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SCALING UP ART IN KENYA: Programmatic issues

SCALING UP ART IN KENYA: Programmatic issues. Mary Wangai MD Deputy 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

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SCALING UP ART IN KENYA: Programmatic issues

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  1. SCALING UP ART IN KENYA: Programmatic issues Mary Wangai MD Deputy Director National AIDS and STD Programme

  2. 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

  3. 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.

  4. HIV Prevalence in Pregnant Women in Sentinel Surveillance Sites in Kenya

  5. HIV Prevalence by Age Group

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

  7. 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”

  8. 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

  9. 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

  10. National ART regimens Adults: • 1st line: Stavudine + Lamivudine + Nevirapine/Efavirenz • 2nd Line: Zidovudine + Didanosine + Nelfinavir/Kaletra(Lopinavir/Ritonavir) Children: • Zidovudine + Lamivudine + Nevirapine

  11. 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

  12. Current anti-retroviral therapy ART Activities • Est. 7 to 9,000patients 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

  13. Public Sector and partners Currently providing ART GOK Partners EldoretMOI Homabay MSF-F Nakuru MOH Nairobi CDC Amref MSF -B Mombasa FHI

  14. Faith based Hospitals Currently providing ART Bungoma Kakamega Butere Nyandarua Meru-N Kisumu-2 Bomet Meru-2 Rachuonyo Nyando Nyeri-2 Meru-S Thika Trans Mara Nairobi-4 Kiambu-3 Machakos

  15. 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

  16. Scale up ART GOK Kitale Partners Busia EldoretMOI Kakamega New Nyanza Hosp Nyeri Embu Homabay MSF Nakuru MOH Thika Garissa Kisii Mbagathi Kenyatta N.Hosp Nairobi CDC/Amref MSH-F Machakos Kilifi Mombasa FHI Mombasa General

  17. GOK to support 5-6 Faith based Hosp CHAK Catholic CHAK Kendu-bay Maua Tenwek Muslim Nazareth Tabaka CHAK MEWA

  18. 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

  19. 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

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