1. LIST OF RELATED ACTIVITIES This activity relates to activities in Abstinence and Being Faithful (#7052), Condoms and Other Prevention (#7051), Blood Safety (#8804), and Counseling and Testing (#7049).

2. ACTIVITY DESCRIPTION Health Communication and Marketing (HCM) is an integrated project, focused primarily (at least 75%) on HIV/AIDS prevention care and treatment in support of other PEPFAR activities in Kenya. The purpose of the HCM award is to improve health outcomes through increased prevention and other healthy behaviors. This will be done through marketing and communications activities within the health sector. This activity will also build the sustainability of local organizations to do this work.

The objectives of this activity in HIV/AIDS are to: 1) Improve the preventive behaviors of Kenyans related to HIV/AIDS, in particular increasing the percent of men and women aged 15-24 abstaining from sex, promoting fidelity, partner reduction, the correct and consistent use of condoms in high-risk sexual encounters, and the percent of men and women going for VCT and receiving their test results (the "ABC" approach). 2) Improve service utilization rates for voluntary counseling and testing (VCT), and prevention of mother to child transmission (PMTCT) of HIV. This includes increasing the percentage of pregnant women who access PMTCT services including VCT and increasing the number of Kenyans who use VCT services and receive their test results. 3) Build the capacity of local institution(s) in Kenya's commercial, non-governmental, and/or faith-based sectors by working in collaboration with them to develop and manage a cost-effective marketing, sales, and distribution network that improves availability and access by key populations to products related to HIV/AIDS; develop and manage a communications initiative to increase knowledge and change behavior of Kenyans with respect to HIV/AIDS including interpersonal communication; and develop the management and technical capacity of these organizations to manage and implement social marketing and communications programs.

This program will not issue sub awards but will pay suppliers of goods and services directly,

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA In FY 2007, in PMCT, this partner will develop and disseminate communication messages/materials on prevention of mother to child activities promoting testing of pregnant women in order to protect the unborn child from HIV infection. This activity will also target People Living with HIV/AIDS (PLWHAs) and especially HIV positive couples planning to have a baby. It is anticipated to promote counseling and testing services and generate demand for PMCT services for both voluntary and provider initiated testing. They will reach over 6 million people through mass media.

4. LINKS TO OTHER ACTIVITIES This activity relates to activities in Abstinence and Being Faithful (#7052), Other Prevention (#7051), Blood Safety (#8804) and Counseling and Testing (#7049) through promotion of networking, referrals and linkages.

The Health Communications and Marketing project is a national level activity that will enforce messages through mass media and interpersonal communication developed in collaboration with MOH/NASCOP PMCT committee at the national level and projects working at the regional level. Both NASCOP and these provincial projects will "feed into" the development of population-specific messages which will strengthen interventions implemented on the ground.

5. POPULATIONS BEING TARGETED PMCT messages will primarily focus on adults both male and female, public and private health providers and NGOs and faith-based programs as well as policy makers.

6. KEY LEGISLATIVE ISSUES ADDRESSED Messages developed will address gender norms and behavior, increased male involvement in matters considering the preservation of the family unit, and reduction of stigma and discrimination.

7. EMPHASIS AREAS HCM is primarily a communications activity focusing on the development of information, education and communication. However, they will also mobilize communities through interpersonal communication and make linkages with other sectors for message development.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Other Prevention (#8930), (#8932), (#8874), (#9040), (#8937), (#8927), (#8942), Counseling and Testing (#8760), (#8776), (#8777), (#8778), (#8781), (#8782), (#8976), Prevention of Mother-to-Child Transmission (#8729), (#8733), (#8734), (#8738), (#8752),(#8764), (#7087), HIV/AIDS Treatment: ARV Services (#8765), (#8774), (#8792), (#8797), (#8805), (#8813), (#8826), (#6899) and HIV/AIDS Treatment: ARV Drugs (#6997).

