We are the lead implementer of PMA2020/Kenya project survey. PMA2020/Kenya is collecting data in 151 nationally representative enumeration areas throughout Kenya. The project employs 151 female resident enumerators, 11 supervisors, and a rapid response team to conduct data collection.

PMA2020/Kenya survey progress: 7 rounds of core data collection completed; 2 round of nutrition data collection completed. PMA2020/Kenya publications and request access to datasets can be accessed here https://www.pma2020.org/program-countries/kenya

PMA Agile relies on mobile data collection methods to rapidly monitor family planning access in urban populations at the health system, client, population and spatial area levels. The initiative collects, assembles and displays data on indicators that are sensitive to change in institutional performance and to client and community needs, service use and practices. PMA Agile aims to capture information flows on urban reproductive health that is timely, flexible, and adaptable, as well as cost-efficient. The project is in three counties: Kericho, Usain Gishu and Migori.
The PMA Agile project is building a monitoring and evaluation platform that will enable tracking of progress toward and impacts from large-scale projects on their intended results.

Young people, defined as persons aged 15-24, constitute one-fifth of Kenya’s total Population, according to the 2009 national census. In the last decade, the

The government of Kenya has increasingly emphasized programming among young women through the Kenya Adolescent Reproductive Health Policy (2003). This policy aims at doubling the use of modern contraceptives from four to eight percent among sexually active adolescents (aged 15-19 years) and from 19.9% to 40% among youth (20-24 years) by 2015. National guidelines for family planning (FP) expressly support the provision of FP services for adolescents and youth. In order to accomplish these policy targets, strategic actions have been identified for promoting the health of adolescents and youth including the acknowledgement of their right to reproductive services and increasing their access to these services as unintended pregnancy among adolescents is a common public health problem globally, and is associated with significant health risks and social costs

ARMADILLO project study is funded by WHO, Department of Reproductive Health and Research. The research trial evaluates youth learning and information retention following delivery of Sexual Reproductive Health information via mobile phones. The study is to determine whether youth given access to Sexual Reproductive Health information through their mobile phones are more knowledgeable about contraception and better able to dispel contraception myths and misconceptions than those without access to SRH content via their mobile phones. Kilifi and Mombasa Counties are the study project areas. This is a multisite study which will refine the existing mHealth platform to the proposed Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) platform. The study is in two stages: stage 1 is the formative phase which has two phases and stage 2 is rollout/scaling up the intervention and measuring its impact. The formative research used qualitative methods to inform the development of an intervention, which would use the popular channel of (SMS) text messages to deliver SRH information to youth.

The formative research occurred in two phases: Phase 1 used a series of focus group discussions (FGDs) with two sets of participants – youth and parents/caregivers of youth – to test the appropriateness and acceptability of the finalized draft architecture and messages. In Phase 2 of this formative research, we developed and piloted the outcome measures that will be used in the Stage 2 coverage and impact study to determine program effectiveness. Youth participants were recruited from the target communities to complete a pre-and post-intervention test consisting of pilot SRH study measures. Youth participants were guided through a usability test by a member of the research team. The findings from this phase will be used to finalize intervention messaging and measurement tools for the Stage 2 coverage and impact study. Stage 1 of the ARMADILLO study established that mobile phones are currently part of young people’s lives and reinforced the fact that sexual and reproductive health messages delivered via text messages from a trusted source will most likely be acceptable to young people owing to its confidential nature.

