1. LIST OF RELATED ACTIVITIES This activity relates to activities in HIV Services (#7015) and Palliative Care (#7014).

2. ACTVITY DESCRIPTION New York University School of Medicine has been supporting the scale up of HIV treatment in adults and children at Bomu Medical Centre (Bomu Clinic) located in the Coast Province since 2004. To date the program has supported a total of 469 adults and children to initiate Antiretroviral (ARV) Therapy. The program has been also supporting the integration of HIV counseling and testing for pregnant women in this facility in both the ANC and Maternity unit. To date, a total of 574 pregnant women have received HIV counseling and testing services, and 36 HIV-positive pregnant women given PMTCT prophylactic ARVs, and has also supported the establishment of a pediatric HIV care clinic with a total of 131 children enrolled on the care program.

In FY 2007, the program proposes to strengthen PMTCT services in both the ANC and Maternity unit and will target to provide HIV counseling and testing to 2,146 women and ARV prophylaxis to 161 HIV-positive women and 161 HIV exposed infants. In addition, the program will support the WHO clinical staging of all HIV-positive pregnant mothers to identify those eligible for HAART in line with the National guidelines, and will target to facilitate linkage or access to HAART for all eligible women identified. CD4 testing, if available, will be used as additional criteria for identification of women eligible for HAART. All HIV-positive women identified through the PMTCT program will be linked to the ongoing HIV care program. The on-going follow-up clinics for HIV positive women and their infants in the entire clinic will be strengthened through the provision of a defined package of care for both mother and infant. For the mother, the care components include counseling on appropriate infant feeding practices, linkage to family planning services, and linkage to HIV care and treatment and Palliative care services. The care package for the infant will include administration of Cotrimoxazole to 161 HIV exposed infants starting six weeks and DBS for PCR-HIV for Early infant diagnosis and will target 152 infants with this intervention. The program will collaborate with the HIV/AIDS treatment/ARV services to provide pediatric HIV services to all eligible infants identified through the program. The program targets to train a total of 12 service providers on PMTCT and will also engage Traditional Health workers for follow up activities.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA PMTCT activities in this facility will contribute to the PEPFAR goals of increasing the number of HIV-positive pregnant women and HIV-positive infants accessing HIV care and treatment services.

4. LINKS TO OTHER ACTIVITIES This activity links to NYU activities in HIV Care and Treatment, and Palliative Care (#7015 and #7014).

5. POPULATIONS BEING TARGETED This activity targets adults, pregnant women, HIV positive pregnant women, Infants and HIV-positive infants. The program also targets public health care workers namely doctors, nurses, traditional birth attendants and other health care workers for training and capacity building.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will increase gender equity in HIV/AIDS programs through providing PMTCT services to pregnant women.

7. EMPHASIS AREAS This activity includes major emphasis on Quality Assurance and Supportive Supervision, with minor emphasis on Training and Development of Network/Linkages/Referral Systems.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in ARV Services (#7015, #8813), PMTCT #8649), and Palliative Care: Basic Health Care and Support (#8934).

2. ACTIVITY DESCRIPTION New York University (NYU) will support palliative care services for 3000 people with HIV/AIDS including 350 children, at Bomu Clinic and two satellite sites in Mombasa. This will be accomplished by continuing to offer on-site material and technical support to build the capacity of this local facility to provide the services. The package of palliative care services will include cotrimoxazole prophylaxis, treatment of opportunistic infections, nutritional supplementation, TB screening, and sexually transmitted infection (STI) diagnosis and treatment, improved access to malaria prevention interventions, and safe water for pediatric households. Funds will provide salary support for health care workers in accordance with Emergency Plan guidance and training for 25 health care workers to deliver HIV palliative care. Activities will include community mobilization, strengthening of logistics capacity (particularly pharmacy management), and procurement of commodities such as laboratory reagents. Data concerning the numbers of patients receiving services will be collected and reported both nationally and through the Emergency Plan. Activities will be conducted in close collaboration with the ART Officer for Coast Province.

