Is There a Role for the Private Sector in Kenya’s HIV Self-Testing Drive?

By Shannon Rosenberg, Market Dynamics Advisor, PSI

The Kenyan government has massively scaled up testing and has made significant progress towards the UNAIDS 90-90-90 targets. However, with declining yield rates, increasing costs, and significant testing gaps for men and youth, achieving the first target of 90% of people living with HIV (PLHIV) knowing their status by 2020 remains a challenge for Kenya.

There is a growing body of evidence on the acceptability and feasibility of HIV self-testing (HIVST), including among groups that have traditionally been hard to reach with other HIV testing services, such as men, adolescents and key populations (e.g., sex workers and men who have sex with men).

In taking HIV testing beyond the traditional clinic and into the household, HIVST transcends many barriers that may keep one from knowing one’s status, including fear of stigma and discrimination, confidentiality, lack of time, distance and cost of transportation to the nearest health facility.

Additionally, while HIV testing has traditionally been driven by the public sector, there is strong evidence[1] that many Kenyans seek health services in the private sector (e.g., private clinics, pharmacies, drug vendors).

With support from the Bill & Melinda Gates Foundation and the Children’s Investment Fund Foundation, PSI and PS Kenya sought to understand what role the private sector could play in getting HIV self-tests (HIVST) into the hands of hard-to-reach groups, such as youth and men, and first-time testers. Research included an innovative combination of market and consumer research, including an auction-style approach to estimate real willingness to pay among consumers who seek health services in the private sector.

The findings, detailed in a recently released project insights presentation, provide an in-depth look into the role of the private providers, barriers to HIVST and potential interventions to leverage the private sector in scaling up self-testing in Kenya.

We found:

  • A significant number of Kenyans expressed preference to obtain HIVST kits through pharmacies and chemists, driven by desire for convenience, an option for confidentiality, and choice of tests.
  • Unclear in-country regulatory pathways have slowed the speed of introduction of new self-test brands. This calls for providing technical assistance to regulatory bodies and engaging in high level advocacy to build political will and develop measurable action plans to address these challenges.
  • Youth, men, and particularly those who have never tested for HIV, can be reached through private pharmacies, but not at current consumer prices (approximately 900 KES or US$9).
  • Combined supply-side interventions (e.g., VAT exemption, extension of product buy-down to products distributed in pharmacies) and demand-side interventions to lower the consumer price (e.g., targeted consumer vouchers) could result in private sector consumer price points with significant demand among those who have never tested. About 71% of people entering pharmacies in Nairobi and Mombasa would purchase an HIV self-test priced at 100Ksh. Approximately, 22% of these could be first-time testers.
  • Additional research is needed into the cost-effectiveness of promotion and linkage to care in the private sector, and similar research could provide insight into other priority markets interested in adding HIVST to hit the first 90 target.

Want to get more in-depth knowledge of the learnings from the project? View the presentation online here: Kenya HIVST Self-Testing Landscape

 

[1] Kenyan Healthcare Sector: Opportunities for the Dutch Life Sciences & Health Sector, 2016

Population Services Kenya, Tracking Results Continually: Reproductive Healthy Survey. Nairobi, Population Services Kenya. 2016.  Unpublished.