1. LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative Care: Basic Health Care and Support (#7005), HIV/AIDS Treatment: ARV Services (#7004), Prevention of Mother-to-Child Transmission (#6925) and Strategic Information (#7002).

2. ACTIVITY DESCRIPTION The Ministry of Health's National AIDS and STI Control Program (NASCOP) will continue to provide leadership and coordination to the national PMTCT program towards the goal of universal access to comprehensive integrated PMTCT services. In collaboration with the MOH's Division of Reproductive Health and Medical Training College (MTC), NASCOP will strengthen its stewardship, regulatory and supervisory functions and quality assurance to ensure delivery of high quality comprehensive integrated PMTCT services that reflect current scientifically proven interventions and in accordance to the National Comprehensive PMTCT guidelines. NASCOP will guide establishment of systems and mechanisms for stronger linkages and coordination between PMTCT and other HIV treatment and care programs to ensure comprehensive care and support to the HIV-positive woman, infant and family members within maternal and child health care settings.

Significant changes from FY 2006 to FY 2007 for this activity are the strengthening of the stewardship function of NASCOP by improving coordination across MOH programs supporting MCH services at the national and district levels with decentralization to the district level. NASCOP, through the Technical Working Group (TWG), will provide the framework and guidance for the national roll out of comprehensive integrated PMTCT services. NASCOP will facilitate and guide development of Provincial PMTCT TWGs that will work at district level to enhance active community participation, coordinate various partner activities, review district microplans and use program data for improving specific regional performance. Other significant changes include strengthening the referral systems for the continuum of care for successful referral of mothers to antiretroviral therapy centers and early infant diagnosis and referral to appropriate care to enhance maternal and child survival.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA. NASCOP has the mandate to provide leadership and policy guidance, direction and support for national PMTCT efforts. The NASCOP PMTCT activities will significantly contribute to PEPFAR goals for primary prevention of HIV and identifying and referring HIV-positive individuals to treatment and care by providing the national framework for strategic comprehensive to PMTCT programming. The proposed national training plan and improved PMTCT management information system will provide critical PMTCT programming information such as staffing level, program uptake, coverage gaps etc., which will be used for improved national PMTCT programming. Strong and effective linkages between PMTCT other HIV care programs at national level will significantly improve access to ART including pediatric HIV care and treatment services at facility level, thereby ensuring comprehensive care services in PMTCT sites. With Emergency Plan funds, NASCOP led the national process in adapting the WHO/CDC generic curriculum into the Kenya National PMTCT Training Curriculum. In FY 2007, NASCOP will continue to provide national direction for staff capacity building to strengthen PMTCT service delivery. NASCOP will also continue to improve PMTCT management information system in order to develop a dynamic data flow system to inform national gaps, coverage rates, and program uptake and monitor national targets. NASCOP will support the development and roll out of a national training plan based on identified needs, maintain a national data base on service providers trained with details of cadre of staff trained, training type, duration of training etc that will be used to inform the nation on staffing needs. NASCOP will work with DRH and MTC to support integration of pre-service and in-service training and supervision of PMTCT services within other maternal, child health and family planning supervisory structures at the district levels.

4. LINKS TO OTHER ACTIVITIES This activity relates to the following: NASCOP ART (#7004), NASCOP SI (#7002), and PMTCT JHPIEGO DRH (#6925). This activity is most immediately linked to palliative care (#7005) and HIV/AIDS treatment/ARV services through the provision of ongoing care to the HIV+ woman in the antenatal and post natal settings, care of the HIV exposed infant in the post natal period and referral to the ART sites for women and infants. In

collaboration with the DRH, this activity will strengthen support supervision efforts for integrated comprehensive PMTCT service delivery including improved data management and utilization at facility level.

5. POPULATIONS BEING TARGETED This activity targets adults, pregnant women, HIV positive pregnant women and HIV positive infants. Public and private health care workers including doctors, laboratory workers, nurses, pharmacists and other health care workers will also be targeted for training to improve service delivery.

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 reduce violence and coercion through training of service providers on couple counseling and stigma reduction, who will in turn use the skills in improved PMTCT service delivery. The activity also addresses male norms and behaviors through supporting national community level interventions.

7. EMPHASIS AREAS This activity includes major emphasis on policy and guidelines and minor emphasis on quality assurance and support supervision; strategic information (M&E, reporting); and development of networks/linkages/referral systems.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#7009), Prevention of Mother-to-Child Transmission (#7006), Palliative Care: Basic Health Care and Support (#7005), Palliative Care: TB/HIV (#7001), Condoms and Other Prevention (#7008), HIV/AIDS Treatment: ARV Services (#7004) and Strategic Information (#7002).

