Kenya AIDS Strategic Framework II - NACC

ForewordKenya strives to remain on the right path towards ending AIDS as apublic health threat by the year 2030, in line with the global SustainableDevelopment Goals (SDGs). Over the last few years, great progress has beenmade leading to a significant reduction in new HIV infections and AIDSrelated deaths. Key success factors include swift translation of scientificevidence in programmes, implementation of robust policy and strategicframeworks, multi-sectoral approach that engages all levels of governance,different sectors of the economy, various stakeholders and partners. Despitenotable progress, HIV and AIDS continues to impact on mortality rates,burden households and strain national health systems in Kenya.Hon. Senator MutahiKagwe, EGHCabinet Secretary forHealthWith this understanding, the Kenya AIDS Strategic Framework (KASF II)hinges on the commitment of national and county governments and theirpartners to scale up cost-effective and socially inclusive interventions for itssuccessful implementation. KASF II re-emphasises on the need for strengthenedcommunity engagement and leadership, an equitable HIV response achievedthrough effective prioritisation of interventions, populations and counties.This framework is aligned with the Constitution of Kenya (2010), Vision 2030development blueprint and its supporting third Medium-Term Plan (MTP)III, national Universal Health Coverage (UHC) aspirations, the East AfricanCommunity HIV and AIDS Prevention and Management Act (2012), and theAfrican Union goals on HIV control.Kenya will continue to invest in a multi-sectoral HIV response and strengthencoordination and governance structures led by the National AIDS ControlCouncil (NACC). Further, the Ministry of Health takes cognisance of thedevolved system of governance and functions of the different levels ofgovernment, the role of other Ministries, Departments and Agencies to drawfrom the policy direction in the implementation of KASF II.To sustain the national response to HIV, KASF II outlines the need forinnovative approaches to secure domestic resources, including through aring-fenced fund. Kenya aims at increasing the domestic resource envelope,in line with the Universal Health Coverage agenda. The Country will investin both preventive and treatment programmes to sustain the gains made andaddress emerging challenges. I call upon all levels of governance, sectors,stakeholders and partners to remain committed in their efforts to implementKASF II.The Second Kenya AIDS Strategic Framework 2020/21-2024/251

PrefaceThe Kenya AIDS Strategic Framework (KASF II) (2020/21-2024/25) marksa critical juncture of the country’s response to HIV. The development andimplementation of KASF II is happening at the time of the emergence ofanother global pandemic of COVID-19. The National AIDS Control Council(NACC) has taken into consideration this unprecedented social, political, andeconomic challenge that is likely to impact on the implementation of KASFII. Kenya has made progress over the last decade in her response to HIV,evidence of which is the reduction of new HIV infections, increased accessto life-saving antiretroviral therapy, and reduction of AIDS-related deaths.In this regard, KASF II calls for the building of national and county-ledAIDS responses that can withstand disruptions, manage uncertainties andunforeseen emergencies to secure these gains.Ms Angeline SiparoChairperson, National AIDSControl CouncilThe Kenya’s HIV response will remain embedded within people-centredapproaches. We will continue to respect constitutionally guaranteed humanrights and ensure that scientific evidence and knowledge are translated intoconcrete programmatic actions. KASF II highlights the need to prioritisegeographical locations and reach all marginalised and excluded populationsin need of HIV services. The Council urges all Kenyans to eliminate HIVrelated stigma and discrimination that continues to undermine the success ofinterventions focusing on priority groups.We encourage meaningful stakeholders’ engagement in the development andimplementation of County AIDS Implementation Plans (CAIPs). We call onall stakeholders to support NACC to deliver on the promise of ‘A Kenya freeof HIV infections, stigma and AIDS-related deaths’.2The Second Kenya AIDS Strategic Framework 2020/21-2024/25

AcknowledgementThe successful development of the Kenya AIDS Strategic Framework (KASFII) (2020/21 - 2024/25) has been a result of enormous contribution and activeparticipation of multiple stakeholders. KASF II draws from recommendationsbased on lived experiences, epidemic analyses and previous programmeimplementation. Key lessons learnt from the implementation of the KenyaAIDS Strategic Framework (KASF I) and the County AIDS Strategic Plans(CASPs) were considered.Dr. Ruth Laibon-MashaChief Executive OfficerNational AIDS ControlCouncilThe NACC would like to thank its staff, partners and stakeholders whocontributed to the development of this framework. They include the leadershipfrom state actors including the National AIDS and STIs Control Programme(NASCOP), Ministry of Health (MoH) Directorates, County Governments, theCouncil of Governors (CoG) and non-state partners. We convey our sinceregratitude to the networks of People Living with HIV (PLHIV), Civil SocietyOrganisations and community representatives, including Key Populations(KPs), Adolescents and Young People (AYPs), Persons with Disabilities(PwDs), women organisations and representatives of elderly personswhose enormous contribution has been captured in the development of thisframework.Incredible appreciation goes to members of the KASF II steering committee,technical and thematic working groups and peer review teams drawn fromcivil society and community-led organisations, public sector institutions,private sector, faith-based organisations, research and academic institutionsand development partners.We wish to acknowledge with gratitude the financial and technicalcontribution of various partners during the development, review and printingof this framework. Specifically, we thank the Global Fund to Fight AIDS,Tuberculosis and Malaria; UN Joint Team on HIV led by UNAIDS, UNDP,WHO, ILO, UNICEF, UNFPA, the World Bank among other agencies; theUS Government for its support through the President’s Emergency Plan forAIDS Relief (PEPFAR) and its agencies (USAID, CDC and DoD); Beyond Zero;the International AIDS Vaccine Initiative (IAVI) and Clinton health AccessInitiative (CHAI). NACC remains committed to working with all stakeholdersto implement KASF II.The Second Kenya AIDS Strategic Framework 2020/21-2024/253

Executive SummaryThe Kenya AIDS Strategic Framework (KASF II) (2020/2021 - 2024/2025)provide the strategic directions that will lead to accerelated progresstowards a Kenya free of HIV infections, stigma and AIDS related deaths.The Kenya AIDS Strategic Framework (II) provides guidancefor implementing an evidence-based HIV response. Itoutlines priority interventions and emphasis on the needto create an enabling system to maximise on the impact ofinterventions. KASF II leverages the gains made underKenya AIDS Strategic Framework I (KASF 1) which wasimplemented through the County AIDS Strategic Plans(CASPs). It promotes the need to strengthen and bringto scale interventions and approaches that have yieldedresults. It is also premised on the Constitution of Kenya(2010) that stipulates the right to highest attainablestandard of health to all citizens and guides the fullengagement of counties in the national health response.The framework builds on the gains made in thedevolved system of planning and governance of the AIDSprogrammes in Kenya. It is aligned with the KenyaUniversal Health Coverage agenda and its roadmap,Kenya’s Vision 2030, the Kenya Health Sector StrategicPlan (KHSSP) of 2018/2019 - 2022/2023, as well as globaland regional health commitments.The development of this framework has been informed byepidemic appraisals and the response. The framework hasbeen developed during a period when the world is facedwith global COVID-19 pandemic challenge and thus hastaken COVID-19 related disruptions into consideration.It provides guidance on priority interventions forimplementation. The vision, goal and the nine thematicareas of the framework are summarised.VISIONA Kenya free ofHIV infections,stigma andAIDS-relateddeathsOBJECTIVESGOALTo provide comprehensiveHIV prevention, treatment,care and support towardsUniversal Health Coveragefor all people in Kenya4The Second Kenya AIDS Strategic Framework 2020/21-2024/25 Reduce new HIV infections by 75% Reduce AIDS-related mortality by 50% Micro-eliminate viral hepatitis andreduce the incidence of sexuallytransmitted infections Reduce HIV related stigma anddiscrimination to less than 25% Increase domestic financing for theHIV response to 50%

