Bridge to Scale Project IAS Satellite Session 25 th July 2017 Dr Elizabeth Irungu Partners Scale up Project Kenya Dr Daniel Were Jhpiego Kenya Background on HIV in Kenya ID: 627743
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Slide1
PrEP Scale Up in Kenya: Bridge to Scale Project
IAS Satellite
Session
25
th July 2017
Dr. Elizabeth IrunguPartners Scale up Project, Kenya
Dr. Daniel Were
Jhpiego, Kenya Slide2
Background on HIV in Kenya National HIV Prevalence – 5.6% 29% FSW18.2% MSM18.2% IDU51% new infections among adolescents 44% of new infections Sero discordant couplesSlide3
PrEP Journey in Kenya 2008-2012 – Partners PrEP study 2013-2017 Demonstration projects July 2016 – Revised ART guidelinesOctober 2016 - TWG formed December 2016 – TDF generics variation by Pharmacy and Poisons BoardMay 2017 – National PrEP scale up launchSlide4
Composition of TWGNASCOPNACCMOHWHOUNAIDSDonor agencies – PEPFAR (USAID, CDC)Implementing partners Slide5
TWG Sub-committees Service delivery Advocacy, communication and community engagement Research and impact evaluation Monitoring and evaluation Commodities and Supply chain Costing and resource mobilization Slide6
TWG Milestones November 2016 – PrEP implementers forum November 2016 – Implementation Planning and Document Review WorkshopJanuary 2017 – Document Finalization Workshop Monthly TWG meetings and recurrent consultationsNovember 2016 – March 2017 - TWG sub-committees working group meetings Slide7
TWG sub committee outputs PrEP implementation frameworkService providers tool kitTraining manual for health workers Communication planM&E and LMIS toolsResearch plan Financing and resource mobilization planSlide8
Bridge to Scale (JILINDE) Project GoalTo demonstrate and document an effective model for how oral Pre-exposure Prophylaxis (PrEP) can be scaled up as an HIV-prevention intervention in low-resource settings Slide9
Target Populations
Adolescent girls and young women
(AGYW)
Female sex workers
(FSWs)
Men who have sex with men
(MSMs)
Including male sex workersSlide10
Geographic Locations and TargetsSlide11
JILINDE PrEP Delivery Approaches Drop in centers Public health facilities Private health facilities Slide12
Partners Scale up project ObjectivesGeographical locationsTarget population Targets Delivery Approaches Slide13
Training Approaches: Case Based Training Curriculum Unit 1: CLINICAL CASE MANAGEMENT OF PrEPCase 1: Risk Assessment and indications for PrEPCase 2: Initiating PrEP in a Discordant CoupleCase 3: PrEP in special circumstances e.g. pregnancy Case 4: A male with multiple male sexual partnersUnit 2: DRUG RESISTANCE TESTING FOR PrEP SERO-CONVERTERSSlide14
Unit 3: COMMODITY MANAGEMENT FOR ORAL PrEPCase Study 1: Dispensing oral PrEPCase Study 2: Completing ART LMIS ToolsUnit 4: MONITORING AND EVALUATION OF PrEP SERVICESCase Scenario 1: PrEP Clinical Encounter Form and RegisterCase Scenario 2: PrEP Monthly Summary ToolSlide15
Partners Scale Up Complementary Training Content and Approaches Sero discordant couplesTraining on Treatment as preventionInclusion of SDC at the training Facility PrEP delivery championsFacility based CMEsSlide16
JILINDE Complementary Training Content and Approaches Whole site orientationsCMEsMentorshipSatisfied PrEP users Key Populations Sensitivity orientation Slide17
Training achievements Trained over 984 providers between both projects Cadres include;Medical officers Clinical officersNursesHIV testing counselors Pharmacists Laboratory technologists Slide18
Training Plans Service providers at PrEP delivery clinics – Critical massHTS providers Peer Educators and community Health volunteers Slide19
Challenges
Solutions
Few trained providers (Attrition, redeployment)
Train additional providers – critical mass
Off site training models
On site training models (Modular CMEs)
Senior cadres not trained on PrEP
Sensitization of senior cadres through professional bodies
Lack of a quick reference document for providers
PrEP Pocket book for providers
Perceived huge workload and provider attitudes
Mentorship, experience sharing by champion providers, Key Populations sensitivity orientation
Few providers trained on Couples HIV testing and counselling
CHTC SensitizationSlide20
Challenges
Solutions
PrEP counselling skills gaps
Training of HTS providers
Develop Counselling module for PrEP
Information gaps on PrEP efficacy
Experiences by PrEP users
Lack of confidence to prescribe PrEP
Develop a pool of clinical mentors, practical PrEP initiation session during training
Functional database of trained providers
Industrial action Slide21
Acknowledgments Partners scale up team Bridge to scale team Bill and Melinda gates foundation Nascop PrEP technical working group