Kenya has delivered successful HIV prevention programmes since the 1990s, which have resulted in a dramatic decrease of new infections.

Over the last two decades access to treatment has also risen significantly. At present approximately one million people are living with HIV in Keyna are on antiretroviral therapy (ART – the use of HIV medicines to treat HIV infection); and the country’s national strategy includes plans to increase coverage rates to 90%.

These plans could create new challenges for Kenya’ health system by increasing the pressure on the already overstretched human resources and infrastructure for ART delivery. To further compound matters, external funding for HIV/AIDS has been declining globally (-7% between 2015 and 2016). In Kenya, such a decline is likely to be felt in the coming years, especially as Kenya is now categorised as a lower middle income country and will be increasingly requested to co-finance its HIV response (at least by the Global Fund).

Against this backdrop, Kenya plans to implement differentiated care to generate efficiencies and improve quality of ART delivery. Differentiated care seeks to develop standardised evidence-informed clinical pathways for different groups of people living with HIV on ART that share similar needs in terms of ARV follow-up, laboratory testing, clinical examinations and counselling services. Instead of a guideline applied for all, DC defines guidelines for different patient groups depending on their common needs.

Members of iDSI visited Kenya and met with representatives of the National AIDS and STI Control Program (NASCOP), the National AIDS Control Council (NACC), members of the Ministry of Health and various academics to hear about current HIV efforts; the evidence gap on costing of ART delivery and differentiated care; and data gaps for economic evaluation of HIV interventions.

The visit was an opportunity to get to know in country-partners and learn about the implementation of differentiated care. The overarching aim of the trip was to understand how economic evaluation can inform the country’s HIV response and help meet the coverage target.

• The take home messages for IDSI as a result of the Kenya visit were:
• There is a need to understand the cost structure and cost drivers of ART delivery – the last extensive costing in the country occurred in 2011.
• There is significant interest in real-life evidence around the costs and cost-savings of differentiated care in Kenya and globally.
• Non-communicable diseases (NCDs) have become a growing source of morbidity and mortality in people living with HIV in Kenya. Future work should aim to document the costs associated with the rising NCD burden. Kenya also needs to experiment with approaches to integrating HIV and NCD care.
• Kenya’s strategy to combat HIV is extremely progressive. Earlier this year the country was the first in Sub-Saharan Africa to receive and start delivering a new generic first line ART.

iDSI hopes to follow up this visit with a workshop to assess how iDSI can contribute to evidence needs.