- After several years of scaling up HIV treatment, it is time to look at the state of the HIV epidemic in Kenya and the impact of prevention, care and treatment services.
- KENPHIA is a national household-based HIV survey that will help health authorities and policymakers to better understand the relative impact of HIV on everyone in the population, not only people living with HIV but also their family, friends, and community.
- This is the first time Kenya will be getting population based HIV estimates at county level. This is a key difference with what has been done in past surveys.
- The survey will also for the first time provide a national rate for Hepatitis B and syphilis prevalence
What are the goals of KENPHIA?
- To estimate the incidence of HIV in Kenya
- Determine the level of viral suppression of HIV among the national population
- Assess the prevalence of HIV infection in Kenya
- Measure coverage and impact of HIV services at population level
- Assess key HIV-related risk behaviors using nationally-representative sample of adult minors
As part of the KENPHIA survey, blood samples will be collected in order to measure biomarkers that will indicate: how many people are currently infected (HIV prevalence), how many have recent infections (HIV incidence), and how many HIV-positive persons are on effective treatment (HIV viral suppression). KENPHIA will be able to measure the coverage of effective treatment and how many people are infected at both national and county levels. By measuring the coverage of testing, treatment and viral load suppression nationally, KENPHIA will benchmark Kenya’s progress towards the UNAIDS 90-90-90 targets (90 percent of persons living with HIV to know their status, 90 percent of these people to be on antiretroviral treatment, and 90 percent of those on antiretroviral treatment to be virally suppressed). The UNAIDS models predict that achieving these 90-90-90 targets by 2020 will dramatically slow the spread of HIV and help end the HIV epidemic by 2030.
Findings from KENPHIA will provide a deeper understanding of the impact of the HIV response at national and sub-national levels. These can be used to guide future investments and help target programs and resources for populations at greatest risk and in most need of services.
KENPHIA also aims to help people learn about their health by providing testing and results to participants.
KENPHIA will also provide information about HIV prevention to all participants.
KENPHIA gives Kenyans an opportunity to share their experience with the health system and provide feedback on the services they’ve received.
KENPHIA also gives Kenyans the opportunity to contribute to public health and the national health response by providing data that will be used for policy and programming.
KENPHIA data will be used to strengthen the delivery of HIV programs and other social services throughout the country.
What is the difference between KENPHIA and the KDHS?
KENPHIA and the Kenya Demographic and Health Survey (KDHS) are two different surveys that are being implemented at the same time, but in different communities. KENPHIA and KDHS will complement each other in providing a broad perspective on public health in Kenya. The table below highlights the key similarities and differences between the two surveys.
|1||Survey purpose||Estimate HIV incidence, rate of viral load suppression, HIV prevalence||Better understand key reproductive and child health trends|
•Hepatitis B, syphilis, HIV co-morbidities
•Nutritional status of HIV-infected individuals
•Uptake of HIV services
• HIV-related behaviour patterns
|•Child, maternal and adult mortality rate
•Maternal health and fertility rates
•Nutritional status of children and women
•Domestic violence and gender circumcision
•HIV-related behavior patterns
|3||Geographic scope||National / All 47 counties||National / All 47 counties|
|4||Sampling approach||Small representative sample of all households in Kenya||Small representative sample of all households in Kenya|
|5||Sample size||20,000 households||40,000 households|
|6||Implementation period||May 2018 – November 2018||May 2014 to October 2014|
|7||Survey Implementer||MOH in collaboration with many partners||MOH in collaboration with many partners|
How will the survey be conducted?
- KENPHIA aims to visit 20,000 randomly selected households, to interview approximately 36,000 people nationally.
- KENPHIA will measure the current coverage of HIV testing, treatment and viral load suppression.
- obtain voluntary informed consent from participants and collect demographic, clinical and behavioral information through face-to-face interview.
- Staff will collect blood samples by venipuncture or a finger stick:
- HIV counseling will be conducted and rapid test results will be given to participants during the same visit through post-test counseling.
- Those who test positive for HIV will also receive referrals to HIV care and their samples will be sent to a central lab for viral load testing.
- Additional testing for Hepatitis B and Syphilis will be conducted on a small pre-selected number of overall survey participants.
- All participants will receive HIV prevention information as part of post-test counseling.
- KENPHIA will return HIV, Syphilis and Hepatitis B test results to participants on the same day of interview. In this way, it brings health services right to your doorstep. Additional viral load testing will be done on samples referred to a central lab and these results will be collected at a nearby facility of the participant’s choice.
