1. LIST OF RELATED ACTIVITIES This activity will relate to the ARV services (#8765), Orphans and Vulnerable Children (#9056), Palliative Care: TB/HIV (#9072), Palliative Care: Basic Health Care and Support (#8936) and Condoms and Other Prevention (#8874).

2. ACTIVITY DESCRIPTION Pathfinder International (PI) supports facilities to provide comprehensive antenatal package for all pregnant women including screening, prevention and treatment for any infections (such as sexually transmitted infections and malaria), nutrition support, prophylactic ARVS, counseling on safe infant feeding, counseling and HIV testing of women and their partners. APHIA II Nairobi/Central will build on this work in both Nairobi and Central provinces. APHIA II Nairobi/Central will continue to support established support groups that are formed around PMTCT sites by mothers who have benefited from the project services. In addition, referral linkages will be established within facilities where APHIA II Nairobi/Central is providing antiretroviral therapy, through which HIV positive clients are assessed and put on treatment where necessary. The number of HIV positive women and children on treatment is increasing steadily through these networks. Laboratory networks will also be established that will greatly improve ART uptake as well as early infant diagnosis.

In 2007, APHIA II Nairobi/Central will consolidate these activities and provide HIV counseling and testing to 35,445 pregnant women and provide antiretroviral prophylaxis to 2,580 HIV-positive women. Of the positive women, 1,290 will receive AZT, 260 HAART and 1,030 single dose nevirapine for prophylaxis. 1,290 exposed infant will receive PCR for early infant diagnosis. At the community level lay counselors will be trained to strengthen the delivery of PMTCT services and to provide continued support for the HIV-positive women and their families. The project will train community health workers to provide community components of PMTCT services. In order to improve the quality of care, 500 health supervisors will learn management skills, including utilization of data for decision making. In 2007, this project will use its experience to consolidate progress in existing facilities, expand to others within the two provinces and continue to strengthen District Health Management Teams, and referral networks for PMTCT-plus activities. Pathfinder will train 500 health workers in PMTCT and comprehensive HIV management for HIV-positive mothers and their families. Efforts will be made to increase early infant diagnosis in order to identify infants that require HIV care and treatment and offer more appropriate advice on infant feeding choices. More efficacious regimens for PMTCT will be introduced and scaled up in all the sites offering services. Linkages to FP/RH will be made as well as to laboratory services in order to offer a more comprehensive package of care.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute to 3.5% of the overall 2007 Emergency Plan PMTCT targets for Kenya. Community participation and male involvement will significantly contribute to PEPFAR goals for primary prevention, access to care and treatment, and support of those affected and infected. Technical assistance to the Ministry of health facilities will contribute to improvement of the quality of services.

4. LINKS TO OTHER ACTIVITES Linkages to HIV care and treatment services will be strengthened, to ensure immediate appropriate care for the woman and exposed infants, and family members as well and thus optimize utilization of complementary services created through Emergency Plan funding. This activity will relate to the ARV services (#8765), OVC care (#9056), TB/HIV services (#9072), HBHC (#8936) and STP services (#8874) funded under the APHIA II Nairobi/Central.

5. POPULATIONS BEING TARGETED This activity targets adults, pregnant women, HIV-positive pregnant women, HIV affected families, and HIV-positive infants. Health care providers including Doctors, Nurses and Other Health care workers will be targeted for training on PMTCT using the national NASCOP PMTCT CDC/WHO based curriculum.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address gender equity in HIV/AIDS programs through improved PMTCT service delivery at ante-natal clinics and maternity units. Community health workers will

conduct community mobilization activities that will help increase service uptake as well as address issues of stigma and discrimination at community level.

7. EMPHASIS AREAS This activity includes major emphasis on Quality Assurance and Supportive Supervision with minor emphasis on Training; Community Mobilization/Participation and Development of Network/Linkages/Referral Systems.

Plus up funds will be used to support capacity for service providers to provide couple HIV Counseling and testing within PMTCT sites.Many women accessing HIV counseling and testing at PMTCT sites do not know their partner's HIV status. The program will strengthen innovative approaches to increase the number of men accessing HIV testing services, thereby enabling discordant couples to know their HIV status -an important HIV prevention strategy among couples.The program will target to reach at least 10,000 couples and will be implemented in Nairobi and Central Province.

