Protecting and Empowering Kenya’s Next Generation
For the past 15 years, programs supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) have worked to improve health outcomes and ensure access to services for individuals affected by HIV, particularly the youngest children and most vulnerable adolescents. While strategies for combating the global epidemic have shifted and scientific research has brought to light new innovations over those years, one approach which has remained constant across PEPFAR’s history is empowering and protecting the next generation–because controlling the HIV epidemic will ensure many future generations can thrive and live AIDS-free.
In Kenya, CDC—with funding from PEPFAR–is a global leader in developing innovative and comprehensive approaches to addressing and protecting the needs of Kenya’s next generation. CDC Kenya’s influence is particularly evident in two distinct, yet related, program areas: prevention of mother-to-child HIV transmission of HIV (PMTCT) and adolescents and young people living with HIV (AYPLHIV).
Protecting the Next Generation through PMTCT
In response to a persistently high mother-to-child transmission rate, CDC Kenya has pioneered change and set an example for protecting the youngest children through its programmatic approaches to PMTCT. In 2014, following national-level adoption of universal treatment for all women accessing PMTCT services, CDC Kenya expanded its efforts to ensure HIV-positive infants being born to women living with HIV are members of an AIDS-free generation.
Rapid initiation of HIV-positive infants on antiretroviral treatment (ART) became a core program priority. For example, every time an infant is diagnosed with HIV, the infant is immediately linked to treatment through a universal case management approach implemented at the health facility level. In addition, CDC partners implement routine HIV screening of mothers and infants in immunization clinics to identify and link mother-infant pairs missed during antenatal care or delivery. Finally, the CDC team in Kenya, in partnership with their site-level partners, uses quarterly meetings for data review and planning. Since October 2016, routine clinical information from every HIV-positive infant in the CDC program has been reviewed during these meetings to identify and narrow the gaps in PMTCT services.
Empowering the Next Generation through Youth Support
CDC Kenya is also working to empower the next generation through focused programming for all children and adolescents living with HIV. As part of the global Accelerating Children’s Treatment initiative from 2014-2016, CDC programs in Kenya observed an increase in the coverage of children on life saving ART by more than 10%. More recently, CDC Kenya has led new approaches to ensuring longer term health for AYPLHIV. AYPLHIV account for approximately 20% (303,700) of all people living with HIV in Kenya. Compared to adult populations, the HIV epidemic among AYPLHIV is characterized by relatively high HIV incidence and lower treatment outcomes, including low adherence to treatment and low viral suppression. AYPLHIV face complex challenges dealing with a chronic illness amidst physical, emotional, and psychological developmental changes as they transition from childhood to adulthood.
To improve viral suppression among AYPLHIV, Kenya launched Operation Triple Zero (OTZ). OTZ engages adolescents, parents and caregivers, and healthcare workers to provide a comprehensive HIV-treatment literacy package to empower adolescents to take ownership of their health. Adolescents commit to achieving “three zeroes”: zero missed clinic appointments, zero missed HIV medications, and zero viral load. This model has been expanded nationally reaching 27 high HIV burden counties and over 16,000 adolescents living with HIV.
These programmatic innovations for empowering and protecting the next generation in Kenya have gained interest from global and regional stakeholders. CDC Kenya’s innovations have been highlighted in global fora such as the 2018 PEPFAR Annual Meeting and the AIDS 2018 meeting in Amsterdam. In addition, peers from programs across the region are traveling to Kenya in late 2018 to participate in peer-to-peer learning with CDC Kenya staff. Innovations tested in the Kenyan context are being replicated in neighboring countries to advance the global communities’ progress towards ending the HIV epidemic among the next generation. Among PEPFAR’s many contributions to empowering and protecting the next generation, CDC Kenya’s accomplishments stand out as exemplary.