KENYA, COUNTY HIV SERVICE DELIVERY PROFILES

Transcription

1 MINISTRY OF HEALTH KENYA, COUNTY HIV SERVICE DELIVERY PROFILES NATIONAL AIDS AND STI CONTROL PROGRAM NASCOP

2 Table of Contents Page Content 4 Abbreviations 5 Introductions 6 Reporting rates 8 Kiambu County 12 Kirinyaga County 16 Muranga County 20 Nyeri County 24 Nyandarua County 28 Kilifi County 32 Kwale County 36 Lamu County 40 Mombasa County 44 Taita Taveta County 48 Tana River County 52 Embu County 56 Isiolo County 60 Kitui County 64 Machakos County 68 Makueni County 72 Marsabit County 76 Meru County 80 Tharaka Nithi County 84 Nairobi County 88 Garissa County 92 Mandera County 96 Wajir County 100 Homa Bay County 104 Kisii County 108 Kisumu County 112 Migori County 116 Nyamira County 120 Siaya County 124 Baringo County 128 Bomet County

3 132 ElgeyoMarakwet County 136 Kajiado County 140 Kericho County 144 Laikipia County 148 Nakuru County 152 Nandi County 156 Narok County 160 Samburu County 164 TransNzoia County 168 Turkana County 172 Uasin Gishu County 176 West Pokot County 180 Bungoma County 184 Busia County 188 Kakamega County 192 Vihiga County 19 Count y

4 Abbreviations AIDS ANC ANC SS ART ARV CCC DTC FANC HIV HTC KAIS KDHS MOH MTCT TB PLHIV PMTCT RBTC STI VCT Acquired Immune Deficiency Syndrome AnteNatal Care AnteNatal care Sentinel Surveillance AntiRetroviral Therapy Antiretroviral Comprehensive Care Centre Diagnostic Testing and Counseling Focused AnteNatal Care Human Immunodeficiency Virus HIV Testing and Counseling Kenya AIDS Indicator Survey Kenya Demographic &Health Survey Ministry Of Health Maternal To Child Transmission Of HIV Tuberculosis People Living with HIV Prevention of Maternal to Child Transmission of HIV Regional Blood Transfusion Centre Sexually Transmitted Infection Voluntary Counseling and Testing

5 Introduction Kenya is located on the Eastern part of Africa. It is one of the developing countries in sub Saharan Africa. Its location is strategic both politically and economically; the country has an HIV epidemic that is very dynamic. SubSaharan Africa has borne the brunt of the HIV pandemic. It still bears the greatest number of HIV infected individuals who need HIV care. Kenya has an overall HIV prevalence of 7.1% (KAIS2007) and 6.2% (KDHS 2008). There is a wide variation in prevalence from one county to another. The availability of quality HIV service delivery data is essential in planning for prioritization and provision of both preventive treatment and care services to the population. There has been a steady progress towards the up scaling of services to meet the demand for care treatment and HIV prevention services. The purpose of this report is to preempt this demand for data by developing county profiles for HIV services. These profiles will provide a one point source of service delivery data for HIV programming at county level. Justification County governments are expected to be operational after the next general elections. It is expected that the demand for quality HIV data at county level will be high. To meet this need for data, NASCOP intends to develop county HIV service profiles to make planning for HIV in the counties a less tedious matter. Methodology The DHIS is the source of service data. It is a consolidated database for routine service delivery data. Health facilities upload their service data to DHIS on monthly basis. The Period under review for this report is Data uploaded following service delivery in health facilities was obtained and organized by county. This information is summarized in a form that County Coordinators of Health will to need to plan for HIV prevention care and treatment services. These are the County HIV profiles. The reporting year was selected for inclusion because it had a more complete set of service delivery data. The 2011 reporting rates to DHIS are relatively high on MOH 711. Background Information County information Kenya has 47 counties as contained in the constitution promulgated in 201. HIV prevalence Overall HIV prevalence ranges from 14% in Nyanza to less than 3% in North Eastern Kenya. The service delivery infrastructure and human resource availability will be reviewed in greater detail. A great discrepancy of service points still exist among counties. A lot of progress has been made in improving access to HIV care and Prevention services.

6 Reporting rates Percent Report Percent Timeliness 10 0 Coast Nyanza Western Eastern North Eastern Central Rift Valley Nairobi Kenya Figure 1.1: Reporting rate summary by NASCOP Region Consideration has to be given to the reporting rates during the interpretation of the HIV service delivery data. The overall reporting rate for 2011 was 73%. North Eastern, Nairobi and central regions had the lowest reporting rates. The highest reporting rates were observed in Coast and Nyanza at 87% and 82% respectively (Figure 1.2) The County with the lowest reporting rate was Turkana County (29.9%). Kirinyaga County had the highest average reporting rate at 99.9% (figure 1.3) Report timeliness was above 50% in Nyanza and Coast regions. The Report Timeliness was the major issue in the period under review. Only two regions managed a report timeliness of above 50% the rest scored well below this.

7 MOH 711 COUNTY REPORTING RATES (2011) Reporting Rate

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9 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year ART need for People Living with HIV (PLHIV) ART coverage for PLWHIV ADULTS CHILDREN TOTAL % PLWHIV WHO ARE CHILDREN 41,400 4,700 46,100 10% 2, ,090 13% 1, ,770 15% 17,500 3,400 20,900 16% 101% 59% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity HTC 90.4% 95.4% 95.8% 92.5% 5.3% 4.3% 3.5% 5.2% 3.8% 4.8% 6.2% 5.4% PMTCT ANC Uptake Cascade 95.8% 75.7% 75.7% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 59.4% stagei 95.1% stage II 81.2% stage III 56.2% stage IV 81.2% Proportion of eligible Clients started on ART 8.1% Proportion of new HIV positive enrolled to care Overall PMTCT cascade 36.4% 26.6% 30.2% 6.8% 68.0% 98.1% MTCT rates at 1st Test 8.1% Overall Prophylaxis for HIV exposed infants 81.2% Proportion of HIV +ve women delivering in hospital 56.2% Overal maternal prophylaxis 81.2% Overall PMTCT test acceptance rate 95.1% Proportion of mothers attending 4 ANC visits 59.4%

10 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 2830 Number of ANC clients attending 4 visits Genital Ulcer Disease 1171 ANC clients counseled for HIV Opthalmia neonatorium 202 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 1368 Syphillis Serology 1167 ANC +ve Clients given prophylaxis 1035 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 1202 Infants given prophylaxis 1035 TBHIV Partners of ANC clients counselled for HIV 2223 TB patients tested for HIV 4444 Partners of ANC clients tested for HIV 1911 TB patients testing HIV positive 1795 Partners of ANC clients HIV Positive 118 TB HIV patient on Cotrim 1658 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 9055 Clients Counselled in VCT Women Tested for HIV in maternity 8375 Clients tested for HIV in VCT Women found HIV Positive in maternity 402 VCT clients found HIV Positive 3156 Women issued prophylaxis in maternity 402 Couples counselled in VCT 8867 Deliveries from HIV +ve women 995 Couples tested for HIV in VCT 8766 Maternity Women started on Cotrimoxazole 564 VCT couples both HIV positive 144 Infants started on Cotrimoxazole 211 Discordant couples in VCT 306 Infants given prophylaxis in maternity 402 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled DTC outpatient counselled DTC inpatient tested 9757 DTC outpatient tested DTC inpatient HIV Positive 823 DTC Outpatient found HIV Positive 3971 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 72% 9% 15% 2% 2% PMTCT TB All others VCT Ward Clients enrolled for HIV care through PMTCT 1008 New clients enrolled for care through VCT 1722 New clients enrolled for care through TB 200 New clients enrolled for care through ward 229 New clients enrolled for care through CWC 36 New clients enrolled for care from others 8218 Total number of clients enrolled for HIV care Patients started on ART by WHO stage I 1490 Patients started on ART by WHO stage II 1088 Patients started on ART by WHO stage III 1237 Patients started on ART by WHO stage IV 277 Total number of clients starting ART 4092 Pregnant women currently on ARVs 188 All others currently on ARVs Clients enrolled, eligible but not started ART 479 Sexual assault on PEP 569 Occupational on Post exposure prophylaxis 104 Patients currently on cotrimoxazole Patients currently on fluconazole 32 Total Adults on ART Total Children on ART % ART Intitiation by WHO stage 30.2% 26.6% BLOOD SAFETY Blood units collected from RBTC 1234 Number of blood units transfused 2646 Linkage to care: Positive test to enrollment 53.4% 54.6% 6.8% 27.2% stagei stage II stage stage III IV 11.1% 4.8% PMTCT VCT TB Ward overall

11 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 38% 94% 96% 73% 47% 3% 45% 52% 23% 41% 35% 6% 34% 60% 30% 66% 4% Blood units collected from RBTC blood units collected from elsewhere Blood safety 53% 47% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 4.2%, with a higher prevalence among those aged 25 to 49 year at 5.3%. This translates to 46,100 people living with HIV in this county of which 4,700 (10%)] are children. In 2011, the average reporting rates for this county on MOH711 was at 65.3 %. This is fairly representative of the reporting facilities in the county. In 2011, of those who were tested for HIV in various settings within the county, the overall positivity was (5.4%) with a higher positivity of 40.4% among those with TB infection. Of all who tested positive for HIV in the county only about 27.2% were linked to HIV care and treatment services within the county with better linkages (54.6%) among those testing within VCT and PMTCT settings. HIV testing acceptance rate among pregnant women was high at 95.1%, for those found to be HIV positive, maternal and infant prophylaxis was provided for 81.2% and 81.2% respectively. Only about 5.3% of ANC women had their partners tested for HIV and only 59.4% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 56.2% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 8.1% Total number of clients on treatment as at the end of 2011 in this county was 20,415 including 1990 children, this translates to a treatment coverage of 105% for adults and 59% for children. Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Wards. Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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13 HIV ESTIMATES INDICATOR People Living with HIV/AIDS New HIV Infections During the Year HIV related Deaths during the year Adults eligible for ART (Need for ART) ART coverage among eligible PLHIV ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 12,800 1,400 14,200 11% % % 5,400 1,000 6,400 19% 77% 49% 73% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Uptake of PMTCT among eligible mothers Uptake of PMTCT among eligible infants Service Coverage (%) Number Proportion % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT 103.0% HIV test acceptance at DTC 89.0% HIV test acceptance at ANC 97.2% HIV test acceptance at Maternity 91.2% HIV test acceptance for partners in ANC 6.6% HIV positivity at VCT 2.7% VCT Couple Discordance rate 2.5% HIV positivity at DTC 2.5% HIV positivity in ANC for Women 2.9% HIV Positivity in Maternity 1.7% HIV positivity for ANC partners 5.5% Overall HIV positivity 3.0% PMTCT ANC Uptake Cascade 95.8% 75.7% 75.7% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 58.8% stagei 95.9% stage II 69.6% stage III 61.7% stage IV 66.8% Proportion of eligible Clients started on ART 6.5% Proportion of new HIV positive enrolled to care Overall PMTCT cascade 30.2% 25.9% 35.7% 8.2% 69.6% 60.5% MTCT rates at 1st Test 6.5% Overall Prophylaxis for HIV exposed infants Proportion of HIV +ve women delivering in hospital Overal maternal prophylaxis 61.7% 66.8% 69.6% Overall PMTCT test acceptance rate 95.9% Proportion of mothers attending 4 ANC visits 58.8%

14 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 2470 Number of ANC clients attending 4 visits 6969 Genital Ulcer Disease 654 ANC clients counseled for HIV Opthalmia neonatorium 64 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 369 Syphillis Serology 202 ANC +ve Clients given prophylaxis 239 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 745 Infants given prophylaxis 227 TBHIV Partners of ANC clients counselled for HIV 866 TB patients tested for HIV 1596 Partners of ANC clients tested for HIV 833 TB patients testing HIV positive 454 Partners of ANC clients HIV Positive 46 TB HIV patient on Cotrim 383 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 3703 Clients Counselled in VCT Women Tested for HIV in maternity 3377 Clients tested for HIV in VCT Women found HIV Positive in maternity 59 VCT clients found HIV Positive 824 Women issued prophylaxis in maternity 59 Couples counselled in VCT 3543 Deliveries from HIV +ve women 264 Couples tested for HIV in VCT 3538 Maternity Women started on Cotrimoxazole 116 VCT couples both HIV positive 45 Infants started on Cotrimoxazole 78 Discordant couples in VCT 89 Infants given prophylaxis in maternity 59 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled 9804 DTC outpatient counselled DTC inpatient tested 8967 DTC outpatient tested DTC inpatient HIV Positive 415 DTC Outpatient found HIV Positive 1095 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 55% 12% 4% 4% 25% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 231 New clients enrolled for care from VCT 506 New clients enrolled for care from TB 74 New clients enrolled for care through ward 80 New clients enrolled for care from others 1072 Total number of clients enrolled for HIV care 1975 stage I 389 stage II 333 stage III 460 stage IV 105 Total number of clients starting ART 1287 Pregnant women currently on ARVs 48 All others currently on ARVs 4669 Clients enrolled, eligible but not started ART 29 Sexual assault on PEP 67 Occupational on Post exposure prophylaxis 19 Patients currently on cotrimoxazole 5953 Patients currently on fluconazole 36 Total Adults on ART 4183 Total Children on ART % ART Intitiation by WHO stage 25.9% 35.7% BLOOD SAFETY Blood units collected from RBTC 1761 Number of blood units transfused % Linkage to care: Positive test to enrollment 61.4% stagei stage II stage III 8.2% stage IV 27.3% 16.3% 5.3% PMTCT VCT TB Ward overall

15 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 33% 94% 97% 84% 29% 4% 59% 37% 25% 38% 17% 14% 64% 22% 29% 67% 4% Blood units collected from RBTC blood units collected from elsewhere Blood safety 0% 100% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 4.4%, with a higher prevalence among those aged 25 to 49 years at (5.8%). This translates to people living with HIV in this county of which 1400 (11%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 96.5%. This is fairly representative of the reporting facilities in the county. In 2011, of those who were tested for HIV in various settings within the county, the overall positivity was 3.0% with a higher positivity of (28.4%) among those with TB infection Despite this only about 27.3% were linked to HIV care and treatment services within the county. Better linkages to care (61.4 %) was observed among those testing within VCT settings followed by PMTCT (48.7%).The wards had the poorest linkage to care (5.3%) HIV testing acceptance rate among pregnant women was high at 95.9%, for those found to be positive maternal and infant prophylaxis was provided for 69.6% and 69.6% respectively. Only about () of ANC women had their partners tested for HIV and only 58.8% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 61.7% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 6.5% Total number of clients on treatment as at the end of 2011 in this county was 4699 including 489 children, this translates to a treatment coverage of 77% for adults and 49% for children Priority Areas for the County Wards. Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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17 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART coverage among PLHIV ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 29,100 3,300 32,400 10% 1, ,170 12% 1, ,190 16% 12,300 2,400 14,700 16% 43% 33% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC PMTCT ANC Uptake Cascade HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 92.6% 81.3% 95.0% 90.9% 3.0% 2.8% 3.0% 3.0% 3.4% 4.5% 3.6% 3.5% 95.0% Testing Uptake 63.4% Maternal prophylaxis uptake 46.2% Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 43.5% stagei 94.5% stage II 68.5% stage III 30.8% stage IV 53.7% Proportion of eligible Clients started on ART 9.3% Proportion of new HIV positive enrolled to care Overall PMTCT cascade 36.4% 23.6% 31.8% 8.2% 69.4% 64.1% MTCT rates at 1st Test Overall Prophylaxis for HIV exposed infants Proportion of HIV +ve women delivering in hospital Overal maternal prophylaxis Overall PMTCT test acceptance rate Proportion of mothers attending 4 ANC visits 9.3% 53.7% 30.8% 68.5% 43.5% 94.5%

18 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 1742 Number of ANC clients attending 4 visits 7256 Genital Ulcer Disease 1076 ANC clients counseled for HIV Opthalmia neonatorium 57 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 533 Syphillis Serology 197 ANC +ve Clients given prophylaxis 338 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 251 Infants given prophylaxis 246 TBHIV Partners of ANC clients counselled for HIV 553 TB patients tested for HIV 1792 Partners of ANC clients tested for HIV 469 TB patients testing HIV positive 557 Partners of ANC clients HIV Positive 17 TB HIV patient on Cotrim 644 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 2128 Clients Counselled in VCT Women Tested for HIV in maternity 1934 Clients tested for HIV in VCT Women found HIV Positive in maternity 87 VCT clients found HIV Positive 588 Women issued prophylaxis in maternity 87 Couples counselled in VCT 1178 Deliveries from HIV +ve women 191 Couples tested for HIV in VCT 1183 Maternity Women started on Cotrimoxazole 95 VCT couples both HIV positive 41 Infants started on Cotrimoxazole 37 Discordant couples in VCT 36 Infants given prophylaxis in maternity 87 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled DTC outpatient counselled DTC inpatient tested 8570 DTC outpatient tested DTC inpatient HIV Positive 299 DTC Outpatient found HIV Positive 1921 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 60% 6% 5% 2% 27% PMTCT VCT TB Ward All others Clients enrolled for HIV care through PMTCT 156 New clients enrolled for care through VCT 701 New clients enrolled for care through TB 119 New clients enrolled for care through ward 38 New clients enrolled for care through CWC 15 New clients enrolled for care from others 1535 Total number of clients enrolled for HIV care 2564 Patients started on ART by WHO stage I 448 Patients started on ART by WHO stage II 291 Patients started on ART by WHO stage III 391 Patients started on ART by WHO stage IV 101 Total number of clients starting ART 1231 Pregnant women currently on ARVs 37 All others currently on ARVs 6036 Clients enrolled, eligible but not started ART 17 Sexual assault on PEP 240 Occupational on Post exposure prophylaxis 16 Patients currently on cotrimoxazole Patients currently on fluconazole 30 Total Adults on ART 5237 Total Children on ART % ART Intitiation by WHO stage 23.6% 31.8% BLOOD SAFETY Blood units collected from RBTC 707 Number of blood units transfused 495 Linkage to care: Positive test to enrollment 119.2% 8.2% stagei stage II stage III stage IV 24.5% 21.4% 25.3% 1.7% PMTCT VCT TB Ward overall

19 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 33% 95% 93% 69% 37% 3% 63% 34% 25% 44% 31% 21% 59% 20% 31% 66% 3% Blood units collected from RBTC blood units collected from elsewhere Blood safety 23% 77% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 5.2% with a higher prevalence among those aged 25 to 49 years at (7.8%). This translates to 32,400 people living with HIV in this county of which 3,300 (10%) are children. In 2011, the average reporting rates for this county on MOH 711 was at 79.5 %. This is fairly representative of the reporting facilities in the county. In 2011, Of those who were tested for HIV in various settings within the county, the overall positivity was 3.5% with a higher positivity of 31.1% among those with TB infection. Despite this only about 25.3% were linked to HIV care and treatment services within the county with. Better linkages 119% was observed from VCT possibly including those tested in the past. Linkage to care was very poor among those testing in the hospital Wards. HIV testing acceptance rate among pregnant women was high at 94.5%, for those found to be positive maternal and infant prophylaxis was provided for 68.5% and 53.7% respectively. Only about 3.0% of ANC women had their partners tested for HIV and only 43.5% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 30.8% delivered within health facilities. The overall mother to child transmission rate at first test in this county was high, at 9.3% Total number of clients on treatment as at the end of 2011 in this county was 6036 including 799 children, this translates to a treatment coverage of 43% for adults and 33% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants especially in maternity. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention should be given to those testing HIV positive in the Wards. Increase ART coverage among both adults and children eligible for ART. Urgently Reduce the Mother to child transmission rates to below 5% by Increasing coverage of PMTCT among eligible mothers and infants Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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21 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ARV coverage among PLHIV ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 12,000 1,400 13,400 12% % % 5,100 1,000 6,100 20% 80% 63% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Uptake of PMTCT among eligible mothers Uptake of PMTCT among eligible infants Service Coverage (%) Number Proportion % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT 91.6% HIV test acceptance at DTC 98.4% HIV test acceptance at ANC 97.3% HIV test acceptance at Maternity 96.2% HIV test acceptance for partners in ANC 3.9% HIV positivity at VCT 7.4% VCT Couple Discordance rate 4.0% HIV positivity at DTC 3.4% HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 3.1% 4.5% 5.9% 5.3% PMTCT ANC Uptake Cascade 97.3% 66.3% 59.7% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 50.3% stagei 97.0% stage II 79.2% stage III 50.1% stage IV 75.1% Proportion of eligible Clients started on ART 6.0% Proportion of new HIV positive enrolled to care Overall PMTCT cascade 39.8% 29.6% 23.4% 7.1% 62.9% 150.7% MTCT rates at 1st Test Overall Prophylaxis for HIV exposed infants Proportion of HIV +ve women delivering in hospital Overal maternal prophylaxis 6.0% 75.1% 50.1% 79.2% Overall PMTCT test acceptance rate 97.0% Proportion of mothers attending 4 ANC visits 50.3%

22 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 936 Number of ANC clients attending 4 visits 6058 Genital Ulcer Disease 367 ANC clients counseled for HIV Opthalmia neonatorium 25 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 380 Syphillis Serology 643 ANC +ve Clients given prophylaxis 252 ANC Clients tested for syphilis 8133 Infants tested for HIV at 6 weeks 232 Infants given prophylaxis 227 TBHIV Partners of ANC clients counselled for HIV 534 TB patients tested for HIV 1100 Partners of ANC clients tested for HIV 475 TB patients testing HIV positive 495 Partners of ANC clients HIV Positive 28 TB HIV patient on Cotrim 407 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 5426 Clients Counselled in VCT Women Tested for HIV in maternity 5220 Clients tested for HIV in VCT Women found HIV Positive in maternity 235 VCT clients found HIV Positive 2186 Women issued prophylaxis in maternity 235 Couples counselled in VCT 1508 Deliveries from HIV +ve women 308 Couples tested for HIV in VCT 1480 Maternity Women started on Cotrimoxazole 206 VCT couples both HIV positive 47 Infants started on Cotrimoxazole 157 Discordant couples in VCT 59 Infants given prophylaxis in maternity 235 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled 4281 DTC outpatient counselled DTC inpatient tested 4510 DTC outpatient tested DTC inpatient HIV Positive 261 DTC Outpatient found HIV Positive 1167 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 88% 3% 7% 1% 1% PMTCT VCT TB Ward All others Clients enrolled for HIV care through PMTCT 185 New clients enrolled for care through VCT 510 New clients enrolled for care through TB 80 New clients enrolled for care through ward 48 New clients enrolled for care from others 6323 Total number of clients enrolled for HIV care 7160 Patients started on ART by WHO stage I 486 Patients started on ART by WHO stage II 362 Patients started on ART by WHO stage III 286 Patients started on ART by WHO stage IV 87 Total number of clients starting ART 1221 Pregnant women currently on ARVs 31 All others currently on ARVs 4731 Clients enrolled, eligible but not started ART 90 Sexual assault on PEP 1467 Occupational on Post exposure prophylaxis 7 Patients currently on cotrimoxazole 6478 Patients currently on fluconazole 23 Total Adults on ART 4099 Total Children on ART % ART Intitiation by WHO stage 29.6% BLOOD SAFETY Blood units collected from RBTC 1266 Number of blood units transfused 1762 Linkage to care: Positive test to enrollment 23.4% 28.8% 23.3% 7.1% 16.2% 17.3% 3.4% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

23 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 30% 91% 92% 71% 33% 3% 61% 36% 21% 46% 33% 16% 66% 18% 34% 63% 3% Blood units collected from RBTC blood units collected from elsewhere Blood safety 28% 72% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 3.9%, with a higher prevalence among those aged 25 to 49 years at 4%. This translates to 13,400 people living with HIV in this county of which 1,400 (12%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 61.1%. This is fairly representative of the reporting facilities in the county. In 2011, Of those who were tested for HIV in various settings within the county, the overall positivity was 5.3% with a higher positivity of (45%) among those with TB infection. Despite this only about (17.3%) of the newly diagnosed were linked to HIV care and treatment services within the county with better linkages 28.8% among those testing within PMTCT. This was still very poor linkage to care. HIV testing acceptance rate among pregnant women was high at 97.3%, for those found to be positive maternal and infant prophylaxis was provided for 79.2% and 75.1% respectively. Only about 3.9% of ANC women had their partners tested for HIV and only 50.3% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 50.1% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 6.0% Total number of clients on treatment as at the end of 2011 in this county was (4,762) including 632 children, this translates to a treatment coverage of 80% for adults and 63% for children Priority Areas for the County Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence *The proportion of HIV positive people enrolled to care is greater than 100% of those testing HIV Positive in 2011 because of poor linkage to care. This results to enrolment to care of people who tested positive in previous years

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25 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 18,300 2,100 20,400 10% New HIV Infections During the Year 1, ,370 12% HIV related Deaths during the year PLHIV eligible for ART (Need for ART) 600 7, , ,200 17% 16% ART Coverage among PLHIV 101% 67% SERVICE COVERAGE Service Service Coverage (%) Number Proportion Number Eligible for PMTCT intervention % Number Identified to Receive PMTCT % Coverage of PMTCT among eligible mothers % Coverage of PMTCT among eligible infants % SERVICE DELIVERY PROFILES HTC PMTCT uptake cascade HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 88.9% 85.0% 87.7% 78.4% 4.6% 3.0% 2.7% 2.7% 2.7% 3.3% 4.4% 3.5% 87.7% Testing Uptake 81.5% Maternal prophylaxis uptake 78.4% Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 73.4% stagei 85.6% stage II 86.0% stage III 70.7% stage IV 34.4% Proportion of eligible Clients started on ART 6.1% Proportion of new HIV positive enrolled to care 37.8% 26.8% 23.7% 11.7% 55.3% 150.7% Overall PMTCT cascade MTCT rates at 1st Test 6.1% Overall Prophylaxis for HIV exposed infants 83.6% Proportion of HIV +ve women delivering in hospital 70.7% Overal maternal prophylaxis Overall PMTCT test acceptance rate 86.0% 85.6% Proportion of mothers attending 4 ANC visits 73.4%

26 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 1522 Number of ANC clients attending 4 visits Genital Ulcer Disease 784 ANC clients counseled for HIV Opthalmia neonatorium 61 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 449 Syphillis Serology 473 ANC +ve Clients given prophylaxis 366 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 351 Infants given prophylaxis 352 TBHIV Partners of ANC clients counselled for HIV 847 TB patients tested for HIV 2654 Partners of ANC clients tested for HIV 755 TB patients testing HIV positive 1283 Partners of ANC clients HIV Positive 33 TB HIV patient on Cotrim 1049 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 5515 Clients Counselled in VCT Women Tested for HIV in maternity 4325 Clients tested for HIV in VCT Women found HIV Positive in maternity 144 VCT clients found HIV Positive 924 Women issued prophylaxis in maternity 144 Couples counselled in VCT 3195 Deliveries from HIV +ve women 419 Couples tested for HIV in VCT 2868 Maternity Women started on Cotrimoxazole 160 VCT couples both HIV positive 31 Infants started on Cotrimoxazole 79 Discordant couples in VCT 78 Infants given prophylaxis in maternity 144 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled DTC outpatient counselled DTC inpatient tested 9895 DTC outpatient tested DTC inpatient HIV Positive 447 DTC Outpatient found HIV Positive 2313 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 87% 3% 7% 1% 2% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 219 New clients enrolled for care from VCT 620 New clients enrolled for care from TB 100 New clients enrolled for care through ward 198 New clients enrolled for care from CWC 24 New clients enrolled for care from others 7266 Total clients enrolled to care 8427 stage I 919 stage II 652 stage III 575 stage IV 285 Total number of clients starting ART 2431 Pregnant women currently on ARVs 41 All others currently on ARVs 9156 Clients enrolled, eligible but not on ART 174 Sexual assault on PEP 124 Occupational on Post exposure prophylaxis 36 Patients currently on cotrimoxazole Patients currently on fluconazole 458 Total Adults on ART 8158 Total Children on ART % ART Intitiation by WHO stage BLOOD SAFETY Blood units collected from RBTC 4823 Number of blood units transfused % 23.7% Linkage to care: Positive test to enrollment 67.1% 11.7% 35.0% 20.3% 7.8% 7.2% Clients starting ART in stagei Clients starting ART in stage II Clients starting ART in stage III Clients starting ART in stage IV PMTCT VCT TB Ward overall

27 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 More findings Distribution 34% 97% 94% 77% 56% 1% 54% 44% 22% 46% 32% 12% 57% 30% 31% 67% 3% Blood units collected from RBTC blood units collected from elsewhere KEY FINDINGS AND PRIORITIES Blood safety Summary Overall HIV prevalence in the county is 4.4%, with a higher prevalence among those aged 15 to 24 years at 2.4%. This translates to 18,300 people living with HIV in this county of which 2,100 (10%)] are children. In 2011, the average reporting rates for this county for MOH711 was at 77.2%. This is fairly representative of the reporting facilities in the county. In 2011, of those who were tested for HIV in various settings within the county, the overall positivity was 3.5% with a higher positivity of 48.3% among those with TB infection. Despite this only about 20.3% were linked to HIV care and treatment services within the county with better linkages (67.1%)among those testing within (VCT) settings. Linkages was low among those testing positive in hospital wards (7.2%) HIV testing acceptance rate among pregnant women was fairly low at 85.6%, for those found to be positive maternal and infant prophylaxis was provided for 86% and 83.6% respectively. Only about 4.6% of ANC women had their partners tested for HIV. An estimated 73.4% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings 70.7% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 6.1. % Total number of clients on treatment as at the end of 2011 in this county was 9,156 including 998 children, this translates to a treatment coverage of 101% for adults and 67% for children 0% 100% Priority Areas for the County Maintain and improve on the relatively Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Reduce the mother to child transmission rates to below 5% Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Linkage to care in TB/HIV setting should be of very high priority Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence *The proportion of HIV positive people enrolled to care is greater than 100% of those testing HIV Positive in 2011 because of poor linkage to care. This results to enrolment to care of people who tested positive in previous years