APHIA II NEP will work only in the North Eastern Province. Northern part of Eastern and Rift Valley provinces will be covered by APHIA II Eastern and APHIA II Rift Valley projects respectively.

Targets

Target Target Value Not Applicable Number of service outlets providing the minimum package of 35
PMTCT services according to national and international standards Number of pregnant women who received HIV counseling and 24,177
testing for PMTCT and received their test results Number of HIV-infected pregnant women who received 881
antiretroviral prophylaxis for PMTCT in a PMTCT setting Number of health workers trained in the provision of PMTCT  services according to national and international standards

Table 3.3.02: Program Planning Overview Program Area: Abstinence and Be Faithful Programs Budget Code: HVAB Program Area Code: 02 Total Planned Funding for Program Area: $ 22,310,385.00

Program Area Context:

Key Result 1: 2.57 million individuals reached with AB community outreach Key Result 2: 260,000 individuals reached with A-only programs Key Result 3: 32,000individuals trained to promote AB

CURRENT PROGRAM CONTEXT AND STATISTICS Prevention activities in Kenya have consistently promoted behavior change among young people emphasizing delayed sexual debut, reduced numbers of partners, and other risk reducing behaviors consistent with the "A" and "B" of the "A-B-C" continuum. US agencies have supported these efforts with diverse international and local partners, including community and faith-based organizations and this will expand in 2007. Given the epidemiology of HIV in Kenya, a focus on youth will remain central.

Although HIV prevalence has declined overall in Kenya, youth, particularly young girls, remain extremely vulnerable to HIV infection. HIV prevalence among young women 20-24 at 9% is more than three times higher than that of young men of the same age (KDHS 2003). Nearly half of young women aged 15-24 who are sexually active have an older male first sexual partner, increasing their risk of HIV infection. Vulnerability to HIV infection is also related to education: youth in school aged 15-19 are less likely to have sex than out of school youth, with girls again at higher risk than boys. Despite these alarming statistics, there are also some encouraging trends including high rates of reported secondary abstinence. More than half of in school youth and more than a third of out of school youth reported no sex in the previous year (BSS 2003).

SERVICES PEPFAR AB partners have developed a robust and broad program that works through faith- and community-based initiatives as well as larger government institutions such as the Kenya Institute of Education (KIE). AB programs also address the underlying gender norms and male behaviors which fuel the epidemic. The highly regarded program with Kenya Girl Guides has expanded to include the Boy Scouts and this will continue in 2007.

Abstinence and faithfulness activities supported by USG in Kenya include peer education, networking, community theatre, mass media programs, and curriculum-based training, primarily targeting youth. The "Nimechill" ("I have chilled" / abstained from sex) campaign continues to be popular and has been enriched by the addition of Chill Clubs in hundreds of schools. In 2007, this program will be reinvigorated through a planned public private partnership with Coca-Cola. Coca-Cola will use the company's wide distribution network to support a follow-on to the "Nimechill" campaign. Programs are also implementing innovative ways of reducing girls' vulnerability by establishing ‘girls-only' days at a number of youth-friendly AB programs to increase their involvement.

Partners implementing AB programs have added elements to help develop a supportive adult environment. Preliminary assessment results of the ‘Families Matter' intervention that trains parents on positive relationships with youth showed a sustained positive effect on parenting and communication skills. This intervention for parents will be scaled up and implemented by others. Other programs continue to involve teachers and community leaders to support youth in adopting and sustaining abstinence.

To address the associated risks of alcohol and substance abuse in relation to HIV sexual risk behavior, programs will incorporate education on alcohol abuse in education and life skills training. Underserved regions like North Eastern province will receive expanded attention, including a new initiative to support AB prevention work in the Dadaab refugee camp through UNHCR. Activities have also begun in underserved regions of Eastern and Central provinces. Programs funded in 2006 will be strengthened, including those targeting marginalized populations such as the physically and mentally handicapped. We will continue to include special populations such as Muslim women, Imams, and pastoralists, and encourage those partners

to work with the Council of Imams and Preachers, and the Young Muslim Association. AB programs will continue targeting a majority of young recruits to the uniformed services as well as young families of the uniformed services community.

