As donor funds shrink, three counties boost HIV treatment to over 94 per cent
Crucially, the continuity of treatment improved. Interruptions in antiretroviral therapy declined significantly across all the three counties.
What you need to know:
- An analysis in Nyandarua identified key barriers to continuous care, including stigma, high transport costs, and unstable income.
A one-year initiative in Nyandarua, Embu, and Meru counties has demonstrated that local ownership of HIV programmes can significantly reduce reliance on donor funding while improving patient outcomes.
The project, ‘Promoting Self-Reliance through a County-Owned, County-Led, and County-Managed HIV Response’, was implemented by the President's Emergency Plan for AIDS Relief (PEPFAR). It aimed to build a sustainable, locally-funded model for HIV management.
It focused on transferring the management and funding of HIV services from international donors to national and local governments. This concept was a response to stricter stances on US government donations, aiming to build resilient, self-sufficient local health systems.
According to Ooko Obiero, a service delivery advisor with the Christian Health Association of Kenya (CHAK), which was among the strategic partners in the programme, the results of using the HIV ownership model have been positive. The uptake of Tuberculosis Preventive Treatment (TPT) rose to 94.19 per cent in Nyandarua and 85.76 per cent in Embu and Meru.
"Among new patients on antiretroviral therapy (ART), TPT uptake was significantly higher in Nyandarua at 81.95 per cent, compared to 56.48 per cent in Embu and Meru," said Mr Obiero.
Crucially, the continuity of treatment improved. Interruptions in ART declined significantly across all the three counties.
"ART interruptions declined most sharply in Nyandarua—falling from 2.3 per cent to 0.6 per cent within the 2024/2025 financial year. Declines were also recorded in Meru (3.0 per cent to 1.6 per cent) and Embu (2.2 per cent to 1.25 per cent)."
Dr Mutugi M’Muriithi of CHAK explained that while PEPFAR has advanced HIV treatment in Kenya, long-term sustainability requires strong county ownership. The County Mentorship and Transition (CMaT) model was co-created with county governments and USAID to address this.
Resilient systems
“The model used in the three counties strengthens county capacity to lead, finance, and deliver high-quality healthcare while building resilient systems. With our affiliate partner USAID Jamii Tekelezi Program and the county governments, we co-created CMaT to reduce donor dependency and strengthen county-owned HIV programmes by fostering a transformative health system grounded in five pillars,” explained Dr Mutugi .
The pillars included mentorship, advocacy, integration, leadership, and sustainability.
In Nyandarua, the county government has committed to fully embracing the model after its successful pilot. Dr
Boniface Gachara, Nyandarua County director of Health, stated that a county-led approach is essential for reducing ART interruptions, which can lead to drug resistance and increased mortality.
“These are the challenges that the model has helped to reduce. Its implementation was a success due to political goodwill and policy.”
An analysis in Nyandarua identified key barriers to continuous care, including stigma, high transport costs, and unstable income.
In response, the county implemented a tiered ‘Smart Strategy’. "For new patients, this includes an intensive 180-day support package with clinician-led counselling and follow-up phone calls.
Another initiative involved a machine-learning tool to assess the risk of treatment interruption among patients who had been on treatment for six months or longer. According to Dr Gachara, individuals identified as high-risk were contacted through automated Ushauri reminders and provided with a customised return-to-care package, designed to address the specific reasons for disengagement uncovered by the analysis.
Other innovations include decentralised ART pick-up points and a smart patient-tracing system managed by peer mentors.
“We differentiated services by decentralising ART pickup through voluntary social networks and optimising appointment spacing. We also established a smart patient tracing system, complemented by community-based ART re-initiation using one-month packs and peer mentor-led appointment management. We are confident this approach will sustain improvements in treatment continuity and patient outcomes, while enhancing accountability and strengthening local health system resilience,” said Dr Gachara.
