HIV TRENDS UNIVERSAL ACCESS TO HIV TREATMENT IN KENYA Dr Irene - - PowerPoint PPT Presentation

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HIV TRENDS

UNIVERSAL ACCESS TO HIV TREATMENT IN KENYA

Dr Irene Mukui National AIDS & STD Control Programme

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Outline

Introduction HIV trends and current Statistics Access to ART Successes Challenges

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Introduction

HIV/AIDS remains a major challenge in Kenya. 50% reduction in prevalence over the past 10

years

Kenya has mixed epidemic both generalized and

concentrated

Heterogeneity across age , sex and regions High HIV discordance within couples up to 45 % Low levels of HIV testing

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HIV Prevalence by Province

Great variation by geography ranging from 1% to 15% across provinces

Kenya 7.1%

Eastern 4.6% North Eastern 0.8% Rift Valley 6.3% Western 5.4% Nyanza 14.9% Nairobi 8.8% Coast 8.1% Central 3.6%

Source KAIS 2007

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HIV Prevalence by Gender

% HIV Infected TOTAL FEMALES MALES 7.1 8.4 5.4

7.1% (1.3 million) Kenyans age 15-64 were infected with HIV.

Source KAIS 2007

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HIV Prevalence by Age & Gender

Female to male ratio decreases with age.

1.0 1.9 7.3 8.9 9.3 5.6 2.3 3.4 3.5 7.4 10.2 13.3 11.2 4.7 1.7 8.3 10.2 8.8 7.5 9.4 2 4 6 8 10 12 14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Age Group HIV Prevalence (%)

Male Female

Source KAIS 2007

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HIV prevalence by Residence

Rural: 6.7% Prevalence

1,027,000 persons infected

Urban: 8.4% Prevalence

390,000 persons infected

Source KAIS 2007

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HIV trends in Kenya

7.0% 8.7% 10.7% 9.0% 8.3% 7.0% 8.5% 8.7% 8.7% 8.5% 7.2% 5.1% 5.7% 6.8% 6.2% 6.9% 7.3% 4.9% 5.2% 3.7% 2.8% 2.6% 1.5% 5.6% 6.1% 6.7% 7.7% 8.2% 3.1% 4.0% 4.9% 5.9% 6.9% 7.9%

0% 2% 4% 6% 8% 10% 12% 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year HIV Prevalence (%)

Total (Actual HIV Prevalence of Pregnant Women) Total (Adjusted HIV Prevalence of Adult Population)

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HIV prevalence by Province comparing KDHS & KAIS

Source KAIS 2007

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HIV trends 2003 and 2007

HIV prevalence among adults 15-49 years

similar from 2003 (6.7%) to 2007 (7.4%).

HIV prevalence in provinces in KDHS 2003 and

KAIS 2007 similar ,increase in North Eastern

HIV prevalence remained high in urban

populations,

Increasing trend in rural populations in 2007 Significant changes by wealth index and

education

• Populations with lower socioeconomic status have higher

prevalence in 2007 than in 2003.

Source KAIS 2007

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Universal Access to Treatment

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Country Commitments

ARVs in Kenyan private sector mid 1990’s Public sector program started in 2003 2006 provision of free ARVs for public sector

through a presidential declaration

Kenya part of WHO 3 by 5 initiative for

treatment : target 95,000 on ART

By end 2005 65,000 patients on ARVs in Kenya

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Universal access

Universal access implies that all people should be

able to have access to information and services that are:

• Equitable – accessible – affordable – comprehensive –

sustainable In 2006, countries worldwide including Kenya

committed to setting ambitious national targets (UN

General Assembly. Political Declaration on HIV/AIDS 2 June 2006)

"Commit ourselves to setting…ambitious national targets that reflect the

commitment of the present Declaration and the urgent need to scale up significantly towards the goal of universal access to comprehensive prevention programmes, treatment, care and support by 2010"

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ART providing sites by affiliation

CBO NGO Private FBO GoK 10 20 30 40 50 60 70 80 GoK FBO Private NGO CBO Over 1000 service delivery points provide treatment Percentage

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Scale up of ART

50000 100000 150000 200000 250000 300000 June 20004 2004 2005 2006 2007 2008 Jun-09

Adult Paediatric

Number

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Universal access ?

12% of HIV-infected adults were taking

Cotrimoxazole daily to prevent infections

Overall, 40% of ARV-eligible adults were taking

ARVs.

Among those who knew they were infected with

HIV,

76% were taking Cotrimoxazole daily 92% of ARV-eligible adults were taking

ARVs.

Data suggests high access to care and treatment

for those aware of HIV status

KAIS 2007

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Universal access ?

2008/2009

520,000 persons in need of ARVs 55 % on ARVs ( 290,000 ) total 50 % of children on ARVs Eligible population increases annually (

projections)

780,000 persons have been enrolled

into care at a point

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Successes

Rapid scale up treatment in past 6 years HIV contributed to health systems strengthening

Infrastructure Personnel Funding

High access to care and treatment for those

aware of HIV status

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Challenges

Health systems

Burden to health care system and weak health

systems

• increasing number of outpatient visits, strain on Human

resources

• Limited infrastructure (space, laboratory)
• drug procurement and supply management systems

System unprepared for chronic care Inequality of service distribution .Majority

concentrated in urban centres

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Challenges

Sustainability of funding for HIV programmes

• predictable and sustainable financing

Challenges posed by decentralization of care to

lower cadres and lower levels vs. quality of care

Stigma and discrimination Weak monitoring systems

• Treatment outcomes
• Quality of care
• Retention of patients on treatment, follow up systems

Low knowledge of HIV status limits access to

treatment

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Emerging Issues

HIV treatment for prevention

Treat all vs. increase in CD4 cut offs for initiation of

treatment

Shift to use of less toxic regimens

Health systems strengthening Sustainable financing, increasing

Government financing for HIV