Cohorts and Capacity Kenya

Transcription

1 Cohorts and Capacity Kenya Dr Joshua Kimani HIV Prevention/Care Program with Most At Risk Populations ( SW,MSM, DU) University of Manitoba / University of Nairobi Program Nairobi

2 -Pop 42 Millions new infections in 2013

3 Kenya and Key Populations Context:- Sex work is illegal and criminalized within the statute books Highly stigmatized No changes within the new constitution 2010 HIV Control Programs operate under the public health act No problems ever encountered with mobilization and care activities *Same with IDUs and MSMs

4 Kenya and Key Populations Context:- MSM MSM stand alone clinic to be opened soon in Nairobi with support from NASCOP and partners Well characterized Cohorts exists in Nairobi, Kilifi and Kisumu FISHER FOLK Cohort well characterized (Lake Region) IDU Active NSP managed by NASCOP MOH and partners MAT National program Initiated by NASCOP in Dec 2014 Pilot phase in Nairobi and active now - Cohort to be formed

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6 Nairobi Sex Workers Cohort / Program -UOM / UON journey in Kenya began in 1980 with STD work Chancroid as a focal point -In 1985 HIV was added into the Research portfolio

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8 A minimum HIV prevention, Care and Treatment package for sex workers Information on safer sex practices Condom information, demonstration on use and provision. HIV testing and counseling (PICT) STI screening and treatment Risk reduction counseling services ARV and HIV basic care Family planning information TB screening and referral PEP Psychosocial support and referral

9 Active Community Engagement and Demand Creation program

10 Outreaches -Hot spot based!!! Peer Led A hotspot is an establishment where sex workers cruise for clients Each hotspot has a Peer Educator

11 Hotspot Focused Peer Led Model Peer Educator Led/ Hot Spot Focused Over time describe the characteristics of each hotspot for outreach:- Number of sex workers Who works at the hot spot Age data & When they work Amount of turnover & Timing Client volume Mobilization and demand creation One on one interventions Condom supply Referral, follow-up and tracing Etc

12 Estimates of active FSW spots in Nairobi, by districts Total: 2,539

13 Estimates of FSWs in Nairobi County, by districts Total Ave.: 27,620 Total Min.: 21,081; Max.: 34,160

14 Number UOM Nairobi Sex Workers Program Numbers MARPS Tested Contacts Enrolled Month

15 No. Enrolled SWOP Enrolment MSM (1154) 1400 No. of Male Clients Enrolled Month

16 % acceptance Proportion of FSW s Accepting HIV Screening 100 % Declined Test % Accepting Test Duration Average Tested 97.75%

17 Proportion of MSM s Accepting HIV Screening % Declined Test % Accepting Test Average Tested 94.65%

18 % condom use FSW - Proportion of clients using condoms always Regular Casual

19 % condom use MSW - Proportion of clients using condoms always Regular Casual

20 No. of Patients Patients on HIV care Mar 06 Sept 06 Sept 07 Sept 08 Sept 09 Sept 10 Sep 11 Sep 12 Dec 12 Annual Cumulative Active

21 No. of patients Clients Initiated on PEP (SWOP City) No. of patients on PEP (1778) Aug - Dec 08 Jan - April 09 May - Aug 09 Sept - Dec 09 Jan - April 10 May - Aug 10 Sept - Dec 10 Jan - April 11 May - Aug 11 Sept - Dec 11 Jan - April 12 May - Aug 12 Sept - Oct 12

22 Why PEP Reason for seeking PEP Condom burst 84.7% Chose not to use a condom 0.3% Client did not want to use a condom 2.8% Rape/coerced sex 7.7% Other 4.6 %

23 Health Education and Empowerment

24 % Positive HIV Status by Age Group-MSM HIV STATUS BY AGE GROUP(n=759) < Age Group NB: Total positive across all age groups 36.2% HIV incidence of 10.9% (95% CI 7.4, 19.3)

25 % Positive HIV Status by Age Group-FSW (SWOP CBD) HIV STATUS BY AGE GROUP(n=8083) < Age Group NB: Total positive across all age groups 28.0% HIV incidence of 2.2% (95% CI 1.6, 3.1)

26 *not included in KAIS I or KDHS 2008/09 **not included in KDHS 2008/09

27 HIV Status by Age Group- FSWs April 2014 NB: Total positive across all age groups 27.8% HIV incidence of 2.2% (95% CI 1.6, 3.1)

28 HIV Status by Age Group-MSM 2014 HIV Prevalence % HIV incidence of 10.9% (95% CI 7.4, 19.3)

29 Sex Workers in Transition Period!! Special Focus on: years In Hot spots Not self declared as sex workers Do not use condoms with most clients At very high risk of HIV acquisition

30 Strategies That Have worked with our SW HIV Cohorts Built trust with the sex workers Active community engagement processes Peer lead networks with monthly consultations Empowerment* and active involvement of the sex workers Supportive and dedicated team outreach, clinical and lab Skilled team with long term focus Active Collaboration between UOM and UON Research team, students and program team Moral Support from MOH

31 DISCORDANT Couples Resurvey Preliminary Results (583 Couples )

32 Kenya - Cohorts and Capacity Cohorts exists - Well characterized Skilled labor and Research culture Clinical Infrastructure with clinical trials capacity Laboratory and biorepository support Research Collaborations not new Functional Ethics and Regulatory bodies NACC and NASCOP support Clear Coordination mechanism by NACOSTI Etc

33 Challenges Funding x 3 EXPENSIVE USD3.5M/ year Coverage and retention Mobile Populations Loss to follow-up issues Ignorance and sense of entitlement esp MSM Declining HIV incidence Ethical challenges dealing with young sex workers - mature minors

34 Asante sana