Kenya Publishes PrEP Guidelines

Kenya becomes the 2nd African country to issue detailed guidance for PrEP implementation.  

South Africa's PrEP Program launched in June of 2016.  The program is based on guidelines issued by the South African Department of Health in May 2016.  The South African AIDS Clinical Society issued updated recommendations for PrEP in March 2016.  

Kenya has provided leadership in HIV prevention in several ways.  It was host to clinical trials that proved that PrEP containing TDF was safe and effective for preventing HIV transmission among serodiscordant couples.  The country also hosted trials that compared daily with non-daily dosing in men who have sex with men and female sex workers.  In addition to PrEP, Kenya hosted one of the 3 key trials that proved the utility of voluntary male medical circumcision, and then played a leadership role in scaling up circumcision services. 

The Kenyan guidelines for the the use of antiretroviral agents for HIV treatment and prevention are an important resource for nationwide implementation.  The guidelines on PrEP are on pages 129 to 134.  

These PrEP guidelines are pioneering in several respects...

PrEP is recommended for couples desiring conception.  This reflects the extensive evidence regarding safaty of TDF in the setting of HIV treatment of pregnant women, and the emerging data from PrEP trials indicating no adverse pregnancy outcomes.  

The Kenya guidelines explicitly include adolescents age 15 and older (provided their weight is over 35 kg).  This reflects evidence of safety of TDF for HIV treatment in adolescents, recently presented information from adolescent PrEP studies (ATN 113) and the high incidence of HIV infection in adolescents.  

The Kenya guidelines highlight acceptable alternative medicines if FTC/TDF is not available.  Both single agent TDF and 3TC/TDF are listed as alternative regimens.  3TC/TDF is more commonly available in low and middle income countries compared with FTC/TDF.  The Kenya guidance reflects extensive  experience with 3TC/TDF in HIV treatment programs, and the most recent guidance from the PEPFAR Scientific Advisory Board which indicated that 3TC/TDF should be considered for PrEP where it is available.

The Kenya guidelines suggest renal monitoring every 12 months, if creatinine testing is available.