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29 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART coverage among PLHIV ADULTS CHILDREN 20,400 3,200 1, ,600 2,300 94% 52% SERVICE COVERAGE TOTAL % PLWHA WHO ARE CHILDREN 23,600 14% 1,490 13% ,900 21% 21% Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 96.8% 89.1% 94.0% 82.9% 1.5% 3.9% 2.2% 3.7% 3.2% 5.4% 5.2% 4.2% PMTCT uptake cascade 94.0% 78.4% 54.6% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 40.0% stagei 93.1% stage II 81.0% stage III 33.9% stage IV 35.6% Proportion of eligible Clients started on ART 10.1% Proportion of new HIV positive enrolled to care 18.2% 47.9% 29.8% 4.0% 86.7% 60.9% Overall PMTCT cascade MTCT rates at 1st Test 10.1% Overall Prophylaxis for HIV exposed infants 35.6% Proportion of HIV +ve women delivering in hospital 33.9% Overal maternal prophylaxis 81.0% Overall PMTCT test acceptance rate 93.1% Proportion of mothers attending 4 ANC visits 40.0%

30 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 3712 Number of ANC clients attending 4 visits Genital Ulcer Disease 1543 ANC clients counseled for HIV Opthalmia neonatorium 149 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 1369 Syphillis Serology 336 ANC +ve Clients given prophylaxis 1073 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 356 Infants given prophylaxis 748 TBHIV Partners of ANC clients counselled for HIV 717 TB patients tested for HIV 3204 Partners of ANC clients tested for HIV 620 TB patients testing HIV positive 1126 Partners of ANC clients HIV Positive 32 TB HIV patient on Cotrim 1019 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 4219 Clients Counselled in VCT Women Tested for HIV in maternity 3496 Clients tested for HIV in VCT Women found HIV Positive in maternity 188 VCT clients found HIV Positive 3368 Women issued prophylaxis in maternity 188 Couples counselled in VCT 9156 Deliveries from HIV +ve women 528 Couples tested for HIV in VCT 9064 Maternity Women started on Cotrimoxazole 162 VCT couples both HIV positive 103 Infants started on Cotrimoxazole 69 Discordant couples in VCT 203 Infants given prophylaxis in maternity 188 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 8111 DTC outpatient counselled DTC inpatient tested 7082 DTC outpatient tested DTC inpatient HIV Positive 568 DTC Outpatient HIV Positive 2105 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 43% 3% 3% 13% 38% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 701 Enrollement for HIV care from VCT 2041 Enrollment into HIV care from TB clinic 145 Enrollment into HIV care from hospital wards 133 Enrollement into HIV care from MCHChild 867 Enrollment into HIV care from other settings 1442 Total clients enrolled for HIV care 5329 WHO stagei 465 WHO stage II 1226 WHO stage III 763 WHO stage IV 103 Total number of clients starting ART 2557 Pregnant women currently on ARVs 71 All others currently on ARVs 9478 Clients enrolled, eligible but not on ART 219 Clients put on PEP due to Sexual assault 266 Clients put on PEP due to occupational exposure 45 Patients currently on cotrimoxazole Patients currently on fluconazole 9 Total Adults on ART 8290 Total Children on ART 1188 ART Intitiation by WHO stage 47.9% BLOOD SAFETY Blood units collected from RBTC 2175 Number of blood units transfused 2349 Linkage to care: Positive test to enrollment 29.8% 60.6% 18.2% 44.1% 34.5% stagei stage II stage III 4.0% stage IV 12.9% 5.0% PMTCT VCT TB Ward overall

31 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 38% 91% 99% 69% 50% 35% 48% 17% 39% 35% 25% 50% 32% 27% 25% 66% 9% Blood units collected from RBTC blood units collected from elsewhere Blood safety 7% 93% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 3.7%, with a higher prevalence among those aged anove 49 years 4.5%). This translates to 23,600 people living with HIV in this county of which 3200 (14%) are children. In 2011, the average reporting rates for this county for MOH711 was 89 %. This is representative of the reporting facilities in the county. In 2011, of those tested for HIV in various settings within the county, the overall positivity was 4.2% with a higher positivity of 35.1% among those with TB infection. Of those tested positive, only about 34.5% were linked to HIV care and treatment services within the county better linkages (60.6%) among those testing within (VCT) settings followed by PMTCT (44.1%) linkages was poor in TB and from Hospital wards. HIV testing acceptance rate among pregnant women was high at 93.1%, for those found to be positive maternal and infant prophylaxis was provided for 81% and 35.6% respectively. Only about 1.5% of ANC women had their partners tested for HIV and only 40% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 33.9% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 10.1%. This is quite high. Total number of clients on treatment as at the end of 2011 in this county was 9478 including 1188 children, this translates to a treatment coverage of 94% for adults and 52% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase partner involvement in PMTCT through partner testing Strengthen the linkage to HIV care for those who test HIV Positive from TB clinic and in the hospital Wards. Increase the number of HIV infected children on ART. Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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33 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART coverage among PLHIV ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 19,800 3,200 23,000 14% 1, ,490 13% % 8,400 2,300 10,700 21% 30% 13% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 97.6% 90.0% 94.0% 88.8% 3.4% 4.3% 4.6% 4.0% 2.8% 4.6% 3.8% 4.4% PMTCT uptake cascade 94.0% 95.1% 54.3% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 34.8% stagei 93.0% stage II 96.4% stage III 29.3% stage IV 91.3% Proportion of eligible Clients started on ART 14.1% Proportion of new HIV positive enrolled to care 30.2% 31.9% 30.8% 7.1% 73.4% 89.7% Overall PMTCT cascade MTCT rates at 1st Test Overall Prophylaxis for HIV exposed infants Proportion of HIV +ve women delivering in hospital Overal maternal prophylaxis Overall PMTCT test acceptance rate Proportion of mothers attending 4 ANC visits 14.1% 91.3% 29.3% 96.4% 93.0% 34.8%

34 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 1533 Number of ANC clients attending 4 visits 9133 Genital Ulcer Disease 877 ANC clients counseled for HIV Opthalmia neonatorium 82 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 750 Syphillis Serology 1073 ANC +ve Clients given prophylaxis 713 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 183 Infants given prophylaxis 407 TBHIV Partners of ANC clients counselled for HIV 1029 TB patients tested for HIV 1683 Partners of ANC clients tested for HIV 896 TB patients testing HIV positive 701 Partners of ANC clients HIV Positive 34 TB HIV patient on Cotrim 694 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 6765 Clients Counselled in VCT Women Tested for HIV in maternity 6005 Clients tested for HIV in VCT Women found HIV Positive in maternity 274 VCT clients found HIV Positive 774 Women issued prophylaxis in maternity 274 Couples counselled in VCT 2463 Deliveries from HIV +ve women 300 Couples tested for HIV in VCT 2310 Maternity Women started on Cotrimoxazole 188 VCT couples both HIV positive 185 Infants started on Cotrimoxazole 65 Discordant couples in VCT 107 Infants given prophylaxis in maternity 274 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 1957 DTC outpatient counselled DTC inpatient tested 1728 DTC outpatient tested DTC inpatient HIV Positive 163 DTC Outpatient HIV Positive 2339 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 71% 10% 14% 3% 2% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 474 Enrollement for HIV care from VCT 617 Enrollment into HIV care from TB clinic 115 Enrollment into HIV care from hospital wards 80 Enrollement into HIV care from MCHChild 46 Enrollment into HIV care from other settings 3182 Total clients enrolled for HIV care 4514 WHO stagei 466 WHO stage II 492 WHO stage III 474 WHO stage IV 109 Total number of clients starting ART 1541 Pregnant women currently on ARVs 35 All others currently on ARVs 2775 Clients enrolled, eligible but not on ART 155 Clients put on PEP due to Sexual assault 465 Clients put on PEP due to occupational exposure 87 Patients currently on cotrimoxazole 6347 Patients currently on fluconazole Total Adults on ART 2486 Total Children on ART % ART Intitiation by WHO stage 31.9% 30.8% BLOOD SAFETY Blood units collected from RBTC 906 Number of blood units transfused 1355 Linkage to care: Positive test to enrollment 79.7% stagei 7.1% stage II stage III stage IV 44.8% 25.5% 16.4% 3.2% PMTCT VCT TB Ward overall

35 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 More findings Distribution 40% 94% 99% 67% 30% 33% 52% 15% 36% 38% 26% 60% 26% 14% 19% 74% 7% Blood units collected from RBTC blood units collected from elsewhere KEY FINDINGS AND PRIORITIES Blood safety Summary Overall HIV prevalence in the county is 6.2%, with a higher prevalence among those aged 25 to 49 at 6.6%. This translates to people living with HIV in this county of which % are children. In 2011, the average reporting rates for this county on MOH 711 was at 87%. This is representative of the reporting facilities in the county. In 2011, Of those who were were tested for HIV in various settings within the county, the overall positivity was 4.4% with a higher positivity of 41.7% among those with TB infection. Despite this level of positivity, only about 25.5% were linked to HIV care and treatment services within the county with. Linkage to HIV care was high (79.7%) among those testing within (VCT) settings. TB HIV and wards had poor linkage to care. HIV testing acceptance rate among pregnant women was high at 93%. For those found to be positive maternal and infant prophylaxis was provided for 96.4% and 91.3% respectively. Only about 3.4%of ANC women had their partners tested for HIV and only 34.8% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 29.3% delivered within health facilities. The overall mother to child transmission rate at first test in this county was high at 14.1% Total number of clients on treatment as at the end of 2011 in this county was 2775 including 289 children, this translates to a low treatment coverage of 30% for adults and 13% for children 33% 67% Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase uptake of prophylaxis for PMTCT among HIV exposed infants in both ANC and maternity. Strengthen PMTCT to reduce vertical HIV transmission to below 5% Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Urgently scale up coverage of ART among both adults and children infected with HIV Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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37 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 4, ,800 15% % 100 1, ,200 29% 23% 28% 14% SERVICE COVERAGE Service Coverage (%) Number Proportion % % % 82 32% SERVICE DELIVERY PROFILES HTC PMTCT uptake cascade HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 98.9% 89.9% 92.6% 85.4% 3.9% 1.9% 1.7% 2.0% 2.0% 7.6% 1.3% 2.5% 92.6% Testing Uptake 100.0% Maternal prophylaxis uptake 69.6% Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 48.9% stagei 91.9% stage II 100.0% stage III 47.2% stage IV 54.0% Proportion of eligible Clients started on ART 10.7% Proportion of new HIV positive enrolled to care Overall PMTCT cascade 18.7% 34.6% 44.0% 2.7% 82.4% 64.4% MTCT rates at 1st Test 10.7% Overall Prophylaxis for HIV exposed infants 77.4% Proportion of HIV +ve women delivering in hospital 47.2% Overal maternal prophylaxis 100.0% Overall PMTCT test acceptance rate 91.9% Proportion of mothers attending 4 ANC visits 48.9%

38 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients 3751 Urethral Discharge 432 Number of ANC clients attending 4 visits 1834 Genital Ulcer Disease 100 ANC clients counseled for HIV 4188 Opthalmia neonatorium 5 ANC clients tested for HIV 3876 STI SCREENING ANC clients found HIV positive 79 Syphillis Serology 88 ANC +ve Clients given prophylaxis 79 ANC Clients tested for syphilis 2430 Infants tested for HIV at 6 weeks 38 Infants given prophylaxis 55 TBHIV Partners of ANC clients counselled for HIV 199 TB patients tested for HIV 254 Partners of ANC clients tested for HIV 152 TB patients testing HIV positive 98 Partners of ANC clients HIV Positive 2 TB HIV patient on Cotrim 60 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 417 Clients Counselled in VCT 5662 Women Tested for HIV in maternity 356 Clients tested for HIV in VCT 5601 Women found HIV Positive in maternity 27 VCT clients found HIV Positive 107 Women issued prophylaxis in maternity 27 Couples counselled in VCT 1033 Deliveries from HIV +ve women 50 Couples tested for HIV in VCT 1031 Maternity Women started on Cotrimoxazole 20 VCT couples both HIV positive 15 Infants started on Cotrimoxazole 7 Discordant couples in VCT 18 Infants given prophylaxis in maternity 27 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 369 DTC outpatient counselled DTC inpatient tested 373 DTC outpatient tested DTC inpatient HIV Positive 31 DTC Outpatient HIV Positive 201 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 55% 13% 5% 3% 24% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 44 Enrollement for HIV care from VCT 86 Enrollment into HIV care from TB clinic 12 Enrollment into HIV care from hospital wards 17 Enrollement into HIV care from MCHChild 6 Enrollment into HIV care from other settings 186 Total clients enrolled for HIV care 351 WHO stagei 34 WHO stage II 63 WHO stage III 80 WHO stage IV 5 Total number of clients starting ART 182 Pregnant women currently on ARVs 11 All others currently on ARVs 552 Clients enrolled, eligible but not on ART 9 Clients put on PEP due to Sexual assault 3 Clients put on PEP due to occupational exposure 4 Patients currently on cotrimoxazole 995 Patients currently on fluconazole 1 Total Adults on ART 483 Total Children on ART 69 ART Intitiation by WHO stage 44.0% BLOOD SAFETY Blood units collected from RBTC 91 Number of blood units transfused % Linkage to care: Positive test to enrollment 80.4% 18.7% stagei stage II stage III 2.7% stage IV 40.7% 29.2% 12.2% 7.3% PMTCT VCT TB Ward overall

39 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 More findings Distribution 44% 94% 97% 50% 23% 59% 18% 30% 40% 30% 15% 70% 15% 28% 71% 2% Blood units collected from RBTC blood units collected from elsewhere Blood safety KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 1.3%, with a higher prevalence among those aged 25 to 49 at 2.5%. This translates to 4,100 people living with HIV in this county of which 700 (15%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 90.1%. This is representative of the reporting facilities in the county. In 2011, The overall positivity for HIV tests from various sites was 2.5% with a higher positivity of 38.6% among those with TB infection. Only about 29.2% of those testing positive were linked to HIV care and treatment services within the county with better linkages ( 80.4%)among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 91.9%, for those found to be positive maternal and infant prophylaxis was provided for 100% and 54% respectively. Only about 3.9% of ANC women had their partners tested for HIV and only 48.9% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only (47.2% delivered within health facilities. The overall mother to child transmission rate at first test in this county was high (10.7%) Total number of clients on treatment as at the end of 2011 in this county was 552 including 69 children, this translates to a treatment coverage of 28% for adults and 14% for children 17% 83% Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Reduce the rate of vertical transmission of HIV Increase uptake of Prophylaxis among HIV exposed infants Increase partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Urgently scale up ART coverage among HIV infected persons. Particularly among children. Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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41 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Uptake of PMTCT among eligible mothers Uptake of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 65,100 10,400 75,500 14% 4, ,810 13% 2,300 27, ,500 2,900 35,000 21% 21% 79% 28% SERVICE COVERAGE Service Coverage (%) Number Proportion 6, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 97.1% 92.6% 95.5% 89.1% 6.6% 6.6% 4.4% 10.3% 5.8% 5.5% 8.0% 8.1% PMTCT uptake cascade 95.5% 87.8% 45.9% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 56.0% stagei 94.3% stage II 90.0% stage III 51.9% stage IV 55.7% Proportion of eligible Clients started on ART 9.5% Proportion of new HIV positive enrolled to care 24.1% 33.2% 36.8% 5.9% 81.3% 80.7% Overall PMTCT cascade MTCT rates at 1st Test Overall Prophylaxis for HIV exposed infants Proportion of HIV +ve women delivering in hospital Overal maternal prophylaxis Overall PMTCT test acceptance rate Proportion of mothers attending 4 ANC visits 9.5% 55.7% 51.9% 56.0% 90.0% 94.3%

42 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 2698 Number of ANC clients attending 4 visits Genital Ulcer Disease 1831 ANC clients counseled for HIV Opthalmia neonatorium 164 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 2050 Syphillis Serology 968 ANC +ve Clients given prophylaxis 1800 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 1148 Infants given prophylaxis 940 TBHIV Partners of ANC clients counselled for HIV 2486 TB patients tested for HIV 5388 Partners of ANC clients tested for HIV 2339 TB patients testing HIV positive 2074 Partners of ANC clients HIV Positive 188 TB HIV patient on Cotrim 1851 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 9268 Clients Counselled in VCT Women Tested for HIV in maternity 8262 Clients tested for HIV in VCT Women found HIV Positive in maternity 457 VCT clients found HIV Positive 8641 Women issued prophylaxis in maternity 457 Couples counselled in VCT Deliveries from HIV +ve women 1302 Couples tested for HIV in VCT Maternity Women started on Cotrimoxazole 180 VCT couples both HIV positive 389 Infants started on Cotrimoxazole 108 Discordant couples in VCT 716 Infants given prophylaxis in maternity 457 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 4653 DTC outpatient counselled DTC inpatient tested 4367 DTC outpatient tested DTC inpatient HIV Positive 650 DTC Outpatient HIV Positive 5676 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 55% 9% 3% 2% 31% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 1441 Enrollement for HIV care from VCT 4968 Enrollment into HIV care from TB clinic 512 Enrollment into HIV care from hospital wards 332 Enrollement into HIV care from MCHChild 179 Enrollment into HIV care from other settings 8492 Total clients enrolled for HIV care WHO stagei 1668 WHO stage II 2298 WHO stage III 2546 WHO stage IV 407 Total number of clients starting ART 4373 Pregnant women currently on ARVs 152 All others currently on ARVs Clients enrolled, eligible but not on ART 837 Clients put on PEP due to Sexual assault 357 Clients put on PEP due to occupational exposure 130 Patients currently on cotrimoxazole Patients currently on fluconazole 641 Total Adults on ART Total Children on ART % ART Intitiation by WHO stage 33.2% 36.8% BLOOD SAFETY Blood units collected from RBTC 2709 Number of blood units transfused % Linkage to care: Positive test to enrollment 57.5% 5.9% 24.7% 36.8% stagei stage II stage III stage IV 5.2% PMTCT VCT TB Ward overall

43 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 20% 90% 82% 65% 15% 58% 27% 40% 35% 25% 56% 35% 8% 35% 62% 3% Blood units collected from RBTC blood units collected from elsewhere Blood safety 45% 55% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 8.2%, with a higher prevalence among those aged above 49 years (12.3%). This translates to 65,100 people living with HIV in this county of which 10,400 (14%] are children. In 2011, the average reporting rates for this county for MOH711 was at 69.2%. This is fairly representative of the reporting facilities in the county. In 2011, of all who were tested for HIV in various settings within the county, the overall positivity was 8.1% with a higher positivity of 38.5% among those with TB infection. Only about 36.8% of those who tested positive were linked to HIV care and treatment services within the county with better linkages seen in PMTCT (53.5% ) and VCT (57.5%. Though TB and ward linkages were stronger than other counties, they were still low. HIV testing acceptance rate among pregnant women was high at 94.3%, for those found to be positive maternal and infant prophylaxis was provided for 90% and 55.7% respectively. Only about 6.6% of ANC women had their partners tested for HIV and only 56% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 51.9% delivered within health facilities. The overall mother to child transmission rate at first test in this county was high at 9.5% Total number of clients on treatment as at the end of 2011 in this county was 23,774 including 2126 children, this translates to a treatment coverage of 79% for adults and 28% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Elimination of Vertical transmission of HIV Increase uptake of prophylaxis among HIV exposed Infants Increase partner testing in PMTCT Strengthen Focused Antenatal care Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Scale up Pediatric ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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45 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Uptake of PMTCT among eligible mothers Uptake of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 10,600 1,700 12,300 14% % % 4,500 1,200 5,700 21% 10% 3% SERVICE COVERAGE Service Coverage (%) Number Proportion % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 99.1% 96.7% 98.4% 97.7% 2.5% 3.4% 2.9% 3.8% 4.1% 6.2% 5.3% 4.3% PMTCT uptake cascade 98.4% 75.7% 51.4% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test 51.6% 98.4% 78.0% 53.4% 56.1% 11.4% ENROLLMENT TO CARE & TREATMENT stagei stage II stage III stage IV Proportion of eligible Clients started on ART Proportion of new HIV positive enrolled to care 23.6% 42.0% 30.4% 4.0% 72.8% 72.3% Overall PMTCT cascade MTCT rates at 1st Test 11.4% Overall Prophylaxis for HIV exposed infants Proportion of HIV +ve women delivering in hospital 56.1% 53.4% Overal maternal prophylaxis 78.0% Overall PMTCT test acceptance rate 98.4% Proportion of mothers attending 4 ANC visits 51.6%

46 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients 6980 Urethral Discharge 569 Number of ANC clients attending 4 visits 3600 Genital Ulcer Disease 179 ANC clients counseled for HIV 6888 Opthalmia neonatorium 39 ANC clients tested for HIV 6779 STI SCREENING ANC clients found HIV positive 276 Syphillis Serology 38 ANC +ve Clients given prophylaxis 209 ANC Clients tested for syphilis 5911 Infants tested for HIV at 6 weeks 128 Infants given prophylaxis 142 TBHIV Partners of ANC clients counselled for HIV 193 TB patients tested for HIV 577 Partners of ANC clients tested for HIV 170 TB patients testing HIV positive 236 Partners of ANC clients HIV Positive 9 TB HIV patient on Cotrim 227 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 477 Clients Counselled in VCT Women Tested for HIV in maternity 466 Clients tested for HIV in VCT Women found HIV Positive in maternity 29 VCT clients found HIV Positive 399 Women issued prophylaxis in maternity 29 Couples counselled in VCT 866 Deliveries from HIV +ve women 163 Couples tested for HIV in VCT 869 Maternity Women started on Cotrimoxazole 53 VCT couples both HIV positive 18 Infants started on Cotrimoxazole 13 Discordant couples in VCT 25 Infants given prophylaxis in maternity 29 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 694 DTC outpatient counselled DTC inpatient tested 599 DTC outpatient tested DTC inpatient HIV Positive 61 DTC Outpatient HIV Positive % Enrollment to CCC by entry point 13% 22% 3% 4% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 178 Enrollement for HIV care from VCT 301 Enrollment into HIV care from TB clinic 43 Enrollment into HIV care from hospital wards 54 Enrollement into HIV care from MCHChild 10 Enrollment into HIV care from other settings 772 Total clients enrolled for HIV care 1358 WHO stagei 215 WHO stage II 382 WHO stage III 277 WHO stage IV 36 Total number of clients starting ART 910 Pregnant women currently on ARVs 19 All others currently on ARVs 2819 Clients enrolled, eligible but not on ART 525 Clients put on PEP due to Sexual assault 52 Clients put on PEP due to occupational exposure 14 Patients currently on cotrimoxazole 5229 Patients currently on fluconazole 1524 Total Adults on ART 444 Total Children on ART 37 ART Intitiation by WHO stage 42.0% BLOOD SAFETY Blood units collected from RBTC 346 Number of blood units transfused % 30.4% 56.7% Linkage to care: Positive test to enrollment 75.4% stagei stage II stage III 4.0% stage IV 30.7% 18.2% 5.8% PMTCT VCT TB Ward overall

47 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 39% 98% 94% 65% 54% 6% 62% 32% 30% 39% 41% 12% 49% 39% 33% 63% 4% Blood units collected from RBTC blood units collected from elsewhere Blood safety 41% 59% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 6.4%, with a higher prevalence among those aged 25 to 49 years at (8.2%). This translates to 12,300 people living with HIV in this county of which 1700 (14%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 87%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 4.3% with a higher positivity of 40.9% among those with TB infection. Only about 30.7% were linked to HIV care and treatment services within the county with better linkages (42.0%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 98.4%, for those found to be positive maternal and infant prophylaxis was provided for 78% and 56.1% respectively. Only about 2.5% of ANC women had their partners tested for HIV and only 51.6% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 53.4% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 11.4% Total number of clients on treatment as at the end of 2011 in this county was 2,819 including 37 children, this translates to a treatment coverage of 10% for adults and 3% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase uptake of HIV testing among partners to HIV pregnant mothers Strengthen ANC retention to ANC and deliveries in hospital among HIV infected women Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase ART coverage among PLHIV especially children Living with HIV Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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49 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 2, ,500 12% % ,200 17% 25% 49% 12% SERVICE COVERAGE Service Coverage (%) Number Proportion % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 94.5% 89.1% 90.4% 95.3% 2.0% 1.0% 1.3% 2.1% 1.3% 3.0% 0.6% 1.9% PMTCT uptake cascade 90.4% 96.2% 71.2% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 36.7% stagei 90.9% stage II 97.0% stage III 28.1% stage IV 77.8% Proportion of eligible Clients started on ART 8.3% Proportion of new HIV positive enrolled to care Overall PMTCT cascade 13.9% 19.7% 63.9% 2.5% 93.5% 92.6% MTCT rates at 1st Test 8.3% Overall Prophylaxis for HIV exposed infants 77.8% Proportion of HIV +ve women delivering in hospital 28.1% Overal maternal prophylaxis Overall PMTCT test acceptance rate 90.9% 97.0% Proportion of mothers attending 4 ANC visits 36.7%

50 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients 7559 Urethral Discharge 167 Number of ANC clients attending 4 visits 2774 Genital Ulcer Disease 108 ANC clients counseled for HIV 8864 Opthalmia neonatorium 17 ANC clients tested for HIV 8012 STI SCREENING ANC clients found HIV positive 104 Syphillis Serology 66 ANC +ve Clients given prophylaxis 100 ANC Clients tested for syphilis 3892 Infants tested for HIV at 6 weeks 28 Infants given prophylaxis 74 TBHIV Partners of ANC clients counselled for HIV 190 TB patients tested for HIV 472 Partners of ANC clients tested for HIV 164 TB patients testing HIV positive 88 Partners of ANC clients HIV Positive 1 TB HIV patient on Cotrim 84 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 1097 Clients Counselled in VCT 9070 Women Tested for HIV in maternity 1045 Clients tested for HIV in VCT 8571 Women found HIV Positive in maternity 31 VCT clients found HIV Positive 82 Women issued prophylaxis in maternity 31 Couples counselled in VCT 1325 Deliveries from HIV +ve women 38 Couples tested for HIV in VCT 1277 Maternity Women started on Cotrimoxazole 27 VCT couples both HIV positive 5 Infants started on Cotrimoxazole 12 Discordant couples in VCT 17 Infants given prophylaxis in maternity 31 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 156 DTC outpatient counselled DTC inpatient tested 109 DTC outpatient tested DTC inpatient HIV Positive 30 DTC Outpatient HIV Positive % Enrollment to CCC by entry point 9% 21% 4% 9% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 51 Enrollement for HIV care from VCT 122 Enrollment into HIV care from TB clinic 23 Enrollment into HIV care from hospital wards 49 Enrollement into HIV care from MCHChild 2 Enrollment into HIV care from other settings 318 Total clients enrolled for HIV care 565 WHO stagei 17 WHO stage II 24 WHO stage III 78 WHO stage IV 3 Total number of clients starting ART 122 Pregnant women currently on ARVs 2 All others currently on ARVs 481 Clients enrolled, eligible but not on ART 6 Clients put on PEP due to Sexual assault 8 Clients put on PEP due to occupational exposure 1 Patients currently on cotrimoxazole 977 Patients currently on fluconazole 1 Total Adults on ART 444 Total Children on ART 37 ART Intitiation by WHO stage 63.9% BLOOD SAFETY Blood units collected from RBTC 286 Number of blood units transfused 293 Linkage to care: Positive test to enrollment 148.8% 13.9% stagei 19.7% stage II stage III 2.5% stage IV 37.5% 40.2% 26.1% 16.1% PMTCT VCT TB Ward overall

51 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 More findings Distribution 44% 79% 98% 57% 36% 31% 14% 47% 43% 10% 67% 28% 5% 21% 72% 7% Blood units collected from RBTC blood units collected from elsewhere KEY FINDINGS AND PRIORITIES Blood safety Summary Overall HIV prevalence in the county is 2%, with a higher prevalence among those aged 15 to 24 years at 2.7%. This translates to 2,500 people living with HIV in this county of which 300 (12%) are children. In 2011, the average reporting rates for this county for MOH711 was at 90.2%. This is representative of the reporting facilities in the county. In 2011, of those tested for HIV in various settings within the county, the overall positivity was 1.9% with a higher positivity of 18.6% among those with TB infection. About 40.2% were linked to HIV care and treatment services within the county with better linkages (148.8%) seen among those testing within VCT settings. HIV testing acceptance rate among pregnant women was 90.9%, for those found to be positive maternal and infant prophylaxis was provided for 97.0% and 77.8% respectively. Only about 2.0% of ANC women had their partners tested for HIV and only 36.7% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 28.1% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 8.3%. Total number of clients on treatment as at the end of 2011 in this county was 481 including 37 children; this translates to treatment coverage of 49% for adults and 12% for children. 2% 98% Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase uptake of HIV testing among partners to HIV pregnant mothers Strengthen ANC retention to ANC and deliveries in hospital among HIV infected women Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase ART coverage among PLHIV especially children Living with HIV Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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53 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 10,900 1,600 12,500 13% New HIV Infections During the Year % HIV related Deaths during the year % PLHIV eligible for ART (Need for ART) 4,600 1,200 5,800 21% ART Uptake among PLHIV 81% 40% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT 93.7% HIV test acceptance at DTC 73.8% HIV test acceptance at ANC 97.2% HIV test acceptance at Maternity 98.0% HIV test acceptance for partners in ANC 4.3% HIV positivity at VCT 3.8% VCT Couple Discordance rate 9.1% HIV positivity at DTC 3.7% HIV positivity in ANC for Women 4.5% HIV Positivity in Maternity 9.9% HIV positivity for ANC partners 5.8% Overall HIV positivity 4.4% PMTCT uptake cascade 97.2% 76.1% 66.7% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 52.2% stagei 97.2% stage II 72.9% stage III 52.7% stage IV 80.5% Proportion of eligible Clients started on ART 10.4% Proportion of new HIV positive enrolled to care 51.6% 23.0% 22.0% 3.4% 48.2% 40.0% Overall PMTCT cascade MTCT rates at 1st Test 10.4% Overall Prophylaxis for HIV exposed infants 80.5% Proportion of HIV +ve women delivering in hospital 52.7% Overal maternal prophylaxis 72.9% Overall PMTCT test acceptance rate 97.2% Proportion of mothers attending 4 ANC visits 52.2%