2. ACTIVITY DESCRIPTION The Kenya National AIDS and STI Control Program (NASCOP) will support, supervise and monitor abstinence and faithfulness programs targeting youth in Kenya. It will also take the lead in developing policies and guidelines as needed. NASCOP will continue to strengthen a coordination mechanism for youth HIV prevention in Kenya. It will continue to explore feasible avenues of strengthening HIV prevention programs such as the integration of alcohol prevention efforts with HIV prevention work. NASCOP will coordinate the development and distribution of print materials as needed in support of abstinence and faithfulness programs for youth as well as youth-friendly services. NASCOP will also partner with the Kenya Medical Training college (KMTC) to help develop in-service training guidelines to KMTC trainees on broad behavioral prevention issues for youth and the provision of youth-friendly services. This element will be in response to the need identified in 2005 by the Kenya Service Provision Assessment (KESPA) which pointed to huge gaps in the provision of youth friendly services. This training will help sensitize health workers on the need to offer appropriate information and counseling to young people to help them adopt healthy behavior and safer sexual practices. These will contribute to improved HIV preventive behaviors among young people, changed social and community norms to promote HIV preventive behaviors among youth and young adults as well as reduced HIV/AIDS stigma and discrimination. Significant changes from 2006 to 2007 that will take place will be that NASCOP will play a key role in ensuring that epidemiological data is captured, analyzed and presented for use in implementation of prevention programs. NASCOP was established within the Ministry of Health (MOH) to conduct surveillance, develop policies and coordinate activities in HIV/AIDS prevention, care and treatment. It will also provide essential linkages that will ensure young people have improved access to related HIV services including youth-friendly counseling and testing, palliative care, care and treatment among others. Since 2001, the USG has been a major supporter of operational activities of NASCOP through a cooperative agreement with CDC that has resulted in the development of VCT, PMCT, ARV, TB-HIV care, HIV testing in clinical settings and other policies; improved support supervision and field coordination with provincial, district and local facilities; and improved surveillance, monitoring and evaluation. This has resulted in increased capacity for the MOH that serves as a platform for the services necessary to reach Emergency Plan targets.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute towards the achievement of the Emergency Plan prevention targets in AB. It will promote the ability of implementing partners to reach their varied emergency plan targets for the year and will guide the implementation of targeted interventions for greater efficacy in behavior change. Because this activity is mainly a coordination role, no specific targets are assigned to this partner.

4. LINKS TO OTHER ACTIVITIES This project will establish essential linkages with other NASCOP coordinated national programs including CT activity (#7009), PMCT acitivity (#7006), ARV services activity (#7004), Palliative Care: Basic Health Care and Support activity (#7005), TB/HIV (#7001), OP (#7008) and strategic information activity (#7002). NASCOP will build on its involvement with the faith-based and non-governmental sectors in Kenya and ensure that abstinence messages for youth are integrated with other services and that a supportive adult environment is cultivated.

5. POPULATIONS BEING TARGETED The activities implemented by NASCOP in this area will target men and women as well as children and youth to be served through the guidelines. National AIDS Control staff and other MOH staff such as the Kenya Medical Training college staff as well as various cadres of public health care workers will be targeted.

6. KEY LEGISLATIVE ISSUES ADDRESSED The primary legislative issue addressed in this project is increasing gender equity in

HIV/AIDS programs and reducing stigma and discrimination.

7. EMPHASIS AREAS This activity includes major emphasis on quality assurance, quality improvement and supportive supervision. It will also result in the development of guidelines for health workers on working with youth. Information, Education and communication materials will be developed and distributed to service providers. Linkages and networks for youth programs to health care services will be established and guidelines on training will be developed.

1. LIST OF RELATED ACTIVITIES This activity relates to injection safety activities implemented through John Snow, Inc/Making Medical Injections Safer (#8985), Supply Chain Management System (#8817), Danya International (#8824), and JHPIEGO (#8821); NASCOP activities in ART (#7004), CT (#7009), and Palliative Care (#7005); and PEPFAR partners in care, prevention, laboratory and treatment.

2. ACTIVITY DESCRIPTION The Ministry of Health, in conjunction with the Division of Curative Services, Division of Preventive and Promotive Health and National AIDS Control Program (NASCOP), will review, develop and monitor the implementation of the national standards, guidelines and strategic plan for injection safety and health care waste management completed in FY 2006 and coordinate the scale up of injection safety by various partners country-wide to ensure coverage of 5 provincial hospitals and 5 provinces by 2008 and national coverage by 2009. Appropriate monitoring tools will be developed and used to determine the impact of these actvities. This activity includes the coordination of the above-mentioned activities to impart improved attitudes and behavior change among health care workers and the general public regarding the role of proper disposal of medical wastes, especially sharps, that contribute to the transmission of HIV/AIDS in hospital settings and the surrounding communities. Transmission of HIV and hepatitis in health care settings can occur through unsafe injections and other unsafe medical practices, including poor disposal of contaminated medical wastes. The persons most at risk of infection through unsafe injection practices are the recipients, health care workers and the wider community through exposure to contaminated sharps waste.

Estimates of the global burden of disease from unsafe injections suggests that, in the year 2000, unsafe injections around the world accounted for five percent of HIV infections, 32 percent of hepatitis B virus infections, 40 percent of hepatitis C virus infections, 28 percent of liver cancers, and 24 percent of cirrhosis cases (World Health Organization, 2003). A Health workers survey in 2005 in Kenya reported that 12% of health care workers had experienced needle stick injury in the previous 12 months. The data suggests that injection overuse and unsafe injection practices contribute to contaminated and often unnecessary injections in the formal and informal health sector, and therefore constitute a significant mode of transmission for HIV and hepatitis.

Secondly, NASCOP will advocate for safer injection practices through collaboration with other partners including Danya Int. and JHPIEGO to guide the development of country-specific information, education and communication (IEC) material and media messages targeted at health care waste handlers, injection prescribers and the community at large. The injection safety program will outsource the sensitization and dissemination of IEC materials and policy document to JHPIEGO who are a partner to NASCOP. These will be aimed at reducing the demand for injections, rationalizing prescription of injectables and increasing awareness about the risks to the community of improperly disposed injection waste. An increased number of injections are being used in the informal health care sector, where the re-use of injections and the occurrence of needle stick injuries result to HIV transmission and are more highly probable. IEC material will be developed in different languages based on the HIV/AIDS prevalence, population density and population groups affected by the epidemic.

The third objective is to monitor injection practices country-wide and give supportive supervision that will strengthen performance at all levels including that of implementing partners. Infection Prevention Committees (IPC) at five major hospitals will be reactivated to oversee safe injection and waste management practices. These will be comprised of a core team of a senior nurse, a public health officer, a clinician and a lab technologist. The lessons learned from these initial hospitals will be used to enhance the functions of IPCs at all hospitals in the country. These committees will serve to ensure sustainability of safe injection practices in years to come.

