1. LIST OF RELATED ACTIVITIES This activity relates to activities in HIV/AIDS treatment/ARV services (#6880), (#7094) and Palliative Care: TB/HIV (#6879).

2. ACTIVITY DESCRIPTION The Eastern Deanery AIDS Relief Program (EDARP) is a faith-based organization under the Roman Catholic Archdiocese of Nairobi that was established in 1993 as a response to the HIV pandemic affecting the people living in a slum setting in the Eastlands area of Nairobi. A network of community health workers and clinical sites has been established, and now provides a variety of HIV prevention and treatment services to many thousands of people with HIV. EDARP has one site that has been offering comprehensive PMTCT and in FY 2005, 517 women were counseled and tested and 134 were offered ARV prophylaxis. In addition referral linkages have been established to centers providing antiretroviral therapy for continuum of care for the mother, male partner and, infant.

In FY 2007, EDARP will consolidate its PMTCT services and initiate services at seven new sites. EDARP will implement integrated comprehensive PMTCT service in accordance with the National Comprehensive PMTCT guidelines. Comprehensive integrated PMTCT services include, but are not limited to counseling and testing of pregnant women and their partners in antenatal clinics, delivery units and postnatal clinics using the opt-out approach, clinical staging of all HIV-positive women using WHO guidelines, use of appropriate antiretroviral regimens including HAART for maternal health in accordance to the National Antiretroviral therapy guidelines, use of zidovudine plus single dose nevirapine or use of single dose nevirapine for women presenting late in pregnancy, postnatal follow-up for the mother and exposed infants, initiation of cotrimoxazole prophylaxis to all exposed infants at 6 weeks, Early Infant Diagnosis (EID) at six weeks via PCR on Dry Blood Spots (DBS) from all exposed infants and successful referral of HIV-positive mothers, their male partners and infected infants to antiretroviral treatment centers. EDARP targets counseling and testing to 600 pregnant women and provide antiretroviral prophylaxis for 80 HIV-positive women. All HIV-positive pregnant women eligible for treatment will be initiated on HAART, all the other women will be given the more efficacious PMTCT regimen of AZT and sd Nevirapine. Early Infant Diagnosis (EID) using Dry Blood Spots (DBS) at six weeks and co-trimoxazole prophylaxis will target all HIV exposed infants. 30 counselors will be trained for enhanced adherence support to HIV-positive women and their families. 100 community health workers will be trained to provide community and facility referral linkages. 15 health supervisors will be trained in program management skills, including utilization of data for decision making for program improvement. Pathfinder will train and update skills of 50 service providers in comprehensive HIV management for HIV-positive pregnant mothers, their infants and their families.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute to 0.06% of the overall 2007 Emergency Plan PMTCT targets for Kenya. Community participation and male involvement will significantly contribute to PEPFAR goals for primary prevention, access to care and treatment, and support of those affected and infected. EDARP will facilitate capacity building of facility management teams for improved management of health services and set up of referral networks and linkages for a continuum of care from facilities to Home-based care within the community and among various programs within the Eastleigh area. This activity contribute to increased awareness, demand creation and stigma reduction leading to increased utilization of services towards the goal of universal access to prevention, care and treatment services.

4. LINKS TO OTHER ACTIVITES Linkages to HIV care and treatment services will be strengthened, to ensure immediate appropriate care for the woman and exposed infants, and family members as well and thus optimize utilization of complementary services created through Emergency Plan funding. This activity will relate to the ARV services of EDARP and University of Manitoba ARV services.

5. POPULATIONS BEING TARGETED This activity targets adults, pregnant women, people living with HIV, HIV affected families, and HIV-positive infants. Health care providers including doctors, nurses and other health care workers will be targeted for training on PMTCT using the national NASCOP PMTCT

CDC/WHO based curriculum.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address gender equity in HIV/AIDS programs through improved PMTCT service delivery at antenatal clinics and maternity units. Community Health workers will conduct community mobilization activities that will help increase service uptake as well as address issues of stigma and discrimination at community level.

7. EMPHASIS AREAS This activity includes major emphasis on development of Network/Linkages/Referral systems with minor emphasis on Quality Assurance and Supportive Supervision; Community Mobilization/Participation and training.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in TB/HIV (#6879), ARV services (#6880), Counseling and Testing Services (#6881) and PMTCT (#8654).

2. ACTIVITY DESCRIPTION The Eastern Deanery AIDS Relief Program (EDARP) will expand services at 10 sites in the Eastleigh slums of Nairobi to provide palliative care to 10,500 people with HIV, including approximately 1,500 children. Funds will also be used to provide training in palliative care services for 50 health care workers. EDARP provides these services in urban slums in Eastern Nairobi, an area with relatively few Ministry of Health medical facilities and extreme challenges including severe poverty and very limited availability of services such as access to affordable housing, sanitation, and safe drinking water. EDARP provides a package of palliative care services including laboratory evaluation, adherence counseling and monitoring, drugs for prevention and treatment of opportunistic infections, improved access to safe drinking water, and end-of-life care. The program also includes a very strong component of community-based support for treatment adherence, infrastructure improvement (renovations at the facilities), and the production and distribution of patient informational materials. For pediatric expansion, EDARP is addressing important issues related to optimizing pediatric care, e.g. EDARP staff are implementing programs designed to support adherence to treatment for children of all ages and are developing policies and best practices related to difficult issues such as disclosure of HIV status to children. Other activities include the initiation of systems to provide emotional support for health care workers who are facing the enormous challenges of providing services in this area and those focused on reducing the risk of HIV transmission in care and treatment settings. EDARP is a faith-based organization under the Roman Catholic Archdiocese of Nairobi. EDARP was established in 1993 in response to the HIV pandemic affecting the people living in the Eastlands area of Nairobi. A network of community health workers and clinical sites has been established, and now provides a variety of HIV prevention and treatment services to thousands of people with HIV. Key elements of the program have been expanded in recent years, including establishment of HIV counseling and testing centers and demonstration programs that have successfully introduced routine HIV testing among TB patients and have served as models for scale up of these activities nationally. By April 2006, EDARP was providing palliative care services to more than 6185 people, including more than 300 children.

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

4. LINKS TO OTHER ACTIVITIES This activity links to other EDARP-supported activities, such as ARV services (#6880), TB/HIV (#6879), PMTCT (#8654), and Counseling and Testing (#6881). The services are implemented in collaboration with the ART officer of Nairobi Province and are linked to the network center at Kenyatta National Referral Hospital, currently supported by University of Nairobi.

5. POPULATIONS BEING TARGETED These activities target people (adults, children, infants) living with HIV/AIDS. Treatment services for diagnosis and care of very young children will continue through a relationship with Kenya Medical Research Institute (KEMRI), whereby filter paper samples are transported to the KEMRI lab for polymerase chain reaction (PCR) for infant testing.

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, information, education, and communication, human resources, quality assurance, quality improvement, and supportive supervision, training, and strategic information.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in CT (#6881) and HTXS (#6880).

2. ACTIVITY DESCRIPTION The Eastern Deanery AIDS Relief Program (EDARP) is a faith-based organization (FBO) under the Roman Catholic Archdiocese of Nairobi established in 1993 in response to the HIV pandemic affecting predominantly poor people living in the eastern slums of Nairobi. Through a network of community health workers and clinical sites, EDARP provides services to thousands of PLWHA. EDARP routinely tests TB suspects for HIV and has underscored the importance of this approach by demonstrating higher HIV rates in suspects without TB at first contact (64%) compared to those with TB (58%). This finding shows that targeting only patients with confirmed TB represents a missed opportunity for identifying large numbers of individuals who need additional HIV-related care. EDARP's TB/HIV activity will continue to partner closely with its ARV program, funded as an HTXS activity. HIV testing for TB suspects identifies large numbers of clients who are eligible for cotrimoxazole (CTX) and ART. This program continues to serve as a model for the scale up of TB/HIV activities nationally. The populations served have high rates of HIV and TB and suffer widespread poverty and limited access to quality health services. In FY 2007, due to increased demand, EDARP will further expand collaborative TB/HIV services at existing TB/HIV service outlets and establish new ones. To achieve this, EDARP will expand and strengthen HIV counseling and testing for all TB suspects/patients, intensify screening of HIV-infected persons for TB and further strengthen patient referral systems between TB and HIV programs. To increase capacity to deliver TB/HIV services, EDARP will hire, retain and train new and existing health workers, improve infrastructure and support supply of HIV test kits and essential medicines. Other activities will include expansion of the network of community health workers through which EDARP has developed a strong patient tracking systems invaluable for TB/HIV case finding and case holding. FY 2007 Emergency Plan funds will also be used to support laboratory and X-ray services, salaries for part of existing and new staff in accordance with Emergency Plan guidelines.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will result in strengthened delivery of integrated HIV and TB services, including strengthened referral systems, improved diagnostics and treatment of TB among HIV-positive patients and of HIV in TB patients, strengthened capacity of health workers to provide integrated HIV and TB services and strengthened systems capacity for program monitoring and evaluation and management of commodities.

4. LINKS TO OTHER ACTIVITIES The TB/HIV activities will be linked to a variety of services, including CT, PMTCT, STI and ART. EDARP also runs a successful feeding program for needy HIV and TB patients. These services are also linked to the network center at Kenyatta National Referral Hospital and to TB/HIV services provided by the Nairobi City Council facilities in the Eastern Deanery.

5. POPULATIONS BEING TARGETTED TB suspects (both adults and children) and PLWHA identified from VCT (adults), PMTCT (pregnant women), STI (adults), ARV clinics (children and adults) and PLWHA organizations - TB screening among PLWHA identified at these sites will be intensified.

6. KEY LEGISLATIVE ISSUES ADDRESSED Diagnostic HIV testing for all TB patients will be on an "opt out" principle. Guidelines on HIV testing based on consent, confidentiality and counseling will be observed as part of standard practice. Increased availability of CT in clinical settings and increased access to HIV-related care for TB patients will help reduce stigma and discrimination.

7. EMPHASIS AREAS Emphasis areas include commodity procurement, development of network/linkages/referral systems, IEC, infrastructure, local organization capacity development, and training.

Eastern Deanery TB clinics provide a significant pool of HIV-infected persons who have not been previously targeted for HIV prevention. The plus-ups will be used to promote partner notification, partner testing, risk reduction and provision of condoms. Other

activities to be supported include: improvement of infrastructure, expansion and enhancement of staff capacity, laboratory and clinical supplies and mobilization of PLWHA and community support groups.

"As pediatric treatment is scaled-up, providers increasingly report frustration with the challenge of having to educate and re-educate the caregivers of children. This primarily comes about in situations where an OVC who is infected does not have a consistent caregiver and therefore is - for example - accompanied to one visit by an aunt, to another by an older sibling, and perhaps to a third by a grandparent. This leads to longer-than-necessary clinic interactions, increased frustration for pediatric providers, and is presumed to contribute to sub-optimal care of children. Five high-volume treatment partners with significant stable adult patient populations (AMPATH, Eastern Deanery AIDS Relief Project, University of Washington/Coptic Hope Center, Kericho District Hospital and NYU/Bomu Medical Center) will receive amounts specified below for an innovation in OVC programming. " "They will be supported to establish programs where experienced adult patients (with a preference for women patients) will be screened, recruited, trained, supervised and compensated to take on a substantive role in assuring continuity of care for pediatric patients. Adult patients who are successfully managing their own treatment will be assigned a small (e.g., 5-7) cohort of pediatric patients and will be trained and supported to: 1)Make periodic (e.g., weekly) home visits to conduct medication counts and observe for signs of side effects or poor response to treatment; 2) Bring children without family caregivers to regularly scheduled medical appointments to provide continuity of contact with health workers and report on household conditions, and 3) Translate provider instructions back to individuals in the home or other setting who are responsible for the child's day-to-day care." In addition to funds to these treatment partners, funding in the amount of $200,000 is awarded to AED/Capable Partners, PEPFAR/Kenya's key ally in scaling-up community based OVC responses to design and implement a real-time evaluation of the efficacy of this approach to improving continuity of care and treatment outcomes for OVC who are HIV-positive. A technical working group representing all funded partners and the assessment partner will be formed to both assure consistency of programs and identify unique opportunities that individual partners may present for fine-tuning the model.

Table 3.3.08:

1. LIST OF RELATED ACTIVITIES This activity relates to activities with Eastern Deanery AIDS Relief Program in other HIV/AIDS activities of ARV treatment (#6880), PMTCT (#8654) and TB-HIV (#6879)

2. ACTIVITY DESCRIPTION The Eastern Deanery AIDS Relief Program (EDARP) is a faith-based organization (FBO) under the Roman Catholic Archdiocese of Nairobi established in 1993 in response to the HIV/AIDS pandemic. They primarily work among the very poor people dwelling in slum areas in the eastern part of Nairobi. In terms of HIV counseling and testing (CT), EDARP has in the past provided mainly the client initiated CT in 7 fixed sites and in community outreach programs. In FY 2005 they began to expand this mandate by commencing the provider-initiated CT, starting with TB patients and later with TB suspects. In FY 2006, this was further enhanced through the provision of pediatric HIV testing and family support. Because of their broad type training, counselors in EDARP are highly qualified and able to provide different types of CT services. The training they receive includes VCT, DTC, couple counseling and CT in children. In FY 2007 EDARP will continue providing all types of CT services in all the previous sites, as well as in the outreach program. They will however establish 4 new VCT sites in the same region. To facilitate the provision of all the CT services in FY 2007, EDARP will train 150 health workers and counselors on both VCT and DTC. This will lead to over 25,000 people being counseled and tested. Because EDARP already has a vibrant comprehensive care and treatment program, with the support of the Emergency Plan, those who will be found to be eligible will receive appropriate care within the same facility, which should minimize loss to follow up. CT services and prevention information will also be provided for family members of patients on treatment. As part of the CT program, EDARP will also carry out community mobilization and education activities in the same area, for the purpose of increasing uptake of CT and other HIV/AIDS services and also in order to reduce the social stigma.

3. CONTRIBUTION TO OVERALL PROGRAM AREA The services provided by EDARP will contribute less than 5% of the USG supported CT services in Kenya in FY 2007. However, EDARP will be working in a unique environment with very innovative CT programs. They have in the past and will in FY 2007 continue to consolidate provider initiated CT as well as the unique VCT programs. They will also provide CT for children, which is an underdeveloped program area in Kenya.

4. LINKS TO OTHER ACTIVITIES This activity will be linked to the other PEPFAR supported EDARP activities, such as ARV treatment (#6880), PMTCT (#8654), STI, and TB-HIV (#6879) activities. Diagnostic HIV testing, which is part of the provider initiated CT will be made available largely in TB and STI clinics. Those who will be found to be eligible will be referred to ARV services.

5. POPULATION BEING TARGETTED EDARP works in a highly populated slum area of Nairobi. In this area EDARP serves the entire population, including all adults and children. Most of the people who live in these slums are of very low socio-economic status. CT services will be provided to patients in the health institutions as well as to the general community in the outreach program. The program will follow a family approach to CT service provision, both for adults and children, be it in health settings or in the community.

6. KEY LEGISLATIVE ISSUES. This activity will particularly address the gender disparities, as well as help reduce stigma and discrimination in HIV/AIDS.

7. EMPHASIS AREA. Major emphasis will be placed on human resource development for quality service provision. They will also undertake community mobilization and development of networks and referral systems. Another minor emphasis will be in the area of information, education and communication in an effort to reduce stigma around testing in the community.

1.LIST OF RELATED ACTIVITIES This activity relates to activities in TB/HIV (#6879), Pallative Care: Basic Health Care and Suupport (#6878), Counseling and Testing (#6881), and PMTCT (#8654).

2. ACTIVITY DESCRIPTION The Eastern Deanery AIDS Relief Program (EDARP) will expand services at 10 sites in the Eastleigh slums of Nairobi to provide ART to 8400 people with advanced HIV including approximately 1,000 children (2,400 new patients, with the total patients ever provided with services at 9,600). Funds will also be used to provide HIV care and treatment training for 50 health care workers. EDARP provides these services in urban slums in Eastern Nairobi, an area with relatively few Ministry of Health medical facilities and extreme challenges including severe poverty and very limited availability of services such as access to affordable housing, sanitation, and safe drinking water. EDARP provides a package of antiretroviral treatment that includes support for staff salaries, training of staff, laboratory evaluation, adherence counseling, and monitoring. ARVs will be supplied to the sites through the distribution system of the USG central supply network currently done through Mission for Essential Drugs and Supplies (MEDS). The program also includes a very strong component of community-based support for ART adherence, infrastructure improvement (renovations at the facilities), and production and distribution of informational materials to patients. In expanding services to children, EDARP is taking a lead role in addressing important issues related to optimizing pediatric care, e.g., EDARP staff is implementing programs designed to support pediatric ART adherence and developing policies and best practices related to difficult issues such as disclosure of HIV status to children. Other activities include the initiation of systems to provide emotional support for health care workers who are facing the enormous challenges of providing services in this area and those focused on reducing the risk of HIV transmission in care and treatment settings.

EDARP is a faith-based organization under the Roman Catholic Archdiocese of Nairobi that was established in 1993 as a response to the HIV pandemic affecting the people living in the Eastlands area of Nairobi. A network of community health workers and clinical sites has been established, and now provides a variety of HIV prevention and treatment services to many thousands of people with HIV. Key elements of the program have been expanded in recent years, including establishment of HIV counseling and testing centers and demonstration programs that have successfully introduced routine HIV testing among TB patients and have served as models for scale up of these activities nationally. By April 2006, the program was providing ART to more than 3,900 people, including more than 150 children.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will expand access to ARV treatment for clinically qualified HIV-positive patients, strengthen human resource capacity to deliver ARV treatment, and strengthen the referral network for provision of ART. Because EDARP is among the first programs providing extensive services to children, their experiences are being shared with other programs and are contributing to the quality of services provided at other sites.

4. LINKS TO OTHER ACTIVITIES This activity links to EDARP supported activities in Palliative Care, TB/HIV, PMTCT and Counseling and Testing services. The services are implemented in collaboration with the ART officer of Nairobi Province and are linked to the network center at Kenyatta National Referral Hospital, supported by University of Nairobi.

5. POPULATIONS BEING TARGETED The populations targeted with this activity are adults and children with advanced HIV who are living in slums in eastern Nairobi. They are a priority because of high rates of HIV and because the population is extremely poor and would otherwise have very limited access to health care services.

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, development of networks/linkages/referral systems, training, human resources, information, education, and communication and supportive supervision, and strategic information.