1. LIST OF RELATED ACTIVITIES This activity relates to Counseling and Testing (#8781), Palliative Care: TB/HIV (#9062) and Palliative Care: Basic Health Care and Support (#8934), HIV/AIDS Treatment: ARV Services (#8813), Condoms and Other Prevention Activities (#8930), and Orphans and Vulnerable Children (#9048).

2. ACTIVITY DESCRIPTION This APHIA II Coast activity will expand PMTCT services in the Coast Province, building on the support previously provided through USAID's IMPACT and AMKENI EngenderHealth Projects. It aims to provide universal uptake of counseling, testing (CT) and ARV prophylaxis in the province. In all the facilities across the six districts, counseling and testing will be provided to 71,935 pregnant women, and ARV prophylaxis to 4,722 HIV-positive women. Of these, 2,360 will receive AZT, 470 HAART and 1,892 single dose nevirapine. 2,360 exposed infants will receive PCR for early infant diagnosis. Service delivery will incorporate best practices, namely opt-out approach and rapid testing. Sites will include, or will be linked to, comprehensive care centers. Opportunistic infection prophylaxis, the use of more efficacious regimens for ARV prophylaxis and PMTCT plus services will start in selected sites. Improved capacity to carry out postnatal follow up of infected mothers and exposed babies to include early infant diagnosis especially in the mother and child health clinics (MCH) are priorities. Cost barriers to ART uptake which include laboratory costs in its sites will be addressed.

Significant changes from 2006 include the universal provision of PMTCT services in the entire district, provincial hospitals and high volume health centers, and the use of more efficacious regimens for ARV prophylaxis. Strategies to provide CT in maternity services during labor and delivery, emphasis on universal uptake of CT and ARV prophylaxis and deployment of additional counselors to ANC sites are other important changes. Postnatal follow up of infants and mothers will include infant diagnosis, cotrimoxazole prophylaxis, treatment, and support for infant feeding practices and appropriate linkages for nutritional support.

In 2007, the APHIA II Coast will support 50 sites, train 150 providers and provide logistical support, renovation, supervision and monitoring. Support to PMTCT plus services will include training of service providers, strengthening of laboratory and commodity logistics capacity, increased access to HB, FBC and CD4 assays and linkages to comprehensive care centers. Operations research will focus on improving service delivery. This activity will use the Ministry of Health's WHO/CDC-based curriculum for training, comply with MOH's clinical and reporting guidelines, and participate in the MOH's Technical Working Group.

Community links in rural areas to provide support especially to HIV+ pregnant women will be established through national organizations of PLWHA. Agreements with Provincial Medical Officers will ensure that PMTCT skills are taught to multidisciplinary treatment and care teams at comprehensive care facilities, and that primary HIV care is integrated into MCH clinics.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA PMTCT in this geographical area will significantly support PEPFAR goals for primary prevention and care by contributing 7.4% of 2007 overall Emergency Plan PMTCT targets for Kenya. Additional sites contribute to the program's efforts to achieve district wide coverage for services. Support to high volume health centers, district and provincial hospitals to provide PMTCT plus services significantly increase opportunities to identify HIV infected patients and potential candidates for ART. Access to services, medical treatment and care will encourage rural women in underserved communities to attend antenatal care services. This will facilitate postnatal follow up of HIV positive women, infants and their family members.

This APHIA II Coast activity also contributes substantively to Kenya's Five-year strategy of encouraging pregnant women to know their status, availing services to reduce mother-to-child infections and providing HIV/AIDS treatment as a step towards preserving the family unit. It also contributes to the strategy to integrate services and improve the referral links.

4. LINKS TO OTHER ACTIVITIES

This activity relates to CT (#8781), OVC (#9048), palliative care (#9062) and (#8934) and other prevention activities (#8930) described under the APHIA II Coast in other parts of the 07 COP. PMTCT plus services include counseling and testing which is largely diagnostic, provision of ARV prophylaxis, management of opportunistic infections and ARV services (#8813). Strengthening laboratory services and improving commodity logistic systems is a crucial part of HIV/AIDS treatment services. Operations research on improving service delivery is included.

5. POPULATIONS BEING TARGETED This APHIA II Coast activity targets adults of reproductive health age, pregnant women, family planning clients, infants, people living with HIV/AIDS, HIV positive pregnant women and HIV positive infants. BCC activities will involve community leaders and community based organizations to increase demand for services. Strategies to improve quality of services will target Ministry of Health staff, doctors, nurses, midwives, laboratory workers, pharmacists and other health care workers such as clinical officers and public health officers.

6. KEY LEGISLATAIVE ISSUES ADDRESSED This APHIA II Coast activity will increase gender equity in programming through partnering with women's groups in the design and implementation of community mobilization approaches. The behavior change communication (BCC) activities will promote a family approach to PMTCT. This will address male norms, encourage male participation and help reduce stigma and discrimination. Increased availability of services will also reduce stigma.