54 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 903 Number of ANC clients attending 4 visits 6610 Genital Ulcer Disease initial Visit 378 ANC clients counseled for HIV Opthalmia neonatorium first visits 21 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 565 Syphillis Serology 106 ANC +ve Clients given prophylaxis 377 ANC Clients tested for syphilis 9790 Infants tested for HIV at 6 weeks 214 Infants given prophylaxis 430 TBHIV Partners of ANC clients counselled for HIV 662 TB patients tested for HIV 1480 Partners of ANC clients tested for HIV 537 TB patients tested HIV positive 461 Partners of ANC clients HIV Positive 31 TB HIV patient on Cotrimoxazole 399 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 1323 Clients Counselled in VCT Women Tested for HIV in maternity 1296 Clients tested for HIV in VCT Women found HIV Positive in maternity 128 VCT clients HIV Positive 743 Women issued prophylaxis in maternity 128 Couples counselled in VCT 3472 Deliveries from HIV +ve women 365 Couples tested for HIV in VCT 2641 Maternity Women started on Cotrimoxazole 198 VCT couples both HIV positive 259 Infants started on Cotrimoxazole 78 Discordant couples in VCT 241 Infants given prophylaxis in maternity 128 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 5615 DTC outpatient counselled DTC inpatient tested 4786 DTC outpatient tested DTC inpatient HIV Positive 376 DTC Outpatient HIV Positive 1476 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 55% 12% 8% 22% 3% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 176 Enrollement for HIV care from VCT 327 Enrollment into HIV care from TB clinic 53 Enrollment into HIV care from hospital wards 119 Enrollement into HIV care from MCHChild 44 Enrollment into HIV care from other settings 793 Total clients enrolled for HIV care 1512 WHO stagei 726 WHO stage II 324 WHO stage III 309 WHO stage IV 48 Total number of clients starting ART 1407 Pregnant women currently on ARVs 52 All others currently on ARVs 4197 Clients enrolled, eligible but not on ART 57 Clients put on PEP due to Sexual assault 157 Clients put on PEP due to occupational exposure 46 Patients currently on cotrimoxazole 7156 Patients currently on fluconazole 45 Total Adults on ART 3718 Total Children on ART % ART Intitiation by WHO stage BLOOD SAFETY Blood units collected from RBTC 4409 Number of blood units transfused 4437 Linkage to care: Positive test to enrollment 44.0% stagei 23.0% 22.0% 3.4% stage II stage III stage IV 24.3% 17.9% 11.5% 6.4% PMTCT VCT TB Ward overall

55 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 33% 99% 98% 77% 57% 3% 56% 40% 27% 31% 42% 21% 56% 22% 31% 65% 4% Blood units collected from RBTC blood units collected from elsewhere Blood safety 1% 99% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 3.7%, with a higher prevalence among those aged 25 to 49 years at 4.4%. This translates to 12,500 people living with HIV in this county of which 1,600 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 73.6%. This is fairly representative of the reporting facilities in the county. In 2011, of those who were tested for HIV in various settings within the county, the overall positivity was 4.4% with a higher positivity of 31.1% among those with TB infection. Only about 17.9% were linked to HIV care and treatment services within the county with better linkages ( 44%)among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 97.2%, for those found to be positive maternal and infant prophylaxis was provided for 72.9% and 80.5% respectively. Only about 4.3% of ANC women had their partners tested for HIV and only 52.2% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 52.7% delivered within health facilities. The overall mother to child transmission rate at first test in this county was high at 10.4% Total number of clients on treatment as at the end of 2011 in this county was 4195 including 479 children, this translates to a treatment coverage of 81% for adults and 40% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase partner involvement in PMTCT through partner testing Strengthen the linkage to HIV care for those who test HIV Positive from TB clinic and in the hospital Wards. Increase the number of HIV infected children on ART. Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

56

57 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 2, ,200 13% New HIV Infections During the Year % HIV related Deaths during the year PLHIV eligible for ART (Need for ART) 100 1, ,518 17% 20% ART Coverage among PLHIV 100% 60% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion % % % 86 47% SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 97.8% 96.7% 96.7% 94.4% 3.6% 2.8% 24.9% 2.4% 2.4% 4.4% 1.1% 2.8% PMTCT uptake cascade 96.7% 76.7% 45.0% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 40.0% stagei 96.4% stage II 80.9% stage III 25.5% stage IV 54.8% Proportion of eligible Clients started on ART 13.3% Proportion of new HIV positive enrolled to care 17.9% 11.1% 70.3% 0.7% 68.4% 24.1% Overall PMTCT cascade MTCT rates at 1st Test 13.3% Overall Prophylaxis for HIV exposed infants 54.8% Proportion of HIV +ve women delivering in hospital 25.5% Overal maternal prophylaxis 80.9% Overall PMTCT test acceptance rate 96.4% Proportion of mothers attending 4 ANC visits 40.0%

58 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients 5025 Urethral Discharge Initial Visit 537 Number of ANC clients attending Genital Ulcer Disease initial Visit 149 ANC clients counseled for HIV 5473 Opthalmia neonatorium first visits 7 ANC clients tested for HIV 5291 STI SCREENING ANC clients found HIV positive 129 Syphillis Serology 25 ANC +ve Clients given prophylaxis 99 ANC Clients tested for syphilis 1976 Infants tested for HIV at 6 weeks 19 Infants given prophylaxis 58 TBHIV Partners of ANC clients counselled for 191 TB patients tested for HIV 349 Partners of ANC clients tested for HIV 189 TB patients tested HIV positive 84 Partners of ANC clients HIV Positive 2 TB HIV patient on Cotrimoxazole 88 PMTCT Maternity HTC (VCT) Women Counselled for HIV in 674 Clients Counselled in VCT 5950 Women Tested for HIV in maternity 636 Clients tested for HIV in VCT 5817 Women found HIV Positive in maternity 28 VCT clients HIV Positive 161 Women issued prophylaxis in maternity 28 Couples counselled in VCT 720 Deliveries from HIV +ve women 40 Couples tested for HIV in VCT 710 Maternity Women started on 27 VCT couples both HIV positive 24 Infants started on Cotrimoxazole 1 Discordant couples in VCT 177 Infants given prophylaxis in maternity 28 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 1200 DTC outpatient counselled DTC inpatient tested 970 DTC outpatient tested DTC inpatient HIV Positive 49 DTC Outpatient HIV Positive 295 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 40% 7% 7% 21% 25% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 12 Enrollement for HIV care from VCT 45 Enrollment into HIV care from TB clinic Enrollment into HIV care from hospital wards Enrollement into HIV care from MCHChild 0 Enrollment into HIV care from other settings 72 Total clients enrolled for HIV care 180 WHO stagei 50 WHO stage II 31 WHO stage III 196 WHO stage IV 2 Total number of clients starting ART 279 Pregnant women currently on ARVs 14 All others currently on ARVs 1503 Clients enrolled, eligible but not on ART 12 Clients put on PEP due to Sexual assault 1 Clients put on PEP due to occupational exposure Patients currently on cotrimoxazole 2443 Patients currently on fluconazole 5 Total Adults on ART 1324 Total Children on ART 179 ART Intitiation by WHO stage 70.3% BLOOD SAFETY Blood units collected from RBTC Number of blood units transfused Linkage to care: Positive test to enrollment 45.2% 17.9% Clients starting ART in stagei 11.1% 0.7% Clients starting ARTClients starting ARTClients starting ART in stage II in stage III in stage IV 28.0% 14.4% 7.5% 3.8% PMTCT VCT TB Ward overall

59 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 26% 92% 97% 45% 66% 27% 7% 32% 35% 34% 84% 16% 0% 32% 67% 1% Blood units collected from RBTC blood units collected from elsewhere Blood safety 0% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 2.2%. This translates to 3,200 people living with HIV in this county of which 400 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 88.5%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 2.8% with a higher positivity of 24.1% among those with TB infection. Only about 14.4% were linked to HIV care and treatment services within the county with better linkages 45.2 % among those testing within TB clinics suggesting fairly strong TB/HIV collaboration. HIV testing acceptance rate among pregnant women was high at 96.4%, for those found to be positive maternal and infant prophylaxis was provided for 80.9% and 54.8% respectively. Only about 3.6% of ANC women had their partners tested for HIV and only 40.4% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 25.5% delivered within health facilities. The overall mother to child transmission rate at first test in this county was Total number of clients on treatment as at the end of 2011 in this county was 1,503 including 179 children, this translates to a treatment coverage of 100% for adults and 60% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase partner involvement in PMTCT through partner testing Strengthen the linkage to HIV care for those who test HIV Positive from TB clinic and in the hospital Wards. Increase the number of HIV infected children on ART. Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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61 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 23,700 3,500 27,200 13% New HIV Infections During the Year 1, ,720 13% HIV related Deaths during the year ,000 20% PLHIV eligible for ART (Need for ART) 10,000 2,500 12,500 20% ART Coverage among PLHIV 66% 42% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT 83.3% 87.7% 70.4% 88.1% 2.5% 3.0% 5.0% HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 3.7% 5.6% 4.3% 10.7% 4.3% PMTCT uptake cascade 92.6% 50.1% 48.3% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 34.5% stagei 92.1% stage II 54.3% stage III 22.8% stage IV 52.6% Proportion of eligible Clients started on ART 8.4% Proportion of new HIV positive enrolled to care 14.3% 39.5% 24.6% 21.5% 78.2% 179.2% Overall PMTCT cascade MTCT rates at 1st Test 8.4% Overall Prophylaxis for HIV exposed infants 52.6% Proportion of HIV +ve women delivering in hospital 22.8% Overal maternal prophylaxis 54.3% Overall PMTCT test acceptance rate 92.1% Proportion of mothers attending 4 ANC visits 34.5%

62 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 1855 Number of ANC clients attending 4 visits Genital Ulcer Disease initial Visit 1257 ANC clients counseled for HIV Opthalmia neonatorium first visits 263 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 1359 Syphillis Serology 411 ANC +ve Clients given prophylaxis 681 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 628 Infants given prophylaxis 656 TBHIV Partners of ANC clients counselled for HIV 900 TB patients tested for HIV 2045 Partners of ANC clients tested for HIV 609 TB patients tested HIV positive 695 Partners of ANC clients HIV Positive 65 TB HIV patient on Cotrimoxazole 1444 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 3236 Clients Counselled in VCT Women Tested for HIV in maternity 2851 Clients tested for HIV in VCT Women found HIV Positive in maternity 124 VCT clients HIV Positive 869 Women issued prophylaxis in maternity 124 Couples counselled in VCT 1469 Deliveries from HIV +ve women 338 Couples tested for HIV in VCT 1294 Maternity Women started on Cotrimoxazole 150 VCT couples both HIV positive 74 Infants started on Cotrimoxazole 73 Discordant couples in VCT 65 Infants given prophylaxis in maternity 124 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 5225 DTC outpatient counselled DTC inpatient tested 4119 DTC outpatient tested DTC inpatient HIV Positive 365 DTC Outpatient HIV Positive % Enrollment to CCC by entry point 4% 7% 2% 1% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 499 Enrollement for HIV care from VCT 946 Enrollment into HIV care from TB clinic 230 Enrollment into HIV care from hospital wards 150 Enrollement into HIV care from MCHChild 79 Enrollment into HIV care from other settings Total clients enrolled for HIV care WHO stagei 508 WHO stage II 1398 WHO stage III 872 WHO stage IV 763 Total number of clients starting ART 3541 Pregnant women currently on ARVs 117 All others currently on ARVs 7655 Clients enrolled, eligible but not on ART 154 Clients put on PEP due to Sexual assault 348 Clients put on PEP due to occupational exposure 10 Patients currently on cotrimoxazole Patients currently on fluconazole 583 Total Adults on ART 6613 Total Children on ART 1042 ART Intitiation by WHO stage 39.5% BLOOD SAFETY Blood units collected from RBTC 503 Number of blood units transfused % 21.5% Linkage to care: Positive test to enrollment 108.9% 14.3% stagei stage II stage III stage IV 32.2% 33.1% 25.8% 3.8% PMTCT VCT TB Ward overall

63 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 26% 92% 97% 45% 66% 27% 7% 32% 35% 34% 84% 16% 0% 32% 67% 1% Blood units collected from RBTC blood units collected from elsewhere Blood safety 0% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 2.2%. This translates to 3,200 people living with HIV in this county of which 400 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 88.5%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 2.8% with a higher positivity of 24.1% among those with TB infection. Only about 14.4% were linked to HIV care and treatment services within the county with better linkages 45.2 % among those testing within TB clinics suggesting fairly strong TB/HIV collaboration. HIV testing acceptance rate among pregnant women was high at 96.4%, for those found to be positive maternal and infant prophylaxis was provided for 80.9% and 54.8% respectively. Only about 3.6% of ANC women had their partners tested for HIV and only 40.4% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 25.5% delivered within health facilities. The overall mother to child transmission rate at first test in this county was Total number of clients on treatment as at the end of 2011 in this county was 1,503 including 179 children, this translates to a treatment coverage of 100% for adults and 60% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase partner involvement in PMTCT through partner testing Strengthen the linkage to HIV care for those who test HIV Positive from TB clinic and in the hospital Wards. Increase the number of HIV infected children on ART. Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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65 INDICATOR People Living with HIV (PLHIV) 28,700 New HIV Infections During the Year 1,900 HIV related Deaths during the year 1,000 PLHIV eligible for ART (Need for ART) 12,100 ART Coverage among PLHIV 81% HIV ESTIMATES SERVICE COVERAGE % PLWHA WHO ARE CHILDREN 4,200 32,900 13% 270 2,170 12% 240 3,000 1,240 15,100 19% 20% 47% ADULTS CHILDREN TOTAL Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 93.9% 94.2% 96.4% 96.9% 3.9% 4.3% 9.7% 6.1% 4.6% 5.9% 11.6% 5.8% PMTCT uptake cascade 100.0% 100.0% 96.4% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 48.8% stagei 96.5% stage II 100.0% stage III 31.9% stage IV 100.0% Proportion of eligible Clients started on ART 10.2% Proportion of new HIV positive enrolled to care 20.2% 62.3% 12.5% 5.0% 62.1% 148.5% Overall PMTCT cascade MTCT rates at 1st Test 10.2% Overall Prophylaxis for HIV exposed infants 100.0% Proportion of HIV +ve women delivering in hospital 31.9% Overal maternal prophylaxis 100.0% Overall PMTCT test acceptance rate 96.5% Proportion of mothers attending 4 ANC visits 48.8%

66 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 2371 Number of ANC clients attending 4 visits Genital Ulcer Disease initial Visit 904 ANC clients counseled for HIV Opthalmia neonatorium first visits 282 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 1327 Syphillis Serology 728 ANC +ve Clients given prophylaxis 1327 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 927 Infants given prophylaxis 1327 TBHIV Partners of ANC clients counselled for HIV 1328 TB patients tested for HIV 2872 Partners of ANC clients tested for HIV 1107 TB patients tested HIV positive 1039 Partners of ANC clients HIV Positive 128 TB HIV patient on Cotrimoxazole 933 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 7507 Clients Counselled in VCT Women Tested for HIV in maternity 7278 Clients tested for HIV in VCT Women found HIV Positive in maternity 430 VCT clients HIV Positive 2528 Women issued prophylaxis in maternity 430 Couples counselled in VCT 3438 Deliveries from HIV +ve women 560 Couples tested for HIV in VCT 3365 Maternity Women started on Cotrimoxazole 445 VCT couples both HIV positive 382 Infants started on Cotrimoxazole 183 Discordant couples in VCT 325 Infants given prophylaxis in maternity 430 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 8651 DTC outpatient counselled DTC inpatient tested 8098 DTC outpatient tested DTC inpatient HIV Positive 892 DTC Outpatient HIV Positive % Enrollment to CCC by entry point 4% 7% 1% 4% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 796 Enrollement for HIV care from VCT 1287 Enrollment into HIV care from TB clinic 282 Enrollment into HIV care from hospital wards 748 Enrollement into HIV care from MCHChild 104 Enrollment into HIV care from other settings Total clients enrolled for HIV care WHO stagei 1899 WHO stage II 5868 WHO stage III 1176 WHO stage IV 470 Total number of clients starting ART 9413 Pregnant women currently on ARVs 43 All others currently on ARVs Clients enrolled, eligible but not on ART 279 Clients put on PEP due to Sexual assault 658 Clients put on PEP due to occupational exposure 318 Patients currently on cotrimoxazole Patients currently on fluconazole 40 Total Adults on ART 9785 Total Children on ART 1396 ART Intitiation by WHO stage 62.3% BLOOD SAFETY Blood units collected from RBTC 2217 Number of blood units transfused 2929 Linkage to care: Positive test to enrollment 20.2% 12.5% 5.0% 42.2% 50.9% 27.1% 10.9% 25.3% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

67 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 26% 97% 100% 56% 38% 3% 61% 36% 32% 45% 23% 18% 55% 26% 29% 68% 3% Blood units collected from RBTC blood units collected from elsewhere Blood safety 24% 76% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 4.7%, with a higher prevalence among those aged above 49 years at (7.5%). This translates to 32,900 people living with HIV in this county of which 4200 (13%) are children. In 2011, the average reporting rates for this county 711 was at 71.4%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 5.8% with a higher positivity of 36.2% among those with TB infection. Only about 25.3% were linked to HIV care and treatment services within the county with better linkages 50.9% among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 96.5%, for those found to be positive maternal and infant prophylaxis was provided for 100% and (100%) respectively. Only about 3.9% of ANC women had their partners tested for HIV and only 48.8% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 31.9% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 10.2% this is very high. Total number of clients on treatment as at the end of 2011 in this county was 11,181 including 1396 children, this translates to a treatment coverage of 81% for adults and 47% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Retention to ANC up to 4th visit Reduce the rate of vertical transmission to less than five percent Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase ART coverage among children and infected adults Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting. *The proportion of HIV positive people enrolled to care is greater than 100% of those testing HIV Positive in 2011 because of poor linkage to care. This results to enrolment to care of people who tested positive in previous years

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69 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 25,500 3,700 29,200 13% New HIV Infections During the Year 1, ,940 12% HIV related Deaths during the year PLHIV eligible for ART (Need for ART) , ,700 1,120 13,500 20% 20% ART coverage among PLHIV 53% 39% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HIV test acceptance at VCT HTC 92.5% 92.3% PMTCT uptake cascade HIV test acceptance at DTC HIV test acceptance at ANC 93.0% 99.8% 68.6% 68.6% HIV test acceptance at Maternity 94.8% HIV test acceptance for partners in ANC 2.1% HIV positivity at VCT 3.2% VCT Couple Discordance rate 11.2% HIV positivity at DTC 4.4% HIV positivity in ANC for Women 4.4% HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 7.1% 8.4% 4.7% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 38.2% stagei 92.6% stage II 73.0% stage III 24.2% stage IV 73.0% Proportion of eligible Clients started on ART 9.0% Proportion of new HIV positive enrolled to care 14.0% 42.1% 33.6% 10.3% 83.5% 72.6% Overall PMTCT cascade MTCT rates at 1st Test 9.0% Overall Prophylaxis for HIV exposed infants 73.0% Proportion of HIV +ve women delivering in hospital 24.2% Overal maternal prophylaxis 73.0% Overall PMTCT test acceptance rate 92.6% Proportion of mothers attending 4 ANC visits 38.2%

70 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 1097 Number of ANC clients attending 4 visits 7441 Genital Ulcer Disease initial Visit 642 ANC clients counseled for HIV Opthalmia neonatorium first visits 183 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 854 Syphillis Serology 234 ANC +ve Clients given prophylaxis 586 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 441 Infants given prophylaxis 586 TBHIV Partners of ANC clients counselled for HIV 454 TB patients tested for HIV 1888 Partners of ANC clients tested for HIV 417 TB patients tested HIV positive 614 Partners of ANC clients HIV Positive 35 TB HIV patient on Cotrimoxazole 568 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 2090 Clients Counselled in VCT Women Tested for HIV in maternity 1981 Clients tested for HIV in VCT Women found HIV Positive in maternity 140 VCT clients HIV Positive 466 Women issued prophylaxis in maternity 140 Couples counselled in VCT 470 Deliveries from HIV +ve women 241 Couples tested for HIV in VCT 483 Maternity Women started on Cotrimoxazole 141 VCT couples both HIV positive 26 Infants started on Cotrimoxazole 98 Discordant couples in VCT 54 Infants given prophylaxis in maternity 140 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 4728 DTC outpatient counselled DTC inpatient tested 3921 DTC outpatient tested DTC inpatient HIV Positive 279 DTC Outpatient HIV Positive 3684 Enrollment to CCC by entry point ART CARE AND TREATMENT 0 NUMBER Enrollment for HIV care from PMTCT 441 Enrollement for HIV care from VCT 485 Enrollment into HIV care from TB clinic % PMTCT Enrollment into HIV care from hospital wards 109 Enrollement into HIV care from MCHChild % VCT Enrollment into HIV care from other settings 2762 Total clients enrolled for HIV care 4406 WHO stagei % TB WHO stage II 884 WHO stage III 705 WHO stage IV % 3% Ward All others Total number of clients starting ART 2099 Pregnant women currently on ARVs 49 All others currently on ARVs 6772 Clients enrolled, eligible but not on ART 19 Clients put on PEP due to Sexual assault 872 Clients put on PEP due to occupational exposure 30 Patients currently on cotrimoxazole Patients currently on fluconazole 38 Total Adults on ART 5725 Total Children on ART 1047 ART Intitiation by WHO stage 42.1% BLOOD SAFETY Blood units collected from RBTC 826 Number of blood units transfused % Linkage to care: Positive test to enrollment 104.1% 14.0% Clients starting ART in stagei Clients starting ART in stage II 10.3% Clients starting ART Clients starting ART in stage III in stage IV 72.8% 42.9% 24.4% 2.8% PMTCT VCT TB Ward overall

71 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 More findings Distribution 22% 93% 100% 47% 36% 4% 73% 23% 31% 45% 24% 37% 54% 9% 33% 63% 3% Blood units collected from RBTC blood units collected from elsewhere KEY FINDINGS AND PRIORITIES Blood safety Summary Overall HIV prevalence in the county is 6.4% with a higher prevalence among those aged 25 to 49 years at (9.9%). This translates to 29,200 people living with HIV in this county of which 3700 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 83.2%.This is fairly representative of the reporting facilities in the county. In 2011,Among those tested for HIV in various settings within the county, the overall positivity was 4.7% with a higher positivity of 32.5% among those with TB infection Only about (24.4%) were linked to HIV care and treatment services within the county with better linkages (104.1 %)among those testing within VCT settings. TB/HIV had a high linkage rate of 72.8%. Wards had the lowest linkage rate (2.8%) HIV testing acceptance rate among pregnant women was high at 92.6%, for those found to be positive maternal and infant prophylaxis was provided for 73.0% and 73.0% respectively. Only about 2.1% of ANC women had their partners tested for HIV and only 38.2% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 24.2% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 9.0% Total number of clients on treatment as at the end of 2011 in this county was 6772 including 1047 children, this translates to a treatment coverage of 53% for adults and 39% for children 11% 89% Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Elimination of Mother to child transmission of HIV Increase Focused ante natal care and Increase partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase coverage of ART among both adults and children Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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73 INDICATOR HIV ESTIMATES ADULTS CHILDREN TOTAL People Living with HIV (PLHIV) 1, New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV 52% 28% SERVICE COVERAGE % PLWHA WHO ARE CHILDREN 1,600 13% 110 9% % % Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion % % 76 76% 61 61% SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 91.9% 78.6% 97.6% 99.1% 5.7% 1.1% 0.3% 2.4% 1.9% 2.7% 4.9% 2.3% PMTCT uptake cascade 97.6% 47.0% 35.8% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 42.3% stagei 97.7% stage II 50.3% stage III 9.9% stage IV 40.4% Proportion of eligible Clients started on ART 11.6% Proportion of new HIV positive enrolled to care 9.2% 38.5% 46.2% 6.2% 87.9% 52.3% Overall PMTCT cascade MTCT rates at 1st Test 11.6% Overall Prophylaxis for HIV exposed infants 40.4% Proportion of HIV +ve women delivering in hospital 9.9% Overal maternal prophylaxis 50.3% Overall PMTCT test acceptance rate 97.7% Proportion of mothers attending 4 ANC visits 42.3%

74 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients 6954 Urethral Discharge Initial Visit 394 Number of ANC clients attending 4 visits 2941 Genital Ulcer Disease initial Visit 114 ANC clients counseled for HIV 7383 Opthalmia neonatorium first visits 61 ANC clients tested for HIV 7205 STI SCREENING ANC clients found HIV positive 134 Syphillis Serology 20 ANC +ve Clients given prophylaxis 63 ANC Clients tested for syphilis 3859 Infants tested for HIV at 6 weeks 52 Infants given prophylaxis 48 TBHIV Partners of ANC clients counselled for HIV 408 TB patients tested for HIV 632 Partners of ANC clients tested for HIV 409 TB patients tested HIV positive 107 Partners of ANC clients HIV Positive 20 TB HIV patient on Cotrimoxazole 104 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 634 Clients Counselled in VCT 9500 Women Tested for HIV in maternity 628 Clients tested for HIV in VCT 8728 Women found HIV Positive in maternity 17 VCT clients HIV Positive 99 Women issued prophylaxis in maternity 13 Couples counselled in VCT 5671 Deliveries from HIV +ve women 15 Couples tested for HIV in VCT 5666 Maternity Women started on Cotrimoxazole 13 VCT couples both HIV positive 52 Infants started on Cotrimoxazole 9 Discordant couples in VCT 15 Infants given prophylaxis in maternity 13 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 1266 DTC outpatient counselled DTC inpatient tested 1185 DTC outpatient tested DTC inpatient HIV Positive 58 DTC Outpatient HIV Positive % Enrollment to CCC by entry point 12% 15% 7% 12% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 49 Enrollement for HIV care from VCT 58 Enrollment into HIV care from TB clinic 27 Enrollment into HIV care from hospital wards 47 Enrollement into HIV care from MCHChild 4 Enrollment into HIV care from other settings 212 Total clients enrolled for HIV care 397 WHO stagei 25 WHO stage II 105 WHO stage III 126 WHO stage IV 17 Total number of clients starting ART 273 Pregnant women currently on ARVs 9 All others currently on ARVs 366 Clients enrolled, eligible but not on ART 18 Clients put on PEP due to Sexual assault 219 Clients put on PEP due to occupational exposure 8 Patients currently on cotrimoxazole 1649 Patients currently on fluconazole 5 Total Adults on ART 310 Total Children on ART 56 ART Intitiation by WHO stage 46.2% 38.5% BLOOD SAFETY Blood units collected from RBTC 18 Number of blood units transfused 419 Linkage to care: Positive test to enrollment 58.6% 9.2% 6.2% 28.7% 25.2% 12.3% 23.8% Clients starting ART in stagei Clients starting ART in stage II Clients starting ART in stage III Clients starting ART in stage IV PMTCT VCT TB Ward overall

75 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 20% 38% 100% 26% 75% 20% 5% 28% 29% 43% 70% 27% 3% 27% 72% 1% Blood units collected from RBTC blood units collected from elsewhere Blood safety 96% 4% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 0.6%, with a higher prevalence among those aged 25 to 49 at (1%). This translates to 1,600 people living with HIV in this county of which 200(13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 67.2%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 2.3% with a higher positivity of 16.9% among those with TB infection. Only about 23.8% were linked to HIV care and treatment services within the county with better linkages ( 58.6%)among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 97.7%, for those found to be positive maternal and infant prophylaxis was provided for 50.3% and 40.4% respectively. Only about 5.7% of ANC women had their partners tested for HIV and only 42.3% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 9.9% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 11.6% Total number of clients on treatment as at the end of 2011 in this county was 366 including 56 children, this translates to a treatment coverage of 52% for adults and 28% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase partner involvement in PMTCT through partner testing Strengthen the linkage to HIV care for those who test HIV Positive from TB clinic and in the hospital Wards. Increase the number of HIV infected children on ART. Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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77 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 24,800 3,600 28,400 13% New HIV Infections During the Year 1, ,830 13% HIV related Deaths during the year PLHIV eligible for ART (Need for ART) , ,600 1,110 13,100 19% 20% ART Coverage among PLHIV 65% 38% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 95.5% 93.9% 95.8% 96.2% 3.2% 3.2% 2.0% 4.4% 3.4% 3.7% 9.9% 4.1% PMTCT uptake cascade 95.8% 60.1% 32.1% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 40.9% stagei 95.8% stage II 67.2% stage III 43.9% stage IV 44.1% Proportion of eligible Clients started on ART 8.5% Proportion of new HIV positive enrolled to care 21.5% 37.6% 24.8% 16.1% 80.3% 53.4% Overall PMTCT cascade MTCT rates at 1st Test 8.5% Overall Prophylaxis for HIV exposed infants 44.1% Proportion of HIV +ve women delivering in hospital 43.9% Overal maternal prophylaxis 67.2% Overall PMTCT test acceptance rate 95.8% Proportion of mothers attending 4 ANC visits 40.9%