Potential partners such as the National Nurses Association of Kenya, National Environmental Management Authority (NEMA), National AIDS Control Council (NACC), WHO and JHPIEGO will be identified to work with NASCOP to improve injection safety. These groups will hold quarterly meetings to discuss the outcomes and plan for the way forward.

Lastly, the injection safety program will provide funding for the Kenya Medical College to hold various trainings for the post-graduate and the pre-service students on injection safety, PEP and waste management in the prevention of nosocomial transmission infections. The college will incorporate safe injection practice into their curriculum.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA As the HIV treatment program is scaled up and brings more HIV/AIDS patients to health care facilities, measures should be put in to place to protect health care workers and other patients from nosocomial infections. This program will contribute to averting up to 5% new cases of HIV in the country. The injection safety and waste management program under the Ministry of Health will guide the development of policy and support implementing partners with the aim of achieving national coverage by 2009 and sustainable safe practices thereafter.

4. LINKED ACTIVITIES This activity relates to injection safety activities implemented through John Snow, Inc/Making Medical Injections Safer (#8985), Supply Chain Management System (#8817), Danya International (#8824), and JHPIEGO (#8821); NASCOP activities in ART (#7004), CT (#7009), and Palliative Care (#7005); and PEPFAR partners in care, prevention, laboratory and treatment.

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 policy-makers, all health care workers (nurses, doctors, clinical officers, pharmacists, lab personnel, health care waste handlers), medical training institutions, the public, and the community.

6. EMPHASIS AREAS COVERED This activity has a major emphasis on policy and guidelines development, with a minor emphasis on quality assurance, quality improvement and supportive supervision to monitor improved skills, knowledge and attitudes regarding safe injection practices of healthcare workers, waste handlers and the community. This activity will also coordinate the development of policies to ensure adequate supplies of appropriate injection supplies at health care facilities.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Abstinence and Be Faithful Programs (#7007), Counseling and Testing (#7009), Prevention of Mother-to-Child Transmission (#7006), Palliative Care: Basic Health Care and Support (#7005), Palliative Care: TB/HIV (#7001), HIV/AIDS Treatment: ARV Services (#7004) and Strategic Information (#7002).

2. ACTIVITY DESCRIPTION The Kenya National AIDS and STI Control Program (NASCOP) will support, supervise and monitor condoms promotion and prevention activities targeting at-risk youth and vulnerable populations in Kenya. NASCOP will also support the procurement and installation of 2000 condom dispensers at targeted outlets. In addition, STI management will be strengthened to provide a special focus on Positive prevention. This will entail educating health workers on the need to intensify STI screening and treatment for individuals with HIV. Guidelines for health service providers will be developed to assure they focus on important aspects such as positive prevention and the provision of youth-friendly services, a gap highlighted in the 2004 Kenya Service Provision Assessment Survey. Training updates for health workers will be done through the Kenya Medical Training College. NASCOP will also take the lead in developing policies and guidelines as needed to ensure a reasonable standard of practice in delivering prevention programs for vulnerable populations. NASCOP will continue strengthening a coordination mechanism for condom promotion, information and education to vulnerable populations in Kenya. It will continue to explore feasible avenues of strengthening HIV prevention programs such as the integration of alcohol prevention efforts with HIV prevention work. NASCOP will coordinate the development and distribution of print materials as needed in support of condoms and other prevention programs for young people and most-at-risk populations. It will support increased condom access through increasing the number of condom outlets country wide. These will contribute to improved HIV preventive behaviors among young people, changed social and community norms to promote HIV preventive behaviors among youth and young adults as well as reduced HIV/AIDS stigma and discrimination. Significant changes from 2006 to 2007 will be that NASCOP will play a key role in ensuring that epidemiological data is captured, analyzed and presented for use in implementation of prevention programs. NASCOP was established within the Ministry of Health (MOH) to conduct surveillance, develop policies and coordinate activities in HIV/AIDS prevention, care and treatment. Since 2001, the USG has been a major supporter of operational activities of NASCOP through a cooperative agreement with CDC that has resulted in the development of VCT, PMCT, ARV, TB-HIV care, HIV testing in clinical settings and other policies; improved support supervision and field coordination with provincial, district and local facilities; and improved surveillance, monitoring and evaluation. This has resulted in increased capacity for the MOH that serves as a platform for the services necessary to reach Emergency Plan targets.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute towards the achievement of the Emergency Plan prevention targets. It will promote the ability of implementing partners to reach their varied emergency plan targets for the year and will guide the implementation of targeted interventions for greater efficacy in behavior change. Because NASCOP plays a coordination role and not a direct implementer, there are no targets assigned to this partner for reaching people with OP messages or training. NASCOP will however provide support to set up 2,000 condom outlets in designated locations.

4. LINKS TO OTHER ACTIVITIES This project will establish essential linkages with other NASCOP coordinated national programs including NASCOP CT activity (#7009); NASCOP AB activity (#7007), NASCOP PMTCT activity (#7006); NASCOP ARV services activity (#7004); NASCOP palliative care: basic health care and support activity (#7005), NASCOP palliative care: TB/HIV (#7001) and NASCOP strategic information activity (#7002).

5. POPULATIONS BEING TARGETED Activities implemented by NASCOP in this area will target partners working towards the reduction of HIV prevalence through prevention of new and secondary infections. Efforts in this activity will target out of school and street youth, children and youth, adults, people living with HIV/AIDS and most at risk populations. Community organizations including FBOs, NGOs, implementing organizations and rural communities will be indirectly targeted by NASCOP.