7. EMPHASIS AREAS This activity includes major emphasis on training, with lesser emphasis placed on development of network/linkages/referral systems, renovation, quality assurance and supportive supervision as detailed in the activity description in Section 1 above.

Plus up funds will be used to support scale up of HIV counseling and testing services to partners and family members of pregnant women, thus addressing the fourth prong of the PMTCT program strategy. This prong has remained largely unaddressed in Kenya. Approximately 4,500 spouses of HIV positive pregnant women and about 35,000 spouses of HIV negative women will be reached. The CT services will be extended to ther family members including children using the pregnant woman as the entry point. This will foster a family centered approach to care and treatment and help improve post natal follow up of the mother-infant pair.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in HIV/AIDS Treatment: ARV Services (#8813), Counseling and Testing (#8781), Orphans and Vulnerable Children (#9048), Palliative Care: Basic Health Care and Support (#8934), Palliative Care: TB/HIV (#9062), Condoms and Other Prevention Activities (#8930), Prevention of Mother-to-Child Transmission (#8764), Strategic Information (#9711).

2. ACTIVITY DESCRIPTION This activity will reach 500,000 youth with abstinence and being faithful messages in Coast Province. The activity will employ the 360-degree Model of Protection that seeks to delay first sexual encounter and increase secondary abstinence among youth ages 10 to 24 years, as well as increase safer sexual practices among sexually active youth, especially mutual fidelity. The model calls upon families, schools, health facilities and communities to meet the HIV/AIDS and RH needs of youth by developing activities that build the capacity of young people to establish and maintain healthy behaviors to avoid HIV and STIs. The model aims to provide young people with a supportive environment that involves their family, peers, school, and community. Approximately 2,000 people will be trained to provide AB programs among youth. The activity will be implemented by FBO sub-partners such as Anglican, Seventh Day Adventist and Catholic Churches as well as the Muslim institutions to integrate life skills programs with their youth programs. These programs have been equipping youth with skills to cope with peer pressure and help them develop positive norms and values to make appropriate and safe choices in relationships. In addition, the activity will work with Kenya Girl Guide Association (KGGA) to reach out to more youth in school with abstinence only messages through a life skills program and the "Sara" communication initiative. Malindi Education Development Association (MEDA) will target Muslim youth in Malindi with abstinence and be faithful programs. The activity will also develop, produce and distribute abstinence-specific communication materials through the various partners and networks implementing the activity in Coast Province.

The activity will expand the youth peer education interventions using the Y-PEER approach established by YouthNet and UNFPA; work with the Provincial Education Office and KGGA to roll out the life skills peer education program established under the IMPACT Project for schools in Coast Province. In addition, the activity will work with the Kenya sign language project (implemented by U.S. Peace Corps) to introduce HIV/AIDS education to institutions such as computer colleges, driving schools, village polytechnics, and Shanzu Teachers Training College. The project will also use the AIDS education approaches of "I Choose Life" who have developed a peer education program for university students and the National Organization of Peer Educaotors' Ambassadors of Change.

Sub awards will be made to the National Organization for Peer Educators, YouthNet, the Kenya Girl Guide Association, Malindi Education Development Association, Seventh day Adventist, Anglican and Catholic churches in Coast province.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This APHIA II Coast project will contribute to the Kenya 5-Year Strategy in which youth are a primary target. This activity will reach 500,000 youth with abstinence and being faithful messages and another 300,000 with abstinence messages in Coast Province. Targets in this project will also contribute to numbers of HIV infections averted.

4. LINKS TO OTHER ACTIVITIES The APHIA II Coast Abstinence and Be Faithful Program activities will relate to HIV/AIDS treatment services (#8813), counseling and testing (#8781), OVC (#9048), HBHC (#8934), TB/HIV care activities (#9062), OP (#8930), PMCT (#8764), and strategic information (#9711). This activity will link the target population to other prevention services especially for the sexually active youth and also encourage all to know their status by linking to counseling and testing services and treatment for those eligible for ART.

5. POPULATIONS BEING TARGETED In- and out-of-school youth and community and religious leaders in three districts are the target group. This target population will be reached through local community, religious leaders, and teachers.

6. KEY LEGISLATIVE ISSUES ADDRESSED

Gender will be addressed through many school programs including those targeting young girls and specifically work with the Kenya Girl Guide Association. The materials developed under this activity will also address issues surrounding stigma and discrimination.

7. EMPHASIS AREAS Emphasis areas covered by this activity include local organization capacity development as a high percentage of effort. Activities will include peer education and training teachers and other leaders to promote AB messages for youth. In addition, the program emphasis includes community mobilization through religious leaders and teachers, information, education and communication through the development and printing of materials such as comic books and magazines articles, and curricula targeting youth and promoting AB.