2. ACTIVITY DESCRIPTION Health Communication and Marketing (HCM) is an integrated project, focused primarily (at least 75%) on HIV/AIDS prevention, care and treatment in support of other PEPFAR activities in Kenya. The purpose of the HCM award is to improve health outcomes through increased prevention and other healthy behaviors. This will be done through marketing and communications activities within the health sector. This activity will also build the sustainability of local organizations to do this work. Through a Public-Private Partnership $200,000 will support the development of a nationwide follow-on to the highly successful PEPFAR-funded "Nime Chill" youth abstinence campaign. Discussion is underway to partner with the Coca Cola Foundation for this project, where Coca Cola would contribute marketing expertise and its access to trucks, kiosks, and other physical structures to display the abstinence message. The objectives of this activity in HIV/AIDS are to 1) improve the preventive behaviors of Kenyans related to HIV/AIDS, in particular increasing the percent of men and women aged 15-24 abstaining from sex, promoting fidelity, partner reduction, the correct and consistent use of condoms in high-risk sexual encounters, and the percentage of men and women going for VCT and receiving their test results (the "ABC" approach); 2) improve service utilization rates for voluntary counseling and testing (VCT), and prevention of mother to child transmission (PMTCT) of HIV. This includes increasing the percentage of pregnant women who access PMTCT services including VCT and increasing the number of Kenyans who use VCT services and receive their test results; 3) build the capacity of local institution(s) in Kenya's commercial, non-governmental, and/or faith-based sectors by working in collaboration with them to develop and manage a cost-effective marketing, sales and distribution network that improves availability and access by key populations to products related to HIV/AIDS; 4) develop and manage a communications initiative to increase knowledge and change behavior of Kenyans with respect to HIV/AIDS including interpersonal communication; and 5) develop the management and technical capacity of these organizations to manage and implement social marketing and communications programs. Through these interventions, the awardee will target at least 50,000 people with AB messages and train at least 500.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA In FY 2007, in AB, this partner will develop and disseminate communication messages/materials on abstinence for youth and build on programs in the education sector targeting in-school youth. It will also promote messages on secondary virginity and the importance of faithfulness within marriage. This activity will generate demand for information about abstinence and being faithful, which will be followed up with interpersonal communication activities.

4. LINKS TO OTHER ACTIVITIES The Health Communications and Marketing project is a national level activity that will enforce messages through mass media and interpersonal communication developed in collaboration with projects working at the regional level. These projects will "feed into" the development of population-specific messages which will strengthen peer education interventions implemented on the ground.

5. POPULATIONS BEING TARGETED AB messages will primarily focus on 10-14 year olds, both in- and out-of-school; youth of reproductive age and teachers, but also adult members of the general population.

6. KEY LEGISLATIVE ISSUES ADDRESSED Messages developed will address gender norms and behavior, stigma and discrimination.

7. EMPHASIS AREAS HCM is primarily a communications activity focusing on the development of information,

education and communication. However, they will also mobilize communities through interpersonal communication, make linkages with other sectors for message development (e.g. CT, PMTCT) and collaborate with the education sector, and train individuals in message development and communication.

PLUS UP: The purpose of the HCM award is to improve health outcomes through increased prevention and other healthy behaviors. This will be done through marketing and communications activities within the health sector. This activity will also build the sustainability of local organizations to do this work. In collaboration with the Ministry of Health, PSI will also promote medical male circumcision as a proven intervention to reduce transmission of HIV. Information about abstinence and being faithful will be shared with those who volunteer to undergo circumcision.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Abstinence and Being Faithful (#7052), Other Prevention (#7051), PMCT (#7050), and Counseling and Testing (#7049).

2. ACTIVITY DESCRIPTION Health Communication and Marketing (HCM) is an integrated project, focused primarily (at least 75%) on HIV/AIDS prevention, care and treatment in support of other PEPFAR activities in Kenya. The purpose of the HCM award is to improve health outcomes through increased prevention and other healthy behaviors. This will be done through marketing and communications activities within the health sector. This activity will also build the sustainability of local organizations to do this work.

The objectives of this activity in HIV/AIDS are to:

1) Improve the preventive behaviors of Kenyans related to HIV/AIDS, in particular increasing the percent of men and women aged 15-24 abstaining from sex, promoting fidelity, partner reduction, the correct and consistent use of condoms in high-risk sexual encounters, and the percent of men and women going for VCT and receiving their test results (the "ABC" approach).

2) Improve service utilization rates for voluntary counseling and testing (VCT), and prevention of mother to child transmission (PMTCT) of HIV. This includes increasing the percentage of pregnant women who access PMTCT services including VCT and increasing the number of Kenyans who use VCT services and receive their test results.

3) Build the capacity of local institution(s) in Kenya's commercial, non-governmental, and/or faith-based sectors by working in collaboration with them to develop and manage a cost-effective marketing, sales, and distribution network that improves availability and access by key populations to products related to HIV/AIDS; develop and manage a communications initiative to increase knowledge and change behavior of Kenyans with respect to HIV/AIDS including interpersonal communication; and develop the management and technical capacity of these organizations to manage and implement social marketing and communications programs.

This activity will not provide any sub awards.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA In FY 2007, in blood safety, this partner will develop and disseminate communication messages/materials targeting the general population and promoting blood donation to save lives. It will also promote messages to encourage blood donors to join blood donor clubs. This activity will contribute indirectly to reduce HIV transmission through blood transfusion.

4. LINKS TO OTHER ACTIVITIES The Health Communications and Marketing project is a national level activity that will enforce messages through mass media and interpersonal communication developed in collaboration with the National Blood Transfusion Services and regional blood transfusion centers. These projects will "feed into" the development of population-specific messages which will strengthen blood donation activities implemented on the ground.

5. POPULATIONS BEING TARGETED Blood Safety messages will primarily focus on the general population, in- and out-of-school youth, youth of reproductive age and teachers.

6. KEY LEGISLATIVE ISSUES ADDRESSED Messages developed will address stigma and discrimination.

7. EMPHASIS AREAS HCM is primarily a communications activity focusing on the development of information, education and communication. However, they will also mobilize communities through interpersonal communication, make linkages with other sectors for message development (e.g. CT, PMTCT), and train individuals in message development and communication.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Abstinence and Being Faithful (#8950), (#8725), (#8731), (#9070), (#9074), (#8994), (#8989), Condoms and Other Prevention Activities (#8930), (#8932), (#8874), (#9040), (#8937), (#8927), (#8942), Counseling and Testing (#8781), (#8782), (#8976), (#8776), (#8778), (#8777), (#8760), and Prevention of Mother-to-Child Transmission (#8764), (#8752), (#8729), (#8733), (#7087), (#8738), (#8734). It also relates to HIV/AIDS Treatment: ARV Services (#6899) and HIV/AIDS Treatment: ARV Drugs (#6969).

2. ACTIVITY DESCRIPTION Health Communication and Marketing (HCM) is an integrated project, focused primarily (at least 75%) on HIV/AIDS prevention care and treatment in support of other PEPFAR activities in Kenya. The purpose of the HCM award is to improve health outcomes through increased prevention and other healthy behaviors. This will be done through marketing and communications activities within the health sector. This activity will also build the sustainability of local organizations to do this work.

The objectives of this activity in HIV/AIDS are to 1) Improve the preventive behaviors of Kenyans related to HIV/AIDS, in particular increasing the percent of men and women aged 15 to 24 abstaining from sex, promoting fidelity, partner reduction, the correct and consistent use of condoms in high-risk sexual encounters, and the percent of men and women going for voluntary counseling and testing (VCT) and receiving their test results (the "ABC" approach); 2) Improve service utilization rates for VCT, and prevention of mother to child transmission (PMTCT) of HIV. This includes increasing the percentage of pregnant women who access PMTCT services, including VCT, and increasing the number of Kenyans who use VCT services and receive their test results; 3) Build the capacity of local institution(s) in Kenya's commercial, non-governmental, and/or faith-based sectors by working in collaboration with them to develop and manage a cost-effective marketing, sales, and distribution network that improves availability and access by key populations to products related to HIV/AIDS; develop and manage a communications initiative to increase knowledge and change behavior of Kenyans with respect to HIV/AIDS including interpersonal communication; and develop the management and technical capacity of these organizations to manage and implement social marketing and communications programs. The awardee will support 35,000 condom outlets nationwide, e.g. in hotels, kiosks, bars and other public places.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA In FY 2007, in OP, this partner will develop and disseminate communication messages/materials on condoms and other prevention targeting over-14 year old youth and high-risk populations. It will also promote messages on abstinence and the importance of faithfulness within marriage to approximately 500,000 members of the target population. This activity will generate demand for information about condoms and other prevention interventions, however as there will not be outreach activities, these targets do not apply.

