1. LIST OF RELATED ACTIVITIES This activity relates to counseling and testing (#8776), ARV services (#8797), palliative care: home based care and support (#8929), abstinence and be faithful (#9070) and other prevention (#9040) activities.

2. ACTIVITY DESCRIPTION This APHIA II Rift Valley activity will expand PMTCT services in the Rift Valley province, building on the support previously provided through USAID's IMPACT and AMKENI Projects. It aims to increase the uptake of counseling, testing (CT) and ARV prophylaxis to at least 80% of pregnant women in selected sites. In 55 facilities across several districts in Rift Valley Province CT will be provided to 134,460 pregnant women, ARV prophylaxis to 7,817 HIV-positive women. Of these 3900 HIV positive women will receive AZT prophylaxis, 3137 will receive single dose nevirapine while 780 will be put on HAART. Service delivery will incorporate best practices namely opt-out approach and rapid testing. Sites will include, or 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 including early infant diagnosis to reach 3900 exposed infants in the mother and child health clinics (MCH) are priorities. Cost barriers to ART uptake especially laboratory costs in its sites will be addressed.

Significant changes from 2006 to 2007 include the provision of universal and more comprehensive PMTCT services in Rift Valley. Strategies to provide CT in maternity services during labor and delivery, emphasis on early infant diagnosis, male involvement, and greater involvement of people living with HIV/AIDS 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 APHIA II Rift Valley will support 55 sites, train 200 additional health care 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 13.4% 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 who are potential candidates for ART. Access to services, medical treatment and care will encourage rural women in underserved communities to attend ante natal care services. This will facilitate postnatal follow up of HIV positive women, infants and their family members.

This APHIA II Rift Valley activity also contributes substantively to Kenya's 5-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, ARV services, Palliative care, OVC, AB and other prevention

activities described in the APHIA II Rift Valley in other areas of the COP. PMTCT plus services include counseling and testing which is largely diagnostic, provision of ARV prophylaxis, management of opportunistic infections and ARV services. Strengthening laboratory services and improving commodity logistic systems is a crucial part of HIV/AIDS treatment services.

5. POPULATIONS BEING TARGETED This APHIA II Rift Valley 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 Rift Valley PMTCT 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 and development of network/linkages/referral systems with minor emphasis on renovation, quality assurance and supportive supervision as detailed in the activity description in Section 1 above.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#8776), Palliative Care: Basic Health Care and Support (#8929), HIV/AIDS Treatment: ARV Services (#8797), Condoms and Other Prevention (#9040), Orphans and Vulnerable Children (#9029), Prevention of Mother-to-Child Transmission (#8733), and Palliative Care: TB/HIV (#9065).

2. ACTIVITY DESCRIPTION This activity will reach 500,000 youth with abstinence and being faithful (AB) messages in Rift Valley Province. The activity will employ the 360 degree Model of Protection that seeks to delay first sex and increase secondary abstinence among youth ages 10 to 24 years old and 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 reproductive health (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 encompasses young people with a supportive environment at every level of their life (family, peers, school, and community). 2,000 people will be trained to provide AB programs among youth. The activity will be implemented by faith-based sub-partners 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 the Kenya Girl Guide Association (KGGA) to reach out to more youth in school with AB messages through a life skills program and a Sara communication initiative targeting girls. The Young Mens Christian Association (YMCA) will target under-served populations including Christian and Muslim youth in Naivasha. APHIA Rift Valley will also develop, produce and distribute AB communication materials through their various partners and networks.

They will expand youth peer education interventions using the Y-PEER approach established by YouthNet and the UN Fund for Population Activities (UNFPA); work with the Provincial Education Office and KGGA to roll out the life skills peer education program established under the IMPACT Project to more schools in Rift Valley Province; and work with tertiary training colleges and universities to integrate HIV/AIDS education using the "I Choose Life" approach and the National Organization of Peer Educators (NOPE)'s Ambassadors of Change. They will collaborate with local youth groups and partners to expand the youth program to four districts in Rift Valley Province.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will reach 500,000 people through AB messages, contributing significantly to the overall 2007 PEPFAR goals. The activity will seek to integrate prevention into all community outreach for treatment and care with a special emphasis on youth. It will significantly contribute to PEPFAR's goals for primary prevention.

