1. LIST OF RELATED ACTIVITIES This activity relates to activities in ART Services (#6853, #6854, #6945) and TB/HIV (#8843).

2. ACTIVITY DESCRIPTION CRS supported sites are implementing a variety of community-based activities to support the understanding of, enrollment in, and adherence to care and treatment programs. The consortium has provided extensive support for monitoring and evaluation, allowing timely reporting to both PEPFAR and the Kenya National Program. The implementing consortium includes Catholic Relief Services, Catholic Medical Mission Board, Futures Group, The Institute of Human Virology at the University of Maryland, and the Interfaith Medical Alliance. The consortium has established agreements with a number of Mission facilities in Kenya, and has supported rapid scale-up of treatment at these facilities. By March 2006, approximately 20,000 patients were receiving palliative care services as a result of Track 1 funding awarded to this partner and more than 1000 additional patients had care services as a result of supplemental funding awarded late in FY 2005.

In FY 2007 the Catholic Relief Services (CRS) Consortium will expand services currently supported both by Track 1 funds and in country funds to support palliative care for 30,000 patients (including more than 2000 children) at 24 service delivery sites throughout Kenya. There will be 75 individuals trained to provide HIV palliative care. CRS supports Mission Hospitals in several geographic areas with a standard package that includes funds for staff salaries, training of staff, laboratory evaluation, adherence counseling and monitoring, drugs for prevention and treatment of opportunistic infection, and end of life care.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute to expansion of palliative care services for clinically qualified HIV-positive patients, strengthen human resource capacity to deliver HIV care, and a strengthen referral network for provision of these services.

4. LINKS TO OTHER ACTIVITIES These activities link to ARV treatment (#6853, #6854) and TB/HIV services (#8843)supported by CRS, to a variety of services provided by Mission facilities in Kenya (including testing and counseling services and prevention of mother to child transmission services), and in many cases to facilities in the Ministry of Health system. For example, in Kisumu, St. Monica's Hospital is being integrated into the network center at the KEMRI-supported Nyanza Provincial Hospital.

5. POPULATIONS BEING TARGETED These activities target people living with HIV/AIDS. Care services for children with HIV are being established or expanded at all sites. The ability to diagnose and provide care for very young children is being established through a relationship with Kenya Medical Research Institute (KEMRI); filter paper samples are transported to the KEMRI lab for infant testing (currently with PCR).

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

7. EMPHASIS AREAS This activity includes minor emphasis in commodity procurement, community mobilization, development of networks/linkages/referral systems, human resources, quality assurance and supportive supervision, strategic information, and training.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative Care: Basic Health Care and Support(#6855) and ARV Services (#6853, #6854).

2. ACTIVITY DESCRIPTION AIDS Relief (a consortium of Catholic Relief Services, Catholic Medical Mission Board, Futures Group, Interchurch Medical Assistance, and the Institute of Human Virology at the University of Maryland) will support HIV/TB services for approximately 30,000 HIV patients at 20 service delivery sites throughout Kenya. AIDSRelief will offer TB screening to all HIV patients; approximately 3,000 will be diagnosed with HIV/TB. Refresher training of laboratory staff will be initiated and basic laboratory microbiology capacity improved in order to meet the increased needs of TB testing. 25 Health care workers will be trained to provide clinical prophylaxis and/or treatment for TB to HIV-infected individuals.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute towards the provision of integrated HIV/TB 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, 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 and ARV services currently supported by AIDSRelief, ART services supported by this partner through in-country funding, and ART services coordinated by and supported through the National AIDS and STD Control Program (NASCOP). 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, community mobilization, development of networks/linkages/referral systems, human resources, local organization capacity development, quality assurance, quality improvement and supportive supervision, strategic information and training.

4. LINKS TO OTHER ACTIVITIES The overall program activity links closely to Palliative care and ARV services currently supported by AIDSRelief, ARV services supported by this partner through in-country funding, and ARV services coordinated by and supported through the National AIDS and STD Control Program (#7004).

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, community mobilization, development of networks/linkages/referral systems, human resources, local organization capacity development, quality assurance, quality improvement and supportive supervision, strategic information and training.

AIDS Relief (a consortium of Catholic Relief Services, Catholic Medical Mission Board, Futures Group, Interchurch Medical Assistance, and the Institute of Human Virology at the University of Maryland) will support HIV/TB services for approximately 30,000 HIV patients at 20 service delivery sites throughout Kenya. AIDSRelief will offer TB screening to all HIV patients; approximately 3500 will be diagnosed with HIV/TB. Refresher training of laboratory staff will be initiated and basic laboratory microbiology capacity improved in order to meet the increased needs of TB testing. 50 Health care workers will be trained to provide clinical prophylaxis and/or treatment for TB to HIV-infected individuals.

AIDSRelief will also offer HIV testing in all TB areas and other clinical areas where TB Patients and TB suspects are seen. Approximately 10,000 TB patients/TB suspects will be tested for HIV.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative care: Basic Health Care and Support (#6855), ARV Services (#6853), TB/HIV (#8843), and OVC (#9048, #9029).

2. ACTIVITY DESCRIPTION AIDSRelief (a consortium of Catholic Relief Services, Catholic Medical Mission Board, Futures Group, Interchurch Medical Assistance, and the Institute of Human Virology at the University of Maryland) will continue provision of ART services to approximately 12,000 patients, including 1000 children (total of 4,000 new patient and 14,000 ever) at 20 service delivery sites throughout Kenya. (These patients are in addition to the 5,000 that will be supported through Track 1 funding for this partner.) AIDSRelief provides on-site preceptorship that builds clinical, adherence counseling, and laboratory skills. Institutional capacity is also strengthened through support for strategic information systems, commodities management, and finance and administrative management capacities. AIDSRelief partners with various in-country organizations (government, FBO, NGO) for additional training resources. Leveraging of other resources through wrap-around programs will increase access to clean water, provide insecticide treated bednets, and support improved nutrition. By working with faith-based CBO's firmly embedded in communities, AIDSRelief ensures that the community supports the health facility by reducing HIV/AIDS stigma, contributing to continuity of care. 45 health care workers will be trained. AIDSRelief supports salaries for comprehensive teams providing HIV treatment, ensuring that each point of service has at least the minimum amount of staffing required by the National AIDS and STD Control Program (NASCOP) for an ART program. In line with the national dialogue regarding an increased role of nurses in AIDS treatment, AIDSRelief is focusing on mentoring and training nurses. The hub for nursing preceptorship will be St. Monica's Hospital in Nyanza province. AIDSRelief also funds the costs of laboratory examinations for all patients on ART at supported sites including CD4 counts as necessary for monitoring patients on treatment. ARVs are supplied to the sites through the distribution system of the Mission for Essential Drugs and Supplies (MEDS). The AIDSRelief consortium has established agreements with a number of Mission facilities in Kenya, and has supported rapid scale up of treatment at these facilities. By June 2006, more than 8,000 patients were accessing ART as a result of Track 1 and in-country funding awarded to this partner.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA AIDSRelief activities will contribute to expansion of ARV treatment for clinically qualified HIV-positive patients at faith-based facilities. AIDSRelief will strengthen human resource capacity to deliver adult and pediatric ARV treatment, tighten linkages between prevention, care, and treatment activities, and strengthen referral networks for AIDS services.

4. LINKS TO OTHER ACTIVITIES The overall program activity links closely to Palliative care and TB/HIV services currently supported by AIDSRelief, ART services supported by this partner through in-country funding, and ART services coordinated by and supported through the National AIDS and STD Control Program (NASCOP). Specific facilities have also developed linkages, for example Nazareth has established treatment referral linkages with Nyeri District Hospital (supported by #6867). There are also linkages to CRS-supported OVC programs as part of the USAID-supported APHIA II (#9048, #9029).

5. POPULATIONS BEING TARGETED These activities target people living with HIV/AIDS including adults, children, and infants. Treatment services for children with HIV are being established or expanded at all sites. Treatment services for diagnosis and treatment of very young children are being established through a relationship with Kenya Medical Research Institute (KEMRI); filter paper samples are transported to the KEMRI lab for infant testing (currently with PCR). Public health care providers, including doctors, nurses, pharmacists, laboratory workers are targeted with increased HIV care and treatment knowledge and skills. Activities also target community- and other faith-based organizations (KEC, CHAK), and community and religious leaders.

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, development of networks/linkages/referral systems, human resources, local organization capacity development, quality assurance, quality improvement and supportive supervision, strategic information and training.