A decade and beyond: learnings from HIV programming with underserved and marginalized key populations in Kenya

Abstract

Introduction Key populations (KP) continue to account for high HIV incidence globally. Still, prioritization of KP in the national HIV prevention response remains insufficient, leading to their suboptimal access to HIV programmes. This commentary aims to share Kenya’s challenges and successes in achieving 2020 global HIV targets and scaling up the KP programme in the last decade. Discussion The KP programme in Kenya has scaled up in the last decade with the inclusion of female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), transgender people and people in prisons as priority populations in the national HIV response. KP coverage based on official size estimates for FSW is 73%, for MSM is 82%, for PWID through needle syringe programme (NSP) is 71%, and through opioid substitution therapy (OST) is 26% and for transgender people is 5%. The service outcomes for KP have been relatively strong in prevention with high condom use at last paid sex for FSW (92%) and use of sterile equipment among PWID (88%), though condom use at last sex with a non‐regular partner among MSM (78%) is still low. The KP programme has not met care continuum targets for all subpopulations with low case findings. The national KP programme led by the Ministry of Health has scaled up the programme through (a) strategic partnerships with KP‐led and competent organizations, researchers and donors; (b) development of policy guidance and programme standards; (c) continuous sensitization and advocacy to garner support; (d) development of national reporting systems, among others. However, the programme is still struggling with uncertain size estimates; lack of updated bio‐behavioural survey data; inadequate scale‐up of interventions among transgender people and people in prison settings; gaps in reaching adolescent and young KP, and effectively addressing structural barriers like violence and stigma. Conclusions To reach the ambitious global HIV targets, sufficient coverage of KP with quality HIV programmes is critical. Despite scaling up the KP programme, Kenya has not yet achieved the 2020 global HIV targets and needs more efforts to scale‐up quality programmes for KP who are underserved in the HIV response.

Barriers and facilitators of HIV and hepatitis C care among people who inject drugs in Nairobi, Kenya: a qualitative study with peer educators

“…Our qualitative study takes place within Nairobi’s urban core with two SAPTA facilities where PEs provide outreach and harm reduction services to surrounding PWID communities. The SAPTA service region caters to roughly 5,000–11,000 PWID, most of whom buy, sell and trade drugs within “dens” that are located in outdoor public spaces [ 9 ]. To avoid contributing to community stigma, location names will not be provided.…”

“…Moreover, PWID living with HIV are more susceptible to acquiring HCV and experiencing HCV-related morbidity and mortality [ 8 ]. Kenya’s national HIV program scale-up for key populations has resulted in significant reductions in HIV incidence among PWID, but service gaps remain with 57% of PWID unaware of their HIV status, 68% of PWID diagnosed with HIV are on antiretroviral treatment (ART), and 64% of those on ART are virally suppressed [ 4 , 9 ]. With the release of direct acting antiretrovirals (DAAs), which are over 90% effective in treating HCV within other PWID settings, HCV elimination is achievable and has shown promising, cost-effective results when incorporated into existing harm reduction and HIV programs for PWID [ 9 – 12 ].…”

“…Kenya’s national HIV program scale-up for key populations has resulted in significant reductions in HIV incidence among PWID, but service gaps remain with 57% of PWID unaware of their HIV status, 68% of PWID diagnosed with HIV are on antiretroviral treatment (ART), and 64% of those on ART are virally suppressed [ 4 , 9 ]. With the release of direct acting antiretrovirals (DAAs), which are over 90% effective in treating HCV within other PWID settings, HCV elimination is achievable and has shown promising, cost-effective results when incorporated into existing harm reduction and HIV programs for PWID [ 9 – 12 ]. Within Kenya, DAA access has been largely cost-prohibitive, with few HCV prevention resources, and there is limited evidence on current PWID knowledge and perceptions of HCV, which can contribute to future HCV programs and services [ 1 , 13 ].…”

“…Kenya’s Ministry of Health supports the collaboration of healthcare providers and harm reduction organizations that have established rapport with PWID communities in order to address the HIV and HCV epidemics [ 14 – 16 ]. Harm reduction programs are largely credited with reducing HIV and HCV incidence among PWID through needle-syringe programs (NSPs), HIV counseling and testing services, social services (e.g., meals, shower facilities) and healthcare referrals [ 9 , 17 ]. Common healthcare referrals include HIV and HCV care, wound care and opioid substitution therapy (OST), with several OST clinics providing more comprehensive healthcare services by offering both OST and HIV treatment to PWID [ 18 ].…”

Capacity and Readiness Assessment of Healthcare Facilities for Digital Health Interventions Against Tuberculosis and HIV in Addis Ababa, Ethiopia

“…There have been decades of investments made in the prevention and control of tuberculosis (TB) and human immunodeficiency virus (HIV), the two infectious diseases of global importance. Several studies have confirmed that TB and HIV will continue to pose major challenges without the deployment of innovative prevention and treatment strategies for everyone who needs them (17)(18)(19)(20)(21). For countries like Ethiopia that are overwhelmed by the dual burden of the two diseases, advancing the diagnosis, care, and treatment programs are essential to meeting global targets such as the 2035 End TB Strategy and the 2030 end AIDS epidemic (22)(23)(24)(25)(26).…”