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Title
Closing the gap: Increasing the availability of child- and youth-focused antiretroviral therapy (ART) at non-state health facilities in Nairobi, Kenya
Presenter
Lauren Weir
Authors
J. White1, M. Bunyi1, L. Kagasi2, D. Kinuthia3, E. Oywer4, N. Gitonga5, P. Mutua6, D. Nyaboke7, C. Karanja8, S. Eagan9, J. Pearson9, D. Sullivan10, J. Tayag10, L. Weir11
Institutions
1Abt Associates Inc., International Health Division, Bethesda, United States, 2Independent Data Consultant, Nairobi, Kenya, 3Kenya Pediatrics Association (KPA), Secretariat, Nairobi, Kenya, 4Kenya Ministry of Health, Nursing, Nairobi, Kenya, 5Insight Health Advisors, CEO, Nairobi, Kenya, 6Abt Associates Inc, Nairobi, Kenya, 7Independent Consultant, Nairobi, Kenya, 8Healthstrat Data, Nairobi, Kenya, 9JSI, Washington, United States, 10USAID, Washington, United States, 11Abt Associates Inc, Rockville, United States

Background: Despite significant investment in the Kenyan HIV response, the number of new HIV infections and treatment needs among children, adolescents, and young people (CAYP) continues to increase. Engaging non-state (private) health providers to deliver HIV testing services (HTS) and antiretroviral therapy (ART) targeted to CAYP could be an effective strategy to augment government efforts to reach this population.
Description: From 2016 to 2018, the USAID-funded Strengthening High Impact Interventions for an AIDS-free Generation (AIDSFree) Project assisted a broad consortium of Kenya-based partners to create a public-private alliance (PPA) aimed at increasing the availability of high quality CAYP-focused ART services among private providers in Nairobi county. The PPA?which included the National AIDS and STI Control Programme, the Kenya Pediatrics Association, and the Kenya Healthcare Federation?trained more than 135 nurses and clinical officers representing 31 separate private clinics, facilitated government supply of HTS and ART commodities, and connected clinics to ongoing clinical mentorship.
Lessons learned: The project demonstrated that private providers in Kenya share a strong commitment to addressing HIV among CAYP. The alliance format addressed multiple public-private concerns in an open forum, facilitated dialogue among previously disconnected health stakeholders, and from January to April 2016, was able to quickly scale up government-supported pediatric ART services to more than 26 private facilities. From April 2016 to September 2017, PPA-affiliated clinics tested 15,755 CAYP (64% female) for HIV and initiated 203 (52% female) CAYP on treatment. The clinics also enrolled 197 CAYP in pre-ART care, indicating that continued efforts are needed to operationalize test-and-treat protocols at the facility level. Working through established partners, such as the Kenya Pediatrics Association, was critical in ensuring ongoing quality improvement of services throughout the monitoring period.
Conclusions/Next steps: Through collaborative public-private action, private providers can be capacitated as critical sources of HIV and ART care for CAYP. The model underscored the need for ongoing investment in clinical mentorship to build private provider confidence and quality while implementing pediatric ART services. Following AIDSFree investments in 2016 and 2017, the Kenya Healthcare Federation and Kenya Pediatrics Association now spearhead the partnership.

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