1. LIST OF RELATED ACTIVITIES This activity relates to activities in TB/HIV (#8830), and ARV Services (#7100).

2. ACTIVITY DESCRIPTION University of Washington (UW) will expand a long-standing research collaboration with the University of Nairobi to provide HIV care to 10,000 people with advanced HIV, including 800 children at 3 care sites, and support the training of 30 individuals in the provision of HIV-related palliative care services. UW will support treatment services at Coptic Hospital, a faith-based facility in Nairobi that provides services to both the general population and to individuals identified through research programs at the University of Nairobi. In addition, UW will support treatment services to two "daughter" clinics (clinics supported by the Coptic Church at facilities in Nyanza Province and in the industrial area of Nairobi. Other important aspects of the UW/Coptic Hospital program support behavior change and risk reduction for people with HIV/AIDS, with specific emphasis on patients with less advanced HIV, in whom rates of discordant partnerships have been found to be high. Funds will be used to support salaries of health care providers in accordance with Emergency Plan guidance, logistics (primarily pharmacy management), dissemination of informational materials (about ARVs and adherence) to patients, and procurement of commodities such as laboratory reagents. This partner will maintain data concerning the numbers of clients served and will report this information both nationally and through the Emergency Plan.

UW has a long presence in Kenya and extensive experience in HIV prevention and treatment both in the United States and internationally. The University has a long-standing research collaboration with the University of Nairobi, and has provided extensive capacity building in immunology and epidemiology, including supporting long-term training for University of Nairobi staff in the United States. University of Nairobi staff has also donated their time to support the establishment of HIV care services at Coptic Hospital. By June 2006, the HIV Clinic (Hope Clinic) was providing care for more than 4000 patients.

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

4. LINKS TO OTHER ACTIVITIES These services will link closely to ARV treatment services provided at Coptic Hospital (#7100), Palliate Care: TB/HIV services (#8830) and also link directly to the Nairobi network center at Kenyatta National Hospital and to other services provided through the expanding partnerships between other US-based Universities and the University of Nairobi.

5. POPULATIONS BEING TARGETED These programs target people living with HIV/AIDS including infants (0 - 5 years) and children (6 - 14 years) and private and public health care workers.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses legislative issues related to stigma and discrimination through community.

7. EMPHASIS AREAS This activity includes minor emphases in commodity procurement, development of network/linkages/referral, human resources, information, education, and communication, local organization capacity building, logistics, strategic information, training, and quality assurance and supportive supervision.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative care (#7099) and ARV Services (#7100, #7004).

2. ACTIVITY DESCRIPTION The University of Washington (UW) will expand a long-standing research collaboration with the University of Nairobi in the support of TB/HIV services for approximately 10,000 patients at 3 delivery sites within Kenya. UW will support treatment services at Coptic Hospital, a faith-based facility in Nairobi that provides services to both the general population and to individuals identified through research programs at the University of Nairobi. In addition, UW will support treatment services to two "daughter" clinics (clinics supported by the Coptic Church at facilities in Nyanza Province and in the industrial area of Nairobi). UW will offer TB screening to all HIV-infected patients; approximately 800 will be diagnosed with TB/HIV. Funds will be used to support improved screening and diagnosis. Refresher training of laboratory staff will be initiated and basic laboratory microbiology capacity improved in order to meet the increased needs of TB testing. 10 health care workers will be trained to provide clinical prophylaxis and/or treatment for TB to HIV-infected individuals.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute towards the provision of integrated TB/HIV 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, 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 and ARV services currently supported by UW, and ART services coordinated by and supported through the National AIDS and STD Control Program (NASCOP).

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 emphases in commodity procurement, human resources, development of networks/linkages/referral systems, local organization capacity development, quality assurance, quality improvement and supportive supervision, and training.

"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 Pallative Care: TB/HIV (#8830) and Pallative Care: Basic Health Care and Support (#7099).

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 3 districts in Nyanza. These activities will support ART services for 6,190 people with advanced HIV (1900 new patients), including 600 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 the results of expansion of ARV treatment for clinically qualified HIV-positive patients, strengthen 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 This activity relates to testing and treatment activities at the Nairobi network center at Kenyatta National Hospital currently supported by and University of Nairobi, and to other services provided through the expanding treatment partnerships between other US-based universities such as University of Manitoba, University of California at San Francisco, and the University of Nairobi.

5. POPULATIONS BEING TARGETED These programs target people (adults and children) living with HIV. 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.

7. EMPHASIS AREAS This activity includes minor emphases in commodity procurement, development of network/links/referral systems, human resources, local organization capacity building,

logistics, information, education, and communication, and quality assurance and supportive supervision, targeted evaluatio, and training.