Успех борьбы с ВИЧ в Кении привел к росту хронических заболеваний и финансовой нагрузки на систему здравоохранения

Kenya has reduced new HIV infections by 83 percent in ten years, from 101,448 in 2013 to 16,752 in 2023, while the number of people receiving antiretroviral therapy more than doubled from 656,369 to 1,336,681 during the same period. According to the National Syndemic Diseases Control Council (NSDCC) report, Aids-related deaths also fell by 65 per cent, from 58,446 to 20,480. By 2023, 97 percent of people living with HIV were receiving treatment. The NSDCC says that the success of antiretroviral therapy has prolonged the lives of people living with HIV and that the ageing population is increasingly affected by multiple chronic conditions. The NSDCC's 2025 Aids Response Progress Report states that 62 percent of people living with HIV have at least one non-communicable disease (NCD), compared to 51 per cent of the general population. “The growing burden is partly a consequence of the success of antiretroviral treatment, which has prolonged the lives of people living with HIV. As this population ages, more are experiencing multiple chronic conditions, including hypertension, diabetes, and cardiovascular disease,” the report said. However, the progress in HIV management is creating financial pressures for patients and the healthcare system. Kenya estimated that it would require Sh647.7 billion to finance its HIV response between 2020/21 and 2024/25 to cover prevention, treatment, care, and support. Yet domestic resources accounted for only 34 per cent of the required financing. For some patients, the additional illnesses mean paying for medicines and clinic visits that were not part of their original HIV treatment. For Grace Maina, living with HIV is no longer her only health concern. She also has diabetes and high blood pressure, conditions that have increased her treatment costs. “The diabetes medication is sometimes too expensive for me. In a month, I can spend up to Sh16,500 on medication and other supplements, which is additional money that I had not planned for in the first place,” said Grace. She said that when her blood pressure rises, she also struggles to control her blood sugar. At one point, her blood pressure reached 200, leaving her severely fatigued and unable to walk. Although her HIV treatment is available through the HIV programme, managing diabetes and hypertension requires additional medication and care. John Otieno, 55, has also had to deal with the added cost of managing diabetes. When his medication is unavailable at the public facility, he has to purchase it from private pharmacies, which adds to his household expenses. The retail price of diabetes medicines varies widely at private pharmacies, ranging from approximately Sh500 for a 30-tablet pack of metformin-based treatment to over Sh4,000 for some com-bination tablets. Insulin and newer injectable medicines can cost more than Sh10,000. These two patients are part of a wider group of people living with HIV who are also dealing with chronic illnesses. A 2025 study involving 6,795 people living with HIV at Homa Bay County Referral Hospital found that 16.2 percent had hypertension and 1.8 percent had diabetes, while 44 per cent of participants were overweight or obese. The researchers reviewed the electronic medical records of adults receiving HIV care. A separate study at Isiolo County Referral Hospital, which involved 231 adults receiving HIV treatment, found that 42.4 per cent had previously been diagnosed with hypertension, and 23.4 percent with diabetes. These additional conditions also incur direct costs for patients. A 2023 study using data collected in Busia and Trans-Nzoia in 2020 found that patients spent an average of Sh7,458 a year on hypertension treatment and Sh8,408 on diabetes treatment. For patients with both conditions, the average annual cost rose to Sh13,149, including healthcare, transport, and other treatment-related expenses. The financial burden of NCDs extends beyond the cost of medicines and hospital visits. A 2016 study by University of Nairobi economists Daniel Mwai and Moses Muriithi found that non-communicable diseases reduced household income by 28.64 per cent, compared with a 13.63 per cent reduction associated with general illnesses. While no newer national study has produced a directly comparable estimate of NCD-related income loss, more recent evidence shows the financial burden remains substantial. A 2024 study estimated that managing type 2 diabetes alone cost Kenya Sh74.5 billion in 2021, while a World Bank analysis estimates that seven major NCDs cost the economy about Sh230 billion annually, with the losses projected to rise to Sh607 billion a year by 2030 without stronger action. “NCDs eat into a household’s current income and reduce the future productivity of patients,” wrote the researchers. According to Dr Mwai, financing is not just about finding more money but also about how existing resources are used. “Financing is not just about raising more money. It is also about how we strategically use this money to address persisting health challenges,” he said in a discussion on domestic health financing. “We can cut the cost of healthcare in Africa by 40 percent if we reorganise and plan its delivery well.” One way of doing this would be to utilise the infrastructure already in place for HIV treatment. A 2020 cost analysis of the AMPATH Chronic Disease Management programme found that adding chronic disease care to an existing HIV clinic cost an average of $10.42 (Sh1,344) per patient visit. Providing chronic disease services through the HIV platform costs about $1 (Sh129) less per visit than adding them to a primary care facility. At the time of the study, the programme was providing chronic disease care to over 24,000 patients across 69 facilities. This approach enables health workers, laboratories and clinic infrastructure that are already sup-porting HIV care to also screen for and manage conditions such as hypertension and diabetes. However, scaling up such services would still require medicines, diagnostic equipment, and staff trained to manage conditions beyond HIV. Kenya's new health financing system is also expected to help carry this burden. The Emergency, Chronic and Critical Illness Fund (ECCIF), which is managed by the Social Health Authority (SHA), pays for care relating to chronic illnesses once the benefits available through the Social Health Insurance Fund have been exhausted. The SHA's financial statements for the year ended June 2025 show ECCIF benefit expenses totalling Sh457.7 million. The fund also reported Sh344.3 million in incurred but not reported claims and Sh455.2 million in outstanding claims reserves, bringing the total ECCIF expenses reported in the financial statements to approximately Sh1.26 billion. In May 2026, the SHA reported a further Sh433 million paid through the ECCIF in its latest claims cycle. However, it does not show how much of this money went specifically to people living with HIV who also have NCDs. Since then, the country has launched the Kenya AIDS Integration Strategic Framework 2025–2030, which brings the management of HIV alongside other conditions such as hypertension, diabetes, tuberculosis, viral hepatitis and mental health conditions closer together. This makes use of existing health facilities and systems instead of running each disease as a separate programme.