6. KEY LEGISLATIVE ISSUES ADDRESSED The primary legislative issue addressed in this project is increasing gender equity in HIV/AIDS programs and reducing stigma and discrimination.

7. EMPHASIS AREAS This activity includes major emphasis on quality assurance, Quality improvement and supportive supervision. Minor emphasis will be on commodity procurement, development of linkages and referrals and the development of guidelines and information, education and communication.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#7009), PMTCT (#7006), ARV Services (#7004), Strategic Information (#7002) and TB/HIV (#7001).

2. ACTIVITY DESCRIPTION This will be an expansion of the 07 activities as described in the COP. The National AIDS and STD Control Program (NASCOP) is the arm of the Ministry of Health that is responsible for implementation of medical interventions related to treatment and prevention of HIV/AIDS. NASCOP will oversee the implementation of all HIV care programs in Kenya. Specific activities supported by NASCOP will result in provision of palliative care services to 25,000 people with HIV (including 2500 children) not included in other reported targets at approximately 25 sites not otherwise supported by the Emergency Plan. These activities will also result in the training of 350 health care workers. Emphasis will be placed on developing regional trainers who will provide classroom training and mentorship of health care workers at the facility level. Specific NASCOP-supported activities will include the coordination of all partners in the provision of care for people with HIV (through national level meetings such as the National ART task force), and supervision of treatment in Ministry of Health and other facilities. Specific guidelines for prevention and treatment of opportunistic infections including sexually transmitted illness, HIV prevention in care settings, and management of nutrition interventions will be kept updated, printed, and distributed. The national system for tracking the numbers of people enrolled in patient support centers (HIV clinics) will be improved. Funds will be used to provide administrative support and transport for the Provincial/Regional ART coordinators so that they can coordinate, track, and provide supportive supervision to sites in their areas and to support regular regional meetings of care providers. The supervisory structure at NASCOP includes a core staff at a national level that consists of a small technical and administrative staff and an expanding staff responsible for M&E. A system of regional supervision of HIV/AIDS treatment activities has been established with Provincial ART Coordinators ("PARTOS") who are responsible to assist with establishment of care and treatment services at additional sites, site evaluations, accreditation, and supervision for care programs. Significant changes from 2006 to 2007 include the development and implementation of HIV prevention activities in clinical care settings, the development of referral systems and care linkages for HIV positive mothers and infants identified through the PMTCT programs, decentralization of care and treatment services to lower level health facilities to increase access and reduce the waiting list at the provincial and district hospitals, an intensified focus on pediatric provision of care, and improved coordination with other sources of support such as the Global Fund for AIDS, Tuberculosis, and Malaria.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities are essential to the overall implementation and coordination of HIV care and treatment programs in Kenya. NASCOP supported activities are essential to the formation/strengthening of the linkages needed in the network model and to the development of a sustainable system to provide HIV care in Kenya.

4. LINKS TO OTHER ACTIVITIES There are strong linkages between these activities and virtually all HIV prevention and treatment activities in Kenya. All Emergency Plan partners have been encouraged to extend efforts to further strengthen these linkages by coordinating with and supporting the activities of the Provincial ART coordinators and by participating in national efforts such as policy/guideline revision and national stakeholders meetings. Activities are closely linked to Management systems of Health (MSH) supported logistics/systems strengthening particularly for the Kenya Medical Supplies Agency (#8401). Other linkages include Counseling and Testing (#7009), PMTCT (#7006), ARV Services (#7004), Strategic Information (#7002) and TB/HIV (#7001)

5. POPULATIONS BEING TARGETED Populations targeted by these activities include people living with HIV/AIDS including HIV positive children (6 - 14 years) and health care workers and others providing services to people with HIV.

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 in quality assurance and supportive supervision, development of networks/linkages/referral systems, logistics, human resources, policy and guidelines, strategic information (M&E, IT, Reporting) and training.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in CT (#7009), PMTCT (#7006), Palliative Care: Basic Health Care and Support (#7005), ARV Treatment (#7004), Laboratory Infrastructure(#7003) and SI (#7002).

2. ACTIVITY DESCRIPTION The National Leprosy and TB Program (NLTP) under the National STD and AIDS Control Program (NASCOP) is responsible for establishing TB policy and provides overall coordination, implementation and evaluation oversight for all TB/HIV activities in Kenya. In FY 2007, the Emergency Plan will provide essential support towards the achievement of targets set in the current NLTP Five-Year (2006 - 2010) Strategic Plan. National roll-out of collaborative TB/HIV activities is being coordinated by the National TB/HIV Steering Committee (NTHSC) established jointly by the NLTP and NASCOP, both of which previously operated as separate delivery systems. TB services in Kenya have been decentralized to the health center level; drug supplies are consistent, and are provided free to all TB patients attending public and mission health facilities. The NLTP projects that over 140,000 cases of TB will be registered for treatment in 2007, 60% of whom will be co-infected with HIV. The NLTP has a well-deserved reputation for widespread coverage, good diagnostic facilities, and for provision of free high-quality TB drugs. In FY 2007, the NLTP will build on gains made in FY 2006 to consolidate and further increase access to integrated TB/HIV services nationwide. Of 108,000 TB patients registered at the end of 2005, 60% received diagnostic HIV counseling and testing, 94% of those testing HIV-positive were placed on cotrimoxazol (CTX) and 30% started ART. In FY 2007, the NLTP will concentrate on getting more eligible TB patients onto ART and intensify, with collaborating partners, TB screening for HIV-infected persons identified in HIV care settings.

