Our Global Strategic Information (GSI) group is the HIV strategic information partner to the National AIDS and STI Control Programme (NASCOP) of the Kenya Ministry of Health. We provide support for HIV surveillance and monitoring & evaluation activities through a cooperative agreement funded by Centers for Disease Control-Kenya (CDC-Kenya). We have a team of more than 20 programmatic staff in Kenya, hired through UCSF Institute for Global Health Sciences’ Global Programs for Research & Training office. GSI has been working in Kenya since 2002.
Kenya AIDS Indicator Survey
The AIDS Indicator Survey (AIS) is a standardized surveillance tool used to monitor nationally representative HIV/AIDS indicators in the general population to evaluate the response to the HIV epidemic and to inform HIV policy. GSI supported the Government of Kenya in data analysis and report writing for the first AIDS Indicator Survey (AIS) in 2007. GSI provided technical assistance on the design, implementation, analysis, and dissemination phases for the second AIS in 2012. Novel elements included electronic data capture, point of care (POC) testing for HIV and CD4 counts, HIV incidence testing, viral load testing, and antiretroviral testing. Findings from the second AIS provided information needed for advocacy and for evaluating and improving interventions for HIV prevention, treatment and care, and were disseminated via a final report and peer-reviewed publications in a JAIDS special supplement.
GSI is collaborating with NASCOP, CDC-Kenya, and other partners on the development and implementation of an HIV case-based surveillance system to capture individual level data on HIV-infected persons in Kenya. HIV case information can help determine HIV disease burden, risk factors for HIV infection, HIV impact on health services, provide information on opportunistic infections, and assess trends in incidence of HIV diagnosis and prevalence of HIV.
GSI provided support to NASCOP to complete a mortuary survey in Nairobi, with the aim of determining the proportion of all-cause, HIV-related, AIDS-related and other cause-specific deaths among adult cadavers in City and Kenyatta National Hospital (KNH) mortuaries. GSI is preparing to provide support for a second mortuary survey in Kisumu. Data from these surveys will help overcome the obstacle of inadequate mortality data, and will aid in elucidating the impact of HIV/AIDS on mortality in Kenya.
Integrated Biological and Behavioral Surveillance
In 2010, Population Council and GSI provided technical assistance to NASCOP on conducting integrated bio-behavioral surveillance (IBBS) surveys among men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID) in Nairobi. These surveys were designed to gather key behavioral and HIV seroprevalence information from these populations, and also examined how best to access and serve these hard to reach groups. Results from the survey are being used by the Government of Kenya and CDC to inform program planning for key populations.
GSI collaborated with CDC and the Field Epidemiology Society of Kenya (FESK) on a study designed to explore the roles, relationships and sexual networks among the various fishing community groups around Lake Victoria in order to understand migratory patterns of the fishing community, and to learn more about the perceived burden of HIV/AIDS in the fishing community as well as HIV risk and protective behaviors. Study findings will be used to design HIV programming in the fisherfolk community. As a follow-up, GSI is collaborating with the Kenya Medical Research Institute (KEMRI) to provide technical assistance for the design and implementation of a bio-behavioral surveillance survey of fisherfolk in the Lake Victoria region.
Research & Evaluation
Longitudinal Study of Treatment in Kenya
NASCOP implemented a second retrospective Longitudinal Study of Treatment in Kenya (LSTIK), conducting chart-based abstraction of patient data to evaluate clinical outcomes, quality of care and effectiveness of the HIV program for a period of 10 years. GSI provided data management support during implementation of the survey and is currently providing data analysis, report writing, and manuscript development support. GSI previously provided technical assistance throughout all phases of the first LSTIK in 2007.
GSI provided technical assistance to NASCOP to assess the utility of using prevention-of-mother-to-child-HIV-transmission (PMTCT) program data instead of conventional antenatal clinic (ANC) based surveillance to estimate HIV prevalence. The PMTCT Assessment found that the prevalence estimates obtained from the day-to-day ANC facility registers were comparable to those obtained from the ANC sentinel surveillance survey, and enabled NASCOP to end ANC sentinel surveillance. In addition, the assessment identified several areas in need of improvement and recommendations were drafted for:
- Improving data management at PMTCT facilities
- Improving quality of HIV testing at the national and facility levels
- Improving proficiency testing
- Transitioning from sentinel surveillance to using PMTCT data for surveillance purposes
ART Adherence Study
In collaboration with CDC, GSI designed and is currently planning for implementation of a qualitative study to assess adherence behaviors of people living with HIV on ART in three counties in Kenya (Siaya, Homa Bay and Nairobi). The study will seek to identify the facilitators and barriers to ART adherence, document provider perspectives on adherence, and understand risk behaviors among those on ART.
