Nairobi — Kenya has made commendable progress in the HIV response as shown by the progressive decline in HIV prevalence among adults (15-49 years), even though the transmission rate is higher among the youth.
In the general population, a new study show that transmissions had reduced from a peak of about 10 percent in the mid-1990s to 4.5% in 2020.
According to the Kenya AIDS Strategic Framework II report (KASF II), new HIV infections declined from 75,000 in 2010 to 41,416 in 2019. This amounts to a 44 percent reduction of cases, which is indicative of substantial progress, but short off the reduction by 75 percent envisioned by 2020.
New HIV infections among children declined from 18,000 to 6,806, while new HIV infections among adults declined from 56,000 to 34,610.
However, despite aggressive efforts to fight HIV, 15 counties have drawn back on gains earlier made and are now witnessing high new infections.
According to the KASFII report , counties like Nandi, Baringo, Narok, Samburu, Uasin Gishu, Nakuru, Kajiado, Bomet, Marsabit, Kisumu, Kisii, and Trans Nzoia have gone on ‘reverse gear’ and more people are getting infected.
A further 13 counties had more than 1,000 new HIV infections, accounting for 72 per cent of all new infections in the country. Homa Bay, Kisumu, Siaya and Migori counties have HIV prevalence at hyper epidemic levels
The report recommends an intensified focus to curb new HIV infections.
“They are now among the priority areas targeted by HIV interventions that previously focused heavily on Nyanza,” the report released this week states.
-Mother to Child Transmission HIV prevention, Management-
Estimate models show that by end of 2019, Kenya had averted 118,300 mother-to-child HIV infections due to the scale-up of prevention of transmission of HIV from mother to child during pregnancy and breastfeeding since 2004.
In 2019, a total of 59,304 (94%) of women living with HIV received ARV prophylaxis to prevent HIV transmission during pregnancy and breastfeeding period.
Despite the annual decline of the number of women in need of prevention of mother to child transmission services from about 85,400 in 2010 to approximately 63,000 in 2019, an estimated 6,696 HIV positive pregnant women did not access treatment for their health and that of their unborn and newborns in 2019.
“The situation demands increased focus to minimize the missed opportunities to provide HIV testing and treatment services for HIV positive women,” the report recommended. “Interventions to prevent mother-to-child infection in the first 1,000 days of a child at risk of HIV infection should be ingrained within the tenets of primary health care.
-Teenage Pregnancy and HIV infection-
According to the KASFII report, HIV transmission among children due to early sexual debut and defilement cases is worrying.
Kenya Health Information System (KHIS) shows 28 per cent (399,028) of all pregnancies registered were among adolescents aged 10-19.
In 2019 a third of these teenage pregnancies occurred in nine counties, namely, Nairobi (26,545), Kakamega (17,555), Nakuru (16,502), Meru (15826), Narok (14,962), Bungoma (14,512), Kiambu (13,562) Homabay (13,644) and Kwale (11,251).
“Factors such as the high number of orphans who require social protection services, low retention, and low transition rates from primary to secondary school – 18 pe cent of girls who do not complete primary education (Kenya Demographic and Health Survey-KDHS 2014) and elimination of all forms of violence against children must be addressed. There is need to target locations with high teenage pregnancies as a proxy-indicator of heightened risk to HIV infections among girls,” the report highlighted.
The report also shows that some 34,337 (32%) children living with HIV were not on ART treatment by the end of 2019.
Among those on treatment, only 51% were virally suppressed leaving a large cohort of children prone to HIV related co-morbidities and ill health.
Adolescent and young people contribute to 42% of the new HIV infections and are now listed as priority population.
Mombasa, Siaya, Kisii, Migori, Kisumu and Homa Bay have extremely high HIV incidence per 1,000 among adolescent girls and young women aged 15-24.
Boys and young men aged 15 to 34 accounts for 53% of new HIV infections
The report noted that the success of ART treatment programs among children (0-14yrs) is largely dependent on early diagnosis and prompt ART initiation.
At least 6,806 new HIV Infections among Children aged 0-14 years across Counties, were recorded in 2019.
– Access to HIV Treatment-
The KASF-II report shows that the number of people living with HIV on treatment increased dramatically since 2010. The increase is largely attributed to the evolution and rapid adoption of global guidelines for HIV treatment.
