Why Ruto changed tune on WHO hub

Geopolitics may have played a role in President William Ruto’s decision to grant the World Health Organization (WHO) 30 acres of land belonging to Kenyatta University.

This decision is in contrast to his stance last year when he opposed the move, which was fronted by his predecessor, Uhuru Kenyatta.

It now emerges that Kenya would have stood to lose more than gain if the Emergency Regional Hub for Eastern and Southern Africa was established elsewhere. 

According to the WHO, Kenya is the most strategic location for the hub, as it provides easy access to 25 countries in the region.

Furthermore, Dr Ruto has pledged to grant the WHO an additional 50 acres of land in Mombasa for its use. 

He endorsed the deal while speaking at the Kenyatta University Teaching and Referral Hospital, stating that the project would position Kenya as a regional hub.

He described the land given to WHO as unutilised and noted that despite the allocation, the university would still have sufficient land for expansion.

Last year, Kenyatta University had opposed giving away the land, arguing it needed it for expansion.

In his speech, the President announced that he had instructed Investments, Trade and Industry Cabinet Secretary Moses Kuria to allocate 50 acres of land in Mombasa to the WHO. 

He said the process would be completed within a month, but did not provide any specific details regarding the location of the land.

“The ball will be squarely in your court thereafter,” Dr Ruto told the WHO representatives during the meeting at the Kenyatta University Teaching, Referral and Research Hospital on Monday when he launched the Cyberknife Centre.

However, a similar plan was opposed last year amid allegations of shady deals and land grabbing. At the time, the vice-chancellor, Prof Paul Wainaina, and the university council stood in the way but were all forced out of office. The government then hastened the transaction before it was stopped by the courts.

Capitalised

Coming just a month before the general election, Dr Ruto who was then deputy president, and the Kenya Kwanza brigade capitalised on the conflict and rallied behind Prof Wainaina. 

After the Kenya Kwanza party came into power, Prof Wainaina was reinstated as the vice-chancellor of Kenyatta University. In addition, he was appointed to serve on the Presidential Working Party on Education Reforms.

“It’s not been easy; it’s been a long way but it happened because you wanted it to happen,” said WHO representative, Dr Abdourahmane Diallo, during the signing of the memorandum of understanding at Afya House that will see the organisation establish the Emergency Regional Hub for Eastern and Southern Africa.

Health Cabinet Secretary Susan Nakhumicha, who signed the MoU on behalf of the government, described the establishment of the hub as a “long overdue, historical and momentous occasion”.

The Emergency Regional Hub for Eastern and Southern Africa is expected to coordinate high-quality responses to health emergencies in Kenya and the region, as well as serve as a modern storage facility for essential medical equipment and consumables. 

The hub is also expected to offer timely support to countries experiencing emergencies.

“The hub will serve as a centre of excellence specialised in capacity building in health crisis and emergency management. Through this partnership with WHO, we will have access to the organisation’s global network of experts, knowledge, and resources. We will also be able to leverage the latest innovations and technologies to improve our response times and our ability to provide essential healthcare services during emergencies,” Ms Nakhumicha said.

Dr Ruto said the hub would provide employment opportunities, capacity building and technology transfer. 

He, however, ruled out giving part of the university land to individuals claiming to be squatters from the Kamae neighbourhood. 

Mr Kenyatta had allocated 190 acres for the settlement of the squatters. The former president had also set aside 10 acres for the Africa Centre for Disease Control and 180 acres for Kenyatta University Teaching, Referral and Research Hospital.

dmuchunguh@ke.nationmedia.com

UNAIDS welcomes the announcement by Medicines Patent Pool (MPP) and ViiV of three licenses signed with generic manufacturers for long-acting PrEP, and urges further urgent action by ViiV

GENEVA, 31 March 2023 — UNAIDS welcomes the announcement by Medicines Patent Pool (MPP) and ViiV of three licenses signed with generic manufacturers Aurobindo, Cipla and Viatris for long-acting Cabotegravir for PrEP (Pre-exposure prophylaxis.) PrEP reduces risk of HIV transmission from sex or injecting drug use. UNAIDS also called for urgent action by ViiV to be taken to reduce the price and increase the production of CAB-LA now.

UNAIDS Deputy Executive Director for Policy, Advocacy and Knowledge, Christine Stegling said:

“UNAIDS applauds this announcement by the Medicines Patent Pool, and congratulates the companies on securing the licensing agreement. The generic production of affordable CAB-LA is essential to preventing millions of new HIV infections. The progress made is a testament to the power of campaigning communities who have mobilised to demand long-acting medicines, and to the determined efforts of access to medicines advocates. UNAIDS thanks ViiV for the commitment to tech sharing made through these agreements, and urges all patent holders of long-acting HIV medicines, including those still in development, to commit to share, and make their technology available, now. UNAIDS welcomes that this is only the first announcement of licensing, not the last, and urges ViiV to expand the geographic coverage of the licensing to all low and middle income countries. Because generic production will take several years to get to medicines being available for use, UNAIDS also urges ViiV to right now provide its own production of CAB-LA to procurers at an affordable price and in volumes that match need. We must all be driven by the fierce urgency of now.”

Progress in the global HIV response is slowing, and too many countries are seeing rising infections. The 2025 targets are in danger, and only bold actions can enable the curve of new infections to be pulled down. The deployment of new technologies such as long-acting CAB-LA at an affordable price is urgent and will help fill critical HIV prevention needs for people facing the highest HIV risks. It is also notably welcome that one of the sub-licenses (Cipla) plans to manufacture in South Africa, in addition to India. This is an important step in support of increased local manufacturing of medicines in Africa. 

UNAIDS acknowledges this concrete step towards generic production of needed innovative products but urges that short term solutions be put in place immediately and until generic products are widely available. UNAIDS is notably concerned with the recent announcements that current supplies of CAB-LA are not at all sufficient to meet growing demand, and are much less than procurers have said they could purchase. Transparency in sharing information on volumes and price by ViiV of long-acting CAB-LA is essential to help drive progress in increasing volumes.

It is vital and urgent that long-acting anti-retrovirals for PrEP be made available at an affordable price everywhere they are needed. Middle-income countries are now where the majority of new HIV infections occur and home to many of the key populations most at risk of HIV transmission and who most need access to long-acting ARVs. But many countries are not included in this license despite considerable need for affordable new health technologies.

The issuance of these three licenses should pave the way for sharing technology on other innovations for long-acting HIV prevention and for long-acting treatment. UNAIDS urges that licensing help develop a path for accelerated market entry of generic formulations of long-acting anti-retrovirals not only for prevention, but also for treatment, when normative guidance is established, and regulatory approvals are in place at country level.

UNAIDS calls on the private sector, governments and funders to ensure that everyone who needs long-acting antiretrovirals can access them. UNAIDS will continue working with the Coalition to Accelerate Access to Long-Acting PrEP that is jointly convened by the Global Fund on AIDS, TB and Malaria, PEPFAR, Unitaid and the World Health Organization (WHO) with AVAC as its Secretariat to find solutions and ensure equitable global access to pandemic-fighting technologies for all.

Kemri TB vaccine likely to get WHO nod after trials

If adopted by the World Health Organisation (WHO), it is going to be the first vaccine to prevent active tuberculosis in adults and adolescents produced in Kenya.

The vaccine being developed by the Kenya Medical Research Institute (Kemri) and the Gates Medical Research Institute is set for Phase III clinical trials.

The research institutes and several African countries participated in the Phase II trials of the m72 candidate conducted in 3,500 adolescents and adults with latent TB in Kenya, South Africa and Zambia from August 2014 to November 2018.

RELATED

• India announces trials for new TB vaccine

• Global funding for TB rises after three years

At least 54 per cent of those who received the vaccine were protected from active TB for three years, surpassing the WHO threshold.

While highlighting milestones against TB, which is responsible for six per cent of deaths in Kenya, the researchers said they are also working on a BCG recombinant Phase III vaccine trial for infants.

Some 1,500 participants have been recruited for the vaccine candidate from the Serum Institute of India for the trial to be conducted in Nairobi and Siaya.

Read: Pandemic, funding shortfalls hamper HIV-TB response

“These vaccines have a likelihood of being adopted by WHO. It means Kemri is making strides in achieving the universal healthcare,” Dr Videlis Nduba, research scientist at Kemri, said.

“The infants were vaccinated in two groups with an improved BCG recombinant comparing this to the normal BCG.”

The study is looking at the preventing infection and subsequent prevention of TB.

BCG is the only licensed TB vaccine. While it provides moderate efficacy in preventing severe forms of TB in infants and children, it does not adequately protect adolescents and adults, who account for close to 90 per cent of transmissions worldwide.

Every year, about 120,000 people in Kenya develop TB, with 48,000 infected with HIV. Some 18,600 die from it, according to the Ministry of Health.

This is despite the disease being curable and preventable. Most patients seek medical attention after developing acute TB.

Read: Alarm as TB deaths among people living with HIV increase

Researchers are also working on the best way to diagnose TB in children. They want to use a system that will confirm the presence of TB in blood and urine.

Dr Jane Ogango, a researcher at Kemri, said the target for the study is to make treatment easy.

“We continue to search for more short treatment regimens. Our objective is to make the patient comfortable,” Dr Ogango said.

Kemri is also working on diagnosis. Most hospitals use Genexpert for diagnosis.

Read: TB deaths in HIV patients increase for first time in 10 years

“This molecular test gives results immediately. It is a more sensitive test compared to what was previously used. There is need to screen everyone with cough symptoms,” she said.

According to Health PS, Josephine Mburu, TB case-finding and lab diagnosis form the backbone of quality patient care and disease surveillance.

Meanwhile, the government will hire at least 90,000 community health workers by next month to boost universal healthcare, Prime Cabinet Secretary Musalia Mudavadi said during events to mark the World TB Day in Eldoret yesterday.

“We will give stipends to the health workers countrywide to ensure they provide the first line of response,” he said.

Mr Mudavadi did not reveal the amount to be given to every health worker.

He stressed commitment to boost health services in line with the Kenya Kwanza economic model.

He added that the government would build a referral hospital in Uasin Gishu County after the elevation of Moi Teaching and Referral Hospital.

At the same time, the Prime CS urged health experts to write prescriptions in Kiswahili.

“Patients need to understand what is being prescribed to them. Not every Kenyan can read or understand English,” Mr Mudavadi said, adding that Kiswahili is the national language.

Additional reporting by Titus Ominde

Meet man taking HIV drugs in public to fight stigma

Ruele Okeyo, 26,  started taking antiretroviral drugs (ARVs) in 2020 after he learnt that he was HIV positive from a random test he took with a couple of his friends.

As much as the virus changed his life, he swore to ensure that he took his pills religiously. Two years later, he started a campaign where he took ARVs in public, recorded himself and posts the videos on social media.

“It all started on TikTok. I already have a podcast but wanted to venture into a new platform with more visuals. When I started watching content from people living with HIV, I did not like the kind of sad and pitiful narrative they were showing. It really sends a bad message, but I understand where they are coming from. It is not easy to have to take ARV pills everyday. However, if you are on social media talking about HIV, you are an ambassador. If I am living with HIV and I come across such content, I will feel terrible about myself and my situation,” he said.

Most HIV positive content creators who were spreading more positive messages were from South Africa, Ghana and Nigeria.

“The only other creator I have seen doing a great job is Doreen Moraa, who uses her platform to educate people about the virus and her experience living with it,” he said.

Doreen, who has over 140,000 followers on TikTok, was born with HIV but was only diagnosed when she turned 13.

Read: Why Kenya is likely to face a HIV crisis 

In most of his videos, Ruele is seen taking out a blue bottle of Acriptega pills that are free for people living with HIV. He then proceeds to take a pill and has since then attracted more than 8,000 followers and 50,000 likes on TikTok. At the end of every video, he asks his followers to suggest a place he should take the pills.

Since he started the campaign, he has taken the pill at Holy Family Basilica, in a matatu, Central Police Station and even at the top of KICC as per the request of his followers.

When I was recording the video at Central Police Station, my friend who acts like my cameraperson was not around so I asked a boda boda rider to record it for me. He asked what it was for. When I told him it was for a HIV campaign, he said that I did not look like someone who has HIV,” said Ruele.

His most viral video that has over 980,000 views shows him taking a pill at a cashier till at Naivas supermarket after buying a bottle of water.

“I received so many positive comments like someone who commented that my content had inspired them to start taking their ARV pills regularly. Another one said they were inspired to start living their life again as living with HIV was not the end of it,” he said.

But there are some negative ones, which shun what Ruele is doing but this does not stop him from encouraging more HIV-positive people to take their pills daily.

“It is not easy taking these pills in public and putting yourself out there bare for them to judge you. Sometimes I feel like maybe I went too far but the impact that I see it has had on others is worth it.”

He said most people who live with HIV are afraid to take medicine even in their own houses. “Some people still continue having unprotected sex with unknowing partners because they have not accepted their diagnosis.”

Ruele narrated how he learnt that he had the virus.

“In September 2020, my friends and I went to support a friend who was having a HIV testing drive. I had a test in August and the test was negative. In my mind, I was just expecting it to be a regular check-up. When the laboratory technician told me my test was positive, I told him to run it again. He did it again and it still came back positive,” he recalled.

Read: Kenya loses 6 youngsters to Aids daily, study says

Ruele tried to remember which of his partners could have infected him but it could not change the test results that transformed his life forever. The only responsible thing that he could do was to be honest with previous partners about his HIV status.

There are drugs that can be used for HIV prevention after possible exposure such as PEP (post-exposure prophylaxis). They are used for emergencies and must be started within 72 hours after a recent possible exposure to HIV, and PrEP (pre-exposure prophylaxis) is taken before possible HIV exposure.

However, it was too late for Ruele to use these methods. It was unfortunate that he was also unable to financially sustain himself at the time.

“On September 28, 2020, I took my first ARV pill at 10am. I did not take them because I had accepted my situation. I was still in denial but I took them because I realised that I was now vulnerable. Anything could attack my immune system easily. I was broke, had no medical insurance and I could not afford to fall sick.”

A strong support system made up of friends and family helped him pull through and find a reason to go on in those dark times.

A study by researcher Matt Pelton found out that the suicide rate for people with HIV is 100 times higher than the general population.

Read: Alarm as more pregnant women test positive for Syphilis 

“What I thought was that my downfall literally gave me a purpose in life. I have had the chance to represent young people living with HIV locally and internationally. Honestly, I am just doing it scared. You still feel stigma even from educated people.”

He is a U=U ambassador for the African Forum, which is part of the Prevention Access Campaign. Undetectable equals Untransmittable (U=U) means that people with HIV can achieve and maintain an undetectable viral load by taking ARVs daily as prescribed and cannot sexually transmit the virus to others.

Ruele also runs a safe house for LGBTQ+ youth who are rendered homeless because they have been kicked out of their home by their parents, evicted from their houses or kicked out by their partners thus left on the street with no immediate support mechanisms.

smuia@ke.nationmedia.com

Consultancy Opportunity - Children, HIV and the COVID-19 Response in the ESA Region: Partners’ Promising Practices

Expected start date: 24th July 2020

Expected Completion date: 6th September 2020

Reporting to: Advocacy Technical Working Group through the RIATT-ESA Programme Manager

Location of Assignment:  Desk review with virtual consultations conducted with RIATT-ESA Partners in the ESA region.

Background and Justification:

RIATT-ESA are proposing to investigate how COVID-19 has been impacting the HIV programmes of its over 30 partner organisations and what measures they have used to adapt their programmes to ensure the continued support of vulnerable children and youth in the ESA region.

Job Summary

Aim of the Study:

This study will investigate how the partner organizations have been impacted by COVID-19, the challenges they have faced and measures they have taken to alleviate and mitigate the impact of COVID-19. The study purpose is to identify and share partners’ promising practices with adapting programmes and conduct advocacy with Governments in the ESA region about the findings.

Scope of this assignment / Detailed Activities and Tasks

Consultation with stakeholders:

Consult with the relevant partners in the ESA region.

Outputs/Deliverables:  

This assignment has 2 deliverables:

1. Inception report

2. Study report including collation of Partners’ Promising Practices

Qualifications & Experience Required:

Education:

Relevant advanced academic degree (Medicine, Social Sciences, Public Health, Development Studies, Economics or related fields); previous experience leading teams; knowledge of HIV programmes; knowledge of institutional development and capacity assessment; high quality report writing skills;

Knowledge & Skills

•         Demonstrated experience in conducting advocacy studies and planning for advocacy campaigns.

•         Demonstrated experience in institutional development and with knowledge of HIV programmes and implementation;

•         Experience working with governments, international donors and others.

•         Sensitivity to and ability to work with people living with HIV, at risk and affected by HIV including key populations.

•         Knowledge and skills in capacity assessment in relation to large scale public programmes;

•         Specific knowledge of mapping, programmes coordination and data base development;

•         Demonstrated ability to prepare for, facilitate and lead, national surveys;

•         Demonstrated ability to present information and ideas and to communicate effectively;

•         Demonstrated data collection and analytical writing skills;

•         Knowledge of the East and Southern Africa Community (EAC & SADC) administrative structures is an added advantage;

•         Proven ability to: (i) handle multiple tasks under pressure with short deadlines; (ii) ability to work independently, seeking guidance on complex issues; and (iii) excellent interpersonal skills, proven team orientation and the ability to work across unit boundaries.

Experience:

1.       At least 5-8 years’ experience working in HIV programmes and institutional development

2.       Demonstrated experience in conducting advocacy studies and planning for advocacy campaigns.

3.       Relevant academic degree (Medicine, Public Health, Social Sciences, Development Studies, Economics or related filed); previous experience leading teams; knowledge of social protection programs; knowledge of institutional development and capacity assessment; high quality report writing skills

4.       Prior experience working closely with the SADC and EAC

5.       Prior experience on information / Data management– database development; qualitative research software skills; mapping skills

Languages: Fluency in English is essential, working knowledge of French, Portuguese and or KiSwahili will be an added advantage.

How to apply: Potential candidates are requested to submit the following to hradmin@repssi.org cc riattesamanagement@repssi.org by             .

·       A cover letter outlining your skills and experience

·       A detailed CV

Only short-listed candidates will be contacted.

Detailed TORs

Detailed Terms of Reference

Children, HIV and the COVID-19 Response in the ESA Region: Collation of promising practices

Eastern and southern Africa is the hardest hit region by HIV. Although it is home to about 6.2% of the world’s population, it accounts for over half (54%) of the total number of people living with HIV in the world (20.6 million people). In 2018, there were 800,000 new HIV infections, just under half of the global total[i].

South Africa accounted for more than a quarter (240,000) of the region’s new infections in 2018. Seven other countries accounted for more than 50% of new infections: Mozambique (150,000), Tanzania (72,000), Uganda (53,000), Zambia (48,000), Kenya (46,000), Malawi (38,000), and Zimbabwe (38,000)[ii].  Overall, new infections in the region have declined by 28% since 2010[iii]. Around 310,000 people died of AIDS-related illnesses in the region in 2018, although the number of deaths has fallen by 44% since 2010[iv]. Despite the continuing severity of the epidemic, significant progress has been made towards meeting the UNAIDS 90-90-90 targets. In 2018, 85% of people living with HIV were aware of their status, 79% of them were on treatment (equivalent to 67% of all people living with HIV in the region), and 87% of those on treatment had achieved viral suppression (equivalent to 58% of all people living with HIV in the region)[v].

Globally, the annual number of new infections among children (0-14 years) has almost halved since 2010 with a 47% reduction in new HIV cases. HIV is having a significant impact on children and adolescents in the region. In 2018, 1.1 million children (0-14 years) were living with HIV in East and Southern Africa.  The proportion of children living with HIV on treatment increased to 62% in 2018 from 22% in 2010. The main route for HIV transmission among children is through mother to child transmission, (MTCT), during pregnancy, childbirth or breastfeeding. East and Southern Africa has achieved the largest decline in MTCT anywhere in the world, falling from 18% of infants born to mothers living with HIV in 2010 to 6% in 2015—a threefold decrease (UNAIDS 2016).Without ART, a third of infants who acquire HIV as a result of MTCT will not reach their first birthday, and half will not reach their second birthday. Approximately 65,000 of the region’s children and adolescents died of an AIDS-related cause in the same year[vi]. While there has been a decline in new HIV infections among adolescents over the last decade, the slow rate of that decline, coupled with the rapidly increasing population of adolescents and high rates of adolescent pregnancy will continue to fuel the HIV epidemic.

The new COVID-19 pandemic, caused by a new strain of coronavirus, has resulted in extraordinary measures being taken around the world to contain, slow the pace, or reduce the impact of the virus in form of partial or total lockdowns and other country, context-specific restrictions. It is anticipated that in Africa a higher incidence of the severe effects of COVID-19 will occur in younger patients because of the demographics and associated endemic conditions that affect the immune system. HIV is likely to increase the severity of COVID-19. Africa may not see the same narrative of “most people who get it will be fine” play out (World Economic Forum 2020).

COVID-19 may impact children and their families affected by HIV and the programmes meeting their needs in several ways:

i)             Negative impact of the measures taken to combat the virus on vulnerable children and their families due to the state of lockdown e.g. lack of exercise, poor nutrition, food shortages, lower family incomes from not being able to work, difficulty accessing health services, more violence and sexual abuse against children at home, poorer mental health, limited schooling and consequent detriment to mental health.

ii)            HIV-specific impacts of COVID-19 virus on children and their families e.g. greater impact of the virus on people living with HIV because of weakened immune system, stock-outs of ARVs and HIV diagnostic kits, non-adherence to ART due to HIV stigma, risky behaviours, greater stress, HIV and TB drugs essential for children being used for COVID-19 without good scientific reason etc. Social and structural exclusions and stigma experienced by young key populations.

iii)           Modifications to programmes to tackle the HIV-specific challenges e.g. multi-month dispensing of medications, strengthening peer groups, ensuring children’s voices continue to be heard etc.

RIATT-ESA are proposing to investigate how COVID-19 has been impacting the HIV programmes of its over 30 partner organisations and what measures they have used to adapt their programmes to ensure the continued support of vulnerable children and youth in the ESA region. Therefore, this study, will investigate how the service organizations have been impacted, the challenges they have faced and what measures they have taken to alleviate and mitigate the impact of COVID-19. The study purpose is to identify and share partners’ best practices with adapting programmes and conduct advocacy with governments about the findings.

There are several potential areas of programming that have been affected by COVID-19 that will be investigated by the study, including:

·         Violence (family related and community related)

·         Human Rights violations by law enforcement agencies during lockdown

·         Limited access to treatment

·         HIV stigma and discrimination

·         Children with low CD4 count

·         Lack of psychosocial support

·         Food insecurity to children and families

·         Food insecurity in communities

·         Children who are not in families

·         Children of IDPs and refugees

·         Children living with TB

·         Young key populations, sex workers

·         Impact of long school closures on children

·         Access to education and absence of resources

·         School feeding programmes

[i] UNAIDS 'AIDSinfo' (accessed April 2020)

[ii] UNAIDS 'AIDSinfo' (accessed April 2020)

[iii] UNAIDS (2019) ‘Communities at the centre: Global AIDS Update 2019’, p.188.

[iv] UNAIDS (2019) ‘Communities at the centre: Global AIDS Update 2019’, p.188.

[v] UNAIDS 'AIDSinfo' (accessed April 2020)

[vi] UNICEF ESARO: https://www.unicef.org/esa/hiv-and-aids

vii World Economic Forum https://www.weforum.org/agenda/2020/03/why-sub-saharan-africa-needs-a-unique-response-to-covid-19/

Closing date: 17th July 2020 at 5pm Johannesburg time