Ensuring Access and Uptake of HIV Prevention Among Key Populations in Kenya

Overview

Key Populations Access to PrEP (K-PAP) Project

EGPAF’s Key Populations Access to PrEP (K-PAP) project began implementation in February 2022 and will conclude in August 2023. K-PAP has four main aims: to increase awareness and demand for PrEP services by KPs in Homa Bay; to increase KP engagement in services; to build capacity of healthcare workers (HCWs) and improve KP-friendly service; and to foster scalable, KP-friendly PrEP infrastructure in Kenya. The KPs included in K-PAP include FSWs, MSM, and PWIDs.

Intentional engagement and collaboration with KP stakeholders from the community were essential elements in the design and implementation of this project. Prior to implementation, the project used community mapping to identify local KP stakeholders. EGPAF leveraged in-country KP networks including the Kisumu Sex Workers Alliance and the Key Populations Consortium. Other key stakeholders in the implementation of project activities include the Ministry of Health, the National AIDS Control Council, LVCT Health, and NASCOP.

EGPAF provides a comprehensive suite of facility and community-based services for KPs in the K-PAP project, which is underpinned by a trained peer cadre [Figure 1]. K-PAP identified and trained KP peer champions to support service delivery. KP champions are KP members from the community who serve as peer navigators, educators, service providers, and supporters of KPs throughout project activities. K-PAP activities are strategically integrated with and aligned to project activities in the PEPFAR-CDC funded Vukisha 95 project, where EGPAF is a consortium partner with LVCT Health. Community-based activities conducted by KP peer champions were designed to meet local KP needs and occur in convenient places.

K-PAP established three Centers of Excellence (CoE) to provide prevention services for KPs. These facilities have dropin centers (DICE) that provide quality, responsive services including testing, counseling, screening, and initiation on PrEP, and referrals for other services.

K-PAP project activities include PrEP advocacy forums facilitated by KP champions, community dialogues with MSM and FSW to build understanding, awareness and to link to retention services, hot spot delivery of PrEP, and mobile outreaches. K-PAP also offers moonlight services and island camps in the form of service delivery pop ups for KPs residing or working on islands on Lake Victoria. Other service delivery models include snowballing modalities such as the “bring a friend initiative” focused on MSM populations and conducted to increase reach and harness the power of social networks. KP peer champions hold community advocacy forums to discuss PrEP, clarify misconceptions, and link their members to care. KP peer champions are paired with HIV testing service providers to provide community testing services. KP peer champions lead activities with support from EGPAF and multi-disciplinary teams (MDT) at K-PAP facilities and meet weekly to review performance and discuss strategic decisions in response to challenges that arise.

Lessons learned

K-PAP outcomes reveal the effectiveness of peer champion systems and show the benefit of maintaining a community-centered approach focused on PrEP uptake among FSW, MSM, and PWID. K-PAP best practice actions include:

• Identify and engage KP stakeholders upon initiating the project to ensure buy-in, support, and responsive tailoring of project activities
• Align strategies of K-PAP activities within the Vukisha 95 project to facilitate access to additional resources and activities for reach, including beach testing where HIV testing and services are provided to fisherfolk during peak hours on the beaches of Lake Victoria
• Integrate PrEP into all service delivery points at facility and community levels, including outreach efforts
• Collaborate with local and national health authorities on communication and updates about K-PAP activities and successes
• Use social networks to identify KPs eligible for prevention or treatment services through snowballing and bring a friend initiatives
• Conduct weekly performance reviews to discuss progress and solutions and share experiences and best practices
• Capacitate peer cadres to provide tailored, peer-level services in an amenable and friendly manner
• Prioritize community-based demand-creation activities to increase awareness and understanding of the availability, eligibility, and efficacy of HIV prevention services for KPs