Pre-exposure prophylaxis rollout in a national public sector program: the Kenyan case study
Sarah Masyuko
A L , Irene Mukui A , Olivia Njathi B , Maureen Kimani A , Patricia Oluoch C , Joyce Wamicwe A , Jane Mutegi D , Susan Njogo A , Micah Anyona D , Phillip Muchiri B , Lucy Maikweki E , Helgar Musyoki A , Prince Bahati F , Jordan Kyongo G , Tom Marwa D , Elizabeth Irungu H , Michael Kiragu G , Urbanus Kioko I , Justus Ogando B , Dan Were D , Kigen Bartilol A , Martin Sirengo A , Nelly Mugo H , Jared M. Baeten J , Peter Cherutich K and on behalf of the PrEP technical working group
A The National AIDS and STI Control Program, Ministry of Health, Afya Annex, Kenyatta National Hospital Grounds, Nairobi, Kenya.
B Clinton Health Access Initiative, Timau Plaza, 3rd Floor, Argwings Kodhek Road, Nairobi, Kenya.
C Centers for Disease Control, KEMRI Complex, Mbagathi Road off Mbagathi Way, Nairobi, Kenya.
D Jhpiego, Ring Road, 14 Riverside, Nairobi, Kenya.
E Population Services International, Lenana Road, Jumuia Place, Wing B, 2nd Floor, Nairobi, Kenya.
F International AIDS Vaccine Initiative, ABC Place, Building 2, 3rd Floor, Waiyaki Way, Nairobi, Kenya.
G LVCT Health, Argwings Kodhek Road, Nairobi, Kenya.
H Kenya Medical Research Institute, Centre for Clinical Research Laboratories, Nairobi, Kenya.
I University of Nairobi, School of Economics, Nairobi, Kenya.
J University of Washington, 510 San Juan Road, Seattle, WA 98195, USA.
K Ministry of Health – Department of Preventive and Promotive Services, Cathedral Road, Nairobi, Kenya.
L Corresponding author. Email: sarah.masyuko@gmail.com
Sexual Health 15(6) 578-586 https://doi.org/10.1071/SH18090
Submitted: 12 June 2018 Accepted: 29 September 2018 Published: 9 November 2018
Abstract
Background: While advances have been made in HIV prevention and treatment, new HIV infections continue to occur. The introduction of pre-exposure prophylaxis (PrEP) as an additional HIV prevention option for those at high risk of HIV may change the landscape of the HIV epidemic, especially in sub-Saharan Africa, which bears the greatest HIV burden. Methods: This paper details Kenya’s experience of PrEP rollout as a national public sector program. The process of a national rollout of PrEP guidance, partnerships, challenges, lessons learnt and progress related to national scale up of PrEP in Kenya, as of 2018, is described. National rollout of PrEP was strongly lead by the government, and work was executed through a multidisciplinary, multi-organisation dedicated team. This required reviewing available evidence, providing guidance to health providers, integration into existing logistic and health information systems, robust communication and community engagement. Mapping of the response showed that subnational levels had existing infrastructure but required targeted resources to catalyse PrEP provision. Rollout scenarios were developed and adopted, with prioritisation of 19 counties focusing on high incidence area and high potential PrEP users to maximise impact and minimise costs. Results: PrEP is now offered in over 900 facilities countrywide. There are currently over 14 000 PrEP users 1 year after launching PrEP.Conclusions: Kenya becomes the first African country to rollout PrEP as a national program, in the public sector. This case study will provide guidance for low- and middle-income countries planning the rollout of PrEP in response to both generalised and concentrated epidemics.
Additional keywords: Africa, HIV, prevention.
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