1. LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative Care: TB/HIV (#6900), Palliative Care: Basic Health Care and Support (#6901), HIV/AIDS Treatment: ARV Services (#6899), and Counseling and Testing (#8758).

2. ACTIVITY DESCRIPTION The Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) is a broad initiative by MUFHS and MTRH in collaboration with Indiana University School of Medicine (IUSM) and other academic centers. AMPATH is a comprehensive program of HIV treatment, prevention, community mobilization, Counseling and Testing (CT), Prevention of Mother-To-Child HIV transmission infection (PMTCT), PMTCT-Plus, nutritional support, on the job training, and outreach activities. The Emergency Plan (EP) and private foundations fund this project. Through this project, 90% of all pregnant women in the targeted sub-locations will receive counseling and testing and 80% of HIV-infected pregnant women will be enrolled in the PMTCT+ program. More effort will be put towards monitoring and evaluation of the PMTCT program. Additionally, at least 50% of spouses of HIV-infected pregnant women will be offered CT in an effort to treat entire families. This is a key outcome of successful PMTCT. IUSM, MUFHS, and MTRH will use EP funds to expand PMTCT services and teach the skills to medical students. In 2006, this program will be continued and expanded to additional health facilities under AMPATH within Rift Valley Province to total 18. These facilities will counsel and test 34,045 pregnant women and provide antiretroviral prophylaxis for 2,392 HIV-positive women. Of these, 1,196 will receive AZT, 240 HAART and 956 single dose nevirapine. 1,196 exposed infants will be reached with PCR for early infant diagnosis. 75 health workers will be trained to provide PMTCT services.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA IUSM in the Rift Valley region will contribute 3.4% of the PEPFAR target of 1,000,000 for PMTCT primary prevention and care. Planned activities will improve equity in access to HIV prevention and care services in underserved rural communities. IUSM will help ensure there are adequate networks and linkages between their sites and other medical sites where AIDS care and treatment are available for both adults and children. These activities will contribute to increased access to CT services, particularly among underserved and high risk populations and result in increased availability of diagnostic counseling and testing services in medical settings to identify the large numbers of HIV infected patients who are potential candidates for ART.

4. LINKS TO OTHER ACTIVITIES The PMTCT activities of the Indiana University Medical School in the Rift Valley region relate to Indiana University's Palliative Care activities (#6900) and (#6901), ARV services providing HIV/AIDS treatment/ARV services (#6899) and nutrition program activities, and counseling and testing services (#8758). PMTCT services include counseling and testing which is largely diagnostic, provision of ARV prophylaxis, and appropriate referrals for the management of opportunistic infections and HIV/AIDS treatment.

5. POPULATIONS BEING TARGETED This activity targets the general population, adults of reproductive health age, pregnant women, family planning clients, University students, infants, and HIV positive pregnant women and special populations such as discordant couples. Behavior Change and Communication (BCC) activities will involve community leaders and community based organizations to increase demand for services amongst community members. Strategies to improve quality of services will target health care providers in public health facilities including doctors, nurses, mid wives and other health care workers such as clinical officers and public health officers. The program will also target traditional birth attendants.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will increase gender equity in programming through PMTCT services targeted to pregnant women and their spouses. IUSM through AMPATH will continue providing nutritional support through its HIV farm as well as microfinance and microcredit activities. Increased availability of PMTCT services will help reduce stigma and discrimination at community and facility level.

7. EMPHASIS AREAS

This activity includes major emphasis on training. Minor emphasis will be placed on, community mobilization, development of networks/linkages systems such as the nutritional programs, and local MUFHS, and MTRH organizational capacity development and quality assurance, quality improvement and supportive supervision.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#8758), TB/HIV (#6900), and PMTCT (#6898).

2. ACTIVITY DESCRIPTION The Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) is a broad initiative by Moi University School of Medicine, Moi Teaching and Referral Hospital, Indiana University School of Medicine and other US academic medical centers. By end of July 2006, AMPATH had opened 18 HIV/AIDS care clinics and screening programs at Moi Teaching and Referral Hospital, four district hospitals (Webuye, Teso, Kapenguria, and Kitale), and seven rural health centers (Mosoriot, Turbo, Burnt Forest, Amukura, Chulaimbo, Naitiri, and Mount Elgon). Moi University Faculty of Health Sciences (MUFHS) is one of two schools of medicine, nursing and public health in Kenya, now providing medical and health education to 670 students. Indiana University School of Medicine (IUSM) has collaborated with MUFHS since MUFHS' inception in 1990. IUSM has supported a team of faculty members on-site in Eldoret for the last sixteen years. AMPATH encompasses a balance of HIV prevention and treatment within a framework of education, research, and clinical service to ensure its relevance and sustainability in Kenya. The program is directed by the Dean of MUFHS and the Director of MTRH, and the institutions cooperate closely in the implementation of the program. In COP 2007, supported activities will include: strengthening of the regional referral center (Moi Teaching and Referral Hospital) to serve as a referral center for HIV/AIDS care, including strengthening of laboratory capacity and management of complicated medical cases, and establishment of quality and best practice standards for HIV care. Patient referrals and linkages with other services such as TB, VCT and PMTCT programs will be supported through this partner and other Emergency Plan partners. During this period, more patients will be enrolled into care in the 18 AMPATT care and treatment sites.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA By September 30, 2008, this activity will provide treatment to more than 50,000 patients, thus contributing to 20% of the USG targets for this program area. This activity will support the expansion of palliative care services to 18 service outlets and the training of 800 individuals in the provision of HIV-related palliative care services.

4. LINKS TO OTHER ACTIVITIES These activities support and link to the network center at Moi Teaching and Referral Hospital, and link to other services such as TB/HIV (#6900), PMTCT (#6898), CT(#8758) and ARV Services (#6899) programs supported primarily by this partner. There are well-established links with other services supported by this and other partners for example, diagnostic testing for HIV among TB patients, orphan support programs and other community services.

5. POPULATIONS BEING TARGETED The main populations targeted by this activity are people affected by HIV/AIDS such as people living with HIV/ AIDS, HIV positive pregnant women and their families. Other populations targeted are health workers who will benefit from training in order to enhance service provision.

6. KEY LEGISLATIVE ISSUES The main legislative issues addressed in this activity are stigma and discrimination and gender. The program uses novel approaches to the support of treatment, and provides business skills training and promotes micro-enterprise for HIV infected patients, especially women. These approaches are designed to reduce stigma against persons living with AIDS and increase gender equity.

7. EMPHASIS AREAS The major emphasis area in this activity is training of health workers, with two minor emphasis areas being infrastructure improvement and community mobilization/ participation by use of PLWHA in care activities.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#8758), ARV Services (#6899, #7004), Palliative Care: Basic Health Care and Support (#6901) and PMTCT (#6898).

2. ACTIVITY DESCRIPTION The Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) is a broad initiative by Moi University School of Medicine, Moi Teaching and Referral Hospital, Indiana University School of Medicine and other US academic medical centers. Moi University Faculty of Health Sciences (MUFHS) is one of two schools of medicine, nursing and public health in Kenya, now providing medical and health education to 670 students. Indiana University School of Medicine (IUSM) has collaborated with MUFHS since MUFHS' inception in 1990. IUSM has supported a team of faculty members on-site in Eldoret for the last sixteen years. AMPATH is one of the most successful HIV treatment programs in Kenya. By July 2006, AMPATH had opened a total of 18 HIV/AIDS care clinics and screening programs, including Moi Teaching and Referral Hospital, six district hospitals (Kabarnet, Busia, Webuye, Teso, Kapenguria, and Kitale), and eleven rural health centers (Mosoriot, Turbo, Burnt Forest, Amukura, Chulaimbo, Naitiri, Khunyangu, Port Victoria, and Mount Elgon). Like other care systems in Kenya, AMPATH has found that active Mycobacterium tuberculosis (TB) affects more than 10% of newly enrolled HIV patients and HIV is found in up to 70% of new TB patients presenting to TB clinics.

The overall objective of the AMPATH HIV/TB care model is to demonstrate a decreased prevalence of TB in areas served by AMPATH and integrate care of co-infected patients into a comprehensive program that meets the objectives of the National Tuberculosis and Leprosy Program [NLTP] and NASCOP. To meet these objectives, AMPATH has initiated a HIV/TB model that supports all AMPATH clinics and surrounding communities through these interventions:

a) Case Finding: Expand the very successful case finding model just completed in Uasin Gishu District to all AMPATH communities. The model deploys community-based cough monitors who are dually trained at sputum collection and diagnostic counseling and testing (DTC) for HIV. In combination with improved training of MOH laboratory personnel and patient follow up, this model has demonstrated very cost-effective case finding and over 90% adherence through completion of TB treatment. In addition, DTC is provided to all TB infected patients. All co-infected patients are referred to the AMPATH HIV/TB clinic for care.

b) Care of the co-infected: AMPATH physicians and clinical officers will provide comprehensive HIV/TB management in all AMPATH clinics. All providers will undergo additional training on NLTP guidelines and all national registration and reporting procedures will be observed. NLTP staff will be integrated into the clinic in an effort to improve reporting and patient convenience. Providers with additional expertise in managing the co-infected patient will be available to all clinics for consultation. The AMPATH Medical Record System will provide electronically generated patient care reminders and alerts in an effort to assure uniform performance and adherence to national guidelines for both HIV and TB care.

c) Contact tracing and outreach: In an effort to further reduce the prevalence of active TB surrounding AMPATH service areas, an active program of contact tracing will be initiated. Home visits will be offered to all co-infected patients and the visit will be done by a dually trained DTC/cough monitor to perform home rapid testing for HIV and sputa collection for AFB smear. In addition, a cough monitor in the field will visit the index patient every two weeks to check on adherence and provide health information. Where necessary, the cough monitor will provide transport support for all HIV infected patients and their children to the AMPATH clinic.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will lead to the identification and care of 6,000 TB/HIV co-infected patients in the AMPATH service areas by September 2008, thus contributing to 9% of the national target in this program area. These activities will contribute to the results of expansion of ARV treatment for clinically qualified TB/HIV co-infected patients, as well as regular screening of HIV positive patients for TB infection.

4. LINKS TO OTHER ACTIVITIES These activities support and link to the network center at Moi Teaching and Referral Hospital, and link to other services such as Counseling and Testing (#8758), ARV Services (#6899, #7004), Palliative Care: Basic Health Care and Support (#6901) and PMTCT (#6898) supported primarily by this partner. There are well-established links with other services supported by this and other partners for example, diagnostic testing for HIV among TB patients, and provision of HIV care and treatment services to HIV positive TB patients.

5. POPULATIONS BEING TARGETED The main populations being targeted by this activity are TB/ HIV co-infected patients and health workers.

6. EMPHASIS AREAS The main emphasis areas are community mobilization/ participation by use of community-based cough monitors who are dually trained at sputum collection and diagnostic counseling and testing (DTC) for HIV. A minor emphasis area is training for health workers.

"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 is related to activities in PMTCT (#6898), Palliative Care: Basic Health Care (#6901), TB/HIV (#6900) and ARV (#6899).

2. ACTIVITY DESCRIPTION The Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) is a broad initiative by Moi University Faculty of Health Sciences and Moi Teaching and Referral Hospital in collaboration with Indiana University School of Medicine (IUSM) and other academic centers. AMPATH is a comprehensive program of HIV treatment, prevention, community mobilization, Counseling and Testing (CT), Prevention of Mother-To-Child HIV transmission infection (PMTCT), PMTCT-Plus, nutritional support, on the job training, and outreach activities. The Emergency Plan (EP) and private foundations fund this project. In 2006, AMPATH initiated aggressive community mobilization activities around their geographical area of operation. These community mobilization activities have traditionally targeted audiences with BCC messages, and CT has been incorporated as an important prevention and care entry point. In addition, DTC programs are just beginning to ramp up in each of the18 AMPATH sites, and through both VCT and DTC, it is expected that a total of 100,000 persons will learn their HIV status in 2007. For those clients that will be diagnosed with HIV, appropriate referrals are planned for the management of opportunistic infections and HIV/AIDS treatment using the existing AMPATH network of HIV care and treatment sites. This activity will train 50 people in CT in 2007.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA Through AMPATH's efforts, a total of 100,000 HIV infected persons will receive counseling and testing, thus contributing to over 30% of persons reached in this program area. These activities will contribute to increased access to CT services, particularly among underserved and high risk populations and result in increased availability of diagnostic counseling and testing services in medical settings to identify the large numbers of HIV infected patients who are potential candidates for ART.

