1. RELATED ACTIVITIES (#7095) ARV services. 2. ACTIVITY DESCRIPTION UON, Department of Obstetrics and Gynecology has been supporting implementation of comprehensive PMTCT services in Kenyatta National Hospital (KNH) and Pumwani Maternity Hospital (PMH) the two largest maternity units in the country and has successfully integrated these services as part of routine care for all women accessing services here. During the past year, the program supported HIV counseling and testing to 31,670 with over 85% of these seen on admission to labor and delivery units. Close to 4,500 HIV-positive mothers were identified and given appropriate PMTCT ARV prophylaxis. Among the HIV-positive mothers provided with care, 30% of them initiated replacement feeding while 11% of them initiated contraception. 810 mothers have been initiated on HAART and are followed up in the post natal clinic, while 199 HIV exposed children have been linked to care and follow up. In FY 2007, the program will continue to support these activities and will provide HIV counseling and testing to 20,589 pregnant women provide ARV prophylaxis to 2,072 HIV-positive pregnant women. Of these HIV positive women 207 will be provided with Highly Active Antiretroviral Treatment (HAART) and 933 will receive more efficacious ARV regimens, while 932 will receive sd Nevirapine. The program will strengthen comprehensive PMTCT including couple counseling. In strengthening the linkage between PMTCT and HIV care services, the program shall support early infant HIV infection diagnosis by use of Polymerase Chain Reaction (PCR) for 1,033 infants and link all eligible infants to the pediatric ART program. The program shall strengthen the post natal HIV care clinic and shall support identified facilities to initiate this strategy. Intra-partum and immediate post partum counseling and testing shall also be strengthened with a target of reaching 100% of all women attending delivery services at the two hospitals. Currently over 50% pregnant women admitted in the labor and delivery units do not know their HIV status. The program will also promote couple counseling and testing to identify discordant and concordant couples to improve primary prevention and facilitate linkage to HIV care and treatment program for the eligible. The program will support the training of 300 service providers on PMTCT, Rationale use of ARVs, and Data collection and reporting. In line with the capacity building mandate of the UoN, the program in collaboration with NASCOP and DRH will facilitate a structured platform for regular review of PMTCT research to inform and guide national PMTCT policy and practice. The program will continue supporting activities of the ongoing Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) study to determine the effectiveness of NNRTI-containing HAART in women with prior exposure to NVP for PMTCT. The study will include the follow up of 100-200 participants. The program also proposes to undertake Impact Evaluation of PMTCT services in Kenya. Approximately 200 sites will be selected for assessment. 3. CONTRIBUTIONS TO OVERALL PROGRAM AREA PMTCT activities in these two high volume national referral facilities will contribute to approximately 2.1% of 2007 overall Emergency plan PMTCT targets for Kenya. Strengthening HIV counseling and testing of women during labor and around delivery will increase the number of HIV-positive women accessing HIV care services. Couple counseling and testing will contribute to more men knowing their HIV status and those who are positive will be able to access other HIV care services. The results of the ongoing NNRTI resistance study and proposed Impact Evaluation will inform policy and practice on the role of NNRTI containing regimens for HIV infected mothers; and the effectiveness of national PMTCT program respectively. This activity also contributes to expansion of pediatric HIV care services. 4. LINKS TO OTHER ACTIVITES (#7095) ART program. All HIV-positive mothers, their infants and partners who are eligible for treatment will be referred to the HIV/AIDS treatment and care services 5. POPULATIONS BEING TARGETED This activity targets adults, pregnant women, HIV-positive pregnant women and HIV positive infants. Health Care providers in these two facilities including doctors, laboratory workers, nurses, pharmacists and other health care workers, for example nutritionists and social workers will also be targeted for training to improve service delivery. This activity also targets National AIDS control program staff and other MOH staff. 6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will increase gender equity in HIV/AIDS programs through providing PMTCT 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.

UON, Department of Obstetrics and Gynecology has been supporting implementation of comprehensive PMTCT services in Kenyatta National Hospital (KNH) and Pumwani Maternity Hospital (PMH) the two largest maternity units in the country and has successfully integrated these services as part of routine care for all women accessing services here. During the past year, the program supported HIV counseling and testing to 31,670 with over 85% of these seen on admission to labor and delivery units. Close to 4,500 HIV-positive mothers were identified and given appropriate PMTCT ARV prophylaxis. Among the HIV-positive mothers provided with care, 30% of them initiated replacement feeding while 11% of them initiated contraception.

810 mothers have been initiated on HAART and are followed up in the post natal clinic, while 199 HIV exposed children have been linked to care and follow up. In FY 2007, the program will continue to support these activities and will provide HIV counseling and testing to 20,589 pregnant women provide ARV prophylaxis to 2,072 HIV-positive pregnant women. Of these HIV positive women 207 will be provided with HAART and 933 will receive more efficacious ARV regimens, while 932 will receive sd Nevirapine. The program will strengthen comprehensive PMTCT including couple counseling. In strengthening the linkage between PMTCT and HIV care services, the program shall support early infant HIV infection diagnosis by use of Polymerase Chain Reaction (PCR) for 1,033 infants and link all eligible infants to the pediatric ART program. The program shall strengthen the post natal HIV care clinic and shall support identified facilities to initiate this strategy. Intra-partum and immediate post partum counseling and testing shall also be strengthened with a target of reaching 100% of all women attending delivery services at the two hospitals. Currently over 50% pregnant women admitted in the labor and delivery units do not know their HIV status. The program will also promote couple counseling and testing to identify discordant and concordant couples to improve primary prevention and facilitate linkage to HIV care and treatment program for the eligible. The program will support the training of 300 service providers on PMTCT, Rationale use of ARVs, and Data collection and reporting. In line with the capacity building mandate of the UoN, the program in collaboration with NASCOP and DRH will facilitate a structured platform for regular review of PMTCT research to inform and guide national PMTCT policy and practice. The program will continue supporting activities of the ongoing NNRTI study to determine the effectiveness of NNRTI-containing HAART in women with prior exposure to NVP for PMTCT. The study will include the follow up of 100-200 participants. The program also proposes to undertake Impact Evaluation of PMTCT services in Kenya. Approximately 200 sites will be selected for assessment.