LINKAGES KENYA

Summary of Achievements
March 2016–October 2019

Background
While HIV in Kenya is characterized as a generalized
epidemic, members of key populations (KPs) – including
male and female sex workers, people who inject drugs
(PWID), and men who have sex with men (MSM) –
shoulder a disproportionate burden of HIV in the
country. Compared to a general population prevalence
of 4.7% (UNAIDS, 2019),1 data from the 2010–2011
Integrated Biological Behavioral Survey2 found the
HIV prevalence among female sex workers (FSWs),
MSM, and PWID in Nairobi to be 29.3%,18.2%, and
18.7%, respectively. In addition, modeling studies have
estimated that FSWs contribute to about 14% of new
infections in the country, and MSM contribute to about Peer educators enjoy down time in safe space at Kikuyu Sasa
15% of new infections.3 Given the nature of the HIV Center, Nairobi.  Photo: Nancy Coste/FHI 360

epidemic in Kenya, the Kenya AIDS Strategic Framework

2014/15–2018/19 (KASF) prioritizes scaling up HIV
programming with a focus on FSWs, MSM, and PWID.
The LINKAGES Kenya project began in March 2016 with
15 implementing partners in 11 counties and later was
expanded to 25 partners in 17 counties.
The program’s objectives were to increase the
availability of comprehensive HIV prevention, care, and
treatment services for sex workers, MSM, and PWID;
enhance and sustain demand for comprehensive
HIV services; and strengthen systems for planning,
monitoring, and evaluating program quality.
Highlights
• FSWs reached increased from about 47,000 in FY16 to
more than 58,000 in FY19
• MSM reached increased from about 9,000 in FY16 to more
than 16,000 in FY19
• Newly diagnosed 4,048 KP individuals with HIV and linked
3,454 of them to ART over the life of project
• Engaged county health management teams in ensuring
DICs met criteria for accreditation to be community ART
sites

Twenty-two of the project’s 25 partners provided direct
service delivery (Table 1). Three other partners were
responsible for above-site activities. Pact, a strategic
partner for the LINKAGES global program, provided
support for organizational capacity building to ensure
local KP partners had structures and systems for
efficient program management, monitoring and
evaluation, financial management, and reporting and
governance. The University of Manitoba was the
technical support unit for the National AIDS and STI
Control Program’s (NASCOP) KP program, providing
• Developed KP program monitoring tools—such as the
UIC code and PLHIV tracker—which were adopted by the
Ministry of Health
• Established effective crisis response teams and systems
for reporting and responding to incidents of violence
perpetrated against KP individuals
• Pioneer in preparing CSO implementing partners to receive
direct funding and building their capacity in programming
and financial management—several have been funded by
other donors
 2

Table 1. LINKAGES Kenya implementing partners

County of Targeted
Partner Coverage Population Leadership
1. Men Against AIDS Youth Group (MAAYGO) Kisumu MSM/MSW MSM Led

2. Mamboleo Peer Empowerment Group (MPEG) Kiambu MSM/MSW MSM Led

Nakuru Youth Development, Education Support

3. Nakuru MSM/MSW MSM Led
Organization (NYDESO)
Health Options for Young Men on HIV AIDS and STI
4. Nairobi MSM/MSW MSM Led
(HOYMAS)
5. Tamba Pwani Kilifi MSM/MSW MSM Led

6. Busia Survivors (SSG)  Busia FSW/MSM/MSW FSW Led

7. Keeping Alive Societies Hope (KASH) Kisumu; Nyamira FSW/MSM/MSW

8. CANA Trans Nzoia FSW/MSM/MSW

9. Kenya AIDS NGO Consortium (KANCO) Kakamega FSW/MSM/MSW  

10. Ace Africa Bungoma FSW/MSM/MSW  

11. Family AIDS Initiative Response (FAIR) Nakuru; Narok FSW/MSM/MSW  

International Center for Reproductive Health, Kenya Mombasa; Kwale;

12. FSW/MSM/MSW  
(ICRHK) Taita Taveta

Kiambu; Machakos;
13. National Organization for Peer Educators (NOPE) FSW/MSM/MSW  
Kitui