NYU has a long history of providing quality AIDS care in a variety of settings and over the past several years has expanded capacity and expertise related to provision of care and treatment in resource limited settings like Africa. The AIDS Research and Family Care Clinic (ARFCC) was established in May 2001 and provides a comprehensive range of free medical and psychosocial services to families living with HIV in and around Mombasa. The clinic is served by a dedicated laboratory that offers HIV tests, basic hematology and chemistry tests, and CD4 counts. The Bomu clinic is a private clinic that provides general medical services to thousands of patients and has recently expanded their capacity to provide specialized HIV services. NYU has supported development of a program that was providing palliative care services for more than 700 patients by June 2006, including more than 100 children. Given that NYU has particular expertise in pediatric care and treatment, this site is expected to rapidly expand care and treatment for children. A key barrier to expansion of the program at the moment is space. NYU has received grant funding from other sources to establish an annex to the main clinic building that will allow substantial expansion of pediatric care and treatment, and Emergency Plan funding will be used for renovations and refurbishment.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute to the results of expansion of access to palliative care services for more than 3000 people with HIV/AIDS, strengthened human resource capacity, and a strengthened referral network for provision of these services.

4. LINKS TO OTHER ACTIVITIES These activities link closely to ART services supported by NYU and FHI (#7015, #8813), and through referral to adult and pediatric HIV services provided at Coast Provincial Hospital, a network center supported by FHI (#8649). There are further links to area VCT and community-based activities currently supported by FHI including Palliative Care: Basic Health Care and Support (#8934).

5. POPULATIONS BEING TARGETED These activities target people (adults, children, infants) living with HIV/AIDS. A key focus of the family clinic is the provision of services to children with HIV, and the identification of children with HIV as a way of reaching entire families that are affected by HIV. Public health care providers, including doctors, nurses, pharmacists, and laboratory workers are targeted for increased HIV care and treatment knowledge and skills. Included among the populations served by these services will be participants in US government funded research programs.

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/linkages/referral systems, human resources, logistics, quality assurance and supportive supervision, strategic information and training.

"New York University (NYU) will support TB/HIV services for approximately 3,000 patients, at Bomu Clinic and two satellite sites in Mombasa, Coast Province. 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 300 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. 10 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. NYU will maintain data concerning the numbers of people served and will report both nationally and through the Emergency Plan. " NYU has a long history of providing quality AIDS care in a variety of settings and over the past several years has expanded capacity and expertise related to provision of care and treatment in resource limited settings like Africa. The AIDS Research and Family Care Clinic (ARFCC) was established in May 2001 and provides a comprehensive range of free medical and psychosocial services to families living with HIV in and around Mombasa. The clinic is served by a dedicated laboratory that offers HIV tests, basic hematology and chemistry tests, and CD4 counts. The Bomu clinic is a private clinic that provides general medical services to thousands of patients and has recently expanded their capacity to provide specialized HIV services. NYU has supported development of a program that was providing palliative care services for more than 700 patients by June 2006, including more than 100 children. Given that NYU has particular expertise in pediatric care and treatment, this site is expected to rapidly expand care and treatment for children. A key barrier to expansion of the program at the moment is space. NYU has received grant funding from other sources to establish an annex to the main clinic building that will allow substantial expansion of pediatric care and treatment, and Emergency Plan funding will be used for renovations and refurbishment. 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 (#7014), ARV Services (#7015,8813) 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) 3
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 300
services that are receiving treatment for TB disease Number of individuals trained to provide treatment for TB to 10
HIV-infected individuals (diagnosed or presumed)

Table 3.3.07:

"As pediatric treatment is scaled-up, providers increasingly report frustration with the challenge of having to educate and re-educate the caregivers of children. This primarily comes about in situations where an OVC who is infected does not have a consistent caregiver and therefore is - for example - accompanied to one visit by an aunt, to another by an older sibling, and perhaps to a third by a grandparent. This leads to longer-than-necessary clinic interactions, increased frustration for pediatric providers, and is presumed to contribute to sub-optimal care of children. Five high-volume treatment partners with significant stable adult patient populations (AMPATH, Eastern Deanery AIDS Relief Project, University of Washington/Coptic Hope Center, Kericho District Hospital and NYU/Bomu Medical Center) will receive amounts specified below for an innovation in OVC programming. " "They will be supported to establish programs where experienced adult patients (with a preference for women patients) will be screened, recruited, trained, supervised and compensated to take on a substantive role in assuring continuity of care for pediatric patients. Adult patients who are successfully managing their own treatment will be assigned a small (e.g., 5-7) cohort of pediatric patients and will be trained and supported to: 1)Make periodic (e.g., weekly) home visits to conduct medication counts and observe for signs of side effects or poor response to treatment; 2) Bring children without family caregivers to regularly scheduled medical appointments to provide continuity of contact with health workers and report on household conditions, and 3) Translate provider instructions back to individuals in the home or other setting who are responsible for the child's day-to-day care." In addition to funds to these treatment partners, funding in the amount of $200,000 is awarded to AED/Capable Partners, PEPFAR/Kenya's key ally in scaling-up community based OVC responses to design and implement a real-time evaluation of the efficacy of this approach to improving continuity of care and treatment outcomes for OVC who are HIV-positive. A technical working group representing all funded partners and the assessment partner will be formed to both assure consistency of programs and identify unique opportunities that individual partners may present for fine-tuning the model.

Table 3.3.08:

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative Care (#7014, #8934) and PMTCT (#8649).

2. ACTIVITY DESCRIPTION "This will be an expansion of the 07 activity. New York University (NYU) will support treatment at Bomu Clinic and two satellite sites in Mombasa, resulting in 2000 individuals receiving ART services, including 250 children (500 new, bringing the total ever served to 2300). This will be accomplished by providing on-site material and technical support that will build the capacity of this local facility to sustain treatment services for people with HIV. Funds will provide salary support for health care workers in accordance with Emergency Plan guidance and training for 20 health care workers. Activities will include community mobilization, strengthening of logistics capacity (particularly pharmacy management), and procurement of commodities such as laboratory reagents, and infrastructure improvement (renovations of the facilities). Data concerning the numbers of patients receiving services will be collected and reported both nationally and through the Emergency Plan. " Treatment activities will be conducted in close collaboration with the coast Provincial ART Officer. NYU has a long history of providing quality AIDS care in a variety of settings and over the past several years has expanded capacity and expertise related to provision of treatment in resource limited settings like Africa. The AIDS Research and Family Care Clinic (ARFCC) was established in May 2001 and provides a comprehensive range of free medical and psychosocial services to families living with HIV in and around Mombasa. The clinic is served by a dedicated laboratory that offers HIV confirmatory testing, basic hematology and chemistry tests, and CD4 counts. The Bomu clinic is a private clinic that provides general medical services to thousands of patients and has recently expanded their capacity to provide specialized HIV services for adults and children. NYU has supported development of a program that was providing treatment to 469 patients by June 2006, including 64 children. NYU brings particular expertise in pediatric treatment, and this site is expected to rapidly expand treatment for children. A key barrier to expansion of the program at the moment is space. NYU has received grant funding from other sources to establish an annex to the main clinic building that will allow substantial expansion of pediatric treatment, and Emergency Plan funding will be used for substantial renovations and refurbishment.

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 adult and pediatric ARV treatment, tighten linkages between prevention, care, and treatment activities, and strengthen referral networks for AIDS services.

4. LINKS TO OTHER ACTIVITIES These activities link to non-ART services supported by NYU and FHI, referral to adult and pediatric HIV services provided at Coast Provincial Hospital through FHI, a network center, and ART services coordinated by and supported through the National AIDS and STD Control Program (NASCOP). There are further links to area VCT and community-based activities currently supported by FHI, advanced training in HIV care supported through FHI, and network strengthening activities being implemented by the Kenya Pediatric Association, a sub-partner of the Cooperative Housing Foundation.

5. POPULATIONS BEING TARGETED These activities target people (adults, children, infants) living with HIV/AIDS. A key focus of the family clinic is the provision of services to children with HIV, and the identification of children with HIV as a way of reaching entire families that are affected by HIV. Treatment services for diagnosis and treatment of very young children will be established through a relationship with Kenya Medical Research Institute (KEMRI), whereby filter paper samples are transported to the KEMRI lab for polymerase chain reaction (PCR) infant testing. Public health care providers, including doctors, nurses, pharmacists, and laboratory workers are targeted for increased HIV care and treatment knowledge and skills. Included among the populations served by these services will be participants in US government funded research programs.

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/linkages/referral systems, human resources, infrastructure, logistics, quality assurance and supportive supervision, strategic information, targeted evaluation, and training.