HIV Prevention, Care & Treatment
Welcome to the HIV Prevention section of your G-jali journey, where we provide vital information on HIV Prevention, Care & Treatment.
Kenya has complex HIV and STI burden, substantive decline in incidence and deaths cannot be realized unless contextual factors that increase HIV and STI risks and vulnerability as well as barriers to health care access across counties, gender and priority groups such as pregnant and breastfeeding women, discordant couples, adolescents and youth, key populations are addressed. There has been adoption an integrated and evidence-informed high impact HIV and STI Combination Prevention approach to achieve KASF’s ambitious vision of eliminating the impact of the AIDS and STIs. Prevention is most effective when delivered as a combination of behavioural, biomedical and structural interventions that identify vulnerable populations to mitigate HIV and STI transmission at multiple points in the transmission cycle. Biomedical interventions: which can reduce infectiousness of people with sexually transmitted infections (STI) and HIV may comprise of a mix of antiretroviral therapy (ART), pre-exposure prophylaxis (PrEP), STI treatment and needles and syringe programme for people who inject drugs (depending on the targeted population), while other HIV prevention strategies such as condom promotion and risk reduction counselling reduce HIV and STI susceptibility among the uninfected.
However, an aggressive roll-out of behavioural and biomedical interventions that merely focuses on set targets may overlook a clients’ right to informed consent, increase the risk of intimate partner and gender-based violence and promote criminalization of HIV and STI-related risk behaviours, particularly among key populations. Rights-based structural interventions such as violence prevention and response or eliminating stigma and social exclusion are vital to assure uptake and effectiveness of HIV prevention. The table illustrates core components of NASCOP’s recommended HIV and STI Combination Prevention service package whose efficacy is strongly backed by evidence.
Summary of Combination Prevention Services
BEHAVIOURAL
To reduce risky behaviours and sustain positive change as well as increase acceptability and demand for biomedical interventions
Examples of core Interventions
- Peer education
- Targeted information, education, and communication -IEC
- Promotion, demonstration, and distribution of male and female condoms and water-based lubricants
- Risk assessment, risk-reduction counselling, and skills-building
- Evidence-informed behavioural interventions (EBI) e.g. Sister-to- Sister
BIOMEDICAL
To influence biological systems via which the virus infects a new host, so as to block virus transmission, decrease infectiousness, or reduce risk of acquiring infection
Examples of core Interventions
- ARV-related prevention (PEP, PrEP)
- HIV testing and counselling
- Assisted partner notification services
- STI screening and treatment
- HIV care and treatment
- Elimination of mother to child transmission
- TB screening and treatment
- Voluntary medical male circumcision
- Needles and syringe programme
- Medically assisted therapy for PWID
- Screening and management of hepatitis B
- Cervical and anal cancer screening
- Family planning sexual and reproductive health services
STRUCTURAL
To address social, economic, political, and environmental factors that affect individual or group HIV risk and vulnerability
Examples of core Interventions
- Shaping policy & creating enabling environment
- Access to education, life skills & social protection
- Provision of stigma-free services
- Empowering community, including ownership and leadership
- Mitigate and manage sexual violence
- Mitigate violation of human rights
- Access to micro credit and other financial products
Standard Package of Care for PLHIV
People living with HIV has need to be put into comprehensive HIV care, to ensure all challenges are addressed, there are 8 basic components of care for this clients, this include:
- All PLHIV are eligible for ART irrespective of CD4 cell count or percentage, WHO clinical stage, age, pregnancy status, or comorbidities
- ART should be initiated as soon as the patient is ready to start, preferably within two weeks from time of HIV diagnosis
- All patients should be counselled and supported for disclosure of HIV status; partner/ family testing and engagement; condom use; family planning; sexually transmitted infections screening; treatment adherence; and pre-exposure prophylaxis for HIV-negative sexual partners
- All females aged 15-49 years and emancipated minors accessing HIV care services should be screened for Intimate Partner Violence (IPV) as part of the standard package of care
- All PLHIV should be provided with HIV education and counselling
Cotrimoxazole Preventive Therapy (CPT) is no longer recommended as life-long prophylaxis, and is only recommended in the following sub populations, unless they have an allergy to sulfur drugs or develop toxicity from CPT
- All HIV Exposed Infants
- HIV infected children < 15 years of age
- All PLHIV > 15 years of age:
- All PLHIV should be screened for STI at every clinic visit
- Pregnancy status should be determined for all women of reproductive age at every visit and their contraception need determined and met
- All HIV positive women between the ages of 18 – 65 years should be screened for cervical cancer (HPV testing conducted every 2 years or Annually
- All PLHIV should be screened for hypertension, diabetes mellitus, dyslipidaemia, and renal disease annually.
- Routine screening should be provided for early detection of cervical cancer, breast cancer, bowel cancer, and prostate cancer
- All PLHIV should receive basic screening for depression and anxiety before initiating ART, and annually thereafter, and whenever there is a clinical suspicion
- All PLHIV should be provided for and linked with support structures to maintain general well-being addressing issues that could affect their mental health
- All adults and adolescents should be screened for alcohol and drug use before initiating ART and regularly during follow-up
- All caregivers should also receive baseline and follow-up screening for depression and alcohol/drug use
- All PLHIV should receive nutritional assessment, counselling, and support tailored to the individual needs of the patients
- All infants irrespective of HIV status should be exclusively breastfed for the first 6 months of life, with timely introduction of appropriate complementary foods after 6 months, and continued breastfeeding up to 24 months or beyond
- PLHIV (including children) should receive vaccinations as recommended by the National Vaccines and Immunization Program
- All PLHIV should receive vaccination for COVID-19 following national guidelines for age and dosing