REFERRALS AND LINKAGES Programs will continue to carefully segment target populations so that appropriate interventions are offered to the right groups. Sexually active youth, especially those choosing to return to abstinence, will be helped to access counseling and testing services. Education on faithfulness is now also linked to couple counseling and testing to ensure it is advocated for as a priority with concordant uninfected partners.

The close association between gender norms and increased vulnerability is an important focus of AB program activities. For example, the ‘Men as Partners' (MAP) curriculum-based program has been implemented among young recruits of the National Youth Service and will be expanded to cover other uniformed services recruits such as those of the Kenya Wildlife Service. Selected programs such as Tuungane will continue to identify young girls who have been victims of sexual coercion and link them to post-exposure prophylaxis and psychosocial support services.

POLICY Efforts to harmonize varied AB curricula have been initiated in close collaboration with the Kenya Institute of Education although this is a slow process given the large number of partners. Additional technical support will be sought to expedite this process. Pre-service training will continue in teacher training colleges as well as in-service training with the Centre for British Teachers (CfBT) and the Ministry of Education to prepare teachers to provide youth with information on HIV/AIDS prevention, stigma reduction and gender sensitivity. Gaps in youth-friendly services identified by the Kenya Service Provider Assessment will be met by working with the National AIDS and STD Control Program and the Kenya Medical Training Institute to develop guidelines for youth-friendly services that will equip health workers with skills to communicate to young people about sexuality and sexual risk reduction, particularly abstinence.

BARRIERS ENCOUNTERED/STRATEGIES FOR RESOLUTION Monitoring AB programs for efficacy and keeping an accurate track of multiple community-based outreach activities continues to be a challenge for the USG team. One way of addressing this will be through regionally-focused APHIA programs working in collaboration with the Ministry of Education and NACC. However, managing a growing number of partners continues to be a challenge.

WORK OF HOST GOVERNMENT AND OTHER DONORS Planned interventions are consistent with the National AIDS Strategic Plan and complement other donor-funded activities including Global Fund awards and the World Bank "Total War on AIDS" project that provided small grants to CBOs through NACC in 2006. The 2007 grant from the World Bank will not be forthcoming until an audit is addressed, which may effect continuity of some programs. USAID will continue to collaborate with DFID to increase coverage of the CfBT training of teachers to implement the HIV/AIDS syllabus nationwide. UNICEF and KIE are partners in producing the Life Skills Manual. CDC has been working with the Kenya Uniformed Services of the Ministry of Home Affairs, including the National Youth Service of the Ministry of Youth Affairs and the Kenya Wildlife Service which falls under the Ministry of Tourism. The US Department of Defense has a strong collaborative relationship with the Kenya Department of Defense.

Program Area Target: Number of individuals reached through community outreach that promotes 257,284 HIV/AIDS prevention through abstinence (a subset of total reached with AB) Number of individuals reached through community outreach that promotes 2,566,843 HIV/AIDS prevention through abstinence and/or being faithful Number of individuals trained to promote HIV/AIDS prevention programs 31,898 through abstinence and/or being faithful

Table 3.3.02:

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#8976), Palliative Care: TB/HIV (#9072), and Prevention of Mother-to-Child Transmission (#8729).

2. ACTIVITY DESCRIPTION In FY 2007, Pathfinder and its prevention partners, including PSI, will target youth and adults with AB messages that are appropriately adapted to different target groups. Peer education, informal and formal worksite interventions, community outreach by PLWA, mobile VCT and life skills education for youth will all serve as a means through which messages will be conveyed. An in-school program for 10 to15 year olds will emphasize creation of support systems for students to focus on long-term goals, self-esteem and life skills. Emphasis will be on delayed sexual debut, and secondary abstinence will be encouraged for those youth who are already sexually active. APHIA II community level partner capacity for undertaking prevention and behavior change activities will also be strengthened, so that messages can be conveyed widely through implementing partners undertaking home and community support activities as well. It is expected that 20,000 individuals will be reached with community outreach HIV/AIDS prevention programs that promote abstinence and/or being faithful, while 25 persons will be trained to provide HIV/AIDS prevention programs that promote abstinence and/or being faithful. Additional project partners to be trained in Other Behavior Change will also contribute to AB message dissemination.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute significantly to the overall 2007 Emergency Plan AB Prevention targets for Kenya. Integrating prevention into all community outreach for treatment and care, with special emphasis on men and youth, will significantly contribute to PEPFAR goals for primary prevention and the Kenya Five-Year strategy for HIV/AIDS.

4. LINKS TO OTHER ACTIVITIES Support to AB Prevention will be one component of a package of integrated support at health facility and community levels in the region, holistically addressing HIV prevention, treatment and care. This activity relates to activities in Counseling and Testing (#8976), Palliative Care: TB/HIV (#9072), and PMTCT (#8729) through referrals and networking.

5. POPULATIONS BEING TARGETED The activity targets youth with messages about abstinence and both adults and youth with messages advocating faithfulness to one partner. Special emphasis will be placed on reaching men through outreach by PLWAs and involvement of community leaders, by couples counseling in PMTCT and through worksite interventions. Implementing partner counterparts from NGOs, CBOs, FBOs and schools will be targeted for training to implement prevention programs.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will be consistent with national strategies for HIV prevention promoting abstinence, delay of sexual debut including secondary abstinence, fidelity, partner reduction and related community and social norms.

7. EMPHASIS AREAS There will be a major emphasis on capacity building of implementing partners (IPs), community-owned resource persons (CORPs) and other community level implementing partners. Community involvement in the design and implementation of activities will play an integral part in ensuring the success of these interventions.

1. LIST OF RELATED ACTIVITIES This activity is linked to Palliative Care: Basic Health Care and Support (#8936), Counseling and Testing (#8976), and Palliative Care: TB/HIV (#9072).

2. ACTIVITY DESCRIPTION This activity will strengthen HIV prevention programs through other behavior change approaches (i.e. all behavior change approaches that do not focus on abstinence and being faithful) under the APHIA II Nairobi/Central Province Project. In FY 2007, Pathfinder and its prevention partners, including PSI, will target youth and adults with behavior change messages that are appropriately adapted to different target groups. Peer education, informal and formal worksite interventions, community outreach by PLWA, mobile VCT, life skills education for youth, high-risk outreach and transport corridor activities will all serve as means through which messages will be conveyed. In particular, the project will capitalize on PSI's experience in targeting informal worksites, market places, and "hot zones" where high-risk behavior is common. Street theater, interactive games, PLWA testimonials, outreach sessions and community mobilization will be used to convey messages that include consistent and correct use of condoms, knowing one's status and knowing your partner's status. APHIA II community level partner capacity for undertaking prevention and behavior change activities will also be strengthened, such that messages can be conveyed widely through implementing partners and undertaking home and community support activities. It is expected that 74,000 individuals will be reached with community HIV/AIDS outreach prevention programs that are focused on more than just abstinence and/or being faithful, while 275 persons will be trained in the same. At the same time, 15 condom outlets will be installed to provide easy access.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute significantly to the overall 2007 PEPFAR OP targets for Kenya. By specifically focusing on men and youth, this activity will significantly contribute to PEPFAR goals for primary prevention through the integration of prevention into all community outreach for treatment and care.

4. LINKS TO OTHER ACTIVITIES Support to Prevention/Other Behavior Change will be one component of a package of integrated support at health facility and community levels in the region, holistically addressing HIV prevention, treatment and care. It is specifically linked to palliative care, basic health care (#8936), counseling and testing (#8976), and palliative care, TB/HIV (#9072).

5. POPULATIONS BEING TARGETED This activity targets both adults and youth, with additional emphasis on worksites to reach men as well as high-risk groups and persons frequenting/working in "hot spots". It will target special populations such as bar maids to improve their HIV risk awareness, their rights as bar maids and how they can protect themselves from acquiring HIV infection. Implementing-Partner counterparts from NGOs, CBOs, FBOs and schools will be targeted for training to implement prevention programs.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will be consistent with national policies regarding other prevention and will specifically address gender to improve gender equity in HIV programming as well as address male norms and behavior that often hinder uptake of prevention activities.

7. EMPHASIS AREAS This activity includes major emphasis on worksites and minor emphases implementing-partner capacity building, linkages with other sectors and initiatives and training.

