1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#6950), Palliative Care: TB/HIV (#6951), and HIV/AIDS Treatment: ARV Services (#6954).

2. ACTIVITY DESCRIPTION The Uniformed Services is comprised of Non-Military Services such as the Prison Services (KPS), National Youth Service (NYS), Kenya Police Department (KPD), Kenya Wildlife Services (KWS), and Administration Police (AP). With Emergency Plan funding, KEMRI U/S project has been supporting implementation of PMTCT activities in the non-military Uniformed Services as part of the HIV/AIDS program. This was done through training of service providers, minor infrastructure renovations, logistics supply, and management and technical assistance. These services have many similarities; the young men and women working there often serve away from their homes and are thus vulnerable to risky sexual behaviors. The various camps and stations have significant numbers of young families. Health services in these camps are also accessed by the surrounding civilian communities who benefit from the PMTCT services. In FY 2007, CDC will continue supporting KPS and NYS, and AP and Police will extend similar support to the rest of the non-military Uniformed Services, with the following objectives: (i) increase access to quality PMCTC services to both members of staff, families and neighboring communities, (ii) integrate quality PMCT service into routine maternal and child health services, (iii) increase awareness, benefits and availability of PMTCT services within the selected sites. CT services will be offered to 5,200 pregnant women and will target to provide a complete course of ARV prophylaxis to 417 HIV-positive pregnant women. All HIV-positive pregnant women eligible for HAART will be linked to the ART program. Postnatal care and follow up of all HIV-positive women and their infants will be strengthened. The care package for the mothers will include regular follow up, linkage to family planning services, OI prophylaxis and counseling on correct infant feeding practices; while infant additional care activities will include OI prophylaxis using Cotrimoxazole starting at six weeks of age, and DBS for HIV- PCR (Early Infant HIV Diagnosis-EID). The program will target 416 for DBS and will link all eligible infants to the ART program (for pediatric HIV care). The program will also encourage male partner HIV testing as well as male involvement and support.

In FY 2007, the USP intends to consolidate activities in the current 18 health facilities and will initiate activities in additional 8 facilities up to a total of 26 facilities. The program will also support the training of 30 service providers on PMTCT.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA The planned activities will improve equity in access to HIV prevention and care services to the uniformed services under "Special Population" category. These activities will contribute to the result of increased access by pregnant women and their families to HIV counseling and testing services, and those identified as HIV infected will be referred for care and treatment.

4. LINKS TO OTHER ACTIVITIES This activity relates to KEMRI U/S ARV services program (#6954), KEMRI U/S counseling and testing (#6950) and KEMRI U/S TB/HIV services (#6951). Linkages between PMTCT service and care outlets will be strengthened to improve utilization of care opportunities created through PEPFAR funding.

5. POPULATIONS BEING TARGETED This activity targets adults of reproductive health age, pregnant women, infants, HIV-positive pregnant women, HIV-positive infants, public health care workers, such as doctors, nurses and other MOH staff. Strategies to improve quality of services will target health care workers, doctors, nurses, midwives, and clinical officers. This activity also targets military personnel.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will increase gender equity in programming through PMTCT services targeted to pregnant women and their male sexual partners. Identifying the women through PMTCT will give them an opportunity to access care, improve pregnancy outcomes, and access services for their partners and family members.

7. EMPHASIS AREAS

The major emphasis area of this activity is infrastructure development. Minor emphasis areas include training and quality assurance and supportive supervision.

1.LIST OF RELATED ACTIVITIES This activity relates to activities in ARV Services (#6954), Counseling and Testing (#6950), TB/HIV(#6951), and PMTCT (#6953).