Bar Hostess Empowerment and Support Program

14. Nairobi FSW FSW Led
(BHESP)
Kenya National Outreach, Counseling and Training
15. Nakuru FSW
Program (KNOTE)
16. Goldstar Kenya (GSK) Kilifi FSW

17. Turkana Pastoralist Development Organization (TUPADO) Turkana FSW

18. Akukuranut Development Trust (ADT) Busia FSW

19. Reach Out Center Trust Mombasa; Kwale PWID

20. Muslim Education and Welfare Association (MEWA) Mombasa PWID

21. Teens Watch Center (TWC) Kwale PWID

22. The Omari Project Kilifi PWID

23. Pact All Capacity and system strengthening

24. KESWA All Structural interventions

25. NASCOP TSU All National support for KPs

 3

support to the government and local partners.

The Kenya Sex Workers Alliance (KESWA) coordinated Figure 1. LINKAGES Kenya coverage area
the human rights response, which included addressing
sexual and gender-based violence (GBV) among KPs.

Key Programmatic Elements Trans Nzoia

Turkana

The LINKAGES project in Kenya delivered a

comprehensive package of services across the entire HIV Bungoma

cascade of services including prevention interventions,

Busia
HIV testing, linkages to and retention in care, initiation
and adherence to ART, and viral load monitoring
Kakamega
(Table 2). These services were delivered primarily

Narok
Kitui
Kisumu

Nyamira

“ Through LINKAGES we got Nakuru

genuine partnerships where we Kiambu Taita Kilifi

Taveta
could sit round the table, discuss Mombasa

issues, and agree on what is best for

Nairobi
KP_Type Machakos

the community. ” FSW

MSM/FSW
Kwale

MSM/FSW/PWID
John Mathenge, HOYMAS director

Table 2. LINKAGES Kenya HIV interventions

Core Services Expanded Services

• Peer education, risk assessment, risk reduction
and planning
• HIV testing services (HTS)
• GBV screening, post-exposure prophylaxis (PEP)
services, and referral for post-GBV clinical care
and legal aid
• 100% condom use promotion, distribution of
condoms and lubricants
• STI syndromic screening, referral, and treatment
• Family planning services for FSWs
• Referral for HIV treatment and follow-up
• Pre-exposure prophylaxis (PrEP) enrollment and
follow-up
• HIV self-testing kits distribution
• Quarterly HTS and sexually transmitted infection (STI) screening
• Repeat risk reduction counseling and referral
• Cervical cancer screening for FSWs
Seropositive
• Tuberculosis (TB) screening and referrals
• Linkage to HIV care and treatment
• Referral for prevention of mother-to-child transmission (PMTCT) for
pregnant FSWs
• Adherence support group for people living with HIV (PLHIV)
• Treatment literacy
• Screening for STIs and other opportunistic infections (OIs) and
referral and treatment
• Viral load monitoring
 4
Figure 2. ART uptake at LINKAGES-supported DICs
through civil society organization (CSO)-led drop-in
centers (DICs) catering to KPs. Over the life of project, Figure 2. ART uptake at LINKAGES-supported DICs
LINKAGES supported the CSO partners to establish
35 DICs. The DICs provided a platform for differentiated 749
service delivery (DSD) to KPs and, over time, as many as 665
50 800
16 of them expanded their service offerings to include 251
40 35
antiretroviral therapy (ART) dispensing (Figure 2). 600

No. of DICs
30

No. on ART
30 121 25
400
Under LINKAGES, the DICs became safe spaces where 20 17
16
KP members could relax, be entertained, and also 10 10 200
6
access a comprehensive package of clinical services. 0
4
0
The community’s involvement in establishing the FY16 FY17 FY18 FY19
DICs included identification of the space, design, and
No. of KPs
management such as setting rules and guidelines for No. of DIC TX_Curr. @ DIC DIC providing ART
accessing ART
clients to ensure efficiency in service delivery and a at the DICs
welcoming environment. The DICs were branded for
visibility, which helped increase KPs’ awareness of them.

Due to the migratory nature and unconventional hours

kept by KP clients, particularly FSWs, some sites offered Figure 3. Growth in testing uptake, new diagnoses, and linkage to A
flexible hours, including being open on weekends and Figure 3. Growth in testing uptake, new diagnoses,
late at night. All DICs conducted both day and night and linkage to ART among all KPs, FY16–FY19
outreach to be available for KPs at hot spots.
90,000 84,197 1,600
One rural-based DIC in Nakuru, which had FSWs 76,500
registered at a county Ministry of Health (MOH) facility 80,000 1,400
1,355
situated some distance away, partnered with the facility

No. diagnosed and linked

70,000
61,319 1,285 1,200
and served as a community ARV dispensing site. This 60,000
1,028
No. Tested

offering mitigated missed appointments at the county 1,040

1,000
50,000
health facility. The county clinician set up a regular 800
660
clinic at the DIC on predetermined days of the week 40,000 815 818
and offered all services, including blood draws for viral 600
30,000 536
load tests. 29,087
400
20,000
To enhance ownership in management of safe spaces, 10,000 200
LINKAGES engaged peer educators in operating DICs.
0 0
They took turns cleaning and were assigned tasks FY16 FY17 FY18 FY19
such as reception and client education. Peers and peer
educators served on community advisory boards and HTS_TST HTS_Pos TX_New
quality assurance improvement committees.

Service Delivery Impact

Over the life of project, LINKAGES Kenya reached
over 128,000 KP members with HIV prevention
interventions, conducted 251,103 HIV tests, newly
diagnosed 4,084 KP individuals with HIV, and linked
3,454 of them to ART. As illustrated in Figure 3, the
number of people diagnosed and linked to treatment
grew steadily over time. In addition, LINKAGES Kenya
collaborated with the Gates Foundation-supported
Jilinde project and the MOH to initiate over 9,688 KP
individuals on pre-exposure prophylaxis (PrEP).
In the final year of the project (October 2018–
September 2019), 77,699 KP members were enrolled
in services by the 22 implementing partners (Figure 4).
LINKAGES tracked KP members enrolled and retained
in the project as a cohort, enabling the accounting of
those who received HIV prevention interventions from
year to year. On average, the program transitioned
60% of KPs reached in a year to subsequent reporting
periods. The project achieved the highest transition
rate for FSWs in FY19 (81%). For MSM, the highest
transition (87%) occurred in FY17 (Figure 5).
 5

Peer education and peer outreach curriculum. LINKAGES’ success in meeting KP_PREV
targets was associated with the engagement of peer
From the beginning, LINKAGES Kenya engaged peer
educators, for whom capacity was developed, support
educators who reached their peers at hot spots and
provided during monthly meetings, and supervision
referred them for clinical services. They were selected
provided at hot spots. LINKAGES Kenya achieved more
as per national KP implementation Tableguidelines and by KP subgroup
3. FY19 performance than 90% of total targets for KP_PREV over the life of
trained over five days using the national peer education
project (Figure 6).

Figure 4. FY19 performance by KP subgroup

Figure 4. MSM and FSWs annual cohort transition
Total KPs: 77,699
80000

70000 16,807 100%

Total KPs: 56,544
60000 87%
80% 78% 76% 81%

Percent transitioned
12,306 71%
50000 65%
60% 69% 61%
40000 55%
40%
58,785
30000
42,398 20% Total KPs: 5,132
20000 Total KPs: 1,355 Total KPs: 1,288
0% 1,315 3,627 195
10000 FY16/17 FY17/18 FY18/19
334 997 24 319 949 20
2,107 1,840 Total FSWs MSM
0
Number of KP members Number who Number who Number successfully Number
reached with HIV received testing tested positive linked to ART currently on ART
prevention interventions services
MSM/MSW FSWs PWID

re 4. MSM Figure
and FSWs annualand
5. MSM cohort
FSWstransition
annual cohort Figure 6. Number of KP individuals reached against
transition Figure 5.
target byNumber
FY of KP individuals reached against target by FY

100%

87% 100,000 KP_PREV targets achievement trend 150%

80% 78% 76% 81%
118%
Percent transitioned

71% 98% 87%

80,000 104%
65% 69%
% target achieved

61%
No. of KP individuals

60%
100%
55% 60,000
78,473

40%
71,399
57,401

86,802

40,000
72,811

75,328
66,440

50%
20%
55,000

20,000
0%
FY16/17 FY17/18 FY18/19 0 0%
FY16 FY17 FY18 FY19
Total FSWs MSM
Target Achieved % Achieved
 6

was given to the FSWs with capacity to effectively

“ The level of support LINKAGES conduct activities.

provided helped us to grow into a LINKAGES engaged five MSM-led organizations to

stronger program, with attention ensure activities addressed their needs and to enhance
their ownership of the program. Coverage of MSM
to details and focus on data quality
increased from 9,787 in FY16 to 15,823 in FY17, and
and data integrity, compliance, that level of coverage was maintained in subsequent
and systems; we give credit to years. Engagement of MSM-led organizations not only
enhanced ownership but also allowed for adaptation in
LINKAGES for this. ”
response to emerging client needs. Better performance
Ochieng’, KNOTE director was observed among organizations that were led by or
engaged with MSM.

The success is also attributed to stronger links HIV testing services and case finding
between the program and peer educators as a result Lay counselors, nurses, and clinical officers offered
of the supporting role of outreach workers (OWs)— HTS as per national guidelines as a LINKAGES key
outstanding peer educators whose capacity was intervention. From April to September 2019, LINKAGES
strengthened to coordinate activities as well as mentor introduced new strategies in an attempt to increase
and supervise other peer educators. HIV case detection among KPs. Strategies included
implementation of risk assessments to determine
Among FSWs, coverage improved from about 47,000
eligibility for testing as well as index testing, risk
in FY16 to more than 58,000 in FY19. In addition,
network referral (RNR), and the enhanced peer
the engagement of FSWs in program implementation
outreach approach (EPOA).4 The result was increased
increased ownership of interventions and influenced
case identification and greater efficiency. During
more to access treatment at the DICs. Two
Q4 FY19, the number of tests reduced by over 50%
implementing partners were led by FSWs.
compared with the previous quarter with case finding
In other organizations not led by FSWs, LINKAGES improving from 1.9% in Q3 to 3.6% in Q4 (Figure 7).
endeavored to ensure priority in implementation roles Figures 8 and 9 show the trends in uptake of testing

Figure 7.6.Trends
Trendsin
inHTS uptakeand
HTS uptake andnew
newcase
case identification
identificationfor
for
allall KPs,
KPs, FY16–FY19
FY16–FY19

HTS services and case finding

Kuja clinic campaign was key in identifying
25,000 KPs who had not been tested 269 4.0%
242 432 3.6%
22,500 237
3.5%
23,656

301
22,721
22,801

20,000 373 322 248

267
21,501

% diagnosed

245
No. of KPs

3.0%
19,749
19,241

17,500 286
18,833

18,880
18,433

2.4%
17,511

15,000 2.5%
15,972

12,500 166 386

250 1.7% 2.0%
1.6%
10,000 1.9% 1.4% 1.5% 1.1%
1.4%
10,403

10,656

1.8% 1.3% 1.9% 1.5%

10,075

7,500 1.1% 1.1%

5,000 1.0%
Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
FY16 FY17 FY18 FY19

Tested New positive Case finding

 7

Figure
Figure 7.
7. Uptake
Uptake of
of prevention
prevention and
and testing
testing among
among FSWs, FY16–FY19
FSWs,FSWs,
FY16–FY19
Figure 8. Uptake of prevention and testing among FY16–FY19
70,000 2.4% 2.5%
70,000 2.2% 2.4% 2.5%
1,864 2.2%
2.0% 1,864 2,866
60,000 2.0% 2,866
60,000 2,596 2.0%
2,596 1.7% 2.0%
50,000 1,522 1.7%
50,000 1,522
997
FSWs

709

positive
997 1.5%
No.No.ofofFSWs

709

%%positive
40,000 1.5%
40,000
720
720
30,000 60,786
30,000 491 60,786 55,919 1.0%
491 51,418 55,919 1.0%
46,092 51,418
20,000 46,092 39,809 41,401
20,000 39,809 41,401
32,302 0.5%
23,886 32,302 0.5%
10,000 23,886
10,000
- 0.0%
- Reached Tested Reached Tested Reached Tested Reached Tested 0.0%
Reached Tested Reached Tested Reached Tested Reached Tested
FY16 FY17 FY18 FY19
FY16 FY17 FY18 FY19

Unknown status Known positive Negative Positive Case finding

Unknown status Known positive Negative Positive Case finding

Figure
Figure 9. Uptake of preventiontesting
and testing among MSM, FY16–FY19
Figure 8.
8. Uptake
Uptake of
of prevention
prevention and
and testing among
among MSM,
MSM, FY16–FY19
FY16–FY19
20,000 5.0%
20,000 5.0%
4.1% 783 1,050
4.1% 783 1,050
1,004 3.8%
16,000 3.6% 1,004 3.8% 4.0%
16,000 3.6% 2.7% 4.0%
2.7%
334
12,000 334 3.0%

positive
MSM

12,000 3.0%

%%positive
484
No.No.ofofMSM

484
319
321 16,602 319
8,000 321 16,602 15,757 2.0%
8,000 14,819 15,757 2.0%
14,819
169 11,972
169 11,972
4,000 9,298 8,167 1.0%
4,000 9,298 7,530 8,167 1.0%
7,530
4,541
4,541
- 0.0%
- 0.0%
Reached Tested Reached Tested Reached Tested Reached Tested
Reached Tested Reached Tested Reached Tested Reached Tested
FY16 FY17 FY18 FY19
FY16 FY17 FY18 FY19

Unknown status Known positive Negative Positive Case finding

Unknown status Known positive Negative Positive Case finding

and case finding over the life of project for FSWs and
MSM, respectively.
ART linkage and retention
LINKAGES tracked clients across the prevention and
treatment cascade, and strong efforts were made to
ensure newly diagnosed KP members were linked
to ART and achieved viral suppression. The project
developed a PLHIV client tracking tool to help capture
client details on services received at ART clinics and
ensure PLHIV accessing ART from linked facilities were
followed up and services received were documented.
LINKAGES also supported a gradual increase in the
number of DICs that provided ART directly. This
resulted in a steady growth of the ART linkage rate for
both FSWs and MSM and an increase in the percentage
of MSM on treatment who achieved viral suppression
(Figure 10).
 8

Figure 9. Linkage to treatment and viral load suppression rates among FSWs and MSM, FY16–FY19
Figure 10. Linkage to treatment and viral load suppression rates among FSWs and MSM, FY16–FY19
Figure 9. Linkage to treatment and viral load suppression rates among
Though LINKAGES Kenya was primarily a prevention program with majority of individuals receiving
120%
treatment at linked facilities, the project began tracking viral load data beginning in FY18
Though LINKAGES Kenya was primarily a prevention program with majo
98% 120%
100% 95% 97% treatment at linked facilities,
95% 96% the project began tracking viral load
% achieved

82% 98%
79%
81% 100%
78% 95% 97%
80% 74% 76% 75%

% achieved
82% 81%
79% 78%
80%
60%

60%
40%
FY16 FY17 FY18 FY19 FY16 FY17 FY18 FY19
FSW 40% MSM
FY16 FY17 FY18 FY19 FY16
% linked to ART % virally supressed
FSW

% linked to ART % virally supre

LINKAGES
Figure engaged county
0. Proportion ofhealth management
KPs linked to treatment at LINKAGES-supported DICs
teams in ensuring the DICs met criteria for Figure 11. Proportion of KPs linked to
accreditation to be community ART sites. As the Figuretreatment at LINKAGES-supported
0. Proportion DICs
of KPs linked to treatment at LINKAGES-supporte
number of DICs 18 offering ART increased so did the50%
45% 44%
proportion of KPs accessing treatment services
45%
from the DICs.16By the end of project, 44% of MSM 18 50%
40% 45% 44%
and 45% of FSWs preferred to be linked at the 40%
45%
DICs and were14accessing ART there (Figure
39% 11). 16
40%
35% 40%
12 31% 14
Addressing structural barriers
% linked at DIC

39%
30%
No. of DICs

35%
10 12 31%
LINKAGES Kenya supported17%each implementing

% linked at DIC
25% 30%
partner to develop and implement activities that
No. of DICs

8 16 10
would help address structural barriers to access 20% 17%
25%
to services by KPs,
6
particularly GBV. This included
8 16
9% staff and beneficiaries 15%
sensitization of program 20%
on how to identify
4 GBV as well 8%as how to report 6
10% 9%
incidents of violence. Partners were10supported 15%
to develop crisis2 response teams,
6 which were 5% 4 8%
10 10%
multidisciplinary and led
4 by MSM and FSWs who
helped to develop0 a reporting system for GBV in 0% 2 6 5%
line with the nationalFY16 FY17
KP program. FY18 FY19
Each partner 4
also instituted a hotline which was used to report 0 0%
# DICS providing ART FY16 FY17 FY18 FY19
incidences of violence in the community.
% FSWs linked at DIC
# DICS providing ART
In collaboration with the Key Affected
% MSM Population
linked at DIC
Health and Legal Rights Alliance (KESWA) and % FSWs linked at DIC

Pact Kenya, LINKAGES Kenya also implemented % MSM linked at DIC

activities in select counties advocating for
human rights protections, including violence
 9
prevention, among KPs. The activities centered on
providing technical assistance and capacity building
support to KP community networks and organizations
to conduct human rights advocacy. KESWA worked
with 13 LINKAGES implementing partners across seven
counties. Together, they established county advocacy
subcommittees; conducted media sensitization for
35 individuals (KPs and media persons); established
crisis response teams in counties of implementation;
and engaged religious leaders, police, judiciary and
other law enforcers on the rights and needs of KPs.
Pact’s human rights activities were implemented in
two counties and focused on adapting and integrating
an economic empowerment model, called WORTH,
with human rights advocacy by uniquely combining
community banking, enterprise development, and
human rights training. By the end of the initiative, six
WORTH groups with 96 members had been established
and had grown their savings to a total of $2,300.
Monitoring and evaluation systems strengthening
LINKAGES Kenya supported the development of an
efficient and sustainable monitoring and evaluation
(M&E) system at the country project level and for
the CSOs supporting project implementation. The
process included a review of reporting tools and KP
data captured to ensure the data necessary for tracking
project performance was obtained. For sustainability,
LINKAGES adopted national MOH tools in tracking
activities, but added new tools — such as unique
Peers relaxing at the safe space in Mamboleo Peer Empowerment Group (MPEG) drop-in center, Thika. 
identifier codes (UIC) and the PLHIV tracker — to
collect other data necessary to effectively monitor
KP programming. The national program adopted
some of these tools for use by all KP implementing
partners. The project also introduced an individualized
tracking system, called e-cascade, which the partners
implemented to capture individual KP data across HIV
prevention and treatment services.
LINKAGES engaged the program implementation team
and the MOH in revising the tools to capture additional
data required by USAID and to improve documentation
of KPs accessing services across different program
areas. LINKAGES also involved CSOs in the creation
and implementation of the M&E system, resulting in
enhanced competencies in monitoring, data analysis,
and use of data for decision-making to improve
coverage and quality of services.
The LINKAGES Kenya team conducted refresher
trainings and online capacity building activities each
year for M&E, clinical, and program staff members
on data analysis and use. CSOs improved their
understanding of program indicators and how to
conduct internal data quality assessments and
verification, leading to improved data quality.
Formation of innovative partnerships
Innovative partnerships were key to LINKAGES’ success
in Kenya. LINKAGES expanded ARV provision from four
to 16 DICs in partnership with county departments of
Photo: Nancy Coste/FHI 360
 10
health that made it possible for the DICs to serve as
ART satellite sites for county facilities. Drugs and other
commodities were sourced from the counties and
distributed through the DICs; reporting and monitoring
were done by the counties. LINKAGES also partnered
with a USAID bilateral project in Kenya to link KP
individuals who preferred to access services such as HIV
testing or ART at facilities other than DICs.
LINKAGES Kenya partnered with Jilinde, a Bill & Melinda
Gates Foundation-funded project led by Jhpiego, to
provide PrEP within LINKAGES sites. Jilinde’s objective
was to learn the best method for PrEP distribution
among adolescent girls and KPs within three regions
in Kenya. LINKAGES provided the infrastructure for
provision, while Jilinde provided medications and
additional support where needed; for instance, by
providing human resources for service provision, funding
outreach, and reporting. Through this partnership, six
LINKAGES-supported local implementing partners were
involved in PrEP provision. As a result, 6,579 FSWs and
3,143 MSM were initiated on PrEP by September 2019.
Strengthening of Local Partner Capacity
LINKAGES implemented different strategies to enhance
sustainability of interventions in line with USAID’s
journey to self-reliance. These included:
• Integration of services within the public health
system; DICs providing ART have been linked to
county facilities, and county health care workers
sensitized on provision of KP-friendly services
• Provision of financial and technical assistance
to county and national technical working groups
to develop their capacity for coordination of KP
programming stakeholders and review of various
guidelines and tools to ensure more efficient
implementation
• Engagement of KP-led organizations in program
design and implementation, financial management,
and resource mobilization
• Engagement of MSM-led and FSW-led organizations
and building their capacities to implement HIV
programming
• Provision of intensive capacity building support by
partner Pact to nine implementing partners that
included undertaking an Integrated Technical and
Organizational Capacity Assessment, development
“ LINKAGES has helped us grow
from a registration certificate
in a pocket to a well-established
organization with structures, office,
and staff. ”
John Odada, NYDESO director
and implementation of institutional strengthening
plans, and annual assessments of progress using the
Organizational Performance Index
• Support of local implementing partners to apply for
funding from other donors; NYDESO, MPEG, Tamba
Pwani, MPEG, MAAYGO, BHESP, and MAAYGO were
all funded
Policy Impact
In addition to expanding access to high-quality
services among KPs, building local partner capacity,
and strengthening national and local monitoring
of KP programming in Kenya, the LINKAGES team
worked closely with the MOH to develop evidence-
based policies and guidelines inclusive of KPs and to
create space for KP community members’ voices in
government-led technical working groups. National
policy documents that LINKAGES Kenya was involved in
developing or updating included:
• National Implementation Guidelines for HIV and STI
Programming Among Young Key Populations
• Framework for the Implementation of Pre-Exposure
Prophylaxis of HIV In Kenya
• Kenya National Guidelines for Prevention,
Management, and Control of Sexually Transmitted
Infections
• Violence Prevention and Response Programming
for Key Populations in Kenya: Standard Operating
Procedure
 11

Future Directions
On October 1, 2019, LINKAGES Kenya transitioned
Linkages across the
to Meeting Targets and Maintaining Epidemic Continuum of HIV Services
Control (EpiC), a five-year, global project funded for Key Populations Affected
by the U.S. President’s Emergency Plan for AIDS
Relief (PEPFAR) and the United States Agency for by HIV (LINKAGES)
International Development (USAID). Building upon
is a global cooperative agreement funded
the successful investments in KP programming
under LINKAGES, EpiC is designed to break through by USAID through PEPFAR. Led by FHI 360
remaining, persistent barriers to the 95-95-95 goals with partners Pact, IntraHealth International,
and promote self-reliant management of national
HIV programs. In Kenya, EpiC will work directly and the University of North Carolina at
with two implementing partners in Nairobi county Chapel Hill, LINKAGES has worked in more
and provide technical support to nine other county
than 30 countries since 2014 to reduce
implementing partners and their subgrantees.
Together, this EpiC team will focus on filling existing HIV transmission among key populations —
HIV prevention, case finding, and treatment gaps, sex workers, men who have sex with men,
and on building capacity for a locally led, sustainable
response to the epidemic in Kenya. transgender people, and people who inject
drugs — and to improve their enrollment and
retention in care.

This brief is made possible by the generous support of the American people through USAID and PEPFAR through the terms
of cooperative agreement #AID-OAA-A-14-00045. The contents are the responsibility of the LINKAGES project and do not
necessarily reflect the views of USAID, PEPFAR, or the United States Government. 

Suggested citation: LINKAGES. LINKAGES Kenya: Summary of Achievements, March 2016–October 2019. Durham (NC): FHI 360; 2019.

1
Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS data 2019. Geneva: UNAIDS; 2019. Available from: https://www.unaids.org/sites/default/files/media_asset/2019-UNAIDS-data_en.pdf.
2
National AIDS and STI Control Programme (NASCOP). 2010–2011 Integrated biological and behavioural surveillance survey among key populations in Nairobi and Kisumu, Kenya. Nairobi: Ministry of
Health, Kenya; 2014.
3
Kenya National AIDS Control Council (KNACC). Kenya HIV prevention response and modes of transmission analysis. Nairobi: KNACC; 2009.
4
For more information about EPOA, please see LINKAGES Enhanced Peer Outreach Approach Implementation Guide.