1. Towards the last 90% of the 90:90:90 strategy: A review of viral suppression rates in a HIV program in Central and Eastern Kenya
Dr Moses Kitheka,
Chief of Party, Jhpiego Kenya
21st International AIDS Conference,
Durban, South Africa.
20th July 2016

2. Background - HIV in Kenya
2013: Estimated 1.6 million PLHIV, (191,840 Children). Estimated 101,560 New Infections
Kenya adopted 90:90:90 approach in programing and implementation
Key Documents:- National plan for Accelerating HIV Care and Treatment & Kenya AIDS Strategic Framework
Viral Load testing for routine treatment monitoring since mid 2014

3. Kenya AIDs Strategic Framework 2014/15- 2018/19

4. Main Objective
To review the Viral suppression rates in samples submitted for viral load testing by APHIAPLUS KAMILI from January 2015 to December 2015

5. Project background
Led by Jhpiego, APHIAPLUS KAMILI is a USAID funded project supporting HIV services in 142 health facilities since January 2011
Total of 35,120 clients on ART (3,332 children) as at December 2015
Viral load monitoring done through specimen collection at facilities, processing and sample transport network to National laboratories
Results posted online immediately, then physical results send to the health facilities

6. What have we done?
Clinical and laboratory staff trained on clinical and laboratory management/monitoring of HIV patients
Commodity support- EDTA Tubes, CryoVials, request forms etc.
On site Technical Assistance and Mentorship
Logistical Support for laboratory transport of specimen to central laboratories
SOPs and Job Aides

7. Methods for analysis
Retrospective, cross sectional analysis of VL results on all specimens send for VL testing with results posted online from January 2015 to December 2015
Source: Results of viral load tests posted online –
Used the R-Statistical software
Viral suppression defined as
Suppressed: VL < 1,000 copies/ml
Not suppressed: VL ≥ 1,000 copies/ml

8. Progress in Viral load testing

9. Results Total Viral load results analyzed-24,030
Crude Viral Suppression rate 84%
Viral suppression analyzed in different different categories

10. Viral Suppression by Sex (N=22,244)
Base: Female
Multivariate: No significant difference p=0.475

11. Viral Suppression by Age (N=21,293)
Base: Age Above 25 years
Bivariate- p<0.001 for all
Multivariate: Same for all

12. Suppression by Duration on ART (N=16,387)
Base 7-12 months
Bivariate: Age 0-6 Months p= the rest are not significant
Multivariate: No significance

13. Suppression based on Indication for VL testing (N=17,264)
Base: Routine VL
Bivariate: significance at clinical failure p-0.017
Multvariate: Clinical failure significanp p=

14. Conclusion Fairly good viral suppression rate, yet to reach 90%
Viral load testing is important in monitoring treatment and program success
Females have better viral suppression than males
Viral suppression lower in younger clients, especially adolescents, and better in those above 25 years of age
Clients identified with possible clinical and immunologic failure had fairly good viral suppression

15. Way forward Need to address the other 90s to complete the cascade
Re-evaluate adolescent care cascade to improve adherence and enhance quality of care
Need to intensify routine viral load monitoring as a way to better monitor treatment success and adherence
Clients not suppressed - Adherence counselling and treatment monitoring for treatment failure

16. Acknowledgments USAID Ministry of Health, Kenya County Governments
All health care workers
Communities

17. Suppression by ART regimen
Base: TDF/3TC/EFV
Bivariate: Significance in all except AZT/3TC/ABC, AZT/3TC/ATVr,
Multivariate: Signifiant for AZT/3TC/NVP, TDF/3TC/ATVr, etc

18. Analysis….. Bivariate Multivariate Variable Odds ratio 95% CI p-Value
Bivariate
Multivariate
Variable
Odds ratio
95% CI
p-Value
Gender: Female  
<0.001
0.475
Age: 25+ yrs
0-2
3-5 years
6-15 years
16-24 years    
Failure: Routine
Clinical failure
Immunological
Pregnant
Drug substitution
0.0177
0.2333
0.0211
0.1574
Duration: 7-12 Months
0-6
13-24
25-60
61-120
120+

19. Regimen: TDF/3TC/EFV
ABC/3TC/NVP
ABC/3TC/ATVr
ABC/3TC/EFV
ABC/3TC/LPVr
AZT/3TC/ EFV
AZT/3TC/ NVP
AZT/3TC/ABC
AZT/3TC/ATVr
AZT/3TC/LPVr
TDF/3TC/ATVr
TDF/3TC/LPVr
TDF/3TC/NVP
<0.001 e NA