This APHIA II program will roll out the Ministry of Eduaction Sector Policy for HIV and AIDS.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in HIV/AIDS Treatment: ARV Services (#8813), Counseling and Testing (#8781), Orphans and Vulnerable Children (#9048), Palliative Care: Basic Health Care and Support (#8934), Palliative Care: TB/HIV (#9062), Abstinence and Be Faithful Programs (#8950), Prevention of Mother-to-Child Transmission (#8764).

2. ACTIVITY DESCRIPTION The activity will build on HIV/AIDS Other Prevention activities implemented under the 06 COP. It will reach 700,000 individuals through community outreach programs and train 1,700 people through existing local NGOs, FBOs and private sector. The activity will focus on reaching individuals in formal and informal settings. Under the leadership of the National Organization of Peer Educators (NOPE), the activity will target women and men at worksites and youth at risk. The local NGO and FBOs will target other high-risk populations including low-income community women, sex workers, truck drivers, cattle traders, uniformed services, discordant couples and women in churches and mosques in the Coast Province. Technical assistance partners will continue to provide assistance and capacity building to partner organizations to implement behavior change prevention programs. The program will link with and provide referrals to existing networks of HIV/AIDS counseling and testing, home-based care and ART programs in the program areas, creating "comprehensive care centers." This intervention will result in reduced HIV risk in the general population, especially among young adults. They will provide increased access to HIV/AIDS prevention services for high-risk and under-served populations, and increase awareness of HIV/AIDS preventive behaviors through the Ministry of Health and other partners. This will also include targeted condom promotion and distribution to high-risk populations through 100 condom outlets and improved quality of STI services working through the Ministry of Health and other partners.

Prevention activities will include the following: targeting out-of-school and most at risk youth with prevention information and referral to youth friendly services; supporting peer education interventions with sex workers in Malindi, Mombasa, Kilifi and Kwale districts and link them to VCT, PMTCT, care and support services; support prevention efforts among the uniformed services by working with the provincial police AIDS Control Unit (ACU) to expand the police peer education program to four districts in the Coast Province; expand the peer education program targeting truck drivers, loaders, and seafarers and link the activities to the existing ROADS Project; support prevention programs targeting hard-to-reach MARPS such as the MSM and injection drug users and the geographically hidden populations such as Orma and Wadei Somalis in Tana River; provide counseling, information and prevention to HIV-positive individuals through peer and provider education, outreach services and regional mass media. In addition, the activity will target people with disabilities and assist them to gain access to integrated networks for care, treatment and support activities. Local implementing partners will integrate prevention messages into models of care and support for OVC and PLWAs. Technical assistance will continue to be provided to implementing partners implementing behavior change communication programs in HIV and substance abuse and develop new print materials addressing alcohol abuse, stigma and discrimination.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute to the Kenya 5-Year Strategy that focuses on HIV prevention targeting high-risk groups. Targets in this project will contribution to HIV infections averted.

4. LINKS TO OTHER ACTIVITIES The APHIA II Coast Other Prevention activities will relate to HIV/AIDS treatment services (#8813), counseling and testing (#8781), OVC (#9048), HBHC (#8934), TB/HIV care activities (#9062), AB (#8950), PMCT (#8764).

5. POPULATIONS BEING TARGETED Men and women in the work place, male and female sex workers and their partners and clients, and other high-risk population including truck drivers and out-of-school youth.

6. KEY LEGISLATIVE ISSUES ADDRESSED This APHIA II TBD project will have a strong gender component. Activities will target men

in the workplace and low-income women in the community.

7. EMPHASIS AREAS Community mobilization/participation will be implemented to reach the communities surrounding worksites. Individuals will be referred for other HIV/AIDS related services, especially counseling and testing services. In addition, peer educators in worksites who are also targeting the community will be trained to provide information related to HIV/AIDS including condom distribution.

APHIA II Coast will undertake Prevention with Positives (PwP) activities working through PLWA support groups linked to the Comprehensive Care Centers in Coast province. $50,000 of unallocated funds will provide support to patient support groups in the CCCS and post-test clubs at VCT centers to ensure promotion of faithfulness and condom use by HIV-infected persons. This will empower 5 HIV+ people in each of 10 patient support groups to become peer and advocacy leaders in prevention at the community level and will reach 10,000 PLWAs.

This APHIA II program will roll out the Ministry of Education Sector Policy for HIV and AIDS.

