1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#6912) and HIV/AIDS Treatment: ARV Services (#6914).

2. ACTVITY DESCRIPTION IRC will continue to support implementation of PMTCT of HIV to the refugee population and surrounding local population in Kakuma, Lokichoggio and Kalokol areas of the Turkana district in Rift Valley Province. Though the HIV prevalence in this region is relatively lower than the rest of the country, estimated at 0-1% among women attending antenatal clinic services, the area is greatly underserved. Turkana district is an arid, vast and remote land with poor infrastructure, limited social services and high poverty rates. The total population of the target area is 271,000 people (of which 91,000 or 34% are refugees). IRC is one of the very few agencies working towards enabling this community to access HIV care and support services. In FY 2007, the program will continue supporting implementation of PMTCT services in the current four facilities, and will provide HIV counseling and testing to 3,200 pregnant women and provide a complete course of antiretroviral prophylaxis to 32 HIV positive women. IRC will continue to strengthen follow up and care of the HIV infected-exposed mother infant- pairs through the Comprehensive PMTCT framework, and will continue to support improved service delivery data management in line with the standardized Ministry of Health (MOH) reporting tools. IRC supports the implementation of PMTCT activities as part of the Comprehensive HIV/AIDS prevention and care program in Kakuma Refugee Camp under the umbrella of the UNHCR, and works with the local African Inland Church in the expansion of services to the local community. Using this platform, the program will continue to support the follow up of HIV-positive women and their infants in the postnatal period through strengthening postnatal care services at facility level. The current package of care for the mother includes regular follow up, linkage to family planning services, OI prophylaxis and counseling on correct infant feeding practices; infant additional care activities include OI prophylaxis using Co-trimoxazole starting at six weeks of age, and DBS for HIV- PCR (Early Infant HIV Diagnosis-EID). The program will target 32 HIV exposed infants for DBS, and will work with the HIV/AIDS treatment program to ensure linkage to pediatric HIV care services for all eligible infants. The program will support the training of 50 service providers on PMTCT including lay counselors and Community Health workers.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute to PEPFAR goals for primary prevention and care by contributing 0.3% of overall 2007 Emergency Plan targets for Kenya in meeting the health needs of women in this special group (refugee setting). The expansion in geographic scope also contributes to the programs efforts for increase access to quality PMTCT services for the refugee population as well as the local host population in this underserved area.

4. LINKS TO OTHER ACTIVITIES This activity links to IRC activities in HIV ART and care services (#6914), Counseling and Testing services (#6912) and Palliative Care: TB/HIV care services. The program will establish clear linkages to ensure that all HIV-positive pregnant women and HIV infected infants access HIV care and treatment services, as well as access TB screening services and treatment where eligible. The program will also encourage male partner testing and will work with CT services to achieve this objective.

5. POPULATIONS BEING TARGETED This activity targets adults, pregnant women, infants, HIV-positive women, and refugees/internally displaced persons. The program also targets public and private health care workers namely doctors, nurses and other health care workers for training and capacity building.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will increase gender equity in HIV/AIDS programs through providing PMTCT of HIV services to pregnant women and their partners. It will also address the health needs of the Refugees in Kakuma Refugee Camp, under the "Other" category.

7. EMPHASIS AREAS This activity includes major emphasis on Quality Assurance and Supportive Supervision,

with minor emphasis on Training and Strategic Information (M&E, IT, Reporting).

8. COVERAGE AREA The geographical focus for this activity is the Kakuma Refugee Camp and selected Faith based facilities in the surrounding region of Turkana District in Rift Valley Province.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#6912), Condoms and Other Prevention (#6910), Prevention of Mother-to-Child Transmission (#6911), Palliative Care: Basic Health Care and Support (#6909) and HIV/AIDS Treatment: ARV Services (#6914)

2. ACTIVITY DESCRIPTION The International Rescue Committee (IRC) will provide abstinence and Be Faithful education to 50,000 refugees and members of the host community and train 100 people to deliver AB education. As the sole implementing partner for the health sector in Kakuma under the UNHCR umbrella since 1997, IRC will continue implementing a comprehensive prevention, care and treatment program in Kakuma Refugee camp, targeting a population of 271,000 people in the areas Kakuma, Lokichoggio and Kalakol, of which 91,000 are refugees. IRC will intensify community involvement by training refugee counterparts as volunteers to provide the services to the community. Intensive community mobilization activities will be carried out as part of health outreach services to educate the community on the benefits of AB in HIV prevention. In line with its new strategy, IRC will strengthen the capacity of local partners such as the African Inland Misison and the Kakuma Mission to undertake components of activities previously solely implemented by IRC. IRC has so far trained a community resource pool of religious and community leaders and refugee volunteers to deliver prevention interventions. These volunteers will receive update training to acquire participatory skills that would enhance greater community participation. The community outreaches will be carefully segmented so that age-appropriate interventions are delivered. In line with this, age appropriate information, education and communication (IEC) materials will be developed and utilized within the population. Young refugees separated from their families will be a special target as there are many unaccompanied youth and young adults in the camp, commonly referred to as the Lost Boys of Sudan. These unaccompanied youth will be involved in activities that provide a peer support mechanism such as youth clubs. Comprehensive youth centers established through other partner support will be utilized for targeted youth interventions. Parents and supportive adults will be involved in selected program activities to enable them support youth in adopting safer sexual behavior. Activities for in-school youth will be developed and the teachers involved in delivering AB messages as well. Youth will be trained in participatory approaches such as magnet theatre. This activity will also target humanitarian aid workers in Kakuma and Lokichoggio through a workplace intervention. These workers are usually separated from their families for long periods of time, rendering them vulnerable to concurrent and other forms of multiple partnerships. IRC has been operational in Kenya since 1992, focusing initially on health outreach activities in Kakuma Refugee Camp. Currently there are approximately 16,000 individuals infected by HIV in Turkana

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities are consistent with the Kenya Five-Year Strategy which focuses on HIV prevention in youth and will work with to provide a supportive adult environment that will reach the youth and young married persons from amongst the 50,000 beneficiaries with AB messages and train 100 to deliver this education.

4. LINKS TO OTHER ACTIVITIES IRC is implementing a comprehensive program in the Kakuma refugee camp, with links to IRC's OP activity (#6910); IRC CT activity (#6912); IRC PMCT activity (#6911); and IRC Care and treatment activities (#6909) and (#6914). Youth and young married people are served through these other program activities as appropriate through a strengthened referral system inside Kakuma camp. In the two host community sites at Lokichoggio and Kalokol, this activity links to CT and OP where integrated outreaches are conducted.

5. POPULATIONS BEING TARGETED This activity will provide a major focus on younger children and youth ages 10 to 18 both through primary and secondary schools as well as men and women of reproductive age. It will target mobile populations including the refugee and the nomadic host communities. Many of the young people living in the refugee camp have had their educations disrupted and can be considered out-of-school youth. Community leaders, program managers, religious leaders and refugee counterpart volunteers will be targeted. In-school programs will closely work with teachers.

6. KEY LEGISLATIVE ISSUES ADDRESSED The primary legislative issue addressed in this project is increasing gender equity in HIV/AIDS programs as well as addressing male norms and behaviors. It will focus on reducing violence and coercion particularly sexual violence affecting young girls and women in a refugee camp setting.

7. EMPHASIS AREAS This activity has a major emphasis on human resources and a minor emphasis on community mobilization, information, education and communication, local organizational capacity development and training as detailed in the activity description above. It will also work towards developing networks and linkages between local organizations and various service segments. IRC will work with local community leaders to strengthen local organizational capacity. The factors that increase project costs include the insecurity, isolation, distance between locations, severe lack of infrastructure in the district, difficulty in recruiting and retaining qualified staff, and higher staff salaries to compensate for the hardship location. Project costs reflect the current lack of local capacity and need to build sustainable partnerships with local partners.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Abstinence and Be Faithful Programs (#6913), Counseling and Testing (#6912), Prevention of Mother-to-Child Transmission (#6911), Palliative Care: Basic Health Care and Support (#6909) and HIV/AIDS Treatment: ARV Services (#6914).

2. ACTIVITY DESCRIPTION Founded in 1933, the International Rescue Committee (IRC) is a leading non-sectarian, voluntary organization providing relief, protection and re-settlement services for refugees and victims of oppression or violent conflict. IRC is committed to freedom, human dignity and self-reliance. This commitment is reflected in well-planned resettlement assistance, global emergency relief, rehabilitation and advocacy for refugees in 33 countries around the world 21 offices in America that assist resettling refugees. IRC has been operational in Kenya since 1992, focusing initially on health outreach activities in Kakuma Refugee Camp (KRC); from 1997, IRC became the sole implementing partner for the entire health sector in KRC, under the operational umbrella of UNHCR. With additional support from CDC, IRC started the implementation of an HIV/AIDS prevention and care program in Turkana District in KRC in September 2001 and in Lokichoggio (Loki) in February 2004 and Kalakol July 2005. Turkana district is an arid, vast and remote land where government infrastructure and social services are weak, poverty is high, and local pastoralists exist only with great difficulty. The total population of the target areas (Kakuma, Lokichoggio and Kalakol) for this program is 271,000 people (of which 91,000 are refugees). Currently there are approximately 16,000 individuals infected by HIV in Turkana, of which less than 1% are receiving any form of care and support. IRC is one of the few agencies working to meet these needs.

The International Rescue Committee (IRC) will continue a comprehensive HIV prevention and care program for refugees and the host population in the Kakuma refugee camp, and in Lokichoggio and Kalokol in northeastern Kenya. IRC will enhance community involvement and mobilization, capacity building of partners and IRC staff, involvement of PLWHAs to foster a partnership between different players to ensure a sustainable prevention program. Messages promoting condoms and safer sexual behavior will reach 60,000 refugees, nomads, and humanitarian workers. 100 persons will be trained in the delivery of effective HIV prevention services. 50 condom outlets will be established. Young refugees separated from their families will be a special target as there are many unaccompanied youth and young adults in the camp, commonly referred to as the Lost Boys of Sudan. An important focus on the OP activity will be Positive prevention. Targeted interventions such as STI screening and treatment for individuals with HIV and their partners as well as behavioral interventions for individuals with HIV will be provided so that the project puts considerable prevention efforts to persons with HIV. This activity will link closely with counseling and testing that will actively promote knowledge of sero-status as the first step to positive prevention.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA 60,000 at risk persons will be reached. 100 people will be trained and 50 condom outlets established.

4. LINKS TO OTHER ACTIVITIES IRC is implementing a comprehensive program in the Kakuma refugee camp, with links to International Rescue Committee AB activity (#6913); International Rescue Committee CT activity (#6912); International Rescue Committee PMCT activity (#6911); International Rescue Committee ARV Services activity (#6914); and International Rescue Committee HBHC activity (#6909).

5. POPULATIONS BEING TARGETED The activities implemented by IRC in this program area will work to prevent HIV infection among adult men and women, most at risk populations including refugees, humanitarian aid workers and transport workers transiting to southern Sudan (a form of migrant workers), underserved and nomadic populations of Turkana district, and commercial sex workers and their clients. Many of the young people living in the refugee camp have had their educations disrupted and can be considered out-of-school youth. IRC will work with local community organizations and community, program, religious leaders and refugee counterpart volunteers. It will also target the Turkana host community, a largely rural

community. People living with HIV/AIDS will also be targeted as well as varied cadre of public health care workers both within and outside the refugee camps.

6. KEY LEGISLATIVE ISSUES ADDRESSED The primary legislative issue addressed in this project is addressing gender equity in HIV/AIDS programs, addressing male norms and behaviors and reducing violence and coercion, particularly sexual violence affecting young refugee girls and women.

7. EMPHASIS AREAS This activity includes major emphasis on human resources and minor emphasis on community mobilization/ participation, development of network systems, information education and communication and training as detailed in the activity description above. The factors that increase project costs include the insecurity, isolation, distance between locations, severe lack of infrastructure in the district, difficulty in recruiting and retaining qualified staff, and higher staff salaries to compensate for the hardship location. Project costs reflect the current lack of local capacity and need to provide trainings and other capacity building support to partners in the district.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in ARV Services (#6914), Counseling and Testing (#6912), and PMTCT (#6911).

2.ACTIVITY DESCRIPTION International Rescue Committee (IRC) will maintain and scale-up provision of palliative care services to 300 HIV-infected individuals, including 50 children at 4 sites in Kakuma, Lokichogio and Lodwar in Turkana District, Rift Valley Province, targeting both refugees and the local population.

Turkana District, the largest district of Kenya, is home to a pastoralist community which is livestock dependent, highly mobile, and has extremely limited access to health services, especially HIV/AIDS services. The district lies on the main truck route between Mombasa and the relief operations in northwestern Kenya and southern Sudan via Lodwar, Kakuma, and Lokichogio. Lokichogio is the main transit center for refugees from Sudan and a base for provision of refugee services. The area is remote, with a population characterized by high rates of absolute poverty (74%) and food poverty (81%). General health services are limited and poorly distributed throughout the district. IRC will support a package of services that includes clinical evaluation and laboratory monitoring, provision of cotrimoxazole prophylaxis, treatment of opportunistic infections, nutritional support and improved access to safe drinking water and malaria prevention interventions; 50 health care workers will also be trained to provide palliative care services. IRC will build on established programs that are currently providing care for people with HIV at health centers within the refugee camps to provide treatment for refugees and will build on existing collaborative relationships with health facilities supported by Africa Inland Church to provide treatment for the local population. IRC will expand care programs by providing technical support, supporting staff salaries, training staff, conducting laboratory evaluation, and providing adherence counseling and monitoring.

IRC has been implementing an HIV/AIDS prevention program and outreach to hard-to-reach populations and rural communities in this area since September 2001. They are uniquely suited to provide care in refugee situations and remote areas and will build on very substantial existing medical capacity in the camps. They have a strong relationship with the local mission hospital, relying on the hospital for operating theatres, OB/GYN care, and other services, and are already collaborating with the mission hospital to build capacity related to provision of basic health services for people with HIV. Targets are modest because of the extreme remoteness of these areas, and the challenges associated with conducting activities in the refugee camps. A significant change from FY 2006 to FY 2007 for this activity include expansion of sites and number of people reached, increase emphasis on provision of care for the local community at the Kakuma Mission Hospital and Lodwar District Hospital and increased emphasis on provision of care for children.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute to expansion of access to IRC-supported palliative care services for people with HIV, strengthened human resource capacity to deliver ARV treatment, and a strengthened referral network for provision of ART.

4. LINKS TO OTHER ACTIVITIES These activities will link to ARV treatment services (#6914), Counseling and Testing services (#6912), and PMTCT (#6911) provided by IRC, and to coordination of ARV scale up supported through National AIDS and STD Control Program (#7004).

5. POPULATIONS BEING TARGETED This activity targets the refugees local populations, especially people living with HIV/AIDS. HIV rates are high among the local Turkana. Although the prevalence of HIV is lower in the refugee populations, HIV infection is now the leading cause of adult death in this group. IRC is mindful of concerns related to continuation of care in the event of repatriation and has the appropriate collaborations in place to facilitate access continued care for repatriated refugees.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses legislative issues related to provision of care and treatment for

refugee populations and stigma and discrimination.

7. EMPHASIS AREAS This activity includes minor emphasis in commodity procurement, human resources, local organization capacity building, community mobilization, quality assurance and supportive supervision, logistics, and training.

" International Rescue Committee (IRC) will support TB/HIV services for approximately 300 patients at 4 sites in Kakuma, Lokichogio and Lodwar in Rift Valley Province, targeting both refugee and local population. 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 30 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. Fund 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. IRC will maintain data concerning the numbers of people served and will report both nationally and through the

" Emergency Plan. IRC has been implementing an HIV/AIDS prevention program and outreach to hard-to-reach populations and rural communities in this area since September 2001. They are uniquely suited to provide care in refugee situations and remote areas and will build on very substantial existing medical capacity in the camps. They have a strong relationship with the local mission hospital, relying on the hospital for operating theatres, OB/GYN care, and other services, and are already collaborating with the mission hospital to build capacity related to provision of basic health services for people with HIV. Targets are modest because of the extreme remoteness of these areas, and the challenges associated with conducting activities in the refugee camps. A significant change from FY 2006 to FY 2007 for this activity include expansion of sites and number of people reached, increase emphasis on provision of care for the local community at the Kakuma Mission Hospital and Lodwar District Hospital and increased emphasis on provision of care for children 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 (#6909), ARV Services (#6914) 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.

Targets

Target Target Value Not Applicable Number of service outlets providing treatment for tuberculosis (TB) 4
to HIV-infected individuals (diagnosed or presumed) in a palliative care setting Number of HIV-infected clients given TB preventive therapy  Number of HIV-infected clients attending HIV care/treatment 30
services that are receiving treatment for TB disease Number of individuals trained to provide treatment for TB to 10
HIV-infected individuals (diagnosed or presumed)

Table 3.3.07:

1. LIST OF RELATED ACTIVITIES This activity relates to activities in AB (#6913), HBHC (#6909), ART (#6914), OP (#6910), and PMCT (#6911).

2. ACTIVITY DESCRIPTION With support from CDC, International Rescue Committee (IRC) has implemented HIV counseling and testing (CT) and other HIV/AIDS intervention programs for refugees at Kakuma Camp and neighboring communities in Turkana District in Northwestern Kenya since 2001. The CT component of the IRC program in Turkana is implemented at four outlets whose capacities will be expanded to provide CT more people during FY 07. During this period, 20 additional counselors will be trained and deployed at these sites and there will be a shift of focus towards providing CT within medical settings as part of clinical care. Through these efforts, IRC will provide CT to 8,000 people during FY 2007. HIV positive individuals identified in this CT program will be referred to care and treatment outlets operated in the same geographical area by IRC through support from the President's Emergency fund. CT services target the local community, comprised primarily of the nomadic Turkana tribe, humanitarian aid workers, refugees, fishermen from Lake Turkana, commercial sex workers, and the youth. With the signing of the peace agreement in Sudan and the expectation of eventual returning home of the Sudanese refugees, significant emphasis is given to building the capacity of Sudanese nationals, to enable them to initiate similar programs when they return home. Founded in 1933, the IRC is a leading non-sectarian, voluntary organization providing relief, protection and re-settlement services for refugees and victims of oppression or violent conflict. IRC is committed to promoting freedom, human dignity and self-reliance. This commitment is reflected in well-planned resettlement assistance, global emergency relief, rehabilitation and advocacy for refugees in 33 countries around the world. IRC has been operational in Kenya since 1992, focusing initially on health outreach activities in Kakuma Refugee Camp. Since 1997, IRC has been the sole implementing partner for the health activities in Kakuma, under the operational umbrella of UNHCR. With additional support from CDC, IRC started an HIV/AIDS prevention and care program in Kakuma in September 2001, in Lokichoggio in February 2004, and in Kalokol in July 2005. Remote and arid, Turkana district covers a vast area where government infrastructure and social services are weak and poverty is high. The Local people are mainly nomadic pastoralists, but the weather is harsh and rainfall unpredictable. This poverty situation is worsened by insecurity and cattle rustling. The total population in the target area is 271,000 people, of whom 91,000 are refugees. Currently there are an estimated 16,000 HIV infected individuals in Turkana, with less than one percent receiving any form of care. IRC is one of the few agencies working to meet these needs.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA CT activities implemented by IRC in this geographical area will result in CT for 12,000 people who will be served in varied settings, including health facilities and stand-alone CT outlets. IRC activities will also result in the training of 20 additional CT service providers. IRC's activities will contribute 2% of the overall USG CT target for Kenya in FY 2007. However this activity will also contribute to Kenya's Five-Year Strategy which encourages Kenyans to learn their status and supports development of strong links between CT care service provision for those who are HIV positive and in need of health care.

4. LINKS TO OTHER ACTIVITIES IRC CT activities in Kakuma are part of a comprehensive program and will be linked to other services the IRC will offer in AB (#6913), OP (#6910), PMTCT (#6911), HBHC (#6909) and ART (#6914) activities in Kalokol and Lokichoggio. These services will be provided through IRC's partner, the African Inland Church. AIC is well-positioned to identify and implement strategies for linkage in these two locations.

5. POPULATIONS BEING TARGETED This activity targets the highly underserved populations in the Turkana District of Northern Kenya. Specific groups targeted for CT activities include the nomadic/pastoralist local community, fishermen, truck drivers, refugees, relief workers and commercial sex workers. These nomadic populations and the commercial sex workers are particularly at risk for HIV infection. Relief workers who often live apart from their families while serving among refugees are also at increased risk of infection. In providing HIV services to refugees, efforts will focus on identifying opinion leaders in the refugee community who will

encourage the refugee community to utilize available services.

6. KEY LEGISLATIVE ISSUES ADDRESSED The primary legislative issue addressed in this project is under the "other" category for refugees and other nomadic, underserved groups. Legislative issues regarding gender equity and reducing discrimination will also be addressed through advocacy and health outreach.

7. EMPHASIS AREAS This activity includes major emphasis on human resources and minor emphasis on infrastructure, quality assurance, community mobilization and training as detailed in the activity description above. The factors that increase project costs include insecurity, isolation, distance between inhabited areas, poor infrastructure, difficulty in recruiting and retaining qualified staff, and the higher staff salaries needed to compensate for the hardship in this location. Project costs reflect the current lack of local capacity and need to provide trainings and other capacity building support to partners in the district.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative Care: Basic Health Care and Support (#6909), Counseling and Testing (#6912), and PMTCT #6911).

2. ACTIVITY DESCRIPTION International Rescue Committee (IRC) will maintain and scale-up existing HIV prevention, care, and antiretroviral treatment services serving both refugee and local populations in Turkana District, Rift Valley Province, Kenya. ARV services will be offered at 4 sites in Kakuma, Lokichogio, and Lodwar to 200 individuals with advanced HIV infection, including 100 new patients (bringing the total ever provided with services to 300); additionally, 50 health care workers will be trained. Turkana District, located in Rift Valley Province, is the largest district of Kenya, and is home to a pastoralist community which is livestock dependent, highly mobile, and has extremely limited access to health services, especially HIV/AIDS services. The district lies on the main truck route between Mombasa and the relief operations in northwestern Kenya and southern Sudan via Lodwar, Kakuma, and Lokichogio. Lokichogio is the main transit center for Sudanese refugees and a base for provision of refugee services. The area is remote, with a population characterized by high rates of absolute poverty (74%) and food poverty (81%). General health services are limited and poorly distributed throughout the district. IRC will build on established care programs for HIV-infected refugees and others at refugee health center camps, and will build on existing collaborative relationships with health facilities supported by Africa Inland Church to provide local treatment. Activities will be conducted in close collaboration with the Provincial ART Officer responsible for the northern part of Rift Valley Province. IRC will establish ART programs by providing technical support, supporting staff salaries, staff training, laboratory evaluation, and adherence counseling and monitoring. ARVs will be supplied to the sites through the USG central distribution system currently done through the Mission for Essential Drugs.

IRC has been implementing an HIV/AIDS prevention program and outreach to hard-to-reach populations and rural communities in this area since September 2001. They are uniquely suited to provision of care in refugee situations/remote areas and will build on very substantial existing medical capacity in the camps. They have a strong relationship with the local mission hospital, relying on the hospital for operating theatres, OB/GYN services, and other services, and have previously worked with the mission hospital to build capacity related to provision of basic health services for people with HIV. Targets are modest because of the extreme remoteness of these areas, and the challenges associated with conducting activities in the refugee camps. A significant change from 2006 to 2007 for this activity includes: expansion of sites and number of people reached, increase emphasis on ART provision for the local community at the Kakuma Mission and Lodwar District Hospitals, and an increased emphasis on pediatric ART pediatric provision.

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

4. LINKS TO OTHER ACTIVITIES This activity relates to HIV prevention and non-ART treatment services supported by IRC: Palliative Care: Basic Health Care and Support (#6909), Counseling and Testing (#6912), and PMTCT (#6911) and coordination of ARV scale up supported through NASCOP.

5. POPULATIONS BEING TARGETED The target populations for this activity are the refugees and the local populations in the areas noted above. HIV rates are high among the local Turkana. Although the prevalence of HIV is lower in the refugee populations, HIV infection is now the leading cause of adult death in this group.

6.KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses legislative issues related to provision of care and treatment for refugee populations and stigma and discrimination.

7. EMPHASIS AREAS

This activity includes minor emphasis in commodity procurement, human resources, local organization capacity building, community mobilization, quality assurance, and supportive supervision, logistics, and training.