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Programme Development & Delivery

PHDA and its partner, the University of Manitoba, have implemented programmes for more than three decades. The team was among the first to initiate HIV prevention and treatment programmes with sex workers in Kenya. Some of the ground-breaking work conducted by PHDA, the University of Manitoba (UoM), and its partners has had an impact on programme and policy in Kenya and other counties.

Some key learnings include:
  • The need for high coverage of key populations with comprehensive HIV prevention and treatment programmes to prevent acquisition and transmission of HIV. The SWOP clinics established by UoM and PHDA, being one of the first large scale programmes in Africa (reaching more than 35,000 sex workers), improved the country and the continent’s understating of how to scale up programmes with key populations
  • The feasibility of integration of HIV self-testing within existing HIV prevention and treatment programmes managed by the MSM led community organizations was established through the PHDA led programmes. This also included estimating the size of undiagnosed MSM and the testing approaches to reach MSM using virtual platforms

Summary of Current Programme Delivery Projects

County Ownership and Networks to maintain Nairobi Epidemic Control (CONNECT)

The CONNECT project aims to support the implementation and expansion of high quality sustainable and comprehensive HIV prevention, care and treatment programs in Nairobi County.

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Integration of Key Population curriculum into the pre-service Police Training Curriculum

This project aims to improve policing practices and inclusion of the law enforcement agencies in Key Population HIV programming in Kenya.

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Kieni Fighters of HIV/AIDS Resource Centre

The primary aim of the Kieni Fighters Resource Centre project is to reduce the rate of HIV/AIDS infection and increase health-care access for individuals with HIV/AIDS in the Kieni constituency of Nyeri county in Kenya.

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Outcome Measurement in Global Fund-supported Adolescent Girls and Young Women (AGYW) Programmes

The Global Fund Strategy 2017–2022, “Investing to End Epidemics”, has committed to scale-up HIV prevention programmes, to support adolescent girls and young women (AGYW) in 13 focus countries in Sub-Saharan Africa.

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Pilot Project with Young Key Populations

The project aims to reduce HIV risk and vulnerability among Young women who sell sex (YWSS) and Young men who have sex with men (YMSM) in Kenya.

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Completed projects

PACT Endeleza Project

The PACT Endeleza project aims to strengthen the prevention and management of STI, HIV and AIDS by establishing sustainable community activities and quality services for key populations in rural and urban Kenya to better help them serve mobile populations at risk of poor treatment outcomes.

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County Ownership and Networks to maintain Nairobi Epidemic Control (CONNECT)

The CONNECT project aims to support the implementation and expansion of high quality sustainable and comprehensive HIV prevention, care and treatment programs in Nairobi County.

Objectives

  • To support continuity of provision of comprehensive HIV prevention interventions for key populations in 10 DICEs in Nairobi County
  • To map optimal hotspots for geographical expansion of service delivery for coverage
  • To support a Key Population peer-led program by engaging new and existing peer educators
  • To expand coverage of comprehensive HIV prevention interventions
  • To expand coverage of comprehensive HIV Treatment interventions
  • To foster an enabling environment for Key Population programming
  • To pilot and scale up integration of Key Population services into county-owned and county-led mechanisms
  • To institute quality improvement frameworks and processes for all supported services
  • To strengthen monitoring and evaluation of Key Population services for quality programming
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The project provides services for Key populations (KPs) and Priority Populations in Kenya. This includes:

Female Sex Workers (FSW)

Men who have sex with men (MSM)

Transgender persons

Through this project, PHDA will continue to support the provision of comprehensive HIV prevention, care and treatment services for sex workers, men who have sex with men and transgender persons residing in Nairobi County. Those reached will be encouraged to be enrolled for routine care and management services at any of the KP-dedicated Sex Workers Outreach Program (SWOP) community-based clinics/ drop-in centers (DICES) located within Nairobi County.

 

The project focus will entail implementation of a minimum package of comprehensive HIV prevention and care continuum from linking clients from the HIV testing services points to prevention services or to treatment services depending on their HIV status.

