1 PrEP Roll-out in Kenya Michael Kiragu 20 July 2016

Building Partnerships, transforming lives2 Outline Why prevention? Kenya context Oral PrEP policy in Kenya What is the evidence? Requirements for scale up? What’s next?

Building Partnerships, transforming lives3 The need for HIV Prevention No. of adults acquiring HIV is decreasing too slowly! There is an urgent need to rapidly scale up proven interventions

Building Partnerships, transforming lives4 Kenya Context Population: 46 million 1.5 Million people living with HIV (UNAIDS, 2015) 71,000 new adult infections every year (UNAIDS, 2015) Mixed epidemic (generalized and concentrated) Concentrated among key populations Wide variation in prevalence and incidence in geographical locations Engendered epidemic (women > men)

Building Partnerships, transforming lives5 Kenya HIV Prevention Revolution Approach Revolutionary approaches to HIV prevention: 1)Combination prevention approach 2)Shift focus from interventions to populations 3)Leverage synergies across sectors 4)Align of the HIV prevention to the geographical disparities in the epidemic Oral PrEP recommended for: Key populations (MSM, sex workers, PWID) Adolescent girls and young women Discordant couples

Building Partnerships, transforming lives6 Policy for oral PrEP Implementation Registration of Truvada for HIV Prevention by regulators PrEP included in the newly in new “national guidelines for test, treat & prevent” launch: Describes situations of HIV risk Outlines clinical and laboratory evaluation for initiation and monitoring Underlying principle is to increase access and minimize barriers Allowing innovation in service delivery (community and facility approaches can be used) Accompanying documents under developmen Data tools Job aids SOPs IEC materials

Building Partnerships, transforming lives7 Evidence for action! Research studyLocationsPopulations Status Partners PrEP StudyKenya, Uganda Serodiscordant couples Completed POWER: Prevention Options for Women Evaluation Research South Africa; Kenya Adolescent girls and young women aged 16-24; women Ongoing LVCT Health and SWOP Kenya (IPCP-Kenya) Kenya Female sex workers (18 and older), MSM (18 and older), young women at high HIV risk (15 -29) Ongoing Gender-Specific Combination HIV Prevention for Youth in High Burden Settings (MP3-Youth) Kenya Adolescent men and women ages (Only enrolling adolescent female arms on PrEP) Complete Partners Demonstration ProjectKenya, UgandaSerodiscordant couples Complete

Building Partnerships, transforming lives8 Plans for scale up ProjectTarget populations DREAMS (PEPFAR)Young women Bridge to scale (JHPIEGO)MSM, FSW and young women Partners PrEPDiscordant couples

Building Partnerships, transforming lives9 Advocacy and Education for Health Providers Address potential stigma (PrEP & users) Willingness to recommend/prescribe PrEP influenced by personal values and level of knowledge Community education and demand creation Educate communities and create demand Change unuseful paradigms of communicating Prevention deemphasize risk Should we use self esteem and intimacy? Make oral PrEP the norm! Microbicide communication materials Borrowed from FHI 360

Building Partnerships, transforming lives10 What do we need for public health scale-up of PrEP Simplification of procedures and decision making Evaluation for eligibility (What’s Substantial risk?) Risk assessment (Caution: Stigma!) Identification and management of adverse events Goals of adherence? Monitoring of adherence? Referral criteria and pathways Discontinuation of PrEP

Building Partnerships, transforming lives11 What lessons/systems can we leverage from ART scale up? Commodity management systems Integrate PrEP in surveillance systems for ARV resistance Integrate data collection & reporting into existing HIV service tools Identify alternative models for service delivery (community, differentiated models of care) Lab sample transportation networking Vertical System?

Building Partnerships, transforming lives12 In closing We need to rapidly scale up oral PrEP Leadership and commitment is key Simplicity will facilitate rapid scale up Community-led education and advocacy Leverage what has worked in the past (ART, HTS, SRH etc)

Acknowledgements and Partnerships Ministry of Health, Kenya: NASCOP and NACC SWOP Clinics (PHDA) UN Family – WHO, UNAIDS, UNICEF PEPFAR CDC/USAID Bill & Melinda Gates Foundation CHAI O’Neill Institute, Georgetown Law London School of Hygiene and Tropical Medicine Imperial College London, Results for Development, IAVI, AVAC, FHI 360, WRHI, FSG, Avenir Health, McANN, Pangaea, Gilead Health Sciences Community serving organizations: HOYMAS, GALCK, KESWA, BHESP, NYARWEK, ISHTAR MSM County and sub-county HMTs

Building Partnerships, transforming lives14 THANK YOU CONTACT US: