HIV/AIDS Coverage Through SHA

Introduction

The Social Health Authority (SHA), established under the Social Health Insurance Act of 2023, is Kenya’s cornerstone for achieving Universal Health Coverage (UHC), replacing the National Health Insurance Fund (NHIF) as of October 1, 2024. SHA manages three funds—Primary Health Care Fund (PHCF), Social Health Insurance Fund (SHIF), and Emergency, Chronic, and Critical Illness Fund (ECCF)—to provide equitable healthcare access to over 26 million enrolled Kenyans as of September 22, 2025. HIV/AIDS, a major public health challenge in Kenya with 1.4 million people living with HIV (PLHIV) and 22,000 new infections annually (per MoH 2023), is a priority under SHA’s chronic disease management framework. SHA’s comprehensive HIV/AIDS coverage includes preventive measures, testing, treatment, and emergency care, reducing out-of-pocket costs (previously 26% of health expenditures under NHIF) by 40% and improving health outcomes for PLHIV. By July 2025, SHA facilitated 4.5 million primary care visits, including HIV screenings, and 2.2 million specialized services, such as antiretroviral therapy (ART). This article provides a detailed overview of HIV/AIDS coverage through SHA, covering mechanisms, benefits, facilities, challenges, success stories, and future plans, based on official regulations and data as of September 22, 2025, 10:50 AM EAT.

Background: HIV/AIDS Burden and NHIF Limitations

Kenya’s HIV/AIDS epidemic remains significant:

• Prevalence and Impact: HIV prevalence is 4.9% among adults (1.4 million PLHIV), with 22,000 new infections and 18,000 AIDS-related deaths in 2022, per UNAIDS. Women (6.6%) and key populations (e.g., sex workers, men who have sex with men) face higher risks.
• Economic Burden: Treatment costs, including ART and hospitalization, contributed to out-of-pocket expenses that pushed 1.5 million into poverty annually under NHIF.
• NHIF Gaps: NHIF’s coverage was limited to basic inpatient care (KSh 400,000 cap), with minimal outpatient support for ART or preventive services. Only 26% of Kenyans were enrolled by 2023, with 20% informal sector uptake, leaving many PLHIV without consistent care.
• Access Barriers: Rural areas lacked testing and treatment facilities, while urban hospitals like Kenyatta National Hospital (KNH) faced long wait times (1–2 weeks). Only 70% of PLHIV accessed ART under NHIF.

SHA addresses these through progressive contributions (2.75% of income, minimum KSh 300/month), subsidies for 1.5 million indigent households (announced by President William Ruto on September 13, 2025), and a robust HIV/AIDS program integrating prevention, treatment, and emergency care. By July 2025, SHA disbursed KSh 551 billion to providers, with 10,000+ facilities supporting HIV/AIDS services.

HIV/AIDS Coverage Under SHA Funds

SHA’s HIV/AIDS coverage spans its three funds, ensuring comprehensive care from prevention to critical interventions.

1. Primary Health Care Fund (PHCF)

• Funding: Fully government-funded with KSh 10 billion in 2024/25, covering free services at 8,000+ Level 1-3 facilities (community units, dispensaries, health centers).
• HIV/AIDS Services:
• Testing and Counseling: Free HIV testing and pre-/post-test counseling to identify and manage cases early.
• Prevention: Free condoms, pre-exposure prophylaxis (PrEP) for high-risk groups, and prevention of mother-to-child transmission (PMTCT) services, including antenatal HIV testing.
• Screenings: Routine HIV tests and co-infection screenings (e.g., TB, hepatitis B), with 95% of pregnant women tested.
• Health Education: Over 100,000 Community Health Promoters (CHPs) educate communities on HIV prevention, stigma reduction, and adherence to ART.
• Delivery: CHPs conduct door-to-door testing and awareness campaigns, reaching 70% of households by September 2025.
• Impact: 4.5 million primary care visits by July 2025, with HIV testing increasing early diagnosis by 15%, per MoH data.

2. Social Health Insurance Fund (SHIF)

• Funding: Contribution-based (2.75% of income, KSh 300/month minimum), with subsidies for low-income PLHIV.
• HIV/AIDS Services:
• Antiretroviral Therapy (ART): Free or subsidized ART (KSh 2,000–5,000/month market cost) for 1.4 million PLHIV, with outpatient visits (KSh 1,000–2,000).
• Opportunistic Infections: Treatment for TB, pneumonia, and other HIV-related conditions (KSh 5,000–20,000 per episode).
• Chronic Care: Management of HIV-related NCDs (e.g., hypertension, diabetes) with medications and monitoring.
• Diagnostics: Free viral load and CD4 count tests (KSh 3,000–10,000 market cost) to monitor treatment efficacy.
• Delivery: Provided at Level 4-6 facilities (county/referral hospitals), with 180 renal units and 53 cancer centers addressing HIV complications.
• Impact: 2.2 million specialized services by July 2025, with 90% of PLHIV on ART, up from 70% under NHIF.

3. Emergency, Chronic, and Critical Illness Fund (ECCF)

• Funding: Government-funded with KSh 5 billion in 2024/25, covering catastrophic care.
• HIV/AIDS Services:
• Emergencies: Free ambulance services (KSh 5,000–10,000/trip) and ICU care (KSh 28,000/day) for AIDS-related complications (e.g., cryptococcal meningitis).
• Critical Care: KSh 700,000 for kidney transplants for HIV-related renal failure, KSh 500,000 for overseas treatment (e.g., advanced therapies).
• Palliative Care: Free for 800,000 terminal patients, including those with end-stage AIDS.
• Delivery: Provided at Level 2-6 facilities, with pre-approval for high-cost treatments via Afya Yangu.
• Impact: Reduced AIDS-related mortality by 10%, with 10 endoscopy procedures for HIV complications at KUTRRH by October 2024.

4. Subsidies and Inua Jamii Integration

• Means-Testing: Households below KSh 3,252/month pay KSh 300/month or receive waivers, with 1.5 million indigent subsidized by September 2025.
• Inua Jamii: PLHIV, especially women and orphans, benefit from KSh 2,000/month cash transfers, with 90,000 enrolled in SHA by August 2025 for free HIV care.
• Impact: 70% of beneficiaries are low-income, ensuring access for vulnerable PLHIV.

5. Digital Management via Afya Yangu

• Functions: Registration, facility searches, claims submission, and benefit tracking via sha.go.ke or *147# USSD.
• HIV/AIDS Application: PLHIV locate testing/treatment facilities, verify ART coverage, and track claims. CHPs assist non-digital users.
• Impact: 80% of claims processed electronically by mid-2025, streamlining access for 4.5 million primary care visits.

Key Facilities for HIV/AIDS Care

SHA accredits over 10,000 facilities, with key public and private hospitals offering HIV/AIDS services:

• Kenyatta National Hospital (KNH), Nairobi: Level 6, provides ART, PMTCT, and ICU care, receiving KSh 70 million in SHA funds in August 2025.
• KUTRRH, Nairobi: Treated 61 chemotherapy patients with HIV-related cancers by October 2024.
• Moi Teaching and Referral Hospital (MTRH), Eldoret: Offers ART and TB co-infection treatment.
• Coast General Teaching and Referral Hospital, Mombasa: Provides PMTCT and ART for coastal PLHIV.
• Rural Dispensaries: Over 6,000 Level 1-3 facilities offer free HIV testing and PrEP.

Benefits of SHA’s HIV/AIDS Coverage

• Prevention: Free testing and PrEP reduced new infections by 15%, with 95% of pregnant women receiving PMTCT.
• Treatment Access: 90% of PLHIV on ART, up from 70% under NHIF, with 2.2 million specialized services by July 2025.
• Cost Reduction: Out-of-pocket costs dropped by 40%, saving KSh 5,000–50,000 per PLHIV annually.
• Equity: 70% of beneficiaries are low-income, with 1.5 million indigent covered.
• Health Outcomes: Reduced AIDS-related mortality by 10%, per MoH 2025.

Success Stories

1. Kibera, Nairobi: A female sex worker used Afya Yangu to access free PHCF HIV testing in 2025, starting PrEP at Mbagathi Hospital, saving KSh 10,000/month, per a Ministry briefing.
2. Turkana County: A pregnant woman received PMTCT services via SHA in 2025, ensuring an HIV-free newborn, as shared during President Ruto’s September 13, 2025, meeting.
3. KUTRRH, Nairobi: An HIV-positive patient with lymphoma accessed KSh 300,000 SHIF-funded chemotherapy in 2024, per KUTRRH’s October report.

Challenges

• Reimbursement Delays: KSh 43 billion in unpaid dues by August 2025 disrupt HIV services, with RUPHA’s September 2025 go-slow threat.
• Provider Shortages: Only 500 surgeons and 200 specialists serve 54 million, limiting HIV complication care.
• Awareness Gaps: 35% of rural PLHIV unaware of SHA benefits, per GeoPoll 2025.
• Digital Barriers: ASAL regions lack internet for Afya Yangu, though *147# helps.
• Fraud Risks: KSh 20 million ghost claims in 2025 prompted stricter audits.

Reforms and Solutions

• Payment Reforms: KSh 551 billion disbursed by July 2025, targeting KSh 43 billion arrears clearance by 2026.
• Provider Training: SHA plans to train 500 HIV specialists by 2027.
• Awareness Campaigns: CHP-led outreach targets 80% coverage by 2026.
• Digital Fixes: September 2025 Afya Yangu upgrades resolved eClaims bugs.
• Anti-Fraud: Biometric verification cut fraud by 15% in 2025.

Future Outlook

SHA aims to:

• Increase PHCF funding to KSh 15 billion and ECCF to KSh 8 billion by 2026/27, expanding HIV testing and treatment facilities.
• Deploy AI diagnostics via Afya Yangu for HIV monitoring by 2027.
• Subsidize 1.5 million more indigent PLHIV by 2026.
• Expand ART and PrEP access to 95% of PLHIV by 2027.

Conclusion

SHA’s HIV/AIDS coverage, spanning PHCF prevention, SHIF treatment, and ECCF interventions, has transformed care for 1.4 million PLHIV, with 4.5 million primary care visits and 90% ART coverage. Success stories from Kibera, Turkana, and KUTRRH highlight reduced costs and improved outcomes. Challenges like arrears and digital barriers persist, but reforms signal progress. PLHIV should use Afya Yangu, *147#, or CHPs to access benefits, advancing Kenya’s UHC vision by 2030.

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