Background

HIV/AIDS has had a devastating impact on all sectors of the Kenyan society. There was a progressive increase in prevalence from early 80s when the disease was first described up to almost 14% in the late 1990s. The Kenyan government declared HIV/AIDS a national disaster in 1999. This resulted in a national move towards creating awareness and advocacy for prevention of new infection. There has been a subsequent decline in prevalence to 7% in the last Kenya Demographics and Health Survey held in 2003. This same decline has been observed in the yearly sentinel surveys held among ANC and STI clinic attendants. Based on KDHS it was estimated that there were about 1.5 million Kenyan adults and children in need of ARVs. Of these about 15% were in urgent need of ARVs.

The benefits of highly active antiretroviral therapy have long been established leading to their use among those patients with deteriorating immunity. ART has been shown to improve the quality of life and survival of those affected, dramatically reduce HIV related hospital admissions and significantly enhance the national prevention efforts. In Kenya, however, like in many developing countries, the cost of these drugs has previously been very high and prohibitive to the majority of the majority of those who needed it. Due to global commitment to making treatment accessible to developing countries, and the advocacy for affordable pricing of these drugs, ARVs are now available to many Kenyans who need it. Recently ART in the public sector has been availed at no cost to the patients.

ART in the public sector was piloted in 5 sites in late 2003. At that time, there were about 11,000 patients on treatment, mostly in the private sector. The first ARVs in the public sector, for 9,000 patients were procured through funds from the government. Since then, with the availability of global funds and PEPFAR, the number of Kenyans who have been able to access affordable and free treatment has risen significantly to about 75,000 patients by the end of May. Treatment is now available in about 240 sites. Our target, as per the KNASP, is to put at least 110,000 Kenyans on treatment by the end of 2006. The provision of ART to the public is available in GOK facilities, FBOs, NGOs, university/teaching hospital and in the private sector.

The successes witnessed so far in the ART program are attributed to presence of a strong national ART task force coordinated by committed government leadership. This task force is made up of multi-sectoral and multidisciplinary stakeholders in ART and meets regularly to deliberate on programmatic and technical issues pertaining to ART. The government of Kenya has played a key role in this scale up by showing high level political involvement, mobilizing of resources, setting up systems and capacity building.
However the achievements witnessed would not have been witnessed without the immense input from key stakeholders who have committed outstanding resources and technical assistance towards this end.


The national scale up of ART has not been without challenges. These include:

• Lack of adequate and trained human resource capable of providing quality care to those affected;
• Poorly developed infrastructure for running the clinics;
• Undeveloped systems necessary for the smooth running of this program including forecasting of ART needs and other related commodities. This has led to frequent stock outs of ARVs, test kits, condoms;
• Poorly developed and equipped laboratories that extremely crucial in managing patients on treatment and assessing those who require ARVs;
• Poorly developed M/E systems, which are necessary for program evaluation and for assessment of program progress.
• Delays in implementation of paediatric ART programs due to unavailable paediatric policies, unavailability of the capacity to diagnose HIV in infants and the unavailability of paediatric formulations for those who cannot not take adult formulations, leading to fewer children being on treatment and care than is needed and more children succumbing to the disease

Objectives

• Coordination and Implementation of ART activities
• Human Resource Development and training
• Improvement of Clinical HIV care services provided at the CCCs
• Implement quality Procurement and Logistics Management System that is secure to ensure a reliable (sustainable) supply of ART related commodities