ministry of health pediatric and adolescent hiv...

Ministry of Health

NASCOP

PEDIATRIC AND ADOLESCENT HIV PROGRAM

Ministry of Health Kenya

Dr Laura OyiengoPediatric and Adolescent HIV Manager

Kenya Background

Total population ~ 42 million

HIV prevalence adults : 6.0%

~ 1.4 million estimated PLHIV

o 179,894 are children < 14 years

o 156,000 adolescent (10 – 19years)

o 1.2 million adults >15 years

Estimated 1.8 million pregnancies/yr

oHIV +ve pregnant women 74,764

oHIV Exposed Infants 74,764

Ministry of HealthNASCOP

PMTCT Program Progress, 2012-2015

61%

70%

66%

72%

36%

57%

63%

68%

0%

10%

20%

30%

40%

50%

60%

70%

80%

0

200000

400000

600000

800000

1000000

1200000

1400000

2012 2013 2014 Jan-June 2015

1st ANC Known Status HIV+ Pregnant women identified

% maternal prophylaxis coverage % infant prophylaxis coverage

July 2014: Start of B+


Use of Option B+ in PMTCT

37%

74%

98%

49%

21%

1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2013 2014 Jun, 2015

Interrupted ART

NVP only

(AZT + SdNVP)

ART

Trend of new child HIV infections due to Mother-Child transmission (6-weeks)

9.8

11.4

10.69.9

8.1 7.8

7

0

2

4

6

8

10

12

2008 2009 2010 2011 2012 2013 2014

EID

Po

sit

ivit

y R

ate

(%

)

Source – EID database


Results: 18-month Infant Outcomes

20159, 66%

500, 2%

1816, 6%

2914, 9%

4308, 14%

1015, 3% % Attending 18 month visit and ABnegative

% Attending 18 month visit and no ABtest done

% Identified as positive between 0 and18 months

% Transferred out between 0 and 18months

% Lost to Follow-Up between 0 and 18months

% Died between 0 and 18 months

July 2011 – Sept 2012 Cohort (n=30,712)

Linkage to care: 1580/1816 (87%)

7


PEDIATRIC TESTING UPTAKE – 2014 HIV TESTING SERVICES

RAPID RESULTS INITIATIVE


Justification for the HTS RRI

• Kenya AIDS Indicator Survey 2012 showed:• 53% of HIV infected persons were unaware of their HIV infection

• Amongst HIV infected women; only a third had taken their children for HIV testing

• More than half of all children aged 18 months to 14 years who had a parent infected with HIV had never been tested for HIV

Rapid Results Initiative (RRI) 2014@ CWC

Variable Number Positivity

1 Total Mothers tested in Post natal clinic

(CWC)

150,287

2 Total Mothers testing positive in PNC

(CWC)

9,532 6%

3 Total Infants 18 months and below tested

in CWC (specimen removed for PCR)

13,705

4 Total infants testing positive linking to

care

1,008 7.4%

Positivity Rate of Infants less than 18 months

County

Number of infants

<18 months tested

Number

positive % positivity

Uasin Gishu 19 12 63

Nyeri 146 44 30

Mombasa 242 68 28

Muranga 58 13 22

Machakos 87 15 17

Makueni 173 26 15

Siaya 747 105 14

Taita Taveta 112 15 13

Turkana 16 2 12

Bomet 154 16 10


Summary of the HTS RRI 2014

• Total 37,245 children of HIV positive mothers who had unknown HIV status• Migori – 6020 (16%)

• Homabay – 4139 (11%)

• Kirinyaga – 3572 (9.5%)

• Kitui- 2503 (6.7%)

• Nakuru – 2391(6.4%)

• Positivity rate of infants less than 18 months – 7.4%

• CONCLUSION:- SCALE UP PEDIATRIC HIV TESTING SERVICES IN HEALTH FACILITIES


ENROLLING CHILDREN INTO CARE

• Cohort Analysis Report – 2015

Strategic Information Unit - NASCOP


Method..

Data collection:

• 2,500 sites offering HIV care & treatment

• All sites using Electronic Medical Records were eligible

• Period under review: Jan 1, 2008 to Dec 31, 2014

• De identified patient records obtained

• CD4 % or count at enrollment for children <14years, was

reviewed.