Targets

Target Target Value Not Applicable Number of targeted condom service outlets 100
Number of individuals reached through community outreach that 75,200
promotes HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful Number of individuals trained to promote HIV/AIDS prevention 15,450
through other behavior change beyond abstinence and/or being faithful

Target Populations: Adults Brothel owners Commercial sex workers Community leaders Community-based organizations Factory workers Faith-based organizations Family planning clients Discordant couples Injecting drug users Men who have sex with men Street youth HIV/AIDS-affected families International counterpart organizations Truck drivers National AIDS control program staff Non-governmental organizations/private voluntary organizations People living with HIV/AIDS Policy makers Seafarers/port and dock workers Rural communities Girls Boys Widows/widowers Migrants/migrant workers Out-of-school youth Partners/clients of CSW Transgender individuals Religious leaders

Key Legislative Issues Addressing male norms and behaviors Volunteers

Stigma and discrimination

Coverage Areas Coast

Table 3.3.05:

1. LIST OF RELATED ACTIVITIES The APHIA II Coast HBHC activities will relate to HIV/AIDS treatment services (#8813), counseling and testing (#8781), Other Prevention (#8930), orphans and vulnerable children (#9048), TB/HIV care activities (#9062), AB (#8950) and PMTCT (#8764).

2. ACTIVITY NARRATIVE This activity will provide integrated and comprehensive home and basic health care to 26,000 people with HIV/AIDS linked to 29 comprehensive care centers and 75 RHFs. Through training of trainers, 200 primary care facility health workers will be trained to provide comprehensive and integrated care training to 100 home /community based care workers who in turn train the primary care givers at home, to complement the facility based services. At 60 health facility clinics integrated training following NASCOP/DRH/Malaria/NLTP curricula will be offered to identified staff to offer services for the prevention, identification and management of OIs, monitoring of the infected adults, children and their families, coupled with appropriate counseling and education. All babies born and children of HIV infected mothers will be followed up at the CCCs or MCHs in the 29 facilities and appropriately managed. A case manager will manage referrals to and from the community. The community based component will include treatment literacy, basic management of OIs, ART and TB treatment adherence, adequate nutrition, home hygiene and nursing skills , malaria prevention and treatment, FP and identification and referral of clients suspected of having HIV and TB.

Formal linkages between health facilities and the community-based activities will be created to enhance effective care, follow-up, and tracking of referrals and assessment of patient satisfaction with the services. Both formal health care workers and community and home based care volunteer workers will be trained on effective referral. Lay treatment support volunteers will be recruited and trained, using the CRS training curricula to provide psychosocial support, adherence support for ART, TB and regular clinic visits.

This activity will also lead to the mobilization and strengthening of organizational and institutional capacity of 7 District institutions to integrate, plan, lead, monitor and evaluate home and community care support programs. Quality Assurance and Quality Improvement of this activity for both facility and community intervention will be key in ensuring that standards of care are met. Care providers will be trained on the MOH SOPs.

Through this activity, the organizational capacity of PLWA groups will be strengthened so as enable them to be pro-active leaders, advocates and participants in the response to the epidemic. In addition, this activity will lead to the linkage of 7000 families with economic support programs using the CRS SILC model. Community members including PLWA and older OVC will be trained on this methodology and also in basic financial and management and skills for their projects and also linked to other microfinance institutions operating in the region. Through linkages with the KARI, 350 people will be trained on improved agricultural techniques and 7 demonstration plots in will be established. APHIA will tap into the CRS' USAID/FFP program to provide supplementary nutrition to families caring for OVC. Continued support will be given to the PLWA families supported through the COPHIA Project.

To ensure continued support for this effort at the community level, FBOs, CBOs, PLHA groups, women and youth groups will be trained in basic program and financial management skills as part of capacity building. Training of paralegals and child counselors will be expanded to the Districts of Kwale, Taita-Taveta, Lamu and Tana River.

This activity also includes support to the following sub recipient for activities integral to the program: Catholic Relief Services who will in turn provide sub awards to local partners.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA The APHIA II Coast will reach 26,000 clients and 5,000 individuals will be trained to provide palliative care through 50 service outlets. This APHIA II Coast activity responds to NACC's priority areas #2 "Improve the quality of life of people infected and affected by HIV/AIDS" and #3 "Mitigation of socio-economic impact". It is expected that the APHIA II-TBD will adhere to GOK policies and guidelines and participate in national-level HIV technical working groups.

4. LINKS TO OTHER ACTIVITIES HIV/AIDS treatment/ARV (#8813), Counseling and Testing (#8781), Condoms and Other Prevention (#8930), Orphans and Vulnerable Children (#9048), Palliative Care: TB/HIV (#9062), Abstinence and Be Faithful (#8950) and Prevention of Mother to Child Transmission (#8764). Efforts will also ensure that ARV and DOTS adherence will be stepped up in FY 2007.