Apart from Emergency Plan, the NLTP receives complementary funding from several partners including WHO and the Global Fund. In 2006 and 2007, the NLTP will receive $600,000 through OGAC/WHO cooperation to support TB/HIV activities in 15 districts that had previously received inadequate coverage. Kenya has been awarded Round 5 TB funding by the Global Fund to support efforts to control MDR-TB through surveillance and treatment. Emergency funds will be used to support efforts to prevent and manage drug-resistant TB among HIV/TB co-infected patients. Kenya has also applied for Round 6 Global Fund support to strengthen TB diagnostic capacity at dispensary level. In order to decrease the burden of HIV among TB patients, the NLTP will promote diagnostic HIV testing for all TB patients and TB suspects (where feasible) and will provide OI prophylaxis, nutritional and psychosocial support to co-infected patients. In order to decrease the burden of TB in PLWHA, the NLTP will intensify TB screening for affected persons, provide quality TB treatment for those with active disease, TB preventive treatment for those who qualify and intensify TB infection prevention measures in health care facilities and congregate settings, such as prisons. Additional activities will include increased attention to prevention with positives in TB settings, sustained TB/HIV media campaigns and increased private-public partnerships in TB/HIV services.

In addition to required PEPFAR TB/HIV indicators, the NLTP will support reporting of the following custom indicators to assist with TB/HIV program management and evaluation: number and percentage of HIV+ patients in care screened for TB, number and percentage of HIV+ registered TB patients, number and percentage of HIV+ TB patients receiving CTX and number and percentage of HIV+ TB patients receiving ART.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will result in strengthened delivery of integrated HIV and TB services, 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 activities will be linked with ongoing VCT, PMTCT, STI and ARV treatment services supported by NASCOP and other implementing partners. In addition, the NLTP will work collaboratively with other programs implementing TB/HIV activities among special populations such as the prisons and refugees. The NLTP will lead all partners in the

development, formulation and approval of national TB/HIV policy guidelines. For instance, while TB preventive treatment is advocated by the Emergency Plans, the NLTP is proceeding cautiously on IPT given recent reports of potential perverse effects of this intervention. Through CDC's support, the NLTP and all partners now have a new TB/HIV training curriculum.

5. POPULATIONS BEING TARGETTED TB suspects (adults and children) from whom the 142,000 TB patients in 2007 will be drawn. The TB suspects will be seen at various clinical settings - both public and private health facilities at different levels of care ranging from hospitals, health centers, dispensaries, faith-based health facilities, the prisons, private hospitals and others. The other populations targeted are HIV+ persons identified from VCT, PMTCT, STI, and ARV clinics and PLWHA organizations - TB screening will be intensified for all PLWHA.

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 clinical settings and increased access to HIV-related care for TB patients will help reduce stigma and discrimination.

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

($1.4 M)Delivery of quality TB diagnostic services and containing emerging threat of MDR-TB are critical to control of HIV-driven TB in Kenya. The Plus-up funds will be used to improve capacity of the Central Reference Laboratory for TB (CRL-TB) to implement a national QA program and support establishment of a strong national MDR-TB surveillance system. The CRL-TB infrastructure will be strengthened by providing a stable power back-up (new generator) and a large capacity autoclave for waste disposal. Communication and monitoring capacity of the CRL will be strenghthened through provision of internet services and establishment of a working relationships with KEMRI TB laboratory. In addtion, funds will be used to maintain adequate supplies of media and other laboratory commodities. Through Global Fund, Kenya is establishing an MDR-TB isolation facility in Nairobi and Plus-Up funds will complement these efforts through staff training, support for infrastructure, support supervision/feedback and promotion of best laboratory and clinical practices. ($500,000) In addition to required PEPFAR TB/HIV indicators, the NLTP supports reporting of the key custom indicators (number and percentage of HIV+ patients in care screened for TB, number and percentage of HIV+ registered TB patients, number and percentage of HIV+ TB patients receiving CTX and number and percentage of HIV+ TB patients receiving ART) to assist with program management and evaluation. These require coordinated effort of all regional and district TB and HIV technical teams to ensure that collaborative care standards are achieved or maintained through sustained support supervision and timely monitoring and reporting. Plus-up funds will assist NLTP provide this support supervision to implementers.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in PMTCT (#7006), ART(#7004), Palliative care: Basic Health Care (#7005), TB-HIV (#7001), AB (#7007), OP (##7008), SI (#7002), HLAB (#7003).

2. ACTIVITY DESCRIPTION The National AIDS/STI Control Program (NASCOP) is the section in the Ministry of Health that coordinates all health sector based HIV/AIDS activities. NASCOP is responsible for developing and promoting the use of national policies, guidelines and standards for all HIV prevention and care activities in the country. In CT NASCOP coordinates the implementation of all types of HIV counseling and Testing (CT) approaches, including provider-initiated and client-initiated CT. The Client-initiated approach (also known as voluntary counseling and testing -VCT) has been highly successful in Kenya, since its launch by NASCOP in 2000. By December 2005, there were 680 registered VCT sites in Kenya, and in that calendar year, at least 500,000 people are counseled and tested in these sites. In VCT NASCOP is currently mainly involved in supervision and quality assurance. NASCOP has in the past developed guidelines, training curricula and operational tools for VCT in Kenya, tools which are used by all partners. In FY 2005, NASCOP published the _Guidelines for HIV testing in Clinical Settings_. These guidelines were developed in order to provide for the all types of HIV testing approaches possible in health care facilities. These efforts led to considerable increase in HIV testing within clinical settings in FY 2005 and FY 2006. Despite this growth in both DTC and VCT, many Kenyans still do not know their HIV status, as seen in the Kenya Demographic and Health Survey in 2003. In FY 2007, NASCOP will mobilize and facilitate stakeholders to provide all types of CT. Through planned activities in FY 2007, NASCOP will promote health workers' participation in testing and counseling and streamline referral linkages between CT and care in government facilities. Increased health worker participation in CT shall be achieved through dissemination of relevant policies and guidelines in CT and through training in all types of CT. The national guidelines and training curricula on CT will be reviewed and updated as necessary. NASCOP will also conduct regional level trainers' courses for provider initiated CT and couple counseling for a total of 100 people, in order to facilitate speedy national scale up of these approaches of CT. Provider initiated CT will be introduced in 80 previously uncovered public health facilities. NASCOP will continue to strengthen the capacity of its national and regional staff to monitor and evaluate CT activities, including proper data collection. NASCOP will also maintain the model VCT site that was established in FY 2004, which will provide CT for at least 6000 people in FY 2007. In FY 2007, NASCOP's target has been revised to reflect the actual services provided by the model VCT site at NASCOP.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA NASCOP is in a unique position to provide leadership and support for CT activities of all partners in the country. NASCOP will receive Emergency Plan resources to develop policies and guidelines for the whole country. They will also ensure that the CT services in Kenya meet national and international standards. NASCOP is the only agency with that mandate and opportunity. The contribution of NASCOP to the goal is therefore largely broad and strategic, and in a small way it is also direct, since the NASCOP VCT site will provide CT services to a small number of people.

4. LINKS TO OTHER ACTIVITIES NASCOP is supported to coordinate HIV/AIDS services in almost all the components. The planned NASCOP CT activities in FY2007 will increase knowledge of HIV status both for primary prevention and linkage to care services for HIV positive individuals. The NASCOP CT program will therefore relate to other NASCOP led programs like ART(#7004), PMTCT (#7006) and Palliative care (#7005). This activity is also linked to NASCOP TB-HIV activity (#7001), AB activity (#7007), OP activity (#7008), SI activity (#7002) , and HLAB activity (#7003).

5. POPULATIONS BEING TARGETED This activity targets the general adult population as well as symptomatic individuals served in public health facilities, especially in Medical wards, TB wards and STI clinics. The primary goal is universal knowledge of HIV status, as well as timely identification of those who would benefit from care and treatment services. In client initiated CT sites existing sites will be strengthened and supported to provide quality services. And for the provider

initiated CT services, the new sites will mainly be public health facilities that have not previously provided CT as part of diagnostic work up of symptomatic patients seeking treatment.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will help reduce HIV related stigma and discrimination by promoting routine HIV testing in clinical settings and linking HIV infected individuals to care. Patients will be sensitized to expect HIV testing as a standard package of good medical care in health facilities. Health care providers will be sensitized to understand patients' basic right to the best diagnostic services including being offered HIV test.

7. EMPHASIS AREAS Major emphasis areas for this activiy is in the development of policy and guidelines at a national level for all CT activities. Minor emphasis areas are in the area of information, education and communication, quality assurance, strategic information and training.

The Plus Up funds will be used to facilitate an accelerated HIV counseling and testing campaign in Kenya, which is an expansion of the International HIV testing day. The Government of Kenya, led by the National AIDS Council and National AIDS/STD Control Program has adopted the Rapid Results Initiative programof scaling up HIV counseling and testing. with a goal of testing 300,000 people in three months. Plus up funds will complement funds from other donors and the Government of Kenya. Funds will be used for emplyment of short-term CT counselors, and for Mobile VCT services in the hard to reach areas of Kenya. Funds will also be used to coordination and supervision (quality assurance).

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#7009), PMTCT (#7006), Palliative Care (#7005), Strategic Information (#7002) and TB/HIV (#7001).

2. ACTIVITY DESCRIPTION The National AIDS and STD Control Program (NASCOP) is the arm of the Ministry of Health that is responsible for implementation of medical interventions related to treatment and prevention of HIV/AIDS. NASCOP will oversee the implementation of all HIV care and antiretroviral treatment programs in Kenya. NASCOP will provide support to 25 sites not otherwise supported by the Emergency Plan to provide treatment to 13,000 people with HIV (including 1,300 children and 3,000 new individuals). These activities will also result in the training of 240 health care workers not included in other targets. Specific activities supported by NASCOP will include the coordination of all partners in the area of ART provision (through national level meetings such as the National ART task force), and supervision of treatment in Ministry of Health-supported and other facilities. NASCOP will also continue to coordinate with other sources of support such as Global fund for AIDS, Tuberculosis and Malaria, and Clinton Foundation. NASCOP will improve the national system for tracking the number of people receiving antiretroviral treatment, and provide financial and administrative support to the Provincial/Regional ART coordinators so that they can coordinate, track and provide supportive supervision to area sites. Funds will also be used to support regular regional meetings of care providers. The supervisory structure at NASCOP includes a core staff at a national level that consists of a small technical and administrative staff, and an expanding staff responsible for monitoring and evaluation activities. A system of regional supervision of HIV/AIDS treatment activities has been established, with Provincial ART Coordinators (PARTOs) who are responsible to assist with establishment of services at additional sites, site evaluations, accreditation, and supervision for ART programs. All activities are closely linked to other MOH and PEPFAR supported HIV treatment and prevention activities, the networks of care in the Private and Mission sectors, and Management System for health (MSH) supported logistics/systems strengthening (particularly for KEMSA, the Kenya Medical Supplies Association). Emphasis will be placed on developing regional trainers who will provide classroom training and mentorship of health care workers at the facility level. Significant changes from 2006 to 2007 include the development and implementation of HIV prevention activities in clinical care settings, the development of referral systems and care linkages for HIV positive mothers and infants identified through the PMTCT programs, decentralization of care and treatment services to lower level health facilities to increase access and reduce the waiting list at the provincial and district hospitals, an intensified focus on pediatric provision of care, and improved coordination with other sources of support such as the Global Fund for AIDS, Tuberculosis, and Malaria.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities are essential to the overall implementation and coordination of HIV treatment programs in Kenya. NASCOP supported activities are essential to the formation/strengthening of the linkages needed in the network model, and to the development of a sustainable system to provide HIV treatment in Kenya.

