Communicable diseases

Communicable diseases (HIV, TB and Malaria)

Our Purpose

We believe that health is a basic human right. Everything we do ensures lasting health change for all.

The Challenge

Communicable diseases (HIV, TB and Malaria) continue to be a major global public health issue. They are among the leading causes of death in Kenya.

HIV/AIDS has resulted in significant deaths due to AIDS complications, with Africa being the hardest hit. Globally, 37.9 million people are living with HIV, with 1.7 million newly infected people and 770,000 people dying from AIDS-related illnesses as at the end of 2018.

In Kenya, there are 1.3 million adults and 139,000 children living with HIV. In 2018, there were 46,000 people newly infected with HIV and 25,000 deaths from AIDS-related illness. This is a significant loss of lives, and if left unchecked, will continue to rob the nation of its vital economic pillar- manpower, as well as continue to push households into poverty due to the redirection of limited resources towards the care of family members facing AIDS-related illnesses.

Malaria is preventable and treatable but continues to have a devastating impact on people’s health and livelihoods around the world. Children under five years are the most vulnerable group accounting for 67 per cent of all malaria deaths worldwide in 2018.

In Kenya, approximately 70 per cent of the population is at risk for malaria, with 14 million people living in endemic areas, and another 17 million in areas of epidemic and seasonal malaria. Malaria accounts for an estimated 16 per cent of outpatient consultations.

Tuberculosis remains a top killer worldwide affecting the world’s poorest and most vulnerable. In 2018, 10 million people fell ill with TB, while 1.5 million died, and about 0.5 million were diagnosed with drug-resistant TB.

Kenya is ranked 15th among the 22 countries with the highest TB burden, largely attributed to the high prevalence of HIV coupled with under-diagnosis. TB remains a leading killer of persons living with HIV, and untreated TB in this group causes the death of 50% of the cases.

The burden of TB in Kenya is estimated at 426 cases per 100,000. TB mostly affects the economically productive age group (15 – 44 years). It is also prevalent in urban settings, with many patients being in the lower economic bracket, and 27% of them facing catastrophic costs while seeking TB treatment and care.

The Opportunity

Kenya has made great strides in managing the HIV epidemic, malaria and TB. There has been significant funding support from donors such USG/PEPFAR and The Global Fund, technical assistance from UNAIDS, WHO, MSF and others who have engaged the Ministry of Health, Civil Society Organisations and communities in addressing the three diseases.

The country saw a decline in HIV prevalence in 2018 to 4.9% among people between the ages of 15 and 64 years. The progress towards meeting the UNAIDS 90-90-90 targets shows mixed results; among the adult population, the country has achieved 79.5% (1st 90) of those living with HIV knowing their status, 96% (2nd 90) of those who know their status enrolled on antiretroviral therapy (ART) and 90.6% (3rd 90) of those who are on ART virally suppressed as per latest HIV/AIDS survey. Kenya has also made significant gains in testing and linking HIV and TB patients to treatment and care.

By deploying a variety of preventive measures, tailored to meet the widely divergent needs of local populations such as Long Lasting Insecticide Treated Nets (LLINs); indoor spraying with insecticides (IRS) in select areas with high transmission around Lake Victoria and the use of Artemisinin combination therapy for all population, the prevalence of malaria reduced from 11% in 2010 to 8% in 2015.

Controlling the rise of HIV new infections noted within the adolescent population, especially among girls and young women, is a key priority in HIV programming. There are 36,000 adults infected with HIV annually, and progress towards achieving the 90-90-90 targets is disproportionately lower among children (0-14 years) living with HIV with the lowest viral suppression of 67%. Lower retention has also been noted especially among those newly initiated on ART. Retaining clients on lifelong treatment is key in suppressing the virus and reducing viral transmission; undetectable = untransmittable (U=U). Those unable to stay on treatment pose a high risk of transmitting HIV. On the other hand, Kenya is working towards the elimination of mother-to-child transmission (MTCT); the estimated MTCT rate is 11% mainly from new infections during pregnancy and breastfeeding and maternal ART discontinuation during pregnancy and breastfeeding.

There is need to address the emerging resistance to the pyrethroid insecticides used in the two biggest malaria prevention tools: bed nets and indoor spraying, and to close the huge Kenya Malaria Strategy 2019 – 2023 funding gap (50%).

TB case detection is low with the country missing 40% of estimated incident TB cases. Among children with TB, nearly two-thirds are not diagnosed; and close to 80 per cent of people with drug-resistant TB are missed; Access to TB diagnosis and treatment is low, with only 24% of health facilities offering TB microscopy services and 43 per cent offering TB treatment services. The inadequate engagement of private providers has contributed to long delays in diagnosis and treatment.