78 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 1193 Number of ANC clients attending 4 visits Genital Ulcer Disease initial Visit 340 ANC clients counseled for HIV Opthalmia neonatorium first visits 138 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 848 Syphillis Serology 1016 ANC +ve Clients given prophylaxis 510 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 286 Infants given prophylaxis 272 TBHIV Partners of ANC clients counselled for HIV 960 TB patients tested for HIV 2806 Partners of ANC clients tested for HIV 807 TB patients tested HIV positive 768 Partners of ANC clients HIV Positive 80 TB HIV patient on Cotrimoxazole 719 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 5120 Clients Counselled in VCT Women Tested for HIV in maternity 4923 Clients tested for HIV in VCT Women found HIV Positive in maternity 182 VCT clients HIV Positive 2256 Women issued prophylaxis in maternity 182 Couples counselled in VCT 6319 Deliveries from HIV +ve women 452 Couples tested for HIV in VCT 6280 Maternity Women started on Cotrimoxazole 207 VCT couples both HIV positive 91 Infants started on Cotrimoxazole 76 Discordant couples in VCT 127 Infants given prophylaxis in maternity 182 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 6908 DTC outpatient counselled DTC inpatient tested 6316 DTC outpatient tested DTC inpatient HIV Positive 473 DTC Outpatient HIV Positive % 6% Enrollment to CCC by entry point 11% 37% 6% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 375 Enrollement for HIV care from VCT 1345 Enrollment into HIV care from TB clinic 208 Enrollment into HIV care from hospital wards 228 Enrollement into HIV care from MCHChild 11 Enrollment into HIV care from other settings 1440 Total clients enrolled for HIV care 3607 WHO stagei 529 WHO stage II 928 WHO stage III 611 WHO stage IV 398 Total number of clients starting ART 2466 Pregnant women currently on ARVs 110 All others currently on ARVs 7797 Clients enrolled, eligible but not on ART 160 Clients put on PEP due to Sexual assault 268 Clients put on PEP due to occupational exposure 68 Patients currently on cotrimoxazole Patients currently on fluconazole 26 Total Adults on ART 6798 Total Children on ART 999 ART Intitiation by WHO stage 37.6% BLOOD SAFETY Blood units collected from RBTC 3216 Number of blood units transfused % 24.8% 16.1% Linkage to care: Positive test to enrollment 59.6% 33.8% 27.1% 31.9% stagei stage II stage III stage IV 8.7% PMTCT VCT TB Ward overall

79 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 32% 96% 92% 80% 41% 8% 63% 28% 42% 35% 23% 21% 59% 20% 28% 68% 4% Blood units collected from RBTC blood units collected from elsewhere Blood safety 26% 74% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 3.2%, with a higher prevalence among those aged 25 to 49 years at (4.1%). This translates to 28,400 people living with HIV in this county of which (13%) are children. In 2011, the average reporting rates for this county MOH 711 was at 58.2%. This represents just over half of the reporting facilities in the county. In 2011, Among tested for HIV in various settings within the county, the overall positivity was 4.1% with a higher positivity of 27.4% among those with TB infection. Only about 31.9% were linked to HIV care and treatment services within the county with better linkages (59.6 %) among those testing within VCT settings followed by PMTCT (33.8%) and TB/HIV (27.1%). HIV testing acceptance rate among pregnant women was high at 95.8% for those found to be positive maternal and infant prophylaxis was provided for 67.2% and 44.1% respectively. Only about 3.2% of ANC women had their partners tested for HIV and only 40.9% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 43.9% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 8.5% Total number of clients on treatment as at the end of 2011 in this county was 7797 including 999 children, this translates to a treatment coverage of 65% for adults and 38% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase partner involvement in PMTCT through partner testing Strengthen the linkage to HIV care for those who test HIV Positive from TB clinic and in the hospital Wards. Increase the number of HIV infected children on ART. Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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81 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) % New HIV Infections During the Year % HIV related Deaths during the year % PLHIV eligible for ART (Need for ART), % ART coverage among PHIV % % SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC PMTCT uptake cascade HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 96.7% 85.0% 97.7% 97.2% 3.8% 2.7% 14.6% 3.5% 3.6% 3.6% 5.5% 3.9% 97.7% Testing Uptake 58.0% Maternal prophylaxis uptake 24.9% Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 57.8% stagei 97.6% stage II 67.4% stage III 45.1% stage IV 41.6% Proportion of eligible Clients started on ART 2.7% Proportion of new HIV positive enrolled to care 55.3% 28.8% 12.4% 3.5% 45.1% 347.5% Overall PMTCT cascade MTCT rates at 1st Test 2.7% Overall Prophylaxis for HIV exposed infants 41.6% Proportion of HIV +ve women delivering in hospital 45.1% Overal maternal prophylaxis 67.4% Overall PMTCT test acceptance rate 97.6% Proportion of mothers attending 4 ANC visits 57.8%

82 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients 9655 Urethral Discharge Initial Visit 827 Number of ANC clients attending 4 visits 5579 Genital Ulcer Disease initial Visit 512 ANC clients counseled for HIV 9735 Opthalmia neonatorium first visits 11 ANC clients tested for HIV 9511 STI SCREENING ANC clients found HIV positive 338 Syphillis Serology 567 ANC +ve Clients given prophylaxis 196 ANC Clients tested for syphilis 7444 Infants tested for HIV at 6 weeks 75 Infants given prophylaxis 84 TBHIV Partners of ANC clients counselled for HIV 386 TB patients tested for HIV 1009 Partners of ANC clients tested for HIV 366 TB patients tested HIV positive 317 Partners of ANC clients HIV Positive 20 TB HIV patient on Cotrimoxazole 253 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 2795 Clients Counselled in VCT Women Tested for HIV in maternity 2716 Clients tested for HIV in VCT Women found HIV Positive in maternity 97 VCT clients HIV Positive 417 Women issued prophylaxis in maternity 97 Couples counselled in VCT 1483 Deliveries from HIV +ve women 196 Couples tested for HIV in VCT 1537 Maternity Women started on Cotrimoxazole 94 VCT couples both HIV positive 21 Infants started on Cotrimoxazole 17 Discordant couples in VCT 225 Infants given prophylaxis in maternity 97 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 1390 DTC outpatient counselled DTC inpatient tested 2066 DTC outpatient tested DTC inpatient HIV Positive 175 DTC Outpatient HIV Positive 564 Enrollment to CCC by entry point 2% 1% 6% 1% 90% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 157 Enrollement for HIV care from VCT 411 Enrollment into HIV care from TB clinic 49 Enrollment into HIV care from hospital wards 53 Enrollement into HIV care from MCHChild 11 Enrollment into HIV care from other settings 6176 Total clients enrolled for HIV care 6857 WHO stagei 814 WHO stage II 424 WHO stage III 183 WHO stage IV 51 Total number of clients starting ART 1472 Pregnant women currently on ARVs 21 All others currently on ARVs 4136 Clients enrolled, eligible but not on ART 137 Clients put on PEP due to Sexual assault 115 Clients put on PEP due to occupational exposure 13 Patients currently on cotrimoxazole 4572 Patients currently on fluconazole 41 Total Adults on ART 3554 Total Children on ART % ART Intitiation by WHO stage 28.8% BLOOD SAFETY Blood units collected from RBTC 1176 Number of blood units transfused 946 Linkage to care: Positive test to enrollment 98.6% stagei stage II 12.4% stage III 3.5% stage IV 34.5% 34.8% 15.5% 7.2% PMTCT VCT TB Ward overall

83 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 More findings Distribution 30% 82% 91% 66% 53% 19% 54% 26% 40% 36% 24% 27% 52% 21% 30% 65% 5% Blood units collected from RBTC blood units collected from elsewhere KEY FINDINGS AND PRIORITIES Blood safety Summary Overall HIV prevalence in the county is 5.1%, with a higher prevalence among those aged 25 to 49 years at (6.6%). This translates to 00 people living with HIV in this county of which (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 83.9%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 3.9% with a higher positivity of 31.4% among those with TB infection. Only about 34.8% were linked to HIV care and treatment services within the county with better linkages (98.6%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 97.7%, for those found to be positive maternal and infant prophylaxis was provided for 67.4% and 41.6% respectively. Only about 3.8% of ANC women had their partners tested for HIV and only 57.8% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 45.1% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 2.7% Total number of clients on treatment as at the end of 2011 in this county was 4,136 including 582 children, this translates to a treatment coverage of 3% for adults and % for children 0% 100% Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Strengthen retention to ANC up to fourth visit, Elimination of mother to Child transmission of HIV. Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. ART uptake among adults and children infected with HIV Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence *The proportion of HIV positive people enrolled to care is greater than 100% of those testing HIV Positive in 2011 because of poor linkage to care. This results to enrolment to care of people who tested positive in previous years

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85 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT* Uptake of PMTCT among eligible mothers* Uptake of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 178,100 16, ,600 8% 11,600 1,680 13,280 13% 6,300 75, ,000 7,260 87,300 13% 14% 87% 49% SERVICE COVERAGE Service Coverage (%) Number Proportion 6, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 95.4% 99.2% 94.8% 86.9% 6.0% 5.9% 6.1% 11.6% 6.2% 6.6% 9.4% 8.2% PMTCT uptake cascade 94.8% 82.8% 67.1% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test 60.8% 93.4% 85.8% 30.0% 72.7% 8.1% Overall PMTCT cascade ENROLLMENT TO CARE & TREATMENT stagei stage II stage III stage IV Proportion of eligible Clients started on ART Proportion of new HIV positive enrolled to care 29.3% 38.7% 26.2% 5.7% 76.3% 106.2% MTCT rates at 1st Test 8.1% Overall Prophylaxis for HIV exposed infants 72.7% Proportion of HIV +ve women delivering in hospital 30.0% Overal maternal prophylaxis 85.8% Overall PMTCT test acceptance rate 93.4% Proportion of mothers attending 4 ANC visits 60.8%

86 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 7473 Number of ANC clients attending 4 visits Genital Ulcer Disease 3182 ANC clients counseled for HIV Opthalmia neonatorium 1063 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 7798 Syphillis Serology 3865 ANC +ve Clients given prophylaxis 6460 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 2931 Infants given prophylaxis 5232 TBHIV Partners of ANC clients counselled for HIV 8563 TB patients tested for HIV Partners of ANC clients tested for HIV 7586 TB patients testing HIV positive 5618 Partners of ANC clients HIV Positive 715 TB HIV patient on Cotrim 7491 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity Clients Counselled in VCT Women Tested for HIV in maternity Clients tested for HIV in VCT Women found HIV Positive in maternity 1596 VCT clients found HIV Positive Women issued prophylaxis in maternity 1596 Couples counselled in VCT Deliveries from HIV +ve women 2818 Couples tested for HIV in VCT Maternity Women started on Cotrimoxazole 1719 VCT couples both HIV positive 1222 Infants started on Cotrimoxazole 1045 Discordant couples in VCT 1301 Infants given prophylaxis in maternity 1596 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled DTC outpatient counselled DTC inpatient tested DTC outpatient tested DTC inpatient HIV Positive 1943 DTC Outpatient found HIV Positive Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 67% 7% 19% 3% 4% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 4088 Enrollement for HIV care from VCT Enrollment into HIV care from TB clinic 1564 Enrollment into HIV care from hospital wards 2322 Enrollement into HIV care from MCHChild 526 Enrollment into HIV care from other settings Total clients enrolled for HIV care WHO stagei 6067 WHO stage II 8008 WHO stage III 5419 WHO stage IV 1185 Total number of clients starting ART Pregnant women currently on ARVs 1626 All others currently on ARVs Clients enrolled, eligible but not on ART 9715 Clients put on PEP due to Sexual assault 6464 Clients put on PEP due to occupational exposure 397 Patients currently on cotrimoxazole Patients currently on fluconazole 8689 Total Adults on ART Total Children on ART 5930 ART Intitiation by WHO stage 38.7% BLOOD SAFETY Blood units collected from RBTC 6850 Number of blood units transfused % 26.2% Linkage to care: Positive test to enrollment 64.3% 5.7% 40.4% 27.8% 12.6% 37.5% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

87 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 52% 96% 85% 65% 55% 4% 3% 6% 22% 38% 40% 1% 4% 96% 29% 66% 5% Blood units collected from RBTC blood units collected from elsewhere Blood safety 27% 73% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 8.6%, with a higher prevalence among those aged 25 to 49 years at 11.4%. This translates to 194,600 people living with HIV in this county of which 16,500 (8%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 60%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 8.2% with a higher positivity of 45.8% among those with TB infection. Only about 37.5% were linked to HIV care and treatment services within the county with better linkages (64.3.6%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 93.4%, for those found to be positive maternal and infant prophylaxis was provided for 85.8% and 72.7% respectively. Only about 6.0% of ANC women had their partners tested for HIV and 60.8% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 30% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 8.1% Total number of clients on treatment as at the end of 2011 in this county was 66,392 including 5930 children, this translates to a treatment coverage of 9% for adults and 78% for children Priority Areas for the County Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Elimination of vertical transmission of HIV Strengthen partner testing in ANC Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase uptake of ART among infected adults Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence *The proportion of HIV positive people enrolled to care is greater than 100% of those testing HIV Positive in 2011 because of poor linkage to care. This results to enrolment to care of people who tested positive in previous years. *The PMTCT service coverage is greater than the eligible population due to the dynamic population of Nairobi that makes eligible population to change as people move in and out of the city. to seek HIV related services from Nairobi.

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89 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants ADULTS 8, ,700 23% SERVICE COVERAGE CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 1,700 10,300 17% % % 1,200 4,900 24% 5% Service Coverage (%) Number Proportion % % 75 13% 55 10% SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 97.8% 85.2% 95.8% 97.6% 7.8% 0.9% 0.6% 0.3% 0.5% 1.1% 0.9% 0.6% PMTCT uptake cascade 95.8% 46.8% 14.5% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 40.2% stagei 96.2% stage II 68.2% stage III 41.8% stage IV 50.0% Proportion of eligible Clients started on ART 8.3% Proportion of new HIV positive enrolled to care Overall PMTCT cascade 13.2% 30.2% 52.2% 4.4% 93.6% 85.1% MTCT rates at 1st Test 8.3% Overall Prophylaxis for HIV exposed infants 50.0% Proportion of HIV +ve women delivering in hospital 41.8% Overal maternal prophylaxis 68.2% Overall PMTCT test acceptance rate 96.2% Proportion of mothers attending 4 ANC visits 40.2%

90 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 473 Number of ANC clients attending 4 visits 5256 Genital Ulcer Disease 88 ANC clients counseled for HIV Opthalmia neonatorium 23 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 62 Syphillis Serology 23 ANC +ve Clients given prophylaxis 29 ANC Clients tested for syphilis 8165 Infants tested for HIV at 6 weeks 15 Infants given prophylaxis 9 TBHIV Partners of ANC clients counselled for HIV 1087 TB patients tested for HIV 716 Partners of ANC clients tested for HIV 1032 TB patients testing HIV positive 64 Partners of ANC clients HIV Positive 9 TB HIV patient on Cotrim 51 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 4408 Clients Counselled in VCT Women Tested for HIV in maternity 4302 Clients tested for HIV in VCT Women found HIV Positive in maternity 48 VCT clients found HIV Positive 341 Women issued prophylaxis in maternity 46 Couples counselled in VCT 1456 Deliveries from HIV +ve women 46 Couples tested for HIV in VCT 1433 Maternity Women started on Cotrimoxazole 24 VCT couples both HIV positive 2 Infants started on Cotrimoxazole 23 Discordant couples in VCT 8 Infants given prophylaxis in maternity 46 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled 2927 DTC outpatient counselled DTC inpatient tested 1866 DTC outpatient tested DTC inpatient HIV Positive 61 DTC Outpatient found HIV Positive 53 43% Enrollment to CCC by entry point 8% 38% 8% 3% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 43 Enrollement for HIV care from VCT 206 Enrollment into HIV care from TB clinic 14 Enrollment into HIV care from hospital wards 44 Enrollement into HIV care from MCHChild 1 Enrollment into HIV care from other settings 235 Total clients enrolled for HIV care 543 WHO stagei 21 WHO stage II 48 WHO stage III 83 WHO stage IV 7 Total number of clients starting ART 159 Pregnant women currently on ARVs 19 All others currently on ARVs 909 Clients enrolled, eligible but not on ART 9 Clients put on PEP due to Sexual assault 36 Clients put on PEP due to occupational exposure 9 Patients currently on cotrimoxazole 350 Patients currently on fluconazole 7 Total Adults on ART 845 Total Children on ART 64 ART Intitiation by WHO stage 52.2% BLOOD SAFETY Blood units collected from RBTC 207 Number of blood units transfused 760 Linkage to care: Positive test to enrollment 13.2% 30.2% 4.4% 36.1% 60.4% 21.9% 38.6% 48.1% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

91 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 18% 53% 96% 28% 72% 13% 15% 26% 32% 42% 68% 12% 20% 30% 68% 2% Blood units collected from RBTC blood units collected from elsewhere Blood safety 73% 27% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 1.7%, with a higher prevalence among those aged 25 to 49 years at (2%). This translates to 10,300 people living with HIV in this county of which 1700 (17%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 71.2%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 0.6% with a higher positivity of 8.9% among those with TB infection. Only about 48.1% were linked to HIV care and treatment services within the county with better linkages (60.4%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 96.2%, for those found to be positive maternal and infant prophylaxis was provided for 68.2% and 50% respectively. Only about 7.8% of ANC women had their partners tested for HIV and only 40.2% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 41.8% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 8.3% Total number of clients on treatment as at the end of 2011 in this county was 4,136 including 582 children, this translates to a treatment coverage of 34% for adults and 22% for children Priority Areas for the County IIncrease the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Strengthen Partner testing and retention to 4th ANC Elimination of vertical transmission of HIV Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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93 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 6,400 1,300 7,700 17% % 200 2, ,600 26% 25% 4% 0.8% SERVICE COVERAGE Service Coverage (%) Number Proportion % 19 4% 9 2% 0 0% SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 94.2% 96.2% 100.0% 98.3% 5.3% 0.4% 0.0% 0.2% 0.2% 0.2% 2.1% 0.3% PMTCT uptake cascade 100.0% 30.8% 0.0% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test 39.1% 99.4% 47.4% 26.3% 0.0% 0.0% Overall PMTCT cascade ENROLLMENT TO CARE & TREATMENT stagei stage II stage III stage IV Proportion of eligible Clients started on ART Proportion of new HIV positive enrolled to care 0.0% 6.7% 90.0% 3.3% 126.3% MTCT rates at 1st Test Overall Prophylaxis for HIV exposed infants 0.0% Proportion of HIV +ve women delivering in hospital 26.3% Overal maternal prophylaxis 47.4% Overall PMTCT test acceptance rate 99.4% Proportion of mothers attending 4 ANC visits 39.1%

94 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients 6442 Urethral Discharge 141 Number of ANC clients attending 4 visits 2516 Genital Ulcer Disease 50 ANC clients counseled for HIV 6224 Opthalmia neonatorium 29 ANC clients tested for HIV 6224 STI SCREENING ANC clients found HIV positive 13 Syphillis Serology 6 ANC +ve Clients given prophylaxis 4 ANC Clients tested for syphilis 2080 Infants tested for HIV at 6 weeks 1 Infants given prophylaxis 0 TBHIV Partners of ANC clients counselled for HIV 359 TB patients tested for HIV 452 Partners of ANC clients tested for HIV 328 TB patients testing HIV positive 14 Partners of ANC clients HIV Positive 7 TB HIV patient on Cotrim 13 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 3555 Clients Counselled in VCT 9952 Women Tested for HIV in maternity 3495 Clients tested for HIV in VCT 9371 Women found HIV Positive in maternity 6 VCT clients found HIV Positive 42 Women issued prophylaxis in maternity 5 Couples counselled in VCT 5113 Deliveries from HIV +ve women 5 Couples tested for HIV in VCT 4787 Maternity Women started on Cotrimoxazole 63 VCT couples both HIV positive 4 Infants started on Cotrimoxazole 3 Discordant couples in VCT 0 Infants given prophylaxis in maternity 0 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled 1675 DTC outpatient counselled DTC inpatient tested 1567 DTC outpatient tested DTC inpatient HIV Positive 10 DTC Outpatient found HIV Positive 26 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 64% 5% 24% 5% 2% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 8 Enrollement for HIV care from VCT 37 Enrollment into HIV care from TB clinic 8 Enrollment into HIV care from hospital wards 4 Enrollement into HIV care from MCHChild 3 Enrollment into HIV care from other settings 97 Total clients enrolled for HIV care 157 WHO stagei 0 WHO stage II 2 WHO stage III 27 WHO stage IV 1 Total number of clients starting ART 30 Pregnant women currently on ARVs 0 All others currently on ARVs 119 Clients enrolled, eligible but not on ART 5 Clients put on PEP due to Sexual assault 7 Clients put on PEP due to occupational exposure 3 Patients currently on cotrimoxazole 180 Patients currently on fluconazole 0 Total Adults on ART 112 Total Children on ART 7 ART Intitiation by WHO stage 90.0% BLOOD SAFETY Blood units collected from RBTC Number of blood units transfused 127 Linkage to care: Positive test to enrollment 88.1% 0.0% stagei 6.7% stage II stage III 3.3% stage IV 57.1% 48.3% 30.8% 11.1% PMTCT VCT TB Ward overall

95 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 19% 38% 99% 30% 76% 17% 7% 29% 35% 36% 73% 19% 7% 34% 62% 4% Blood units collected from RBTC blood units collected from elsewhere Blood safety 0% 100% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 1.3%, with a higher prevalence among those aged 15 to 24 years at 1.9%. This translates to 7,700 people living with HIV in this county of which 1300 (17%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 58.8%. This is fairly low representing about half of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 0.3% with a higher positivity of 3.1% among those with TB infection. Only about 48.3% were linked to HIV care and treatment services within the county with better linkages (88.1%) among those testing within VCT settings followed by TB/HIV at 57%. HIV testing acceptance rate among pregnant women was high at 99.4%, for those found to be positive maternal and infant prophylaxis was provided for 47.4% and 26.3% respectively. Only about 5. 3% of ANC women had their partners tested for HIV and only 39.1% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 26.3% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 0% Total number of clients on treatment as at the end of 2011 in this county was 112 including 7 children, this translates to a treatment coverage of 4% for adults and 0.8% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence *The proportion of HIV positive people enrolled to care is greater than 100% of those testing HIV Positive in 2011 because of poor linkage to care. This results to enrolment to care of people who tested positive in previous years

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97 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN % % % % 34% 8% SERVICE COVERAGE Service Coverage (%) Number Proportion % 11 21% 7 13% 2 4% SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 98.9% 87.4% 93.8% 96.8% 3.3% 0.5% 0.0% 0.0% 0.1% 0.1% 0.4% 0.2% PMTCT uptake cascade 93.8% 50.0% 0.0% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 43.6% stagei 94.5% stage II 63.6% stage III 27.3% stage IV 18.2% Proportion of eligible Clients started on ART 0.0% Proportion of new HIV positive enrolled to care 11.5% 0.0% 84.6% 3.8% 94.5% 81.9% Overall PMTCT cascade MTCT rates at 1st Test 0.0% Overall Prophylaxis for HIV exposed infants 18.2% Proportion of HIV +ve women delivering in hospital 27.3% Overal maternal prophylaxis 63.6% Overall PMTCT test acceptance rate 94.5% Proportion of mothers attending 4 ANC visits 43.6%

98 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients 7274 Urethral Discharge 147 Number of ANC clients attending 4 visits 3171 Genital Ulcer Disease 29 ANC clients counseled for HIV 7917 Opthalmia neonatorium 2 ANC clients tested for HIV 7427 STI SCREENING ANC clients found HIV positive 8 Syphillis Serology 7 ANC +ve Clients given prophylaxis 4 ANC Clients tested for syphilis 3038 Infants tested for HIV at 6 weeks 0 Infants given prophylaxis 0 TBHIV Partners of ANC clients counselled for HIV 289 TB patients tested for HIV 382 Partners of ANC clients tested for HIV 247 TB patients testing HIV positive 7 Partners of ANC clients HIV Positive 1 TB HIV patient on Cotrim 7 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 2526 Clients Counselled in VCT 9024 Women Tested for HIV in maternity 2446 Clients tested for HIV in VCT 8928 Women found HIV Positive in maternity 3 VCT clients found HIV Positive 44 Women issued prophylaxis in maternity 3 Couples counselled in VCT 3816 Deliveries from HIV +ve women 3 Couples tested for HIV in VCT 3816 Maternity Women started on Cotrimoxazole 2 VCT couples both HIV positive 2 Infants started on Cotrimoxazole 1 Discordant couples in VCT 1 Infants given prophylaxis in maternity 2 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled 1095 DTC outpatient counselled DTC inpatient tested 880 DTC outpatient tested DTC inpatient HIV Positive 1 DTC Outpatient found HIV Positive 8 9% 8% Enrollment to CCC by entry point 7% 12% 64% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 4 Enrollement for HIV care from VCT 38 Enrollment into HIV care from TB clinic 5 Enrollment into HIV care from hospital wards 5 Enrollement into HIV care from MCHChild 0 Enrollment into HIV care from other settings 7 Total clients enrolled for HIV care 59 WHO stagei 3 WHO stage II 0 WHO stage III 22 WHO stage IV 1 Total number of clients starting ART 26 Pregnant women currently on ARVs 2 All others currently on ARVs 109 Clients enrolled, eligible but not on ART 4 Clients put on PEP due to Sexual assault 8 Clients put on PEP due to occupational exposure 4 Patients currently on cotrimoxazole 141 Patients currently on fluconazole 0 Total Adults on ART 101 Total Children on ART 8 ART Intitiation by WHO stage 84.6% BLOOD SAFETY Blood units collected from RBTC 120 Number of blood units transfused 675 Linkage to care: Positive test to enrollment 86.4% 71.4% 55.6% 72.2% 11.5% 0.0% 3.8% 33.3% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

99 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 7% 35% 98% 29% 81% 13% 6% 22% 33% 45% 85% 8% 7% 29% 68% 2% Blood units collected from RBTC blood units collected from elsewhere Blood safety 82% 18% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is could not be estimated with the available sample size, This translates to 800 people living with HIV in this county of which 100 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 65.4%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 0.2% with a higher positivity of 1.8% among those with TB infection. About 72.2% were linked to HIV care and treatment services within the county with better linkages (86.4%) among those testing within VCT settings. TB had linkage to care of 71.4% HIV testing acceptance rate among pregnant women was high at 94.5%, for those found to be positive maternal and infant prophylaxis was provided for 63.6% and 18.2% respectively. Only about 3.3% of ANC women had their partners tested for HIV and only 43.6% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 27.3% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 0% Total number of clients on treatment as at the end of 2011 in this county was 109 including 8 children, this translates to a treatment coverage of 34% for adults and 8% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Strengthen retention to 4th ANC visit Maintain strong linkage to care as clients increase Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART and Adults Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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101 HIV ESTIMATES INDICATOR People Living with HIV PLHIV New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 124,400 22, ,700 15% 8,100 1,170 9,270 13% 4,400 1,300 5,700 23% 52,600 16,100 68,700 23% 58% 17% SERVICE COVERAGE Service Coverage (%) Number Proportion 9, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 98.4% 92.0% 89.8% 83.0% 5.7% 13.6% 17.1% 15.5% 15.9% 21.0% 29.2% 16.3% PMTCT uptake cascade 100.0% 100.0% 89.8% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 35.1% stagei 89.0% stage II 100.0% stage III 42.6% stage IV 100.0% Proportion of eligible Clients started on ART 11.7% Proportion of new HIV positive enrolled to care 43.4% 24.0% 26.2% 6.4% 68.9% 92.6% Overall PMTCT cascade MTCT rates at 1st Test 11.7% Overall Prophylaxis for HIV exposed infants 100.0% Proportion of HIV +ve women delivering in hospital 42.6% Overal maternal prophylaxis 100.0% Overall PMTCT test acceptance rate 89.0% Proportion of mothers attending 4 ANC visits 35.1%

102 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 1776 Number of ANC clients attending 4 visits Genital Ulcer Disease 1999 ANC clients counseled for HIV Opthalmia neonatorium 77 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 4680 Syphillis Serology 780 ANC +ve Clients given prophylaxis 4680 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 2551 Infants given prophylaxis 4680 TBHIV Partners of ANC clients counselled for HIV 1908 TB patients tested for HIV 4234 Partners of ANC clients tested for HIV 1689 TB patients testing HIV positive 3668 Partners of ANC clients HIV Positive 493 TB HIV patient on Cotrim 3576 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 4131 Clients Counselled in VCT Women Tested for HIV in maternity 3430 Clients tested for HIV in VCT Women found HIV Positive in maternity 719 VCT clients found HIV Positive Women issued prophylaxis in maternity 719 Couples counselled in VCT 3754 Deliveries from HIV +ve women 2301 Couples tested for HIV in VCT 3685 Maternity Women started on Cotrimoxazole 849 VCT couples both HIV positive 680 Infants started on Cotrimoxazole 510 Discordant couples in VCT 631 Infants given prophylaxis in maternity 719 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled 7490 DTC outpatient counselled DTC inpatient tested 5437 DTC outpatient tested DTC inpatient HIV Positive 1645 DTC Outpatient found HIV Positive % Enrollment to CCC by entry point 8% 20% 2% 5% PMTCT VCT TB Ward All others ART CARE AND TREATMENT Enrollment for HIV care from PMTCT 3158 Enrollement for HIV care from VCT 7892 Enrollment into HIV care from TB clinic 751 Enrollment into HIV care from hospital wards 1767 Enrollement into HIV care from MCHChild 779 Enrollment into HIV care from other settings Total clients enrolled for HIV care WHO stagei 6120 WHO stage II 3376 WHO stage III 3695 WHO stage IV 904 Total number of clients starting ART Pregnant women currently on ARVs 460 All others currently on ARVs Clients enrolled, eligible but not on ART 1038 Clients put on PEP due to Sexual assault 276 Clients put on PEP due to occupational exposure 68 Patients currently on cotrimoxazole Patients currently on fluconazole 270 Total Clients on ART Total Adults on ART Total Children on ART % ART Intitiation by WHO stage BLOOD SAFETY Blood units collected from RBTC 1723 Number of blood units transfused 2714 Linkage to care: Positive test to enrollment 24.0% 26.2% 53.6% 67.3% stagei stage II stage III 6.4% stage IV 34.8% 20.5% 10.0% PMTCT VCT TB Ward overall

