9,000 Kenyans take up daily HIV prevention pill (PrEP)

By Gatonye Gathura

gatonyegathura1@gmail.co.ke

About 9,000 healthy Kenyans have so far taken up the daily HIV prevention pill officially lunched in May by the Ministry of Health.

Kenyans taking up the pill, a new update shows include, discordant couples, male and female prostitutes and youth  at high risk of HIV infections.

Data on the pill uptake presented 10 days ago (17 November), estimates 8,500 -9,000 Kenyans have taken up this latest HIV prevention method called Pre-Exposure Prophylaxis or PrEP.

The method involves taking the prescription only pill every day for as long as one is engaging in risky sex behaviour.

The new data is presented by PrEPWatch, a global database tracking PrEP use and maintained by the American HIV advocacy NGO called AVAC.

It says Kenya targets at recruiting 50,000 – 55,000 users in the next few years.  However this is still a long way from the targeted 500,000 PrEP users by the Ministry of Health by 2022.

The US President’s Emergency Plan For AIDS Relief (PEPFAR), a major financier of the initiative, PrEPWatch says targets at recruiting 4,496 users in 2018.

Since May, PrepWatch says the Pharmacy and Poisons Board has registered two generic version of the original brand Truvada manufactured by the Gilead Sciences of the US.

The two generics our inquiries indicate are manufactured by Hetero and Aurobindo pharmaceutical manufacturers of India under a yet to be made public arrangement with Gilead Sciences.

Launching the PrEP in May, Dr Martin Sirengo, Director National AIDS and STI Control Programme-NASCOP, said the availability of generic versions would dramatically lower the price of providing the pill.

In the private sector, Dr Jackson Kioko, the Director of Medical Services says it costs about Sh 3,600 per month but free in government facilities.

However the estimated Sh3, 600 cost in private facilities does not include required continuous, HIV, hepatitis and kidney tests for people on PrEP. Neither does it include hospital markup.

An earlier expert estimate prepared for the government by the US-funded Health Policy Plus showed it would cost about Sh48, 667 to keep one individual on PrEP annually.

The 2017 national Framework for the Implementation of Pre-exposure Prophylaxis of HIV in Kenya estimates the project to require about Sh 32 billion for a five year period to 2022.

However only about Sh 1.4 billion is currently available hence a funding deficit of more than Sh 30 billion.

“The estimated cost to implement PrEP over the next five years is $328,262,179 against $13, 3963,511 available resources indicating a funding gap of $314, 298, 668,” says the implementation framework

Information from multiple sources shows the project is grappling with monumental social, technical and financial problems.

“There are people saying PrEP does not work or they should use it without a condom and if they turn positive they should sue the government,” says Mombo Ngua (a.k.a. Mantully).

Ngua is a sexual minority activist affiliated with the Sex Workers Outreach Programme (SWOP), Nairobi, which is a project of NASCOP.

In the current report of the International AIDS Vaccine Initiative (IAVI) Ngua who has been on PrEP for two years says there is a lot of misinformation about use of the prevention pill.

“There are people who are saying that PrEP finishes sexual feeling and adds a tummy. They are asking if PrEP works, what’s the use of condoms?”

Data presented at the July global HIV conference in Paris, France showed the uptake of PrEP in Kenya even among prostitutes at the SWOP clinics in Nairobi is excruciatingly slow.

Joseph Ouko of the Kenya AIDS Control Project said of a total 2,044 female sex workers whom they reached with information on PrEP, only739 had visited the facility to enquire about the pill.

Of these, 576 were found eligible with 346 put on the drug but only 148 are still on the pill.

At the same conference a study called SEARCH investigating best way to implement PrEP by the University of California, US and Kenya Medical Research Institute reported similar challenges.

Carol S. Camlin of the University of California said while young men view PrEP as the new vehicle to sexual adventure, girls think the invention is a license to freely engage with ‘sponsors’ in condomless sex.

Among reported reasons for the low uptake of PrEP include complicated compliance procedures such as regular HIV, hepatitis and kidney tests.

Users are supposed to go for at least three kidney function tests per year which the Ministry of Health says may prove expensive for users and a challenge to provide in public facilities.

The implementation framework says about 70 per cent of the 47 counties lack specialized capacity such as kidney and HIV drug resistance testing required in PrEP care.

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Some facts

  1. May 2017 official launch of PrEP
  2. Data shows slow uptake
  3. Ministry of Health targets 500,000 PreP users by 2022
  4. Donors targets 55,000 PrEP users in next few years
  5. Current users 8500-9000 mainly from pre-launch research projects
  6. Cost Sh3, 600 in private facilities per month exempting mandatory tests and monitoring
  7. Sh48, 667 estimated cost to fully cover one individual on PrEP in public sector annually
  8. $328,262,179 estimated national PrEP cost for five years
  9. $13, 3963,511 available resources
  10. $314,298,668 deficit.
  11. Kenya targets to reduce annual new adult infections by 75 per cent by 2019.
  12. At present, over 80 per cent of new HIV infections occur in adults
  13. Targets at raising PrEP awareness to 50 per cent of Kenyan adults

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