1. LIST OF RELATED ACTIVITIES This activity relates to activities in HIV/AIDS treatment/ARV services (#6945) and, TB/HIV (#6944).

2. ACTIVITY DESCRIPTION University of California at San Francisco (UCSF) has been supporting palliative care and treatment services in Nairobi and Nyanza provinces. The UCSF approach through its FACES program promotes family-centered care for HIV rather than individuals with HIV. This innovative approach has ensured equity and greater disclosure within families. UCSF will implement comprehensive integrated PMTCT services in 20 facilities in Migori district starting with high volume facilities offering Antenatal care, delivery and postnatal services. Community peer support groups involving People Living with HIV/AIDS (PLWA) will be formed and supported.

In FY 2007, UCSF will implement integrated comprehensive PMTCT service in accordance with the National Comprehensive PMTCT guidelines. Comprehensive integrated PMTCT services include, but are not limited to counseling and testing of pregnant women and their partners in antenatal clinics, delivery units and postnatal clinics using the opt-out approach, clinical staging of all HIV positive women using WHO guidelines, use of appropriate antiretroviral regimens including HAART for maternal health in accordance to the National Antiretroviral therapy guidelines, use of zidovudine plus single dose nevirapine or use of single dose nevirapine for women presenting late in pregnancy, postnatal follow-up for the mother and exposed infants, initiation of cotrimoxazole prophylaxis to all exposed infants at 6 weeks, Early Infant Diagnosis (EID) at six weeks via PCR on Dry Blood Spots (DBS) from all exposed infants and successful referral of HIV-positive mothers, their male partners and infected infants to antiretroviral treatment centers. UCSF targets counseling and testing to 24,826 pregnant women and provide antiretroviral prophylaxis for 6,000 (600 on HAART, 3000 on AZT+sdNVP and 2,400 sdNVP) HIV-positive women. Early Infant Diagnosis (EID) using Dry Blood Spots (DBS) at six weeks and cotrimoxazole prophylaxis will target 3,600 HIV exposed infants. 200 counselors will be trained for enhanced adherence support to HIV-positive women and their families. 300 community health workers will be trained to provide community and facility referral linkages. 50 health supervisors will be trained in program management skills, including utilization of data for decision making for program improvement. UCSF will train and update skills of 150 service providers in comprehensive HIV management for HIV-positive pregnant mothers, their infants and their families.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute to 2.6% of the overall 2007 Emergency Plan PMTCT targets for Kenya. Community participation and male involvement will significantly contribute to PEPFAR goals for primary prevention, access to care and treatment, and support of those affected and infected. Technical assistance to the Ministry of health facilities will contribute to improvement of the quality of services. UCSF will facilitate capacity building of DHMTs for improved management of health services and set up of referral networks and linkages for a continuum of care from facilities to Home-based care within the community and among various programs within the district. This activity will contribute to increased awareness, demand creation and stigma reduction leading to increased utilization of services towards the goal of universal access to prevention, care and treatment services.

4. LINKS TO OTHER ACTIVITES Linkages to HIV care and treatment services will be strengthened, to ensure immediate appropriate care for the woman and exposed infants, and family members as well and thus optimize utilization of complementary services created through Emergency Plan funding. This activity will relate to the ARV services of KEMRI.

5. POPULATIONS BEING TARGETED This activity targets adults, pregnant women, HIV-positive pregnant women, HIV affected families, and HIV-positive infants. Health care providers including doctors, nurses and other health care workers will be targeted for training on PMTCT using the national NASCOP PMTCT CDC/WHO based curriculum.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address gender equity in HIV/AIDS programs through improved PMTCT service delivery at ante-natal clinics and maternity units. Community Health workers will conduct community mobilization activities that will help increase service uptake as well as address issues of stigma and discrimination at community level.

7. EMPHASIS AREAS This activity includes major emphasis on development of Network/Linkages/Referral systems with minor emphasis on Quality Assurance and Supportive Supervision; Community Mobilization/Participation and training.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in ARV Services (#7090, #6945), Counseling and Testing (#6941, #6907), TB/HIV (#9054, #6944), ART training (#6991) and PMTCT (#6949).

2. ACTIVITY DESCRIPTION The University of California at San Francisco (UCSF) will increase and strengthen its support at its existing sites in Nairobi and Nyanza, as well as substantially expand services in 4 districts in Nyanza to include 3 sites in Kisumu, 17 in Suba, 10 in Migori, and 8 in Kuria. These activities will support palliative care services for 12,000 people with HIV, including 1200 children. Services will include diagnostic testing; ongoing counseling with a particular focus on counseling for couples (including those with discordant HIV results); and prevention, diagnosis, and management of opportunistic infections. Funds will support salaries for health care workers and infrastructure through renovation in accordance with Emergency Plan guidance, in addition to training 50 individuals to provide HIV-related palliative care services. An area of emphasis for the UCSF supported program is to manage families rather than individuals with HIV. The programs supported by UCSF make extensive efforts to identify and provide treatment to family members of enrolled patients and have structured care provision to optimize the provision of care to families. UCSF also works closely with partners providing HIV prevention services to youth, and will provide youth-friendly HIV treatment services to individuals referred from those programs. Other areas of focus include identification and provision of care for children; integration of treatment with other services like TB, MCH and family planning; greater involvement of PLWHAs as peer educators and strengthening commodity management system. UCSF is collaborating with the National AIDS and STD Control Program (NASCOP) to develop a system for telephone consultation that will allow care providers in rural areas to access HIV expertise. Additional activities will include community mobilization and dissemination of informational materials to patients. UCSF will maintain data concerning the numbers of people served and will report both nationally and through the Emergency Plan.

Because of the geographic foci of the HIV epidemic in the United States, UCSF has vast experience providing HIV care and has long been recognized as one of the premier institutions providing HIV care in the United States. The faculty of UCSF also has extensive experience developing training materials and implementing HIV care and treatment programs in resource limited settings, including Kenya. Given that UCSF has a long-standing research presence in Kenya, these activities will capitalize on the resulting knowledge of Kenya as well as technical expertise in care and treatment. By March 2006, the established patient care centers in Nairobi and Nyanza were providing palliative care services to more than 3,500 people with HIV.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute to the expansion of palliative care services for clinically qualified HIV-positive patients, strengthened human resource capacity to deliver care services, and a strengthened referral network for provision of those services. The activities will specifically support improved quality of care, particularly for difficult to manage patients.

4. LINKS TO OTHER ACTIVITIES This activity relates to ARV activities (#7090, #6945), Counseling and Testing (#6941, #6907), TB/HIV (#9054, #6944), PMTCT programs (#6949) and to ART training (#6991).

5. POPULATIONS BEING TARGETED These activities target people (adults, children, infants) living with HIV/AIDS, including participants in US government sponsored research programs, couples with HIV, discordant couples, and families. Services for children with HIV are being established or expanded at all sites. Public health care providers, including doctors, nurses, pharmacists, and laboratory workers are targeted for increased HIV care and treatment knowledge and skills.

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

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

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative Care (#7089), ARV Services (#7090), Counseling and Testing (#6941, #6907) and PMTCT (#6949).

2. ACTIVITY DESCRIPTION University of California at San Francisco (UCSF) will support TB/HIV services for approximately 12,000 patients at 39 sites in Nairobi and Nyanza Provinces. TB screening 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 1,000 patients will be identified as being infected with both TB and HIV. Funds will support refresher training of laboratory staff and improvement of basic laboratory microbiology capacity in order to meet the increased needs for TB testing. 25 health care workers will be trained to provide clinical prophylaxis and/or treatment for TB to HIV-infected individuals. Additional activities will include community mobilization and dissemination of educational materials to patients. UCSF will maintain data concerning the numbers of people served and will report both nationally and through the Emergency Plan. Because of the geographic foci of the HIV epidemic in the United States, UCSF has vast experience providing HIV care and has long been recognized as one of the premier institutions providing HIV care in the US. The faculty of UCSF also has extensive experience developing training materials and implementing HIV treatment programs in resource limited settings, including Kenya. UCSF has a long-standing research presence in Kenya whose activities will capitalize on their technical expertise in treatment.

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 service.s

4. LINKS TO OTHER ACTIVITIES The overall program activity links closely to Palliative Care (#7089), ARV Services (#7090) currently supported by this partner, Counseling and Testing provided by KEMRI (#6941) and IMC (#6907), and PMTCT services offered by KEMRI (#6949).

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.

"This will be an expansion of exisiting activity in COP 07. 2. ACTIVITY DESCRIPTION University of California at San Francisco (UCSF) will support TB/HIV services for approximately 12,000 patients at 40 sites in Nairobi and Nyanza Provinces. Intensified TB screening 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 1,500 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. 75 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.

" UCSF will maintain data concerning the numbers of people served and will report both nationally and through the Emergency Plan. Because of the geographic foci of the HIV epidemic in the United States, UCSF has vast experience providing HIV care and has long been recognized as one of the premier institutions providing HIV care in the US. The faculty of UCSF also has extensive experience developing training materials and implementing HIV treatment programs in resource limited settings, including Kenya. UCSF has a long-standing research presence in Kenya whose activities will capitalize on their technical expertise in treatment.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative Care (#7089, #6942), Counseling and Testing (#6907, #6941), TB/HIV (#6944, #9054), and PMTCT (#6949).

2. ACTIVITY DESCRIPTION The University of California at San Francisco (UCSF) will increase and strengthen its support at its existing sites in Nairobi and Nyanza, as well as substantially expand services in 4 districts in Nyanza to include 3 sites in Kisumu, 10 in Suba, 10 in Migori, and 8 in Kuria. These activities will support ART services for 4,500 people with advanced HIV (1500 new patients), including 450 children. Services will include diagnostic testing; ongoing counseling with a particular focus on counseling for couples (including those with discordant HIV results); and prevention, diagnosis, and management of opportunistic infections. Funds will support salaries for health care workers in accordance with Emergency Plan guidance, and will improve infrastructure through renovation. An area of emphasis for the UCSF supported program is to manage families rather than individuals with HIV. The programs supported by UCSF make extensive efforts to identify and provide treatment to family members of enrolled patients, and are structured to optimize the provision of care to families. UCSF also works closely with partners providing HIV prevention services to youth and will provide youth-friendly HIV treatment services to individuals referred from those programs. Other areas of focus include identification and treatment of children, integration of treatment with other facility services like TB and MCH, decentralization of services, greater involvement of PLWAs as peer educators and strengthening the commodity management system. In addition, UCSF will provide high-level technical assistance to sites in Nyanza Province and will collaborate with the National AIDS and STD Control Program (NASCOP) in the development of a system for telephone consultation that will allow care providers in rural areas to access HIV expertise. Funding will be used to provide 50 health care workers with ART training. Additional activities will include community mobilization and dissemination of educational materials to patients. UCSF will maintain data concerning the numbers of people served and will report both nationally and through the Emergency Plan.

Because of the geographic foci of the HIV epidemic in the United States, UCSF has vast experience providing HIV care and has long been recognized as one of the premier institutions providing HIV care in the US. The faculty of UCSF also has extensive experience developing training materials and implementing HIV treatment programs in resource limited settings, including Kenya. UCSF has a long-standing research presence in Kenya whose activities will capitalize on their technical expertise in treatment. By March 2006, the established centers in Nairobi and Nyanza were providing ARV treatment to more than 1,000 people.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute to expansion of ARV treatment for clinically qualified HIV-positive patients, strengthened human resource capacity to deliver ARV treatment, and a strengthened referral network for provision of ART. The activities will specifically support improved quality of care, particularly for difficult to manage patients.

4. LINKS TO OTHER ACTIVITIES This activity relates to other UCSF, KEMRI and International Medical Corps activities in Palliative Care (#7089, #6942), Counseling and Testing (#6907, #6941), TB/HIV (#6944, #9054), and PMTCT (#6949).

5. POPULATIONS BEING TARGETED These activities target people (adults, children, infants) living with HIV/AIDS, including participants in US government sponsored research programs, couples with HIV, discordant couples, and families. Services for children with HIV are being established or expanded at all sites. Public health care providers, including doctors, nurses, pharmacists, and laboratory workers are targeted for increased HIV care and treatment knowledge and skills.

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, human resources, local organization capacity building, logistics, quality assurance and supportive supervision, targeted evaluation, and training.