#IAS2017 | @IAS_conferenc #FastTrackCities | @IAPAC NAIROBIS FAST-TRACK

#IAS2017 | @IAS_conferenc #FastTrackCities | @IAPAC NAIROBIS FAST-TRACK

#IAS2017 | @IAS_conferenc #FastTrackCities | @IAPAC NAIROBIS FAST-TRACK CITY STRATEGY, A DATA-DRIVEN RESPONSE TO FOCUS HIV RESOURCES DR. THOMAS OGARO, MBCHB, MPH, PhD COUNTY DIRECTOR OF HEALTH SERVICES NAIROBI CITY COUNTY #IAS2017 | @IAS_conferenc #FastTrackCities | @IAPAC Presentation Outline Background Information City County Road Map Key Achievements to date Key Activities and Milestones Challenges 2017/2018 Priorities 2

Nairobi City, Kenya #IAS2017 | @IAS_conferenc #FastTrackCities | @IAPAC Background Information Description Kenya Total Population 44,354,000 5.9% HIV Prevalence Nairobi City 4,463,150 (10%) 6.1% 1,517,707 171,510 (11.3%) 8,223 (8.4%) 0-14 Years 98,170 4,719 (6.7%) Overall 71,034 New Infections 262 (4%)

0-14 years 6,613 People living with HIV/AIDs Overall Mother-tochild transmission HIV related Deaths (2015) 4.7% 8% 30,817 Source: HIV County Estimates 2015 2,437 #IAS2017 | @IAS_Conference #IAS2017 | @IAS_conferenc Nairobi City Key Population Estimates #FastTrackCities | @IAPAC County Key Population Estimate

6,216 IDU 29,494 FSW 10,000 MSM Source: MOT Study 2009 HIV Prevalence among Key Populations in Kenya 18.2% 29.3% 18.3% MSM (Men Having sex with Men) 33% of the new HIV infections FSWs (Female Sex Workers) occur in Key Populations IDU (Injecting Drug Users) Source: Kenya AIDS epidemic Update: NACC 2012,Studies conducted between 2009 & 2011,Modes of transmission study,2009 6 #IAS2017 | @IAS_conferenc

#FastTrackCities | @IAPAC Nairobi City: Road map for 2016 Action areas Scaling up whats working Key Result/Deliverable 1. 2. 3. 4. 5. Increased HIV testing and linkage to care Increased ART initiation among TB/HIV co-infected patients Scale up prevention and care services for Key Population Scale up of eMTCT services All-In: Reach more adolescents and young women New way(s) for delivering programmes 1. /services 2. 3. Unblock viral load testing (high workload) Increase access to HIV treatment facilities Integrate of HAART in MCHs Collecting and use of data 1.

2. 3. 4. Track progress towards 90:90:90 targets Improve Quality of data through routine DQAs and Data Audits Scale-up EMR Use of sub-county and facility level 90-90-90 and care continuum data to best focus resources and target interventions Management, coordination and financing 1.City County HIV strategic plan developed 2.Coordinate Partner activities 3.Advocacy for Human Rights(Review of by laws) 4.Resource mobilization 5.Implementation of roadmap #IAS2017 | @IAS_conferenc #FastTrackCities | @IAPAC HIV Program Performance: 2016 ART Cascades Nairobi County Pediatric Cascade Nairobi County Adults Cascade 180,000 160,000 77%

140,000 120,000 8,000 90% 31 7,000 84% 278 50% 2,375 5,000 8,223 40% 100,000 80,000 6,000 53,262 163,287 60,000 40,000

3,000 20,000 2,000 Achieved ed Ad ul ts Su pp re ss AR on tl y en Cu rr ss up re ad

sS Gap Pe Achieved en tly ed T AR on en lt y Cu rr Cu rr en tly in CH

Ca re LIV - in AL HI Ca re V 1,000 T - Cu rr 4,000 74% 12,246

21,789 9,000 Gap #IAS2017 | @IAS_conferenc #FastTrackCities | @IAPAC HIV Program Performance: 2016 Nairobi County Overall Cascade 200,000 180,000 160,000 77% 140,000 21,820 74% 11,968 41% 120,000 100,000 80,000 55,137

171,510 132,539 60,000 126,955 40,000 69,894 20,000 - PLHIV Currently in Care Achieved Currently on ART Gap Overall Suppressed #IAS2017 | @IAS_conferenc 909090 Progress from 2014 to 2016 #FastTrackCities | @IAPAC

90% of those who are HIV positive identified 2014-7,564 2016-7,370 2014-110,291 2016-125,169 2014-117,855(66%) 2016-132,539(77%) Increased persons knowing status by 11% 90% of those identified are on ART 2014-6,325 2016-6,939 2014-86,996 2016-120,016 2014-93,321(79%) 2016-126,955(96%) Increased persons on ART by 17% 90% of those on ART are virally suppressed 2014-1,316 2016-4,120 2014-9,543 2016-65,774

