Declines in HIV prevalence in female sex workers accessing an HIV treatment and prevention programme in Nairobi, Kenya over a 10-year period

Tago, Achieng; McKinnon, Lyle R.; Wanjiru, Tabitha; Muriuki, Festus; Munyao, Julius; Gakii, Gloria; Akolo, Maureen; Kariri, Anthony; Reed, Neil; Shaw, Souradet Y.; Gelmon, Lawrence; Kimani, Joshua

doi:10.1097/qad.0000000000002747

Cited by 20 publications

(22 citation statements)

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“…Despite this, in Nairobi there has been no obvious increase in HIV/STBBI incidence to date. Whether this is due to natural decline [80] or COVID-19 is uncertain, and if the decrease is due to economic reasons, there could be an increase in incidence following economic recovery, which needs to be monitored carefully [81].…”

Section: Case Study 3: Kenyamentioning

confidence: 99%

Socioeconomic Burdens of the COVID-19 Pandemic on LMIC Populations with Increased HIV Vulnerabilities

McClarty

Lazarus

Pavlova³

et al. 2021

Curr HIV/AIDS Rep

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Purpose of ReviewTo review the impact of the COVID-19 pandemic and its public health response on key populations at risk of HIV infection, with a focus on sex workers. Recent Findings Since last year several groups have documented how the COVID-19 pandemic has impacted the livelihoods and health of sex workers. We focus on case studies from Kenya, Ukraine, and India and place these in the broader global context of sex worker communities, drawing on common themes that span geographies. Summary COVID-19-associated lockdowns have significantly disrupted sex work, leading to economic and health challenges for sex workers, ranging from HIV-related services to mental health and exposure to violence. Several adaptations have been undertaken by sex workers and frontline workers, including migration, a move to mobile services, and struggling to find economic supports. Strengthening community-based responses for future pandemics and other shocks is critical to safeguard the health of marginalized populations.

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Section: Case Study 3: Kenyamentioning

confidence: 99%

Socioeconomic Burdens of the COVID-19 Pandemic on LMIC Populations with Increased HIV Vulnerabilities

McClarty

Lazarus

Pavlova³

et al. 2021

Curr HIV/AIDS Rep

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“…The HIV epidemic among key populations (KP) shows geographical and gender diversity with self‐reported HIV prevalence among FSWs ranging from 49% in Homabay to 16% in Mombasa and 36% among female PWID to 17% among male PWID [8]. Newer studies from Nairobi [9] and Mombasa [10] report that HIV prevalence among FSWs decreased over time in all age groups. This decline is attributed by the researchers to the scale‐up of HIV prevention and treatment services in Kenya [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…Newer studies from Nairobi [9] and Mombasa [10] report that HIV prevalence among FSWs decreased over time in all age groups. This decline is attributed by the researchers to the scale‐up of HIV prevention and treatment services in Kenya [9,10]. Another study conducted with MSM and transgender women in coastal Kenya between 2016 and 17 found that overall, HIV‐1 incidence was 5.1 (95% confidence interval (CI): 2.6 to 9.8) per 100 person‐years (PY) (men who had sex with men exclusively (4.5 per 100 PY)) and transgender women (20.6 per 100 PY) [11].…”

Section: Introductionmentioning

confidence: 99%

A decade and beyond: learnings from HIV programming with underserved and marginalized key populations in Kenya

et al. 2021

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Introduction Key populations (KP) continue to account for high HIV incidence globally. Still, prioritization of KP in the national HIV prevention response remains insufficient, leading to their suboptimal access to HIV programmes. This commentary aims to share Kenya’s challenges and successes in achieving 2020 global HIV targets and scaling up the KP programme in the last decade. Discussion The KP programme in Kenya has scaled up in the last decade with the inclusion of female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), transgender people and people in prisons as priority populations in the national HIV response. KP coverage based on official size estimates for FSW is 73%, for MSM is 82%, for PWID through needle syringe programme (NSP) is 71%, and through opioid substitution therapy (OST) is 26% and for transgender people is 5%. The service outcomes for KP have been relatively strong in prevention with high condom use at last paid sex for FSW (92%) and use of sterile equipment among PWID (88%), though condom use at last sex with a non‐regular partner among MSM (78%) is still low. The KP programme has not met care continuum targets for all subpopulations with low case findings. The national KP programme led by the Ministry of Health has scaled up the programme through (a) strategic partnerships with KP‐led and competent organizations, researchers and donors; (b) development of policy guidance and programme standards; (c) continuous sensitization and advocacy to garner support; (d) development of national reporting systems, among others. However, the programme is still struggling with uncertain size estimates; lack of updated bio‐behavioural survey data; inadequate scale‐up of interventions among transgender people and people in prison settings; gaps in reaching adolescent and young KP, and effectively addressing structural barriers like violence and stigma. Conclusions To reach the ambitious global HIV targets, sufficient coverage of KP with quality HIV programmes is critical. Despite scaling up the KP programme, Kenya has not yet achieved the 2020 global HIV targets and needs more efforts to scale‐up quality programmes for KP who are underserved in the HIV response.