103 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 45% 92% 10% 73% 51% 6% 70% 24% 63% 31% 6% 49% 29% 22% 21% 62% 9% Blood units collected from RBTC blood units collected from elsewhere Blood safety 37% 63% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 25.7%, with a higher prevalence among those aged above 49 years at (34.8%). This translates to 146,700 people living with HIV in this county of which 22,300 (15%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 82.3%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 16.3% with a higher positivity of 86.6% among those with TB infection. Only about 34.8% were linked to HIV care and treatment services within the county with better linkages (67.6%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 89%, for those found to be positive maternal and infant prophylaxis was provided for 100% and 100% respectively. Only about 5.7% of ANC women had their partners tested for HIV and only 35.1% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 42.6% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 11.8% Total number of clients on treatment as at the end of 2011 in this county was 33,028 including 2755 children, this translates to a treatment coverage of 58% for adults and 17% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. HIV testing Retention to 4th ANC visit Elimination of MTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected adults & children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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105 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 60,500 10,800 71,300 15% 3, ,470 13% 2,100 25, ,800 2,730 33,400 23% 23% 45% 15% SERVICE COVERAGE Service Coverage (%) Number Proportion 4, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 88.4% 141.6% 94.2% 90.0% 3.8% 5.1% 3.3% 3.4% 5.0% 6.0% 10.1% 4.4% PMTCT uptake cascade 94.2% 77.4% 70.1% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 39.2% stagei 93.5% stage II 83.2% stage III 26.2% stage IV 80.9% Proportion of eligible Clients started on ART 11.1% Proportion of new HIV positive enrolled to care Overall PMTCT cascade 30.5% 32.8% 26.4% 10.3% 74.1% 96.6% MTCT rates at 1st Test 11.1% Overall Prophylaxis for HIV exposed infants 80.9% Proportion of HIV +ve women delivering in hospital 26.2% Overal maternal prophylaxis 83.2% Overall PMTCT test acceptance rate 93.5% Proportion of mothers attending 4 ANC visits 39.2%

106 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 2500 Number of ANC clients attending 4 visits Genital Ulcer Disease 1842 ANC clients counseled for HIV Opthalmia neonatorium 163 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 1578 Syphillis Serology 810 ANC +ve Clients given prophylaxis 1221 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 659 Infants given prophylaxis 1106 TBHIV Partners of ANC clients counselled for HIV 1481 TB patients tested for HIV 2092 Partners of ANC clients tested for HIV 1214 TB patients testing HIV positive 796 Partners of ANC clients HIV Positive 123 TB HIV patient on Cotrim 829 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 6753 Clients Counselled in VCT Women Tested for HIV in maternity 6081 Clients tested for HIV in VCT Women found HIV Positive in maternity 363 VCT clients found HIV Positive 3040 Women issued prophylaxis in maternity 394 Couples counselled in VCT Deliveries from HIV +ve women 509 Couples tested for HIV in VCT 9764 Maternity Women started on Cotrimoxazole 344 VCT couples both HIV positive 469 Infants started on Cotrimoxazole 89 Discordant couples in VCT 325 Infants given prophylaxis in maternity 464 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled DTC outpatient counselled DTC inpatient tested DTC outpatient tested DTC inpatient HIV Positive 823 DTC Outpatient found HIV Positive % Enrollment to CCC by entry point 11% 23% 2% 1% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 1151 Enrollement for HIV care from VCT 2397 Enrollment into HIV care from TB clinic 259 Enrollment into HIV care from hospital wards 115 Enrollement into HIV care from MCHChild 157 Enrollment into HIV care from other settings 6523 Total clients enrolled for HIV care WHO stagei 1374 WHO stage II 1480 WHO stage III 1192 WHO stage IV 466 Total number of clients starting ART 4512 Pregnant women currently on ARVs 115 All others currently on ARVs Clients enrolled, eligible but not on ART 240 Clients put on PEP due to Sexual assault 367 Clients put on PEP due to occupational exposure 64 Patients currently on cotrimoxazole Patients currently on fluconazole 97 Total Adults on ART Total Children on ART % ART Intitiation by WHO stage 32.8% 26.4% BLOOD SAFETY Blood units collected from RBTC 827 Number of blood units transfused 4294 Linkage to care: Positive test to enrollment 78.8% 10.3% 55.8% 32.5% 35.7% stagei stage II stage III stage IV 2.3% PMTCT VCT TB Ward overall

107 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 29% 95% 99% 74% 43% 4% 51% 46% 41% 39% 19% 46% 37% 17% 31% 65% 4% Blood units collected from RBTC blood units collected from elsewhere Blood safety 81% 19% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 6.2%, with a higher prevalence among those aged 25 to 49 years at (7.4%). This translates to 71,300 people living with HIV in this county of which 10,800 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 82.3%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 4.4% with a higher positivity of 38% among those with TB infection. Only about 35.7% were linked to HIV care and treatment services within the county with better linkages (78.8%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 93.5%, for those found to be positive maternal and infant prophylaxis was provided for 83.2% and 80.9% respectively. Only about 3.8% of ANC women had their partners tested for HIV and only 39.2% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 26.2% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 2.7% Total number of clients on treatment as at the end of 2011 in this county was 12,009 including 1135 children, this translates to a treatment coverage of 45% for adults and 15% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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109 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 93,700 16, ,500 15% 6, ,980 13% 3, ,280 23% 40,398 12,100 52,498 23% 109% 37% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Uptake of PMTCT among eligible mothers Uptake of PMTCT among eligible infants Service Coverage (%) Number Proportion 7, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 31.5% 89.7% 96.1% 88.3% 3.5% 11.4% 14.5% 13.5% 15.1% 18.8% 25.7% 14.3% PMTCT uptake cascade 96.1% 84.5% 84.5% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 40.7% stagei 87.7% stage II 87.8% stage III 42.6% stage IV 87.8% Proportion of eligible Clients started on ART 13.6% Proportion of new HIV positive enrolled to care Overall PMTCT cascade 50.4% 26.0% 18.9% 4.7% 59.1% 61.5% MTCT rates at 1st Test 13.6% Overall Prophylaxis for HIV exposed infants 87.8% Proportion of HIV +ve women delivering in hospital 42.6% Overal maternal prophylaxis 87.8% Overall PMTCT test acceptance rate 87.7% Proportion of mothers attending 4 ANC visits 40.7%

110 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 2722 Number of ANC clients attending 4 visits Genital Ulcer Disease 2329 ANC clients counseled for HIV Opthalmia neonatorium 151 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 5712 Syphillis Serology 810 ANC +ve Clients given prophylaxis 4827 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 2926 Infants given prophylaxis 4827 TBHIV Partners of ANC clients counselled for HIV 1886 TB patients tested for HIV 4406 Partners of ANC clients tested for HIV 1304 TB patients testing HIV positive 3506 Partners of ANC clients HIV Positive 335 TB HIV patient on Cotrim 3016 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 9242 Clients Counselled in VCT Women Tested for HIV in maternity 8158 Clients tested for HIV in VCT Women found HIV Positive in maternity 1535 VCT clients found HIV Positive Women issued prophylaxis in maternity 1535 Couples counselled in VCT 4546 Deliveries from HIV +ve women 3090 Couples tested for HIV in VCT 4227 Maternity Women started on Cotrimoxazole 830 VCT couples both HIV positive 352 Infants started on Cotrimoxazole 476 Discordant couples in VCT 613 Infants given prophylaxis in maternity 1535 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled DTC outpatient counselled DTC inpatient tested DTC outpatient tested DTC inpatient HIV Positive 3117 DTC Outpatient found HIV Positive % Enrollment to CCC by entry point 11% 34% 3% 2% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 3057 Enrollement for HIV care from VCT 9170 Enrollment into HIV care from TB clinic 411 Enrollment into HIV care from hospital wards 680 Enrollement into HIV care from MCHChild 375 Enrollment into HIV care from other settings Total clients enrolled for HIV care 0 WHO stagei 9214 WHO stage II 4758 WHO stage III 3454 WHO stage IV 862 Total number of clients starting ART Pregnant women currently on ARVs 727 All others currently on ARVs Clients enrolled, eligible but not on ART 3626 Clients put on PEP due to Sexual assault 1222 Clients put on PEP due to occupational exposure 323 Patients currently on cotrimoxazole Patients currently on fluconazole 156 Total Adults on ART Total Children on ART % stagei ART Intitiation by WHO stage 26.0% stage II 18.9% stage III 4.7% stage IV BLOOD SAFETY Blood units collected from RBTC 6328 Number of blood units transfused % Linkage to care: Positive test to enrollment 90.4% 11.7% 3.1% 30.9% PMTCT VCT TB Ward overall

111 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 49% 93% 27% 69% 56% 4% 62% 34% 48% 36% 16% 31% 33% 36% 27% 66% 7% Blood units collected from RBTC blood units collected from elsewhere Blood safety 0% 100% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 18.1%, with a higher prevalence among those aged above49 years at (24.7%). This translates to 110,500 people living with HIV in this county of which 16,800 (15%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 83%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was1 4.3% with a higher positivity of 79.6% among those with TB infection. Only about 30.9% were linked to HIV care and treatment services within the county with better linkages (90.4%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 87.7%, for those found to be positive maternal and infant prophylaxis was provided for 87.8% and 87.8% respectively. Only about 3.5% of ANC women had their partners tested for HIV and only 40.7% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 42.6% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 13.6% Total number of clients on treatment as at the end of 2011 in this county was 48,534 including 4,518 children, this translates to a treatment coverage of 109% for adults and 37% for children Priority Areas for the County Increase test acceptance in PMTCT Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission should be given high priority Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence *The ART coverage and testing for PMTCT is higher than eligible population. This is possibly because being a City, Non resident clients from other counties seek HIV services from this county from sorrounding counties.

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113 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 56,900 10,200 67,100 15% 3, ,240 13% 2,000 24, ,400 2,590 31,500 23% 23% 70% 31% SERVICE COVERAGE Service Coverage (%) Number Proportion 4, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 96.4% 89.4% 95.3% 88.2% 10.5% 13.8% 10.3% 12.3% 12.3% 14.7% 18.8% 14.1% PMTCT uptake cascade 95.3% 92.6% 85.1% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 43.1% stagei 90.5% stage II 94.0% stage III 33.0% stage IV 88.0% Proportion of eligible Clients started on ART 10.6% Proportion of new HIV positive enrolled to care Overall PMTCT cascade 25.9% 50.4% 19.7% 4.0% 72.7% 63.4% MTCT rates at 1st Test 10.6% Overall Prophylaxis for HIV exposed infants 88.0% Proportion of HIV +ve women delivering in hospital 33.0% Overal maternal prophylaxis 94.0% Overall PMTCT test acceptance rate 90.5% Proportion of mothers attending 4 ANC visits 43.1%

114 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 2781 Number of ANC clients attending 4 visits Genital Ulcer Disease 2289 ANC clients counseled for HIV Opthalmia neonatorium 285 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 4102 Syphillis Serology 1516 ANC +ve Clients given prophylaxis 3797 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 1878 Infants given prophylaxis 3492 TBHIV Partners of ANC clients counselled for HIV 3776 TB patients tested for HIV 4005 Partners of ANC clients tested for HIV 3479 TB patients testing HIV positive 3070 Partners of ANC clients HIV Positive 655 TB HIV patient on Cotrim 2835 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 7687 Clients Counselled in VCT Women Tested for HIV in maternity 6779 Clients tested for HIV in VCT Women found HIV Positive in maternity 994 VCT clients found HIV Positive 4679 Women issued prophylaxis in maternity 994 Couples counselled in VCT 3171 Deliveries from HIV +ve women 1681 Couples tested for HIV in VCT 2823 Maternity Women started on Cotrimoxazole 787 VCT couples both HIV positive 465 Infants started on Cotrimoxazole 392 Discordant couples in VCT 290 Infants given prophylaxis in maternity 994 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled 7520 DTC outpatient counselled DTC inpatient tested 7937 DTC outpatient tested DTC inpatient HIV Positive 1807 DTC Outpatient found HIV Positive % Enrollment to CCC by entry point 10% 37% 2% 2% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 1775 Enrollement for HIV care from VCT 6505 Enrollment into HIV care from TB clinic 317 Enrollment into HIV care from hospital wards 241 Enrollement into HIV care from MCHChild 703 Enrollment into HIV care from other settings 7908 Total clients enrolled for HIV care 0 WHO stagei 3313 WHO stage II 6460 WHO stage III 2527 WHO stage IV 507 Total number of clients starting ART 0 Pregnant women currently on ARVs 265 All others currently on ARVs Clients enrolled, eligible but not on ART 850 Clients put on PEP due to Sexual assault 223 Clients put on PEP due to occupational exposure 426 Patients currently on cotrimoxazole Patients currently on fluconazole 533 Total Adults on ART Total Children on ART % ART Intitiation by WHO stage 50.4% 19.7% BLOOD SAFETY Blood units collected from RBTC 1602 Number of blood units transfused 2562 Linkage to care: Positive test to enrollment 139.0% stagei stage II stage III 4.0% stage IV 30.9% 32.1% 10.3% 1.7% PMTCT VCT TB Ward overall

115 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 38% 89% 42% 76% 53% 5% 73% 22% 52% 35% 13% 50% 34% 16% 18% 69% 13% Blood units collected from RBTC blood units collected from elsewhere Blood safety 37% 63% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 17.2%, with a higher prevalence among those aged 25 to 49 years at (25%). This translates to 67,100 people living with HIV in this county of which 10,800 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 83%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 14.1% with a higher positivity of 76.7% among those with TB infection. Only about 32.1% were linked to HIV care and treatment services within the county with better linkages (139%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 90.5%, for those found to be positive maternal and infant prophylaxis was provided for 94% and 88% respectively. Only about 10.5% of ANC women had their partners tested for HIV and only 43.1% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 33% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 10.6% Total number of clients on treatment as at the end of 2011 in this county was 19,228 including 2262 children, this translates to a treatment coverage of 70% for adults and 31% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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117 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 14,100 2,500 16,600 15% ,030 13% % 6,000 1,800 7,800 23% 85% 22% SERVICE COVERAGE Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 95.2% 87.9% 97.7% 88.5% 6.9% 3.4% 4.2% 3.8% 4.9% 6.3% 6.2% 4.2% PMTCT uptake cascade 97.7% 81.0% 81.0% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test 35.6% 92.0% 83.6% 28.7% 47.9% 13.5% ENROLLMENT TO CARE & TREATMENT stagei stage II stage III stage IV Proportion of eligible Clients started on ART Proportion of new HIV positive enrolled to care Overall PMTCT cascade 36.3% 25.0% 35.1% 3.6% 71.8% 113.0% MTCT rates at 1st Test 13.5% Overall Prophylaxis for HIV exposed infants 83.6% Proportion of HIV +ve women delivering in hospital 28.7% Overal maternal prophylaxis 83.6% Overall PMTCT test acceptance rate 92.0% Proportion of mothers attending 4 ANC visits 35.6%

118 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 1424 Number of ANC clients attending 4 visits 6296 Genital Ulcer Disease 904 ANC clients counseled for HIV Opthalmia neonatorium 41 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 840 Syphillis Serology 260 ANC +ve Clients given prophylaxis 680 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 374 Infants given prophylaxis 680 TBHIV Partners of ANC clients counselled for HIV 1234 TB patients tested for HIV 909 Partners of ANC clients tested for HIV 1201 TB patients testing HIV positive 419 Partners of ANC clients HIV Positive 74 TB HIV patient on Cotrim 439 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 2403 Clients Counselled in VCT Women Tested for HIV in maternity 2126 Clients tested for HIV in VCT Women found HIV Positive in maternity 134 VCT clients found HIV Positive 905 Women issued prophylaxis in maternity 134 Couples counselled in VCT 2607 Deliveries from HIV +ve women 280 Couples tested for HIV in VCT 2582 Maternity Women started on Cotrimoxazole 151 VCT couples both HIV positive 67 Infants started on Cotrimoxazole 89 Discordant couples in VCT 108 Infants given prophylaxis in maternity 134 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled 3885 DTC outpatient counselled DTC inpatient tested 4028 DTC outpatient tested DTC inpatient HIV Positive 343 DTC Outpatient found HIV Positive % Enrollment to CCC by entry point 6% 13% 2% 3% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 401 Enrollement for HIV care from VCT 901 Enrollment into HIV care from TB clinic 154 Enrollment into HIV care from hospital wards 231 Enrollement into HIV care from MCHChild 92 Enrollment into HIV care from other settings 5170 Total clients enrolled for HIV care 0 WHO stagei 664 WHO stage II 457 WHO stage III 641 WHO stage IV 66 Total number of clients starting ART 0 Pregnant women currently on ARVs 64 All others currently on ARVs 5525 Clients enrolled, eligible but not on ART 137 Clients put on PEP due to Sexual assault 146 Clients put on PEP due to occupational exposure 23 Patients currently on cotrimoxazole Patients currently on fluconazole 7 Total Adults on ART 5128 Total Children on ART % ART Intitiation by WHO stage 35.1% BLOOD SAFETY Blood units collected from RBTC 470 Number of blood units transfused % Linkage to care: Positive test to enrollment 99.6% stagei stage II stage III 3.6% stage IV 38.3% 36.8% 29.1% 6.7% PMTCT VCT TB Ward overall

119 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 33% 97% 98% 76% 44% 2% 45% 53% 39% 42% 19% 41% 43% 16% 32% 66% 3% Blood units collected from RBTC blood units collected from elsewhere Blood safety 7% 93% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 6.9%, with a higher prevalence among those aged 25 to 49 years at 7.6%. This translates to 67,100 people living with HIV in this county of which 10,800 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 85%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 4.2% with a higher positivity of 46.1% among those with TB infection. Only about 29.1% were linked to HIV care and treatment services within the county with better linkages (99.6%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 90.5%, for those found to be positive maternal and infant prophylaxis was provided for 94% and 88% respectively. Only about 10.5% of ANC women had their partners tested for HIV and only 43.1% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 33% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 10.6% Total number of clients on treatment as at the end of 2011 in this county was 5,525 including 397 children, this translates to a treatment coverage of 76% for adults and 22% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence *The proportion of HIV positive people enrolled to care is greater than 100% of those testing HIV Positive in 2011 because of poor linkage to care. This results to enrolment to care of people who tested positive in previous years

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121 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage Among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 83,200 14,900 98,100 15% % % % % 23% SERVICE COVERAGE Service Coverage (%) Number Proportion % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 98.1% 90.0% 99.4% 83.8% 4.5% 14.1% 13.4% 15.8% 17.1% 23.3% 28.1% 17.6% PMTCT uptake cascade 100.0% 100.0% 99.4% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 42.8% stagei 86.4% stage II 100.0% stage III 41.3% stage IV 100.0% Proportion of eligible Clients started on ART 11.8% Proportion of new HIV positive enrolled to care Overall PMTCT cascade 26.0% 40.4% 29.1% 4.5% 76.4% 74.5% MTCT rates at 1st Test 11.8% Overall Prophylaxis for HIV exposed infants 100.0% Proportion of HIV +ve women delivering in hospital 41.3% Overal maternal prophylaxis 100.0% Overall PMTCT test acceptance rate 86.4% Proportion of mothers attending 4 ANC visits 42.8%

122 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 1537 Number of ANC clients attending 4 visits Genital Ulcer Disease 1800 ANC clients counseled for HIV Opthalmia neonatorium 91 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 5036 Syphillis Serology 517 ANC +ve Clients given prophylaxis 5036 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 3057 Infants given prophylaxis 5036 TBHIV Partners of ANC clients counselled for HIV 1469 TB patients tested for HIV 4886 Partners of ANC clients tested for HIV 1333 TB patients testing HIV positive 4121 Partners of ANC clients HIV Positive 374 TB HIV patient on Cotrim 4040 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 6051 Clients Counselled in VCT Women Tested for HIV in maternity 5073 Clients tested for HIV in VCT Women found HIV Positive in maternity 1180 VCT clients found HIV Positive 5503 Women issued prophylaxis in maternity 1180 Couples counselled in VCT 3177 Deliveries from HIV +ve women 2569 Couples tested for HIV in VCT 3047 Maternity Women started on Cotrimoxazole 991 VCT couples both HIV positive 457 Infants started on Cotrimoxazole 501 Discordant couples in VCT 409 Infants given prophylaxis in maternity 1180 HTC (Diagnostic HTC in Patient) HTC (Diagnostic HTC Outpatient) DTC inpatient counselled DTC outpatient counselled DTC inpatient tested 9715 DTC outpatient tested DTC inpatient HIV Positive 1492 DTC Outpatient found HIV Positive Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 61% 11% 2% 2% 24% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 2918 Enrollement for HIV care from VCT 6232 Enrollment into HIV care from TB clinic 549 Enrollment into HIV care from hospital wards 437 Enrollement into HIV care from MCHChild 455 Enrollment into HIV care from other settings Total clients enrolled for HIV care 0 WHO stagei 3130 WHO stage II 4864 WHO stage III 3497 WHO stage IV 545 Total number of clients starting ART 0 Pregnant women currently on ARVs 466 All others currently on ARVs Clients enrolled, eligible but not on ART 378 Clients put on PEP due to Sexual assault 169 Clients put on PEP due to occupational exposure 90 Patients currently on cotrimoxazole Patients currently on fluconazole 174 Total Adults on ART Total Children on ART 2778 ART Intitiation by WHO stage 40.4% BLOOD SAFETY BLOOD SAFETY 2214 Number of blood units transfused % 29.1% Linkage to care: Positive test to enrollment 113.2% stagei stage II stage III 4.5% stage IV 44.3% 28.7% 13.3% 2.3% PMTCT VCT TB Ward overall

123 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 20% 90% 82% 65% 15% 58% 27% 40% 35% 25% 56% 35% 8% 35% 62% 3% Blood units collected from RBTC blood units collected from elsewhere Blood safety 2% 98% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 19.5%, with a higher prevalence among those aged 25 to 49 years at (28.9%). This translates to 98,100 people living with HIV in this county of which 14,900 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 82.3%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 17.6% with a higher positivity of 84.3% among those with TB infection. Only about 28.7% were linked to HIV care and treatment services within the county with better linkages (113.2%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 86.4%, for those found to be positive maternal and infant prophylaxis was provided for 100% and 100% respectively. Only about 10.5% of ANC women had their partners tested for HIV and only 42.8% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 41.3% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 11.8% Total number of clients on treatment as at the end of 2011 in this county was 31,747 including 2,778 children, this translates to a treatment coverage of 82% for adults and 26% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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125 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 11,400 1,800 13,200 14% % 400 4, , ,100 20% 21% 25% 14% SERVICE COVERAGE Service Coverage (%) Number Proportion % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 90.1% 85.6% 92.3% 94.2% 2.1% 2.9% 1.0% 2.2% 2.9% 1.7% 7.8% 2.9% PMTCT uptake cascade 92.3% 32.3% 24.5% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 40.5% stagei 92.7% stage II 41.1% stage III 15.5% stage IV 34.2% Proportion of eligible Clients started on ART 10.3% Proportion of new HIV positive enrolled to care 31.9% 27.2% 36.3% 4.6% 75.1% 46.4% Overall PMTCT cascade MTCT rates at 1st Test 10.3% Overall Prophylaxis for HIV exposed infants 34.2% Proportion of HIV +ve women delivering in hospital 15.5% Overal maternal prophylaxis 41.1% Overall PMTCT test acceptance rate 92.7% Proportion of mothers attending 4 ANC visits 40.5%

126 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 766 Number of ANC clients attending 4 visits 5782 Genital Ulcer Disease initial Visit 171 ANC clients counseled for HIV Opthalmia neonatorium first visits 54 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 400 Syphillis Serology 137 ANC +ve Clients given prophylaxis 129 ANC Clients tested for syphilis 6897 Infants tested for HIV at 6 weeks 193 Infants given prophylaxis 98 TBHIV Partners of ANC clients counselled for HIV 395 TB patients tested for HIV 897 Partners of ANC clients tested for HIV 293 TB patients tested HIV positive 332 Partners of ANC clients HIV Positive 23 TB HIV patient on Cotrimoxazole 297 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 3968 Clients Counselled in VCT Women Tested for HIV in maternity 3737 Clients tested for HIV in VCT Women found HIV Positive in maternity 65 VCT clients HIV Positive 499 Women issued prophylaxis in maternity 62 Couples counselled in VCT 2367 Deliveries from HIV +ve women 72 Couples tested for HIV in VCT 2335 Maternity Women started on Cotrimoxazole 50 VCT couples both HIV positive 48 Infants started on Cotrimoxazole 26 Discordant couples in VCT 23 Infants given prophylaxis in maternity 61 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 5111 DTC outpatient counselled DTC inpatient tested 4204 DTC outpatient tested DTC inpatient HIV Positive 162 DTC Outpatient HIV Positive 829 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 47% 10% 14% 4% 25% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 148 Enrollement for HIV care from VCT 272 Enrollment into HIV care from TB clinic Enrollment into HIV care from hospital wards Enrollement into HIV care from MCHChild 21 Enrollment into HIV care from other settings 483 Total clients enrolled for HIV care WHO stagei WHO stage II 160 WHO stage III 214 WHO stage IV 27 Total number of clients starting ART 589 Pregnant women currently on ARVs 21 All others currently on ARVs 1359 Clients enrolled, eligible but not on ART 42 Clients put on PEP due to Sexual assault 78 Clients put on PEP due to occupational exposure 16 Patients currently on cotrimoxazole 1543 Patients currently on fluconazole 6 Total Adults on ART 1178 Total Children on ART % ART Intitiation by WHO stage 27.2% 36.3% BLOOD SAFETY Blood units collected from RBTC 1005 Number of blood units transfused 1049 Linkage to care: Positive test to enrollment 54.5% 4.6% 30.3% 13.3% 10.5% 24.6% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

127 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 27% 90% 98% 65% 48% 5% 61% 34% 28% 47% 25% 43% 39% 18% 34% 63% 4% Blood units collected from RBTC blood units collected from elsewhere Blood safety 4% 96% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 4.2%, with a higher prevalence among those aged 25 to 49 years at (4.3%). This translates to 13,200 people living with HIV in this county of which 1800 (14%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 74.7%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 2.9% with a higher positivity of 37% among those with TB infection. Only about 24.6% were linked to HIV care and treatment services within the county with better linkages (54.5%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 92.7%, for those found to be positive maternal and infant prophylaxis was provided for 41.1% and 34.2% respectively. Only about 2.1% of ANC women had their partners tested for HIV and only 40.2% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 15.1% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 10.3% Total number of clients on treatment as at the end of 2011 in this county was 1357 including 181 children, this translates to a treatment coverage of 25% for adults and 14% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Give particular attention to those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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129 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 15,800 2,500 18,300 14% New HIV Infections During the Year 1, ,150 13% HIV related Deaths during the year % PLHIV eligible for ART (Need for ART) 6,700 1,800 8,500 21% ART coverage among PLHIV 50% 21% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 96.1% 88.3% 92.3% 94.0% 5.9% 4.1% 3.6% 4.1% 2.7% 4.0% 4.4% 4.2% PMTCT uptake cascade 92.3% 64.8% 64.5% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 44.6% stagei 92.4% stage II 74.6% stage III 23.3% stage IV 90.8% Proportion of eligible Clients started on ART 8.1% Proportion of new HIV positive enrolled to care* 24.4% 33.8% 35.0% 6.7% 86.8% 116.7% Overall PMTCT cascade MTCT rates at 1st Test 8.1% Overall Prophylaxis for HIV exposed infants 90.8% Proportion of HIV +ve women delivering in hospital 23.3% Overal maternal prophylaxis 74.6% Overall PMTCT test acceptance rate 92.4% Proportion of mothers attending 4 ANC visits 44.6%

130 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 1001 Number of ANC clients attending 4 visits 9793 Genital Ulcer Disease initial Visit 382 ANC clients counseled for HIV Opthalmia neonatorium first visits 43 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 577 Syphillis Serology 146 ANC +ve Clients given prophylaxis 374 ANC Clients tested for syphilis 9910 Infants tested for HIV at 6 weeks 349 Infants given prophylaxis 372 TBHIV Partners of ANC clients counselled for HIV 1440 TB patients tested for HIV 1349 Partners of ANC clients tested for HIV 1270 TB patients tested HIV positive 401 Partners of ANC clients HIV Positive 56 TB HIV patient on Cotrimoxazole 340 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 2037 Clients Counselled in VCT Women Tested for HIV in maternity 1915 Clients tested for HIV in VCT Women found HIV Positive in maternity 76 VCT clients HIV Positive 816 Women issued prophylaxis in maternity 113 Couples counselled in VCT 1337 Deliveries from HIV +ve women 152 Couples tested for HIV in VCT 1299 Maternity Women started on Cotrimoxazole 127 VCT couples both HIV positive 48 Infants started on Cotrimoxazole 74 Discordant couples in VCT 47 Infants given prophylaxis in maternity 138 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 5988 DTC outpatient counselled DTC inpatient tested 6095 DTC outpatient tested DTC inpatient HIV Positive 445 DTC Outpatient HIV Positive % Enrollment to CCC by entry point 8% 13% 2% 12% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 407 Enrollement for HIV care from VCT 725 Enrollment into HIV care from TB clinic 105 Enrollment into HIV care from hospital wards 655 Enrollement into HIV care from MCHChild 38 Enrollment into HIV care from other settings 3467 Total clients enrolled for HIV care 5397 WHO stagei 287 WHO stage II 397 WHO stage III 411 WHO stage IV 79 Total number of clients starting ART 1174 Pregnant women currently on ARVs 152 All others currently on ARVs 3744 Clients enrolled, eligible but not on ART 310 Clients put on PEP due to Sexual assault 117 Clients put on PEP due to occupational exposure 36 Patients currently on cotrimoxazole Patients currently on fluconazole 5125 Total Adults on ART 3365 Total Children on ART 379 ART Intitiation by WHO stage 33.8% 35.0% BLOOD SAFETY Blood units collected from RBTC 1066 Number of blood units transfused % Linkage to care: Positive test to enrollment 88.8% 6.7% 57.4% 26.2% 24.3% 40.9% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

131 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 34% 94% 95% 78% 56% 5% 65% 30% 44% 37% 20% 50% 28% 22% 29% 68% 3% Blood units collected from RBTC blood units collected from elsewhere Blood safety 54% 46% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 5.5%, with a higher prevalence among those aged 25 to 49 years at (7.4%). This translates to 18,300 people living with HIV in this county of which 2500 (14%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 69.4%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 4.2% with a higher positivity of 29.7% among those with TB infection. About 40.9% were linked to HIV care and treatment services within the county with better linkages (88.8%) among those testing within VCT settings followed by PMTCT (57.4%). HIV testing acceptance rate among pregnant women was high at 94.2%, for those found to be positive maternal and infant prophylaxis was provided for 74.6% and 50% respectively. Only about 5.9% of ANC women had their partners tested for HIV and only 44.6% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 23.3% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 8.1% Total number of clients on treatment as at the end of 2011 in this county was 3744 including 379 children, this translates to a treatment coverage of 50% for adults and 21% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Give Particular attention to those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people *** Number of all others on ART has been corrected for arithmetic error n/athere was insufficient sample size to be used for estimating the prevalence *The proportion of HIV positive people enrolled to care is greater than 100% of those testing HIV Positive in 2011 because of enrollment of people tested in previous years during this reporting year.

