OBJECTIVES: People who inject drugs (PWID) in Kenya have high HIV (range across settings: 14-26%) and HCV (11-36%) prevalence. We evaluated the impact of existing and scaled-up interventions on HIV and HCV incidence among PWID in Kenya.
DESIGN: HIV and HCV transmission model among PWID, calibrated to Nairobi and Kenya’s Coastal region.
METHODS: For each setting, we projected the impact (% of HIV/HCV infections averted in 2020) of existing coverages of antiretroviral therapy (ART; 63-79%), opioid agonist therapy (OAT; 8-13%) and needle and syringe programmes (NSP; 45-61%). We then projected the impact (reduction in HIV/HCV incidence over 2021-2030), of scaling-up harm reduction (‘Full HR’: 50% OAT, 75% NSP) and/or HIV (UNAIDS 90-90-90) and HCV treatment (1000 PWID over 2021-25) and reducing sexual risk (by 25/50/75%). We estimated HCV treatment levels needed to reduce HCV incidence by 90% by 2030.
RESULTS: In 2020, OAT and NSP averted 46.0-50.8% (range of medians) of HIV infections and 50.0-66.1% of HCV infections, mostly due to NSP. ART only averted 12.9-39.8% of HIV infections due to sub-optimal viral suppression (28-48%). Full HR and ART could reduce HIV incidence by 51.5-64.0% and HCV incidence by 84.6-86.6% by 2030. Also halving sexual risk could reduce HIV incidence by 68.0-74.1%. Alongside Full HR, treating 2,244 PWID over 2021-2025 could reduce HCV incidence by 90% by 2030.
CONCLUSION: Existing interventions are having substantial impact on HIV and HCV transmission in Kenya. However, to eliminate HIV and HCV, further scale-up is needed with reductions in sexual risk and HCV treatment.
Modelling the impact of HIV and HCV prevention and treatment interventions among people who inject drugs in Kenya
AIDS, 36 (15), 2191-2201. doi: 10.1097/QAD.0000000000003382. PMCID: PMC9671825.