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Icap-Supported Rapid Scale-Up of Hiv Prevention, Care, and Treatment Contents Addressing the Global Hiv Epidemic

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Icap-Supported Rapid Scale-Up of Hiv Prevention, Care, and Treatment Contents Addressing the Global Hiv Epidemic KENYA Icap-supPORTED RAPid scale-up oF HIV PREVENTION, CARE, AND TREATMENT Contents ADDRESSING THE GLOBAL HIV EPIDEMIC . 1 ICAP IN KENYA. 4 KEY THEMES . 6 WHAT WAS ACHIEVED?. 13 THE NEXT CHAPTER . 24 Children play in the nursery at the Thika District Hospital ADDRESSING THE GLOBAL HIV EPIDEMIC HIV Prevalence (%), Ages 15–49, 2008–2009 lobally, 34 treatment (ART),3 almost a 22-fold increase million people since 2001 and an achievement that many 7.1–13.9 1.0–3.5 are living with G1 considered impossible 10 years earlier. Over 4.8–7.0 0.9 HIV, and 7,000 are newly the same period, the rate of new HIV infec- infected each day.2 As of 2011, Eastern North Eastern tions in 22 of the most severely affected countries 3.6–4.7 HIV has infected more than 60 dropped by more than 26 percent.4 Funding for this report was provided to ICAP at the Mailman School of million people and caused at Rift Valley Public Health, Columbia University as part of the Multicountry Columbia Western Antiretroviral Program (MCAP) and is supported by Cooperative Agreement least 30 million deaths. A major reason for this dramatic turnaround has #U62PS223540 from the Centers for Disease Control and Prevention (CDC). been the initiation of the United States President’s The contents of this report are solely the responsibility of the authors and do In the face of such over- Central not necessarily represent the official views of the CDC. Emergency Plan for AIDS Relief (PEPFAR), which Acknowledgements whelming figures, it is easy Nyanza was launched in 2003. Now, with its eighth More information on ICAP and its activities in Kenya can be obtained by The ICAP team would like to extend its sincere gratitude to the Ministry of Public to lose sight of the remark- NAIROBI anniversary, it has proved notable in its size, calling +254-020-271 8156, e-mailing [email protected], or writing to Health and Sanitation and the Ministry of Medical Services for their immense able strides that have been made Nairobi ICAP, P O Box 29840-00202, Nairobi, Kenya. Information on ICAP’s global support and partnership during this project. We would like to express our Coast scale, and impact on increasing access to HIV activities can be addressed to ICAP, Columbia University, 722 West 168th appreciation to the President’s Emergency Plan for AIDS Relief (PEPFAR) and in the response to HIV over the past prevention, care and treatment and has proven one Street, New York, NY 10032 USA or by email to [email protected]. the people of America for the funding support and to the Centers for Disease decade. Millions of people living with HIV Control and Prevention –Kenya for their technical and funding support. of the most successful large-scale global public health www.columbia-icap.org/ have built better futures for themselves, their families, undertakings ever. By September 2011, the US government ICAP would also like to express its thanks to the hospital and district and their communities as a result of innovative, effec- © February 2012 by ICAP. All rights reserved. management teams and all facility staff for their dedication in coordinating and had directly supported antiretroviral therapy (ART) for 50% implementing HIV services at ICAP-supported facilities. tive HIV prevention, care, and treatment programs. of the global response—more than 3.9 million men, women, We wish to thank the Vision Garden and Gatanga Kiiga Home Based Care and for their collaboration with ICAP and for their active involvement in HIV At the end of 2010, roughly 6.65 million people in low- and children worldwide, and more than 13 million of those in prevention, care and treatment programs. We would also like to thank all peer and middle-income countries were receiving antiretroviral HIV care and support services.5 educators, who tirelessly gave of their time and effort to expand family-focused HIV services and bring about sustainable behavior change in their communities. Asanteni sana wote! ICAP in KENYA f 1 Understanding how this turnaround was achieved can help Today a global leader in HIV service delivery, human capacity inform health and development efforts around the world. development, and systems strengthening, ICAP has supported work at more than 2,000 facilities across 21 countries. More Key Partner than one million people have accessed HIV services through ICAP-supported programs, and approximately one patient in 10 In 2002, in response to the United Nations Secretary General’s receiving PEPFAR-funded ART in sub-Saharan Africa is obtain- Call to Action, the Mailman School of Public Health at ing it at an ICAP-supported health facility. Columbia University helped to establish the MTCT-Plus Initiative to address the HIV treatment and care needs of ICAP is grounded in the belief that HIV services should be impoverished communities around the world. This initiative, universally accessible and that people in resource-poor areas can funded first by a coalition of private foundations and adhere