HIV TRENDS UNIVERSAL ACCESS TO HIV TREATMENT IN KENYA

Transcription

1 HIV TRENDS UNIVERSAL ACCESS TO HIV TREATMENT IN KENYA Dr Irene Mukui National AIDS & STD Control Programme 1

2 Outline Introduction HIV trends and current Statistics Access to ART Successes Challenges 2

3 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 3

4 HIV Prevalence by Province Western 5.4% Nyanza 14.9% Eastern 4.6% Rift Valley 6.3% North Eastern 0.8% Central 3.6% Great variation by geography ranging from 1% to 15% across provinces Nairobi 8.8% Kenya 7.1% Source KAIS 2007 Coast 8.1% 4

5 HIV Prevalence by Gender 7.1% (1.3 million) Kenyans age were infected with HIV. % HIV Infected TOTAL FEMALES MALES Source KAIS

6 HIV Prevalence by Age & Gender HIV Prevalence (%) Source KAIS Female to male ratio decreases with age Age Group Male Female

7 HIV prevalence by Residence Rural: 6.7% Prevalence Urban: 8.4% Prevalence 1,027,000 persons infected 390,000 persons infected Source KAIS

8 HIV trends in Kenya 12% 10.7% 10% HIV Prevalence (%) 8% 6% 4% 8.5% 8.7% 8.7% 8.5% 8.7% 7.9% 8.2% 6.9% 7.0% 7.3% 6.9% 6.2% 5.9% 4.9% 5.2% 4.9% 4.0% 3.7% 3.1% 2.6% 2.8% 9.0% 8.3% 7.7% 7.2% 7.0% 6.7% 6.1% 6.8% 5.7% 5.6% 5.1% 2% 1.5% 0% Total (Actual HIV Prevalence of Pregnant Women) Total (Adjusted HIV Prevalence of Adult Population) Year 8

9 HIV prevalence by Province comparing KDHS & KAIS Source KAIS

10 HIV trends 2003 and 2007 HIV prevalence among adults 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 Source KAIS 2007

11 Universal Access to Treatment 11

12 Country Commitments ARVs in Kenyan private sector mid 1990 s Public sector program started in 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 ,000 patients on ARVs in Kenya 12

13 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" 13

14 ART providing sites by affiliation Percentage 80 GoK 70 Over 1000 service delivery points provide treatment FBO Private NGO CBO 0 GoK FBO Private NGO CBO 14

15 Scale up of ART Number June Jun-09 Adult Paediatric 15

16 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

17 2008/2009 Universal access? 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 17

18 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 18

19 Health systems Challenges 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 19

20 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 20

21 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 21