Kenya PrEP Ring Rollout Scenarios Analysis
Analysis conducted by the PROMISE Consortium in January 2022 highlights the prioritized counties for introducing the monthly dapivirine ring as an HIV prevention method for women in Kenya. The scenarios consider HIV incidence among women and current oral PrEP uptake across counties to determine the best approach for implementing the new prevention method. The document outlines high-priority counties such as Homa Bay, Kisumu, Siaya, and Migori, along with other counties with varying levels of incidence and PrEP uptake. Different rollout scenarios are presented, each with its own set of prioritized counties based on different criteria.
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KENYA PrEP Ring Rollout Scenarios PROMISE PROMISE Preparing for Ring Opportunities through Market Introduction Support and Knowledge Exchange JANUARY 2022
Context and key takeaways Key Takeaways Context Across all three scenarios, four counties are high priority for introduction of the ring: Homa Bay, Kisumu, Siaya, and Migori As Kenya considers introduction of the monthly dapivirine ring (the PrEP ring ), a new HIV prevention method for women, an outstanding question is how and where the ring should be introduced relative to oral PrEP Nine other counties are also high priority in several scenarios: Kajiado, Kakamega, Kiambu, Kisii, Machakos, Mombasa, Nairobi, Nakuru, and Uasin Gishu To support decision making, the PROMISE Consortium developed this analysis to consider several possible scenarios, defined by HIV incidence among women and the current state of oral PrEP uptake across counties Prioritizing counties that are high incidence vs. those counties that have the greatest numbers of new infections yields different priority counties for the ring Two of the three scenarios include counties with relatively high HIV incidence but low oral PrEP uptake the ring could be a particularly helpful addition in these counties The following slides include an overview of these three scenarios as well as details on the analysis for each scenario
Rollout scenarios SUMMARY OVERVIEW
Kenya rollout scenarios overview First priority Second priority Third priority Total Scenario 1 Prioritize counties with high HIV incidence among adult women and large PrEP programs. 2 counties 2 counties N/A 4 counties 19% (3,116) annual new infections among women age 20+ 12% (1,903) annual new infections among women age 20+ 31% (5,020)annual new infections among women age 20+ Scenario 2 Prioritize all counties with high HIV incidence among adult women, regardless of oral PrEP use. 2 counties 2 counties 4 counties 8 counties 19% (3,116) annual new infections among women age 20+ 12% (1,903) annual new infections among women age 20+ 24% (3,898) annual new infections among women age 20+ 55% (8,918) annual new infections among women age 20+ Scenario 3 Prioritize counties with large numbers of new HIV infections among adult women. 3 counties 2 counties 8 counties 13 counties 32% (5,204) annual new infections among women age 20+ 12% (1,903) annual new infections among women age 20+ 28% (4,625) annual new infections among women age 20+ 72% (11,732) annual new infections among women age 20+
Kenya rollout scenarios county detail Description First priority Second priority Third priority Scenario 1 Prioritize counties with high HIV incidence among adult women and large PrEP programs. Roll out the ring where oral PrEP is already widely available in counties with high incidence among adult women (age 20+). Kisumu Siaya Homa Bay Migori N/A Scenario 2 Prioritize all counties with high HIV incidence among adult women, regardless of oral PrEP use. Roll out the ring in counties with high incidence among adult women (age 20+), regardless of the size of oral PrEP rollout. Kisumu Siaya Homa Bay Migori Machakos Kisii Mombasa Nairobi ** These counties have low PrEP uptake but high HIV incidence among women and could be a good fit for the ring, with delivery through complementary channels. Scenario 3 Prioritize counties with large numbers of new HIV infections among adult women. Roll out the ring in counties with large numbers of new HIV infections in adult women (age 20+). Kisumu Nairobi Siaya Homa Bay Migori Kajiado Kakamega Kiambu Kisii Machakos Mombasa Nakuru Uasin Gishu ** These counties have low PrEP uptake but high HIV incidence among women and could be a good fit for the ring, with delivery through complementary channels.
Rollout scenarios DATA ANALYSIS
Data analysis framework This analysis plots counties along two dimensions that inform the rollout scenarios. Rollout Scenario Framework 10,000 9,000 Moderate priority Roll out the PrEP ring in these regions by building on oral PrEP rollout in regions where ring introduction does not require significant additional investment. High priority Prioritize introduction of the ring in these regions, largely building on processes and systems developed for oral PrEP rollout and scale-up. 8,000 7,000 6,000 5,000 Total current PrEP users 4,000 Low priority Deprioritize these regions for initial ring rollout when resources are limited. High priority Prioritize introduction of the ring in these regions but explore new models and channels that will complement existing oral PrEP delivery points to expand the reach of HIV prevention delivery to new users. 3,000 2,000 1,000 - 0 HIV incidence or new HIV infections 0.2 0.4 0.6 0.8 1 1.2
Scenarios 1 and 2 Prioritize counties with high HIV incidence 600 MIGORI Size of circle represents number of new infections among women age 20+ Orange circles represent DREAMS counties KISUMU 500 Current PrEP users per 1,000 women age 20+ (2021) National average HIV incidence = 0.9 Second priority SIAYA HOMA BAY 400 First priority 300 200 KIAMBU KITUI MAKUENI MERU Third priority MOMBASA 100 NAIROBI KISII MACHAKOS - 0.00 1.00 2.00 3.00 4.00 5.00 6.00 HIV incidence per 1,000 women age 20+ (2019)
Scenario 3 Prioritize counties with significant new HIV infections 2,000 Orange circles represent DREAMS counties Total current PrEP users among women age 20+ (2021) Second priority KISUMU 1,500 MIGORI First priority HOMA BAY SIAYA 1,000 Third priority NAIROBI KAKAMEGA MACHAKOS UASIN GISHU MOMBASA 500 NAKURU KIAMBU KISII - 0 500 1,000 1,500 2,000 2,500 New HIV infections among women age 20+ (2019)