Stage1 – developed and tested the message content that formed the ARMADILLO system for Stage 2: the effect of ARMADILLO on knowledge for action, attitudes and self-efficacy using quantitative and qualitative methods and Stage 3 – the coverage study. The main objective of stage 2 was to use an individually randomized design to assess differential learning related to sexual reproductive health and rights compared to those who are asked to learn on their own.  It was to determine whether youth given access to SRH information through their mobile phones are more knowledgeable about contraception and better able to dispel contraception myths and misconceptions than those without access to SRH content via their mobile phones. Following a series of focus-group discussions, the study used an individually-randomized, open three-arm comparative design to assess the study objectives. After obtaining written informed consent, individuals randomized to the ‘intervention’ arm of the ARMADILLO trial received access to ARMADILLO content over the course of the intervention and used their mobile phones to access this content on demand. Those randomized to the ‘contact’ arm were alerted to various SRH domains like health topics, including Relationships, Pregnancy and STIs; they will be encouraged to learn on their own. Those randomized to the ‘control’ arm received no intervention. Selected SRH outcomes were assessed via a survey at baseline, following the introduction of a new domain at intervention end, and at eight weeks (two months) following the end of the intervention. All outcomes of interest are linked to domains and content from the ARMADILLO system. Control group participants will receive no messaging; only assessments at baseline and times corresponding to the intervention end and follow-up for the other two groups. A series of in-depth interviews were also conducted with a sub-sample of intervention participants at intervention end, in order to assess the system’s usability.  These will include youth and adolescents aged 18-24 years, adults from private or public pharmacies, local, regional or national regulatory or those dealing with contraception and staff from local NGOs.

COMMERCIAL SEXUAL EXPLOITATION OF CHILDREN (CSEC) PROJECT

Project description

With support from Kindernothilfe, ICRH Kenya has been implementing Commercial Sexual Exploitation of Children (CSEC) project since September 2016. The three-year project is ending in July 2019. It covers the larger Changamwe and Kisauni Sub-Counties in Mombasa County. Kenya. Its overall objective is to contribute to the reduction of commercial sexual exploitation and sexual abuse of children as well as improve service delivery to the victims through institutional linkages of both children and caregivers.

Specific objectives of the project

1. To strengthen the capacity of the community and other stakeholders to prevent and respond to commercial sexual exploitation and sexual abuse of children.
2. To contribute to behavior change and communication among children who are vulnerable to commercial sexual exploitation and sexual abuse with life skills.
3. To strengthen services for victims of CSEC and sexual abuse through institutional linkages of both children and caregivers.

Activities

The following interventions are being given; one on one counselling, life skills training sessions and vocational training.  Also being identified and followed up with information are caregivers of the children who are in CSEC, Community Volunteers and different stakeholders including the police, officers from the children department and Ministry of Education officers.

Capacity building sessions on child protection are being carried out on different stakeholders including;  local administrators, religious leaders, paralegals, teachers, school peer educators, community volunteers, out of school peer educators and bar owners. These stakeholders are in turn supposed to reach to children and adults leading to an increased number of CSEC cases being reported.

Poverty being a major contributing factor to CSEC, caregivers are also trained in business skills so as to provide for their children hence reduce the chances of their children getting back to CSEC.

Family planning/contraceptive (FP/C) uptake has been on the rise globally though not at the rate anticipated to meet the global targets for FP 2020. Even where commodities are available, demand has been low. There is the need for better understanding of how demand and use can be measured to drive FP/C to reach the desired targets. Social Network Analysis (SNA) is a study on the impacts of social norms and social network effects on the adoption of modern contraception approaches within the rural parts of Kilifi, Kenya. The social project is financially supported by the Bill and Melinda Gates through George Washington University and conducted by ICRH-Kenya in collaboration with North Western University. In Kenya, the SNA study was launched in March 2017 and expected to be completed by mid-2018. Kilifi County was the preferred project site area following a prior finding on data collected by the PMA 2020 project conducted within the same areas of the County on the adoption of modern contraception approaches and as it also featured trends of sites with high, medium, and low levels of prevalence on adoption of modern contraceptives. The findings also depicted a possibility of failure by many counties to meet the global FP2020 targets unless a demand creation intervention was made while maintaining a flawless supply chain of the contraceptives for easy access by the communities within the urban and suburb vicinities of the respective counties.

The theoretical framework that guides the study is the Diffusion of innovation theory which addresses the gap between the introduction of a new idea or behaviour and the actual adoption of the behaviour by a community or group. It explains a process of Diffusion where an innovation is communicated through certain channels over time among the members in a social system. The SNA project was in 2 phases. SNA Phase 1 is a qualitative study conducted with an aim of catalyzing the adoption of modern contraception approaches by exploring the influence of social norms and social networks on the use of modern family planning methods. The main objective of phase 1 was to determine social networks-methodology can provide a rigorous and superior understanding about demand-side drivers of MC adaptation and result in valid measurements of the adaptation of modern contraceptives (MC) in rural areas in Kenya. The qualitative research was conducted in three contrasting village clusters – Ganga A with high modern contraceptive (MC) use, Chanagande with medium MC use, and Mweza Moyo with low MC use. The inclusion criteria included Adolescent boys and girls aged 15-17 and men and women aged 18 to 60 years old. In this phase, a qualitative design with focus group discussions and key informant interviews were used. This design was used to allow the researchers to identify social, cultural and contextual factors (facilitators and barriers) that may affect the decision-making process with respect to MC use. These contextual factors included social and gender role patterns, village hierarchies, attitudes, beliefs, norms, and cultural interpretive frameworks regarding fertility and birth regulation.

Phase 2 (SNA) is a cross-sectional study that entailed collection of quantitative data and social network analysis. The main purpose of the study is to develop a prototype methodology for conducting district-level assessment, for individual, group and collective and family planning behaviours via quantitative research and social network analysis (SNA). It purposed to interview the residents, in the 2 enumeration areas: Ganga A and Mweza Moyo who were 15 years and above so as to support to generate large-scale and comprehensive sociocentric networks which would capture both direct and indirect ties in the community hence provide a complete picture of the connections among all the individual in the respective communities. It comprised of two stages, which entailed taking the photographic roster and conducting house to house individual interviews. The research was used face to face approach and Trellis software was the application being used for the photographic roster and the survey.

Female sex workers are at considerable risk of unintended pregnancies, which contribute substantially to material and perinatal morbidity and mortality and socioeconomic vulnerability. Public health interventions that increase uptake of family planning methods among FSWs, including dual protection i.e. use of condoms and another modern method of contraception could markedly benefit this population. In addition, there is a growing acknowledgement of the potential importance of nutrition in the population, and the paucity of quality on rates of Malnutrition among sex workers and effective interventions to improve their nutritional status and metabolic health. Women’s Health Intervention Using SMS for Preventing Unintended Pregnancy (WHISPER) or SMS Intervention to Improve Nutritional Health Outcomes (SHOUT) is a two-arm cluster randomized controlled trial to assess the effectiveness of two mHealth interventions (SRH and nutrition). The study is a collaboration between the International Centre for Reproductive Health (ICRH) in Kenya and the Burnet Institute in Australia, along with collaborating investigators from other institutions. It is funded by the National Health and Medical Research Council of Australia. The study was conducted in two areas of Mombasa: Changamwe (where 1,223 FSWs work from 248 venues) and Kisauni (where 3,617 FSWs work from 263 venues) (National AIDS & STI Control Programme (NASCOP) and National AIDS Council (NAC) 2012). Eligible women recruited from sex work venues (the clusters identified in the mapping exercise) were randomized to receive either a 12-month sexual and reproductive health intervention or a 12-month nutritional health intervention via mobile phone. Effectiveness assessment was done for each of the interventions with the other as the control group. As each intervention addresses a unique set of specific issues, and the delivery of the intervention is the same, they each form an appropriate control group.

A two-stage sampling process was used. At the first sampling stage, FSW venues (nightclubs, bars, hotels, private brothels, small businesses, street sites/corners) were selected proportionate to the size and randomised to either control or intervention arms. At the second sampling stage, the study aimed to consecutively select 10 FSWs from each randomised venue, based on an estimated average FSW venue cluster size of 12(National AIDS & STI Control Programme (NASCOP) and National AIDS Council (NAC) 2012). Cluster randomisation was done centrally. Participants and study team were blinded to intervention and control allocation until after cluster enrolment was completed and all baseline questionnaires administered for that cluster. Overall, the steps above allowed optimal sampling from the FSW population but minimised the potential dilution effect of individual randomisation through message sharing.

