Miles and Misses in HIV Prevention, treatment and Support:

Progress towards Zero AIDS

DR MARTIN SIRENGO, MD,MMEDHEAD, NATIONAL AIDS AND STI CONTROL PROGRAM (NASCOP)

MINISTRY OF HEALTH18th June 2014 - KICC Nairobi

Outline Introduction Program status and progress MNCH HIV and young people Challenges (Misses) Opportunities Conclusion

IntroductionThe Constitution:Stipulates that, every person has the right to the highest attainable standard of health

Draft health policy 2012-2030: Aims to ‘attaining the highest possible health standards in a manner responsive to the population needs.

Update on HIV program status in Kenya

The roadmap First reported case of HIV in

1983 Epidemic initially concentrated

among CSWs NASCOP formed in 1987 initially

as a STI unit 1999 – HIV and AIDS declared

a national disaster PMTCT and ART programs

Leading causes of death and disability in Kenya

Causes of deathRank Disease or injury  % total

1 HIV and AIDS 29.32 Perinatal conditions 9.03 Lower respiratory infections 8.14 Tuberculosis 6.35 Diarrhoeal diseases 6.06 Malaria 5.87 Cerebrovascular disease 3.38 Ischaemic heart disease 2.89 Road traffic accidents 1.910 Violence  1.6

DALY: Disability Adjusted Life Years

The HIV burden Population in 2012- 41 million No of people living with HIV 1.5 million Kenya ranks no 4, among countries with

highest burden of HIV globally 54 % of HIV infections are just in 9 counties

Trends in HIV prevalence

Women Men Total0

1

2

3

4

5

6

7

8

9

108.9

4.6

6.8

9.0

5.6

7.68.2

4.3

6.46.9

4.2

5.6

KDHS 2003 KAIS 2007 KDHS 2008 KAIS 2012

HIV

pre

vale

nce

(%)

18 months-

14*

15-24 25-34 35-44 45-54 55-640

2

4

6

8

10

12

3.8

10.5 10.3

7.8

3.3

0.92.1

6.4

99.1

4.2

KAIS 2007

Perc

ent

HIV burden is highest among the productive age groups 25-55 years.

HIV prevalence by age category, KAIS 2007 and 2012

Sources of HIV infections

Progress in HIV Control-HTC Entry point to HIV prevention and treatment Testing coverage 80% ever tested for HIV (KAIS

2012). Increased awareness from 28% in 2007

Awareness of status among HIV infected persons at 47% (KAIS 2012) up from 16% (KAIS 2007)

Gap in the knowledge of HIV infected status 53%

ART Progress Adult ART coverage

An estimated 63% of Eligible HIV infected persons on treatment in 2012 (KAIS)

Pediatric ART coverage Has increased from 38% to 43% (More needs to be

done) Adult retention to ART (2014 cohort analysis)

12 months retention 75% 60 months retention 62% LTFU still high

Low and middle income countries with highest estimated numbers of pregnant women living

with HIV

The Global EMTCT Plan

Angola LesothoBotswana Malawi

Burundi MozambiqueCameroon Namibia

Chad NigeriaCôte d’Ivoire South Africa

DR Congo SwazilandEthiopia Uganda

Ghana TanzaniaIndia Zambia

Kenya Zimbabwe89%

2011

Reduce the number of new HIV infections among children by 90% from a baseline of 2009

90%

maternaldeaths

50%reduction inAIDS-related

New paediatri

c infections

Two specific targets for 2015

New HIV infections among children

For every 16 children newly infected with HIV in Africa, 1 child is from Kenya

Source: Global Plan Progress report 2012, UNAIDS

Prevalence of MTCT, by PCR (n=272,342)

04/08/2023 17

Progress in HIV Control (cont..) New HIV Infections dropped from 166,000 (2007) to

103,000 (2012) -40% decline 30% of these occur among 15-24 years HIV related deaths decline from 72,000 (2007) to

54,000 (2012) Since 2000, 340,000 deaths have been prevented

and 270,000 new infections averted

Progress in HIV Control HIV Prevalence 2012 5.6 % ( Down from

13.4% in 2000) No on ART 670,000 Treatment sites 2,000 Voluntary male circumcision 700,000 in the

last 5 yearsImpact Viral load suppression on ART : 78% (KAIS II) HIV transmission to Children: 14% (18 months)

Status of Maternal Health 5,500 women die every year because of

pregnancy related causes 1998 2003 2009 2013 Maternal mortality ratio 519 414 488 360(Per 100,000 live births)

Three quarters of maternal deaths are due to bleeding and difficult child birth

Effect of HIV on Maternal and Child Health

HIV is the underlying cause of 30% of all hospital deaths

HIV Causes 20% of maternal mortality

HIV is the cause of 15% of child mortality

Why focus on young people . Declining parental guidance

Age of sexual debut declining 60% of adolescents are

sexually active by 18 years (KAIS 2007)

Condom use at first sexual act is dismal- 26:28% (M vs F) (KAIS 2007)

High rate of alcohol and substance abuse

The conventional design of many health care services are not youth friendly

MDGs

3/4

6. Combat HIV/AIDS,TB & malaria

50%

Challenges Illiteracy Unemployment and poverty Socio-cultural factors Stigma and discrimination Lack of access to information and services Social media and explicitly internet sites Retrogressive laws

Opportunities1. Free primary and secondary education: 2. Free maternity services: June 2013

Skilled birth attendance has increased from 44% to 66%3. Beyond Zero campaign4. MoEST HIV policy

Age appropriate HIV and SRH messaging for learners Capacity building of Teachers to be responsive to the needs of learners

Opportunities5. Women and Youth Fund6. Contraceptives7. County profiles- opportunity for

targeted interventions Identifying Counties that have met

their Targets or not Tailoring interventions to either at

meet targets or maintain performance

County HIV prevalence

County Adult Prevalence

County Adult Prevalence (%)

County Adult Prevalence (%)

Homabay 25.7 Nakuru 5.3 Laikipia 3.7Siaya 23.7 Muranga 5.2 Kericho 3.3Kisumu 19.3 Trans Nzoia 5.1 Embu 3.7Migori 14.7 Machakos 5 Nandi 3.7Kisii 8 Narok 5 Kirinyaga 3.4Nairobi 8 Samburu 5 Bungoma 3.2Mombasa 7.4 Kajiado 4.1 Meru 3Turkana 7.6 Uasin Gishu 4.3 Baringo 3Busia 6.8 Kilifi 4.4 West Pokot 2.8Nyamira 6.4 Tharaka Nithi 4.3 Elgeyo 2.5

County HIV prevalence

County Adult Prevalence

County Adult Prevalence (%)

County Adult Prevalence (%)

Taita Taveta 6.1 Kitui 4.3 Lamu 2.3

Kakamega 5.9 Isiolo 4.2 Garissa 2.1

Bomet 5.8 Nyeri 4.3 Mandera 1.7

Kwale 5.7 Kiambu 3.8 Marsabit 1.2

Makueni 5.6 Vihiga 3.8 Tana River 1.0

Nyandarua 3.8 Wajir 0.2

Conclusion Zero HIV/AIDS is a

realistic public health goal

Team effort is key We have to be

accountable to our actions

.

Progress report

Vision

END