- Children and adolescents:
- We are inviting children and adolescents to participate in this study to learn more about their health as well.
- Children <15 years will be sampled in every other 2 households (33%), and minors (15-17) will be selected in every household for participation in the survey.
- We want to understand whether services are reaching children and whether they are effective.
- All survey procedures are safe for children.
- We will not invite any child to participate without first asking their parent or guardian’s permission.
- For children aged 10 – 18, we will also ask the child if he/she agrees to participate.
- Households will be visited by survey staff trained in confidentiality procedures. They will
Why should I participate in the KENPHIA survey?
- Your participation provides important information about health in Kenya and is an opportunity to contribute to the greater good.
- This survey is an opportunity to receive HIV, Hepatitis B and syphilis tests in the comfort of your own home.
- Testing regularly for HIV is recommended. If you test positive, treatment is available that can help you live a healthy and long life. KENPHIA staff will provide counseling support to help you learn your HIV status and will make sure you know where you can go to get care for HIV.
- If you test positive for Syphilis and Hepatitis B, you will also be referred to a nearby health facility of your choice for further assessment and treatment.
- Men matter: This survey wants to understand the health of men, so we can improve the health services available to men like you.
- Young people are Kenya’s future: This survey wants to hear from young people so that we can improve services to help youth stay healthy.
- Women: Women use the health system more than anyone else. This survey wants to understand how the health system is serving women’s health and how it can be improved.
- People living with HIV:
- If you are HIV-positive, this is a chance to get additional tests at no cost. You will receive, viral load results at a nearby clinic of your choice or where you are already receiving care. This helps your doctor understand how you are doing and make sure that you get the right care.
- Information for HIV-positive people is also important to the survey and will help inform the development of new programs for people living with HIV.
- People living with HIV will be able to share their experiences and challenges to help MOH improve HIV programming.
Why should parents let their children participate in KENPHIA?
- KENPHIA is a chance to learn about your child’s health in the comfort of your own home
- It is extremely important that children, especially babies, learn their HIV status as early as possible and if they are HIV positive, receive HIV care and treatment right away.
- If your child tests positive for HIV, treatment is available to help him or her live a long and healthier life. You will also receive counseling support and KENPHIA staff will let you know where to take your child to get HIV treatment, care and support. You will also receive test results that can help your doctor manage your child’s health.
On questions related to blood draw:
- KENPHIA staff is trained to minimize any pain or discomfort due to blood draw.
- KENPHIA staff will take approximately two teaspoons of blood from each participant. This is a very small amount compared to the amount of blood in your body. It is very safe to remove this small amount of blood.
- Blood samples will be taken to a central lab for further testing. These tests help us to better understand the HIV epidemic.
- Blood will not be used for any purpose other than testing in a laboratory to understand health in Kenya.
On questions about privacy/confidentiality:
- The KENPHIA visit to your home is private and survey staff has been specially trained to protect your confidentiality.
- Your answers and test results are also confidential.
- You will be given a unique Identification number but your name will be kept separate from your answers to the questions.
- Only people working on the survey will have access to the information we collect during the survey. They will not tell anyone what you say or your test results from the survey.
- You can choose the location where you speak with survey staff.
- You may also choose to skip any question or stop the survey at any time. Nothing bad will happen if you do
Who supports KENPHIA?
The Ministry of Health through the National AIDS and STI Control Program (NASCOP) is the lead body overseeing all aspect of the KENPHIA national survey. KENPHIA will be implemented by ICAP at Columbia University, which is funded by the US Government President’s Emergency Plan for HIV/AIDS (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC).
This survey is being conducted in collaboration with the following partners: The Ministry of Health (MOH) through the National AIDS & STI Control Program (NASCOP) National Public Health Laboratories (NPHLS), National AIDS Control Council (NACC), and the Kenya Medical Research Institute (KEMRI); The Ministry of Planning and Devolution (MOPD) through the Kenya National Bureau of Statistics (KNBS), and the National Council for Population and Development (NCPD); Ministry of Interior and Coordination of National Government, and the Kenya Council of Governors (CoG). Additional stakeholders include non-governmental partners involved in HIV prevention and care, the United Nations (UN) Family, National Empowerment Network of People Living with HIV/AIDS in Kenya (NEPHAK), the President’s Emergency Plan for AIDS Relief (PEPFAR), US Centres for Disease Control (CDC), and ICAP. The success of KENPHIA will help strengthen the social services requirements on reducing HIV infections.