2014-10,859(12%) 2016-69,894(55%) Increased persons with viral suppression by 43% #IAS2017 | @IAS_conferenc #FastTrackCities | @IAPAC Progress from 2014 to 2016 contd. Increased Number of: ART sites from 169 to 189 eMTCT sites from 180 to 302 Infant prophylaxis increased from 52% to 95% Maternal prophylaxis increased from 72% to 94% VMMC services increased by 2% Persons tested for HIV increased from half a million to over 1 million Percentage of TB Patients starting on ART increased from 80% to 88% 11 #IAS2017 | @IAS_conferenc #FastTrackCities | @IAPAC

HOW HAVE WE DONE IT HIV Messaging: #IAS2017 | @IAS_conferenc #FastTrackCities | @IAPAC Leadership and Governance Political good will and strong leadership (Governor and CEC) with specific commitments for increased domestic HIV resource allocation Development of the County AIDS strategic Plan (CASP) Development and launch of the Nairobi city county AIDS strategic plan aligned to the Kenya AIDS Strategic Framework Partners Coordination Strong partnership and coordination of stakeholders with increased private sector involvement Establishment of the county Multi-sectoral HIV and AIDS committee that meets quarterly to review progress by the various technical working groups(Adolescent/C&T,KP,M&E,EMTCT,VMMC,PREP) Coordinated Trainings #IAS2017 | @IAS_conferenc Elimination of Mother To Child HIV transmission (eMTCT) Integrating HIV treatment(HAART) into MCHs has provided a one stop shop for our HIV-infected pregnant women and their infants up to 2 years. Engagement of mentor mothers and

community based peer educators to support linkage and retention to care and psychosocial support at both facility and community level Bring Back the Women and Children initiative as a rapid results initiative. Involving health care workers as eMTCT champions for the same. Other Services Increase access to HIV treatment facilities. Strengthened TB/HIV collaboration including integration of TB/HIV services in health facilities Enhanced Key population (KP) Services e.g Methadone Assisted Therapy (MAT) Services and targeted testing outreaches for KPs #FastTrackCities | @IAPAC MAT Clinic in Nairobi #IAS2017 | @IAS_conferenc Data Management #FastTrackCities | @IAPAC We conduct Quality Management quarterly and Biannual program performance review meeting performance review We have Scaled up Electronic Medical Records (EMR) for HIV services

Laboratory Strengthening Improved linkage to viral load testing at the National reference laboratory Accreditation for 15 labs on going, All laboratories are connected to EQA systems for HIV and TB related tests. We conduct regular training and updates on new HTC testing policy guidelines. HIV Testing and Prevention Services We conduct HIV testing outreaches. HIV self testing (HIVST) has been roll out in May 2017 Pre-Exposure Prophylaxis (PreP) has been rolled out in 44 facilities and already 501 clients have been enrolled in May 2017. We have so far trained 20 surgeons who conduct Voluntary Medical Male Circumcisions (VMMC) #IAS2017 | @IAS_conferenc #FastTrackCities | @IAPAC Focus on the Adolescent Nairobi city has rolled out the "Kenyas Fast-track plan to end HIV and AIDS among adolescents and young people" Adolescent &Youth Technical Working Group (TWG) formed and meets quarterly. Number of facilities Offering Youth Friendly Services/ Adolescent

Support have increased (Public 6 and Private 4) Development of youth led initiatives- Nairobi city we launched the SAUTI SIKIKA (Adolescents Living With HIV, Nairobi Chapter). Continued capacity Building and Training of Health care workers on adolescent package for care and youth friendly service delivery. Collaboration with other sectors and programs especially Ministry of Education to empower adolescents, young girls and also mobilize communities to reduce sexual risks of HIV transmission. #IAS2017 | @IAS_conferenc Challenges #FastTrackCities | @IAPAC Highly mobile and unstable population with unclear settlement areas thus making it difficult to follow-up. Data data/reports timeliness and completeness; We still have data quality gaps Low uptake of EMR About 60% of population seek health care in both formal and informal: High turnover of health providers which affects quality of care. Poor date quality reports in terms of completeness and timeliness Stigma still persists and particularly in the growing numbers of key populations Providing quality care to adolescents & children e.g. issues of access, dose adjustments for children, counseling &

disclosure Sometimes occasional stock outs of HIV test kits. #IAS2017 | @IAS_conferenc Key Priorities for 2017/18 #FastTrackCities | @IAPAC Continued targeted HIV Testing Services as well as scale up HIV self Tesing Increase number of HIV treatment sites and sustained access to HIV treatment services. Continued Private sector engagement in HIV program Scale up VMMC sites Continued scale up of adolescent services Strengthening of TB/HIV Collaboration and integration Scaling up of EMR, data quality audits (DQAs) and continued data review meetings. Improved results turn around time for viral load testing Continued EQA and scale. Scale up PREP services Strengthen and expand MAT services Continued regular training, updates and CMEs Scale up use of HIPPOS( Partner reporting website) Continue to strengthen EMTCT program Thank you: #IAS2017 | @IAS_conference 19

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