4. LINKS TO OTHER ACTIVITIES The activity will link to other APHIA Rift Valley activities in CT (#8776), HBHC (#8929), ART (#8797), OP (#9040), OVC (#9029), PMTCT (#8733) and TB/HIV (#9065) that all seek to provide comprehensive, district-based services coordinated at the provincial level.

5. POPULATIONS BEING TARGETED This activity targets adults, children and youth particularly girls, boys, primary and secondary school students.

6. KEY LEGISLATIVE ISSUE ADDRESSED Key legislative issues which will be addressed include gender, addressing male norms and behaviors, volunteers, stigma and discrimination, and education at primary and secondary levels.

7. EMPHASIS AREAS The activity will have a major emphasis on local organization capacity development with lesser emphases on information, education and communication, training and community mobilization and participation.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#8776), Palliative Care: Basic Health Care and Support (#8929), HIV/AIDS Treatment: ARV Services (#8797), Abstinence and Be Faithful Programs (#9070), Orphans and Vulnerable Children (#9029), Prevention of Mother-to-Child Transmission (#8733) and Palliative Care: TB/HIV (#9065).

2. ACTIVITY DESCRIPTION The activity will build on HIV/AIDS prevention activities implemented under FY 2006 in the area of "other prevention." It will reach 700,000 individuals through community outreach programs and train 2,000 people through existing local non-governmental organizations (NGOs), faith-based organizations (FBOs) and the private sector thus reaching individuals in formal and non-formal sectors. Under the leadership of National Organization of Peer Educators (NOPE), the activity will aim to reach women and men in worksites and youth at risk. The local NGOs 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 Rift Valley 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 antiretroviral treatment (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 (MOH) and other partners. This will also include targeted condom promotion and distribution to high-risk populations and referral for STI services by the MOH 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 Narok, Nakuru and Naivasha; linking them to voluntary counseling and testing (VCT), prevention of mother to child transmission (PMTCT), care and support services; supporting prevention efforts among the uniformed services by working with the provincial police AIDS Control Unit (ACU); expanding the peer education program targeting truck drivers patronizing the various truck stops along the Nairobi-Nakuru-Eldoret road and linking the activities to the existing ROADS Project; targeting most-at-risk populations (MARPS) such as the cattle traders and linking the programs to the sex worker programs. Local implementing partners will integrate prevention messages into models of care and support for orphans and vulnerable children (OVCs) and people living with AIDS (PLWA). Technical assistance will continue to be provided to partners implementing behavior change communication (BCC) 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 overall 2007 Emergency Prevention Plan for Kenya target reaching individuals through other behavior change beyond abstinence and/or being faithful. The activity will seek to integrate prevention with positives into all community outreach for treatment and care with special emphases on youth. It will significantly contribute to PEPFAR's goals for primary prevention.

4. LINKS TO OTHER ACTIVITIES The activity will link APHIA Rift Valley to other activities in CT (#8776), HBHC (#8929), ART (#8797), AB (#9070), OVC (#9029), PMTCT (#8733), and TB/HIV (#9065) that all seek to provide comprehensive district-based services coordinated at the provincial level. It will also link with the comprehensive cluster projects of the FHI-TCI project along the major Mombasa-Busia highway.

5. POPULATIONS BEING TARGETED The activity targets special populations particularly the most-at-risk populations of commercial sex workers, military personnel, discordant couples and truck drivers. The activity also targets adult men and women.

6. KEY LEGISLATIVE ISSUE ADDRESSED

The activity addresses both gender and stigma and discrimination.

7. EMPHASIS AREAS The major emphasis area for this activity is training with minor emphases on information, education and communication and community mobilization/participation.

APHIA II Rift Valley will undertake (1) prevention activities with HIV positives (PwP) working through PLWA support groups linked to the Comprehensive Care Centers in Nakuru and Naivasha. $50,000 of unallocated funds will provide support to patient support groups and post-test clubs in VCT centers to ensure promotion of faithfulness and condom use by HIV-infected persons. This will empower 5 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.

1. LIST OF RELATED ACTIVITIES The APHIA II Rift Valley HBHC activities will relate to HIV/AIDS treatment services (#8797), Counselling and Testing (#8776), Other Prevention (#9040), OVC (#9029), TB/HIV care activities (#9065), AB (#9070), PMTCT (#8733) and Strategic Information (#8895).

2. ACTIVITY DESCRIPTION This activity will provide integrated and a comprehensive home and basic health care package to 14,000 people with HIV/AIDS linked to 22 comprehensive care centers and a network of 175 Rural Health Facilities (RHFs). Through a cascaded training of trainers, primary care facility health workers will be trained to provide comprehensive and integrated care training to the home /community based care workers who in turn train the primary care givers at home, to complement the facility based services. At the health facility clinic, 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 counselling and education. All babies and children of HIV infected mothers will be followed up at the CCCs or MCHs in the 22 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. The main link to and from the health facility will be the CHWs many of whom will be treatment supporters. Formal linkages between health facilities and the community-based activities will be strengthened to enhance effective care, follow-up, and tracking of referrals and assessment of patient response and satisfaction with the services. Both formal health care workers and community and home-based volunteer care workers will be trained on effective referrals. In some instances, 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 17 DHMTs institutions to integrate, plan, lead, monitor and evaluate home and community care support programs.

This activity will lead to the linkage of 10,000 families with economic support programs using the CRS SILC model. Community members including PLWA and some 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. 25,000 PLWH and their family members will receive nutritional and food support and through collaboration with AGRI, 2,500 people will be trained on improved agricultural techniques for food production. APHIA will tap into other USAID/FFP program to provide supplementary nutrition to families caring for OVC. 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. Paralegal and child counsellor training will be strengthened and through active monitoring and follow-up to assess its impact to the children and PLWA

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA The APHIA II Rift Valley will reach 14,000 clients and 2,500 individuals will be trained to provide palliative care through 197 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 The activity will link to APHIA Rift Valley other activities in PMTCT (#8733), TB/HIV HIV/AIDS treatment services (#8797), Counselling and Testing (#8776), Other Prevention (#9040), OVC (#9029), TB/HIV care activities (#9065), AB (#9070) that all seek to provide comprehensive district based services coordinated at the provincial level.

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 community and religious leaders as well as other health workers.

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 Wrap Arounds 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 activity will link to APHIA Rift Valley other activities in CT (#8776), Palliative Care: Basic Health Care and Support (#8929), ARV services (#8797), Condoms and Other Prevention (#9040), Orphans and Vulnerable Chiildren (#9029), Prevention of Mother to Child Transmission (#8733) and Abstinence and Be Faithful (#9070).

2. ACTIVITY DESCRIPTION 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 urban, poor populations in Mombasa and Nairobi. In addition, these activities have supported strengthening of the Central Reference Laboratory, linkage into the home-care programs to introduce/strengthen community-based DOTS, 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. In the nomadic pastoralist population of Samburu district, this activity funded the SADIA Project that strengthened ‘manyatta' TB care and introduced community-based DOTS and HIV care to nomadic populations.

This activity seeks to provide 1,000 HIV infected clients attending HIV care/treatment services treatment for TB disease and increase the number of service outlets providing clinical prophylaxis and/or treatment for TB for HIV infected individuals by 40. 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. In addition, INH prophylaxis will be introduced at select Comprehensive Care Clinics (CCCs) and the congregate settings of Naivasha GK Prison and other prisons. CTX prophylaxis will be introduced for all HIV infected TB cases and referrals for ART made to all CCCs. 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 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 either the public HIV/AIDS and TB programs or the Gold Star Network whose target is paying clients in the private sector.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This APHIA II RV TB/HIV care activity will provide clinical prophylaxis and treatment for TB to 1,000 people and train 100 health workers in TB/HIV related activities in 40 health care facilities in Rift Valley Province.

4. LINKS TO OTHER ACTIVITIES The activity will link to APHIA Rift Valley other activities in CT (#8776), Palliative Care: Basic Health Care and Support (#8929), ARV services (#8797), Condoms and Other Prevention (#9040), Orphans and Vulnerable Chiildren (#9029), Prevention of Mother to Child Transmission (#8733) and Abstinence and Be Faithful (#9070) that all seek to provide comprehensive district based services coordinated at the provincial level.

5. POPULATIONS BEING TARGETED This activity targets People Living with HIV/AIDS and also HIV/AIDS affected families.

6. EMPHASIS AREAS This activity has a major emphasis on networks/linkages/referral systems and minor emphases in supportive supervision, development of referral systems, IEC, and linkages with other sectors and initiatives.

1. LIST OF RELATED ACTIVITIES This activity relates to Abstinence and Be Faithful (#9070), Counseling and Testing (#8776), Palliative Care: basic health care (#9065), PMTCT (#8733),TB/HIV (#9065), Other Prevention (#9040), and ARV (#8797).

2. ACTIVITY DESCRIPTION Orphans and Vulnerable children remain a key challenge in the provision of care and support and Rift Valley Province faces huge challenges in this area as it is estimated to have the second highest number of OVC in Kenya after Nyanza Province. There are already existing programs responding to the needs of OVC but these are in most cases providing a scattered and uncoordinated response.

This will be achieved by provision of a comprehensive package of support by APHIA Rift Valley directly but also work to coordinate partners to ensure that a comprehensive package of support to OVC is provided by all partners. Through the technical leadership of World Vision and Social Impact the capacity of NGOs, CBOs, FBOs will be strengthened through training of trainers so as to enable them train caregivers to provide a high quality comprehensive care to OVC. Recognising the role that they play in the response to taking care of their own, key community stakeholders who include civic leaders, parents, caregivers, 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, one of the APHIA Rift Valley technical partners will provide support in mobilising the community to lead the response to OVC.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity therefore seeks to provide comprehensive support to 35,000 orphans and their households directly and through leveraged resources from other partners in the region and also train 8,750 caregivers thereby contributing significantly to the national target of over 287,956 OVC being directly cared for by the Emergency Plan.

4. LINKS TO OTHER ACTIVITIES This activity links to APHIA Rift Valley other activities in Abstinence and Be Faithful (#9070), Counseling and Testing (#8776), Palliative Care: basic health care (#9065), PMTCT (#8733),TB/HIV (#9065), Other Prevention (#9040), and ARV (#8797) that are intended to enhance service delivery and linkages between the community and service delivery sites as well as strengthening the referral network for care.

5. POPULATIONS BEING TARGETED This activity targets people affected by HIV/AIDS and specifically orphans and vulnerable children and also caregivers of OVC, in addition this activity will target the community including community leaders and religious leaders as well as community based and faith based organizations in the capacity development of the community to serve the needs of the OVC.

6. KEY LEGISLATIVE ISSUE ADDRESSED This activity will address mainly issues in gender, particularly for the girl child, as they relate to issues of child labour, increasing women and girls access to income and productive resources and addressing the issues of inheritance rights and protection of property rights for children and women. Wrap- around issues as they relate to food and education will also be addressed.

7. EMPHASIS AREAS The major emphasis area will be in community mobilization/participation with minor emphasis in the area of local organization capacity development.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in HIV/AIDS treatment services (#8797), abstinence and be faithful (#9070), OVC (#9029), HBHC (#8929), TB/HIV care activities (#9065), other prevention (#9040), PMCT (#8733) and strategic information (#8857).

2. ACTIVITY NARRATIVE: This activity will provide counseling 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. GOK, through the MOH already approved HIV testing protocol of serial testing of whole blood and simple rapid HIV tests. Previous efforts concentrated on diagnostic testing mainly of patients who had signs and symptoms of HIV disease and clinical indications of AIDS. This will be strengthened further through routine testing of TB suspects and cases, pregnant women 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.

Recognizing the important role that dispensaries play in the provision of health services in the Rift Valley Province, outreach services will be provided from selected static sites to high volume dispensaries. Home-based / family CT will also be initiated in Nakuru, Naivasha and Molo Districts starting with the families of index patients who are enrolled in home based care programs. This will require the recruitment and training or orientation of support or session staff and community counselors who will work closely with mobile/outreach teams.

Through partnership with Family Health options, the IMPACT project had established VCT services for young people. This will be scaled up through community mobilization and outreach services for young people in the region together with NOPE and other local youth service organizations. Building on NOPE's work with workplace HIV/AIDS programs, CT will be integrated in workplace programs in Naivasha and other workplaces and actively link those that are infected to care and treatment either through the public program or the Gold Star Network.

