models for service delivery (community, differentiated models of care) • Lab sample transportation networking Vertical System? Building Partnerships, transforming lives www.lvcthealth.org

  12. In closing • We need to rapidly scale up oral PrEP • Leadership and commitment is key • Simplicity will facilitate rapid scale up • Community-led education and advocacy • Leverage what has worked in the past (ART, HTS, SRH etc) Building Partnerships, transforming lives www.lvcthealth.org

  13. Acknowledgements and Partnerships Ministry of Health, Kenya: NASCOP and NACC SWOP Clinics (PHDA) UN Family – WHO, UNAIDS, UNICEF PEPFAR CDC/USAID Bill & Melinda Gates Foundation CHAI O’Neill Institute, Georgetown Law London School of Hygiene and Tropical Medicine Imperial College London, Results for Development, IAVI, AVAC, FHI 360, WRHI, FSG, Avenir Health, McANN, Pangaea, Gilead Health Sciences Community serving organizations: HOYMAS, GALCK,KESWA, BHESP, NYARWEK, ISHTAR MSM County and sub-county HMTs

  14. THANK YOU CONTACT US: Email: mkiragu@lvcthealth.org www.lvcthealth.org Building Partnerships, transforming lives

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