2. ACTIVITY DESCRIPTION The Kenya Medical Research Institute (KEMRI) in collaboration with the Kenya Uniformed Services Program (USP), comprising the National Youth Service (NYS), Kenya Wildlife Services (KWS), Kenya Prison Services (KPS), Administration Police (AP) and Kenya Police Department (KPD), will provide basic health care and support to over 1000 HIV-positive service personnel, their dependents, prisoners and surrounding communities at 8 health centers in Nairobi, Coast, Nyanza, and Rift Valley Provinces, Additionally, 30 individuals will receive training in the provision of HIV care services. Activities will focus upon improving the quality of life of Kenya Uniformed Service personnel, their families, prisoners and surrounding communities infected with HIV and needing care. At these sites, KEMRI will provide technical assistance, equipment and supplies and infrastructure improvement. In addition, KEMRI will provide basic health care, in line with the national guidelines which includes; cotrimoxazole prophylaxis for prevention of opportunistic infections, treatment of opportunistic infections and psychosocial support. Prevention of spread of HIV from those infected will also be emphasized. These centers are already providing HIV/TB clinical care for staff and the local populations. Referral systems and networking will be developed to ensure care. The Kenya USP will manage data on people served and will report both nationally and through Emergency plan. Over the last three years, USP, in partnership with CDC, has been encouraging VCT testing among uniformed personnel to identify those requiring HIV care. Over 20,000 people are targeted to receive VCT services in 2007/2008, with an anticipated 600 (3%) HIV infected individuals to be offered care services. The USP medical services are limited and can only provide palliative care within the catchment areas of the above health centers. An appropriate referral system will be developed to Ministry of Health or other approved health facilities for the rest of the HIV infected people identified. A follow-up network system will also be developed to cover transferred staff as well as inmates on drug therapy who get discharged from prison.

3. CONTRIBUTION TO OVERALL PROGRAM AREA These activities will contribute to the expansion of care services for HIV infected individuals among special populations, strengthen human resource capacity to deliver care services, and strengthen referral networks for the provision of HIV services.

4. LINKS TO OTHER ACTIVITIES These activities will link closely with counseling and testing services (#6950), PMTCT (#6953), ARV services (#6954) and Palliative Care: TB/HIV (#6951).

5. POPULATIONS BEING TARGETED The target populations for this activity are HIV-infected prisoners, Uniformed Services staff, their families, and residents in the neighborhoods where prisons are located. The activity also targets public health workers.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses legislative issues related to stigma and discrimination through community sensitization activities.

7. EMPHASIS AREAS This activity include minor emphasis in workplace programs, training, commodity procurement, logistics, development of networks, infrastructure, quality assurance and supportive supervision, and strategic information.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in CT (#6950), Palliative Care: Basic Health Care and Support (#6956) and ARV Treatment (#6954) and PMTCT (#6953).

2. ACTIVITY DESCRIPTION TB and AIDS are the leading causes of deaths in overcrowded Kenyan prisons, the majority of which remain underserved. Failure to contain TB and HIV in the prisons is failure to contain TB and HIV in the civilian population from which the prisoners come and to which they are released. Controlling TB/HIV in the prisons is one of the priorities of the Government of Kenya and constitutes a multi-faceted reform agenda being implemented to decongest and improve prison living conditions. In partnership with the National Leprosy and TB Program (NLTP) and Kenya Prisons Services (KPS), CDC's Uniformed Services Program (USP) will coordinate a phased support for collaborative TB/HIV services in the prisons. This activity will leverage additional support through partnerships with other programs and with other donor agencies, such as WHO and the Futures Group. In order to achieve a more efficient and coordinated response, the USP channeled FY 2006 funding for prison TB/HIV activities through the CDC/KEMRI cooperative agreement (CoAg). In FY 2006, USG supported KPS and the NLTP to develop a new medical tool for screening new inmates for TB, HIV and other medical conditions. This tool will be used to monitor the scope and trend of diseases new inmates come with or acquire during their incarceration. FY 2007 activities will focus on additional investment in prisons' TB/HIV infrastructure and HR capacity. These efforts, which also support ART services in selected prisons, will be strengthened and expanded through partnerships with other programs. The key TB/HIV activities that target the inmates, prison staff and host communities alike include: testing TB patients/ suspects for HIV, screening HIV-infected persons for TB, providing HIV-infected TB patients with additional care (cotrimoxazole, ART), risk reduction counseling and psycho-social support, training of prison health workers to build capacity to deliver TB/HIV services, and supporting infrastructure and supply of HIV test kits and medicines. Additional activities will include production and distribution of TB screening protocols for the prisons, support for essential staff and supply of additional 5 X-ray units and 20 microscopes to enhance TB diagnostic capacity in prisons not catered for previously.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will result in strengthened capacity to deliver integrated HIV and TB services in the Kenya prisons, 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 These TB/HIV activities will be linked to ongoing VCT, PMTCT, STI and ARV treatment services in some prisons and will be mainstreamed into the national network of services coordinated by the NLTP and NASCOP (#7001)) and supported by KEMRI (#6944), Kenya Prisons Services, PLWHA organizations and other partners.

5. POPULATIONS BEING TARGETED TB suspects and PLWHA among prisoners, prison staff and host communities.

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 the prisons and increased access to HIV care for TB patients will help reduce stigma and discrimination. This program serves the needs and rights of prisoners as a special risk population

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

Plus-up funds will support expansion of integrated HIV/TB services in additional 9 prisons

among several that still remain underserved. Funds will support improvement of clinical and laboratory infrastructure, staff training, referral systems, data tracking systems and coordinating meetings. TB suspects among prisoners, prison staff and host communities will be screened for HIV and those living with HIV/AIDS screened for TB.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative Care (#6956), Counseling and Testing (#6950), TB/HIV(#6951), and PMTCT (#6953).

2. ACTIVITY DESCRIPTION The Kenya Uniformed Services Program (USP) comprising the National Youth Service (NYS), Kenya Wildlife Services (KWS), Kenya Prison Services (KPS), Administration Police (AP), and Kenya Police Department (KPD) plans to support the provision of antiretroviral treatment to 250 HIV-infected service personnel, their dependents, prisoners and surrounding communities at 8 health centers in Nairobi, and Coast, Nyanza, and Rift Valley Provinces. Additionally, 20 health care workers will receive ART training according to the national guidelines. This program will build upon established services including HIV/TB diagnostic counseling and testing and provision of non-ART care (treatment of opportunistic infections, psychological and spiritual support, etc.). The USP health facilities offer services to their staff, the local communities as well as prison inmates for the KPS, and these will all be targeted by the program. ARVs will be provided at the sites through the Kenya Medical Supplies Agency (KEMSA) and Mission for Essential Drugs and Supplies (MEDS). Funds will be used to provide training for 20 health care workers; and support the procurement of necessary equipment and supplies such as test kits, laboratory reagents, and drugs for prevention and treatment of opportunistic infections. The Kenya USP will manage data on people served and will report both nationally and through Emergency Plan. The Uniformed Services have had a longstanding collaboration with US government agencies in Kenya. This collaboration has resulted in effective VCT and PMTCT services and establishment of non-ARV treatment services with a special emphasis on provision of integrated TB/HIV services. As of September 2006, the program has identified over 800 HIV-infected people, about 60 of whom are on ARVs. Transfer and release of prison inmates is frequent and there is need to introduce mechanisms for follow-up care, and support for such prisoners, to ensure adherence to ARV and TB treatment.

3. CONTRIBUTIONS TO OVERALL 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 ARV treatment.

4. LINKS TO OTHER ACTIVITIES This activity relates to activities in Palliative Care (#6956), Counseling and Testing (#6950), TB/HIV(#6951), and PMTCT (#6953).

5. POPULATIONS BEING TARGETED The target population for this activity are HIV-infected prisoners, prison staff and their families, and residents in the neighborhoods where prisons are located.

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 on commodity procurement, development of referrals, logistics, human resources and training and quality assurance, supportive supervision as well as strategic information and workplace programs.