The broadening of entry points to counseling and testing will require that at least 200 service providers are trained in Routine and diagnostic counseling 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 counseling and youth and adolescent counseling for all existing counselors will also be conducted.

Through the collaboration with (CLUSA) and using the FHI model for SBC, community mobilization campaigns for couple counseling and testing will be conducted

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

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This APHIA II Rift Valley 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 Rift Valley Counseling and Testing activities will relate to HIV/AIDS treatment services (#8797), Abstinence and Be Faithful Program Abstinence and Be Faithful Program (#9070), OVC (#9029), HBHC (#8929), TB/HIV care activities (#9065), OP (#9040)), PMCT (#8733) and strategic information (#8857). 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. This activity will also target most at risk populations like commercial sex workers, discordant cuoples, street youth, truck drivers, migrant workers, out-of-school youth and partners of CSWs.

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 has a major emphasis in the development and implementation of referral systems and minor emphasis in quality assurance and supportive supervision for CT counselors. This 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 Rify Valley province to strengthen their capacity to implement programs.

1. LIST OF RELATED ACTIVITIES The activity will link to other APHIA - Rift Valley activities in CT (#8776), HBHC (#8929), AB (#9070), OP (#9040), OVC (#9029), PMTCT (#8733) and TB/HIV (#9065).

2. ACTIVITY DESCRIPTION This activity will consolidate established programs in several geographic areas of the Rift Valley Province and will expand activities to include new areas. As a result of these activities, 4,500 people with HIV will receive antiretroviral therapy (1,000 will initiate treatment, 3,400 are expected to be in continuous treatment for more than 12 months) at 22 CCCs and 175 RHF facilities for treatment follow-up by nurse health workers while 220 health care workers will be trained in the provision of antiretroviral therapy. The proportion of children on ART at the 22 CCCs is expected to be 450, and health worker training and orientation will be undertaken to prioritize pediatric ART. Activities will include infrastructure improvements for laboratories and service delivery areas, supply of equipments and commodities, production and dissemination of IEC materials such as pamphlets addressing adherence to antiretrovirals, 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 and STI clinic services. All services will be tightly linked across the spectrum of care with other services in basic home-based and community support in conjunction with strengthening systems for effective service delivery. Prevention and positive behavior change services in care settings will be strengthened through improvement of institutional infection prevention practices and injection safety, PEP, appropriate nutrition including therapeutic and supplemental feeding that includes adequate micronutrient supply, and reduction of risk of infection among discordant couples. Substance abuse treatment programs will be integrated help 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, nursing homes and workplace clinics. An additional 100 providers in the private sector will be recruited in Rift Valley 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 for treatment access. Because the issue of stigma and discrimination is still high amongst health workers in Kenya this activity whilst conducting clinical training will also train health workers on stigma and discrimination using a specially produced curriculum.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute to 4,500 adult patients including 450 paediatric patients on ARV treatment by the end of the reporting period.

4. LINKS TO OTHER ACTIVITIES The activity will link to other APHIA - Rift Valley activities in CT (#8776), HBHC (#8929), AB (#9070), OP (#9040), OVC (#9029), PMTCT (#8733) and TB/HIV (#9065) that all seek to provide comprehensive district based services coordinated at the provincial level.

5. POPULATIONS BEING TARGETED This activity targets adults both men and women, people living with HIV/AIDS and will also provide treatment to HIV positive infants and HIV positive children.

6. KEY LEGISLATIVE ISSUE ADDRESSED Stigma and discrimination.

7. EMPHASIS AREAS The main emphasis area is local organisation capacity development. Minor emphases include infrastructure, logistics, IEC, quality assurance and supportive supervision.

This plus up funding will be used to more rapidly scale up pediatric ART to 200 children in Rift Valley 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 the strategic information activities to be carried out by University of North Carolina/MEASURE Evaluation (#7098), NASCOP (#7002), and TE/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 Rift Valley/FHI 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 Rift Valley/FHI 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 Rift Valley/FHI 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 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 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 Rift Valley/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 Rift Valley/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 Rift Valley 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 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 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.

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

Table 3.3.14:

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

Table 3.3.14: