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Title
The progress and utility of HIV case-based surveillance in Kenya for public health response, 2014-2022
Presenter
Anthony Waruru
Authors
A. Waruru1, W. Waruiru2, K. King’utu2, M. Ndisha1, O. Osborn Otieno3, L. Kingwara3, F. Weissglas2, P. Mwele4, L. Odero5, G. Omoro6, N. Springstubb7, M. Patel7, S. Jonnalagadda7
Institutions
1US Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Nairobi, Kenya, 2University of California San Francisco, Global Programs for Research and Training (GPRT), Nairobi, Kenya, 3National AIDS and STI Control Program (NASCOP), Nairobi, Kenya, 4Palladium, Nairobi, Kenya, 5The United States Agency for International Development (USAID), Nairobi, Kenya, 6Walter Reed Army Institute of Research, Nairobi, Kenya, 7US Centers for Disease Control and Prevention (CDC), Atlanta, United States

BACKGROUND: HIV case-based surveillance (CBS) is a person-centric system that provides timely data across the HIV cascade – from prevention, testing, and treatment to longer-term health care and outcomes. The CBS system has individual-level robust data for sentinel events-driven public health response (PHR), thereby achieving the complete data collection cycle and use for improving treatment outcomes. We present the Kenyan experiences, 2014 to date, and the system's utility for PHR.
DESCRIPTION: In Kenya, CBS pilot activities were started in 2014-15 in two counties, followed by a proof of concept in 2016-17. Since 2018, the national data warehouse (NDW) data have been used for CBS after an extraction, loading, and transformation (ETL) process. By 2021, data from 40/47 counties accounting for ~95% (1,107,173) of PLHIV currently on treatment were part of the CBS system. Reporting rates to NDW are estimated to be 89% (figure). To support CBS, county and health facility staff are routinely trained through an interactive eLearning platform, and CBS implementation is monitored through quarterly progress review meetings.
LESSONS LEARNED: Case-level data are used to generate individual-level PHR reports identifying every client needing attention, e.g., diagnosed but not linked to care, not virally suppressed, and shared with the facilities for timely decision-making. CBS data are extracted from NDW and analyzed for scientific dissemination, addressing key epidemiologic questions and identifying areas for programmatic strengthening and focus.
CONCLUSIONS: The high coverage of PLHIV in EMRs provides rich data for informing CBS sentinel events-anchored PHR in Kenya. The PHR reports have revolutionized the utility of CBS and accelerated its buy-in in Kenya. To the best of our knowledge, Kenya is the first sub-Saharan African country to implement the complete cycle of CBS, including PHR as a feedback loop to the facilities and improving services to PLHIV. To strengthen the CBS system, an evaluation is currently underway.

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