1. LIST OF RELATED ACTIVITIES This activity relates to activities in Prevention of Mother-to-Child Transmission (#7006).

2. ACTIVITY DESCRIPTION In FY 2006 USAID's ACCESS Project implemented by JHPIEGO supported the DRH to strengthen its supervisory function, quality assurance program and referral systems to ensure the delivery of high quality PMTCT services at public sector and faith-based facilities. Because the linkages between PMTCT and CCCs are still weak, HIV-free survival of infants born to HIV infected mothers cannot be guaranteed. In FY 2007, JHPIEGO will continue to build upon FY 2006 initiatives by further supporting the central DRH to develop capacity of 16 provincial and 120 district level DRH and NASCOP officers to oversee the integration of reproductive health (RH) with HIV services and assure better referrals and linkages between PMTCT and ART services. At program start the DRH with NASCOP will provide guidance on how to strengthen PMTCT/ART integration to 16 provincial and 120 district level DRH and NASCOP officers using the standard-based management and recognition approach. Through regular support to the district and provincial PMTCT training and supervision teams, DRH with NASCOP will ensure a coordinated scale up of integrated HIV care and treatment, family planning, postnatal care including psychosocial support while assuring effective linkages between PMTCT, PMTCT plus services and HIV care and treatment services for HIV positive women, their infants and family members. The practice of exclusive breastfeeding in Kenya has greatly reduced from 17% in 1998 to 2.6%. JHPIEGO will therefore support the DRH to operationalize the Infant Feeding Policy through the development of appropriate BCC programs and messages in collaboration with USAID's APHIA II partners. This will also help to scale up the utilization of integrated PMTCT services at public and faith based facilities by women that were previously not accessing ANC services. Finally, a PMTCT consultative meeting for 100 stakeholders/partners will be organized by DRH and NASCOP to assess progress with PMTCT/ART integration and provide technical updates on linkages and referral systems, post-partum care, efficacious regimens, infant feeding, etc. This program is designed in consultation with the Ministry of Health's Division of Reproductive Health (DRH) which provides leadership and coordination to the National PMTCT program in partnership with the National AIDS and STI Control Program (NASCOP). The DRH co-chairs the National PMTCT Technical Working Group (TWG) with NASCOP.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA The MOH's division of reproductive health provides leadership, coordination and advocacy for national reproductive health programs and NASCOP. By supporting the provision of integrated PMTCT/ART services the DRH will significantly contribute to the PEPFAR goals for primary prevention, care and treatment. The decentralized training and supervision system will build capacity of provincial and district DRH and NASCOP officers in managing comprehensive PMTCT with HIV and RH services and universal access to ARV prophylaxis across provinces. This activity also contributes substantively to Kenya's Five-Year strategy of availing services, which can reduce mother-to-child infections, and providing critical links to HIV/AIDS treatment as a step towards preserving the family unit. It also contributes to the strategy to integrate testing with other health services and improving the referral links among all of these services.

4. LINKS TO OTHER ACTIVITIES This activity relates to activities in PMTCT though NASCOP (#7006) to improve the quality and supervision of integrated prevention care and treatment services. It also enhances referral linkages within HIV services.

5. POPULATIONS BEING TARGETED Strategies to improve quality of services will directly target policy makers, National AIDS control program staff, other Ministry of Health staff working as program managers in the DRH at provincial and district level. Service providers such as doctors, nurses, mid wives, other health care workers including clinical officers and public health officers working in both public and faith based facilities, as well as infants and pregnant women in rural and urban communities will also benefit from support supervision. The PMTCT TWG works with faith-based organizations, non-governmental organizations and implementing organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will increase gender equity in programming through PMTCT services targeted towards pregnant women and their spouses. Increased availability of PMTCT and PMTCT+ services and the BCC program for infant feeding will increase access and help reduce stigma at community and facility level. This activity has a wrap around component namely supporting linkages between HIV/AIDS and RH services

7. EMPHASIS AREAS The activity includes a major emphasis on quality assurance and supportive supervision. There is a minor emphasis on development of network/linkages/referral systems and information, education and communication.

1. LIST OF RELATED ACTIVITIES The ACCESS/JHPIEGO injection safety activities will relate to all the other injection safety activities under the PEPFAR initiative and coordinated by the Ministry of Health, National AIDS and STI Control Program (NASCOP) and CDC.

