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The East African country of Kenya has a population of over 40 million people and an average life expectancy of 51 years. The per capita income in Kenya is $783 (among the highest in Africa) and approximately one-third of the population lives in urban areas.
HIV in Kenya
National HIV seroprevalence in Kenya is 7.4 percent in adults aged 15-49. The epidemic is geographically diverse, with a particularly high prevalence in the provinces of Nyanza (15%), Nairobi (8.8%), and Coast (8.1%). HIV prevalence is 8.4 percent in urban areas and 6.7 percent in rural areas, although 70 percent of people infected with HIV in Kenya live in rural areas. Women are more likely to be infected than men, and young women aged 15-24 years are at particularly high risk. Despite the considerable success of HIV prevention and treatment programs, HIV incidence remains high, with 132,000 new infections occurring among adults and 34,000 new infections occurring among children each year. While over 98 percent of Kenyans are aware of HIV, only 36 percent have ever been tested. Multiple sexual partners, inconsistent condom use, young age at first sex, and a low male circumcision rate (15%) are some of the key factors associated with sexual transmission of HIV in Kenya. By December 2012, over 800,000 people had been enrolled in HIV care and 440,000 had been initiated on antiretroviral therapy (NASCOP data, 2012).
Health Care System
Kenya’s health care system consists of a mix of public and private services staffed by more than 4,500 physicians and 37,000 nurses. The system’s structure is based on a referral system extending from Kenyatta National Hospital in Nairobi, through county and district hospitals, to rural health centers and dispensaries. In recent decades, a rapidly growing population, in combination with the HIV epidemic, has put increasing strain on the country’s ability to provide basic health services to its population.
ICAP in Kenya
In 2002, ICAP initiated collaboration with Indiana University to support the Government of Kenya in its efforts to provide HIV services in the Western region of the country. In 2006, ICAP began direct program implementation in Kenya, supporting HIV care and treatment services first only in Central province and later in Eastern and Nyanza provinces and the Eastern North Region as well.
In Kenya, ICAP supports HIV care and treatment, TB/HIV collaborative activities, prevention of mother-to-child transmission, HIV testing and counseling, adherence and psychosocial support, voluntary medical male circumcision, community-based services, and—more recently— reproductive, maternal, neonatal, and child health activities.
Specific activities include:
- Training health care providers in adult and pediatric HIV care and treatment
- Renovating comprehensive care centers, laboratories, and maternity units
- Integrating services, including integrating TB and HIV services, HIV care and maternal and child health services, and HIV care and family planning services
- Strengthening laboratories by supplying hematology, clinical chemistry, and CD4 equipment and reagents, and by establishing sample transport networks
- Establishing computerized medical record systems at high-volume comprehensive care clinics
- Establishing vibrant peer education programs that provide essential psychosocial support to people living with HIV
- Establishing on-site support of programs to diagnose HIV in early infancy
- Establishing regional Centers of Excellence capable of providing the most complex aspects of HIV care
ICAPs work has been characterized by close collaboration and partnership with national, provincial, and district health management teams—essential components of the Government of Kenya’s HIV response. ICAP also works closely with local NGOs, including the Center for Health Solutions (currently implementing HIV prevention, care, and treatment activities in Central Province) as well as the Ogra Foundation and the Matibabu Foundation (which implement HIV care and treatment activities in Nyanza province).
ICAP’s research portfolio in Kenya has recently expanded and now includes research on PMTCT retention and the integration of cardiovascular disease risk screening and primary management into HIV care programs.