4. LINKS TO OTHER ACTIVITIES Since NASCOP coordinates HIV prevention and treatment activities throughout Kenya, there are strong linkages between these activities and virtually all HIV prevention and treatment activities in Kenya. All Emergency Plan partners have been encouraged to extend efforts to further strengthen these linkages by coordinating with and supporting the activities of the Provincial ART coordinators and by participating in national efforts such as policy/guideline revision and national stakeholders meetings.

5. POPULATIONS BEING TARGETED Populations targeted by these activities include people living with HIV/AIDS including HIV positive children (6 - 14 years) and health care workers and others providing services to people with HIV.

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 in development of networks, human resources, policy and guidance development, quality assurance and supportive supervision, training, and strategic information.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in laboratory services, particularly (#6845, #7113 and #8763) Counseling and Testing (#6941), TB/HIV (#6944), and all activites in MTCT.

2. ACTIVITY DESCRIPTION Funding to the National Public Health Laboratory Service (NPHLS) through the National HIV/AIDS and STD (NASCOP) will contribute to expansion of capacity in support of HIV prevention and treatment programs throughout the Kenyan national network of laboratories. This network includes the national public health lab, 8 provincial/regional laboratories, 100 district and sub-district facilities, numerous laboratories at lower level health facilities, and 1500 HIV rapid testing sites. Together, the labs will support HIV testing of more than 2 million people and performance of 450,000 CD4 and 5000 viral load tests. Key activities for NPHLS will be: i) Training and supportive supervision related to performance of standard laboratory assays to support HIV prevention and treatment (HIV serology, CD4 cell count monitoring, routine hematology and chemistry), ii) Expansion of capacity to conduct sophisticated assays such as DNA PCR within the laboratory network, iii) Support for/oversight of expansion of specific quality assurance activities, and iv) improvement in monitoring and evaluation of laboratory services (with support from APHL).

Supportive supervision is being decentralized. The NHRL will provide regional supervision on a quarterly basis to provincial/regional laboratories; provincial lab staff in turn will supervise district coordinators who are responsible for lab performance at all facilities in their districts. By September, 2006, supervisory staff from more than 20 districts had been trained. In FY 2007, expanded support for supervision, including provision of 5 double cab pick up vehicles and 8 motorcycles for district supervisors, will be piloted in 8 districts.

During FY 2006, capacity for early diagnosis of HIV-positive infants expanded dramatically in Kenya, with more than 2,635 infants from more than 77 sites undergoing testing. This testing was conducted as a clinical service by several laboratories supporting research initiatives. During FY 2007, capacity to conduct infant PCR will be established at NPHLS and other clinical/reference laboratories. Capacity for other sophisticated laboratory assays such as BED incidence assays will also be established at NPHLS.

With support from APHL, the NPHLS will strengthen data management at the national reference laboratory, eight provincial and six pilot district laboratories. The national reference laboratory and four of the provincial laboratories have already been equipped for data management. During FY 2007, four more provincial laboratories and the six district laboratories will be equipped with computers and staff trained in data entry and analysis.

Through its National HIV Reference Laboratory (NHRL), NPHLS will oversee expansion of a National Quality Assurance (QA) Program for HIV and ART monitoring. By September, 2006, capacity to conduct QA for HIV rapid testing had been established at four provincial/regional laboratories. During FY 2007 this capacity will be established at four remaining provincial/regional laboratories. Currently, 7 provincial laboratories, and 13 other high volume CD4 testing centers are enrolled in the UK NEQAS program for QA/QC. During FY 2007, all sites conducting HIV rapid testing and/or CD4 cell count testing (currently MOH 44 sites) will be enrolled in relevant proficiency testing programs.

All activities will be implemented in accordance with the five-year National Laboratory Strategic Plan [2005-2010] which was developed with support from the Emergency Plan through APHL and is to be launched in September 2006.

3. CONTRIBUTION TO OVERALL PROGRAM AREA This activity will contribute to training of 1,200 individuals in lab-related services and to improvement in the capacity of 507 laboratories to perform HIV, CD4, and/or lymphocyte tests, allowing focused prevention efforts or referral to HIV treatment, and appropriate monitoring of people receiving treatment for HIV.

4. LINKS TO OTHER ACTIVITIES This activity is linked to activities in laboratory services, particularly (#6845, #7113 and #8763), Counseling and Testing supported by all partners, especially (#6941), TB/HIV

activities, particularly (#6944), and all activities in PMTCT. The supported services are further linked to ART services carried out by NASCOP and other treatment partners.

5. POPULATION BEING TARGETTED Laboratory workers, people with HIV/AIDS.

6. EMPHASIS AREAS The major emphasis area for this activity is in infrastructure, with minor areas in quality assurance and support supervision, commodity procurement, training, policy and guidelines (specifically to develop and implement Standard Operating Procedures).

1. LIST OF RELATED ACTIVITIES This activity relates to HTXS (#7004), MTCT (#7006), HVCT (#7009), HLAB (#7003 and #6940), and HVSI (#6988, #6824, #6946, #9012, and #7098).

2. ACTIVITY DESCRIPTION The National AIDS/STI Control Programme (NASCOP) is the department in the Ministry of Health responsible for coordinating all HIV/AIDS related activities. NASCOP continues to provide leadership in surveillance, program monitoring and HMIS, and in conducting national surveys and targeted evaluations.