2. ACTIVITY DESCRIPTION The ACCESS project implemented by JHPIEGO will disseminate the injection safety and waste management guidelines in 12 districts of Nyanza and Rift Valley Provinces and provide orientation to 600 health workers. Subsequently these health workers will give service orientation to 3,000 health workers using a cascade on-the-job approach. This activity will promote awareness of injection safety among health care workers resulting in improved injection safety and waste disposal practices in Ministry of Health facilities, a vital part of HIV prevention. JHPIEGO will support the Ministry of Health and National AIDS and STI Control Program (NASCOP) to develop an orientation package that breaks down the knowledge component of the guidelines and allows continuing education credit for health workers successfully completing this orientation. This orientation for health workers helps to improve the quality of injection safety practice. An additional intent is to develop sustained capacity to continue these programs after the project ends by encouraging ‘‘bundling'' of injectable vaccines, injectable contraceptives and medicines in donor supported programs with single-use needles and syringes that include re-use prevention features and safety boxes. JHPIEGO will also work closely with other stakeholders in the area of injection safety including the Ministry of Health Infection Prevention and Control Committee, the Nosocomial TB/HIV Prevention Unit of NASCOP and John Snow, Inc./Making Medical Injections Safer (JSI-MMIS). At the planning stage, both central and appropriate peripheral levels of the Ministry of Health will be involved along with other stakeholders.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute to reduction in HIV transmission in Kenya. In FY 2007, dissemination of the guidelines will strengthen and improve safe injection and waste disposal practices through training of 600 trainers of trainers.

4. LINKED ACTIVITIES The injection safety initiative is linked to the Kenya Expanded Program for Immunization (KEPI), which already procures non re-use injection devices for its program. Other Kenyan stakeholders in the area of injection safety have been mobilized including the Ministry of Health Infection Prevention and Control Committee and the Nosocomial TB/HIV Prevention Unit of NASCOP. A National Injection Safety Steering Committee has been established at the Ministry of Health chaired by the Deputy Director of Medical services and Head of Preventive Health Services. Membership to this committee is drawn from all the programs at the MOH and incorporates the National Environmental Management Authority (NEMA). World Health Organization (WHO), National AIDS Control Council (NACC), CDC and USAID.

5. POPULATIONS BEING TARGETED This activity targets health care workers, the community, medical waste handlers, and policy-makers .

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address GOK and international standards and guidelines for universal precautions. This activity will contribute to the development of Quality Assurance Standards (the Kenya Quality Model - KQM) as outlined in the MOH Second National Health Sector Strategic Plan of Kenya, August 2005. This activity will also contribute to the Kenya National HIV/AIDS Strategic Plan 2005/6 - 2009/10.

7. EMPHASIS AREAS COVERED This activity has major emphasis on training to impart improved skills, knowledge and attitudes regarding safe injection practices to health care workers, waste handlers and the community.

The Ministry of Health (MOH) has recently approved the national policy on injection Safety and medical health care waste management. JHPIEGO will work with MOH and the National Aids and STD Control Program (NASCOP) to disseminate this policy to

stakeholders. This activity will complement training of health care workers in safe injection practices conducted by JSI-MMIS. Where possible, health delivery facilities will be encouraged to implement this policy with their own training and procurement resources. The MOH has already committed to procuring AD syringes and safety boxes. These however are insufficient to meet the national requirement. This activity will enable the Injection Safety program make a leap towards reduction of HIV transmission through medical injections and achieve national coverage by 2009.

1. LIST OF RELATED ACTIVITIES This activty is related to acivities in counseling and testing [#8760, #8776, #8777, #8778, #8781, #8782, #8976] and counseling and testing [#8009]. This activity is also related to activities in injection safety [#8821].