4. LINKS TO OTHER ACTIVITIES The Health Communications and Marketing project is a national level activity that will enforce messages through mass media and interpersonal communication developed in collaboration with projects working at the regional level. These projects will "feed into" the development of population-specific messages which will strengthen peer education interventions implemented on the ground. Approximately 1,000 people will be trained to disseminate behavior change messages.

5. POPULATIONS BEING TARGETED OP messages will primarily focus on over 14 year olds, adults and high-risk populations such as substance-abusers and street youth.

6. KEY LEGISLATIVE ISSUES ADDRESSED Messages developed will address gender norms and behavior, stigma and discrimination.

7. EMPHASIS AREAS HCM is primarily a communications activity focusing on the development of information, education and communication. However, they will also mobilize communities through

interpersonal communication, make linkages with other sectors for message development (e.g. CT, PMTCT), and train individuals in message development and communication.

Plus up: The purpose of the HCM award is to improve health outcomes through increased prevention and other healthy behaviors. This will be done through marketing and communications activities within the health sector. This activity will also build the sustainability of local organizations to do this work. HCM is primarily a communication activity focusing on the development of information, education, and communication. In collaboration with the Ministry of Health, PSI will also promote medical male circumcision as a proven intervention to reduce transmission of HIV. Information about other prevention, including condom use, will be shared with those who volunteer to undergo circumcision.

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Table 3.3.07: Program Planning Overview Program Area: Palliative Care: TB/HIV Budget Code: HVTB Program Area Code: 07 Total Planned Funding for Program Area: $ 16,150,000.00

Program Area Context:

Key Result 1: Intensified screening and treatment for HIV among TB patients and for TB among HIV+ patients Key Result 2: Expanded and strengthened delivery of integrated HIV and TB services, including strengthened referral systems Key Result 3: Strengthened capacity of health workers to provide integrated HIV and TB services Key Result 4: Overall strengthened partnerships for TB/HIV activities

CURRENT PROGRAM CONTEXT In 2005, the National Leprosy and TB Program (NLTP) reported 108,000 cases of TB, 60% of which were estimated to be co-infected with HIV. This represents a more than five-fold increase in the national TB burden over the last 15 years. Due to the high rate of HIV infections among TB patients, the KNLTP 5-Year Strategic Plan (2006 -2010) recognizes that the integration of TB and HIV services is essential to ensure that patients affected by both epidemics receive appropriate TB and HIV care and treatment. In FY 2006, USG resources and technical assistance complemented GOK efforts in the development of a TB/HIV training curriculum, support for TB/HIV activities in the prisons and for a multi-media TB/HIV campaign. Additional support targeted the private sector as an important underutilized resource for TB/HIV activities. Diagnostic counseling and testing for all TB patients is now the standard of care in Kenya and 60% coverage was achieved in 2006 during which 94% and 30% of eligible HIV+ TB patients were placed on CTX and ART, respectively. USG support for TB/HIV surveillance continues to yield essential data to monitor and evaluate program performance and benchmark targets and quality of care.

NEW INTIATIVES The emphasis of USG support in FY 2007 will be provision of HIV counseling and testing for all persons evaluated for TB disease (TB suspects and TB patients); screening HIV-infected patients receiving HIV services in patient support centers and medical in-patient wards, as well as other HIV care settings for TB and treat or refer for treatment as appropriate; linking all HIV-infected TB suspects to TB diagnosis, and appropriate TB/HIV care, and strengthening training in TB and HIV diagnosis/care/management. Through the national, regional and district TB/HIV coordinating bodies, the linkage between TB services with accredited HIV treatment sites will be strengthened and expanded as will be TB laboratory services, patient referral/tracking systems, and recording and reporting systems. PEPFAR funds will also be used to support procurement of essential commodities such as HIV test kits and cotrimoxazole (CTX), and to improve infrastructure.

Increased access to CTX and ART is planned for all eligible TB patients in 2007. Further, support for participation of private practitioners in TB/HIV activities will be strengthened and expanded through public-private partnerships. Ongoing activities also aim to provide technical and financial support to provincial and district health management teams to increase local ownership and strengthen referral networks between TB and HIV services. Staff support to the NLTP and National AIDS and STD Control Program will enhance TB and AIDS program linkages to care and treatment. It is expected that FY 2007 efforts will: 1) increase the proportion of TB patients tested for HIV from 60% to 80%; 2) increase the proportion of HIV+ TB patients on CTX from 94% to 100%; 3) increase the proportion of PLWHA screened for TB from 10% to at least 20%; and 4) increase the proportion of HIV+ TB patients receiving ART from 30% to 50%

WORK OF HOST GOVERNMENT AND OTHER DONORS To meet these targets, USG agencies (CDC, USAID and DOD) will work complementarily with the national HIV/AIDS and TB programs, WHO, and all implementing TB/HIV partners. The Emergency Plan funds a variety of other programs supporting TB services such as the large AMPATH ART program in western Kenya. The Laboratory Program is supporting the National TB Reference Laboratory to provide staff training and EQA to all smear microscopy, mycobacterial culture and TB drug susceptibility networks. The

TB/HIV program will partner with the VCT program to implement prevention with positives in TB clinics. The care and treatment and strategic information program areas are supporting selected TB/HIV targeted evaluations (TEs) whose outcomes will improve program performance. The USG team will continue to promote integration of TB/HIV care and health care worker training into core programs such as VCT, PMTCT and care/treatment. For instance, the potential of initiating ART in TB clinics / TB therapy in ART clinics will be evaluated as will new diagnostic algorithms to diagnose smear negative, extrapulmonary and pediatric TB as these become available. Appropriate attempts will be made to include HIV-infected children in all TB/HIV policies and programs.

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 patients. Kenya also expects to receive Round 6 Global Fund support to strengthen TB diagnostic capacity at the dispensary level. Additional support amounting to $600,000 will be received in 2006/2007 through an OGAC/WHO collaboration to support collaborative TB/HIV activities in 15 districts.

In addition to required PEPFAR TB/HIV indicators, in 2007 we will also document the following custom indicators to assist with TB/HIV program management and evaluation: 1) number and percentage of HIV+ patients in HIV care screened for TB; 2) number and percentage of TB suspects/patients tested for HIV; 3) number and percentage of HIV+ registered TB patients/suspects; 4) number and percentage of HIV+ TB patients receiving CTX; and 5) number and percentage of HIV+ TB patients receiving ART.

Program Area Target: Number of service outlets providing treatment for tuberculosis (TB) to 1,650 HIV-infected individuals (diagnosed or presumed) in a palliative care setting Number of HIV-infected clients attending HIV care/treatment services that are 98,250 receiving treatment for TB disease Number of HIV-infected clients given TB preventive therapy 0 Number of individuals trained to provide treatment for TB to HIV-infected 2,500 individuals (diagnosed or presumed)

Table 3.3.07:

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Abstinence and Being Faithful (#8950, #8725, #8731, #9070, #9074, #8994, #8989), Counseling and Testing (#8760, #8776, #8777, #8778, #8781, #8782, #8976), PMTCT (#8729, #8733, #8734, #8738, #8752, #8764) and ARV Services (#8765, #8774, #8792, #8797, #8805, #8813, #8826).

2. ACTIVITY DESCRIPTION Health Communication and Marketing (HCM) is an integrated project, focused primarily (at least 75%) on HIV/AIDS prevention care and treatment in support of other PEPFAR activities in Kenya. The purpose of the HCM award is to improve health outcomes through increased care, prevention and other healthy behaviors. This will be done through marketing and communications activities within the health sector. This activity will also build the sustainability of local organizations to do this work.

The objectives of this activity in HIV/AIDS is to build the capacity of local institution(s) in Kenya's commercial, non-governmental, and/or faith-based sectors by working in collaboration with them to develop and manage a cost-effective marketing, information and communication strategy, and distribution network that improves availability and access by key populations to information related to HIV/AIDS; develop and manage a communications initiative to increase knowledge and change behavior of Kenyans with respect to HIV/AIDS including interpersonal communication; and develop the management and technical capacity of these organizations to manage and implement social marketing and communications programs. This will improve the care and understanding of orphans and vulnerable children and their caregivers.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA In FY 2007, this partner will develop and disseminate communication messages/materials on OVC issues in a wider forum. It will also promote messages on abstinence and the importance of faithfulness within marriage. This activity will generate demand for information about OVC and caregivers. However no direct targets will be achieved but more population will be enlightened on OVC issues and it is assumed that more OVC and caregivers will be reached indirectly.

4. LINKS TO OTHER ACTIVITIES The Health Communications and Marketing project is a national level activity that will enforce messages through mass media and interpersonal communication developed in collaboration with projects working at the regional level. These projects will "feed into" the development of population-specific messages which will strengthen peer education interventions implemented on the ground. This activity has links in the following activities: Abstinence and Being Faithful (#8950, #8725, #8731, #9070, #9074, #8994, #8989), Counseling and Testing (#8760, #8776, #8777, #8778, #8781, #8782, #8976), PMTCT (#8729, #8733, #8734, #8738, #8752, #8764) and ARV Services (#8765, #8774, #8792, #8797, #8805, #8813, #8826).

5. POPULATIONS BEING TARGETED OVC messages will primarily focus general population, caregivers, widows, widowers, policy makers, community and religious leaders as well as community-based and faith-based organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED Messages developed will address gender norms and behavior, stigma and discrimination.

EMPHASIS AREAS HCM is primarily a communications activity focusing on the development of information, education and communication. However, they will also mobilize communities through interpersonal communication, make linkages with other sectors for message development (e.g. CT, PMTCT), and train individuals in message development and communication.

The original activity was a TBD in the 07 COP and now awarded to PSI under the APHIA II - Health Communications and Marketing Project (HCM). These funds will also support a health marketing and communications campaign to encourage early and appropriate testing of children so they may be referred to health and psycho-social support related to their disease in OVC and other child-caring agencies where an estimated 2,000 undiagnosed HIV+ children between the ages of 2 and 12 are in care ($500,000).

Table 3.3.09: Program Planning Overview Program Area: Counseling and Testing Budget Code: HVCT Program Area Code: 09 Total Planned Funding for Program Area: $ 18,960,000.00

Program Area Context:

Key Result 1: 583 service outlets providing counseling and testing according to national and international standards Key Result 2: 937,900 individuals receiving counseling and testing for HIV and receiving their test result Key result 3: 2,220 individuals trained in counseling and testing according to national and international standards

CURRENT PROGRAM CONTEXT HIV counseling and testing (CT) is a key HIV/AIDS intervention for prevention as well as for care and treatment. CT is a distinct priority in both the Kenya National AIDS Strategic Plan and in the Emergency Plan's five-year strategy. Initial emphasis was almost exclusively focused on client-initiated CT (i.e., VCT). Since publication by the Ministry of Health (MOH) of Guidelines for HIV testing in Clinical Settings in November 2004, other approaches have come to the fore and CT is now seen in a broader context.

HIV prevalence in Kenya is currently estimated at 6.7%, meaning that there are 1.25 million Kenyans living with HIV/AIDS (PLWHA). According to the Kenya Demographic and Health Survey 2003, more than 80% of them do not know their HIV status, although most were willing to learn it. At least 200,000 currently need anti-retroviral therapy (ART).

By the end of FY 2007, 158,000 Kenyans will be on ART directly supported by the Emergency Plan, a 33% increase from 2006. At least 287,000 will need to be counseled and tested in a proper environment to achieve this increase. Apart from meeting treatment targets, CT services will also greatly enhance prevention efforts.

CT services are well dispersed geographically, with a higher concentration in more densely populated areas. In some of the more remote and difficult to reach areas, innovative approaches such as mobile VCT are employed. By the end of 2006, 600,000 Kenyans will have been tested in VCT settings, with more than 60% of these tests directly supported by USG.

CT services are provided largely by counselors who have been trained and certified using a nationally accepted curriculum. They use a standard algorithm including HIV rapid tests in series. All tests used have been approved by the national lab committee. Quality assurance is also done for both counseling and testing.

VCT The USG team works closely with the VCT team at the National AIDS and STD Control Program (NASCOP) in strengthening VCT services country-wide. The HHS/CDC cooperative agreement with NASCOP provides funds to the GOK for national oversight and supervision of CT services, and almost all CT services in Kenya are either directly or indirectly supported by the Emergency Plan.

Emergency Plan funds support mobile VCT (MVCT) in rural and underserved areas using converted trucks, containers on wheels, bicycles, and camels. These services have proved to be extremely popular, and we plan to increase MVCT to reach nearly 80,000 individuals in FY 2007. Rapid scale-up of ART services has meant that most VCT clients found to be HIV positive can be referred for care and treatment services nearby.

In FY 2006, home based (or door to door) VCT was piloted in parts of Nyanza province. This will be scaled up substantially in FY 2007 to other high prevalence provinces and districts. This strategy will lead to large numbers of previously undiagnosed people knowing their HIV status and accessing treatment. Home based VCT will be part of a comprehensive community HIV/AIDS program that includes aspects of care and prevention.

DTC Since the launch to the Guidelines for HIV Testing in Clinical Settings, many partners and health institutions have embraced provider-initiated CT. Although this has not attained complete national coverage, it has received widespread acceptance and support, including in the private health sector. The program was initiated in TB and STI clinics and expanded to inpatient wards. In FY 2007, DTC will be further scaled up through dissemination of guidelines, training and media campaigns. Routine testing in health settings will be piloted and evaluated in 2007.

REFERRAL AND LINKAGES In FY 2007, strengthening communication between CT and other HIV/AIDS services, especially care and treatment, will be a priority. In VCT, partners have been encouraged to formalize the referral of clients to care, within limits of confidentiality. As most provider-initiated CT is based in health care settings, health workers will be sensitized about the benefits of testing and referral. Managers of heath institutions will also be informed about CT to solicit their support in encouraging health workers to be involved in CT work. In a limited number of carefully selected sites, routine CT for all patients visiting a health facility will be piloted and evaluated. We have also encouraged partners to implement a training package to equip counselors to multi-task, e.g., to do both VCT and DTC, for adults, children and couples as necessary.

TEST KITS HIV test kits are procured MOH and distributed to all CT providers. The Ministry has and will continue to procure with support from the Global Fund and other development partners. The erratic supply reported in the past has been a function of weak distribution and reporting systems which the USG team in Kenya will continue working closely GOK officials to improve.

NEW INITIATIVES Novel approaches such as door to door testing in high prevalence areas, testing of family members of patients on ART, and self testing for health workers will be piloted and evaluated. Innovative approaches intended to improve access to CT by special populations including the disabled, injection drug users, refugees, nomads, long distance truck drivers and prisoners have been initiated, and significant scale up of these activities is planned in this COP, leading to testing of approximately 75,000 marginalized people. Building on the success of mass media promotion of VCT services in Kenya, which has markedly increased the demand for VCT services, we propose to introduce mass media promotion of CT services in clinical sites. 100% of CT activities will contribute to the 2006 treatment target.

BARRIERS ENCOUNTERED/STRATEGIES FOR RESOLUTION Irregular and unpredictable supply of HIV test kits continues to be a major challenge to the CT program in Kenya. This is caused by a multiplicity of factors including long procurement procedures and inadequate forecasting. In FY 2007, the USG will greatly expand its procurement of HIV rapid test kits to help stabilize supply. The USG team will also work with other partners in the area of test kits. The actual funds in FY 07 will come from several program areas, the bulk being in HLAB.

WORK OF HOST GOVERNMENT AND OTHER DONORS Counseling and testing is a high priority intervention, and CT is supported by the Government of Kenya, the Global Fund, the UK Department for International Development, and many international NGOs.

Program Area Target: Number of service outlets providing counseling and testing according to 771 national and international standards Number of individuals who received counseling and testing for HIV and 969,700 received their test results (including TB) Number of individuals trained in counseling and testing according to national 5,072 and international standards

Table 3.3.09:

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Abstinence and Being Faithful (#7052), Other Prevention (#7051), Blood safety (##8804), and PMTCT (#7050).

2. ACTIVITY DESCRIPTION Health Communication and Marketing (HCM) is an integrated project, focused primarily (at least 75%) on HIV/AIDS prevention care and treatment in support of other PEPFAR activities in Kenya. The purpose of the HCM award is to improve health outcomes through increased prevention and other healthy behaviors. This will be done through marketing and communications activities within the health sector. This activity will also build the sustainability of local organizations to do this work.

The objectives of this activity in HIV/AIDS are to 1) Improve the preventive behaviors of Kenyans related to HIV/AIDS, in particular increasing the percent of men and women aged 15-24 abstaining from sex, promoting fidelity, partner reduction, the correct and consistent use of condoms in high-risk sexual encounters, and the percent of men and women going for VCT and receiving their test results (the "ABC" approach). 2) Improve service utilization rates for voluntary counseling and testing (VCT), and prevention of mother to child transmission (PMTCT) of HIV. This includes increasing the percentage of pregnant women who access PMTCT services including VCT and increasing the number of Kenyans who use VCT services and receive their test results. 3) Build the capacity of local institution(s) in Kenya's commercial, non-governmental, and/or faith-based sectors by working in collaboration with them to develop and manage a cost-effective marketing, sales, and distribution network that improves availability and access by key populations to products related to HIV/AIDS; develop and manage a communications initiative to increase knowledge and change behavior of Kenyans with respect to HIV/AIDS including interpersonal communication; and develop the management and technical capacity of these organizations to manage and implement social marketing and communications programs.

This program will not issue sub awards but will pay suppliers of goods and services directly,

5. CONTRIBUTIONS TO OVERALL PROGRAM AREA In FY 2007, in CT, this partner will develop and disseminate communication messages/materials on counseling and testing promoting provider initiated testing and continues VCT promotion especially targeting the couple testing and discordant couples. It is anticipated to promote counseling and testing services and generate demand for CT services for both voluntary and provider initiated testing. They will reach over 6 million through mass media.

4. LINKS TO OTHER ACTIVITIES This activity relates to activities in Abstinence and Being Faithful (#7052), Other Prevention (#7051), Blood safety (#8804), and PMTCT (#7050).

The Health Communications and Marketing project is a national level activity that will enforce messages through mass media and interpersonal communication developed in collaboration with MOH/NASCOP CT committee at the national level and projects working at the regional level. Both NASCOP and these provincial projects will "feed into" the development of population-specific messages which will strengthen interventions implemented on the ground.

5. POPULATIONS BEING TARGETED CT messages will primarily focus on adults both male and female, public and private health providers and NGOs and faith-based programs. This activity will also work with the National AIDS Control Program staff and policy makers in the coordination of efforts in this program area.

6. KEY LEGISLATIVE ISSUES ADDRESSED Messages developed will address gender norms and behavior, stigma and discrimination.

7. EMPHASIS AREAS HCM is primarily a communications activity focusing on the development of information,

education and communication. However, they will also mobilize communities through interpersonal communication and make linkages with other sectors for message development.

The proposed unallocated funding of $350,000 is for the expansion of an exisiting activity in the 2007 COP. Funds will be used to carry out media and public education activities in CT. The specific areas to be supported include Media campaigns at various levels, production of educational materials for both health facilities and in the community and the development of a CT communication strategy for Kenya. In FY 07 this activity will focus on three main areas; the HIV testing week (RRI), PITC and, door-to-door CT.

In this program area, the APHIA Health Communication and Marketing activity will work to broaden cultural acceptance of medical male circumcision as a prevention intervention to reduce the risk of HIV transmission. This will be done through media campaigns as well as interpersonal communication.

Table 3.3.14: