1. DR. THOMAS OGARO, MBCHB, MPH, PhD
NAIROBI’S 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

2. Presentation Outline Background Information City County Road Map
Key Achievements to date
Key Activities and Milestones
Challenges
2017/2018 Priorities

3. Nairobi City, Kenya

4. Background Information
Description
Kenya
Nairobi City
Total Population
44,354,000
4,463,150 (10%)
HIV Prevalence
5.9%
6.1%
People living with HIV/AIDs
Overall
1,517,707
171,510 (11.3%)
0-14 Years
98,170
8,223 (8.4%)
New Infections
71,034
4,719 (6.7%)
0-14 years
6,613
262 (4%)
Mother-to-child transmission 8%
4.7%
HIV related Deaths (2015)
30,817
2,437
Source: HIV County Estimates 2015

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

7. Key Result/Deliverable
Nairobi City: Road map for 2016
Action areas
Key Result/Deliverable
Scaling up what’s working
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 /services
Unblock viral load testing (high workload)
Increase access to HIV treatment facilities
Integrate of HAART in MCHs
Collecting and use of data
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 and care continuum data to best focus resources and target interventions
Management, coordination and financing
City County HIV strategic plan developed
Coordinate Partner activities
Advocacy for Human Rights(Review of by laws)
Resource mobilization
Implementation of roadmap

8. HIV Program Performance: 2016 ART Cascades

9. HIV Program Performance: 2016

10. 90–90–90 Progress from 2014 to 2016
90% of those who are HIV positive identified
2014-7,564
2016-7,370
,291
,169
,855(66%)
,539(77%)
Increased persons knowing status by 11%
90% of those identified are on ART
2014-6,325
2016-6,939
,996
,016
,321(79%)
,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
,774
,859(12%)
,894(55%)
Increased persons with viral suppression by 43%

11. 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%
Persons tested for HIV increased from half a million to over 1 million
VMMC services increased by 2%
Percentage of TB Patients starting on ART increased from 80% to 88%

12. How have we done it…
HIV Messaging:

13. 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

14. 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
MAT Clinic in Nairobi

15. Data Management
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)

16. Focus on the Adolescent
Nairobi city has rolled out the "Kenya’s 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.

17. Challenges
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.

18. Key Priorities for 2017/18
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

19. Thank you: