1. LIST OF RELATED ACTVITIES These activities relate to HIV/AIDS Treatment: ARV Services (#6836), (#6945) Laboratory Infrastructure (#6940), Counseling and Testing (#6941) and Palliative Care: TB/HIV services (#6944).

2. ACTIVITY DESCRIPTION African Medical Research and Educational Foundation (AMREF) has supported the introduction of PMTCT services since 2004 and will continue to support the implementation and expansion of PMTCT program in Machakos district in Eastern Province and in the Kibera Slum area in Nairobi City. These areas recorded high HIV prevalence rates of 6% and 12%, respectively, among women. AMREF currently supports PMTCT activities in 18 health facilities. Initially, the focus was on district and sub-district hospitals. In the FY 2006 semiannual report, AMREF counseled and tested 3,483 women.

In FY 2007, the program will consolidate activities to expand the scope of services to 30 new public health facilities starting with the high volume health centers and eventually the dispensaries. AMREF will also provide counseling and testing to 27,910 pregnant women, and provide ARV prophylaxis to a total of 1,555 HIV positive women: sdNVP and AZT to 780 HIV positive women, HAART to 150 HIV positive women and sdNVP to 625 women. Early infant diagnosis will be provided to 780 infants exposed to HIV. AMREF will develop models of providing comprehensive PMTCT services to HIV positive women and their families, and provide care and follow up to a total of 780 HIV infected-exposed mother- infant pairs. Postnatally, mothers will be counseled on infant feeding practices, linked to family planning services and to care and treatment. The HIV exposed infant will have DBS for early infant diagnosis and will be started on cotrimoxazole at the age of six weeks. All HIV positive women and their families identified through the PMTCT program will be linked to Care and ARV treatment programs. In FY 2007, AMREF will train 80 service providers on PMTCT and comprehensive PMTCT which includes DBS (dry blood spot) sample collection technique.

Significant changes from FY 2006 to FY 2007 for this activity include increasing the uptake of counseling and testing in the ANC to 90%, and maternity testing to 80% from the current 18% increasing the uptake of ANC mother NVP from the current 12% to 80%, increase of maternity NVP from the current 17% to 80%, and infant NVP uptake from the current 5% to 80%. AMREF will strengthen the Health Management Information System at district level through staff training and computerization of the data management. AMREF will support the district to effectively use the national MOH/NASCOP data collection tools. AMREF will also develop innovative strategies for stigma reduction and will use the local radio station channel to reach a wider local audience. In particular, AMREF will improve support supervision to health facilities. This will contribute to increase in uptake of services at facility level, as well as contribute to community support to PMTCT activities.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA PMTCT activities in Machakos and Kibera slum will contribute to approximately 2.9% of 2007 overall Emergency PMTCT targets for Kenya. The increase in number of sites contributes to the program's efforts to achieve district-wide coverage for improving equity and access particularly in these underserved areas. The provision of PMTCT+ services to the women, infants and other members of the family provides an entry point for HIV positive individuals to access comprehensive HIV care and other HIV care and support services including safe infant feeding practices. The improved district Health Management Information System will identify gaps in coverage that will be addressed to increase district wide coverage. This activity contributes substantively to Kenya's Five-year strategy of providing HIV counseling and testing services to pregnant women thus increasing the number of women who learn their HIV status, as well as improving access of the HIV+ pregnant women to interventions for reducing HIV infection to infants.

4. LINKS TO OTHER ACTIVITIES The PMTCT activities in Machakos district and Kibera slum relate to AMREF ARV Services (#6836) and CDC KEMRI ARV Services (#6945), CDC/KEMRI laboratory (#6940), VCT (#6941) and TB/HIV services (#6944). AMREF has been supporting a successful ART site in Kibera, and will use this site to test the appropriate model for strengthening the linkages between the PMTCT program and ART program in the providing PMTCT+ services to the women, the infants and members of the woman's family. Further, women identified

through the PMTCT program will be referred to the ART program for care and treatment.

5. POPULATIONS BEING TARGETED This activity targets pregnant women, HIV+ pregnant women, and HIV+ infants (0 to 4 years). The PMTCT+ initiatives will also target HIV affected families through providing mechanism for improving access to care of the family members of the HIV+ women. Public health care workers such as doctors, nurses, and other health care workers including nutritionists, clinical officers and public health officers will also be targeted for training using the nationally adopted CDC/WHO approved training packages, to equip them with knowledge and skills to provide comprehensive HIV prevention and care services.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will increase gender equity in HIV/AIDS programming through provision of HIV counseling and testing services of pregnant women, and improved access to other HIV care programs for the HIV infected woman, her infant and other family members. It will also reduce violence and coercion through stigma at the community level.

7. EMPHASIS AREAS This activity includes major emphasis on quality assurance and supportive supervision. Minor emphasis is placed on Development of Network/Linkages/Referral Systems; Community Mobilization/Participation, Food/Nutrition; Linkages with other Sectors and Initiatives and Training.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in ARV services (#6836), ARV services (#7095), Palliative Care: Basic Health Care and Support (#7096) and PMTCT(#6837).

2. ACTIVITY DESCRIPTION The African Medical Research Foundation (AMREF) will continue a successful HIV treatment program operating in 2 sites in Kibera, a very large informal settlement in Nairobi, Kenya, and expand activities to 2 additional area sites, providing a package of basic health services to 1400 people with HIV, including 200 children. AMREF will support staff salaries, training, laboratory evaluation, adherence counseling, and monitoring, provide drugs for prevention and treatment of opportunistic infections, and expand access to safe drinking water and malaria prevention interventions. Funding will include provision of HIV care. Patient care is managed by multidisciplinary teams, and care interventions are supported through extensive involvement of community health workers and peer educators, including many people who themselves have HIV/AIDS. The community health workers and peer educators work in both the clinics and communities to support adherence, provide counseling and education about nutrition and other key aspects of care, and assist with recognition of adverse drug reactions and early referral. AMREF staff conducts extensive activities in the community that educate and sensitize church, political, and administrative leaders as well as all members of the community. Activities are implemented in collaboration with the Provincial ART officer for Nairobi. This activity will be primarily an expansion of the existing program to increase both the number of sites and number of people reached. Provision of care for children including psychosocial support, and expansion of HIV prevention activities in care settings will be emphasized. The central AMREF laboratory will be strengthened to continue supporting quality assurance for labs at the satellite sites. AMREF has extensive experience and expertise in implementing community-based HIV/AIDS prevention and care programs throughout Africa. The HIV treatment program in Kibera has been recognized as a model of community-based care for PLWAs. By April 2006, the program was providing palliative care services to more than 622 patients. Rates of adherence to care are very high. The community sensitization activities have already contributed substantially to a reduction in stigma and discrimination in this community and are expected to continue to do so.

3. CONTRIBUTIONS TO OVERALL PROGRAM These activities will contribute to the results of expansion of palliative care services for people with HIV, strengthened human resource capacity to deliver palliative care services for HIV, and a strengthened referral network for HIV care.

4. LINKS TO OTHER ACTIVITIES AMREF's palliative care activities link closely to community services supported by CBOs such as Kibera Community Self Help Program (KICOSHEP), AMREF-supported PMTCT services (#6837), AMREF-supported ARV services (#6836), and to the established network referral center at Kenyatta Hospital (#7096) through the referral of complicated cases.

5. POPULATIONS BEING TARGETED The population targeted with this activity are the HIV-infected Kibera adult and pediatric residents that will be served by these programs and have great need for HIV treatment that relates not only to high HIV prevalence, but also very severe poverty and lack of basic services such as clean water, food, and education. The associated community sensitization activities raise awareness among men, women and children living in the slums. Other targeted populations include public health workers and NGOs/private voluntary organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses legislative issues related to stigma and discrimination through community sensitization activities

7. EMPHASIS AREAS This activity includes minor emphases in commodity procurement, community mobilization, human resources, quality assurance and supportive supervision, and training.

"African Medical Research Foundation (AMREF) will support TB/HIV services for approximately 1,400 patients at 3 sites in Nairobi Province. Intensified TB screening and treatment for all HIV patients and HIV screening for all TB suspects/patients will be offered as a standard of care in all the facilities; approximately 140 patients will be identified as being infected with both TB and HIV. Funds will support refresher training of laboratory staff and improvement of basic laboratory microbiology capacity in order to meet the increased needs for TB testing. 10 health care workers will be trained to provide clinical prophylaxis and/or treatment for TB to HIV-infected individuals. Funds will support expanded and strengthened delivery of integrated HIV and TB services including strengthened referral systems. Additional activities will include community mobilization and dissemination of educational materials to patients. AMREF will maintain data concerning the numbers of people served and will report both nationally and through the Emergency Plan. " AMREF has extensive experience and expertise in implementing community-based HIV/AIDS prevention and care programs throughout Africa. The HIV treatment program in Kibera has been recognized as a model of community-based care for PLWAs. By April 2006, the program was providing palliative care services to more than 622 patients. Rates of adherence to care are very high. The community sensitization activities have already contributed substantially to a reduction in stigma and discrimination in this community and are expected to continue to do so. 3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute towards the provision of integrated HIV/TB services for dually infected patients care by reducing TB morbidity and mortality in HIV-infected individuals and also reducing HIV related morbidity and mortality in TB patients co-infected with HIV. These activities will strengthen referral systems, improve diagnostics and treatment of TB among HIV-positive patients and strengthen capacity of health workers to provide integrated HIV and TB services. 4. LINKS TO OTHER ACTIVITIES The overall program activity links closely to Palliative Care (#7096), ARV Services (#7095) and PMTCT Services ((#6837) currently supported by this partner as well as HIV/TB services supported by NLTP. 5. POPULATIONS BEING TARGETED These activities target people living with HIV/AIDS. Public health care providers, including doctors, nurses, pharmacists, laboratory workers will receive training in the diagnosis and management of TB using government guidelines. 6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses legislative issues related to stigma and discrimination through community sensitization activities. 7. EMPHASIS AREAS This activity includes minor emphasis in commodity procurement, development of networks/linkages/referral systems, community mobilization, human resources, local organization capacity development, quality assurance, quality improvement and supportive supervision, and training.

Table 3.3.07:

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative Care: Basic Health Care and Support (#6838, #7096), ARV Services (#7095), and Prevention of Mother to Child Transmission (#6837).

2. ACTIVITY DESCRIPTION The African Medical Research Foundation (AMREF) will expand a successful HIV treatment program operating in two sites in Kibera, a very large informal settlement in Nairobi, Kenya and will build on experiences with this program to expand activities to two additional area sites, providing antiretroviral treatment to 1,200 people with HIV (400 new), including 150 children, bringing the total ever treated to 1,400. AMREF implements antiretroviral treatment by supporting staff salaries, training, laboratory evaluation, adherence counseling, and monitoring. Funding will include provision of ART training to 30 health care workers. ARVs are supplied to the sites through the current distribution system of the Mission for Essential Drugs and Supplies (MEDS) / USAID Mission Competitive Procurement. Treatment is provided by multidisciplinary teams, and treatment services are supported through extensive involvement of community health workers and peer educators, including many people who themselves have HIV/AIDS. The community health workers and peer educators work in both the clinics and communities to support adherence, provide counseling and education about nutrition and other key aspects of care, and assist with recognition of adverse drug reactions and early referral. AMREF staff conducts extensive activities in the community that educate and sensitize church, political, and administrative leaders, as well as all members of the community. Evaluation components include the assessment of the feasibility and acceptability of caregivers supporting ART adherence and delivery at the community level; 30 health care workers will be trained. This activity will be primarily an expansion of the existing program to increase both the number of sites and number of people reached. Provision of care for children including psychosocial support, and expansion of HIV prevention activities in care settings will be emphasized. The central AMREF laboratory will be strengthened to continue supporting quality assurance for labs at the satellite sites. Activities are implemented in collaboration with the Provincial ART officer for Nairobi. AMREF has extensive experience and expertise implementing community-based HIV/AIDS prevention and care programs throughout Africa. The HIV treatment program in Kibera has been recognized as a model of community-based ART. By September 2006 the program was providing ART to more than 300 patients. Rates of drug adherence are very high, and rates of complete viral load suppression are comparable to those seen in research settings in the US and Europe. The community sensitization activities have already contributed substantially to a reduction in stigma and discrimination in this community and are expected to continue to do so.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute to the results of expansion of ARV treatment for clinically qualified HIV-positive patients, strengthened human resource capacity to deliver ARV treatment, and a strengthened referral network for provision of ART.

4. LINKS TO OTHER ACTIVITIES This activity relates to community services supported by KICOSHEP, a sub-partner of Cooperative Housing Foundation (#6869), to PMTCT services supported by AMREF (#6837), and to the established network referral center established at Kenyatta National Hospital, supported by the University of Nairobi and other partners.

5. POPULATIONS BEING TARGETED The populations targeted with this activity are HIV-infected adult and pediatric Kibera slum residents that will be served by these programs and have great need for HIV treatment that relates not only to high HIV prevalence, but also very severe poverty and lack of basic services such as clean water, food, and education. The associated community sensitization activities raise awareness among men, women and children living in the slums.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses legislative issues related to stigma and discrimination through community sensitization activities.

7. EMPHASIS AREAS This activity includes minor emphasis in commodity procurement,

community mobilization, human resources, training, quality assurance and supportive supervision, training, and strategic information.