Secure The Future – Kenya

Lead by the Bristol-Myers Squib Foundation, the SECURE THE FUTURE® initiative works with their partners in Africa to provide care and support for communities affected by HIV.

Background and Need

Adolescent girls are a key demographic in the fight to reduce HIV and HPV infections, AIDS and cervical cancer because they are disproportionately at risk. Significant advancements have been made against HIV/AIDS over the past decade amongst adult populations. However, the threat from HPV/cervical cancer to this demographic is increasing especially in the presence of HIV co-infection. Currently, approximately 10.3 million women aged 15 years and above in Kenya are at risk for cervical cancer, with an annual incidence projected to rise by 74% by the year 2025.

In terms of primary prevention, a major development in the past few years has been the introduction of the HPV vaccine through a GAVI‐supported HPV vaccination demonstration project in 2013‐2014. Highly successful, the two‐year demonstration project in Kitui County, Kenya, utilized a school‐based approach targeting girls in form 4 and out of school girls 10 years of age. The project vaccinated 40,000 girls with a coverage rate of over 85% in both years. While initially thought to be cost effective, this strategy resulted in $20.67 per student, inclusive of vaccine costs. 13 key lessons that emerged from this project included the critical importance of community sensitization, engagement   and male involvement, the importance of accurate targeting to avoid vaccine shortfalls, and the need to explore ways to bundle HPV vaccine with other adolescent health services. As a follow‐up to this project, GAVI approved a follow-up demonstration project to be implemented within 2017 to vaccinate 65,240 girls in and out of school, utilizing a facility/mobile outreach approach, coordinating with schools as well as the First Lady’s “Beyond Zero” campaign around cervical cancer.  The Ministry of Health plans to review and revise the Kenya Cancer Prevention and Management Strategy, possibly providing a window of opportunity for policy advocacy.

While there is a favorable policy framework and encouraging movement toward policies across health and education, many gaps exist in implementation of these policies, especially in areas of high risk populations such as adolescent girls, as they are a high risk population for exposure to HPV at an early age due to exposure of risks. Another risk is the parents’ resistance to HPV vaccination and cancer screening for their daughters. The protective factor of schooling is also limited due to high dropout rates between primary and secondary levels. HPV vaccinations in conjunction with cervical cancer screenings and treatment are paramount for reducing the mortality rate for cervical cancer in Kenya. CMMB is working with the rural, poor and marginalized communities in Kitui South to improve access to maternal and child health services as well as enhance quality of care at lower level facilities.  By training community health workers, nurses and health professionals in local government health facilities through provision of training programs on cancer screening and care ensuring that women are able to access these services beyond the project implementation period.

Monitoring and Evaluation

Monitoring and evaluation will be facilitated through the already existing CHAMPS programmatic portfolio and structures within Kenya and remain the responsibility of CMMB.  Periodic reports will provided to BMSF.

Expected Outcomes

  • Improved capacity of community health workers, nurses and health professionals in local government health facilities
  • Improved access to women’s healthcare services for underserved communities
  • Improved advocacy on policies towards improving access to health care for both cancer prevention and treatment
  • Improved access to maternal and child health services as well as enhance quality of care at level of community, dispensaries and health centers.