Dr Ruth Laibon Masha, PhD, EBS�Chief Executive Officer��National Syndemic Diseases Control Council�Kenya

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From Boutique to systemic and sustainable scale up:

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The case of HIV prevention

The HIV Response …

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• Invest in care and treatment
• Address Treatment Interruption
• Stop stigma

• Invest in effective HIV Prevention interventions implemented to scale

The Programmes within HIV prevention response operate in siloes

The prevention programme predominantly focuses on biomedical solutions

The prevention programme is highly dependent on donors.

The prevention programme needs innovation and scale up

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Challenges

Systemic challenges

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Translating the thinking differently into doing differently..

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1. Clear goals for Treatment, but none for prevention
2. Adopting a ‘one size fits all’
3. Inefficient deliveries
4. Decision is not data-based
5. Shared responsibility and accountability undefined
6. HIV response still heavily bio-medical
7. Sub-national levels of investment case

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Thinking differently…

^{People Living with HIV in Kenya (2013)}

^{Differentiation of sub-populations (2013)}

Sub-national level heterogenous (2013)

Data for decision making

• A data feedback model for accountability and responsibility

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• Focus on outcomes

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• Improved surveillance

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• Research for local solutions

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• Modeling for decision making

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• Research uptake

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• New prevention technologies

Rationale …..

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• To utilise existing resources to implement the right combination of intervention to targeted populations in most at risk population groups and geographical areas to achieve maximum impact.
• Tailor Combination Prevention for the 47 Counties based on the nature of the epidemic in their county

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Saves lives

Saves Money

By 2030

1,149,000 new HIV infections &

761,000 AIDS-related deaths

11,000 children deaths

will be averted at no extra cost

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New HIV infections reduced by 78.2% in the last decade from 101, 448 in 2013 to 22,154 in 2022

2013

2015

2018

2019

2020

2021

52,800

41,416

34,540

101,448

77,647

32,027

2022

22,154

Source: HIV Estimates 2023

HIV situation in 2022

1,377,784

Kenyans living with HIV in 2023

67,869

Children (0-14 years) living with HIV in 2023

National HIV prevalence is 3.7%

18,473

AIDS-related deaths 2022

HIV PREVALENCE AMONG KEY POPULATIONS

22,154

New HIV Infections

4,474

12,558

5,122

Children aged 0-14

Women

Men

Source: Kenya HIV Estimates 2023

Kenya Demographic Health Survey 2022

Kenya Health Information Systems 2023

New HIV infections

41%

Adult new HIV infection occur among Adolescents and Young People aged 15-24 years

What have we learnt?

• County-level capacity for designing, implementing, and monitoring effective prevention programs at scale is sub-optimal.
• Existing interventions are often generic and fail to consider the diversity in epidemic typology. The analysis of the size and location of priority populations for planning population-based prevention interventions is incomplete.
• Prevention programs operate independently rather than as part of a cohesive continuum, hindering the monitoring of individuals across the spectrum.
• Various determinants of health, both at the individual and broader structural levels, pose challenges for HIV prevention. Lack of coordination and collaboration results in duplicated efforts and negatively impacts healthcare costs.
• Interventions predominantly focus on biomedical approaches, with minimal emphasis on behavioral and structural strategies that are community-led.
• Analytical capacity and data utilization at both national and county levels are insufficient, leading to poor feedback mechanisms to relevant stakeholders.
• There is a higher dependence on donor funding, and HIV prevention receives low priority in planning and budgeting.

Strategy 1: Apply a precision and differentiated HIV prevention approach based on incidence, prevalence, and changing epidemic typology in the geography ��

“Concentrated” epidemic in

22 counties

“Generalizing” epidemic in

4 counties

“Mixed” epidemic in

21 counties

Start

Sustain effective interventions for key populations

Strategy 2: Develop tools to measure quality, coverage and impact of interventions to address coverage and utilization gap��

���Strategy 3: Strengthen and expand community-led HIV prevention services���

• Promote community-led initiatives to empower local decision-making in HIV prevention and service delivery.
• Establish national and subnational targets for expanding the involvement of community-led organizations accountability forums
• Advocate for funding (domestic and external) for community led organisations engaged in HIV prevention
• Create a supportive environment for non-governmental organizations to operate, offer services through enhanced technical and managerial capabilities.

Strategy 4 ; Integrate HIV prevention by strengthening health systems and leveraging multiple sectors �

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• Integration of HIV prevention within universal health coverage discourse to expand these achievements beyond addressing a single disease.
• Intra and inter-sectoral integration between

a) HIV prevention programs, including PrEP, VMMC, condom promotion, and initiatives targeting specific sub-populations.

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b) HIV prevention with other health sector programs, including tuberculosis control, viral hepatitis prevention and care, reproductive, maternal and child health, adolescent health, family planning, and sexually transmitted infection control.

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c) With other non-health sectors platforms such as education, gender equity, housing and social protection.

Strategy 5: Improve utilization of programme data

Strategy 5: Invest and prepare for adoption of HIV prevention choices and technology�

1980’s

2030

Scheckter M, 2002

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Preventing transmission and acquisition of HIV: A timeline

1990’s

2000’s

2020’s

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Leverage on development synergies …Interventions with proven Impact

– Economic Empowerment of women and girls (IMAGE studies; cash transfer programmes)

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– Secondary education for girls and young women

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– Community empowerment (sex workers in India)

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– Harm reduction policies

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Going back to basics

New Kid on the block

• The story of condoms- effective, cost effective but…challenges with commodity security, demand, access, Utilization and disposal and most important monitoring, tracking and evaluation

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• Countries should define priorities

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• Instititutionalize prevention :
• Social contracting or other mechanisms for funding for communities
• Development and Strengthening of systems to demonstrate community contribution

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Strategy 6 : Prioritize prevention funding…..

An analysis of the AIDS Spending Categories (ASC) according to the KNASA report 2022 .

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Care and Treatment -51 %

HIV Testing -12 %

Prevention -9%

Social protection and economic support 7%

Research (0.1%).

Prevention progress not fast enough…strategic investments still required….

HIV prevention must be prioritized in funding transitions and sustainability agendas �

• Costing for HIV prevention is a key priority

Source: KNASA 2022