CD4 at Enrollment

4%6%

13%

16%

16%

45%

Distribution CD4% at enrolment of pediatric 0-4yrs , N=5,211

0-4%

5-9%

10-14%

15-19%

20-24%

25%+

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

5-9 yr 10-14 yr Total

Distribution of Paediatric CD4 count at enrolment by age

500+

350-499

250-349

0-249


Result 1 – CD4 at Enrollment

• While 45% of children aged 0-5 have a high CD4 at enrolment, reflecting the benefits of early identification and enrolment in care, over a quarter of children aged 5-14 are severely immuno-suppressed at enrolment, and the % suppressed increases with age.

• Testing at CWC (MNCH) will result in identification of “well” children


• ART COVERAGE…..

Progress So Far


90-90-90 Cascade: ChildrenSeptember 2015

179894

83,500 75,393 71,654

78,40570,321 59,489

0

50000

100000

150000

200000

CLHIV Currently in Care Currently on ART Virally Suppressed

Achieved Gap

48%48%

52%52%

45%

55%


Viral suppression is consistently lower in children

96,585

71,654

0 20000 40000 60000 80000 100000 120000

Pediatric VL Tests

VLs Suppressed

Children Viral Load Testing and Suppression

Pediatric VL Tests VLs Suppressed

74%


What is our Vision?


Kenya AIDs Strategic Framework 2014/15-2018/19

22

A Kenya free of HIV new HIV infection, stigma and AIDS related deaths

Reduce new infections by

75%

Reduce AIDS related

mortality by 25%

Reduce HIV related stigma and

discrimination by 50%

Increase domestic

financing of the HIV

response to 50%

Contribute to achieving Vision 2030 through universal access to comprehensive HIV Prevention, Care and Treatment

Priority Interventions and Recommended Actions; SD 1 - 8 .

Ob

ject

ive

s


KASF Strategic DirectionsSTRATEGIC DIRECTIONS (SD)

SD 1:

Reducing new HIV infections

SD 2

Improving health outcomes and

wellness of all people living with HIV

SD 3

Using human rights approaches to

facilitate access to service for

PLHIV, key populations and other

priority groups in all sectors

SD 4

Strengthening integration of

health and community systems

SD 5

Strengthening research and innovation

to inform the KASF goals

SD 6

Promoting utilization of strategic

information, research and

monitoring and evaluation (M&E) to

enhance programming.

SD 7

Increasing domestic Financing

for sustainable HIV response

SD 8

Promoting accountable leadership for

delivery of the KASF results by all

sectors and actors


Linkages to care and

treatment

Access to ART

Retention , adherence

Treatment outcomes :

Viral suppression

Identification and diagnosis

24

KASF Targets SD 2 : 90-90-90 by 2019

90% of HIV infected persons are identified

90% on Antiretroviral therapy

90% of those on ART achieve viral suppression

2016/2017 2018/19

KA

SF G

oal

s

90% of PLHIV identified 90% of identified PLHIV on ART

Ch

ildre

n

Ad

ult

s

90% of PLHIV on ART virally suppressed

1,305,941

Road Map to 90-90-90: National Targets

Identify 80%

130,206 Treat 90 %

144,674

Identify 80%

Treat 90 %

Identify 90%

Treat 90 %

Identify 90%

Treat 90 %

161,905

145,714

1,175,347

1,169,576

1,052,619


WHAT DOES 90-90-90 MEAN FOR A CHILD

90% of all CLHIV are diagnosed

• HIV risk identified

• Taken for HIV test by caretaker

• Gets blood drawn

• Caretaker learns test results

90% of all diagnosed

CLHIV receive treatment

• Gets referred for care

• Is taken to clinic for care

• Caretaker learns how to manage HIV in child

• Child receives and starts ART

90% of all CLHIV on

treatment are virally

suppressed

• Is given ART as prescribed (lifelong)

• Is brought to clinic regularly for: - Adherence support, Clinic/lab evaluation, Medication refills & other health care services

• When appropriate, learns about HIV-positive status; begins managing own care

• Transitions to adolescent and later adult care


Accelerating Paediatric Treatment

• Lag in access to Paediatric ART

• Low identification

• Challenges in linkage

• Access to ART low

• Poor viral suppression

• High targets to meet!


IMPROVING PEDIATRIC ART IN KENYA

SUPPRESS

TREAT

TEST

COMMUNITY IndividualHouseholdSchool & institutions

FACILITY StaffService deliverySystems

COUNTY Leadership ManagementAccountability

NATIONAL Policy guidancePartnerships & NetworkingHealth financing


Populations are targeted!!

• All PLHIV

• Pregnant women

• Children

• Adolescents

• Adults

• KPs


Our Vision remains, and to achieve it..

Optimize access along all the steps of the cascade

ministry of health pediatric and adolescent hiv...

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