HIV TRENDS UNIVERSAL ACCESS TO HIV TREATMENT IN KENYA Dr Irene Mukui National AIDS & STD Control Programme 1
Outline Introduction HIV trends and current Statistics Access to ART Successes Challenges 2
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
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
HIV Prevalence by Gender 7.1% (1.3 million) Kenyans age 15-64 were infected with HIV. % HIV Infected TOTAL FEMALES MALES 7.1 8.4 5.4 Source KAIS 2007 5
HIV Prevalence by Age & Gender HIV Prevalence (%) 14 12 10 8 6 4 2 0 Source KAIS 2007 3.5 1.0 7.4 1.9 10.2 7.3 13.3 8.9 11.2 Female to male ratio decreases with age. 9.3 9.4 10.2 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 Age Group 8.8 5.6 7.5 8.3 Male Female 4.7 2.3 3.4 1.7 6
HIV prevalence by Residence Rural: 6.7% Prevalence Urban: 8.4% Prevalence 1,027,000 persons infected 390,000 persons infected Source KAIS 2007 7
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% 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Total (Actual HIV Prevalence of Pregnant Women) Total (Adjusted HIV Prevalence of Adult Population) Year 8
HIV prevalence by Province comparing KDHS & KAIS Source KAIS 2007 9
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. 10 Source KAIS 2007
Universal Access to Treatment 11
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 12
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
ART providing sites by affiliation Percentage 80 GoK 70 Over 1000 service delivery points provide treatment 60 50 40 30 FBO 20 10 Private NGO CBO 0 GoK FBO Private NGO CBO 14
Scale up of ART Number 300000 250000 200000 150000 100000 50000 0 June 20004 2004 2005 2006 2007 2008 Jun-09 Adult Paediatric 15
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 16
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
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
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
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
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