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133 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 7,100 1,100 8,200 13% New HIV Infections During the Year % HIV related Deaths during the year % Adults eligible for ART (Need for ART) 3, ,800 21% ART Coverage for PLHIV 31% 15% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion % % % 92 21% SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT 88.1% HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 61.2% 93.7% 87.7% 3.4% 3.9% 2.5% 2.1% 2.3% 3.7% 3.9% 2.8% 93.7% Testing Uptake PMTCT uptake cascade 36.8% Maternal prophylaxis uptake 16.5% Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 29.7% stagei 93.1% stage II 42.9% stage III 18.5% stage IV 29.9% Proportion of eligible Clients started on ART 2.9% Proportion of new HIV positive enrolled to 57.8% 9.7% 27.7% 4.9% 56.4% 87.6% Overall PMTCT cascade MTCT rates at 1st Test 2.9% Overall Prophylaxis for HIV exposed infants 29.9% Proportion of HIV +ve women delivering in hospital 18.5% Overal maternal prophylaxis 42.9% Overall PMTCT test acceptance rate 93.1% Proportion of mothers attending 4 ANC visits 29.7%

134 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 849 Number of ANC clients attending 4 visits 3015 Genital Ulcer Disease initial Visit 315 ANC clients counseled for HIV Opthalmia neonatorium first visits 88 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 261 Syphillis Serology 52 ANC +ve Clients given prophylaxis 96 ANC Clients tested for syphilis 7949 Infants tested for HIV at 6 weeks 6 Infants given prophylaxis 43 TBHIV Partners of ANC clients counselled for HIV 407 TB patients tested for HIV 597 Partners of ANC clients tested for HIV 380 TB patients tested HIV positive 151 Partners of ANC clients HIV Positive 15 TB HIV patient on Cotrimoxazole 181 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 1443 Clients Counselled in VCT Women Tested for HIV in maternity 1266 Clients tested for HIV in VCT Women found HIV Positive in maternity 47 VCT clients HIV Positive 408 Women issued prophylaxis in maternity 36 Couples counselled in VCT 376 Deliveries from HIV +ve women 57 Couples tested for HIV in VCT 364 Maternity Women started on Cotrimoxazole 27 VCT couples both HIV positive 7 Infants started on Cotrimoxazole 16 Discordant couples in VCT 9 Infants given prophylaxis in maternity 49 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 4614 DTC outpatient counselled DTC inpatient tested 3927 DTC outpatient tested DTC inpatient HIV Positive 214 DTC Outpatient HIV Positive % Enrollment to CCC by entry point 8% 22% 2% 9% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 114 Enrollement for HIV care from VCT 290 Enrollment into HIV care from TB clinic 24 Enrollment into HIV care from hospital wards 125 Enrollement into HIV care from MCHChild 18 Enrollment into HIV care from other settings 775 Total clients enrolled for HIV care 1346 WHO stagei 428 WHO stage II 72 WHO stage III 205 WHO stage IV 36 Total number of clients starting ART 741 Pregnant women currently on ARVs 22 All others currently on ARVs 1056 Clients enrolled, eligible but not on ART 55 Clients put on PEP due to Sexual assault 52 Clients put on PEP due to occupational exposure 3 Patients currently on cotrimoxazole 1156 Patients currently on fluconazole 381 Total Adults on ART 937 Total Children on ART % ART Intitiation by WHO stage 27.7% BLOOD SAFETY Blood units collected from RBTC 712 Number of blood units transfused 788 Linkage to care: Positive test to enrollment 71.1% 9.7% 4.9% 35.3% 15.9% 19.1% 36.0% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

135 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 27% 98% 83% 69% 62% 5% 66% 29% 33% 38% 28% 55% 34% 12% 29% 66% 5% Blood units collected from RBTC blood units collected from elsewhere Blood safety 10% 90% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 3.8%, with a higher prevalence among those aged 25 to 49 years at (6.7%). This translates to 8200 people living with HIV in this county of which 1,100 (16%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 61.6 %. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 2.8% with a higher positivity of 25.3% among those with TB infection. Only about 36.0% were linked to HIV care and treatment services within the county with better linkages (71.1%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 93.1%, for those found to be positive maternal and infant prophylaxis was provided for 42.9% and 29.9% respectively. Only about 3.4% of ANC women had their partners tested for HIV and only 29.7% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 18.5% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 2.9% Total number of clients on treatment as at the end of 2,011 in this county was 1056 including 119 children, this translates to a treatment coverage of 31% for adults and 15% for children Priority Areas for the County Priority Areas for the County Increase reporting rates for MOH 711 Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Give particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

136

137 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 18,800 2,900 21,700 13% New HIV Infections During the Year 1, ,380 13% HIV related Deaths during the year % PLHIV eligible for ART (Need for ART) 7,942 2,100 10,042 21% ART Coverage among PLHIV 100% 47% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Uptake of PMTCT among eligible mothers Uptake of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT 72.6% HIV test acceptance at DTC 93.2% HIV test acceptance at ANC 93.7% HIV test acceptance at Maternity 92.6% HIV test acceptance for partners in ANC 3.7% HIV positivity at VCT 5.8% VCT Couple Discordance rate 6.4% HIV positivity at DTC 4.1% HIV positivity in ANC for Women 4.0% HIV Positivity in Maternity 5.2% HIV positivity for ANC partners 5.8% Overall HIV positivity 5.3% PMTCT uptake cascade 93.7% 62.2% 40.4% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 43.6% stagei 93.5% stage II 71.7% stage III 26.1% stage IV 53.8% Proportion of eligible Clients started on ART 8.1% Proportion of new HIV positive enrolled to care 20.6% 21.1% 56.7% 1.6% 78.4% 60.9% Overall PMTCT cascade MTCT rates at 1st Test 8.1% Overall Prophylaxis for HIV exposed infants 53.8% Proportion of HIV +ve women delivering in hospital 26.1% Overal maternal prophylaxis 71.7% Overall PMTCT test acceptance rate 93.5% Proportion of mothers attending 4 ANC visits 43.6%

138 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 2839 Number of ANC clients attending 4 visits 9523 Genital Ulcer Disease initial Visit 976 ANC clients counseled for HIV Opthalmia neonatorium first visits 119 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 933 Syphillis Serology 871 ANC +ve Clients given prophylaxis 580 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 298 Infants given prophylaxis 377 TBHIV Partners of ANC clients counselled for HIV 1145 TB patients tested for HIV 1992 Partners of ANC clients tested for HIV 863 TB patients tested HIV positive 939 Partners of ANC clients HIV Positive 50 TB HIV patient on Cotrimoxazole 908 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 4683 Clients Counselled in VCT Women Tested for HIV in maternity 4336 Clients tested for HIV in VCT Women found HIV Positive in maternity 226 VCT clients HIV Positive 2917 Women issued prophylaxis in maternity 251 Couples counselled in VCT 2965 Deliveries from HIV +ve women 303 Couples tested for HIV in VCT 2781 Maternity Women started on Cotrimoxazole 331 VCT couples both HIV positive 100 Infants started on Cotrimoxazole 130 Discordant couples in VCT 177 Infants given prophylaxis in maternity 247 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 2956 DTC outpatient counselled DTC inpatient tested 2848 DTC outpatient tested DTC inpatient HIV Positive 272 DTC Outpatient HIV Positive 2708 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 55% 8% 3% 4% 30% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 397 Enrollement for HIV care from VCT 1478 Enrollment into HIV care from TB clinic 183 Enrollment into HIV care from hospital wards 154 Enrollement into HIV care from MCHChild 148 Enrollment into HIV care from other settings 2536 Total clients enrolled for HIV care 4896 WHO stagei 610 WHO stage II 624 WHO stage III 1675 WHO stage IV 46 Total number of clients starting ART 2955 Pregnant women currently on ARVs 158 All others currently on ARVs 8940 Clients enrolled, eligible but not on ART 288 Clients put on PEP due to Sexual assault 122 Clients put on PEP due to occupational exposure 274 Patients currently on cotrimoxazole 8278 Patients currently on fluconazole 94 Total Adults on ART 7963 Total Children on ART 977 ART Intitiation by WHO stage 56.7% BLOOD SAFETY Blood units collected from RBTC 995 Number of blood units transfused 1204 Linkage to care: Positive test to enrollment 50.7% 20.6% 21.1% stagei stage II 1.6% stage III stage IV 32.8% 27.5% 19.5% 5.2% PMTCT VCT TB Ward overall

139 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 More findings Distribution 40% 87% 93% 51% 29% 28% 30% 42% 37% 33% 30% 27% 14% 59% 28% 65% 6% Blood units collected from RBTC blood units collected from elsewhere KEY FINDINGS AND PRIORITIES Blood safety Summary Overall HIV prevalence in the county is 4.6%, with a higher prevalence among those aged 25 to 49 years at (5%). This translates to 21,700 people living with HIV in this county of which2900 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 58.6%. This is low, but fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 5.3% with a higher positivity of 47.1% among those with TB infection. Only about 27.5% were linked to HIV care and treatment services within the county with better linkages (50.7%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 93.5%, for those found to be positive maternal and infant prophylaxis was provided for 71.7% and 53.8% respectively. Only about 3.7% of ANC women had their partners tested for HIV and only 43.6% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 26.1% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 8.1% Total number of clients on treatment as at the end of 2011 in this county was 8,940 including 977 children, this translates to a treatment coverage of 100% for adults and 47% for children 17% 83% Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase partner testing Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Give particular attention to those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/a There was insufficient sample size to be used for estimating the prevalence

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141 INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) HIV ESTIMATES ART Coverage Among PLHIV 69% ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 13,900 2,200 16,100 14% ,030 13% % 5,900 1,600 7,500 21% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT 96.6% HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 97.6% 92.3% 92.8% 14.8% 2.9% 3.1% 3.5% 3.9% 4.3% 4.3% 3.6% PMTCT uptake cascade 92.3% 65.2% 60.2% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 33.6% stagei 92.4% stage II 72.1% stage III 39.1% stage IV 68.1% Proportion of eligible Clients started on ART 11.7% Proportion of new HIV positive enrolled to care* 19.3% 45.4% 28.4% 7.0% 83.2% 272.0% Overall PMTCT cascade MTCT rates at 1st Test 11.7% Overall Prophylaxis for HIV exposed infants 68.1% Proportion of HIV +ve women delivering in hospital 39.1% Overal maternal prophylaxis 72.1% Overall PMTCT test acceptance rate 92.4% Proportion of mothers attending 4 ANC visits 33.6%

142 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 2758 Number of ANC clients attending 4 visits 8100 Genital Ulcer Disease initial Visit 1035 ANC clients counseled for HIV Opthalmia neonatorium first visits 65 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 917 Syphillis Serology 232 ANC +ve Clients given prophylaxis 598 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 369 Infants given prophylaxis 552 TBHIV Partners of ANC clients counselled for HIV 3628 TB patients tested for HIV 1782 Partners of ANC clients tested for HIV 3511 TB patients tested HIV positive 654 Partners of ANC clients HIV Positive 152 TB HIV patient on Cotrimoxazole 549 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 5662 Clients Counselled in VCT Women Tested for HIV in maternity 5256 Clients tested for HIV in VCT Women found HIV Positive in maternity 226 VCT clients HIV Positive 3103 Women issued prophylaxis in maternity 226 Couples counselled in VCT 5916 Deliveries from HIV +ve women 447 Couples tested for HIV in VCT 5855 Maternity Women started on Cotrimoxazole 161 VCT couples both HIV positive 185 Infants started on Cotrimoxazole 69 Discordant couples in VCT 181 Infants given prophylaxis in maternity 226 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 7900 DTC outpatient counselled DTC inpatient tested 6031 DTC outpatient tested DTC inpatient HIV Positive 621 DTC Outpatient HIV Positive 2082 Enrollment to CCC by entry point 2% 1% 6% 1% 90% ART Intitiation by WHO stage 45.4% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 439 Enrollement for HIV care from VCT 1207 Enrollment into HIV care from TB clinic 201 Enrollment into HIV care from hospital wards 276 Enrollement into HIV care from MCHChild 230 Enrollment into HIV care from other settings Total clients enrolled for HIV care WHO stagei 429 WHO stage II 1011 WHO stage III 632 WHO stage IV 155 Total number of clients starting ART 2227 Pregnant women currently on ARVs 634 All others currently on ARVs 9186 Clients enrolled, eligible but not on ART 54 Clients put on PEP due to Sexual assault 416 Clients put on PEP due to occupational exposure 601 Patients currently on cotrimoxazole Patients currently on fluconazole 11 Total Adults on ART 8082 Total Children on ART 1104 BLOOD SAFETY Blood units collected from RBTC 2855 Number of blood units transfused % 28.4% Linkage to care: Positive test to enrollment 38.9% 33.9% 30.7% 27.4% stagei stage II 7.0% stage III stage IV 10.2% PMTCT VCT TB Ward overall

143 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 More findings Distribution 20% 90% 82% 65% 15% 58% 27% 40% 35% 25% 56% 35% 8% 35% 62% 3% Blood units collected from RBTC blood units collected from elsewhere KEY FINDINGS AND PRIORITIES Blood safety Summary Overall HIV prevalence in the county is 4.4%, with a higher prevalence among those aged 25 to 49 years at (6.5%). This translates to 27,200 people living with HIV in this county of which 4300 (16%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 81.2%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 3.6% with a higher positivity of 36.7% among those with TB infection. Only about 27.4% were linked to HIV care and treatment services within the county with better linkages (38.9%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 92.4%, for those found to be positive maternal and infant prophylaxis was provided for 72.1% and 68.1% respectively. Only about 14.8% of ANC women had their partners tested for HIV and only 33.6% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 39.1% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 11.7% Total number of clients on treatment as at the end of 2011 in this county was 6,452 including 1,104 children, this translates to a treatment coverage of 100% for adults and 69% for children 14% 86% Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Maintain and improve the rate of partner testing in ANC Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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145 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants ADULTS 8,900 CHILDREN 1,400 TOTAL 10,300 % PLWHA WHO ARE CHILDREN 14% % 300 3, , ,800 21% 21% 35% 19% SERVICE COVERAGE Service Coverage (%) Number Proportion % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 93.7% 84.1% 90.6% 87.8% 3.0% 3.9% 2.3% 3.8% 2.9% 8.7% 4.3% 4.5% PMTCT uptake cascade 90.6% 73.9% 52.9% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 42.4% stagei 90.3% stage II 80.5% stage III 24.3% stage IV 64.8% Proportion of eligible Clients started on ART 17.7% Proportion of new HIV positive enrolled to care 74.8% 15.5% 8.4% 1.3% 49.3% 124.6% Overall PMTCT cascade MTCT rates at 1st Test 17.7% Overall Prophylaxis for HIV exposed infants 64.8% Proportion of HIV +ve women delivering in hospital 24.3% Overal maternal prophylaxis 80.5% Overall PMTCT test acceptance rate 90.3% Proportion of mothers attending 4 ANC visits 42.4%

146 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients 9552 Urethral Discharge Initial Visit 998 Number of ANC clients attending 4 visits 4050 Genital Ulcer Disease initial Visit 184 ANC clients counseled for HIV Opthalmia neonatorium first visits 19 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 295 Syphillis Serology 134 ANC +ve Clients given prophylaxis 218 ANC Clients tested for syphilis 6054 Infants tested for HIV at 6 weeks 108 Infants given prophylaxis 156 TBHIV Partners of ANC clients counselled for HIV 339 TB patients tested for HIV 887 Partners of ANC clients tested for HIV 303 TB patients tested HIV positive 410 Partners of ANC clients HIV Positive 13 TB HIV patient on Cotrimoxazole 328 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 1308 Clients Counselled in VCT Women Tested for HIV in maternity 1148 Clients tested for HIV in VCT Women found HIV Positive in maternity 100 VCT clients HIV Positive 704 Women issued prophylaxis in maternity 100 Couples counselled in VCT 1674 Deliveries from HIV +ve women 96 Couples tested for HIV in VCT 1650 Maternity Women started on Cotrimoxazole 93 VCT couples both HIV positive 36 Infants started on Cotrimoxazole 47 Discordant couples in VCT 38 Infants given prophylaxis in maternity 100 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 3220 DTC outpatient counselled DTC inpatient tested 2933 DTC outpatient tested DTC inpatient HIV Positive 236 DTC Outpatient HIV Positive % 3% Enrollment to CCC by entry point 11% 43% 3% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 322 Enrollement for HIV care from VCT 1330 Enrollment into HIV care from TB clinic Enrollment into HIV care from hospital wards Enrollement into HIV care from MCHChild 92 Enrollment into HIV care from other settings 1136 Total clients enrolled for HIV care WHO stagei WHO stage II 394 WHO stage III 213 WHO stage IV 33 Total number of clients starting ART 2543 Pregnant women currently on ARVs 25 All others currently on ARVs 1530 Clients enrolled, eligible but not on ART 240 Clients put on PEP due to Sexual assault 54 Clients put on PEP due to occupational exposure 19 Patients currently on cotrimoxazole 3519 Patients currently on fluconazole 5 Total Adults on ART 1345 Total Children on ART % ART Intitiation by WHO stage BLOOD SAFETY Blood units collected from RBTC 512 Number of blood units transfused 747 Linkage to care: Positive test to enrollment 188.9% stagei 15.5% stage II 8.4% 1.3% stage III stage IV 78.9% 74.9% 25.9% 9.5% PMTCT VCT TB Ward overall

147 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 29% 93% 89% 70% 49% 51% 32% 31% 39% 30% 22% 42% 36% 32% 65% 3% Blood units collected from RBTC blood units collected from elsewhere Blood safety 31% 69% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 2.8%, with a higher prevalence among those aged 25 to 49 years at (5.3%). This translates to 10,300 people living with HIV in this county of which 1,400 (14%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 85.4%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 4.5% with a higher positivity of 38.9% among those with TB infection. About 74.9% were linked to HIV care and treatment services within the county with better linkages (188.9%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 90.3%, for those found to be positive maternal and infant prophylaxis was provided for 80.5% and 64.8% respectively. Only about 3.0% of ANC women had their partners tested for HIV and only 42.4% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 24.3% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 17.7% Total number of clients on treatment as at the end of 2011 in this county was 1530 including 185 children, this translates to a treatment coverage of 35% for adults and 19% for children Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Urgently assess and Prioritize Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence *The proportion of HIV positive people enrolled to care is greater than 100% of those testing HIV Positive in 2011 because of poor linkage to care. This results to enrolment to care of people who tested positive in previous years n/athere was insufficient sample size to be used for estimating the prevalence

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149 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Uptake of PMTCT among eligible mothers Uptake of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 48,900 7,600 56,500 13% 3, ,660 13% 1,700 20, ,500 2,140 26,200 21% 21% 66% 30% SERVICE COVERAGE Service Coverage (%) Number Proportion 3, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 97.2% 85.6% 91.1% 87.3% 3.0% 6.0% 5.4% 5.7% 4.0% 3.8% 7.8% 6.3% PMTCT uptake cascade 91.1% 74.0% 65.1% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 39.5% stagei 90.4% stage II 78.4% stage III 48.8% stage IV 71.1% Proportion of eligible Clients started on ART 7.9% Proportion of new HIV positive enrolled to care 30.8% 47.4% 18.7% 3.1% 66.9% 141.2% Overall PMTCT cascade MTCT rates at 1st Test 7.9% Overall Prophylaxis for HIV exposed infants 71.1% Proportion of HIV +ve women delivering in hospital 48.8% Overal maternal prophylaxis 78.4% Overall PMTCT test acceptance rate 90.4% Proportion of mothers attending 4 ANC visits 39.5%

150 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 5095 Number of ANC clients attending 4 visits Genital Ulcer Disease initial Visit 1662 ANC clients counseled for HIV Opthalmia neonatorium first visits 314 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 1890 Syphillis Serology 2101 ANC +ve Clients given prophylaxis 1398 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 626 Infants given prophylaxis 1231 TBHIV Partners of ANC clients counselled for HIV 1558 TB patients tested for HIV 6303 Partners of ANC clients tested for HIV 1403 TB patients tested HIV positive 2788 Partners of ANC clients HIV Positive 109 TB HIV patient on Cotrimoxazole 2895 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity Clients Counselled in VCT Women Tested for HIV in maternity Clients tested for HIV in VCT Women found HIV Positive in maternity 393 VCT clients HIV Positive 4550 Women issued prophylaxis in maternity 393 Couples counselled in VCT 5484 Deliveries from HIV +ve women 1115 Couples tested for HIV in VCT 5425 Maternity Women started on Cotrimoxazole 655 VCT couples both HIV positive 301 Infants started on Cotrimoxazole 114 Discordant couples in VCT 293 Infants given prophylaxis in maternity 393 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled DTC outpatient counselled DTC inpatient tested DTC outpatient tested DTC inpatient HIV Positive 1270 DTC Outpatient HIV Positive % Enrollment to CCC by entry point 3% 12% 2% 2% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 883 Enrollement for HIV care from VCT 3242 Enrollment into HIV care from TB clinic Enrollment into HIV care from hospital wards Enrollement into HIV care from MCHChild 51 Enrollment into HIV care from other settings Total clients enrolled for HIV care WHO stagei WHO stage II 3847 WHO stage III 1513 WHO stage IV 250 Total number of clients starting ART 8109 Pregnant women currently on ARVs 63 All others currently on ARVs Clients enrolled, eligible but not on ART 275 Clients put on PEP due to Sexual assault 861 Clients put on PEP due to occupational exposure 160 Patients currently on cotrimoxazole Patients currently on fluconazole 67 Total Adults on ART Total Children on ART 1628 ART Intitiation by WHO stage 47.4% BLOOD SAFETY Blood units collected from RBTC 2425 Number of blood units transfused % Linkage to care: Positive test to enrollment 71.3% stagei stage II 18.7% stage III 3.1% stage IV 36.9% 27.4% 13.6% 6.4% PMTCT VCT TB Ward overall

151 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 32% 93% 92% 74% 55% 6% 59% 35% 32% 41% 26% 14% 42% 44% 24% 71% 4% Blood units collected from RBTC blood units collected from elsewhere Blood safety 0% 100% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 5.3%, with a higher prevalence among those aged 25 to 49 years at (7.6%). With a high prevalence among those over 49 years as well (6.3%) This translates to 56,500 people living with HIV in this county of which 7600 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 72.5%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 6.3% with a higher positivity of 44.2% among those with TB infection. Only about 27.4% were linked to HIV care and treatment services within the county with better linkages (71.3%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 90.4%, for those found to be positive maternal and infant prophylaxis was provided for 85.2% and 71.1% respectively. Only about 3.0% of ANC women had their partners tested for HIV and only 39.5% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 48.8% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 7.9% Total number of clients on treatment as at the end of 2011 in this county was 15,323 including 1,628 children, this translates to a treatment coverage of 66% for adults and 30% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence *The proportion of HIV positive people enrolled to care is greater than 100% of those testing HIV Positive in 2011 because of poor linkage to care. This results to enrolment to care of people who tested positive in previous years

152

153 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 18,700 2,900 21,600 13% New HIV Infections During the Year 1, ,380 13% HIV related Deaths during the year % PLHIV eligible for ART (Need for ART) 7,900 2,100 10,000 21% ART Coverage among PLHIV 63% 24% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT 96.9% HIV test acceptance at DTC 90.3% HIV test acceptance at ANC 99.9% HIV test acceptance at Maternity 92.2% HIV test acceptance for partners in ANC 3.0% HIV positivity at VCT 2.7% VCT Couple Discordance rate 2.5% HIV positivity at DTC 5.7% HIV positivity in ANC for Women 4.0% HIV Positivity in Maternity 3.8% HIV positivity for ANC partners 5.8% Overall HIV positivity 3.9% PMTCT uptake cascade 99.9% 46.9% 46.9% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 32.7% stagei 93.3% stage II 52.3% stage III 19.3% stage IV 52.3% Proportion of eligible Clients started on ART 7.9% Proportion of new HIV positive enrolled to care 34.4% 33.2% 23.7% 8.7% 61.1% 51.1% Overall PMTCT cascade MTCT rates at 1st Test 7.9% Overall Prophylaxis for HIV exposed infants 52.3% Proportion of HIV +ve women delivering in hospital 19.3% Overal maternal prophylaxis 52.3% Overall PMTCT test acceptance rate 93.3% Proportion of mothers attending 4 ANC visits 32.7%

154 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 1288 Number of ANC clients attending 4 visits 6206 Genital Ulcer Disease initial Visit 429 ANC clients counseled for HIV Opthalmia neonatorium first visits 55 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 763 Syphillis Serology 168 ANC +ve Clients given prophylaxis 358 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 230 Infants given prophylaxis 358 TBHIV Partners of ANC clients counselled for HIV 677 TB patients tested for HIV 815 Partners of ANC clients tested for HIV 565 TB patients tested HIV positive 327 Partners of ANC clients HIV Positive 33 TB HIV patient on Cotrimoxazole 283 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 2435 Clients Counselled in VCT Women Tested for HIV in maternity 2246 Clients tested for HIV in VCT Women found HIV Positive in maternity 86 VCT clients HIV Positive 1665 Women issued prophylaxis in maternity 86 Couples counselled in VCT 5330 Deliveries from HIV +ve women 164 Couples tested for HIV in VCT 5266 Maternity Women started on Cotrimoxazole 80 VCT couples both HIV positive 90 Infants started on Cotrimoxazole 54 Discordant couples in VCT 131 Infants given prophylaxis in maternity 86 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 2628 DTC outpatient counselled DTC inpatient tested 2040 DTC outpatient tested DTC inpatient HIV Positive 249 DTC Outpatient HIV Positive % Enrollment to CCC by entry point 11% 33% 10% 1% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 239 Enrollement for HIV care from VCT 706 Enrollment into HIV care from TB clinic 28 Enrollment into HIV care from hospital wards 208 Enrollement into HIV care from MCHChild 39 Enrollment into HIV care from other settings 940 Total clients enrolled for HIV care 2160 WHO stagei 752 WHO stage II 727 WHO stage III 518 WHO stage IV 190 Total number of clients starting ART 2187 Pregnant women currently on ARVs 40 All others currently on ARVs 5512 Clients enrolled, eligible but not on ART 157 Clients put on PEP due to Sexual assault 232 Clients put on PEP due to occupational exposure 914 Patients currently on cotrimoxazole 9687 Patients currently on fluconazole 195 Total Adults on ART 4998 Total Children on ART 514 ART Intitiation by WHO stage 34.4% 33.2% BLOOD SAFETY Blood units collected from RBTC 434 Number of blood units transfused % Linkage to care: Positive test to enrollment 42.4% 8.7% 27.1% 8.6% 15.4% 28.0% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

155 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 32% 97% 91% 77% 43% 4% 69% 28% 36% 42% 22% 45% 36% 19% 24% 72% 4% Blood units collected from RBTC blood units collected from elsewhere Blood safety 11% 89% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 4.5%, with a higher prevalence among those aged 25 to 49 years at (6.6%). This translates to 21,600 people living with HIV in this county of which 2900 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 65.5%. This is low but fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 3.9% with a higher positivity of 40.1% among those with TB infection. Only about 28% were linked to HIV care and treatment services within the county with better linkages (42.4%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 93.3%, for those found to be positive maternal and infant prophylaxis was provided for 52.3% and 52.3% respectively. Only about 3.0% of ANC women had their partners tested for HIV and only 32.7% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 19.3% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 7.9% Total number of clients on treatment as at the end of 2011 in this county was 5512 including 514 children, this translates to a treatment coverage of 63% for adults and 24% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

156

157 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 19,500 3,000 22,500 13% New HIV Infections During the Year 1, ,480 12% HIV related Deaths during the year % PLHIV eligible for ART (Need for ART) 8,300 2,200 10,500 21% ART Coverage among PLHIV 36% 13% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT 97.0% HIV test acceptance at DTC 85.4% HIV test acceptance at ANC 89.4% HIV test acceptance at Maternity 87.5% HIV test acceptance for partners in ANC 4.5% HIV positivity at VCT 3.4% VCT Couple Discordance rate 2.6% HIV positivity at DTC 3.1% HIV positivity in ANC for Women 2.5% HIV Positivity in Maternity 3.2% HIV positivity for ANC partners 3.7% Overall HIV positivity 3.5% PMTCT uptake cascade 89.4% 72.5% 53.8% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 26.4% stagei 89.2% stage II 76.5% stage III 25.4% stage IV 60.4% Proportion of eligible Clients started on ART 11.2% Proportion of new HIV positive enrolled to care* 10.7% 32.9% 52.3% 4.1% 89.2% 108.4% Overall PMTCT cascade MTCT rates at 1st Test 11.2% Overall Prophylaxis for HIV exposed infants 60.4% Proportion of HIV +ve women delivering in hospital 25.4% Overal maternal prophylaxis 76.5% Overall PMTCT test acceptance rate 89.2% Proportion of mothers attending 4 ANC visits 26.4%