Key Population Size Estimation Consensus Exercise
GSI led a Population Size Estimation Consensus Exercise to share existing data on key population size estimates obtained from 2006-2013 and build consensus among stakeholders regarding ‘best available’ size estimates for KP in different geographic regions of Kenya. The consensus process and the population size estimates obtained from this exercise were documented in a report, and are being used to inform proper allocation of human and financial resources and KP programming.
Key Population Triangulation
GSI collaborated with members of the National Key Population (KP) Technical Working Group (TWG), as well as other stakeholders on a KP triangulation activity. This activity synthesized existing data sources to correlate changes in HIV prevalence with specific risk behaviors, geographic areas, and programs in the context of a mixed epidemic. Results from this activity may be used to inform policy and programmatic decisions related to KP, and to enhance and improve KP prevention, care and treatment programs.
Training and Education
Targeted Needs-Based Trainings
GSI provides trainings and mentorship in surveillance and monitoring & evaluation methods, data analysis, data interpretation, and scientific writing (reports, abstracts, posters, and manuscripts), as well as mentorship skills development for MOH professionals in leadership positions.
GSI provides data analysis, manuscript writing, and publication support. This has built the capacity of Kenyan researchers to develop scientific manuscripts and has directly contributed to the publication of several manuscripts in peer-reviewed journals.
M&E Best Practices Conference
GSI supported NASCOP in planning and implementing the 3rd Annual National M&E Best Practices Conference in May 2016: “M & E Best Practices: Embracing e-health for improved service delivery, data quality and data use.” This conference highlighted best practices for HIV monitoring & evaluation in Kenya, and served as a forum for sharing and cross-learning among participants. The conference drew participation from M&E officers from the national to the facility level, including government and implementing partner staff.
Program Monitoring and Quality Improvement
National M&E Tool Rollout
In 2016, NASCOP developed a comprehensive set of new and revised M&E tools for Kenya’s National HIV programming. GSI supported this endeavor by developing a master training and tool rollout plan that incorporated a training of trainers model to train several cadres of M&E officers and data clerks at various levels nationwide. GSI created training materials for all of the tools, and led the training of 55 national level trainer-of-trainers (TOT) and a further 853 county TOTs nationwide. GSI also revised the training materials, and is continuing to support sub-county trainings.
DREAMS Monitoring & Evaluation
As the M&E partner for the DREAMS initiative in Kenya, GSI has worked in close collaboration with PEPFAR implementing partners (IPs) to develop a robust M&E framework for DREAMS in order to track progress towards the goal of preventing new infections in the most vulnerable sub groups of females 10-24 in target locations and populations in Kenya. GSI developed and rolled out an Open Data Kit (ODK) enrollment form and web-based DREAMS database, and trained IPs on these new tools, which are now in use by all IPs. GSI holds quarterly M&E monitoring visits to IPs and data review forums to provide support for IPs and enable two-way feedback on use and functionality of the tools. GSI is currently working on developing additional functionalities within the database, including development of reports that address IP, national and PEPFAR reporting needs.
Data Quality Assessment
GSI collaborated with CDC to develop a data quality assessment (DQA) strategy, incorporating current national DQA methods and aligning with the methods used by PEPFAR in previous CDC-supported DQA activities.
GSI has supported NASCOP in a series of cohort analysis workshops for both paper and electronic based systems. To build capacity for cohort analysis at subnational and site levels in a sustainable way, GSI is developing mechanisms to implement and monitor routine cohort analysis using mixed methods of training of trainers and distance learning. This will include routine cohort analysis in both EMR and non-EMR sites. The focus of this TA will be on data abstraction, data management and cleaning, analysis, reporting, dissemination and use.
NASCOP, in collaboration with CDC partners, developed a data warehouse that collects de-identified data for individuals who are enrolled in ART at facilities with electronic medical records. GSI provides ongoing analysis and dissemination of data sent to the data warehouse.