FY 2007 funds for NASCOP will support several activities. (i) AIS: First, NASCOP will continue with work begun in 2006 on a national AIDS Indicator Survey (AIS). The AIS will provide national prevalence estimates in all age groups and provide data that can be used to measure progress in the Kenya National AIDS Strategic Plan and EP targets including improvements in knowledge of and access to treatment and prevention services (CT, PMTCT, ART). Household interviews, counseling and HIV testing will be done and results given at home to consenting participants. The survey will yield gender-specific 10-year age-band estimates of HIV prevalence for each of Kenya's 8 provinces. NASCOP will, alongside Central Bureau of Statistics (CBS), coordinate and supervise the interviewing, counseling, blood collection and testing component of the survey. CBS, with the support of ORC MACRO will lead in the sampling methodology and data management. A writing workshop will assist in analysis and preparation of the final report while building capacity for analysis and synthesis of data. This activity will also see the printing and dissemination of 12,000 copies of the AIS report.

(ii) Sentinel Surveillance: FY 2007 funding will also continue to support Kenya's national sentinel surveillance system which now includes 46 representative rural and urban sites that measure trends in HIV infection over time. PMTCT test acceptance and results are recorded in order to evaluate uptake and quality of testing. NASCOP trains health workers in these facilities, works with the National Public Health Laboratory Services and CDC to test samples for HIV and recent infection by BED assay. Data will be double-entered at regional and central levels, analyzed for prevalence and incidence trends, and reported to policy-makers and program managers to improve programs.

(iii) Monitoring and Evaluation Support: The implementation of a decentralized monitoring and evaluation system is essential to measuring the progress of EP implementation activities. The national rollout has begun and will continue in the next fiscal year. In order for the health facility based data to flow to the national level, the harmonized M&E registers and patient cards will be printed for all facilities and distributed. There will be ongoing training of health care workers, data clerks, district and provincial health management teams as well as M&E officers at the national office. Support supervision will be devolved to provincial level to facilitate faster collation and reporting of data as well as feedback to the health facilities. Motorbikes will be purchased to enable district level supervision in all the 74 districts. The integrated HIV/AIDS reporting of PMTCT, CT, ART and other HIV service indicators in a single paper-based form at facility level that will be computerized at the district level (MOH Form 727) to assist with national and Emergency Plan reporting of care, treatment and prevention indicators, including PMTCT, CT, care, and ART. Through this activity NASCOP will complete the implementation and use of an integrated Heath Management Information System to capture facility-level HIV service indicators.

(iv) As part following up the management of HIV/AIDS patients, NASCOP will oversee the implementation of an Electronic Medical Records (EMR) system at MOH facilities, with the assistance of the PHR+. The number of patients enrolled at comprehensive care clinics continues to grow as HIV-related mortality declines. Maintaining patient records on paper based systems is proving to be a big challenge to health care providers due to the volumes of paper they have to deal with. A pilot testing of the EMRs has been completed in Eastern province and this will now be scaled up nationally. The activity will provide detailed long term electronic data on follow-up of patients on treatment and provide easy mechanism of transfer of patient records whenever they change facility of treatment. It will also provide ready longitudinal data on treatment for program evaluation.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute by training 400 personnel in strategic information (sentinel surveillance, monitoring and evaluation, survey methodology) and by providing supportive supervision and improvement to the 46 sentinel surveillance sites, 74 District Health Management Teams and 10 Provincial/subprovincial MoH AIDS control offices. In addition, the activities will generate important data for EP program evaluation and policy formulation.

4. LINKS TO OTHER ACTIVIITES This activity relates to other NASCOP activities across multiple program areas: HTXS (#7004), MTCT (#7006]), HVCT (#7009), HLAB (#7003), HVSI (#6988), HLAB (#6940), HVSI (#6824), HVSI (#6946), HVSI (#9012) and HVSI (#7098).

5. POPULATIONS BEING TARGETED The HIV/AIDS indicator survey will target the general population, sentinel surveillance targets pregnant women and STI patients, the training and capacity building activities targets health workers, data managers, and the reports generated by this activity target policy makers.

6. EMPHASIS AREAS This activity has four emphasis areas, none of which are over 50% of the activity, including an AIS population survey , HMIS, surveillance systems, and the USG database and reporting system, which relies heavily on facility data produced by NASCOP.

Circumcision Policy Development and Dissemination: PEPFAR will support the Ministry of Health in the rapid development of Male Circumcision policy guidelines. This will involve the development of policy, implementation and technical guidelines by NASCOP. Funding will include support for technical assistance, dissemination and sensitization costs. A regional consultation prior to policy finalization will also be supported in Nyanza Province given the focus on implementation in this high prevalence, low-circumcizing area. WHO/UNAIDS normative guidance for countries regarding male circumcision will be evaluated in the context of Kenya as a component of HIV prevention, tool kits for rapid assessment, and guidance on training will be adapted. Funding will also support education and mobilization work with Luo elders and key stakeholders in Nyanza Province to address cultural and communication issues to prepare for programmatic scale-up.

Table 3.3.14:

Funding will support NASCOP and other key stakeholders to rapidly develop and disseminate STI and Prevention with Positive policies and guidelines for service providers throughout Kenya. Technical training and support for service providers will ensure strengthened service delivery for STI control, particularly within sexually active HIV-infected populations.

Table 3.3.14:

This activity complements the same activity under plus up funding. Funding will support NASCOP and other key stakeholders to rapidly develop and disseminate STI and Prevention with Positive policies and guidelines for service providers throughout Kenya. Technical training and support for service providers will ensure strengthened service delivery for STI control, particularly within sexually active HIV-infected populations.

Table 3.3.14: