Wednesday, May 21, 2025
5/21/2025
GH20-2084: County Government Implementation, Management and Sustainability of High Quality HIV Services in Homa Bay, Kiambu, Kirinyaga - PROJECT ABSTRACT Project tittle: Kirinyaga WEZESHA project Background: With an estimated 1.5 million persons living with HIV (PLHIV) at the end of 2019, Kenya has the fourth largest burden of HIV in the world. According to KENPHIA 2018, the HIV prevalence in Kenya is 4.4% among adults. The HIV epidemic in is generalised but concentrated among key population (KP) groups. An analysis of KASF I achievements suggests that incident infections decreased by 43% against a target of 75%. The number of AIDS related deaths (ARD) declined by 65% during the implementation of KASF I (2014/15-2019/20) compared to the modest target of 25%. While KASF I aimed at increasing domestic funding for HIV by 50%, actual funding levels increased by 32%. The HIV prevalence rate in Kirinyaga County is 3.0% (Adult female 3.9%, male 2.1%). People living with HIV are estimated at 14,594 (Adult 13,803 and Paediatric 791) with new HIV infections of 169 (Adults 128 and paediatrics 41) and HIV related deaths of 226 (Adults 188, Paediatrics 38) annually while the adolescent and young adults (AYP) account for 5.6% of all PLHIV. Though the County has near universal PMTCT coverage and prophylaxis at 99%, the maternal child transmission rate is high at 9% (regional estimates). The HIV program in Kirinyaga County began in 2004 with 1 site (Kerugoya District Hospital) providing HIV counselling and testing and care and treatment. Since then, the number of ART sites has increased to 62 where 11,130 (KHIS June 2020) patients are enrolled. Through the support of the PEPFAR/CDC supported Local Implementing Partners, the county has a well-established network of facilities and trained staffs offering HIV services. The proposed project aims at strengthening CHMT oversight role as well as capacity building on project implementation to prepare for a seamless transition of HIV services to the county. APPROACH AND OUTCOMES: Building from experience accrued over a decade of implementing HIV activities under PEPFAR, the CHMT proposes a health systems strengthening approach across the 95-95-95 cascade and along the facility to community continuum to progressively manage, sustain, and transition financing of HIV service delivery from PEPFAR. The project seeks to increase CHMT leadership in service delivery as well as increase its capacity to budget, plan and execute plans for HIV activities in the county. The CHMT will work to create efficiencies in HIV programming by promoting service integration, human resource right-sizing and decentralised models of care including strengthened community health systems supported by robust linkage and referral systems. CHMT will strengthen health information systems to support strategic planning, reporting, quality assurance, decision-making and surveillance. Critically, CHMT will strengthen the capacity for Sub-county teams, facilities and units to routinise continuous quality improvement cycles across all programmatic components in line with the principles of total quality management (TQM). In the first year of award, focus will be on Mwea Constituency (Kirinyaga South/Mwea East and Kirinyaga North/Mwea West Sub counties) an agro-economic urban region with high poverty levels, overcrowding and poor sanitation. In the second year, an incremental extension to additional Sub-Counties will be initiated, eventually leading to transition of all the 5 Sub-Counties to the CHMT within the project period. We will employ 8 strategies with very clear specific objectives and activities on each to achieve the long-time goal. At the end of the project, expected outcomes includes; increased CHMT leadership in HIV service delivery, increased County financing towards HIV services, reduced HIV related mortality among all the sub-groups of people living with HIV and reduced MTCT transmission rates
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