Abstract:
Background While advances have been made in HIV prevention and treatment, new HIV
infections continue to occur. The introduction of pre-exposure prophylaxis (PrEP) as an
additional HIV prevention option for those at high risk of HIV may change the landscape
of the HIV epidemic, especially in sub-Saharan Africa, which bears the greatest HIV
burden.
Methods: This paper details Kenya's experience of PrEP rollout as a national public
sector program. The process of a national rollout of PrEP guidance, partnerships,
challenges, lessons learnt and progress related to national scale up of PrEP in Kenya, as
of 2018, is described. National rollout of PrEP was strongly lead by the government, and
work was executed through a multidisciplinary, multi-organisation dedicated team. This
required reviewing available evidence, providing guidance to health providers,
integration into existing logistic and health information systems, robust communication
and community engagement. Mapping of the response showed that subnational levels
had existing infrastructure but required targeted resources to catalyse PrEP provision.
Rollout scenarios were developed and adopted, with prioritisation of 19 counties
focusing on high incidence area and high potential PrEP users to maximise impact and
minimise costs.
Results: PrEP is now offered in over 900 facilities countrywide. There are currently over
14000 PrEP users 1 year after launching PrEP.
Conclusions: Kenya becomes the first African country to rollout PrEP as a national
program, in the public sector. This case study will provide guidance for low- and middle-
income countries planning the rollout of PrEP in response to both generalised and
concentrated epidemics.