5. POPULATIONS BEING TARGETED Two populations are being targeted. 1) People affected by HIV/AIDS (including Caregivers, HIV positive children and infants, HIV/AIDS-affected families and People living with HIV/AIDS) and 2) Groups/Organizations (including community-based organizations, country coordinating mechanisms and faith-based organizations. Other populations targeted include comunity and religious leaders as well as health workers both in private and public sectors for training.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address Stigma and Discrimination by providing access to increased resources in order to address the wide spectrum of problems that are faced by households when dealing with a debilitating disease in an adult family member. In addition, it will address Wraparounds through the provision of food and microfinance/micro credit.

7. EMPHASIS AREAS The main emphasis is on Local Organization Capacity Development through building the capacity of communities and local organizations to implement community-based care and support to HBC clients and OVC. There is a minor emphasis on Training, Linkages with Other Sectors and Initiatives (Linkages and strong collaboration with other public and private sector prevention and treatment efforts will help to overcome resource limitations and build sustainability. Efforts will also link more clients to ARV and to ensure ARV and DOTS adherence will be stepped up in the coming year) and Community Mobilization/ Participation (building the capacity of community organizations to assist families).

1. LIST OF RELATED ACTIVITIES The APHIA II TB/HIV care activities relate to activities in AB (#8950), CT (#8781), OVC (#9048), Palliative Care: Basic Health Care and Support (#8934), ARV Services (#8813) , Condoms and Other Prevention (#8930), PMTCT (#8764), and Strategic Information (#9711).

2. ACTIVITY NARRATIVE This activity has in the preceding years received funding from USAID to support TB control activities with the National Leprosy and Tuberculosis Program (NLTP) in Mombasa and Nairobi. In addition, these activities have supported strengthening of the Central Reference Laboratory, linkage into the home-care programs, continued school health education, increased number of TB diagnostic and treatment centers, development of effective referrals, dissemination of provider job-aides, educational campaigns, strengthening of management of drug resistance, and surveillance and institutionalization of TB/HIV collaboration.

This activity will support training of HIV and TB care staff on routine diagnostic testing and counseling of TB suspects and cases using the NLTP/NASCOP curriculum, provide additional staff if required, screening of HIV cases for TB, upgrading of laboratories with additional equipment, and renovation of laboratory space, as necessary. In addition, INH prophylaxis will be introduced at select CCCs and the congregate settings of Shimo-la-Tewa and other prisons. CTX prophylaxis will be introduced for all HIV infected TB cases. Therapeutic and supplementary nutrition will be provided to eligible TB/HIV patients. Planning, monitoring and supervisory mechanisms for collaborative activities will be strengthened at provincial, district and community levels. The capacity of select HIV/AIDS CBOs and local NGOs like Mkomani Clinic Society will be increased to integrate TB into their on-going HIV/AIDS activities. Low literacy materials on TB/HIV will be supplied. The private providers will be trained and linked to either the public HIV/AIDS and TB programs or the Gold Star Network whose target is paying clients in the private sector.

3. CONTRIBUTION TO OVERALL PROGRAM AREA This APHIA II Coast TB/HIV care activity will provide clinical prophylaxis and treatment for TB to 2,000 people and train 100 health workers in TB/HIV related activities in 50 health care facilities in Coast Province.

4. LINKS TO OTHER ACTIVITIES The APHIA II TB/HIV care activities relate to other APHIA II- Coast activities in AB, CT, OVC, Palliative Care: BHCS, ARV Services, Condom and Other Prevention, PMTCT, and strategic information.TB patients will be linked to HIV counseling and testing, prevention and treatment services.

5. POPULATIONS BEING TARGETED General population, health workers, and PLWHA with dual TB/HIV infections.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address gender, stigma and discrimination through its community activities.

7. EMPHASIS AREAS Major emphasis is training, with minor emphases in community mobilization/participation, development referral systems, local organizations capacity development, workplace programs, and IEC.

APHIA II Coast with these additional Plus Up funds will intensify provider-driven DCT in health care settings seeking to enhance testing in TB diagnostic centres that currently do not provide ART services. These facilities are largely health centres and dispensaries that offer TB diagnostic services but are not providing ART. HIV positive patients identified via these activities will be referred to nearby treatment sites. This will complement the current DCT program that has intensified testing in facilities where both TB and ART services are provided ($200,000).

1. LIST OF RELATED ACTIVITIES The APHIA II Coast orphans and vulnerable children activities will relate to HIV/AIDS treatment services (#8813), counseling and testing (#8781), Other Prevention (#8930), HBHC (#8934), TB/HIV care activities (#9062), AB (#8950) and PMTCT (#8764).

2. ACTIVITY DESCRIPTION This activity will lead to provision of comprehensive support to 11,600 OVC and their households both directly and through leveraged resources from other partners in the region. There are existing programs responding to the needs of OVC but this is, in most cases, a scattered and an uncoordinated response. Initial activities will therefore focus on strengthening that and ensuring it is comprehensive package as laid out in the USG guidelines.

Through the technical leadership of CRS (Catholic Relief Services) and Social Impact the capacity of NGOs CBOs, FBOs will be strengthened through training of trainers so as to enable them train at least 2,900 care givers provide a high quality comprehensive care to OVC. Recognizing the role that they play in the response to taking care of their own, key community stakeholders who include civic leaders, parents, care givers, community leaders, religious leaders and community groups will be engaged through capacity development activities to survey vulnerable children and their needs, assess existing community resources and gaps, establish a coordination and referral mechanism, plan and monitor a joint response to the OVC. CLUSA, who are one of the strategic Partners for APHIA Coast will provide technical leadership in mobilizing the community to lead the response to OVC.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute to the Kenya 5-year strategy, will increase the number of OVC receiving HIV/AIDS care and support, and will reach 11,600 OVC with comprehensive quality services and train 2,900 caregivers.

4. LINKS TO OTHER ACTIVITIES The APHIA II Coast OVC activities will relate to HIV/AIDS treatment services (#8813) , counseling and testing (#8781), Other Prevention (#8930), home based care services (#8934), abstinence and be faithful (#8950), prevention of mother to child transmission (#8764) and TB/HIV (#9062). This activity will provide referral, as appropriate, to OVC and their community to necessary HIV/AIDS services especially counseling and testing and treatment.

5. POPULATIONS BEING TARGETED This activity targets orphans and vulnerable children, caregivers of OVC, and community health workers. The local capacity of each organization will be strengthened by working with community leaders, religious leaders, volunteers as well as partnering with other existing community-based and faith-based organizations that exist in the same community.

6. KEY LEGISLATIVE ISSUES ADDRESSED The key legislative issues being addressed is stigma and discrimination through close links in building the capacity of the community to address the local needs of the OVC in each community as well as in training the caregivers of the OVC. This activity also addresses the wrap around issue of food and education. Ensuring the needs of the girl child will also be addressed as the needs relate to being an OVC.

7. EMPHASIS AREAS Major emphasis is in community mobilization/participation and minor emphasis areas in developing network/linkages, local organization capacity development and training.

1. LIST OF RELATED ACTIVITIES This activity is related to activities in TB/HIV care activities (#9062), HIV/AIDS treatment services (#8813), abstinence and be faithful (#8950), OVC (#9048), HBHC (#8934), other prevention (#8930) and PMCT (#8764).

2. ACTIVITY DESCRIPTION This activity will provide counselling and testing services to 100,000 people through the broadened entry points which include the clinical care settings through the provider initiated testing (PIT) and the traditional VCT sites, both integrated and free standing. The MOH already has an approved HIV testing serial testing protocol using whole blood and simple rapid tests. Previous efforts concentrated on diagnostic testing mainly of patients who had clinical indications of AIDS. This will be strengthened further through routine counselling and testing of TB and STI patients. Also previous efforts concentrated on integrating HIV testing in level III and IV health care facilities. This will be scaled up to the lower level health facilities especially in Districts where CC-ART sites have been decentralized. This activity will target 50 sites and train 150 counselors.

The coast region has already established counselling and testing services but some Districts have hard to reach populations. Outreach mobile teams will be facilitated to conduct CT services to these communities. Home/family based CT services will be initiated in Mombasa, Malindi and Kilifi who already have index clientele enrolled in care. This will require the recruitment, training or orientation of lay counsellors to support this activity.

Voluntary counseling and testing will be scaled up through community mobilization and outreach services for youth and adolescents in the region. This will be done in collaboration with National organization for Peer Educators (NOPE) who is one of the Strategic Partners to promote the culture of the need to know one's sero status among the youth. Building on NOPE's work with workplace HIV/AIDS programs, CT and testing will be integrated in workplace programs that already have HIV/AIDS policies and care and treatment programs so that there is an active linkages for those testing HIV positive.

The broadening of entry points to counselling and testing will require that at least 150 service providers are trained in routine and diagnostic counselling and testing especially at lower levels of health care provision. The training will encompass aspects of care and treatment and the need for systematic referral. Training in couple counselling and youth and adolescent counselling for all existing counsellors will also be conducted. Through the collaboration with (CLUSA) and using the FHI model for SBC, community mobilization campaigns for couple counselling and testing will be conducted. Quality assurance and Quality Improvement are key to the fulfillment of the government objectives and the Districts will be supported to provide supervision to the service providers including training of more people in support supervision.

Sub agreements in this program will be awarded to National organization for Peer Educators (NOPE) and the Ministry of Health. Amounts and other sub agreements TBD.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This APHIA II Coast project will contribute to the Kenya 5-Year Strategy which focuses on HIV prevention. Targets in this project will contribute to numbers counseled and tested for HIV/AIDS. The proposed program contributes to COP 2007 targets, and is consistent with the PEPFAR 5-Year Strategy, in the following manner: Increased access to counseling and testing clinical services, and increased availability of counseling and testing clinical services.

4. LINKS TO OTHER ACTIVITIES The APHIA II Coast Counseling and Testing activities will relate to HIV/AIDS treatment services (#8813), Abstinence and Be Faithful Program (#8950), OVC (#9048), HBHC (#8934), TB/HIV care activities (#9062), OP (#8930), and PMCT (#8764). This activity will ensure referral for services for those that test positive especially to prevention services and post test clubs and to care services such as TB, and treatment while others will be referred to post test clubs.

5. POPULATIONS BEING TARGETED: This activity will target the general population including adults (Men,Women, FP clients,Youth), People affected by HIV/AIDS (Children

born of HIV infected mothers, Spouses of HIV infected persons, Family members of an HIV infected person), Community members including Faith based organizations, Non-governmental organizations, and Community based organizations. Health providers both in the private and public sector providers will be targeted.

6. KEY LEGISLATIVE ISSUES ADDRESSED Gender is a key legislative issue addressed in this activity. This includes activities supporting counseling that challenges norms about masculinity, delayed sexual activity and reduced multiple sex partners for boys and men and transactional sex. The activity also include support for testing and support services for victims of sexual abuse and violence, training on couple counseling, risk assessment, stigma reduction, and supporting women to mitigate potential violence.

7. EMPHASIS AREAS This activity supports the development and implementation of referral systems, quality assurance and supportive supervision for CT counselors. The activity will also support the training of additional counselors especially targeting testing for youth and in clinical setting. The activity will also work with local organizations and MOH in Coast province to strengthen their capacity to implement programs.

1. LIST OF RELATED ACTIVITIES This activity relates to other activities in abstinence and be faithful (#8950), counseling and testing (#8781), OVC (#9048), palliative care: basic health care and support (#8934), TB/HIV care activities (#9062), condoms and other prevention (#8930), PMTCT (#8764), and strategic information (#9711).

2. ACTIVITY NARRATIVE This activity will consolidate established programs in several geographic areas of the Coast Province and will expand activities to include new areas. As a result of these activities, 8,000 people (including 800 pediatric) with HIV will receive antiretroviral therapy at 29 CCCs and 75 RH facilities for treatment follow-up by nurse health workers while 300 health care workers will be trained in the provision of antiretroviral therapy. Activities will include infrastructure improvements for laboratories and service delivery areas, supply of equipments and commodities such as laboratory reagents, production and dissemination of informational materials such as pamphlets addressing adherence to antiretroviral drugs, training of health workers for adult and pediatric ART, and institutionalization of QA/QI and supervision systems.

In addition to supporting outpatient provision of ARVs, specific activities will increase the opportunities to detect eligible patients for ART in the in-patient wards and from key service areas of the health facilities like TB clinics, MCH/FP services. All services will be tightly linked across the spectrum of care with other services in basic home-based care and community support in conjunction with systems strengthening. Prevention services in care settings will be strengthened through improvement of institutional infection prevention practices and injection safety, reinforcement of behavior change, sustenance of low risk behavior, condom supply; appropriate nutrition including therapeutic and supplemental feeding that includes adequate micronutrient supply, and reduction of risk of infection among discordant couples. Substance abuse treatment and injecting drug use programs introduced will be integrated and assist them ensure adherence to treatment and to reduce the risk of transmission. This activity will also strengthen the private sector approach through the Gold Star Network initiative that works with private practitioners, private hospitals, especially Aga Khan Hospital Mombasa and nursing homes and workplace clinics. An additional 50 providers in the private sector will be recruited in Coast Province. The activity will also focus on activities to support vulnerable groups such as women who may be engaged in high-risk sexual activities by targeting CSWs. This activity also includes support sub recipients for activities integral to the program: Mkomani Clinic Society and the Ministry of Health. Because the issue of stigma and discrimination is still high amongst health workers in Kenya this activity whilst conducting clinical training will also train workers on stigma and discrimination using a curriculum specifically produced for this purpose.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA As a result of these activities, 8,000 people with HIV will receive antiretroviral therapy at 29 CCCs and 75 RH facilities.

4. LINKS TO OTHER ACTIVITIES The APHIA II Coast HIV/AIDS treatment services activities will relate to abstinence and be faithful (#8950), counseling and testing (#8781), OVC (#9048), HBHC (#8934), TB/HIV care activities (#9062), condoms and other prevention (#8930), PMTCT (#8764), and strategic information (#9711).