2. ACTIVITY DESCRIPTION In FY 2007 USAID'S ACCESS project implemented by JHPIEGO will continue to promote the availability and delivery of high quality counseling and testing services in public Ministry of Health (MOH) facilities, an essential element of clinical and preventive care. The guidelines will be disseminated in additional 30 districts nationally and orientation provided to 600 health workers. Subsequently these health workers will give service orientation to 3,000 health workers using a cascade on-the-job (OJT) approach. This activity will continue to monitor activities initiated in FY 2006 and FY 2005 in Western, Coast, Nyanza and Rift Valley Province This activity will also promote the availability of diagnostic counseling and testing (DCT) in Ministry of Health facilities, a vital entry point to prevention, treatment and care. Strengthening referrals and linkages to care, treatment, and prevention will continue to be a priority for FY 2007. This activity will enable health workers to reach individuals who are most likely to benefit from ARV treatment, through integration with STI, TB, and in patient services. Effective linkages to comprehensive care centers (CCC) for HIV treatment will be established. The activity also focuses on increasing linkages between STI, TB and in patient services with HIV treatment services. The increased availability of DCT will help to reduce stigma associated with HIV testing. Significant changes from initiated in 2006 include the advancement of training for health workers through on the job (OJT) cascade training. The activity also focuses on increasing linkages between STI, TB and in patient services with HIV treatment services. The increased availability of DCT will help to reduce stigma associated with HIV testing. In FY 2005 JHPIEGO supported the National AIDS and STI Control Program (NASCOP) to develop an orientation package for health workers to build skills in counseling and testing in medical settings as defined in the National Guidelines. This orientation for health workers helped to improve the quality of DCT in 8 districts in Central, Eastern and Nairobi Province. In FY 2006 this activity advanced the DCT skills of health workers in Western, Nyanza, Rift Valley, and Coast Province and improve the quality of prevention, palliative and HIV treatment services. JHPIEGO will participate in the MOH's Technical Working Group to ensure coordination of activities and compliance with MOH guidelines for service delivery. JHPIEGO will also collaborate with local non-governmental organizations for people living with HIV/AIDS and community healthcare workers to reduce stigma towards DCT. At the planning stage, both central and appropriate peripheral levels of the ministry of health will be involved along with other stakeholders.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute to the 2007 Emergency Plan result for increased availability of diagnostic counseling and testing through training of health workers. It will enable service providers to identify the large numbers of HIV infected patients who are potential candidates for ART. This activity will increase access to prevention and treatment services particularly among underserved and high risk populations. It also contributes to Kenya's 5-year strategy emphases of encouraging Kenyans to learn their status and developing strong links between counseling and testing and HIV services for those who are HIV positive and in need of health care.

4. LINKS TO OTHER ACTIVITIES JHPIEGO/ACCESS activities are focused on trainings and are therefore linked to counseling and testing activities conducted by the APHIA II partners in counseling and testing in the different provinces: Coast (#8781), Rift Valley (#8776), Western (#8777), NEP (#8778), Eastern (#8782), Nairobi/Central (#8976), Nyanza (#8760). It is also related to NASCOP/MOH (#7009) counseling and testing. This activity is also related to JHPIEGO/ACCESS activities in Injection safety (#8821).

5. POPULATIONS BEING TARGETED This activity targets MOH staff including program managers in the NASCOP, public health care doctors and nurses, other health care workers including community health workers.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will help to reduce stigma associated with HIV status by increasing the

availability of routine testing for diagnosis in medical settings.

7. EMPHASIS AREAS COVERED This activity includes major emphasis on training and minor emphasis in development of network/linkages/referral systems as detailed in the activity description in Section 1 above as well as minor emphasis on policy and guidelines.

Plus-up funding will enable partners to to initiate and enhance standardized approaches to Prevention with Positives at health facilities and through community organizations (specifically PLWHA support groups and networks) including HIV testing. This activity will encourage approaches that promote status disclosure to partners and testing of family members; training of HIV/AIDS health workers on STI and FP; printing and dissemination already developed IEC materials for patients/health workers. JHPIEGO will work with MOH/NASCOP to update, print and dissseminate the materials to health workers throughout the country. JHPIEGO will also be resposible for the in-service training of health workers, and thereby contribute to over 350 health workers being trained on STI and FP.

Targets

Target Target Value Not Applicable Number of service outlets providing antiretroviral therapy  Number of individuals who ever received antiretroviral therapy by  the end of the reporting period Number of individuals receiving antiretroviral therapy by the end of  the reporting period Number of individuals newly initiating antiretroviral therapy during  the reporting period Total number of health workers trained to deliver ART services, 350
according to national and/or international standards

Key Legislative Issues Stigma and discrimination

Table 3.3.11: