Detailed Mechanism Funding and Narrative

Years of mechanism: 2007 2008 2009

Details for Mechanism ID: 4914
Country/Region: Kenya
Year: 2007
Main Partner: Johns Hopkins University
Main Partner Program: JHPIEGO
Organizational Type: University
Funding Agency: USAID
Total Funding: $7,926,474

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $630,000

1. LIST OF RELATED ACTIVITIES The APHIA II Eastern PMTCT activities will relate to HIV/AIDS treatment/ARV services (#8792), counseling and testing (#8782), Orphans and Vulnerable Children (#9041), Palliative Care (#8863), TB/HIV (#9069) and Condoms and Other Prevention (#8932) activities in the same region.

2. ACTIVITY DESCRIPTION APHIA II Eastern will continue to provide technical assistance to a number of health facilities within targeted districts in Eastern Province, providing PMTCT services. This assistance will increase management, as well as technical, capacity of staff at these sites improving quality and productivity. The project will also work to improve PMTCT outcomes, examining ways to increase compliance with infant feeding and treatment guidelines and to increase the number of women who return to facilities for delivery and post-partum follow-up. The APHIA II Eastern will train 200 health providers in 39 facilities providing PMTCT services.

In 2007, the APHIA II Eastern will work with several types of partners in Kenya. First, it will continue to support expansion and quality improvements for PMTCT services through working closely with the faith-based facilities, with the explicit purpose of building programmatic and administrative capacity to implement HIV programs. Second, it will expand support for PMTCT services to public sector facilities in 8 of the 12 districts in the province. Supported sites will counsel and test 52,488 pregnant women and provide ART prophylaxis to 2507 HIV positive women. Of the HIV positive women, 1250 will receive AZT, 250 HAART and 1007 single dose nevirapine for prophylaxis. 1250 exposed infants will receive PCR for early infant diagnosis.

The APHIA II Eastern will continue to participate in the Ministry of Health's (MOH) Technical Working Group to ensure coordination of site selection, project activities, monitoring and evaluation and linkages between these sites. They will comply with MOH clinical and reporting guidelines and will use the WHO/CDC-based national training curriculum. APHIA II Eastern will also help the more mature facilities to graduate to PMTCT+ sites, providing ART and other care and support services to HIV+ women and their families. It will establish laboratory networks which will provide easy access to CD4 counts as well as other chemistry tests that often hinder access to ART uptake. It will build on its work already established in some parts of Eastern province to increase access to these services as well as access to early infant diagnosis. It will put emphasis on male involvement, psychosocial support, as well as psychosocial support for health care providers and care givers of HIV infected children.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA APHIA II Eastern activities in the specific geographic regions will contribute to 5.2% of 1,000,000 pregnant women in COP 2007 PEPFAR goals for PMTCT primary prevention and care. Planned activities will improve equity in access to HIV prevention and care services since the currently underserved communities will have better access, and APHIA II Eastern will work to ensure there are adequate networks and linkages between their sites and medical sites where AIDS care and treatment are available for both adults and children. On top of this APHIA II Eastern will offer PMTCT+ services in selected sites. These activities will contribute to the result of increased access to counseling and testing services, particularly among underserved and high risk populations and the result of increased availability of diagnostic counseling and testing services in medical settings to identify the large numbers of HIV infected patients who are potential candidates for ART.

4. LINKS TO OTHER ACTIVITIES Linkages between PMTCT service and care outlets will be strengthened to improve utilization of care opportunities created through PEPFAR funding. The APHIA II Eastern PMTCT activities will relate toHTXS, HVCT, OVC, HBHC, HVTB and HVOP activities in the same region.

5. POPULATIONS BEING TARGETED This activity targets adults of reproductive health age, pregnant women, family planning clients, infants, and HIV positive pregnant women. Strategies to improve quality of services will target health care workers in public, private and faith based facilities such as doctors, nurses, and other health care workers such as clinical officers, mid wives and

public health officers. It will also target host country government workers such as the National AIDS control program staff.

6. KEY LEGISLATIVE ISSUES ADDRESSED This APHIA II Eastern activity will increase gender equity in programming through PMTCT services targeted to pregnant women and their spouses. Women have the highest HIV burden both through infection and as care givers. Identifying them through PMTCT will give them an opportunity to access care and improved pregnancy outcomes for themselves their spouses and their infants. Increased availability of PMTCT and PMTCT+ services will increase access and help reduce stigma at community and facility level.

7. EMPHASIS AREAS This activity includes major emphasis focused on training of health care workers in PMTCT service provision, minor emphasis will focus on local organization capacity development to manage PMTCT services, quality assurance and supportive supervision and infrastructure development.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $790,000

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#8782), HIV/AIDS Treatment: ARV Services (#8792), Orphans and Vulnerable Children (#9041), Condoms and Other Prevention (#8932), and Palliative Care: Basic Health Care and Support (#8863).

2. ACTIVITY DESCRIPTION After a pilot project in two districts, in FY 2006 PATH and Population Council Frontiers project implemented the Kenya Adolescents Reproductive Health Project in Western province. Together with local staff of three Ministries: Health (MOH), Education (MOE), and Gender, Culture and Social Services (MOGCSS), PATH and Frontiers covered all the districts of the province. Although messages need to be tailored to specific target groups, all of them include reducing stigma associated with HIV/AIDS, the protective effects of abstinence and faithfulness to a partner of known HIV status, and the importance of knowing one's HIV status and taking appropriate action. These actions could be starting and adhering to ART if HIV-positive, and practicing healthy behaviors, including condom use when appropriate, regardless of serostatus. Providing appropriate messages and services to pre-adolescents and their families will also continue to be a priority. The grant-making process, including the formation of the technical review committee, establishing criteria, and identifying local partner capacity-building needs started in FY 2006, as did community entry activities to mobilize village health committees (VHCs). These serve as a link between the needs of communities and available services provided by existing health facilities and comprehensive care centers. In FY 2007, the process will be expanded to provide VHCs with ongoing training and support project-based animators. Communities will conduct health self-assessments and develop action plans, assisted by "quick-win" grants to operationalize the necessary structures and enlist widespread support. Health management committees will receive mentorship and training to introduce transparency into their programmatic and financial operations. Using the key messages already known and accepted by the community, outreach and health action days will be implemented as will appropriate activities to reach youth, such as the Youth Sports Initiative to build life skills and disseminate HIV/AIDS information focusing on abstinence and being faithful. These sub-grantees will, depending on the focus of the organization, conduct mobilization activities to engage youth and their families in ways that will minimize their risk of engaging in unsafe behaviors, reduce stigma associated with HIV/AIDS, and encourage community members to access local services. Selected groups will be provided with both structured capacity-building support as well as reinforcement through mentorship. This ongoing relationship will include assisting sub-grantees to better access local services, to participate in community mobilization, and to share the results of their work with other local groups. To complement the sub-grants program, APHIA II Eastern will undertake advocacy with groups including religious leaders, elected officials and other opinion leaders. In FY 2007, the process will be expanded to reach a larger number of community members. Organizations that will be selected for grants will, as part of this training and the ongoing mentoring through supportive supervision that constitutes an essential program activity, be updated on national policy and international standards.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will reach 20,000 individuals and especially youth with abstinence and being faithful messages. Two hundred individuals will also be trained to promote HIV/AIDS prevention through abstinence and/or being faithful. This will greatly contribute to USG's 5-year strategy in support of Kenya's integrated HIV/AIDS programs, by developing strong networks at the community level for a sustained response. Activities will link sub-grantees to other groups undertaking age-appropriate community outreach activities that deliver prevention messages, involve them in youth sports initiatives, encourage them to participate in message development, and facilitate reaching them through community-based radio programs.

4. LINKS TO OTHER ACTIVITIES This activity relates to activities in counseling and testing (#8782), ART (#8792), OVC (#9041), OP (#8932), and home-based care services (#8863). Capacity development of partners currently engaged in community mobilization to support the needs of community members using key messages that conform to national priorities and strategies targeted to local conditions and specific target populations will be addressed.

5. POPULATIONS BEING TARGETED This activity directly targets youth and their parents to support increased positive communication. Secondary targets are groups that serve youth, as these groups will be supported to better serve their constituencies using approaches and messages based on state-of-the-art knowledge and approaches. It also indirectly targets adults in the general population through its efforts to reduce the stigma surrounding HIV/AIDS and to promote gender equity. Strategies to improve the use of services will target policy makers, the general population, and Ministry of Health staff working as program managers in the DRH at provincial and district level, and local community leaders.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will reduce stigma associated with being affected by HIV/AIDS, increase gender equity in programming through the delivery of key messages and wrap arounds in education.

7. EMPHASIS AREAS Major emphasis is capacity building of local organizations and minor emphasis on information, education and communication and strategic information.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $976,000

1. LIST OF RELATED ACTIVITIES: This activity relates to activities in Counseling and Testing (#8782), Prevention of Mother-to-Child Transmission (#8752), Orphans and Vulnerable Children (#9041), Abstinence and Be Faithful Programs (#8725), HIV/AIDS Treatment: ARV Services (#8792), Palliative Care: TB/HIV (#9069) and Palliative Care: Basic Health Care Support (#8863).

2. ACTIVITY DESCRIPTION Civil society activities are crucial to promoting health behaviors. Significant and sustained behavior change requires not only information transmission, but attitudinal change and sustained reinforcement that increases levels of perceived self-efficacy that ultimately results in normative change. Although messages need to be tailored to specific target groups, all of them, developed in harmony with National AIDS and Sexually Transmitted Infection (STI) Control Program (NASCOP) and the Division of Reproductive Health (DRH), include reducing stigma associated with HIV/AIDS, the protective effects of abstinence and faithfulness to a partner of known HIV status, and the importance of knowing one's HIV status and taking appropriate action. These actions could be starting and adhering to antiretroviral treatment (ART) if HIV positive, and practicing health behaviors, (including condom use and use of MCH/FP services) regardless of serostatus. In FY 2006, a grant-making process was established through PATH and CLUSA, who have used this approach in other areas of Kenya. A first set of grants was made and activities started up. In FY 2007 this program will be expanded to reach more families and communities. Work will include implementing prevention interventions through civic group partners, and through men's and women's groups. Activities will integrate prevention messages about parent-child communication, gender-based violence, and youth participation. Other avenues used will include working through the Youth Sports Initiative as a means to build life skills. Communities will conduct health self-assessments and develop action plans, assisted by "quick-win" grants to operationalize the necessary structures and enlist widespread support. Village health committees (VHCs) within a facility catchment area will form sub-location health coordination committees, which in turn will serve as forums for sharing among VHCs and for coordinating activities that affect multiple VHCs. Health management committees will receive mentorship and training to introduce transparency into their programmatic and financial operations. This ongoing relationship will include assisting sub-grantees to better access local services, to participate in community mobilization, and to share the results of their work with other local groups. Key messages and strategies developed by National AIDS and Sexually Transmitted Infection (STI) Control Program (NASCOP), and local DHMTs will form part of all social mobilization activities. In FY 2007 the program will also be expanded to include identification of workplaces- including those in non-health sectors such as agriculture, banking, transportation, trade, food and hospitality, fuel service and education- for dissemination of information and counseling and testing service delivery. For example, due to the long distance travel associated with commercial trade, truckers often frequent hotels and transient lodges along the highway that runs along the southeast border of Eastern province. These lodgings are excellent settings for information dissemination that will build on and complement programs such as the regional Corridors program. Police posts, hotels, and will also be reached through the program. Peer coordinators will be trained through a cascading trainers program. Informal workplaces will also form part of the program. PATH will work with youth as a cross-cutting population that has access to other groups within families. Youth will function both as advocates during interventions, and as a means of reaching their peers. Using the overall behavior change communication (BCC) strategy and key messages developed in FY 2006, activities this year will include community outreach activities that are youth-centered, including production and distribution of Nuru comic, Magnet theater (a technique already in use elsewhere in Kenya that targets a whole community on a repeated basis), youth murals, and contest of various types. The team will also train faith-based and non-governmental organizations (FBOs and NGOs) to deliver ABC messages to high-risk groups, men's groups to disseminate accurate and appropriate information and promote the use of voluntary counseling and testing (VCT), prevention of mother-to-child HIV transmission (PMTCT) and antiretroviral treatment (ART) services, and will expand message reach through community radio programs. Messages will also aim to reduce stigma. People living with AIDS (PLWAs) will be involved in the design and implementation of outreach programs. To complement the prevention program, JHPIEGO and its partners (particularly the DHMT) will undertake advocacy with groups including religious leaders, elected officials and other opinion leaders.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA Activities being carried out will contribute directly to USG's 5-year strategy in support of Kenya's integrated HIV/AIDS programs, by developing strong networks at the community level for a sustained response. The activity will serve 250 condom service outlets and 20,500 individuals will be reached through community outreach that promotes HIV/AIDS prevention through other behavior change beyond abstinence and being faithful. A total of 100 individuals will be trained to promote HIV/AIDS prevention programs.

4. LINKS TO OTHER ACTIVITIES This activity relates to activities in orphans and vulnerable children (#9041), counseling and testing (#8782), abstinence/be faithful to promote health behaviors amongst youth and reduce stigma by encouraging individuals to know their HIV status (#8725). It also relates to PMTCT (#8752), Palliative Care: TB/HIV and HBHC (#9069) and (#8863) and ARV services (#8792) expanding HIV prevention in care and treatment settings.

5. POPULATIONS BEING TARGETED This activity directly targets the general population as well as youth and their parents, as well as at-risk groups to support increased positive communication and increased use of services. Secondary targets are groups that serve youth, as these groups will be supported to better serve their constituencies using approaches and messages based on state-of-the-art knowledge and approaches. Strategies to improve the use of services will target policy makers as well as the general population, Ministry of Health staff working as program managers in the DRH at provincial and district level, and local community leaders.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity addresses stigma reduction associated with being affected by HIV/AIDS, increase gender equity in programming through the delivery of key messages.

7. EMPHASIS AREAS Major emphasis addressed in this activity is community mobilization/participation and minor emphasis on development of network/linkages/referral systems, training and linkages with other sectors.

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

Funding for Care: Adult Care and Support (HBHC): $250,000

1. LIST OF RELATED ACTIVITIES The APHIA II Eastern HBHC activities relate to HIV/AIDS treatment/ARV services (#8792), Counseling and Testing (#8782), Other Prevention (#8932), Orphans and Vulnerable Children (#9041), TB/HIV care activities (#9069), AB (#8725), PMTCT (#8752) and Strategic Information (#8875).

2. ACTIVITY NARRATIVE Persons living with HIV/AIDS, their families and caregivers must have access to a variety of resources in order to address the wide spectrum of problems that are faced by households, especially poor households, when dealing with a debilitating disease in an adult family member. This activity will provide integrated and comprehensive home and basic health care to 10,000 PLWAs. These patients will be linked to 20 health facilities providing care. Through a cascaded training of trainers, 150 primary care facility health workers will be trained to provide comprehensive and integrated care training to 600 home /community based care workers who in turn train the primary care givers at home, to complement the facility based services. At 20 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 20 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.

Through this activity, the organizational capacity of PLHA groups will be strengthened so as enable them to be pro-active leaders, advocates and participants in the response to the epidemic. Community members including PLHA 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.

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.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA The APHIA II Eastern will reach 10,000 clients. 750 individuals, including 150 facility-based health workers and 600 community-based caregivers, will be trained to provide palliative care through 20 service outlets. This APHIA II Eastern 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-Eastern will adhere to GOK policies and guidelines and participate in national-level HIV technical working groups.

4. LINKS TO OTHER ACTIVITIES The APHIA II Eastern HBHC activities will relate to HIV/AIDS treatment/ARV services (#8792), Counseling and Testing (#8782), Other Prevention (#8932), Orphans and Vulnerable Children (#9041), Palliative Care: TB/HIV (#9069), AB (APHIA II Eastern), PMTCT (#8752), Strategic Information (#8875). Efforts will also link more clients to HIV counseling and testing, ARV and to ensure ARV and DOTS adherence will be stepped up in FY 2007.

5. POPULATIONS BEING TARGETED Populations are being targeted are: 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 other health workers 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. Contingent on enhanced funding for year one activities (2006/2007) Wrap Arounds will be addressed by the network of community-based sub grantees.

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).

Funding for Care: TB/HIV (HVTB): $220,000

1. LIST OF RELATED ACTIVITIES The activity will link to APHIA Eastern other activities in CT (#8782), HBHC (#8863), ART (#8792), OP (#8932), OVC (#9041), PMTCT (#8752) and AB (#8725).

2. ACTIVITY DESCRIPTION In FY 2007 USAID'S APHIA II Eastern project (implemented by JHPIEGO and its Implementing Partners) will provide support to TB control activities with the National Leprosy and Tuberculosis Program (NLTP) and continue to build the capacity of health workers in Ministry of Health (MOH) facilities in Northern region of Eastern Province, to provide for TB and HIV treatment and care services.

