1. LIST OF RELATED ACTIVITIES This activity relates to activities in ARV Services (#6985, #8983), Counseling and Testing (#6983), TB/HIV (#6944), PMTCT (#6949) and HBHC activities (#7043).

2. ACTIVITY DESCRIPTION Liverpool Voluntary Counseling, Testing and Care Project (LVCT) will expand existing programs to provide palliative care services to 8,000 people with HIV, including 800 children at 8 sites in Nairobi, and Nyanza and Eastern Provinces. The package of palliative care services includes cotrimoxazole prophylaxis for opportunistic infections, treatment of opportunistic infections, multivitamins, improved access to malaria prevention interventions, and end-of-life care. LVCT will also support implementation of regional activities such as regional quality assurance and coordination meetings in collaboration with the Provincial ART Officer and the TBD care and treatment partner for Eastern south. Funds will be used to support salaries for health care providers in accordance with Emergency Plan guidance, train 80 individuals in the provision of HIV-related palliative care services, and to procure commodities such as laboratory reagents. Supported activities will also include sensitization and mobilization of the communities in the areas of the supported facilities and dissemination of informational brochures. Significant changes from FY 2006 to FY 2007 include geographic consolidation of activities, expanded support for coordination activities, and an increased emphasis on support for treatment of children and quality assurance for care through semi-annual audits.

LVCT is a local, Kenyan organization that started as a project under the Liverpool School of Hygiene and Tropical Medicine. When LVCT became a Kenyan NGO, they retained the name of Liverpool because of its wide recognition in Kenya. LVCT has been a key provider of VCT services in Kenya and since 2003 has been supporting implementation of HIV care and treatment programs. In the specific area of palliative care, Liverpool staff brings substantial medical expertise, and have played a crucial role in development of national policies and training materials and a desk-top referral manual that has now been made available throughout Kenya.

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

4. LINKS TO OTHER ACTIVITIES These activities link ARV treatment services supported by LVCT in these sites (#6985), LVCT HBHC activities (#7043)and ART and non ART services supported by other provincial partners, e.g. KEMRI in Nyanza TB/HIV (#6944), and PMTCT (#6949), University of Nairobi in Kenyatta National Hospital, and JHPIEGO (#6925) and TBD in Eastern (#8983).

5. POPULATIONS BEING TARGETED The primary target group for these activities is people living with HIV/AIDS, including HIV positive children (6 - 14 years). LVCT activities serve high priority, vulnerable, and stigmatized populations, e.g., high risk slum populations, the deaf, and men who have sex with men. Health care workers are also targeted for training in care and treatment.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses legislative issues related to stigma and discrimination through involvement of PLWAs in service provision and community sensitization activities.

7. EMPHASIS AREAS This activity includes minor emphasis in commodity procurement, community mobilization, development of networks, human resources, information, education, and communication, local organization capacity building, policy and guideline development, training, quality assurance and supportive supervision, and logistics.

Liverpool Voluntary Counseling, Testing and Care (LVCT) will support TB/HIV services for approximately 8,000 patients at 10 sites in Nairobi, Eastern and Nyanza Provinces. 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 800 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. 25 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.

LVCT will maintain data concerning the numbers of people served and will report both nationally and through the Emergency Plan. LVCT is a local, Kenyan organization that started as a project under the Liverpool School of Hygiene and Tropical Medicine. When LVCT became a Kenyan NGO, they retained the name of Liverpool because of its wide recognition in Kenya. LVCT has been a key provider of VCT services in Kenya and since 2003 has been supporting implementation of HIV care and treatment programs. In the specific area of palliative care, Liverpool staff brings substantial medical expertise, and have played a crucial role in development of national policies and training materials and a desk-top referral manual that has now been made available throughout Kenya. 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 (#6984), ARV Services (#6985) 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) 10
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 800
services that are receiving treatment for TB disease Number of individuals trained to provide treatment for TB to 25
HIV-infected individuals (diagnosed or presumed)

Table 3.3.07:

1. LIST OF RELATED ACTIVITIES This activity relates to activities in ARV treatment/services (#6985).

2. ACTIVITY DESCRIPTION During FY 2007, Liverpool VCT and Care program (LVCT) will continue to improve model programs of CT and care through technical assistance to non-governmental organizations (NGO), community-based organizations and faith-based organizations (FBO). Core activities will include provision of CT to 130,000 people in medical and non-medical settings, training of 380 service providers and quality assurance support to partners. CT services will be provided in 56 sites and HIV positive clients referred to comprehensive care centers established through the President's Emergency funds. Specific efforts will be aimed at promoting couple CT, assisting discordant couples, and assisting HIV infected clients to disclose their status to their sexual partners. These activities will increase access to high quality HIV prevention and care services. LVCT plans to train 150 counselors in VCT and another 150 in Diagnostic Counseling and testing (DCT) and 80 in couple counseling. LVCT will continue to address the CT needs of special groups including men who have sex with men and people with visual and hearing impairments. In FY 2007 LVCT will continue facilitating prompt and appropriate referrals to care. It will maintain a regional presence in Eastern province, Central Nairobi and Nyanza provinces and will implement multiple models of CT services including mobile VCT where appropriate. By the end of FY 2007, 3000 HIV positive persons tested will be started on ART at LVCT-operated care outlets. In addition, 6,500 will receive non-ARV treatment including prophylaxis for opportunistic infections. In keeping with its commitment to enhance local capacity to provide quality HIV/AIDS services, LVCT will conduct various types of CT trainings including DCT, VCT, couple counseling and Training of Trainers courses. To enhance service delivery of CT and care to the public, LVCT will provide technical assistance, capacity building and program support to selected government institutions. LVCT will also offer ongoing quality assurance trainings for its service providers and those of collaborating partners to ensure continuous improvement in quality of CT services. LVCT will also continue to carry out counselor supervision in 14 districts of Nyanza and central provinces in support of QA improvement. LVCT is a Kenyan NGO widely known for its leading role in providing quality VCT services and trainings. LVCT has been a CDC Kenya partner since 2002 and was awarded a CDC Cooperative agreement in September 2004 to continue providing VCT using multiple approaches, to train service providers in CT and support supervision; and to expand access to both ART and non ART Care for CT clients who test HIV positive. LVCT will continue to expand these activities during FY 2007.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA Through LVCT's efforts, an estimated 120,000 Kenyans will access CT in settings with well-established linkages to care services created through the president's Emergency fund. LVCT's CT targets for 2006 will contribute 17% to the overall Emergency Plan CT targets for Kenya and will include significant numbers of counselors trained. LVCT will also provide mobile VCT services in selected underserved parts of Central, Eastern, Rift valley and Nyanza provinces to improve access to HIV prevention and care services. Many underserved rural communities will have better access to these essential services. Linkages between outreach Mobile VCT programs and medical sites where AIDS care and treatment are available will be enhanced thereby enabling many HIV infected individuals to access appropriate medical care and prevention services.

4. LINKS TO OTHER ACTIVITIES HIV positive individuals identified through LVCT's CT activities will be linked to LVCT's Comprehensive Care Centers whose expansion will be designed to serve geographical clusters of CT sites. The model CT sites operated by LVCT will continue to be centers for best practice and training of service providers besides forming a platform to pilot activities that will guide National CT program improvement. Model youth friendly CT sites operated by LVCT will improve the program's responsiveness to the needs of the youth thereby improving access to services by this highly vulnerable sub-segment of Kenya's population. LVCT will also receive President's Emergency Fund to implement other HIV interventions that complement CT efforts. Such interventions will include direct links to LVCT ARV treatment/services activity (#6985) and other efforts that can be implemented as integrated packages.

5. POPULATIONS BEING TARGETED

This activity targets multiple high risk groups including people with disabilities, young people, as well as other most at risk populations especially men who have sex with men and survivors of rape. Public health care workers as well as leaders of FBOs and NGOs will be trained to address the particular needs of these groups, which also include widows/widowers, HIV positive pregnant women and mobile populations such as truck drivers and migrant workers.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will increase equity in programming through expansion of CT services that are responsive to the unique needs of the deaf, blind, men who sex with men, rape survivors, the youth and other marginalized groups. Increased availability of CT services for these special vulnerable groups will help to reduce stigma and discrimination amongst them.

7. EMPHASIS AREAS This activity includes major emphasis in trainings on provider-initiate CT, client-initiated CT and quality assurance. There will be minor emphasis on development of infrastructure to provide space for CT service delivery, especially in medical facilities that have not yet institutionalized provider initiated CT. Another minor emphasis is in the area of quality assurance through LVCT catering to the ncrease in interest in quality of CT by the Kenyan Ministry of Health has been demonstrated through recent approval of new National strategy and tools for supervision and quality assurance (QA) for CT. Other minor emphasis areas are in the area of community mobiliziation and development of network/linkages/referral systems.

1.LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative Care: Basic Health Care and Support (#6984), Counseling and Testing (#6983), Palliative Care: TB/HIV (#6944), and PMTCT (#6949).

2. ACTIVITY DESCRIPTION Liverpool Voluntary Counseling, Testing and Care Project (LVCT) will expand existing programs to provide antiretroviral therapy to 4,000 people (1,000 new), including 400 children with advanced HIV at 8 sites in Nairobi, Nyanza, and Eastern Provinces. LVCT will also support implementation of regional activities such as regional quality assurance and coordination meetings in collaboration with the provincial ART officer. Funds will be used to support salaries for health care providers in accordance with Emergency Plan guidance, to train 80 health care workers, and to procure commodities such as laboratory reagents. Supported activities will also include sensitization and mobilization of the communities in the areas of the supported facilities and dissemination of informational brochures, for example information about ARVs and the importance of adherence and psychosocial support to PLWAs. Significant changes from 2006 to 2007 include geographic consolidation of activities, expanded support for coordination activities, and an increased emphasis on support for treatment of children.

LVCT is a local, Kenyan organization that started as a project under the Liverpool School of Hygiene and Tropical Medicine. When LVCT became a Kenyan NGO, they retained the name of Liverpool because of its wide recognition in Kenya. LVCT has been a key provider of VCT services in Kenya and since 2003 has been supporting implementation of HIV treatment programs. In the specific area of HIV treatment, Liverpool staff brings substantial medical expertise, and have played a crucial role in development of national policies and training materials and a desk-top referral manual that has now been made available throughout Kenya.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute to 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 This activity relates to LVCT-supported non-ART care and CT services, CT, PMTCT, ART, and non-ART Services by other Emergency Plan partners (University of Nairobi and Pathfinder in Nairobi, TBD and JHPIEGO for Eastern Province, and KEMRI in Nyanza).

5. POPULATIONS BEING TARGETED The primary target group for these activities is people living with HIV/AIDS, including HIV positive children (6 - 14 years). LVCT activities serve high priority, vulnerable, and stigmatized populations, e.g., high risk slum populations, the deaf, and men who have sex with men. Health care workers are also targeted for training in care and treatment.

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, community mobilization, development of networks, human resources, information, education, and communication, local organization capacity building, policy and guideline development, quality assurance and supportive supervision, training, and logistics.