1. Implementing and scaling up HIV self testing in Kenya
Dr Sarah Masyuko
NASCOP

2. Background
In 2015, about 1.5 million Kenyans were living with HIV with 268,588 being young people
About 1 million are currently on treatment
About 500,000 are yet to be initiated on treatment
ST a tool to reach the 90:90:90 goal

4. Knowledge of HIV status
Percentage of women and men aged who received an HIV test in the past 12 months and know their results
As per last KAIS we still had not reached universal testing coverage and there was still a good percentage of HIV infected persons who were unaware of status.

5. HIV testing yield
Despite an increase in number of HIV tests conducted, the positivity rate continues to decline with a positivity of 1.7% in Therefore targeted testing becomes more useful

6. Progress on the 90:90:90 cascade
Those not identified are most likely Men and Adolescents and Youth:
Adolescents and youth have 43% ART coverage compared to 68% for those above 25 years

7. Progress on the 90:90:90 cascade
46% gap compared to a national gap of 29% for those identified positive and in care 45% vs 23% gap for those on treatment
Those not identified are most likely Men and Adolescents and Youth:
Adolescents and youth have 43% ART coverage compared to 68% for those above 25 years

8. Journey to ST roll out
HIVST first included in the national guidelines since 2009
However it has taken 7 years for it be implemented
7 years of formative research on ST
72% of respondents in last KAIS 2012 indicated that they would be willing to use a self test kit.
Acceptability
Packaging
Social harms

9. Evidence on self testing
High uptake of self-testing has been reported in Kenya by Health workers.
High uptake of self -testing has specifically been reported among the youth, men and those who had tested before.
Benefits: First time testers, privacy, convenience, reduced stigma.
Pharmacies identified as point of distribution.
Concerns on need for counselling.
There is no significant harm associated with HIVST
Health workers study 2005
Cross sectional study in urban and rural Kenya
-91% of respondents were willing to use an oral fluid-based HIVST kit compared to other HIV testing alternatives (Sidze et al.2014)
Cohort study among HIV-negative women years old who presented at antenatal care (ANC) or post-partum care (PPC) settings and female sex workers presenting at drop-in centres were provided HIV self-test kits to deliver to their male partners and social networks. 
-Four women reported IPV after self test kit distribution to their partners(1.5%) Thirumurthy et al 2016
-26 of 41 newly identified HIV positive partners of sex workers (65%) had sought confirmatory testing within the 3 month follow-up period and 23 (58%) were reported to have linked to care. Thirumurthy et al 2016

10. From Research to Practice

11. Progress made with adoption of HIV self testing
Inclusion in Kenya HIV Testing Guidelines 2015
HIV Self Testing operational manual developed
HIV Self testing to be launched together with PrEP at end of April
Three HIV Self test kits registered in country by Pharmacy and Poisons Board
Lab board listing ongoing
Resource mobilization through PEPFAR, Global Fund and UNITAID

12. HIV ST Operational manual
Programmatic Approaches and Models
Package of services provided under HIVST
Commodity management systems for HIVST
Biosafety and infection control measures
Quality assurance strategies in HIVST

13. Approaches
Oral and Blood Based self tests

14. HIVST Service Delivery Approaches
Facility based
OPD, STI clinic, TB clinic, Pharmacy, ANC, CCC, Wards, maternity,Private clinics etc
Community based
VCT centres, DICEs, CHVs
Others
Pharmacy, Vending machines, Internet, dial-a-HIVST,

15. Algorithm This should be performed using approved national algorithm
HIVST should however not be used for HIV diagnosis, all positives results should be confirmed as per the national protocols.

16. Support and Linkage tools
Client information inserts
Community based follow up
Vouchers, coupons or rebates – applicable mostly to key populations
Internet, computer based programs and applications include online audio or video counselling services
Partner HIVST and couples who deliver test kits to partners and link them to care and treatment.
Telephone hotlines for pretest and posttest counselling and can still offer linkage to HTS.
Bulk mobile phone text message services
Through public gathering (baraza’s)

17. Challenges or Unanswered questions
Cost remains high- $7-8 retail price. Ex works price of $3-4
Private sector distribution of self test
Linkage to care for those positive and linkage to prevention for those who test negative
Lose of data on HIV testing
Support systems for those who test HIV positive
WHO prequalification of the test kits
ERP approval
As kits not available, Kenya is piloting scale up in private sector

18. Unanswered questions
After ST, Confirmatory testing prior to ART initiation or do they follow the whole national algorithm
Monitoring of HIVST usage using barcodes
Use of the call centre to collect data and provide support vs use of a web app
Reality of linkage within 90 days
Monitoring of adverse events eg GBV, IPV

19. Public sector Limited distribution
Key populations and their partners
ANC and their partners
Adolescents and Young people
Men
Health care workers
Awaiting procurement after WHO prequalification

20. Pilot with the Private sector
Operational framework/SOPs for roll out in private sector developed
IEC materials drafted
Pilot to simulate how ST will work in private sector
Anonymous survey: models, client profile of early adopters, privacy, data, linkage
Selected 16 pharmacies in Nairobi, Mombasa and Kisumu to pilot ST
Linked to hotline managed by LVCT health
Referral sites available for linkage

21. Next Steps Public private partnership
Results from pilot to inform scale up for the launch of ST
Capacity Building
Launch of ST end of April 2017
Roll out to begin with private sector at a wider scale
Procurement of test kits to kick off public sector self testing
Continuous learning

22. Acknowledgements NASCOP HTS TWG WHO
CHAI, PS Kenya, Pharmaceutical Society of Kenya, Kenya Pharmaceutical Association, LVCT Health