Pre-exposure prophylaxis rollout in a national public sector program: the Kenyan case study

Abstract

Background While advances have been made in HIV prevention and treatment, new HIV infections continue to occur. The introduction of pre-exposure prophylaxis (PrEP) as an additional HIV prevention option for those at high risk of HIV may change the landscape of the HIV epidemic, especially in sub-Saharan Africa, which bears the greatest HIV burden.

Methods: This paper details Kenya's experience of PrEP rollout as a national public sector program. The process of a national rollout of PrEP guidance, partnerships, challenges, lessons learnt and progress related to national scale up of PrEP in Kenya, as of 2018, is described. National rollout of PrEP was strongly lead by the government, and work was executed through a multidisciplinary, multi-organisation dedicated team. This required reviewing available evidence, providing guidance to health providers, integration into existing logistic and health information systems, robust communication and community engagement. Mapping of the response showed that subnational levels had existing infrastructure but required targeted resources to catalyse PrEP provision. Rollout scenarios were developed and adopted, with prioritisation of 19 counties focusing on high incidence area and high potential PrEP users to maximise impact and minimise costs.

Results: PrEP is now offered in over 900 facilities countrywide. There are currently over 14000 PrEP users 1 year after launching PrEP.

Conclusions: Kenya becomes the first African country to rollout PrEP as a national program, in the public sector. This case study will provide guidance for low- and middle-income countries planning the rollout of PrEP in response to both generalised and concentrated epidemics.

Figure 1.

Timeline for pre-exposure prophylaxis (PrEP) implementation in Kenya. ART, antiretroviral treatment; PrEP, pre-exposure prophylaxis; TWG, technical working group; NASCOP, National AIDS & STI Control Programme; TDF, Tenofovir disoproxil fumarate

Figure 2.

Sample messaging posters for pre-exposure prophylaxis (PrEP).

Figure 3.

Rollout scenarios considered for population and geographic targeting of oral pre-exposure prophylaxis (PrEP) scale up in Kenya. SDC, serodiscordant couples; AGYW, adolescent girls and young women; DICEs, drop-in centres; NGO, non-governmental organisation; HTC, HIV testing and counselling; ARV, antiretroviral; CCC, comprehensive care clinic; PLHIV, people living with HIV.