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“…This was achieved through the implementation of an aggressive strategy that prioritizes specific populations and geographic regions with high HIV prevalence and incidence (8). Kenya has a vibrant combination of HIV prevention programs that target key populations, with FSWs as a predominant priority population, and recent studies highlight significant progress in intervention uptake and the reduction of HIV prevalence among FSWs (9)(10)(11).…”

Section: Discussionmentioning

confidence: 99%

Unmet Need for Contraception Among Female Sex Workers Initiating Oral Pre-Exposure Prophylaxis for HIV Prevention During Kenya's National Scale-Up: Results From a Programmatic Surveillance Study

Kamau¹,

Musau²,

Were³

et al. 2022

Front. Glob. Womens Health

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BackgroundFemale sex workers (FSWs) experience a higher risk for both HIV acquisition and unwanted pregnancies compared to women in the general population. Pre-exposure prophylaxis (PrEP) for HIV prevention offers protection against HIV infection but has no contraceptive effect. We examined the determinants of unmet need for contraception among FSWs who initiated PrEP to inform programs and policies to optimize contraceptive services and avert unwanted pregnancy among this high-risk group.Materials and MethodsA cross-sectional analysis was conducted on routine, de-identified client data from a large-scale PrEP service delivery project, from February 2017 to December 2019. Data were collected from FSWs during clinic visits using Ministry of Health approved tools. Records for all 17,456 FSWs initiated on PrEP from 79 health facilities in 10 counties across three geographic clusters with high and medium HIV incidence were examined for eligibility for the analysis. Unmet need for non-barrier contraception was defined as not being pregnant, not currently using the non-barrier contraceptive method, and not trying to conceive or intending to have a child in the near future. Univariate and multivariable regression analyses were conducted with selected variables to examine associations.ResultsIn the 79 sites, eligible records from 17,063 FSWs who initiated PrEP were included. Two-thirds were under 30 years, and the majority were not married and had received PrEP at drop-in centers. Overall, the unmet need for non-barrier contraception was 52.6%, higher for those under 20 years of age (60.9%) and those served in public and private health facilities (67.4 and 83.2%, respectively) rather than drop-in centers (50.6%). Women from the Nairobi and Coast cluster regions reported a higher unmet need for contraception compared to those from the Lake region. All these associations were significant (p < 0.05) at the multivariate level.ConclusionsThe high unmet need for non-barrier contraception among FSWs initiating PrEP highlights the need for integrated delivery of contraception services within PrEP programs. Identifying groups with a high unmet need could lead to higher success in an integrated program. Two recommended approaches include training healthcare providers to deliver clear contraception messaging during PrEP initiation and making a range of contraceptives accessible within PrEP services for high-risk groups. Furthermore, accelerated research on multipurpose prevention technologies is necessary to reduce the burden on individuals using multiple prevention products concurrently.

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Declines in HIV prevalence in female sex workers accessing an HIV treatment and prevention programme in Nairobi, Kenya over a 10-year period

Cited by 20 publications

References 21 publications

Socioeconomic Burdens of the COVID-19 Pandemic on LMIC Populations with Increased HIV Vulnerabilities

Socioeconomic Burdens of the COVID-19 Pandemic on LMIC Populations with Increased HIV Vulnerabilities

A decade and beyond: learnings from HIV programming with underserved and marginalized key populations in Kenya

Unmet Need for Contraception Among Female Sex Workers Initiating Oral Pre-Exposure Prophylaxis for HIV Prevention During Kenya's National Scale-Up: Results From a Programmatic Surveillance Study

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