With $150,000 in plus-up funding APHIA II Nairobi/Central will expand their activities to target 100,000 high-risk youth by training 50 peer educators. HIV prevention activities targeting glue-sniffing youth, a growing IDU population, and other alcohol and susbstance abusers will be expanded in Nairobi and Central province. With $250,000 they will focus on HIV prevention with 100,000 male and female sex workers to promote alternatives to commercial sex work as well as protective barriers to prevent HIV transmission, both with commercial partners and steady boyfriends/girlfriends and husbands/wives. To do this

they will train 50 adults. In addition they will use $100,000 to expand support in HIV prevention and supportive services to 20,000 victims of gender-based violence in Nairobi and central province through the Nairobi Womens Hospital and outreach centers and train 20 health workers and community participants.

1. LIST OF RELATED ACTIVITIES The APHIA II Nairobi/Central HBHC activities will relate to HIV/AIDS treatment services (#8765), Counseling and Testing (#8976), Other Prevention (#8874), OVC (#9056), TB/HIV care activities (#9072), AB (#8731), PMTCT (#8729) and Strategic Information (#8870).

2. ACTIVITY DESCRIPTION This activity relates to care and support for people and families affected by HIV/AIDS under the APHIA II Nairobi/Central Province Project. In FY 2007, Pathfinder International (PI) and its partners will target 8,000 people with home and community based palliative care in Nairobi and Central Province. Palliative care (basic) will include a comprehensive package of community home-based care consisting of home nursing, clinical care, nutrition, STI/HIV prevention, education, OVC care, paralegal support and protection, psychosocial and spiritual support and links to income generating activities. PI will work with local implementing partners including established NGOs, CBOs, and FBOs. PI will strengthen the technical and institutional capacity of partners and build collaborative working relationships with a variety of stakeholders to encourage effective, efficient programming. Gender and youth issues will be addressed. PLWHA will be involved to ensure expansion and high quality of care and support programming. To promote GIPA, PLWHA will be recruited through implementing partners such as KENWA and others as CHWs, as they can be particularly effective not only in improving the quality of services but also in combating the serious issue of stigma.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This APHIA II Nairobi/Central activity will reach 8,000 clients and 200 individuals will be trained to provide palliative care through 50 service outlets. This APHIA II Nairobi/Central 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- Nairobi/Central will adhere to GOK policies and guidelines and participate in national-level HIV technical working groups.

4. LINKS TO OTHER ACTIVITIES Linkages to clinical services will be established through a two-way referral system and will include HIV/AIDS treatment services (#8765), Counseling and Testing (#8976), Other Prevention (#8874), TB/HIV care activities (#9072), AB (#8731) and PMTCT (#8729). Clinical supervisors and other health care providers will reinforce clinic to community referrals by being kept up-to-date on local resources for psychosocial, economic, legal and food security support. PI will link with local partners such as K-Rep to address economic insecurity through microfinance and business skills training. Implementing partners will collaborate with local programs and agencies to address food insecurity and nutrition needs.

5. POPULATIONS BEING TARGETED This activity targets people and families affected by HIV/AIDS. Local implementing partners will be targeted for training and capacity building. Health care providers will be targeted for sensitization and training related to home-based care. CHWs and caregivers will be trained and receive periodic refresher training. Groups/Organizations targeted include community-based and faith-based organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address issues of stigma and discrimination by improving the health and lives of the PLWAs, allowing them to provide increased care for their children and potentially return to work.

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).

Pathfinder/APHIA II has been identified as the prime partner for a private public partnership with the African Wildlife Foundation and Starbucks Coffee Company, in their project to enhance HIV prevention, care and support to small holder coffee farmers in the Nyeri, Samburu and Isiolo districts, collectively referred to as the Samburu Heartland. The proposed activity will be managed by a TBD USAID implementing partner. Starbucks, a leading coffee retailer, has approved coffee samples from selected coffee cooperatives in KHCP and supports the purchase of their coffees. AWF is Starbucks' local implementing partner, leading the KHCP mission of conserving wildlife and the environment while increasing livelihoods through sustainable coffee production.

Active engagement in HIV/AIDS activities is a key component of sustainable coffee production, as HIV continues to infect and affect a growing population of coffee farmers in these rural areas. The KHCP seeks to enrich existing conservation and livelihood objectives of small scale coffee farmers and coffee cooperatives through awareness creation and quality care to HIV/AIDS infected and affected farmers and their families.