Table 1: Summary of KASF II Thematic Areas and Strategic Focus AreasThematic AreaStrategic Focus AreasThematic Area 1:Universal access tocomprehensive, quality,and integrated preventionof HIV and Sexuallytransmitted infections Adapt and scale up comprehensive and high impact HIV prevention interventions Accelerate efforts towards elimination of mother to child transmission of HIVand syphilis Re-invigorate and scale up prevention, management and control of SexuallyTransmitted Infections (STIs) and Viral Hepatitis Enhance identification and linkages to HIV prevention, treatment, care andsupport servicesThematic Area 2:Revitalise shared fasttrack commitment toachieve treatment targets Optimise ART treatment for all sub-populations to improve patient healthoutcomes. Strengthen differentiated service delivery models to improve access Strengthen management of TB, NCD’s and comorbidities among PLHIV Strengthen multisectoral engagement including private sector in HIV servicedelivery to enhance coverage and effectiveness Prioritise mental health and control of substance and alcohol abuseinterventions in HIV programmesThematic Area 3:Protect the rights ofpeople to live a life freeof violence, stigma anddiscrimination Promote accountability and responsiveness for enhanced human rights protection Promote access to justice through public awareness of legal frameworks andredress institutions Institutionalise progress monitoring of HIV related stigma and discriminationand other health and human rights violations Reduce all forms of violence among vulnerable priority groupsThematic Area 4:Invest in resilient systemsfor Health to improve HIVresponse and other healthoutcomes Integrated service delivery and quality improvement Improve the management of human resources for health including communityhealth workers Strengthen health management information systems and monitoring and evaluation Strengthen the health product management systems Harmonise and strengthen financial management system Enhanced infrastructure and equipment management systems and servicesThematic Area 5:Leverage on communitiesled programmes for aneffective HIV response Design and implement people centred responses Reinforce the critical role of community-led interventions Strengthen community-led data monitoring and social accountabilityThematic Area 6:Integrate HIV inhumanitarian andemergency responses Enhance multi-level and multi-sectorial capacity for risk preparedness,reduction and mitigation against impact of disasters Establish a framework to ensure continuity of HIV services duringhumanatarian and emegency crisis Strengthen community centred emergency responsesThematic Area 7:Swift translation ofinnovations, strategicinformation, research,surveillance, andimplementation of scienceinto programmes Strengthen routine programme reporting capacities for HIV, STIs and otherco-morbidities Promote timely translation of research into policy and practice Strengthen surveillance and periodic surveys for HIV, STIs and other comorbidities Develop and disseminate timely strategic information products and capacitiesto improve data access, demand and useThematic Area 8:Invest in long-term HIVinvestments and efficiencyin use of resources Enhanced domestic resource mobilisation to respond to HIV Enhanced efficiency and effectiveness in resource utilisation Put in place regulary updated plans to manage HIV resources transitionsThematic Area 9:Promote Leadership,Communication andAdvocacy Promote transformational leadership among political and technical leaders forthe national and county HIV and AIDS responses Enhance the use of data-led and results-based coordination mechanisms forthe multi-sectoral HIV and AIDS response Ensure social accountability of the HIV programme promoted at all levels Ensure sustained communication and advocacyThe Second Kenya AIDS Strategic Framework 2020/21-2024/255

01IntroductionThe Kenya AIDS Strategic Framework II is the 5thagreed HIV/AIDS Action Framework that providesthe basis for coordinating the work of all partnersinvolved in the HIV response in Kenya. KASF II will beoperationalised through 47 County AIDS ImplementationPlans in line with principles of devolved governance andreported through agreed country level Monitoring andEvaluation System. The National AIDS Control Councilwill coordinate the broad based multi-sector partnersinvolved in implementation.6The Second Kenya AIDS Strategic Framework 2020/21-2024/25

1.1Addressing HIV is critical toachieving the right to healthThe Kenyan Health Policy 2014-2030 prioritises theelimination of communicable diseases including HIVand AIDS in line with the right to the highest attainablestandard of health mandated by the Constitution ofKenya (2010). Despite the tremendous progress made inmore than three decades of the HIV and AIDS response,the epidemic continues to be a significant contributor tothe national disease burden. In 2017, HIV accounted for19% of all years of life lost in that year. Since the firstcase was officially reported in 1984 in Kenya, about 2People-centred 2025 targetsmillion people have lost their lives due to AIDS-relateddeaths (KenyaHIV Estimates, 2020). At the peak of theThe proposed targets for 2025 fall into threeepidemiccategories:in the mid-1990s, HIV caused a decline in lifeexpectancy by about 12 years and led to an increase inchild mortalityby 20%. Fortunately,there has been a1. ComprehensiveHIV services.reversal of this trend in the last two decades, spurred2. People-centred,context-specificby significantprogress in preventingnew serviceinfections,integration.increasing access to life-saving antiretroviral therapies(ART) and scaling up of care and support services for the3. Removal of societal and legalPLHIV. By the end of 2019, at least, 1.5 million Kenyansimpediments to an enabling environmentwere found to be living with HIV while 41,416 newfor HIV services.infections were reported and 20,997 AIDS-related deathshad occurred.This strategic framework maps out priority areas, strategicinterventions, population groups, geographical areas andidentifies critical social and programmatic enablers toeffectively respond to the HIV challenge. It also providesimplementation and management arrangements that willpromo

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