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

1. Miles and Misses in HIV Prevention,
treatment and Support:
Progress towards Zero AIDS
DR MARTIN SIRENGO, MD,MMED
HEAD, NATIONAL AIDS AND STI CONTROL PROGRAM (NASCOP)
MINISTRY OF HEALTH
18th June 2014 - KICC Nairobi

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

3. Introduction
The 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.

4. Update on HIV program status in Kenya

5. 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

6. Leading causes of death and disability in
Kenya
Causes of death
Rank Disease or injury % total
1 HIV and AIDS 29.3
2 Perinatal conditions 9.0
3 Lower respiratory infections 8.1
4 Tuberculosis 6.3
5 Diarrhoeal diseases 6.0
6 Malaria 5.8
7 Cerebrovascular disease 3.3
8 Ischaemic heart disease 2.8
9 Road traffic accidents 1.9
10 Violence 1.6
DALY: Disability Adjusted Life Years

7. 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

9. Trends in HIV prevalence
8.9
4.6
6.8
9.0
5.6
7.6
8.2
4.3
6.4
6.9
4.2
5.6
0
1
2
3
4
5
6
7
8
9
10
Women Men Total
HIVprevalence(%)
KDHS 2003 KAIS 2007 KDHS 2008 KAIS 2012

10. 3.8
10.5 10.3
7.8
3.3
0.9
2.1
6.4
9.0
9.1
4.2
0
2
4
6
8
10
12
18 months-14* 15-24 25-34 35-44 45-54 55-64
Percent
KAIS 2007 KAIS 2012
HIV burden is highest among the productive age groups 25-55 years
HIV prevalence by age category, KAIS 2007 and 2012

11. Sources of HIV infections

12. 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%

13. 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

14. Low and middle income
countries with highest
estimated numbers of
pregnant women living
with HIV
The Global EMTCT Plan
Angola Lesotho
Botswana Malawi
Burundi Mozambique
Cameroon Namibia
Chad Nigeria
Côte d’Ivoire South Africa
DR Congo Swaziland
Ethiopia Uganda
Ghana Tanzania
India Zambia
Kenya Zimbabwe
89%
2011

15. Reduce the number of new HIV infections among
children by 90% from a baseline of 200990%
maternal
deaths
50%
reduction in
AIDS-related
New
paediatric
infections
Two specific targets for 2015

16. 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

17. Prevalence of MTCT, by PCR
(n=272,342)
7/21/2014 17

18. 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

19. 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 years
Impact
 Viral load suppression on ART : 78% (KAIS II)
 HIV transmission to Children: 14% (18 months)

20. 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

21. 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

22. 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%

23. 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

24. Opportunities
1. Free primary and secondary education:
2. Free maternity services: June 2013
 Skilled birth attendance has increased from 44% to 66%
3. Beyond Zero campaign
4. MoEST HIV policy
 Age appropriate HIV and SRH messaging for learners
 Capacity building of Teachers to be responsive to
the needs of learners

25. Opportunities
5. Women and Youth Fund
6. Contraceptives
7. 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

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

27. 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

28. Conclusion
 Zero HIV/AIDS is a
realistic public health
goal
 Team effort is key
 We have to be
accountable to our
actions
.
Progress
report

29. Vision

30. END