to life-saving treatment regimens. ICAP works with min- subsequently expanded with funding from the United States istries of health, local organizations, and people living with HIV Agency for International Development (USAID), supported to develop sustainable, locally appropriate HIV prevention, care, provision of comprehensive and specialized care, including and treatment programs that are integrated with national AIDS ART, to HIV-infected women, their partners, and their children control programs. ICAP’s comprehensive model consists of: identified in prevention of mother-to-child transmission (PMTCT) programs. Mailman’s experience implementing ■ A family-focused approach to HIV prevention, care, the MTCT-Plus Initiative helped to inform the model and and treatment services approaches later adopted by ICAP. ■ Support for multidisciplinary teams of health care providers Columbia University’s role in implementing PEPFAR services began in 2003, when it received funding from the Global ■ A continuum of clinical and supportive services to meet AIDS Program of the Centers for Disease Control and Preven- patient and family needs at every stage of HIV disease tion (CDC) under the University Technical Assistance Projects ■ Programs to promote retention and adherence to HIV (UTAP) to support the development of important components care and treatment of national HIV programs, including treatment protocols and ■ Empowerment of patients and their families training. In 2004, ICAP was founded and was awarded a new ■ cooperative agreement from CDC under the PEPFAR frame- Linkages to community resources work to provide comprehensive HIV care and treatment in five ■ High-quality services, with carefully set standards of care countries: Kenya, Mozambique, Rwanda, South Africa, and and methodologies for program evaluation, operations Tanzania, with programming in Côte d’Ivoire, Ethiopia, and research, and program improvement Nigeria subsequently added. This initiative, the Multicountry Columbia Antiretroviral Program (MCAP), has rapidly ex- panded programs for HIV care and ART by promoting early di- 1. Joint United Nations Programme on HIV/AIDS (UNAIDS). AIDS at 30. Nations at the Crossroads. Geneva, Switzerland: UNAIDS; 2011. Available at: http://www.unaids.org/en/ agnosis of HIV infection, maintaining the health of those living resources/presscentre/pressreleaseandstatementarchive/2011/june/20110603praids30/. with HIV, and preventing further transmission of HIV within 2. United Nations General Assembly. Political Declaration on HIV/AIDS: Intensifying Our Efforts to Eliminate HIV/AIDS. Resolution Adopted by the General Assembly on 10 June 2011. A/ the community. MCAP programming, in addition to being RES/65/277. Geneva, Switzerland: UNAIDS; 2011. Available at: http://www.unaids.org/en/media/ focused on rapidly scaling up care and treatment in partnership unaids/contentassets/documents/document/2011/06/20110610_UN_A-RES-65-277_en.pdf. with host-country governments, also has emphasized the full 3. Joint United Nations Programme on HIV/AIDS (UNAIDS). Global HIV/AIDS Response. Epidemic Update and Health Sector Progress Towards Universal Access. Progress Report 2011. continuum of HIV-related services, continued capacity building Geneva, Switzerland: UNAIDS; 2011. Available at: http://www.unaids.org/en/media/unaids/ and health systems strengthening, and transition of operations to contentassets/documents/unaidspublication/2011/20111130_UA_Report_en.pdf. 4. UNAIDS. World AIDS Day Report 2011. Geneva, Switzerland: UNAIDS; 2010:7. Available host governments and local nongovernmental organizations. at: http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/ JC2216_WorldAIDSday_report_2011_en.pdf. 5. United States President’s Emergency Plan for AIDS Relief. Washington, DC: US Agency of the Global AIDS Coordinator, Bureau of Public Affairs, US State Department. Using science to save lives: latest PEPFAR results. Available at: http://www.pepfar.gov/results/index.htm. 2 f ICAP in KENYA ICAP-Supported Facilities in Kenya As of September 30, 2011, ICAP was supporting 691 facilities in Kenya. Turkana Trans Nzoia Marakwet Samburu Wajir Mt Elgon Baringo Bungoma Lugari Teso Uasin Gishu North Western Isiolo Busia Kakamega Eastern Keiyo Laikipia Meru North Butere/mumias Garissa Nandi Siaya Vihiga Koibatek Meru Central Kisumu Bondo Tharaka Nyando Kericho Nyandura Meru South ICAP IN KENYA Rachuonyo Nyeri Nakuru Embu Bomet Central Buret Kirinyaga Suba Nyamira Muranga Homa Bay Mbeere Mwingi Bomet Nyanza Gucha Central Kisii Rift Valley Maragua n estimated one million Kenyans are HIV infected, Migori Trans Mara Thika representing about 7.4 percent of the population aged Kuria Kiambu A Narok Nairobi Nairobi 15–49. Prevalence is higher among women than men, and Tana River Machakos Eastern HIV accounts for more than half of all hospital admissions. In Kitui addition, HIV has orphaned an estimated 1 million children. Eastern North Eastern Kajiado Makueni Rift Valley According to the 2008–2009 Demographic Health Survey, Western Central all-age HIV prevalence in ICAP-supported regions ranges Nyanza NAIROBI Nairobi Malindi from a low of 1.0 percent in Eastern Province to a high of 13.9 Coast percent in Nyanza Province.
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