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Health Ministry wants to integrate HIV treatment into SHA as USAID funding disrupted
The Health ministry wants to ensure continuity in HIV management programmes amid the uncertainty of a move by US President Donald Trump to suspend funding through USAID.
The Ministry of Health has recommended an increase in its budget to support the integration of essential HIV test kits, drugs and condoms into the Social Health Authority (SHA) insurance scheme to cover shortfalls due to frozen funding from the United States Agency for International Development (USAID).
The ministry said this would ensure continuity in HIV management programmes, amid the uncertainty of a move by US President Donald Trump to suspend funding through USAID.
"We propose that the government facilitate the inclusion of key strategic and essential HIV commodities under the Social Health Authority by increasing the GOK (Government of Kenya) vote in the financial year 2025/2026 budget cycle for all within the treatment programme," Harry Kimtai, the Principal Secretary for Medical Services, said in a brief to the State and backed by the National Aids and STIs Control Programme and the Kenya Medical Supplies Authority.
However, recent uncertainties in global funding, including the temporary suspension of PEPFAR funding by the US government, have exposed the vulnerabilities associated with this dependence.
According to a 2024 report by the Joint United Nations Programme on HIV/Aids (UNAIDS), Kenya needs about Sh128 billion annually to effectively manage its HIV programmes. Despite this need, the country faces a significant funding gap, with projections suggesting a shortfall of more than $1.8 billion (Sh232.41 billion) over the next five years, exacerbated by declining donor contributions.
In recent budget cycles, the government has allocated funds to support HIV initiatives. For example, in the 2024 financial year, the National Aids Control Council received Sh971.95 million, while the National Aids Control Programme was allocated Sh144.75 million. In addition, a special Global Fund HIV grant contributed Sh4.03 billion to the country's efforts.
According to the ministry's analysis, Kenya's HIV programme needs an estimated $220 million (Sh28.41 billion) for the current financial year, including procurement and supply management costs. However, current donor and government funding commitments leave a significant shortfall of $78 million, threatening the sustainability of critical treatment and prevention programmes.
Specifically, $65 million is needed for antiretroviral drugs, with major contributions coming from PEPFAR and the Global Fund. In contrast, the Kenyan government's allocation is minimal at just over $260,000, highlighting the urgent need for increased domestic funding.
Nutrition programmes for people living with HIV require nearly $34 million (Sh4.38 billion), but face a critical funding gap of more than $30 million. This shortfall threatens the health of vulnerable populations, including children and people living with HIV, who require adequate nutritional support for effective treatment.
In addition, Kenya needs more than $28 million (Sh3.61 billion) for condoms and related supplies, but only a fraction of this amount has been secured, leaving a gap of $21 million (Sh2.71 billion). This shortfall could have serious consequences for national HIV prevention strategies and contribute to rising infection rates.
Voluntary medical male circumcision, another key HIV prevention strategy, requires $320,000 (Sh41.31 million), but has only received $80,000 (Sh10.32 million), leaving a 75% funding gap. Without urgent intervention, this programme could stall, increasing the risk of HIV transmission among young men.
Laboratory monitoring, which is crucial for tracking the effectiveness of HIV treatment, requires $44 million (Sh5.68 billion) but is currently underfunded by $13 million (Sh1.67 billion). Inadequate funding for laboratory services can delay timely treatment adjustments for patients.
Programmes targeting high-risk populations such as sex workers and injecting drug users require $8 million, but $6 million (Sh774.54 million) remains unfunded, leaving these vulnerable communities at higher risk of infection.
Effective procurement and supply chain management is also essential to optimise resource use and reduce waste, ensuring that available funds are used effectively to sustain Kenya's HIV response.
"By increasing government investment, Kenya aims to reduce its dependence on external donors and ensure a more resilient and self-sufficient health system. This initiative underscores the government's commitment to protecting the health of its citizens and sustaining the progress made in the fight against HIV/Aids," said Mr Kimtai.
The analysis also shows imbalances in the stocks of essential HIV commodities purchased with PEPFAR grants.
As of December 2024, health facilities have less than three months' supply of several key adult ARVs, including DTG 50mg, TDF 3TC and DTG 300 50mg (90s), which could put patients at risk of treatment interruptions.
The situation for paediatric ARVs is equally worrying, with drugs such as NVP 50mg (5ml), ABC 3TC 120 60mg and DTG 10mg also facing stock-outs. With limited availability, these drugs may run out before the next procurement cycle, disrupting care for both adults and children living with HIV.
Despite the shortages at health facilities, some ARVs are well stocked at Central Medical Supplies (CMS), indicating a distribution challenge rather than an absolute supply crisis.
For example, TDF 3TC EFV has significantly higher stock levels at CMS than at health facilities, while AZT 3TC 60 30mg for paediatric use is oversupplied centrally but has much lower stock levels at hospitals and clinics. This discrepancy suggests that although drugs are available at central level, they may not be reaching health facilities efficiently, possibly due to logistical or administrative bottlenecks.
Pending orders can help stabilise stock levels for some drugs, but timely delivery is crucial. The most significant pending order is for paediatric AZT 50mg (5ml), with a significant quantity expected, indicating efforts to increase supplies for children.
Other key adult ARVs, such as DTG 50mg and TDF 3TC DTG 300 300 50mg (90s), also have pending orders that could alleviate shortages. However, supplies of these drugs are already critically low and any delays in delivery could worsen the situation.