By the end of 2019, a total of 1,160,479 (1,087,511 adults and 72,968 children) were on antiretroviral therapy, representing an estimated treatment coverage of 80% among adults (68% among children).
Positive health outcomes attributed to ART still remain elusive for close to half a million Kenyans who are not aware of HIV status.
Even though women still carry the highest HIV burden, men are more likely to die of the disease. Doctors have attributed this to men rarely going to hospital even when sick, hence lowering chances of them getting tested.
Men also tend to have a lower viral suppression load even when they are on ARVs.
“The lower levels of viral suppression among men contribute to higher mortality rates among men and impact negatively on increased number of new HIV infections among their sexual partners,” said the report.
Only 74% of people living with HIV are on ARVs against a target of 81%. Out of those who are on treatment, 68 per cent had a suppressed viral load against a target of 73%.
Progress varies by age and sex, as 74% of adult women had a suppressed viral load, while only 61% of adult men and 51% of children had a suppressed viral load.
Vulnerable populations, including people in prisons, internally displaced persons (IDPs), fisher folk, long distance truckers, people living in large-scale agricultural plantations, people with disabilities and members of uniformed services will also get prioritized care.
– AIDS Related Deaths, viral suppression-
The report shows that AIDS-related deaths declined rapidly from 51,000 in 2010 to 20,997 in 2019, representing a 59% reduction.
AIDS related deaths declined more significantly among children – from 16,000 in 2010 to 4,300 in 2019.
AIDS related deaths among women also declined from 22,000 to 7,300, while the deaths among men only declined moderately from 13,000 in 2010 to 9,400 in 2013.
In 2019, 90% of all Kenyans living with HIV knew of their HIV status, which means that the 2020 target of achieving 90 percent across the cascade was achieved.
Some 74% of people living with HIV were on treatment against a target of 81% and 68% had a suppressed viral load against a target of 73%.
Progress varies by age and sex, as 74% of adult women had a suppressed viral load, achieving the 2020 targets was however only 61% of adult men and 51% of children had a suppressed viral load.
The lower levels of viral suppression among men contributed to higher mortality rates among men and impact negatively on increased number of new HIV infections among their sexual partners.
The report further indicated that “the low level of viral suppression among men and children points to continued service gaps and barriers that need to be urgently addressed.”
The end term review of KASF 1 performance against key target indicators on four objectives: Shows that on reducing new infections, 44% was achieved against the targeted 75%.
Reducing AIDS-related mortality, an impressive 64% was achieved against the targeted 25%.
Reducing HIV-related stigma and discrimination still remains at 50% this is because progress in elimination of HIV related stigma and discrimination is off track. According to the KDHS 2014 the percentage of women reporting accepting attitudes towards PLHIV reduced from 33% in 2010 to 26% in 2014.
Similarly, the same indicator showed a decrease from 48% to 44% among men who reported accepting attitudes. Programmatic reports show that specific groups, such as key populations, continue to face stigma and discrimination even in health care settings. There is need to address policy and legal barriers that impact negatively on access to HIV services.
The fourth objective is on increase in domestic financing of HIV response of which of the targeted 50% only 32% was achieved.
Key recommendations made in the KASF II include,
Strengthening of partnerships across key sectors and communities, including the private sector to bridge gaps in programs and improve quality.
Enhance community-led and based interventions such as use of trusted access platforms to improve coverage, quality and outcomes of HIV program.
Integrate and link HIV prevention and treatment with programs addressing sexual and reproductive health and rights (SRHR) including sexually transmitted infections (STIs) and contraceptive services, viral hepatitis, cancers, non-communicable diseases (NCDs), other chronic diseases and nutrition.
Strengthen the health workforce, commodity security and laboratory infrastructure.
Scale up interventions to address human rights violations, access to justice against HIV related stigma and discrimination.
Develop alternative models for HIV investment to bridge funding gaps at the county and national level, among others.
The Kenya AIDS Strategic Framework II in partnership with the Ministry of Health and its agencies such as the National AIDS and STI’s Control Program will focus on bridging the gaps in program coverage through differentiated approaches that meet the needs of citizens within their geographical locations.