28. Equip, mobilize, and support faith leaders, FBOs, people in places of worship, and the wider community to create demand for testing of infants and children.
29. Combat stigma and discrimination among faith leaders and within communities of faith.
30. Further collaborate and coordinate community mobilization, education and outreach to find otherwise hard-to-reach children, adolescents, youth and adults for age appropriate prevention education, testing and linkage to treatment and health and social support services and integrate into the national system.
31. Ensure FBO participation in local and national diagnostic product/supplies forecasting.
32. Support and participate in national efforts to improve the use and impact of pediatric diagnostics and develop national strategies to optimize the use of new technologies and interventions.
33. Work to implement new HIVST modalities (such as oral fluid testing) in communities and homes, where national polices and regulations allow for lay implementation with children.
Commitments 28, 29, and 30:
In February and March 2019, EDARP (located in the Nairobi slums) supported by WCC-EAA and a cooperative agreement with PEPFAR through the CDC provided trainings to 1,300 EDARP Community Health Workers, Young Adult Peer Mentors and to selected male EDARP staff members on the Kenyan National HIV Guidelines including HIV self-testing. They were also trained on new innovations to improve identification of HIV positive adolescents and interventions to increase retention to care and treatment. The trainings included preparation and orientation of newly identified HIV positive paediatric/adolescent clients, including enrollment in peer support groups (both physical and virtual) and the involvement of their parents and guardians to maximize adherence and retention in care.
The health care providers training was part of EDARPs effort to increase health care providers (social workers, community mobilizers, and facility team leads [who are nurses and clinical officers] in their knowledge, attitude and practices with regards to gender-based violence and work with key populations. This training aimed at 1) enhancing identification of new positive individuals particularly among key populations, adolescents and young people, 2) Ensuring person centered, targeted care to key populations already enrolled on care at EDARP facilities to improve their outcomes and quality of life and 3) improve the identification of gender based violence survivors, provide immediate post GBV care and provide appropriate referrals.
EDARP operates in 14 sites in the Eastern Slums of Nairobi with 390 staff, and over 1,200 community health educators and peer mentors; 26.000 adults and 1.500 children on ART.
Between January and September 2019, EDARP has found 2,034 new HIV positive persons and successfully linked 99.9% to treatment. This includes 1,971 adults and 63 children under the age of 18 years. From June through September, EDARP is one of the first FBO’s in Kenya to integrate HIV Self Testing into its programing. EDARP has distributed 2,058 kits during this time and has confirmed results on 678. 4.5% of the returned results were reactive and confirmed positive. 100% have been linked to treatment. Between July and September 2019, EDARP integrated more target HIV testing toward individuals most-at-risk. During this period 4,368 partners of HIV positive persons were elicited and tested, resulting in an HIV positivity yield of 17%. 21% of the HIV negative partners are now receiving PrEP. EDARP is currently providing HIV treatment services for 25,618 adults and 1,457 children under 18 years of age. 85% of these children have achieved viral load suppression.
38. Support and participate in national efforts to improve and integrate the use and impact of pediatric diagnostics for TB and HIV and develop national strategies to optimize the use of new technologies and interventions.
71. Equip, mobilize, and support faith leaders, FBOs, people in places of worship, and the wider community to create awareness of the importance of HIV testing of infants and children of people living with HIV. Demand that national school curricula include scientifically appropriate information on HIV prevention, testing and treatment.
72. Combat stigma and discrimination among faith leaders and within communities of faith around HIV prevention, testing and treatment. Create demand for client-centered and stigma-free care within health facilities as well as access to community-based treatment.
73. Further collaborate and coordinate community mobilization, education and outreach to find otherwise hard-to-reach children, adolescents, youth and adults for age appropriate prevention education, testing, and linkage to and continuity of treatment, health, psycho-social and spiritual support services and integrate into the national system.
EDARP continues to provide fully integrated HIV/TB for children and adolescent. For Children and adolescent on HIV care and treatment, the viral suppression rate is at 83% and 91% respectively.
The main concerns during the past 6 months have been;
Low stocks and eventual stock out of Isoniazid syrup for pediatric TB preventive therapy
Stock out of Kaletra syrup and facilities have put all children on Lopinavir/ritonavir on Kaletra pellets
Social economic challenges arising from COVID-19 impact negatively affecting care giver support for children and adolescent on ART- EDARP continues to work closely with OVC program (MWENDO implementing partners) to link households to social support.
Stock outs of early infant diagnosis commodities resulting in slowed down testing and missed testing at 6 weeks and follow up testing at 1 years for HIV exposed infants
Viral load testing reagent stock outs for the last 2 months resulting in temporary suspension of VL monitoring for PLHIV including children and adolescents. This has a negative impact on the follow up of children with previously High VL that are on MDT follow up who are scheduled for repeat VL.
52. Ensure FBO participation in local and national forecasting of optimal paediatric drug formulations.
53. Collaborate with GAP-f partners to develop, test, and disseminate training tools for treatment initiation with LPV/r and other optimal pediatric formulations.
54. Support and increase family treatment initiation and retention for children, adolescents, and families by:
Increasing identification and provision of same-day/same-appointment mother/infant pair treatment through FBO clinics;
Promoting male/father engagement in EMTCT programmes; and
Increasing stigma reduction interventions through mobilized faith leaders and faith communities
Providing social work interventions to assist fathers to support treatment and adherence of their partners and children living with HIV.
55. Foster and more actively participate in coordinated and collaborative advocacy to:
Increase funding for research & development, introduction and scale-up of priority pediatric drugs and formulations;
Accelerate regulatory processes for rapid adoption and uptake of optimal paediatric drugs and formulations; and
Ensure sustainable access to optimal testing and treatment for infants and children.
119. Advocate for and support Ministries of Health to rapidly transition to optimal paediatric formulations as outlined by the latest WHO guidelines, provide coordinated support for the development and implementation of transition plans, inform clinicians and patients of the value of transitioning to new formulations, and ensure communication of reliable information on the availability of new formulations in-country.
120. Support the scale up of access to priority formulations and diagnostics and take steps to facilitate their wider roll-out, including by performing operational research, developing introductory guidance and education, materials, and other tools for health facilities and local community health structures.
121. Promote the revision of national procurement plans to align with WHO recommended regimens and the EML-C, and support the provision of reliable forecasts and the consolidation of orders.
122. Mobilize their networks and work with communities to help build treatment literacy, generate demand, and expand access to TB diagnosis and treatment among children in close collaboration with other stakeholders.
123. Raise awareness in local, national, and global fora about the unmet diagnostic and treatment and prevention needs of children with or at risk for TB.
124. Foster and more actively participate in coordinated and collaborative advocacy to:
Increase funding for TB research & development, introduction and scale-up of priority paediatric drugs and formulations;
Accelerate regulatory processes for rapid adoption and uptake of optimal paediatric TB drugs and formulations; and
Ensure sustainable access to optimal TB testing and treatment for infants and children.
125. Tackle the TB stigma and discrimination in communities, schools, and healthcare settings that prevent children and adolescents living with TB or at risk of TB from accessing testing and treatment, including promotion of awareness of the difference between infection and disease and include messages of hope regarding treatment of both HIV and TB.
126. Promote uptake by mobilizing their networks of hospitals and community structures to distribute paediatric medicines in hard to reach places and in situations of conflict and crisis.
127. Support and increase TB treatment initiation and retention for children, adolescents, and families by:
Identifying all TB-exposed children and connecting them to treatment and preventive TB treatment through FBO clinics and within communities of faith;
Reducing TB stigma and discrimination through mobilization and evidence-based education and training of faith leaders and faith communities