In FY 2005 JHPIEGO supported the training of 250 health workers in ART across twenty districts in Eastern and Nairobi province, which helped to improve the quality of TB/HIV services in 20 sites. JHPIEGO will continue to participate in the MOH's Technical Working Group to ensure coordination of TB and HIV activities and compliance with MOH guidelines. APHIA II Eastern will increase the number of providers and sites that can offer effective TB care, which will in turn increase the number of individuals provided with HIV and TB services, as well as the number of HIV infected clients given TB preventive therapy.

This activity seeks to provide TB treatment to 1,000 HIV infected clients attending HIV care/treatment services and increase the number of service outlets providing clinical prophylaxis and/or treatment for TB for HIV infected individuals by 20. The activity will support training of HIV and TB care staffs on routine diagnostic testing and counseling of TB suspects and cases using the NLTP/NASCOP curriculum, provide additional staff as required, screen HIV cases for TB, upgrade laboratories with additional equipment, and renovate laboratory space, as necessary. CTX prophylaxis will be introduced for all HIV infected TB cases and referrals for ART made to all CCCs. 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 will be increased to integrate TB into their on-going HIV/AIDS activities. Low literacy materials on TB/HIV will be reproduced and supplied. The private providers will be trained and linked to the public HIV/AIDS and TB programs.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This APHIA II Eastern TB/HIV care activity will provide clinical prophylaxis and treatment for TB to 1,000 people and train 200 health workers in TB/HIV related activities in 20 health care facilities in Eastern Province. It also contributes to Kenya's 5-year strategy emphases of developing effective linkages between prevention, care and treatment services within an integrated network.

4. LINKS TO OTHER ACTIVITIES The activity will link to APHIA Eastern other activities in CT (#8782), HBHC (#8863), ART (#8792), OP (#8932), OVC(#9041), PMTCT (#8752) and AB (#8725) that all seek to provide comprehensive district based services coordinated at the provincial level. This partner will also work closely with CDC supported partners in the Southern region of Eastern Province.

5. POPULATIONS BEING TARGETED This activity targets people living with HIV/AIDS, including infants and children. It also targets other MOH staff including program managers in the NASCOP, and public health care doctors and nurses.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will help to reduce stigma and discrimination.

7. EMPHASIS AREAS This activity includes major emphasis on training and minor emphasis on development of network/linkages/referral systems.

APHIA II Eastern 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 ($100,000).

Funding for Care: Orphans and Vulnerable Children (HKID): $2,500,000

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#8782), ARV services (#8792), Palliative Care: Basic Health Care and Support (#8863).

2. ACTIVITY DESCRIPTION The Ministry of Home Affairs, particularly the Children's Department, in partnership with the Ministries of Health and Education, provide leadership and coordination to the National OVC program. Part of the GOK's role has been the development of a policy on OVC. The APHIA II-Eastern project will use this policy as a framework to support locally based NGOs, CBOs and FBOs to provide services to OVC as part of a comprehensive care system. In FY 2006, APHIAII Eastern worked with PMO staff, the District Children's Officers and the DHMT to adapt a grant-making process and cycle modeled after the Maanisha model that has been in place in Nyanza and Western for several years. With AMREF, the developer and successful implementer of the model, taking the lead on this activity, the grant-making process, including the formation of the technical review committee, establishing criteria, and identifying local partner capacity-building needs has commenced. In FY 2007, the process will be expanded to reach a larger number of OVC. Organizations that will be selected for grants will identify OVC and families and support communities to support OVC in non-institutional settings in a variety of ways, depending on the focus of the organization. Examples include working to keep OVC in school (paying for school fees and uniforms), providing them with vocational training, providing psycho-social support assisting them to obtain health services and/or nutritional support, and otherwise engaging them in ways that will minimize their risk of engaging in unsafe behaviors. All sub-grantees will, as part of this training and the ongoing mentoring through supportive supervision that constitutes an essential program activity, be updated on national policy and international standards. Selected groups are not simply given funds and asked for reports, but they are provided with both structured capacity-building support as well on on-the-job type training and reinforcement. This ongoing relationship will include assisting sub-grantees to better access local services, to participate in community mobilization, and to share the results of their work with other local groups.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA The 2007 activities will serve 20,000 OVC and train 5,000 caregivers. Through its activities APHIA II Eastern will emphasize strengthening community-level capacity to develop, implement and sustain appropriate responses to the HIV/AIDS crisis.

4. LINKS TO OTHER ACTIVITIES This activity is linked to the counseling and testing (#8782) and efforts to prevent future HIV infections, home based care (#8863) community services and provision of care for those already infected, and creating a positive image of VCT. Efforts will link to work being done on offering effective ART (#8792) and provision of care to HIV infected children so that families with affected and infected children can benefit from appropriate care.

5. POPULATIONS BEING TARGETED This activity directly targets OVC and adults that are involved in providing them with care. It also indirectly targets adults in the general population through its efforts to reduce the stigma surrounding OVC and policy makers. Building the local capacity of these communities will rely on closely working with community and religious leaders as well as local community based and faith based organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will reduce stigma associated with being affected by HIV/AIDS as well as increasing gender equity in programming through the delivery of key messages. Linkages will be created with systems/groups offering support in food, microfinance, education, and as appropriate, reproductive health.

7. EMPHASIS AREAS Major emphasis will be development of networks/linkages and referral systems while minor emphasis is information, education and communication, and strategic information.

Funding for Prevention: HIV Testing and Counseling (HVCT): $630,000

1. LIST OF RELATED ACTIVITIES This activity relates to activities in PMTCT (#8752), TB (#9069), AB (#8725) and OP (#8932), and ART (#8792).

2. ACTIVITY DESCRIPTION In FY 2007 USAID's APHIA II Eastern Project - JHPIEGO will continue to promote the availability and delivery of high quality counseling and testing (CT) services in public Ministry of Health (MOH) facilities, an essential element of clinical and preventive care. JHPIEGO and other organizations such as EGPAF have found that ART initiation is increased where the diagnostic testing and counseling program was established in 2006. APHIA II Eastern project will collaborate with the Ministry of Health's (MOH) National AIDS and STI Control Program (NASCOP) and National TB and Leprosy program (NLTP) to strengthen provincial level management and coordination of Counseling and Testing in the clinical setting related to in-service training at all levels of health care delivery. This will be done through the following strategies; strengthen planning, implementation and coordination of CT in-service training; develop a provincial core team of trainers by conducting a training of trainers course (TOT) for NASCOP/NLTP / and Provincial Health Management team (PHMT). In FY 2007 this activity will continue to expand the geographical coverage of this service to increase access for couples and families. A total of 25 new VCT sites will be established in public and faith based health facilities. Training in VCT and DCT will be provided for 150 counselors and health care workers respectively. As a result 20,000 individuals will be counseled and tested and referred to care, treatment and other services as required. Increasing access to antiretroviral therapy dictates that CT efforts quickly transform to accommodate active case finding through provider initiated testing, PIT, in clinical settings, in addition to the more passive client initiated testing, CIT. Existing integrated VCT sites are particularly well placed to support these efforts; they will be strengthened to support DTC efforts e.g. supporting start up activities, providing testing for partners and other family members of index patients, and providing ongoing counseling. Testing in clinical settings will require support for logistics, creation and renovation of space especially at inpatient facilities, supportive supervision, ongoing monitoring, and mainstream CT reporting. Existing supported VCT sites already serve a large population of young people aged 24 and younger. In addition to existing dedicated youth VCT services, counselors at general VCT sites will be trained to work with young people. Targeted outreaches to youth centers and tertiary institutions, will also reach young people. Experiences with comprehensive counseling services at existing youth VCT centers including alcohol and substance abuse prevention counseling; gender based violence prevention and counseling, pregnancy prevention/FP; STI prevention, diagnosis and treatment; and referral to addiction treatment services; will be documented and used to scale up these efforts at existing general VCT sites. Outreach services, health action days, will require effective supervision, sessional staff, supplies, data collection and other logistics. BCC strategies supported by CBOs, FBOs, churches and mosques will encourage people to know their HIV status, and develop discordant couples support groups.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This program will contribute to 2007 emergency plan result for increased availability of counseling and testing through training of health workers. A total of 20,000 individuals will receive CT services.

4. LINKS TO OTHER ACTIVITIES This activity is linked to the prevention of mother to child transmission (#8752), TB (#9069), AB (#8725), OP (#8932) and other care programs including treatment (#8792). The proposed CT training and supervision activities by NASCOP will link with APHIA II Eastern Program activities.

5. POPULATIONS BEING TARGETED This activity targets adolescents and adults, including HIV positive pregnant women. It also targets Ministry of Health staff working as provincial ART Program Officers, physicians, pediatricians as well as clinical officers, nurses, midwives and other health care workers in public and faith based facilities. Most at risk populations will also be a target for this activity with a focus on commercial sex workers, discordant couples and street youth.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will help reduce stigma associated with HIV status by increasing the

availability of routine testing for diagnosis in medical settings.

7. EMPHASIS AREAS The activity includes a major emphasis on training. Minor emphasis will be in quality assurance and supportive supervision and development of network/linkages/referral systems. Minor emphasis on community mobilization activities as the activity will be integrated to the prevention program.

Funding for Treatment: Adult Treatment (HTXS): $1,792,474

1. LIST OF RELATED ACTIVITIES This activity is related to CT (#8782), TB/HIV (#9069) and HBHC (#8863).

2. ACTIVITY DESCRIPTION In FY 2007 USAID'S APHIA II Eastern project, implemented by JHPIEGO and its consortium partners, will continue to build the capacity of health workers in Ministry of Health (MOH) facilities in Eastern Province, to initiate and follow-up patients on ART. In collaboration with National AIDS and STD Control Program (NASCOP) JHPIEGO will develop competency-based orientation materials for comprehensive care, based on MOH National Guidelines for HIV/AIDS treatment. In Eastern Province health workers will be trained to provide ART using the MOH Guidelines and service providers will be trained in facilitative supervision. Strengthening referrals and linkages to care, treatment, and prevention are priorities for FY 2007. This activity will enable health workers in public and faith-based health facilities to reach individuals who are most likely to benefit from ARV treatment, and will contribute to the provision of ART to 3800 HIV positive patients, which will include 380 children. Significant changes from 2006 include the advancement of training for health workers through development of orientation materials. In FY 2005 JHPIEGO supported the training of 250 health workers in ART, which helped to improve the quality of services in 20 ART sites. In 2007, Emergency Plan funding will be used to provide competency-based tools for training in comprehensive care, to increase the number of skilled trainers and advance the ART skills of health workers in Eastern Province. JHPIEGO will continue to participate in the MOH's Technical Working Group to ensure coordination of activities and compliance with MOH guidelines for service delivery. In FY 2007, increasing effort will be given to integrating services. In particular, APHIA II Eastern will increase the number of providers and sites that can offer effective ART care. 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 This activity will increase skilled health workers to provide care and treatment, and provide 3,800 HIV infected patients with ARV treatment.

4. LINKS TO OTHER ACTIVITIES This activity is related to other activities by APHIA II - Eastern in CT (#8782), TB/HIV (#9069) and HBHC (#8863).

5. POPULATIONS BEING TARGETED This activity targets people living with HIV/AIDS, HIV positive infants, HIV positive children. It also targets other MOH staff including program managers in the NASCOP, and public health care doctors and nurses based in Eastern Province.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will help to reduce stigma associated with HIV status by increasing the availability of comprehensive care.

7. EMPHASIS AREAS This activity includes major emphasis on training and minor emphases on development of network/linkages/referral systems, community mobilization, and policy and guidelines.

Funding for Strategic Information (HVSI): $75,000

1. LIST OF RELATED ACTIVITIES This activity is related to strategic information activities to be carried out by University of North Carolina/MEASURE Evaluation (#7098), NASCOP (#7002), and SI Targeted Evaluation/TBD (#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 Committees (CACC) levels by NACC through three key components.

Component 1: Support APHIA II EASTERN/JHPIEGO and MOH program data collection processes for performance reporting needs (quarterly, semi-annual, annual). This component will support a participatory, coordinated and efficient data collection, analysis, use and provision of information to track achievement of APHIA II EASTERN/JHPIEGO and MOH's district level Annual Operation Plan II objectives, and 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 EASTERN/JHPIEGO and MOH to measure progress towards its contribution to the overall country's Emergency plan, National Health Sector Strategic Plan II and Kenya National HIV/AIDS Strategic Plan goals and results frameworks. Specific activities will include building capacity of 20 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 lead role in coordinating M&E activities in the province to meet the information needs of USAID/Kenya, the Emergency Plan, MOH, NACC and other stakeholders, in line with the "three ones" principle. APHIA II EASTERN/JHPIEGO 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 55 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 Eastern/JHPIEGO 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 Eastern 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 local organizations/health facilities in strategic information in addition to supporting the training of 55 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 University of North Carolina/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 be 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 and other health care workers like M&E and HMIS officers responsible 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 in 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.

Funding for Health Systems Strengthening (OHSS): $63,000

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

Table 3.3.14:

Subpartners Total: $0
Save the Children: NA
Young Women's Christian Association: NA
Meru Hospice: NA