158 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 1651 Number of ANC clients attending 4 visits 6893 Genital Ulcer Disease 555 ANC clients counseled for HIV Opthalmia neonatorium 79 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 630 Syphillis Serology 1344 ANC +ve Clients given prophylaxis 457 ANC Clients tested for syphilis 8986 Infants tested for HIV at 6 weeks 250 Infants given prophylaxis 339 TBHIV Partners of ANC clients counselled for HIV 1321 TB patients tested for HIV 1725 Partners of ANC clients tested for HIV 1142 TB patients testing HIV positive 615 Partners of ANC clients HIV Positive 42 TB HIV patient on Cotrim 609 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 3776 Clients Counselled in VCT Women Tested for HIV in maternity 3305 Clients tested for HIV in VCT Women found HIV Positive in maternity 105 VCT clients found HIV Positive 1137 Women issued prophylaxis in maternity 105 Couples counselled in VCT 2542 Deliveries from HIV +ve women 187 Couples tested for HIV in VCT 2447 Maternity Women started on Cotrimoxazole 79 VCT couples both HIV positive 37 Infants started on Cotrimoxazole 53 Discordant couples in VCT 64 Infants given prophylaxis in maternity 105 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 5228 DTC outpatient counselled DTC inpatient tested 5228 DTC outpatient tested DTC inpatient HIV Positive 403 DTC Outpatient HIV Positive % Enrollment to CCC by entry point 8% 15% 3% 4% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 397 Enrollement for HIV care from VCT 748 Enrollment into HIV care from TB clinic 144 Enrollment into HIV care from hospital wards 182 Enrollement into HIV care from MCHChild 83 Enrollment into HIV care from other settings 3449 Total clients enrolled for HIV care 5003 WHO stagei 178 WHO stage II 548 WHO stage III 870 WHO stage IV 69 Total number of clients starting ART 1665 Pregnant women currently on ARVs 41 All others currently on ARVs 3252 Clients enrolled, eligible but not on ART 199 Clients put on PEP due to Sexual assault 159 Clients put on PEP due to occupational exposure 354 Patients currently on cotrimoxazole 5130 Patients currently on fluconazole 4 Total Adults on ART 2975 Total Children on ART 277 ART Intitiation by WHO stage 52.3% BLOOD SAFETY Blood units collected from RBTC 727 Number of blood units transfused % 51.1% Linkage to care: Positive test to enrollment 65.8% 10.7% 4.1% 23.4% 10.6% 34.6% Clients starting ART in stagei Clients starting ART in stage II Clients starting ART in stage III Clients starting ART in stage IV PMTCT VCT TB Ward overall

159 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 26% 76% 95% 56% 29 41% 47% 11% 56% 32% 13% 76% 18% 6% 28% 67% 5% Blood units collected from RBTC blood units collected from elsewhere Blood safety 10% 90% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 4.9%, with a higher prevalence among those aged 25 to 49 years at (6.3%). This translates to 22,500 people living with HIV in this county of which 3,000 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 73.3%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 3.5% with a higher positivity of 35.7% among those with TB infection. Only about 28.5% were linked to HIV care and treatment services within the county with better linkages (73.9%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was 89.2%, for those found to be positive maternal and infant prophylaxis was provided for 89.2% and 60.4% respectively. Only about 4.5% of ANC women had their partners tested for HIV and only 26.4% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 25.4% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 11.2% Total number of clients on treatment as at the end of 2011 in this county was 2975 including 277 children, this translates to a treatment coverage of 36% for adults and 13% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence *The proportion of HIV positive people enrolled to care is greater than 100% of those testing HIV Positive in 2011 because of poor linkage to care. This results to enrolment to care of people who tested positive in previous years

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161 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 5, ,100 13% New HIV Infections During the Year % HIV related Deaths during the year % PLHIV eligible for ART (Need for ART) 2, ,900 21% ART Coverage for PLHIV 13% 8% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion % % % 85 25% SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT 92.7% HIV test acceptance at DTC HIV test acceptance at ANC 83.2% 81.1% HIV test acceptance at Maternity 90.6% HIV test acceptance for partners in ANC 4.3% HIV positivity at VCT 2.1% VCT Couple Discordance rate 2.1% HIV positivity at DTC 2.1% HIV positivity in ANC for Women 1.4% HIV Positivity in Maternity 3.8% HIV positivity for ANC partners 6.3% Overall HIV positivity 2.6% PMTCT uptake cascade 81.1% 69.4% 27.6% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 43.0% stagei 83.0% stage II 75.0% stage III 51.7% stage IV 49.4% Proportion of eligible Clients started on ART 21.4% Proportion of new HIV positive enrolled to care 25.4% 51.5% 21.8% 1.3% 72.0% 91.5% Overall PMTCT cascade MTCT rates at 1st Test Overall Prophylaxis for HIV exposed infants Proportion of HIV +ve women delivering in hospital 21.4% 49.4% 51.7% Overal maternal prophylaxis 75.0% Overall PMTCT test acceptance rate 83.0% Proportion of mothers attending 4 ANC visits 43.0%

162 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients 6619 Urethral Discharge Initial Visit 2403 Number of ANC clients attending 4 visits 2847 Genital Ulcer Disease initial Visit 210 ANC clients counseled for HIV 8775 Opthalmia neonatorium first visits 7 ANC clients tested for HIV 7119 STI SCREENING ANC clients found HIV positive 98 Syphillis Serology 281 ANC +ve Clients given prophylaxis 68 ANC Clients tested for syphilis 3014 Infants tested for HIV at 6 weeks 24 Infants given prophylaxis 27 TBHIV Partners of ANC clients counselled for HIV 395 TB patients tested for HIV 586 Partners of ANC clients tested for HIV 304 TB patients tested HIV positive 194 Partners of ANC clients HIV Positive 19 TB HIV patient on Cotrimoxazole 218 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 2146 Clients Counselled in VCT 9018 Women Tested for HIV in maternity 1945 Clients tested for HIV in VCT 8356 Women found HIV Positive in maternity 74 VCT clients HIV Positive 174 Women issued prophylaxis in maternity 61 Couples counselled in VCT 1540 Deliveries from HIV +ve women 89 Couples tested for HIV in VCT 1504 Maternity Women started on Cotrimoxazole 50 VCT couples both HIV positive 12 Infants started on Cotrimoxazole 27 Discordant couples in VCT 32 Infants given prophylaxis in maternity 58 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 1396 DTC outpatient counselled DTC inpatient tested 1298 DTC outpatient tested DTC inpatient HIV Positive 134 DTC Outpatient HIV Positive % 11% 5% Enrollment to CCC by entry point 25% 32% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 213 Enrollement for HIV care from VCT 279 Enrollment into HIV care from TB clinic 41 Enrollment into HIV care from hospital wards 93 Enrollement into HIV care from MCHChild 22 Enrollment into HIV care from other settings 209 Total clients enrolled for HIV care 857 WHO stagei 243 WHO stage II 493 WHO stage III 209 WHO stage IV 12 Total number of clients starting ART 957 Pregnant women currently on ARVs 6 All others currently on ARVs 355 Clients enrolled, eligible but not on ART 272 Clients put on PEP due to Sexual assault 259 Clients put on PEP due to occupational exposure 8 Patients currently on cotrimoxazole 2609 Patients currently on fluconazole 82 Total Adults on ART 306 Total Children on ART 49 ART Intitiation by WHO stage 51.5% BLOOD SAFETY Blood units collected from RBTC 654 Number of blood units transfused % 21.8% 111.5% Linkage to care: Positive test to enrollment 160.3% 66.8% 1.3% 21.1% 24.6% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

163 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 More findings Distribution 31% 77% 69% 39% 35% 50% 39% 10% 58% 26% 16% 58% 37% 5% 37% 60% 3% Blood units collected from RBTC blood units collected from elsewhere KEY FINDINGS AND PRIORITIES Blood safety Summary Overall HIV prevalence in the county is 5.1%, with a higher prevalence among those aged 25 to 49 years at (7.2%). This translates to 6,100 people living with HIV in this county of which 800 (13%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 72.4%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 2.6% with a higher positivity of 33.1% among those with TB infection. Only about 66.8% were linked to HIV care and treatment services within the county with better linkages (160.3%) among those testing within VCT settings and PMTCT (111.5%.) suggesting a backlog of patients previously tested now enrolling to care. HIV testing acceptance rate among pregnant women was high at 83.0%, for those found to be positive maternal and infant prophylaxis was provided for 75% and 49.4% respectively. Only about 4.3% of ANC women had their partners tested for HIV and only 43% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 51.7% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 2.6% Total number of clients on treatment as at the end of 2011 in this county was 355 including 49 children, this translates to a treatment coverage of 13% for adults and 8% for children 0% 100% Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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165 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 29,400 4,600 34,000 14% New HIV Infections During the Year 1, ,180 13% HIV related Deaths during the year 1, ,270 21% PLHIV eligible for ART (Need for ART) 12,500 3,300 15,800 21% ART Coverage among PLHIV 39% 19% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC PMTCT uptake cascade HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 99.4% 96.3% 100.0% 89.8% 3.9% 5.9% 2.5% 5.7% 3.1% 4.1% 10.8% 5.1% 100.0% Testing Uptake 40.2% Maternal prophylaxis uptake 24.3% Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 22.7% stagei 99.2% stage II 43.7% stage III 12.5% stage IV 28.3% Proportion of eligible Clients started on ART 13.7% Proportion of new HIV positive enrolled to care 28.0% 24.7% 43.0% 4.3% 64.1% 61.6% Overall PMTCT cascade MTCT rates at 1st Test 13.7% Overall Prophylaxis for HIV exposed infants 28.3% Proportion of HIV +ve women delivering in hospital 12.5% Overal maternal prophylaxis 43.7% Overall PMTCT test acceptance rate 99.2% Proportion of mothers attending 4 ANC visits 22.7%

166 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 1624 Number of ANC clients attending 4 visits 4838 Genital Ulcer Disease initial Visit 815 ANC clients counseled for HIV Opthalmia neonatorium first visits 115 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 1002 Syphillis Serology 812 ANC +ve Clients given prophylaxis 403 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 76 Infants given prophylaxis 243 TBHIV Partners of ANC clients counselled for HIV 1308 TB patients tested for HIV 697 Partners of ANC clients tested for HIV 1252 TB patients tested HIV positive 294 Partners of ANC clients HIV Positive 135 TB HIV patient on Cotrimoxazole 280 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 2919 Clients Counselled in VCT Women Tested for HIV in maternity 2622 Clients tested for HIV in VCT Women found HIV Positive in maternity 107 VCT clients HIV Positive 1305 Women issued prophylaxis in maternity 82 Couples counselled in VCT 2309 Deliveries from HIV +ve women 139 Couples tested for HIV in VCT 2277 Maternity Women started on Cotrimoxazole 71 VCT couples both HIV positive 34 Infants started on Cotrimoxazole 53 Discordant couples in VCT 57 Infants given prophylaxis in maternity 71 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 2051 DTC outpatient counselled DTC inpatient tested 1973 DTC outpatient tested DTC inpatient HIV Positive 305 DTC Outpatient HIV Positive 1307 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 57% 9% 3% 1% 30% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 237 Enrollement for HIV care from VCT 834 Enrollment into HIV care from TB clinic 79 Enrollment into HIV care from hospital wards 41 Enrollement into HIV care from MCHChild 5 Enrollment into HIV care from other settings 1550 Total clients enrolled for HIV care 2746 WHO stagei 667 WHO stage II 587 WHO stage III 1023 WHO stage IV 102 Total number of clients starting ART 2379 Pregnant women currently on ARVs 71 All others currently on ARVs 5565 Clients enrolled, eligible but not on ART 53 Clients put on PEP due to Sexual assault 126 Clients put on PEP due to occupational exposure 20 Patients currently on cotrimoxazole 7423 Patients currently on fluconazole 18 Total Adults on ART 4929 Total Children on ART 636 ART Intitiation by WHO stage 43.0% BLOOD SAFETY Blood collected fromrbtc 1140 Number of blood units transfused % 24.7% Linkage to care: Positive test to enrollment 63.9% 4.3% 19.1% 26.9% 26.7% stagei stage II stage III stage IV 2.5% PMTCT VCT TB Ward overall

167 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 More findings Distribution 33% 86% 92% 61% 41% 7% 62% 31% 32% 54% 14% 37% 38% 25% 29% 68% 3% Blood units collected from RBTC blood units collected from elsewhere KEY FINDINGS AND PRIORITIES Blood safety Summary Overall HIV prevalence in the county is 7.2%, with a higher prevalence among those aged 25 to 49 years at (9.6%). This translates to people living with HIV in this county of which 4600 (14%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 59.5%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 5.1% with a higher positivity of 42.2% among those with TB infection. Only about 26.7% were linked to HIV care and treatment services within the county with better linkages (63.9%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 99.2%, for those found to be positive maternal and infant prophylaxis was provided for 43.7% and 28.3% respectively. Only about 3.9% of ANC women had their partners tested for HIV and only 22.7% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 28.3% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 13.7% Total number of clients on treatment as at the end of 2011 in this county was 10,735 including 1173 children, this translates to a treatment coverage of 39% for adults and 19% for children 3% 97% Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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169 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 43,300 6,700 50,000 13% New HIV Infections During the Year 2, ,210 13% HIV related Deaths during the year 1, ,890 21% PLHIV eligible for ART (Need for ART) 18,300 4,900 23,200 21% ART Coverage among PLHIV 12% 4% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 2, % % 225 8% 202 7% SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 96.9% 95.7% 83.2% 75.9% 2.1% 4.4% 1.9% 5.5% 7.7% 4.0% 8.9% 6.2% 83.2% Testing Uptake PMTCT uptake cascade 26.6% Maternal prophylaxis uptake 23.3% Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 28.0% stagei 82.4% stage II 30.7% stage III 14.5% stage IV 27.6% Proportion of eligible Clients started on ART 9.4% Proportion of new HIV positive enrolled to care 13.8% 27.0% 51.5% 7.7% 90.8% 167.5% Overall PMTCT cascade MTCT rates at 1st Test 93 Overall Prophylaxis for HIV exposed infants 7 5 Proportion of HIV +ve women delivering in hospital 14 4 Overal maternal prophylaxis 30 7 Overall PMTCT test acceptance rate Proportion of mothers attending 4 ANC visits 28 0

170 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients 9896 Urethral Discharge Initial Visit 732 Number of ANC clients attending 4 visits 2771 Genital Ulcer Disease initial Visit 550 ANC clients counseled for HIV Opthalmia neonatorium first visits 39 ANC clients tested for HIV 8987 STI SCREENING ANC clients found HIV positive 691 Syphillis Serology 359 ANC Clients given preventive ARVs 184 ANC Clients tested for syphilis 2954 Infants tested for HIV at 6 weeks 77 Infants given preventive ARVs (ANC) 161 TBHIV Partners of ANC clients counselled for HIV 242 TB patients tested for HIV 883 Partners of ANC clients tested for HIV 191 TB patients tested HIV positive 391 Partners of ANC clients HIV Positive 17 TB HIV patient on Cotrimoxazole 364 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 1351 Clients Counselled in VCT Women Tested for HIV in maternity 1026 Clients tested for HIV in VCT Women found HIV Positive in maternity 41 VCT clients HIV Positive 699 Women issued preventive ART in maternity 41 Couples counselled in VCT 2786 Deliveries from HIV positive women 106 Couples tested for HIV in VCT 2774 Maternity Women started on Septrin 35 VCT couples both HIV positive 53 Infants started on Cotrimoxazole 10 Discordant couples in VCT 52 Infants given preventive ARVs in maternity 41 HTC (DTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 6071 DTC outpatient counselled DTC inpatient tested 5913 DTC outpatient tested DTC inpatient HIV Positive 412 DTC Outpatient HIV Positive 749 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 81% 3% 9% 3% 4% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 151 Enrollement for HIV care from VCT 463 Enrollment into HIV care from TB clinic 128 Enrollment into HIV care from hospital wards 189 Enrollement into HIV care from MCHChild 16 Enrollment into HIV care from other settings 4077 Total clients enrolled for HIV care 5024 WHO stagei 94 WHO stage II 183 WHO stage III 350 WHO stage IV 52 Total number of clients starting ART 679 Pregnant women currently on ARVs 29 All others currently on ARVs 2290 Clients enrolled, eligible but not on ART 114 Clients put on PEP due to Sexual assault 123 Clients put on PEP due to occupational exposure 25 Patients currently on cotrimoxazole 5237 Patients currently on fluconazole Total Adults on ART 2116 Total Children on ART 174 ART Intitiation by WHO stage 51.5% BLOOD SAFETY Blood units collected from RBTC 507 Number of blood units transfused 603 Linkage to care: Positive test to enrollment 66.2% 27.0% 13.8% 7.7% 20.2% 32.7% 16.3% 31.0% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

171 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 More findings Distribution 20% 90% 82% 65% 15% 58% 27% 40% 35% 25% 56% 35% 8% 35% 62% 3% Blood units collected from RBTC blood units collected from elsewhere KEY FINDINGS AND PRIORITIES Blood safety Summary Overall HIV prevalence in the county is 3.7%, with a higher prevalence among those aged anove 49 years 4.5%). This translates to 23,600 people living with HIV in this county of which 3200 (14%) are children. In 2011, the average reporting rates for this county for MOH711 was 89 %. This is representative of the reporting facilities in the county. In 2011, of those tested for HIV in various settings within the county, the overall positivity was 4.2% with a higher positivity of 35.1% among those with TB infection. Of those tested positive, only about 34.5% were linked to HIV care and treatment services within the county better linkages (60.6%) among those testing within (VCT) settings followed by PMTCT (44.1%) linkages was poor in TB and from Hospital wards. HIV testing acceptance rate among pregnant women was high at 93.1%, for those found to be positive maternal and infant prophylaxis was provided for 81% and 35.6% respectively. Only about 1.5% of ANC women had their partners tested for HIV and only 40% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 33.9% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 10.1%. This is quite high. Total number of clients on treatment as at the end of 2011 in this county was 9478 including 1188 children, this translates to a treatment coverage of 94% for adults and 52% for children 7% 93% Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase partner involvement in PMTCT through partner testing Strengthen the linkage to HIV care for those who test HIV Positive from TB clinic and in the hospital Wards. Increase the number of HIV infected children on ART. Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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173 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) % New HIV Infections During the Year 13% HIV related Deaths during the year ,0 2 % PLHIV eligible for ART (Need for ART) % ART Coverage among PLHIV % % SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT 96.8% HIV test acceptance at DTC 108.7% HIV test acceptance at ANC 93.1% HIV test acceptance at Maternity 96.5% HIV test acceptance for partners in ANC 3.9% HIV positivity at VCT 4.2% VCT Couple Discordance rate 5.5% HIV positivity at DTC 8.4% HIV positivity in ANC for Women 3.5% HIV Positivity in Maternity 5.9% HIV positivity for ANC partners 3.5% Overall HIV positivity 5.8% PMTCT uptake cascade 93.1% 40.2% 28.2% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 29.9% stagei 93.9% stage II 39.5% stage III 35.5% stage IV 44.4% Proportion of eligible Clients started on ART 11.0% Proportion of new HIV positive enrolled to care Overall PMTCT cascade 49.7% 14.1% 27.2% 9.0% 31.8% 477.0% MTCT rates at 1st Test 11.0% Overall Prophylaxis for HIV exposed infants 44.4% Proportion of HIV +ve women delivering in hospital 35.5% Overal maternal prophylaxis 39.5% Overall PMTCT test acceptance rate 93.9% Proportion of mothers attending 4 ANC visits 29.9%

174 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 1530 Number of ANC clients attending 4 visits 7181 Genital Ulcer Disease initial Visit 539 ANC clients counseled for HIV Opthalmia neonatorium first visits 63 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 859 Syphillis Serology 345 ANC +ve Clients given prophylaxis 345 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 56 Infants given prophylaxis 242 TBHIV Partners of ANC clients counselled for HIV 1027 TB patients tested for HIV 1051 Partners of ANC clients tested for HIV 961 TB patients tested HIV positive 490 Partners of ANC clients HIV Positive 34 TB HIV patient on Cotrimoxazole 461 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 8234 Clients Counselled in VCT Women Tested for HIV in maternity 7946 Clients tested for HIV in VCT Women found HIV Positive in maternity 466 VCT clients HIV Positive 2166 Women issued prophylaxis in maternity 179 Couples counselled in VCT 2266 Deliveries from HIV +ve women 471 Couples tested for HIV in VCT 2219 Maternity Women started on Cotrimoxazole 43 VCT couples both HIV positive 178 Infants started on Cotrimoxazole 30 Discordant couples in VCT 123 Infants given prophylaxis in maternity 346 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 5559 DTC outpatient counselled DTC inpatient tested 5718 DTC outpatient tested DTC inpatient HIV Positive 275 DTC Outpatient HIV Positive 2773 Enrollment to CCC by entry point 2% 0% 0% 2% 96% PMTCT VCT TB Ward All others ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 522 Enrollement for HIV care from VCT 754 Enrollment into HIV care from TB clinic 81 Enrollment into HIV care from hospital wards 148 Enrollement into HIV care from MCHChild 129 Enrollment into HIV care from other settings Total clients enrolled for HIV care WHO stagei 3234 WHO stage II 916 WHO stage III 1770 WHO stage IV 583 Total number of clients starting ART 6503 Pregnant women currently on ARVs 211 All others currently on ARVs Clients enrolled, eligible but not on ART 191 Clients put on PEP due to Sexual assault 78 Clients put on PEP due to occupational exposure 40 Patients currently on cotrimoxazole Patients currently on fluconazole 544 Total Adults on ART Total Children on ART % ART Intitiation by WHO stage 27.2% BLOOD SAFETY Blood units collected from RBTC Number of blood units transfused % Linkage to care: Positive test to enrollment 34.8% 14.1% 9.0% 16.5% 21.3% stagei stage II stage III stage IV 4.9% PMTCT VCT TB Ward overall

175 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 More findings Distribution 38% 93% 89% 67% 52 4% 58% 38% 36% 41% 23% 24% 41% 35% 26% 68% 6% Blood units collected from RBTC blood units collected from elsewhere KEY FINDINGS AND PRIORITIES Blood safety Summary Overall HIV prevalence in the county is 4.9%, with a higher prevalence among those aged 15 to 24years at (14%). This translates to,000 people living with HIV in this county of which 00 (1 %) are children. In 2011, the average reporting rates for this county for MOH 711 was at 55%. This represents just half of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 5.8% with a higher positivity of 46.6% among those with TB infection. Only about 21.3% were linked to HIV care and treatment services within the county with better linkages (38.4%) among those testing within PMTCT and VCT settings. HIV testing acceptance rate among pregnant women was high at 93.9%, for those found to be positive maternal and infant prophylaxis was provided for 39.5% and 44.4% respectively. Only about 3.9% of ANC women had their partners tested for HIV and only 29.9% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 35.5% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 11% Total number of clients on treatment as at the end of 2011 in this county was 15,985 including 1,751 children, this translates to a treatment coverage of % for adults and % for children 0% 100% Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence *The proportion of HIV positive people enrolled to care is greater than 100% of those testing HIV Positive in 2011 because of poor linkage to care. This results to enrolment to care of people who tested positive in previous years *The proportion of HIV positive people enrolled to care is greater than 100% of those testing HIV Positive in 2011 because of poor linkage to care. This results to enrolment to care of people who tested positive in previous years

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177 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 5, ,400 14% New HIV Infections During the Year % HIV related Deaths during the year PLHIV eligible for ART (Need for ART) 200 2, ,900 20% 21% ART Coverage among PLHIV 43% 22% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion % % % 47 13% SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 92.5% 91.0% 92.2% 96.0% 1.4% 5.3% 2.9% 1.8% 1.8% 2.5% 10.5% 2.5% PMTCT uptake cascade 92.2% 33.8% 7.4% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 17.5% stagei 92.5% stage II 38.7% stage III 19.9% stage IV 18.0% Proportion of eligible Clients started on ART 18.3% Proportion of new HIV positive enrolled to care Overall PMTCT cascade 22.2% 18.5% 36.5% 22.8% 78.3% 48.6% MTCT rates at 1st Test Overall Prophylaxis for HIV exposed infants Proportion of HIV +ve women delivering in hospital 18.3% 18.0% 19.9% Overal maternal prophylaxis 38.7% Overall PMTCT test acceptance rate 92.5% Proportion of mothers attending 4 ANC visits 17.5%

178 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit 380 Number of ANC clients attending 4 visits 2362 Genital Ulcer Disease initial Visit 171 ANC clients counseled for HIV Opthalmia neonatorium first visits 13 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 231 Syphillis Serology 336 ANC +ve Clients given prophylaxis 78 ANC Clients tested for syphilis 6239 Infants tested for HIV at 6 weeks 45 Infants given prophylaxis 17 TBHIV Partners of ANC clients counselled for HIV 220 TB patients tested for HIV 1000 Partners of ANC clients tested for HIV 181 TB patients tested HIV positive 148 Partners of ANC clients HIV Positive 19 TB HIV patient on Cotrimoxazole 191 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 1263 Clients Counselled in VCT 7148 Women Tested for HIV in maternity 1212 Clients tested for HIV in VCT 6611 Women found HIV Positive in maternity 30 VCT clients HIV Positive 348 Women issued prophylaxis in maternity 23 Couples counselled in VCT 897 Deliveries from HIV +ve women 52 Couples tested for HIV in VCT 883 Maternity Women started on Cotrimoxazole 11 VCT couples both HIV positive 48 Infants started on Cotrimoxazole 5 Discordant couples in VCT 26 Infants given prophylaxis in maternity 30 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 2882 DTC outpatient counselled DTC inpatient tested 2864 DTC outpatient tested DTC inpatient HIV Positive 188 DTC Outpatient HIV Positive 320 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 40% 9% 10% 8% 33% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 65 Enrollement for HIV care from VCT 229 Enrollment into HIV care from TB clinic 55 Enrollment into HIV care from hospital wards 63 Enrollement into HIV care from MCHChild 7 Enrollment into HIV care from other settings 270 Total clients enrolled for HIV care 689 WHO stagei 114 WHO stage II 95 WHO stage III 187 WHO stage IV 117 Total number of clients starting ART 513 Pregnant women currently on ARVs 9 All others currently on ARVs 1120 Clients enrolled, eligible but not on ART 19 Clients put on PEP due to Sexual assault 65 Clients put on PEP due to occupational exposure 15 Patients currently on cotrimoxazole 447 Patients currently on fluconazole 7 Total Adults on ART 988 Total Children on ART 132 ART Intitiation by WHO stage 36.5% BLOOD SAFETY Blood units collected from RBTC 1092 Number of blood units transfused % 18.5% 22.8% Linkage to care: Positive test to enrollment 65.8% 23.2% 37.2% 12.4% 32.1% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

179 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 15% 72% 97% 50% 18% 46% 47% 7% 48% 39% 13% 87% 13% 0% 27% 67% 5% Blood units collected from RBTC blood units collected from elsewhere Blood safety 20% 80% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 1.5%, with a higher prevalence among those aged 25 to 49 years at (2.5%). This translates to 6,400 people living with HIV in this county of which 900 (14%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 76.6%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 2.5% with a higher positivity of 14.8% among those with TB infection. Only about 32.1% were linked to HIV care and treatment services within the county with better linkages (65.8%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 92.5%, for those found to be positive maternal and infant prophylaxis was provided for 38.7% and 18.0% respectively. Only about 1.4% of ANC women had their partners tested for HIV and only 17.5% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 19.9% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 18.3% Total number of clients on treatment as at the end of 2011 in this county was 1,120 including 132 children, this translates to a treatment coverage of 43% for adults and 22% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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181 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 22,900 4,300 27,200 16% New HIV Infections During the Year 1, ,720 13% HIV related Deaths during the year PLHIV eligible for ART (Need for ART) 800 9, ,100 1,050 13,018 24% 24% ART Coverage among PLHIV 96% 38% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 98.7% 98.0% 94.8% 88.6% 2.3% 5.2% 3.9% 3.8% 2.3% 4.2% 2.6% 4.2% PMTCT uptake cascade 94.8% 76.9% 72.0% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test 29.0% 94.2% 80.7% 30.1% 76.7% 8.7% ENROLLMENT TO CARE & TREATMENT stagei stage II stage III stage IV Proportion of eligible Clients started on ART Proportion of new HIV positive enrolled to care 30.2% 29.7% 29.1% 11.0% 73.2% 51.8% Overall PMTCT cascade MTCT rates at 1st Test Overall Prophylaxis for HIV exposed infants Proportion of HIV +ve women delivering in hospital Overal maternal prophylaxis Overall PMTCT test acceptance rate Proportion of mothers attending 4 ANC visits 8.7% 76.7% 30.1% 80.7% 29.0% 94.2%