"Pathfinder/APHIA II has been identified as the prime partner for a private public partnership with the African Wildlife Foundation and Starbucks Coffee Company, in their project to enhance HIV prevention, care and support to small holder coffee farmers in the Nyeri, Samburu and Isiolo districts, collectively referred to as the Samburu Heartland. The proposed activity will be managed by a TBD USAID implementing partner. Starbucks, a leading coffee retailer, has approved coffee samples from selected coffee cooperatives in KHCP and supports the purchase of their coffees. AWF is Starbucks' local implementing partner, leading the KHCP mission of conserving wildlife and the environment while increasing livelihoods through sustainable coffee production.

Active engagement in HIV/AIDS activities is a key component of sustainable coffee production, as HIV continues to infect and affect a growing population of coffee farmers in these rural areas. The KHCP seeks to enrich existing conservation and livelihood objectives of small scale coffee farmers and coffee cooperatives through awareness creation and quality care to HIV/AIDS infected and affected farmers and their families.

Table 3.3.06:

1. LIST OF RELATED ACTIVITIES This activity will be linked to ARV services (APHIA II Nairobi/Central), Basic Health Care services (#8936), CT Services (#8976) and other TB/HIV activities (#7001).

2. ACTIVITY DESCRIPTION This activity relates to support for strengthening and expanding palliative care in clinical settings addressing TB and HIV. Pathfinder International (PI), the lead partner in APHIA II Nairobi/Central will develop and implement new interventions, expanding and integrating service delivery in Year 1 in sites targeted under the APHIA II Nairobi/Central Project. Emphasis will be on filling gaps in service delivery and linking to community based services. TB prevention, treatment and care programs will be strengthened and effective linkages made between TB and HIV services. Service quality and supervision at all levels of facility care and referral will be improved. Drug supply management, case management, records systems, supervision and community-based adherence/follow-up will be strengthened. All health facilities targeted by the project will provide OI treatment, including TB, cotrimoxazole prophylaxis, and nutritional support. APHIA II Nairobi/Central will work to expand diagnostic and DOTS case management capacity. According to GOK policy, all HIV+ patients will be screened for TB, and all TB patients tested for HIV. Malteser, a PI partner, will provide guidance for training of nurses and community health workers, annual refresher training on TB/HIV/AIDS care and education and basic training on clinical observation and case management. PI will ensure that cotrimoxazole prophylaxis, de-worming, intermittent treatment for malaria, and ITNs are provided at all HIV care sites in collaboration with KEMSA and PSI. Lab staff will be trained to be more responsive to the needs of TB patients.

In FY 2007 PI will pilot ART provision in TB clinics in an effort to decentralize and treat patients where they are presenting for care. In both Nairobi and Central 4,780 HIV infected people will be administered TB therapy, 200 health care workers will be trained in TB/HIV services from a total of 20 sites.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will result in 4,780 persons accessing TB/HIV services in Nairobi and Central, as well as better prevention and control of urban Tb in Nairobi.

4. LINKS TO OTHER ACTIVITIES Clinic-based palliative care is one component in a comprehensive treatment and care approach under APHIA II, such that clients will benefit from long term ART as appropriate and linkages to community services. Linkages will also be made with the NLTP and VCT sites.

5. POPULATIONS BEING TARGETED This activity targets in-patients and clients of DTC, TB-ward patients and clients of home and community support services who are referred for clinical care by community health workers. Health care providers including Doctors, Nurses and Other Health care workers will be targeted for training using national curricula.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address stigma and discrimination against persons infected with HIV.

7. EMPHASIS AREAS This activity includes major emphasis on Quality assurance and supportive supervision with additional focus on training; development of networks/linkages/referral systems.

1. LIST OF RELATED ACTIVITIES This activity relates to counseling and testing (#8976), ARV Services (#8765) and palliative care: Basic Health Care and Support (#8936).

2. ACTIVITY DESCRIPTION This activity relates to expanded support to be provided to OVC. Pathfinder International (PI), the lead partner in APHIA II Nairobi/Central, will partner with Christian Children's Fund (CCF) to provide integrated, age-appropriate services to build resilience of children infected with and affected by HIV/AIDS. Emphasis will be placed on development of healthy and supportive home and community environments where OVC and guardians/families have access to psychosocial support, education, health and nutrition services, economic livelihood support, shelter and protection from exploitation and abuse. Institutional capacity and technical expertise of implementing partners will be strengthened. OVC support will be integrated with and linked to the project's home and community support. Village Health Committees and implementing partners will identify OVC, who are often in the same households as those individuals receiving home-based care and support.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA It is anticipated that in FY 2007 a total of 8,500 OVC in Nairobi and 13,000 in Central (total 21,500) will be reached. Training of individuals in caring for OVC will cover 2000 people in Nairobi and 3,400 in Central (total caregivers 5,400). A total of 25 implementing partners (IP) (12 in Nairobi; 18 in Central) will be supported to provide care and support for OVC. Caretaker support groups will include OVC needs (4 in Nairobi and 8 in Central). This will contribute to the overall 2007 Emergency Plan OVC targets for Kenya.

4. LINKS TO OTHER ACTIVITIES This activity will be linked with other Pathfinder International APHIA II activities in the areas of counseling and testing (#8976), ARV Services (#8765) and Palliative Care: Basic Health Care and Support (#8936) in both Central and Nairobi Provinces.

5. POPULATIONS BEING TARGETED This activity targets orphans and vulnerable children, caregivers, Community Health Workers, guardians and educators involved with OVC. Capacity building efforts with the local communities will focus on the community and religious leaders as well as partnering with other community and faith based groups that exist in the area.

6. KEY LEGISLATIVE ISSUES ADDRESSED Issues addressed are stigma and discrimination and the wrap around services in food and education.

7. EMPHASIS AREAS This activity includes major emphasis in the development of the local organization and minor emphasis in the areas of community mobilization and participation.

1. LIST OF RELATED ACTIVITIES: This activity is related to activities in HIV/AIDS treatment services (#8765), abstinence and be faithful (#8731), TB/HIV care (#9072), OVC (#9056), HBHC (#8936), other prevention (#8874), PMCT (#8729) and strategic information (#8870)

2. ACTIVITY DESCRIPTION: This activity relates to support to be provided to increase VCT coverage while taking account of the need to emphasize diagnostic testing and counseling (DTC) as well. New VCT sites may be needed, for example, in large companies where employees lack easy access. Mobile VCT will complement fixed sites. Youth friendly services will be emphasized. Where possible, VCT will be integrated with facility and community level treatment and social support services for individuals testing positive and with prevention activities for discordant couples and individuals testing negative. DTC will be scaled up in support of the National AIDS and STI Control Program. Year 1 will see expansion and strengthening of DTC in imperative site facilities, PMTCT and blood transfusion sites and in district hospitals and health centers with laboratory capacity. A subcontractor will train counselors from target facilities and work with GOK and NGO counterparts to ensure supervision. Individuals who test positive will be systematically referred to CCC and higher levels for comprehensive testing and linkages to community services. Pathfinder will liaise with NASCOP to ensure HIV test kit supply. It is anticipated that in FY 2007, 31,900 people in Nairobi will be tested in 40 sites while 9,100 will be tested in Central in 10 sites. In Nairobi in FY 2007, 86 people will be trained in counseling and testing while Central will have 54 people trained as counselors.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA: This activity will contribute to COP 07 Counseling & Testing targets for Kenya. Integrating promotion of VCT into all community outreach for treatment and care will significantly contribute to PEPFAR goals for primary prevention.

3. LINKS TO OTHER ACTIVITIES: Support to counseling and testing will be a linchpin activity in APHIA II resulting in increased numbers of individuals accessing care, treatment and support and in strengthening prevention efforts. The APHIA II Nairobi and Central Provinces activities will relate to HIV/AIDS treatment services (#8765), abstinence and be faithful (#8731), TB/HIV care (#9072), OVC (#9056), HBHC (#8936), other prevention (#8874), PMCT (#8729), and strategic information (#8870)

4. POPULATIONS BEING TARGETED: This activity targets a wide range of population groups, including, for DTC, those receiving other clinical services, and for VCT, the general population, with emphasis on sexually active individuals, youth, and high risk groups such as bar workers, matatu and other transport workers. Health service providers will be targeted for training. All efforts are in coordination with the National AIDS control program staff. Community based and faith based groups will also be targeted in the community mobilization of CT services.

