1. LIST OF RELATED ACTIVITIES This activity relates to injection safety activities implemented by the National AIDS and STI Control Program (NASCOP) (#7010) and field-funded John Snow, Inc. (#8985).

2. ACTIVITY DESCRIPTION This activity relates to the prevention of HIV transmission among health care workers, medical waste handlers and the community. The activity will focus on increasing and improving injection safety interventions through activities that build on internationally accepted strategies. The World Health Organization (WHO) estimates of global burden of disease suggest that unsafe injections around the world account for 5% of HIV infections, 32% of hepatitis B virus infections and 40% of hepatitis C virus infections. A 2004 survey by JSI Making Medical Injections Safe (JSI-MMIS) in Kenya revealed that over 70% of respondents received an average of 1.5 injections per year. Needle stick injuries within the previous six months were reported by 58% of health care workers. These findings support those of an earlier study by the University of Nairobi among 214 nurses in Nairobi, which reported 61% needle stick injuries in health care workers over a three-month period. Needle recapping accounted for 46% of the injuries while 12% occurred in the process of sharps disposal. A majority of health facilities surveyed reported having experienced a shortage of disposable injection supplies in the 12 months prior to the survey, particularly in the curative sector. This reflects a less than optimal logistics system for forecasting, procurement, distribution and stock monitoring that may contribute to re-use of injections. Analysis of the status of injection logistics in the country revealed that there was no data to support rational forecasting of injection requirements. Procurement was based on previous consumptions. Appropriate product selection was poor due to lack of national standards for injection devices, registered suppliers of injection equipment and an appropriate board to handle non-pharmaceutical equipment. The JSI-MMIS activity commenced in Kenya in 2004 under PEPFAR.

The activity aims to: 1) improve training of health workers and managers on safe injection practices, infection control and disposal procedures; 2) institute an advocacy strategy to decrease demand for injections by the population; 3) establish reliable estimates of re-use prevention injection device equipment requirements, minimum stock levels and effective supply and distribution systems for re-use prevention injection device equipment; 4) institute monitoring and supervision procedures to ensure adequate supplies at all levels and correct practices by health workers; 5) ensure safe disposal of used injection equipment through the progressive introduction of appropriate incinerators; and 6) secure the required budget for injection safety and infection control including safe disposal of used equipment. Significant changes in FY 2007 include scale up of activities to Coast and Rift valley provinces as well as total coverage of Kenyatta National Hospital in addition of continuation of services in Nakuru, Embu, Kisumu, Kakamega and Nyeri provincial hospitals and Kiambu and Bondo districts. In FY 2006 JSI-MMIS received supplemental country funds to facilitate faster expansion towards national coverage. It is expected that national coverage will be achieved by 2008. The Ministry of Health has committed to increase procurements of auto-disable injection devices and health care waste disposal containers.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will reduce at least 5% of HIV transmission in the intervention regions of Kenya. In 2004 safe injection practices were introduced to two of 74 districts in Kenya. 243 health care workers, 30 logistics officers and 103 health waste handlers were trained. All health care facilities in the two districts were issued with re-use prevention injection commodities and sharps waste disposal boxes. In 2005, while intervention continued in these two districts, two provincial hospitals were embraced. The level of funding precluded extension of activities beyond the hospitals. These have, however, been used as model sites for outlying health care facilities. 234 health care workers, 48 logistics officers and 92 medical waste handlers have been trained on safe injection practices. In 2006, additional 400 individuals (health care workers, logistical officers and medical waste handlers) will be trained on injection safety. 400 health care workers will be trained in 2007.

4. LINKS TO OTHER 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) and USAID.

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

6. EMPHASIS AREAS This activity has major emphasis on training to impart improved skills, knowledge and attitudes regarding safe injection practices to healthcare workers, waste handlers and the community. A second area of emphasis will be commodity procurement of re-use prevention injection devises, sharps disposal containers and needle removers for intervention hospitals. This activity will also guide the development of policies to ensure adequate supplies of appropriate injection supplies at health care facilities.