The FSWs were screened for eligibility before being enrolled into the study. During the first visit (baseline), there was administering of the structured baseline questionnaire, clinical examination, urine pregnancy test, STI syndromic management, HIV and Syphilis rapid tests, haemoglobin assessment using haemoglobinometer, Eyenaemia mobile application, and blood withdrawal for full haemogram (including Hb, haematocrit, white blood count, and mean cell volume).

During follow-up visits at month 6 and month 12, study procedures were similar to those at baseline and include administering the structured questionnaire, clinical examination, urine pregnancy test, STI syndromic management, HIV and Syphilis rapid testing, haemoglobin assessment using haemoglobinometer (month 12 only), Eyenaemia mobile application (month 12 only), and blood withdrawal for full haemogram (Month 12 only).

Population based-surveys conducted over the last 10 years indicate that the Human Immune Virus (HIV) prevalence in Kenya is declining. While prevalence in the general adult population (estimated at 5.6%) is declining, Key populations (KPs), specifically Female Sex Workers (FSW), Men who have Sex with Men (MSM), and Male Sex Workers (MSW) continue to report higher prevalence and incidence of HIV and Sexually Transmitted Infections (STIs). HIV prevalence among FSW is estimated at 29.3% while MSM and MSW report an estimate of (18.2%).  Specific to the coast region, Mombasa County has the fifth highest HIV prevalence nationwide.

Linkages Across the Continuum of HIV services for the Key Populations Affected by HIV (LINKAGES) is a five-year project funded by USAID/PEPFAR through Family Health International and ICRH Kenya is the implementing partner at the  Coast region of Kenya. The overarching objective of the project is to scale-up interventions to increase access to HIV/STI prevention and treatment services, increase demand for HIV prevention and treatment interventions,  and strengthen systems for KP programming in Mombasa, Kilifi and Kwale counties.

The project aims at;

1. Improving HIV testing and piloting of oral HIV self-testing, expansion of peer educator, peer supervisor and peer navigator activities in order to, i). Scale-up community-based HIV prevention services and linkage to care and treatment, ii). Increase the distribution of condoms and lubricants, and iii). Improve planning and forecasting for condom distribution.
2. Establishing new Drop-In Centers (DICs) while maintaining support for the all existing DICs, implementing of  “Test and Start” approach for HIV positive KPs, providing  additional psychosocial support for HIV positive MSM and FSWs, scaling up on screening for sexually transmitted infections (STI) and cervical cancer, and championing for anal health for both MSM and FSWs, integrating  pre-exposure prophylaxis to the HIV prevention interventions, and scaling up  comprehensive family planning services to FSWs.
3. Strengthening systems to prevent and address sexual and gender-based violence, collecting information on the sexual, reproductive and psychosocial health needs for young FSWs and designing interventions to address these, addressing alcohol and drug use among MSM and FSWs, and recruiting anti-drug abuse champions.
4. Strengthening monitoring and evaluation systems, and introducing a program database and programmatic monitoring system.

Pre-exposure prophylaxis (PrEP) trials of Tenofovir’s efficacy have been done in some studies in South Africa and USA and it has been discovered that when adherence is high, so is the efficacy. PrEP will provide an additional HIV prevention intervention and studies have demonstrated high efficacy for both men and women assuming full adherence to a daily regime. Oral PrEP was endorsed by the WHO in 2015 and Kenya as a country has included it in its revised Anti-Retroviral Therapy (ART) guidelines of July 2016. Modeling shows the potential effectiveness of 99% for Men having Sex with Men (MSM) and 94% for Female Sex Workers (FSWs) assuming full adherence to a daily treatment regime. Time is ripe to move PrEP rapidly from research and small-scale demonstration projects to service delivery at scale worldwide. However, countries need to be convinced that population-level PrEP interventions are feasible and effective.

ICRHK is implementing Bridge to Scale project with a consortium of partners; JHPIEGO, NASCOP, PSI Kenya, and Avenir Health among others. It aims to bridge the gap in HIV prevention among Key Populations (KPs) by the introduction of oral PrEP.

The four-year project demonstrates and documents an affordable, effective and sustainable model on how oral PrEP can be scaled up as an HIV prevention intervention under low-resource, real-market conditions in order to generate the enthusiasm needed to catalyze global scale-up of oral PrEP amongst populations at high risk. The project areas are; Mombasa, Kilifi, Taita Taveta and Kwale Counties.

The GBVRC is a public-private partnership between the Ministry of Health and ICRH. It was set up in May 2007 to complement and strengthen services available at the CPGH and provide comprehensive, quality care for survivors of rape, sexual violence and sexual exploitation. Coast Province General Hospital (CPGH) is one of the largest public hospitals in Kenya based in Mombasa and serves as a referral and training centre for the Coast region. The GBVRC is situated next to the casualty/emergency unit of the hospital to ensure ease of access to services by survivors of Sexual and Gender-Based Violence (SGBV).

Services provided at the centre include:
• Medical: management of injuries, provision of Post Exposure Prophylaxis (PEP) to prevent HIV transmission, Emergency Contraceptive Pills (ECP), prevention and treatment of Sexually Transmitted Infections (STIs), forensic collection and management (collection of physical evidence and samples, filling in of Post Rape Care (PRC) and P3 forms etc
• Psycho-social care: trauma counselling of survivor and family/relatives, HIV counselling and Testing (HCT) and  adherence counselling
• Legal counselling and support: referral to police, court preparation and watching brief in court
• Referral for specialized services (medical, psycho-social and legal)

The Centre has developed initiatives to:
• provide comprehensive, quality and continuous care for survivors of sexual and gender-based violence as outlined in the national guidelines on the management of sexual violence in Kenya;
• offer improved physical and psychological services in a confidential and supportive environment;
• assist with legal and social counselling to Survivors who have experienced violence and their families;
• monitor and evaluate the follow-up care of survivors;
• create evidence-based outcomes promoting public health care alongside legal advocacy;
• raise awareness around the physical, social, and legal implications of sexual and gender-based violence at the individual, community, hospital, national and regional levels.

The practice of rape and girls’ defilement in Kenya is so common it can be described as an epidemic. Every 30 minutes a girl/woman is raped in the country. Studies have revealed that as many as 68% of school‐aged children have experienced sex under coercive conditions, that roughly 165 children are ‘defiled’ every month, and that defilement incidents continue to be on the rise. The perpetrators include family members and community members, some of whom are guided by the misconception that having sex with a virgin is a cure for HIV/AIDS. In reality, the epidemic of girl child rape leaves these young girls at increased risk of contracting HIV/AIDS themselves. Despite the stiff criminal law penalties against defilement (the term used in the Kenyan Sexual Offences Act to refer to the rape of girls under 18), the law is not adequately being enforced. As a general pattern, police fail to conduct adequate criminal investigations into these crimes, resulting in a culture of impunity which only serves to perpetuate this violence.

The equality effect commenced the 160 Girls – Kenya project in 2011 working with the Kenyan‐based children’s rights organization, Ripples International. Ripples operates the Brenda Boone Tumaini Girls’ Rescue Centre, a shelter in Meru, Kenya that provides care and support for defilement victims. At the time this project was launched, the Centre had sheltered over 160 defilement victims, between the ages of 3‐17 years of age, who needed access to justice. That figure continues to rise by the week. The aim of the “160 Girls” project is to hold the police and the Kenyan state accountable for the enforcement of defilement laws and thereby meet their duty to protect girls in Kenya from this most appalling form of violence. The equality effect’s 160 Girls project team, includes lawyers, academics, and activists from Canada, Ghana, Kenya and Malawi, considered various options for addressing the widespread police failure in the handling of defilement cases. A team of legal volunteers from around the world assisted in the legal research in support of the case (all of the lawyers working to support the “160 Girls” case volunteer their time). Ultimately it was decided that a constitutional petition would be brought against the State, arguing that its failure to enforce the laws meant to protect girls from rape amounted to a violation of their constitutional human rights. This avenue was seen as the strategy with the most potential for widespread, systemic impact.

The overall objective is to monitor police treatment of defilement cases reported at the Gender-Based Violence Recovery Center (GBVRC) based at Coast Provincial General Hospital (CPGH) –Mombasa, through a standard `intake and monitoring’ form. The activities for the project are: Recruiting, monitoring and documenting police treatment of defilement claims of survivors attended to at the CPGH-GBVRC, divide the intake forms into the specific police stations under which every defilement claim had been reported and make interactive phone calls to the guardians of the survivors to get updates on the progress of each claim documented in the intake form at the GBVRC. ICRHK implemented 160 Girls project which conducted public legal education in primary schools and the community in sub-counties of Mombasa County with support from equality effect.  With an aim to raise community awareness that, pursuant to the Order of the High Court of Kenya in the “160 Girls” case, police must conduct “prompt, effective, proper and professional” (PEPP) investigations into defilement cases and bring all perpetrators of defilement to justice. The community education program focus was legal educational empowerment and establishing a partnership between community members and police and civil society.  The school workshops have been conducted  using the “Girls for Justice” training program used to promote children’s awareness of the“160 Girls” decision, their equality rights, and duties owed to them by police and their community—empowering them to help girls stand up against defilement, report defilement and be agents of change in their communities. The focus is to equip girls with increased knowledge and voice to bring greater community attention to defilement, provide a stronger check on police and community actions that are harmful to girls, and ultimately serve to make girls safer in their communities.

Female and male sex work are the primary driver of the HIV epidemic in Kenya. They are at a heightened risk for acquiring and transmitting HIV infection because of biological, behavioral and structural risk factors. In Kenya’s Coast region, sex workers and their clients accounted for 18.2% of new HIV infections, and men who have sex with men, including those who sell sex, for 20.5%.  In a community-based study of patterns of alcohol use and unsafe sex among 719 Mombasa FSWs, binge drinkers were more likely to report inconsistent condom use and sexual violence and to have had an STI, this shows alcohol plays a significant role in sexual risk behavior.  There is recognition that intensified HIV prevention interventions targeting most at risk population is necessary to bring the epidemic under control.

The BORESHA project was a study assessing the feasibility of conducting HIV prevention interventions at entertainment venues, such as bars or clubs, to sex workers and their clients in Mombasa county and Mtwapa. The study was implemented with technical support from ICRH-Belgium and the HIV Center for Clinical and Behavior Studies of Columbia University. It aimed to understand the socio-cultural context of risk behavior, beliefs/understandings of HIV and risk; barriers to and facilitators of risk-reduction; and responses to intervention messages. In collaboration with local key informants, it designed a multi-level risk-reduction intervention tailored to the local context, informed by theory and prior work. It also tested the intervention package developed in Phase 2 for feasibility, acceptability, as well as participant level of exposure and intervention contamination at control sites via process measures. It tested the feasibility of an intervention evaluation design to be used in a future study. The study used both qualitative and quantitative approaches.

In the formative study, in depth interviews (IDIs) were conducted with sex workers and their clients of which resulted to two publications and the data analyzed has been used in presentations internationally at the AIDS and Impact conferences. Biomarkers study aimed to determine the usefulness of the SPERM HY-LITER and RSID-semen tests as biomarkers for non-condom use for anal sex among sex workers. The Intervention development aimed to test the intervention package developed for feasibility, acceptability, as well as participant level of exposure and intervention contamination at control sites via process measures to be used in a future study.  Post Intervention focus group discussion were conducted with female and male sex workers  obtained their perceptions of the intervention, including satisfaction, what worked and did not work, challenges, recommendations for future interventions, and next steps.

Cohort 1 and 2 assessed the feasibility of recruiting and retaining a client cohort for 6 Two independent cross-sectional surveys were conducted with each of the three target populations (FSWs, MSWs, clients). The first cross-sectional survey was implemented 2 months before initiating the venue-based intervention to measure the prevalence of potential variables to be used as outcome measures in an actual trial. The second cross-sectional survey was conducted 2-month after the intervention had ended, to assess exposure to the piloted venue-based intervention and acceptability, satisfaction with the intervention, to assess exposure to HIV prevention interventions and assess any major changes in potential outcome measures or contextual factors among a random sample of venue patrons.