5. KEY LEGISLATIVE ISSUES ADDRESSED: This activity will address gender, stigma and discrimination through post test clubs and legislation related to protection of human rights and confidentiality.

6. EMPHASIS AREAS: This activity includes major emphasis on capacity building of C&T providers and CHWs. The activity emphasizes VCT as a major prevention strategy. IPs, CORPS and other community level implementing partners are key to its success. Training is a major emphasis area and this activity will train 140 people to implement CT activities. Minor emphasis is also in community mobilization.

1. LIST OF RELATED ACTIVITIES This activity will specifically be linked to other APHIA II Nairobi and Central supported activities in PMTCT (#8729), OVC (#9056) and TB/HIV (#9072), HBHC (#8936).

2. ACTIVITY DESCRIPTION This activity relates to support to be provided to strengthen and expand ART services in Nairobi and Central Provinces under the APHIA II Nairobi/Central Province Project. In FY 2007, Pathfinder International (PI) and its partners will target eleven sites in Nairobi Province that are already providing ARV services, in order to ensure continuity of services previously supported by other USG partners. Support will be initiated for an additional five sites in Nairobi and Central Provinces during this period, for a total of 17 ART service outlets. Support at ongoing and new sites will enable MOH supervision as well as strengthen quality assurance, integrating HIV with RH/FP and TB services and HMIS. At new sites, service providers will receive training in adult and pediatric HIV care. Efforts will be made to introduce and scale up early infant diagnosis as well as scale up pediatric care and treatment. Prevention with positives will be given more attention in order to curb the tide of new infections. Treatment at the CCCs will be expanded to link and network other entry points such as the out patient departments, inpatient departments community services, PMTCT and VCT centers. Efforts will be made to decentralize services so that patients get treatment where they are presenting for care. Efforts will be made to facilitate laboratory networks that improve uptake of ARV services. It is expected that 6,000 individuals will receive ART at these sites. 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 put 6,000 patients on ARV treatment, 600 of whom will be children. More children will be identified through early infant diagnosis.

4. LINKS TO OTHER ACTIVITIES Support to ART services will be one component of a package of integrated support at health facility and community levels in the region, holistically addressing HIV prevention, treatment and care. This activity will specifically be linked to other APHIA II Nairobi and Central supported activities in PMTCT (#8729), OVC (#9056) and TB/HIV (#9072), HBHC (#8936). and other prevention activities ensuring successful referral of individuals that require ART care and support.

5. POPULATIONS BEING TARGETED This activity targets HIV+ adults and children. Health care providers including Doctors, Nurses and Other Health care workers will be targeted for training using national curricula.

6. KEY LEGISLATIVE ISSUES ADDRESSED The key legislative issue addressed in this activity is stigma and discrimination against people infected and affected by HIV/AIDS.

7. EMPHASIS AREAS This activity includes major emphasis on quality assurance and supportive supervision with additional focus on training; development of networks/linkages/referral systems.

APHIA II Nairobi/Central will renovate and expand physical infrastructure at current or potential treatment sites particularly hospitals (district and sub-district hospitals) where an estimated 7,000 HIV positive individuals will receive care. This will complement the current renovation work undertaken by PATHFINDER in Nairobi that concentrates on renovating lower down facilities - health centres and dispensaries. The activitiy is expected to renovate approximately 10 district or sub-district hospitals improving their ability to provide essential ART services ($200,000).

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 (CACCS) levels by NACC through 3 key components. Component 1: Support APHIA II NAIROBI-CENTRAL/PATHFINDER INTERNATIONAL 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 NAIROBI-CENTRAL/PATHFINDER INTERNATIONAL 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 NAIROBI-CENTRAL/PATHFINDER INTERNATIONAL 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 the 40 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 NAIROBI-CENTRAL/PATHFINDER INTERNATIONAL 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 110 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 Nairobi-Central/Pathfinder International 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 Nairobi/Central provinces. 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 forty local organizations/health facilities in strategic information in addition to supporting the training of 110 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 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 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 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.