Kenya, also called the Republic of Kenya is an East African country named after Mount Kenya. The country motto is ‘Harambee’ which literally means “all pull together” in Swahili. Its capital city Nairobi is a regional centre of commerce. It is a country famous for its safaris and wildlife reserves. Kenya has considerable land area devoted to wildlife habitats, including the Masai Mara, where Blue Wildebeest and other bovids participate in a large scale annual migration.

Kenya is the largest country in eastern Africa, with a population of approximately 38.6 million people (1). The population has tripled in the past 40 years. Approximately 43 per cent of Kenyans are under the age of 15 (1). The estimated prevalence of HIV in Kenya has declined since the mid-1990s and now appears to have stabilised (2). HIV prevalence among people aged 15-49 year olds is estimated to be 6.3 per cent, although rates vary across regions and population groups (3). Between 1.3 and 1.6 million people are estimated to be living with HIV (2).

1. Kenya National Bureau of Statistics (2010) Population and Housing Census 2009
2. UNGASS on HIV and AIDS (2010) Country Report – Kenya
3. Kenya National Bureau of Statistics (2010) Demographic and Health Survey 2008-09

Integra research in Kenya is investigating three different models of integrated HIV and SRH service provision in 33 facilities operated by the government and by Family Health Options Kenya (FHOK), an affiliate member of the International Planned Parenthood Federation.

Model 1: Integrated family planning (FP) model – Integration of HIV counselling and testing, sexually transmitted infection (STI) screening and management, cervical cancer screening, and condom promotion within FP consultations, and active referral to anti-retroviral therapy (ART) units for HIV positive clients. This model is being studied in six intervention sites and six comparison sites, all government-operated, in Central Province.

Model 2: Integrated PNC model – Integration of family planning services, repeat HIV testing for mother, HIV testing for infant, and referral to HIV services for HIV positive women with PNC for mother and baby. This model is being studied in six intervention sites and nine comparison sites, all government-operated, in Eastern Province.

Model 3: Integrated SRH – Includes family planning, maternal and child health services, HIV testing, HIV care, STI services, cervical cancer screening, and services for youth. This model is being studied in six FHOK clinics in Eldoret, Kisumu, Meru, Nairobi West, Nakuru, and Thika.

All intervention sites received support, training, equipment and supplies to introduce the new services. For Model 2, clinics were also provided with additional support to strengthen their existing post-natal care services.

For Models 1 and 2, the study design involves comparing measurements of the primary research outcomes collected at the baseline with those collected at the end of the study. These include HIV risk behaviours, incidence of unintended pregnancies, uptake of SRH and HIV services, contraceptive use, HIV-related stigma, and costs. For Model 3, various HIV and SRH integration indicators are being monitored over the course of the project at each of the six sites. Data collection methods focus on three different study groups: facilities, clients, and populations. A mix of qualitative and quantitative research is being conducted.

For information about research findings to date, click here.

Resources

Minimum Package for Reproductive Health and HIV Integration in Kenya.
Year 2012 I Authors: Ministry of Public Health and Sanitation and the Ministry of Medical Services, Kenya
The Minimum package for RH/HIV Integration services seeks to provide guidance to implementers or service providers on the minimum requirements in terms of infrastructure, human resource, skills set and training materials, equipment, commodities and supplies, and M&E that are necessary at any level of care for effective service provision. The use of this package will guide the delivery of standardized, coordinated and integrated services
(Download PDF)

Mentoring Toolkit for RH/HIV Integrated Service Provision in Kenya
Year 2013 I Author: Ministry of Health, Republic of Kenya
These National Guidelines for Mentoring are designed to provide guidance to mentors participating in mentorship programme for proper integration of RH/HIV services and effective capacity-building. The guidelines describe a programme designed to mentor health workers and emphasizes the provision of quality care as well as ensuring appropriate documentation, referrals, and client linkages to services.
The package includes:
An overview document (Download PDF)
A mentors guide (Download PDF)
A mentees guide (Download PDF)

Research

Liambila W., Warren C., et al. (2008).Feasibility, Acceptability, Effect and Cost of Integrating Counseling and Testing for HIV within Family Planning Services in Kenya. Frontiers in Reproductive Health, Population Council. This quasi-experimental design study compared two models of integration:

1. Family planning clients were educated about voluntary counselling and testing for HIV (VCT) and were offered VCT within the routine family planning visit by the family planning provider.
2. Interested family planning clients were referred to a specialist VCT service for testing and post-test counselling.

Model 1, used in the Integra study, was built on the model of providing VCT in family planning clinics.