  • Project Initiated in 2021
  • Partnership: PHDA is partnering with University of Maryland and the Center for International Health, Education and Biosecurity (CIHEB) with funding support from PEPFAR

Integration of Key Population curriculum into the pre-service Police Training Curriculum

This project aims to improve policing practices and inclusion of the law enforcement agencies in Key Population HIV programming in Kenya.

Objectives

  • Develop KP module within the Kenya Police pre-service.
  • Include law enforcement-specific critical indicators in the annual performance contracts of the senior law enforcers.
  • Train police recruits to understand key populations, their rights, and the link between policing practices, KPs, and HIV.
  • Increase law enforcers’ responsiveness towards violence, stigma, and discrimination against KPs.
  • Ensure institutionalization and sustainability mechanism of KP programming into the law enforcement agencies

The project uses a multi-sectoral approach by engaging the National Police Service as a key stakeholder through their AIDS Control Units (ACUs). The project expects to:

  1. reduce law enforcement perpetrated violence against KPs,
  2. improve access to health and justice services for KPs.
  • Project Initiated in 2020
  • Partnership: NASCOP and the National Police Service with funding support from the Open Society Initiative for Eastern Africa (OSIEA)

Kieni Fighters of HIV/AIDS Resource Centre

The primary aim of the Kieni Fighters Resource Centre project is to reduce the rate of HIV/AIDS infection and increase health-care access for individuals with HIV/AIDS in the Kieni constituency of Nyeri county in Kenya.

Objectives

  • During this pilot project (15 months), the project expects the programme to reach a minimum of 150 women and girls in Kieni. PHDA and the University of Manitoba are the evaluation partners in this project.
  • The evaluation method of the project will be a pre-test post-test quasi-experimental mixed-methods process evaluation. If this concept is deemed successful after being tested, we expect this initiative to be applied to communities across Kenya.
Click here to read more on Kieni Fighters of HIV/AIDS Resource Centre
  • Project Initiated in 2020
  • Partnership: University of Manitoba, KIDS Initiative Inc, EPI research Inc and Kieni Fighters of HIV/AIDS. The project is funded by Funds for Innovation and Transformation (FIT), Canada.

Outcome Measurement in Global Fund-supported Adolescent Girls and Young Women (AGYW) Programmes

The Global Fund Strategy 2017–2022, “Investing to End Epidemics”, has committed to scale-up HIV prevention programmes, to support adolescent girls and young women (AGYW) in 13 focus countries in Sub-Saharan Africa.

The goal is to reduce new HIV infections among adolescent girls and young women aged 15-24 by 58% by addressing the behavioral, biological, and structural factors driving HIV acquisition and transmission by and to AGYW. PHDA and the University of Manitoba are measuring outcomes of the Global Fund-supported AGYW programmes implemented in Malawi, Lesotho, Namibia, Cameroon, and Botswana

Objectives

  • Implement a rapid, simple, cost-effective, efficient, easy to administer approach and innovative method to gather sexual, behavioral and structural outcomes of AGYW programmes within a programme set up and not a research setting;
  • Design a method for collecting sexual, behavioral, and structural outcomes. This will include the development of tools, data collection, and analysis
  • Build the capacity of programme staff of SRs (sub-recipients) and an identified local organization so that it can replicate this approach to collect outcome indicators regularly

The outcome assessment will use the mixed-method approach for data collection. For the quantitative assessment, we will conduct “Polling Booth Surveys’’: a group interview method which has been used by the PHDA and the UM to measure sexual, behavioral and structural outcomes among key populations, adolescent girls, young women and the general population in several African and Asian countries.

Additionally, we will conduct “in-depth interviews or focus group discussions” with programme staff to develop an understanding of the programme package for the AGYW and understand factors leading to certain trends in outcomes

  • Project Initiated in 2020
  • Partnership: University of Manitoba. The project is funded by the Global Fund for Tuberculosis, Malaria, and HIV (GFATM). PHDA will also partner with the Principal Recipients of Global Fund in the 5 countries to implement the assessment.

