Presented by Dr. Sarah Masyuko, NASCOP, Nairobi, Kenya March 2017

1. Implementing and
scaling up HIV self
testing in Kenya
Dr Sarah Masyuko
NASCOP

2. Background
• In 2015, about 1.5 million
Kenyans were living with HIV
with 268,588 being young
people
• About 1 million are currently
on treatment
• About 500,000 are yet to be
initiated on treatment
• ST a tool to reach the 90:90:90
goal

4. Percentage of women and men aged 15-49 who received an HIV test in the past
12 months and know their results
Knowledge of HIV status

5. HIV testing yield

6. Progress on the 90:90:90 cascade
1,419,537
902,305 883,631
542,558
375,278
266,194
492,284
29%
23%
48%
-
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
ALHIV Currently in Care Currently on ART Adults Suppressed
KENYA ADULTS CASCADE
Achieved Gap
Those not identified are most likely Men and Adolescents and Youth:
Adolescents and youth have 43% ART coverage compared to 68% for those above 25 years

7. Progress on the 90:90:90 cascade
Those not identified are most likely Men and Adolescents and Youth:
Adolescents and youth have 43% ART coverage compared to 68% for those above 25 years

8. Journey to ST roll out
• HIVST first included in the national guidelines
since 2009
• However it has taken 7 years for it be
implemented
• 7 years of formative research on ST
• 72% of respondents in last KAIS 2012 indicated that
they would be willing to use a self test kit.
• Acceptability
• Packaging
• Social harms

9. Evidence on self testing
• High uptake of self-testing has been reported in
Kenya by Health workers.
• High uptake of self -testing has specifically been
reported among the youth, men and those who
had tested before.
• Benefits: First time testers, privacy, convenience,
reduced stigma.
• Pharmacies identified as point of distribution.
• Concerns on need for counselling.
• There is no significant harm associated with HIVST

10. From Research to
Practice

11. Progress made with adoption of
HIV self testing
• Inclusion in Kenya HIV Testing Guidelines 2015
• HIV Self Testing operational manual developed
• HIV Self testing to be launched together with PrEP
at end of April
• Three HIV Self test kits registered in country by
Pharmacy and Poisons Board
• Lab board listing ongoing
• Resource mobilization through PEPFAR, Global
Fund and UNITAID

12. HIV ST Operational manual
• Programmatic Approaches and Models
• Package of services provided under HIVST
• Commodity management systems for HIVST
• Biosafety and infection control measures
• Quality assurance strategies in HIVST

13. Approaches
• Oral and Blood Based self tests

14. Approaches
HIVST Service Delivery
Approaches
Facility based
OPD, STI clinic, TB clinic, Pharmacy,
ANC, CCC, Wards, maternity,Private
clinics etc
Community based
VCT centres, DICEs, CHVs
Others
Pharmacy, Vending
machines, Internet, dial-a-
HIVST,

15. Algorithm
• This should be performed using approved national
algorithm
• HIVST should however not be used for HIV
diagnosis, all positives results should be
confirmed as per the national protocols.

16. Support and Linkage tools
• Client information inserts
• Community based follow up
• Vouchers, coupons or rebates – applicable mostly to
key populations
• Internet, computer based programs and applications
include online audio or video counselling services
• Partner HIVST and couples who deliver test kits to
partners and link them to care and treatment.
• Telephone hotlines for pretest and posttest
counselling and can still offer linkage to HTS.
• Bulk mobile phone text message services
• Through public gathering (baraza’s)

17. Challenges or Unanswered
questions
• Cost remains high- $7-8 retail price. Ex works
price of $3-4
• Private sector distribution of self test
• Linkage to care for those positive and linkage to
prevention for those who test negative
• Lose of data on HIV testing
• Support systems for those who test HIV positive
• WHO prequalification of the test kits
• ERP approval
• As kits not available, Kenya is piloting scale up in
private sector

18. Unanswered questions
• After ST, Confirmatory testing prior to ART
initiation or do they follow the whole national
algorithm
• Monitoring of HIVST usage using barcodes
• Use of the call centre to collect data and provide
support vs use of a web app
• Reality of linkage within 90 days
• Monitoring of adverse events eg GBV, IPV

19. Public sector
• Limited distribution
• Key populations and their partners
• ANC and their partners
• Adolescents and Young people
• Men
• Health care workers
• Awaiting procurement after WHO prequalification

20. Pilot with the Private sector
• Operational framework/SOPs for roll out in private
sector developed
• IEC materials drafted
• Pilot to simulate how ST will work in private sector
• Anonymous survey: models, client profile of early
adopters, privacy, data, linkage
• Selected 16 pharmacies in Nairobi, Mombasa and
Kisumu to pilot ST
• Linked to hotline managed by LVCT health
• Referral sites available for linkage

21. Next Steps
• Public private partnership
• Results from pilot to inform scale up for the
launch of ST
• Capacity Building
• Launch of ST end of April 2017
• Roll out to begin with private sector at a wider
scale
• Procurement of test kits to kick off public sector
self testing
• Continuous learning

22. Acknowledgements
• NASCOP
• HTS TWG
• WHO
• CHAI, PS Kenya, Pharmaceutical Society of Kenya,
Kenya Pharmaceutical Association, LVCT Health