KENYA, COUNTY HIV SERVICE DELIVERY PROFILES

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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

28

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

32

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%

Brief EXPLORING 10 YEARS OF HEALTH SERVICE COST AND USE IN KENYA. Key Findings. Background. Outpatient Utilisation and Expenditure.

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