Pilot Project with Young Key Populations

The project aims to reduce HIV risk and vulnerability among Young women who sell sex (YWSS) and Young men who have sex with men (YMSM) in Kenya.

Objectives

  • To test the feasibility of implementing the National Guidelines for HIV programming with Young Key Population developed by NASCOP at the Ministry of Health, Kenya.

PHDA is leading the monitoring, and evaluation of the project.

  • Project Initiated in 2019
  • Partnership: JHPIEGO, NASCOP, ICRH-K and MPEG. The project is supported by Bill & Melinda Gates Foundation

PACT Endeleza Project

The PACT Endeleza project aims to strengthen the prevention and management of STI, HIV and AIDS by establishing sustainable community activities and quality services for key populations in rural and urban Kenya to better help them serve mobile populations at risk of poor treatment outcomes.

Objectives

  • Support transition of adult populations to more effective antiretroviral regimens and establish functional viremia clinics.
  • Scale-up differentiated care models for the various populations, including multi-month dispensing, institution of robust patient support systems, structure counselling, and patient tracking systems.
  • Provide voluntary medical male circumcision (VMMC) services.
  • Provide HIV prevention services to female sex workers and men who have sex with men.

The project provides services for Key populations (KPs) and Priority Populations in Kenya. This includes:

Female Sex Workers (FSW)

Adolescent girls and young women (AGYW)

Men who have sex with men (MSM)

The project implemented through PHDA managed SWOP clinics, deliver a wide range of sexual and reproductive health interventions aimed at meeting KP specific needs. This approach is augmented by their efforts to address structural barriers related to violence, stigma, and poverty.


Through the 7 SWOP clinics, the project continues to offer HIV prevention services to 45000 female sex workers, 3000 MSM, and 1000 AGYW. The clinics also offer HIV testing services (HTS) and linkage to ART for key population members living with HIV. This has ensured that we meet the UNAIDS targets of 90-90-90 by 2020.

  • Project Initiated in 2016
  • Partnership: University of Maryland and the University of Manitoba with funding support from the CDC

Assessing Outcomes in HIV Prevention and treatment Programmes with Key Populations, in Nairobi, Kenya: enhanced Polling Booth Survey (ePBS)

The study aims to assess the HIV prevention outcomes in programmes with female sex workers (FSW) and men who have sex with men (MSM) in Nairobi, Kenya. The study will use polling booth method, a novel data collection tool used to collect behavioral data. It is a group interview method in which individuals provide responses through a ballot box in an unlinked and anonymous way. The sample size for the quantitative survey is 680 FSW and 379 MSM. Sampling procedure will use a two-stage i) random selection of participants ii) HIV rapid tests will be conducted for all consenting participants; urine rapid tests will be conducted for all those who report to be on PrEP to test for tenofovir and blood samples will be collected from all those who are positive to test for HIV recency and viral suppression.

Objectives

  • To estimate the incidence and prevalence of HIV among key populations (female sex workers and men who have sex with men) in Nairobi, Kenya
  • To assess biomedical (condom use, PrEP uptake, 95-95-95 cascade), behavioural (knowledge and risk behaviours) and structural outcomes (experience of violence, stigma and discrimination) of the KP programme in Nairobi, Kenya
  • To assess access and use of comprehensive package of HIV prevention and treatment services among key populations in Nairobi, Kenya
  • To understand the barriers contributing to gaps in access and utilization of services among key populations

Project Initiated 2023

The study was initiated in March 2023.

The study population includes two key population groups: female sex workers and men who have sex with men and will take place in 4 groups where a sample size of each group will be divided by an average of 10-12 respondents per Polling Booth Surveys (PBS) to arrive at the number of PBS to be conducted. The study will be using the list of locations and the population size estimation of mapping conducted in the year 2018 and a will take place in 17 sub-counties in Nairobi county.

Funders

This study is funded by Bill and Melinda Gate Foundation (BMGF)