5. POPULATIONS BEING TARGETED Populations being targeted by this activity are mainly people living with HIV/AIDS and health workers.

6. KEY LEGISLATIVE ISSUES ADDRESSED The main legislative issues addressed by this activity are gender and stigma and discrimination. The activity will also focus on activities to support vulnerable groups such as women. Activities will include support to the reduction in violence and coercion as well as stigma and discrimination.

7. EMPHASIS AREAS The major emphasis area is training of health workers with minor emphasis being

development of networks/ linkages/ referral systems, information, education and communication, and workplace programs.

This plus up funding will be used to more rapidly scale up pediatric ART to 200 children in Coast province ($100,000) It will strengthen and expand pediatric counselling and testing, strengthen linkages with PMTCT services at facilitesand strengthen early infant diagnosis networks using improved dried blood spot sample collection, transportation and reporting; improve community mobilization to increase community awareness and sensitise health workers on availability of pediatric testing, counselling and treatment, provide training and mentorship to strengthen the HIV component of integrated management of childhood illnesses (IMCI). It will contribute to over 1,000 children being initiated on ART and 300 health workers trained for improved identification and care and treatment of HIV infected children.

1. LIST OF RELATED ACTIVITIES This activity is related to other activities in Strategic Information (#7098, #7002 and #9220).

2. ACTIVITY DESCRIPTION This activity will strengthen the provincial and district level Health Management Information Systems (HMIS) currently in use by MOH at health facilities and Community Based Program Activity Reporting (COBPAR) currently being rolled out at Constituency AIDS Control Committee (CACC) levels by the National AIDS Control Council (NACC) through three key components.

Component 1: Support APHIA II Coast/FHI and MOH program data collection processes for performance reporting needs (quarterly, semi-annual, annual). This component will support participatory, coordinated and efficient data collection, analysis, use and provision of information to track achievement of APHIA II Coast/FHI and MOH's district level Annual Operation Plan II objectives. This process will also inform decisions at the local, district and provincial levels, using standardized M&E/HMIS tools approved by the MOH.

Component 2: Strengthen community and facility based reporting systems being rolled out by NACC and NASCOP. The component will support APHIA II Coast/FHI and MOH to measure progress towards its overall contribution to the country's Emergency Plan, National Health Sector Strategic Plan II and Kenya's National HIV/AIDS Strategic Plan goals and results frameworks. Specific activities will include building capacity of 25 local organisations and facilities to collect, report, analyse, and use both routine facility and non-facility data for planning and program improvement.

Component 3: Take the lead role in coordinating M&E activities in the province to meet the information needs of the Emergency Plan, MOH, NACC and other stakeholders, in line with the "three ones" principle. APHIA II Coast/FHI will organize district-level consensus building forums on M&E issues, distribute standardized data collection and reporting tools, conduct regular data quality assurance processes at all data generation points, train 75 facility based data point staff on the new data collection/reporting tools and data use for improving program performance, and hold provincial level quarterly and annual stakeholders' information dissemination meetings. APHIA II Coast/FHI will be held accountable for tangible results, especially in increased use of harmonized data collection and reporting tools at health facilities developed by MOH, increased data use in planning and at dissemination workshops to various stakeholders, increased supportive-supervisory visits and routine data quality assessments at all data collection points by M&E/HMIS officers, and improved coordination of M&E activities in Coast province. These efforts should result into demonstrated evidence in increased national level reporting by up to 60% from health facilities to NASCOP national database.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA The activity builds on the FY 2006 activities that support the national M&E systems as well as contributing to the Emergency Plan's training outputs. In overall, the activity will provide technical assistance to twenty five local organizations/health facilities in strategic information in addition to supporting the training of 75 SI and program managers in M&E/HMIS, reporting and data use for program management.

4. LINKS TO OTHER ACTIVITIES This activity is related to the strategic information activity to be carried out by MEASURE Evaluation (#7098), where MEASURE Evaluation will be supporting NACC in rolling out COBPAR system for community level reporting. It is also related to the strategic information to be carried out by NASCOP (#7002), where NASCOP will rolling out Form 726, Form 727 and program specific client registers for data collection and reporting at health facilities. It is also related to SI TE/TBD (#9220), that will attempt to investigate the causes for low reporting rate by health facilities and recommend strategies for achieving 100% reporting level by health facilities.

5. POPULATIONS BEING TARGETED This activity targets host government workers and other health care workers like M&E and HMIS officers for data collection, analysis, reporting and use at both health facilities and community level. Program managers are as well targeted for orientation on the role M&E

program management.

6. EMPHASIS AREAS The major emphasis area is Health Management Information Systems (HMIS) and minor areas include Monitoring, evaluation, or reporting (or program level data collection) and Other SI Activities.