Supporting the sustainable implementation of comprehensive high-quality HIV prevention, care and treatment programs in the western region of the republic of kenya under the president's emergency…

Supporting the sustainable implementation of comprehensive high-quality HIV prevention, care and treatment programs in the western region of the republic of kenya under the president's emergency plan - pepfar is a leading the transition of the global HIV epidemic from crisis towards control. Driven by the pepfar strategy for accelerating HIV/aids epidemic control (2017-2020), some supported countries have achieved epidemic control benchmarks and unaids 90-90-90 targets. Through pepfar, over 17.2 million people were on life saving antiretroviral treatment (art), 2.8 million babies were born HIV-free, and over 6.7 million orphans, vulnerable children (OVC), and their caregivers received critical care and support as of september 30, 2020 (pepfar, 2021). The global response has already transitioned to the more ambitious unaids 95-95-95 targets in the backdrop of disruptions as a result of the covid-19 pandemic. Kenya recently launched the second aids strategic framework (kasf II) for the period 2020-2025 to guide the achievement of the people-centered 95-95-95 targets by 2025. Having the fifth largest epidemic with 1.5 million people living with HIV (plhiv), the country?s incidence to prevalence ratio (IPR) in 2019 was 2.77 indicating progress towards epidemic control. Declining aids-related deaths and new infections by 59 and 44 percent respectively in 2019 compared to 2010, averting 118,300 mother-to-child infections, as well as achieving the first 90 target, demonstrate this important progress (unaids, 2020). However, significant disparities exist ? In 2019, a third of all new infections were among adolescent girls and young women (agyw) aged 10 to 24 years; treatment coverage was skewed with a larger GAP among children (at 32%); viral suppression was lower among adult men and children compared to adult women (61% and 51% respectively VS 74%); mortality was highest among adult men; and key populations remain vulnerable because of stigma, discrimination, criminalization, and violence. By geography, nine out of 13 prioritized counties accounted for 44% of all new infections in 2019 (MOH, 2021). Homabay, kisumu, siaya, migori, and kisii counties i n western kenya are among the 13 prioritized by the kasfii based on their incidence to prevalence ratios. HIV prevalence in homabay county is five times higher than the national average, and together with kisumu, siaya, and migori, represent counties with the highest HIV prevalence in kenya. These four counties also account for a third of plhiv, a third of new HIV infections, a third of HIV positive pregnant women in kenya and are home to traditionally non-circumcising communities, key populations, and a large fisher folk community. By end of 2019, all five counties contributed over a third (35%) of 1.16 million plhiv on art in kenya, with mean coverage rates of 82% (lowest in kisii at 78%), achieving viral suppression rates above 90%. Gaps need to be addressed to achieve the 95-95-95 targets. Scale-up of art is required to close the 26% unmet treatment need in the five counties. Also, program gaps including sub-optimal retention on art, sub-optimal viral suppression among children and adolescents, tuberculosis-related mortality, high mother-to-child transmission rate (9.3%), and high vulnerability to HIV infection among agyw require attention. Further, voluntary medical male circumcision (vmmc) coverage gaps particularly among young men aged 10 to 29 years will need to be addressed. Addressing these last mile gaps will require optimizing interventions that shift from generalized population-based approaches to surveillance enabling robust, real-time detection of new infections and outbreaks, case-based surveillance, excellence in treatment services for durable viral load suppression and rapid return to treatment for those alive but no longer in care. In addition, protecting and advancing the lifesaving HIV gains in the context of the dual pandemics of HIV and covid-19, will be critical t