Mwangi A., Warren C., Koksei N., Blanchard, H. (2008). Strengthening Postnatal Care Services Including Postpartum Family Planning in Kenya. Frontiers in Reproductive Health, Population Council. This study looked at the feasibility and acceptability of introducing an additional postnatal visit within the first two weeks of birth as well as ensuring that postpartum women received family planning advice and counselling on STI/HIV risk and condom use. The Integra initiative drew from this study in developing research Model 2.

National Network for Empowerment of People Living with HIV in Kenya (NEPHAK) (2011). The People Living with HIV Stigma Index – Kenya. The People Living with HIV Stigma Index, a community-based research initiative measuring HIV-related stigma and discrimination, was implemented in Kenya in 2010 and involved interviews with over 1,000 people living with HIV. The report provides details of the process, findings, conclusions and recommendations of the study.

WHO, UNFPA, UNAIDS, IPPF (2008). Linking Sexual and Reproductive Health and HIV/AIDS, Gateways to Integration: a Case Study from Kenya.This report is part of a series of case studies of country-level experiences related to linking and integrating HIV and SRH services. The report focuses on the delivery of antiretroviral therapy within a SRH setting in Nakuru, Kenya. The case studies featured in this series were chosen to demonstrate the diversity of integration models and to provide a brief overview of why the decision to integrate was taken, by whom, and what actions were needed to make it happen.

Other national research

Studies conducted in Kenya are contributing to the growing body of research related to HIV and SRH integration. The following studies have been published in peer-reviewed journals from 2009 onward.

Brubaker S. G., Bukusi E. A., Odoyo J., Achando J., Okumu A., Cohen C. R. (2011) Pregnancy and HIV transmission among HIV-discordant couples in a clinical trial in Kisumu, Kenya. HIV Medicine, Vol. 12 (5), pp316-321, 2011. HIV transmission between discordant couples (one HIV-positive and one HIV-negative) who did and did not conceive during participation in a clinical trial in Kisumu, Kenya was examined. Pregnancy was associated with an increased risk of HIV seroconversion in discordant couples. These data suggest that the intention to conceive among HIV-discordant couples may be contributing to the HIV epidemic.

Katz A., Kiarie J. N., John-Stewart G. C., Richardson B. A., John F. N., Farquhar C. HIV testing men in the antenatal setting: understanding male non-disclosure. International Journal of STD & AIDS, Vol. 20 (11): pp. 765-7. This study examined male HIV disclosure in couples attending a Nairobi antenatal clinic who had individual HIV testing and were counselled to disclose to their partner. The study found that male HIV testing did not result in shared knowledge of HIV status and concluded that couple counselling models that incorporate disclosure may yield greater HIV prevention benefits than models offering individual partner HIV testing services at antenatal clinics.

Keraka, M., Serem, W. (2009) Factors influencing fertility choices among HIV infected mothers in Uasin Gishu District, Kenya. Discovery and Innovation, 21(1 & 2), p25. The impact of contraceptive knowledge on the fertility choices of women with HIV was examined in the Rift Valley Province, Kenya. The study concluded that with adequate knowledge about family planning, women are able to adopt better family planning practices and recommended that reproductive health counselling be improved among women with HIV.

Liambila W., Askew I., Mwangi J., Ayisi R., Kibaru J., Mullick S. (2009) Feasibility and effectiveness of integrating provider initiated testing and counselling within family planning services in Kenya. AIDS 23 (supplement 1): S115–S121. The aim of this study was to assess an intervention for increasing access to and use of HIV testing among family planning clients through provider-initiated testing and counselling for HIV. The study found that the proportion of consultations in which HIV prevention counselling was provided and HIV testing offered increased significantly. The authors concluded that provider-initiated testing and counselling is feasible and acceptable in family planning services, does not adversely affect the quality of the family planning consultation, and increases access to and use of HIV testing in a population whose members would benefit from knowing their status.

Undie C., Madise N., Kebaso J., Kimani-Murage E. (2009) ‘If you start thinking positively, you won’t miss sex’: narratives of sexual (in)activity among people living with HIV in Nairobi’s informal settlements. Culture, Health & Sexuality, 11 (8), p767-782. This qualitative research examined narratives of sexual activity (or lack of it) among people living with HIV in two poor urban settings in Kenya and the ways in which these narratives relate to the ‘ABC’ (Abstinence, Be Faithful, Condom Use) HIV prevention strategy.

For further information about the Integra Initiative in Kenya, please contact:

Esther Muketo
Family Health Options Kenya FHOK
email: emuketo@fhok.org