4. LINKS TO OTHER ACTIVITIES The CT activities of the AMPATH in the Rift Valley region relate to AMPATH's Palliative Care activities (#6901), ARV services (#6899), PMTCT (#6898) and TB/HIV (#6900) services.

5. POPULATIONS BEING TARGETED This activity targets the general population, adults of reproductive health age, pregnant women, family planning clients, University students, infants, and HIV positive pregnant women. Behavior Change and Communication (BCC) activities will involve community leaders and community based organizations to increase demand for services amongst community members. Strategies to improve quality of services will target health care providers in public health and private facilities including lay counselors, nurses, mid wives and other health care workers such as clinical officers and public health officers. This activity will also target most at risk populations like commercial sex worker, discordant couples and street youth.

6. KEY LEGISLATIVE ISSUES ADDRESSED It is envisaged that increased availability of Counseling and Testing services will help reduce stigma and discrimination at community and facility level.

7. EMPHASIS AREAS The major emphasis for this activity is in quality assurance and supportive supervision. This activity supports the development and implementation quality assurance and supportive supervision for CT counselors. Other minor emphasis areas in this activity will be in the support of training of additional counselors especially targeting testing in clinical setting. The activity will also work with the MOH in the program area to strengthen their capacity to implement programs.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#8758), Palliative Care: Basic Health Care and Support (#6901), TB/HIV (#6900), and PMTCT (#6898).

2. ACTIVITY DESCRIPTION The Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) is a broad initiative by Moi University School of Medicine, Moi Teaching and Referral Hospital, Indiana University School of Medicine and other US academic medical centers. Moi University Faculty of Health Sciences (MUFHS) is one of two schools of medicine, nursing and public health in Kenya. Indiana University School of Medicine (IUSM) has collaborated with MUFHS since MUFHS' inception in 1990. AMPATH is one of the most successful HIV treatment programs in Kenya. By July 2006, AMPATH had opened a total of 18 HIV/AIDS care clinics and screening programs. In the 2007 COP period, supported activities will include strengthening of the regional referral center to serve as a referral center for HIV/AIDS care, including strengthening of laboratory capacity and management of complicated medical cases such as those failing first line ART. AMPATH encompasses a balance of HIV prevention and treatment within a framework of education, research, and clinical service to ensure its relevance and sustainability in Kenya. This activity will cover 18 sites and train 600 health care workers.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA AMPATH will provide antiretroviral treatment to more than 25,000 patients, thus contributing to 15% of the USG targets for this 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 These activities support and link to the network center at Moi Teaching and Referral Hospital, and link to Indiana University/ AMPATH's program in Counseling and Testing (#8758), Palliative Care: Basic Health Care and Support (#6901), TB/HIV (#6900), and PMTCT (#6898). There are well-established links with other services supported by this and other partners for example, diagnostic testing for HIV among TB patients, long-term ART follow-up for HIV infected mothers and their infants.

5. POPULATIONS BEING TARGETED The main populations targeted by this activity are people living with HIV/ AIDS, HIV positive pregnant women and their families. Other populations targeted are health workers who will benefit from training in order to enhance service provision.

6. KEY LEGISLATIVE ISSUES ADDRESSED The main legislative issues addressed in this activity are stigma and discrimination and gender.These issues are addressed through a program called the "Family Preservation Initiative" that provides business skills training and promotes microenterprises for HIV infected patients, especially women.

7. EMPHASIS AREAS The major emphasis area in this activity is training of health workers, with two minor emphasis areas in infrastructure improvement and community mobilization/ participation.