There is an urgent need to sustain the gains made, close gaps in case finding and prevent new HIV, TB and malaria infections.

Our Theory of Change

Through multi-sector approaches that include meaningful engagement of private sector, government and community actors, we continue to work towards closing the gap of finding the missing TB cases critical to the control of TB and TB/HIV in Kenya.

Amref has been at the forefront of managing the HIV epidemic by supporting the Ministry of Health in building sustainable health systems. We pioneered HIV management in Kibera in Nairobi County, one of the largest slums in Kenya, by providing vital HIV care and treatment in an integrated manner with much success. We have achieved 96% viral load suppression rates among our clients and less than 5% mother-to-child transmission rate among the pregnant and breastfeeding women under the PMTCT program.

Adolescents, especially the girls and young women, are the most vulnerable population, and this has necessitated the adoption of adolescent responsive services and psychosocial support through peer-to-peer mentorship at all our supported facilities. Those who are HIV positive are enrolled in “Operation Triple Zero-Plus (OTZ +)” clubs. OTZ empowers participants to take charge of their health, take control of their decisions, receive support from and identify with peers who are doing well on their treatment journey.

We are implementing several innovations to find Kenya’s missing TB cases. The Kenya Innovation Challenge to find TB (KIC TB) to find missing TB cases; the Public-Private Mix that enhances the contribution of Unengaged Standalone Formal and Informal Health Providers in Finding Missing People with Tuberculosis; Pay for Performance (P4P) approach where health facilities diagnosing and managing TB patients are reimbursed for each additional TB case notified, and rewarded for adherence to the national standards and protocols for TB prevention and care; Community TB care delivery using the ENGAGE TB approach to engage Community Health Workers and TB champions to: undertake tracing of treatment interrupters; systematic Contact investigation for 1) all child contacts of patients with TB 2) all household contacts of bacteriologically confirmed TB patients and, 3) household contacts of multi-drug resistant (MDR) TB patients; as well as the adoption of new TB technologies including the roll-out, expansion, networking and maintenance of new TB diagnostics (GeneXpert) to over 200 diagnostic sites in partnership with the National TB programme and national supply authority, KEMSA.

Our priorities are to strengthen contact management to ensure early detection and reduce transmission in the community backed by the correct documentation and testing key populations for Latent TB Infection and ensuring they are treated.

Amref Health Africa is deeply engaged in Kenya’s efforts towards the elimination of malaria. Building on our extensive experience in designing and delivering PHC services and community health services, we are deploying scalable models. Community Case Management of Malaria: This equity-focused strategy complements and extends the reach of health services by providing timely and effective diagnosis and treatment of malaria to populations with limited access to facility-based health care. Community Health Workers (CHWs) use malaria rapid diagnostic tests (mRDT) to diagnose malaria and prescribe artemether-lumefantrine (AL) to uncomplicated malaria cases. Malaria Microscopy: The Amref Central Laboratory is a certified training centre for malaria expert microscopists in sub-Saharan Africa, and deploys portable laboratories used for training and outbreak investigation in remote sites, evaluation of new diagnostic devices and kits, and support towards Quality Assurance for Malaria microscopy and produces Panel Tests (PT) for national PT scheme for malaria microscopy. Through Integrated Community System Strengthening, the capacity of CHWs is built to offer integrated HIV/AIDS, TB and Malaria services. This approach eliminates duplication of efforts and resources and maximises effectiveness, efficiency and quality of services provided.

Amref is working to accelerate the integration of the three diseases into primary health care and community health services; differentiating response guided by data and evidence, as well as county government ownership for long term sustainability with incremental domestic resource allocation.

We work with national and county governments, funding agencies, the private sector and other stakeholders, through shared value platforms, to deploy these interventions.

Our Ask

We seek more collaboration and funding for shared value partnerships with players in the private and public sectors to sustain the gains in combating HIV, TB and Malaria in Kenya.

The partnerships we seek are to (i) generate better data and evidence to close the tap of new infections and improve the health outcomes of children living with HIV, (ii) build the life skills of OTZ club members and support income-generating activities to make them self-sufficient (iii) scale-up of the integration of HIV programming and community case management into primary health care and community health services (iv) active community case finding and malaria surveillance (v) strengthen malaria microscopy, (vi) adopt, deploy and scale up innovative technologies for malaria diagnosis and TB control.