1. PrEP Scale Up in Kenya: Bridge to Scale Project
IAS Satellite Session
25th July 2017
Dr. Daniel Were
Jhpiego, Kenya
Dr. Elizabeth Irungu
Partners Scale up Project, Kenya

2. Background on HIV in Kenya
National HIV Prevalence – 5.6%
29% FSW
18.2% MSM
18.2% IDU
51% new infections among adolescents
44% of new infections Sero discordant couples

3. PrEP Journey in Kenya 2008-2012 – Partners PrEP study
Demonstration projects
July 2016 – Revised ART guidelines
October TWG formed
December 2016 – TDF generics variation by Pharmacy and Poisons Board
May 2017 – National PrEP scale up launch

4. Composition of TWG NASCOP NACC MOH WHO UNAIDS
Donor agencies – PEPFAR (USAID, CDC)
Implementing partners

5. TWG Sub-committees Service delivery
Advocacy, communication and community engagement
Research and impact evaluation
Monitoring and evaluation
Commodities and Supply chain
Costing and resource mobilization

6. TWG Milestones November 2016 – PrEP implementers forum
November 2016 – Implementation Planning and Document Review Workshop
January 2017 – Document Finalization Workshop
Monthly TWG meetings and recurrent consultations
November 2016 – March TWG sub-committees working group meetings

7. TWG sub committee outputs
PrEP implementation framework
Service providers tool kit
Training manual for health workers
Communication plan
M&E and LMIS tools
Research plan
Financing and resource mobilization plan

8. Bridge to Scale (JILINDE) Project Goal
To demonstrate and document an effective model for how oral Pre-exposure Prophylaxis (PrEP) can be scaled up as an HIV-prevention intervention in low-resource settings

9. Target Populations Female sex workers (FSWs)
Men who have sex with men (MSMs) Including male sex workers
Adolescent girls and young women (AGYW)

10. Geographic Locations and Targets

11. JILINDE PrEP Delivery Approaches
Drop in centers
Public health facilities
Private health facilities

12. Partners Scale up project
Objectives
Geographical locations
Target population
Targets
Delivery Approaches

13. Training Approaches: Case Based Training Curriculum
Unit 1: CLINICAL CASE MANAGEMENT OF PrEP
Case 1: Risk Assessment and indications for PrEP
Case 2: Initiating PrEP in a Discordant Couple
Case 3: PrEP in special circumstances e.g. pregnancy
Case 4: A male with multiple male sexual partners
Unit 2: DRUG RESISTANCE TESTING FOR PrEP SERO-CONVERTERS

14. Unit 3: COMMODITY MANAGEMENT FOR ORAL PrEP
Case Study 1: Dispensing oral PrEP
Case Study 2: Completing ART LMIS Tools
Unit 4: MONITORING AND EVALUATION OF PrEP SERVICES
Case Scenario 1: PrEP Clinical Encounter Form and Register
Case Scenario 2: PrEP Monthly Summary Tool

15. Partners Scale Up Complementary Training Content and Approaches
Sero discordant couples
Training on Treatment as prevention
Inclusion of SDC at the training
Facility PrEP delivery champions
Facility based CMEs

16. JILINDE Complementary Training Content and Approaches
Whole site orientations
CMEs
Mentorship
Satisfied PrEP users
Key Populations Sensitivity orientation

17. Training achievements
Trained over 984 providers between both projects
Cadres include;
Medical officers
Clinical officers
Nurses
HIV testing counselors
Pharmacists
Laboratory technologists

18. Training Plans
Service providers at PrEP delivery clinics – Critical mass
HTS providers
Peer Educators and community Health volunteers

19. Challenges Solutions Few trained providers (Attrition, redeployment)
Train additional providers – critical mass
Off site training models
On site training models (Modular CMEs)
Senior cadres not trained on PrEP
Sensitization of senior cadres through professional bodies
Lack of a quick reference document for providers
PrEP Pocket book for providers
Perceived huge workload and provider attitudes
Mentorship, experience sharing by champion providers, Key Populations sensitivity orientation
Few providers trained on Couples HIV testing and counselling
CHTC Sensitization

20. Challenges
Solutions
PrEP counselling skills gaps
Training of HTS providers
Develop Counselling module for PrEP
Information gaps on PrEP efficacy
Experiences by PrEP users
Lack of confidence to prescribe PrEP
Develop a pool of clinical mentors, practical PrEP initiation session during training
Functional database of trained providers
Industrial action

21. Acknowledgments Partners scale up team Bridge to scale team
Bill and Melinda gates foundation
Nascop PrEP technical working group