182 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 2680 Number of ANC clients attending 4 visits Genital Ulcer Disease 2577 ANC clients counseled for HIV Opthalmia neonatorium 165 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 1067 Syphillis Serology 1126 ANC +ve Clients given prophylaxis 820 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 333 Infants given prophylaxis 768 TBHIV Partners of ANC clients counselled for HIV 1123 TB patients tested for HIV 2599 Partners of ANC clients tested for HIV 1076 TB patients testing HIV positive 1010 Partners of ANC clients HIV Positive 28 TB HIV patient on Cotrim 822 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 5707 Clients Counselled in VCT Women Tested for HIV in maternity 5059 Clients tested for HIV in VCT Women found HIV Positive in maternity 214 VCT clients found HIV Positive 2239 Women issued prophylaxis in maternity 214 Couples counselled in VCT 3651 Deliveries from HIV +ve women 385 Couples tested for HIV in VCT 3623 Maternity Women started on Cotrimoxazole 157 VCT couples both HIV positive 103 Infants started on Cotrimoxazole 88 Discordant couples in VCT 141 Infants given prophylaxis in maternity 214 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled DTC outpatient counselled DTC inpatient tested DTC outpatient tested DTC inpatient HIV Positive 802 DTC Outpatient HIV Positive 3358 Enrollment to CCC by entry point ART CARE AND TREATMENT NUMBER 45% 6% 2% 10% 37% PMTCT VCT TB Ward All others Enrollment for HIV care from PMTCT 466 Enrollement for HIV care from VCT 1655 Enrollment into HIV care from TB clinic 110 Enrollment into HIV care from hospital wards 256 Enrollement into HIV care from MCHChild 76 Enrollment into HIV care from other settings 1954 Total clients enrolled for HIV care 4517 WHO stagei 912 WHO stage II 897 WHO stage III 878 WHO stage IV 331 Total number of clients starting ART 3018 Pregnant women currently on ARVs 136 All others currently on ARVs Clients enrolled, eligible but not on ART 63 Clients put on PEP due to Sexual assault 210 Clients put on PEP due to occupational exposure 66 Patients currently on cotrimoxazole Patients currently on fluconazole 35 Total Adults on ART 9559 Total Children on ART 1173 ART Intitiation by WHO stage 30.2% 29.7% 29.1% BLOOD SAFETY Blood units collected from RBTC 2595 Number of blood units transfused 5414 Linkage to care: Positive test to enrollment 73.9% stagei stage II stage III 11.0% stage IV 35.6% 28.5% 10.9% 6.2% PMTCT VCT TB Ward overall

183 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 34% 96% 96% 64% 40% 3% 63% 34% 28% 47% 25% 45% 41% 14% 31% 66% 3% Blood units collected from RBTC blood units collected from elsewhere Blood safety 52% 48% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 3.5%, with a higher prevalence among those aged 25 to 49 years at (3.2%). This translates to 27,200 people living with HIV in this county of which 4300 (16%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 77.5%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 4.2% with a higher positivity of 38.9% among those with TB infection. Only about 28.5% were linked to HIV care and treatment services within the county with better linkages (73.9%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 94.2%, for those found to be positive maternal and infant prophylaxis was provided for 80.7% and 76.7% respectively. Only about 2.3% of ANC women had their partners tested for HIV and only 29% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 30.1% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 8.7% Total number of clients on treatment as at the end of 2011 in this county was 10,735 including 1173 children, this translates to a treatment coverage of 96% for adults and 38% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Give particular attention to those testing HIV positive in the Wards. Increase the number of HIV infected children on ART. Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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185 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 52,500 9,700 62,200 16% New HIV Infections During the Year 3, ,890 13% HIV related Deaths during the year Adults eligible for ART (Need for ART) 1,800 22, ,000 2,370 29,200 24% 24% ART Coverage among PLHIV 69% 20% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 2, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 98.7% 96.9% 96.7% 100.4% 6.5% 5.9% 4.9% 7.3% 5.4% 8.8% 12.8% 7.3% PMTCT uptake cascade 96.7% 100.0% 43.5% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test 39.3% 97.3% 89.4% 36.3% 57.7% 10.1% ENROLLMENT TO CARE & TREATMENT stagei stage II stage III stage IV Proportion of eligible Clients started on ART Proportion of new HIV positive enrolled to care* 31.3% 42.0% 22.0% 4.7% 47.6% 188.7% Overall PMTCT cascade MTCT rates at 1st Test Overall Prophylaxis for HIV exposed infants Proportion of HIV +ve women delivering in hospital Overal maternal prophylaxis Overall PMTCT test acceptance rate Proportion of mothers attending 4 ANC visits 10.1% 57.7% 36.3% 89.4% 97.3% 39.3%

186 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 1559 Number of ANC clients attending 4 visits Genital Ulcer Disease 1908 ANC clients counseled for HIV Opthalmia neonatorium 83 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 1406 Syphillis Serology 1104 ANC +ve Clients given prophylaxis 1406 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 629 Infants given prophylaxis 612 TBHIV Partners of ANC clients counselled for HIV 1764 TB patients tested for HIV 1724 Partners of ANC clients tested for HIV 1694 TB patients testing HIV positive 1029 Partners of ANC clients HIV Positive 216 TB HIV patient on Cotrim 855 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 5332 Clients Counselled in VCT Women Tested for HIV in maternity 5355 Clients tested for HIV in VCT Women found HIV Positive in maternity 472 VCT clients found HIV Positive 2377 Women issued prophylaxis in maternity 272 Couples counselled in VCT 3574 Deliveries from HIV +ve women 682 Couples tested for HIV in VCT 3504 Maternity Women started on Cotrimoxazole 147 VCT couples both HIV positive 175 Infants started on Cotrimoxazole 246 Discordant couples in VCT 173 Infants given prophylaxis in maternity 472 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 6856 DTC outpatient counselled DTC inpatient tested 6371 DTC outpatient tested DTC inpatient HIV Positive 681 DTC Outpatient HIV Positive 3587 Enrollment to CCC by entry point 4% 1% 6% 0% 89% ART Intitiation by WHO stage 42.0% PMTCT VCT TB Ward All others ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 697 Enrollement for HIV care from VCT 1056 Enrollment into HIV care from TB clinic 112 Enrollment into HIV care from hospital wards 78 Enrollement into HIV care from MCHChild 45 Enrollment into HIV care from other settings Total clients enrolled for HIV care WHO stagei 2138 WHO stage II 2869 WHO stage III 1505 WHO stage IV 320 Total number of clients starting ART 6832 Pregnant women currently on ARVs 263 All others currently on ARVs Clients enrolled, eligible but not on ART 146 Clients put on PEP due to Sexual assault 144 Clients put on PEP due to occupational exposure 115 Patients currently on cotrimoxazole Patients currently on fluconazole 49 Total Adults on ART Total Children on ART 1431 BLOOD SAFETY BLOOD SAFETY 1010 Number of blood units transfused % 22.0% 33.3% Linkage to care: Positive test to enrollment 44.4% stagei stage II 4.7% stage III stage IV 19.9% 10.9% 1.8% PMTCT VCT TB Ward overall

187 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Categories None Primary Secondary Age at sexual debut < >18 Wealth Poor Middle income Rich Sexual partners 0 1 >1 More findings Distribution 38% 97% 51% 68% 48% 8% 70% 22% 43% 40% 17% 55% 28% 18% 34% 62% 4% KEY FINDINGS AND PRIORITIES Blood units collected from RBTC blood units collected from elsewhere Blood safety 65% 35% Summary Overall HIV prevalence in the county is 6.6%, with a higher prevalence among those aged 25 to 49 years at (9.2%). This translates to 27,200 people living with HIV in this county of which 4300 (16%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 80.6%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 7.3% with a higher positivity of 59.7% among those with TB infection. Only about 19.9% were linked to HIV care and treatment services within the county with better linkages (44.4%) among those testing within VCT settings followed by PMTCT 33.3%. HIV testing acceptance rate among pregnant women was high at 94.2%, for those found to be positive maternal and infant prophylaxis was provided for 80.7% and 76.7% respectively. Only about 2.3% of ANC women had their partners tested for HIV and only 29% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 30.1% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 8.7% Total number of clients on treatment as at the end of 2011 in this county was 16,732 including 1,431 children, this translates to a treatment coverage of 69% for adults and 20% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Give Particular attention to those testing HIV positive in the Wards and TB. Increase the number of HIV infected adults and children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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189 HIV ESTIMATES INDICATOR ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN People Living with HIV (PLHIV) 45,800 8,500 54,300 16% New HIV Infections During the Year 3, ,430 13% HIV related Deaths during the year PLHIV eligible for ART (Need for ART) 1,600 19, ,200 2,100 25,600 24% 24% ART Coverage among PLHIV 73% 26% SERVICE COVERAGE Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Uptake of PMTCT among eligible mothers Uptake of PMTCT among eligible infants Service Coverage (%) Number Proportion 3, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 97.0% 97.2% 90.2% 90.9% 1.6% 6.6% 5.3% 5.2% 3.9% 7.5% 12.7% 5.8% PMTCT uptake cascade 90.2% 87.0% 82.7% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 32.5% stagei 90.3% stage II 88.9% stage III 25.9% stage IV 57.0% Proportion of eligible Clients started on ART 9.2% Proportion of new HIV positive enrolled to care 25.5% 46.3% 23.6% 4.6% 81.0% 181.8% Overall PMTCT cascade MTCT rates at 1st Test Overall Prophylaxis for HIV exposed infants Proportion of HIV +ve women delivering in hospital Overal maternal prophylaxis Overall PMTCT test acceptance rate Proportion of mothers attending 4 ANC visits 9.2% 25.9% 32.5% 85.3% 88.9% 90.3%

190 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 2666 Number of ANC clients attending 4 visits Genital Ulcer Disease 2148 ANC clients counseled for HIV Opthalmia neonatorium 225 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 1972 Syphillis Serology 2343 ANC +ve Clients given prophylaxis 1716 ANC Clients tested for syphilis Infants tested for HIV at 6 weeks 704 Infants given prophylaxis 1631 TBHIV Partners of ANC clients counselled for HIV 1167 TB patients tested for HIV 2937 Partners of ANC clients tested for HIV 814 TB patients testing HIV positive 1261 Partners of ANC clients HIV Positive 103 TB HIV patient on Cotrim 1178 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 5020 Clients Counselled in VCT Women Tested for HIV in maternity 4564 Clients tested for HIV in VCT Women found HIV Positive in maternity 342 VCT clients found HIV Positive 4085 Women issued prophylaxis in maternity 342 Couples counselled in VCT 5620 Deliveries from HIV +ve women 600 Couples tested for HIV in VCT 5540 Maternity Women started on Cotrimoxazole 295 VCT couples both HIV positive 137 Infants started on Cotrimoxazole 188 Discordant couples in VCT 294 Infants given prophylaxis in maternity 342 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 9177 DTC outpatient counselled DTC inpatient tested 8340 DTC outpatient tested DTC inpatient HIV Positive 781 DTC Outpatient HIV Positive % Enrollment to CCC by entry point 4% 13% 1% 2% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 1102 Enrollement for HIV care from VCT 3290 Enrollment into HIV care from TB clinic 257 Enrollment into HIV care from hospital wards 548 Enrollement into HIV care from MCHChild 75 Enrollment into HIV care from other settings Total clients enrolled for HIV care WHO stagei 1217 WHO stage II 2211 WHO stage III 1129 WHO stage IV 218 Total number of clients starting ART 4775 Pregnant women currently on ARVs 173 All others currently on ARVs Clients enrolled, eligible but not on ART 290 Clients put on PEP due to Sexual assault 353 Clients put on PEP due to occupational exposure 360 Patients currently on cotrimoxazole Patients currently on fluconazole 1211 Total Adults on ART Total Children on ART 1591 ART Intitiation by WHO stage 46.3% BLOOD SAFETY Blood units collected from RBTC 2318 Number of blood units transfused % 23.6% Linkage to care: Positive test to enrollment 80.5% stagei stage II 4.6% stage III stage IV 45.6% 37.4% 20.4% 8.9% PMTCT VCT TB Ward overall

191 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 32% 91% 95% 69% 47% 9% 63% 28% 38% 42% 19% 51% 38% 11% 27% 65% 8% Blood units collected from RBTC blood units collected from elsewhere Blood safety 0% 100% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 6.3%, with a higher prevalence among those aged 25 to 49 years at 8.2. This translates to 54,300 people living with HIV in this county of which 4300 (16%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 67.5%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 5.8% with a higher positivity of 42.9% among those with TB infection. Only about 37.4% were linked to HIV care and treatment services within the county with better linkages (80.5%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 90.3%, for those found to be positive maternal and infant prophylaxis was provided for 88.9% and 85.3% respectively. Only about 1.6% of ANC women had their partners tested for HIV and only 32.5% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 25.9% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 9.2% Total number of clients on treatment as at the end of 2011 in this county was 15,705 including 1,591 children, this translates to a treatment coverage of 96% for adults and 38% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Give Particular attention to those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

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193 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART Coverage Among PLHIV Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants ADULTS CHILDREN TOTAL % PLWHA WHO ARE CHILDREN 16,200 3,000 19,200 16% 1, ,250 12% % 6,800 2,200 9,000 24% 76% 27% SERVICE COVERAGE Service Coverage (%) Number Proportion 1, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 99.2% 95.2% 98.4% 94.2% 1.5% 5.3% 5.0% 5.9% 5.1% 9.0% 12.8% 6.5% PMTCT uptake cascade 98.4% 84.5% 79.1% Testing Uptake Maternal prophylaxis uptake Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test ENROLLMENT TO CARE & TREATMENT 42.7% stagei 94.9% stage II 86.2% stage III 32.2% stage IV 81.4% Proportion of eligible Clients started on ART 7.0% Proportion of new HIV positive enrolled to care 28.9% 32.8% 32.1% 6.2% 84.9% 126.3% Overall PMTCT cascade MTCT rates at 1st Test 7.0% Overall Prophylaxis for HIV exposed infants 81.4% Proportion of HIV +ve women delivering in hospital 32.2% Overal maternal prophylaxis 86.2% Overall PMTCT test acceptance rate 94.9% Proportion of mothers attending 4 ANC visits 42.7%

194 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge 702 Number of ANC clients attending 4 visits 6008 Genital Ulcer Disease 796 ANC clients counseled for HIV Opthalmia neonatorium 50 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive 703 Syphillis Serology 301 ANC +ve Clients given prophylaxis 594 ANC Clients tested for syphilis 8280 Infants tested for HIV at 6 weeks 300 Infants given prophylaxis 556 TBHIV Partners of ANC clients counselled for HIV 250 TB patients tested for HIV 1535 Partners of ANC clients tested for HIV 203 TB patients testing HIV positive 847 Partners of ANC clients HIV Positive 26 TB HIV patient on Cotrim 747 PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity 1017 Clients Counselled in VCT Women Tested for HIV in maternity 958 Clients tested for HIV in VCT Women found HIV Positive in maternity 86 VCT clients found HIV Positive 1477 Women issued prophylaxis in maternity 86 Couples counselled in VCT 2194 Deliveries from HIV +ve women 254 Couples tested for HIV in VCT 2183 Maternity Women started on Cotrimoxazole 100 VCT couples both HIV positive 134 Infants started on Cotrimoxazole 37 Discordant couples in VCT 109 Infants given prophylaxis in maternity 86 HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled 2492 DTC outpatient counselled DTC inpatient tested 2242 DTC outpatient tested DTC inpatient HIV Positive 229 DTC Outpatient HIV Positive % Enrollment to CCC by entry point 5% 19% 2% 14% PMTCT VCT TB Ward All others 0 ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT 338 Enrollement for HIV care from VCT 1400 Enrollment into HIV care from TB clinic 123 Enrollment into HIV care from hospital wards 980 Enrollement into HIV care from MCHChild 41 Enrollment into HIV care from other settings 4303 Total clients enrolled for HIV care 7185 WHO stagei 506 WHO stage II 574 WHO stage III 562 WHO stage IV 109 Total number of clients starting ART 1751 Pregnant women currently on ARVs 46 All others currently on ARVs 5740 Clients enrolled, eligible but not on ART 138 Clients put on PEP due to Sexual assault 184 Clients put on PEP due to occupational exposure 37 Patients currently on cotrimoxazole Patients currently on fluconazole 18 Total Adults on ART 5149 Total Children on ART % ART Intitiation by WHO stage 32.8% 32.1% BLOOD SAFETY Blood units collected from RBTC 505 Number of blood units transfused 1008 Linkage to care: Positive test to enrollment 94.8% 6.2% 41.5% 42.9% 52.4% 14.5% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

195 More findings Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 Distribution 27% 90% 98% 65% 48% 5% 61% 34% 28% 47% 25% 43% 39% 18% 34% 63% 4% Blood units collected from RBTC blood units collected from elsewhere Blood safety 50% 50% KEY FINDINGS AND PRIORITIES Summary Overall HIV prevalence in the county is 6%, with a higher prevalence among those aged 25 to 49 years at (8%). This translates to 19,200 people living with HIV in this county of which 3,000 (16%) are children. In 2011, the average reporting rates for this county for MOH 711 was at 80.7%. This is fairly representative of the reporting facilities in the county. In 2011, Among those tested for HIV in various settings within the county, the overall positivity was 6.5% with a higher positivity of 55.2% among those with TB infection. About 52.4% were linked to HIV care and treatment services within the county with better linkages (94.8%) among those testing within VCT settings. HIV testing acceptance rate among pregnant women was high at 94.9%, for those found to be positive maternal and infant prophylaxis was provided for 86.2% and 81.4% respectively. Only about 1.5% of ANC women had their partners tested for HIV and only 42.7% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 32.3% delivered within health facilities. The overall mother to child transmission rate at first test in this county was 7.0% Total number of clients on treatment as at the end of 2011 in this county was 5,470 including 591 children, this translates to a treatment coverage of 76% for adults and 27% for children Priority Areas for the County Increase the Uptake of ARV prophylaxis for PMTCT among mothers and HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase retention to ANC up to 4th visit Elimination of Mother to child transmission, and Partner testing in PMTCT Strengthen the linkage to HIV care for those who test HIV Positive from all service areas. Particular attention being those testing HIV positive in the Wards. Increase the number of HIV infected children on ART Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

196 KENYA Introduction Population Estimate Estimated population living with HIV Health facilities Providing HIV testing Health Facilities Providing PMTCT Health Facilities providing ART 1,614,400 5,140 4,694 1,405 Strata HIV Prevalence in Kenya KDHS (2008) % Overall Overall 6.3 Gender Male Female Age group 1519yrs 2024 Yrs 2529 Yrs 3034 Yrs 3539 Yrs 4044 Yrs 4549 Yrs Education level No formal education /Primary Sec/Higher 5.1 Marital status Not married 2.4 Married mono 5.7 Married poly Seperated/ divorced Widowed HIV prevalence by Age Category ( %) HIV/AIDS Situation in Kenya HIV/AIDS continues to present a major public health challenge in subsaharan Africa (ssa) where the epidemic is home to an estimated 22.4 million people around two thirds of people living with HIV globally. Kenya is one of the six HIV high burden countries in ssa. National HIV surveys in the country have become primary sources of data used for describing the epidemic, national projections and international reporting. Survey results have demonstrated substantial variations in the geographic distribution of the epidemic in the country. This has helped the national AIDS program in identifying administrative regions that suffer the heaviest brunt of the epidemic. It has also enabled the Ministry of health, through the national government, customize and deliver population targeted HIV interventions and responses aimed at achieving maximum effectiveness. Indeed, there has been a steady progress towards the scale up of HIV services to meet the demands for prevention, care and treatment. Traditionally, provinces have been used as the largest geographic administrative level in the country for planning and implementation purposes. Recently however, the constitution of Kenya introduced a devolved structure of governance comprising of 47 counties. According to the constitution, county governments are expected to implement their own policies, including health (and HIV related) interventions. However, there is currently no county level HIV data to provide guidance for decisionmaking, planning and resource allocation. In line with its mandate, the National AIDS and STI Control Program (NASCOP) and the National AIDS Control Council (NACC) are faced with the need to not only lay the foundation for successful implementation of the National AIDS responses, but also to offer technical HIV/AIDS support to county governments. Providing county profiles is therefore a vital step towards creating awareness of the HIV situation for every county. It also offers a baseline for advocacy, implementation, monitoring and evaluation of county specific HIV responses and interventions. Methods This fact sheet aims to describe countyspecific HIV/AIDS profiles using nationally representative surveillance data, service delivery data and population level modeling estimates. A secondary analysis of data from three national HIV surveys, the District Health and Information Software (DHIS) system and outputs from the Estimation and Projection Package modeling tool 1519yrs 2024 Yrs 2529 Yrs 3034 Yrs 3539 Yrs 4044 Yrs 4549 Yrs

197 HIV ESTIMATES INDICATOR People Living with HIV (PLHIV) New HIV Infections During the Year HIV related Deaths during the year PLHIV eligible for ART (Need for ART) ART coverage among PLHIV ADULTS CHILDREN 1,398, ,700 91,000 13,180 49,100 12, , ,100 72% 30% SERVICE COVERAGE TOTAL % PLWHA WHO ARE CHILDREN 1,614,400 13% 104,180 13% 61,660 20% 747,700 21% Service Number Eligible for PMTCT intervention Number Identified to Receive PMTCT Coverage of PMTCT among eligible mothers Coverage of PMTCT among eligible infants Service Coverage (%) Number Proportion 86, % % % % SERVICE DELIVERY PROFILES HTC HIV test acceptance at VCT HIV test acceptance at DTC HIV test acceptance at ANC HIV test acceptance at Maternity HIV test acceptance for partners in ANC HIV positivity at VCT VCT Couple Discordance rate HIV positivity at DTC HIV positivity in ANC for Women HIV Positivity in Maternity HIV positivity for ANC partners Overall HIV positivity 87.1% 92.2% 93.6% 90.4% 4.5% 5.6% 4.7% 6.2% 5.3% 6.6% 9.7% 6.5% 93.6% Testing Uptake PMTCT uptake cascade 82.4% Maternal prophylaxis uptake 75.5% Infant prophylaxis uptake PMTCT SUMMARY (ANC & MATERNITY) Proportion of mothers attending 4 ANC visits Overall PMTCT test acceptance rate Overal maternal prophylaxis HIV +ve women delivering in hospital Overall Prophylaxis for HIV exposed infants MTCT rates at 1st Test MTCT rates at 1st Test Overall Prophylaxis for HIV exposed infants HIV +ve women delivering in hospital ENROLLMENT TO CARE & TREATMENT 42.3% stagei 93.1% stage II 85.6% stage III 36.0% stage IV 79.9% Proportion of eligible Clients started on ART Proportion of new HIV positive enrolled to care Overall PMTCT Cascade 79.9% 36.0% 32.5% 35.6% 25.8% 6.1% 70.1% 100.0% Overal maternal prophylaxis 85.6% Overall PMTCT test acceptance rate 93.1% Proportion of mothers attending 4 ANC visits 42.3% Series4 Series3 Series2 Series1

198 PMTCTANC NUMBER STI New Ante Natal Care (ANC) clients Urethral Discharge Initial Visit Number of ANC clients attending 4 visits Genital Ulcer Disease initial Visit ANC clients counseled for HIV Opthalmia neonatorium first visits 5355 ANC clients tested for HIV STI SCREENING ANC clients found HIV positive Perons tested for Syphilis ANC +ve Clients given prophylaxis ANC Clients tested for syphilis Infants tested for HIV at 6 weeks Infants given prophylaxis TBHIV Partners of ANC clients counselled for HIV TB patients tested for HIV Partners of ANC clients tested for HIV TB patients tested HIV positive Partners of ANC clients HIV Positive 4763 TB HIV patient on Cotrimoxazole PMTCT Maternity HTC (VCT) Women Counselled for HIV in Maternity Clients Counselled in VCT Women Tested for HIV in maternity Clients tested for HIV in VCT Women found HIV Positive in maternity VCT clients HIV Positive Women issued prophylaxis in maternity Couples counselled in VCT Deliveries from HIV +ve women Couples tested for HIV in VCT Maternity Women started on Cotrimoxazole VCT couples both HIV positive 7410 Infants started on Cotrimoxazole 5781 Discordant couples in VCT 8540 Infants given prophylaxis in maternity HTC (Diagnostic HTC in Patient) HTC (DTC Outpatient) DTC inpatient counselled DTC outpatient counselled DTC inpatient tested DTC outpatient tested DTC inpatient HIV Positive DTC Outpatient HIV Positive HIV positivity by service Point 46.6% ART CARE AND TREATMENT NUMBER Enrollment for HIV care from PMTCT Enrollement for HIV care from VCT % 6.2% 5.6% 70% Enrollment to CCC by entry point 7% 18% 2% 3% PMTCT VCT TB Ward 6.5% VCT DTC PMTCT TB/HIV Overall HIV positivity All others Enrollment into HIV care from TB clinic 9008 Enrollment into HIV care from hospital wards Enrollement into HIV care from MCHChild 5848 Enrollment into HIV care from other settings Total clients enrolled for HIV care WHO stagei WHO stage II WHO stage III WHO stage IV Total number of clients starting ART Pregnant women currently on ARVs 7259 All others currently on ARVs Clients enrolled, eligible but not on ART Clients put on PEP due to Sexual assault Clients put on PEP due to occupational exposure 5428 Patients currently on cotrimoxazole Patients currently on fluconazole Total Adults on ART Total Children on ART % ART Intitiation by WHO stage 35.6% 25.8% BLOOD SAFETY Blood units collected from RBTC Number of blood units transfused Linkage to care: Positive test to enrollment 71.9% 6.1% 41.0% 19.3% 6.9% 31.6% stagei stage II stage III stage IV PMTCT VCT TB Ward overall

199 Indicator HIV testing coverage ANC coverage Male circumcision Employed Condom use Education Age at sexual debut Wealth Sexual partners Categories None Primary Secondary < >18 Poor Middle income Rich 0 1 >1 More findings Distribution 20% 90% 82% 65% 15% 58% 27% 40% 35% 25% 56% 35% 8% 35% 62% 3% Blood units collected from RBTC blood units collected from elsewhere KEY FINDINGS AND PRIORITIES Blood safety Summary Overall HIV prevalence in the county is 6.3%, with a higher prevalence among those aged 40 to 44 years at 10.3%. This translates to 1,398,700 people living with HIV in this county of which 215,700 (14%) are children. In 2011, the average reporting rates for this for MOH711 Kenya was 71.9 %. This is representative of the reporting facilities in the country. In 2011, of those tested for HIV in various settings within the county, the overall positivity was 6.5% with a higher positivity of 46.6% among those with TB infection. Of those tested positive, only about 31.6% were linked to HIV care and treatment services within the country better linkages (71.9%) was observed among those testing within VCT settings followed by PMTCT (41%) linkages was poor in TB and from Hospital wards. HIV testing acceptance rate among pregnant women was high at 93.1%, for those found to be positive maternal and infant prophylaxis was provided for 85.6% and 79.9% respectively. Only about 4.5% of ANC women had their partners tested for HIV and only 42.3% of the women who attended ANC made the requisite four visits for ANC as required by the focused antenatal care (FANC) approach. Of all the women who test positive for HIV within PMTCT settings only 36.0% delivered within health facilities. Total number of clients on treatment as at the end of 2011 in this county was 474,393 including 47,462 children, this translates to an estimated treatment coverage of 72% for adults and 30% for children 7% 93% Priority Areas for the Kenya Increase the Uptake of ARV prophylaxis for PMTCT among HIV exposed infants. Increase the proportion of mothers testing HIV positive who deliver under skilled care in Health facilities. Increase partner involvement in PMTCT through partner testing Strengthen the linkage to HIV care for those who test HIV Positive from TB clinic and in the hospital Wards. Increase the number of HIV infected children and Adults on ART. Note: **Figures for mothers and infants given prophylaxis in maternity and ANC (where appropriate) have been corrected for double counting *Figures were estimated using sample sizes less than 50 people n/athere was insufficient sample size to be used for estimating the prevalence

200 HIV TESTING AND POSITIVITY Numerator Denominator VCT test Acceptance rate Clients tested for HIV in VCT Clients Counselled in VCT DTC test Acceptance rate Sum of clients tested for HIV in Outpatient and Inpatient Sum of clients counselled for HIV in inpatient and outpatient ANC Test Acceptance rate ANC clients tested for HIV ANC clients counseled for HIV Maternity Test Acceptance for PMTCT ANC Partner Test Uptake VCT positivity Women Tested for HIV in maternity Partners of ANC clients tested for HIV Women Counselled for HIV in Maternity ANC clients tested for HIV Clients tested for HIV in VCT Clients Counselled in VCT VCT Couple Discordance rate Discordant couples in VCT Couples tested for HIV in VCT DTC Positivity ANC positivity HIV Positive in DTC outpatient and Intpatient ANC clients found HIV positive Proportion of all tested ANC clients tested for HIV Maternity Positivity HIV positive in Maternity Mothers tested inmaternity ANC partner Positivity Overall HIV positivity PMTCT SUMMARY (ANC & MATERNITY) Partners of HIV clients tested Partners to ANC clients tested HIV positive for HIV Total Tested positive from Total Tested for HIV in ANC,Maternity, VCT, DTC (in ANC,Maternity, VCT, DTC (in patient and Outpatient), TB patient and Outpatient), TB clinic and Partner testing in clinic and Partner testing in ANC ANC Overall PMTCT test acceptance rate Overal maternal PMTCTprophylaxis rate Proportion Of HIV positive Mothers delivering in Hospitals Sum of mothers tested for HIV in Maternity and ANC Mothers given ARV prophylaxis in ANC and in Maternity Deliveries from HIV +ve women Sum of mothers counselled for HIV in ANC and Maternity Mothers testing HIV positive in Maternity and ANC Sum of mothers testing HIV positive in Maternity and ANC

201 INDICATOR Numerator Denominator Sum of Infants issued ARV Overall prophylaxis rate for HIV Infants testing HIV positive in prophylaxis in ANC and exposed Infants ANC and Materntiy maternity MTCT rates based on tests done ENROLLMENT TO CARE & TREATMENT Proportion of eligible Clients started on ART Proportion of new HIV positive enrolled to care TBHIV HIV positivity In TB BLOOD SAFETY Total number of clients starting ART Total persons tested HIV positive from ANC, Maternity VCT, DTC(in patient& Outpatient), and Partner testing sites TB patients testing HIV positive % of transfused blood from RBTC Blood Units Transfused Clients enrolled, eligible but not on ART Total persons enrolled to care from PMTCT VCT, DTC(in patient& Outpatient) TB patients tested for HIV Blood Units Collected from RBTC

202 National AIDS & STI Control Programme NASCOP Kenyatta National Hospital Grounds P. O. Box , Nairobi Tel: 254 (20) Website: www. nascop.or.ke