PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED
REFERENCES TO TARGETS AND BUDGETS.
1. LIST OF RELATED ACTIVITIES
This activity relates to activities in Palliative Care: Basic Health Care and Support (#6960), Counseling and
Testing (#6957) and HIV/AIDS Treatment: ARV Services (#6958).
2. ACTIVITY DESCRIPTION
The Kenya Department of Defense (KDOD) medical service provides health care to 100,000 military
personnel, their dependants, and the civilian staff employed by KDOD. In FY 2008, KDOD will continue to
extend Prevention of Mother-To-Child Transmission (PMTCT) services to communities living in the
neighborhood of the military barracks with a total population of approximately 500,000. Currently the KDOD
offers PMTCT services in 20 of the 40 military camps sites nationwide. The PMTCT program will provide
Counseling and Testing (CT) in the PMTCT setting to 5,000 pregnant service women, spouses of service
personnel, and underserved populations in the neighboring communities surrounding the military barracks.
Antiretroviral prophylaxis will be provided to at least 300 of the HIV-infected pregnant women; these will
include AZT prophylaxis from 28 weeks gestation to at least 50% of them while 50% of them will be given
the more comprehensive regime consisting of AZT and NVP. 80% of their HIV exposed infants will also be
provided with ARV prophylaxis. Cotrimoxazole prophylaxis will be provided to all HIV exposed infants and
their mothers. Counseling on infants feeding will also be provided. The PMTCT services will continue to be
integrated into all existing military maternity facilities targeting 500 eligible women who will be served with
family planning information and services. The KDOD also will continue to offer sexual partner testing
targeting 500 men. In order to improve on sustainability, KDOD will train 30 additional health care workers in
PMTCT including family planning and nutrition. A further 30 health care workers will receive refresher
training on PMTCT. Training will be in accordance with the guidelines set by the Ministry of Health (MOH).
Quality assurance will be ensured through establishment of a strategic information and monitoring system
that will facilitate data analysis. Regular consultations and sharing of experiences within the military and
with the MOH will be undertaken in an effort to improve PMTCT services and strengthen follow up of infants
born to HIV infected women. The KDOD will undertake PMTCT site infrastructure renovations as necessary.
Linkages with HIV care and treatment services including antiretroviral treatment (ART) offered by the KDOD
will be strengthened to ensure that all those identified as HIV-infected have access to them. Linkages will
also be made to family planning services. The KDOD will continue to receive technical assistance from the
United States Department of Defense (USDOD).
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute to overall PEPFAR and Kenya government national goal of ensuring that at least
80% of all health facilities are providing PMTCT services by the end of year 2008. KDOD PMTCT activity
will also contribute to 0.4% of the overall national target of 1,200,000 pregnant women accessing PMTCT
services in FY 2008. The planned activities will also improve equity in access to HIV prevention and care
services of the most at risk populations. These activities will contribute to the result of increased access to
CT services, and those identified, as HIV-infected will be referred for care, support and treatment.
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 PMTCT activities will relate to KDOD activities in
palliative care (#6960), CT (#6957) and HIV/AIDS treatment/ART services (#6958). PMTCT services
include CT which is largely diagnostic, provision of ARV prophylaxis, and appropriate referrals for the
management of opportunistic infections and HIV/AIDS treatment.
5. POPULATIONS BEING TARGETED
This activity targets adult of reproductive health age, pregnant women, HIV-exposed/ infected infants, and
HIV positive pregnant women. Strategies to improve quality of services will target health care workers,
doctors, nurses, midwives, clinical officer, and the local communities.
6. KEY LEGISLATIVE ISSUES ADDRESSED.
This activity will increase gender equity in programming through PMTCT services targeted towards
pregnant women and their male sexual partners. Identifying the women through PMTCT will give them an
opportunity to access care for themselves, partners, and their children-all resulting in improved pregnancy
outcomes. Increased availability of PMTCT and PMTCT+ services will increase access to HIV care,
treatment and help reduce stigma and discrimination at military community and facility level.
7. EMPHASIS AREAS
The major emphasis areas in this activity will be in training more health care workers to meet the demands
of the improved PMTCT uptake. Minor emphasis will include infrastructure renovations at targeted health
facilities as needed to provide appropriate client privacy and confidentiality. Supportive supervision, quality
assurance, and strategic information planning will also be provided to improve PMTCT service delivery
quality.
This activity is related to activities in Counseling and Testing (#6957) and Condoms and Other Prevention
(#6962).
In FY 2007, Kenya Department of Defense (KDOD) trained 25 personnel as master trainers for the Men as
Partners in Prevention program (MAPP): five from each barrack (Lanet Army Barracks, Eldoret Recruits
Training College, Embakasi Garrison, Moi Air Base and Mtongwe Naval Base). The MAPP program focused
on the recruits and young dependents of military personnel living in the camps. Using lessons learned from
this experience, the KDOD intends to continue to expand on these activities in FY 2008. This activity aims
at identifying young people early at the entry point of their military careers and targeting specific behaviors
that are consistent with ensuring the prevention of HIV. This program has proven to be a success in building
skills that protect the military personnel against HIV infection. In FY 2008, the program will also focus and
address pervasive gender stereotypes and male behaviors that are relevant to uniformed personnel which
continue to be risk factors for HIV transmission. Due to the wide distribution of KDOD personnel in remote
areas of the country, the program will train 250 additional staff including 20 peer educators with the aim of
strengthening the integration of the curriculum into regular KDOD training not only at the basic training
stage following recruitment but also into the ongoing cadre course training of the KDOD program. In FY
2008, the KDOD AB activity will also focus on the dependents of the military personnel that are between the
ages of 10 and 18 with the development of a peer education program which addresses issues of youth
prevention and AB. In FY 2008, KDOD intends to promote greater command-level involvement in all
aspects of HIV prevention in the military through seminars and workshops to enhance their ownership and
participation in the prevention program. The major emphasis of the AB component of the program will
contribute to the outcome of changed social norms to promote HIV prevention behaviors among youth who
constitute a part of the population highly vulnerable to HIV infection. This will ensure that larger numbers are
reached with HIV prevention efforts and adults become actively involved as supportive mentors for youth. A
total 12,000 additional individuals in the KDOD community and its environs is expected to be reached with
messages that promote HIV/AIDS prevention through abstinence and/or being faithful.
AB activities within the KDOD program will contribute to FY 2008 prevention targets for Kenya, especially
among young recruits who are entering the military. The activities will also focus on youthful dependents
within the military community and young people living in the neighborhood of the military barracks in order
to address the prevention needs of the whole military community.
4 LINKS TO OTHER ACTIVITIES
This activity is linked to KDOD counseling and testing (CT) activity (#6957) by promoting VCT services as a
way of promoting secondary abstinence. This activity also links to the KDOD Condoms and Other
Prevention activity (#6962) by offering comprehensive prevention messages for the military community.
This activity targets young adults, both men and women of reproductive age. It will have a special focus on
the KDOD military personnel who, due to the nature of their duties, are vulnerable to HIV transmission.
Particular emphasis will be placed on young military recruits and young dependants of military personnel
residing inside the barracks as well as young people living in the neighborhood of the military barracks.
Leaders within the KDOD will have their capacity strengthened to provide leadership in this area.
6. KEY LEGISLATIVE ISSUES ADDRESSED
Through the skill building and behavior change that occurs as a part of the men as partners program, this
activity will address male norms and behavior and reduction of violence and coercion as well as stigma and
discrimination. The involvement of both male and female in AB activities will promote increased gender
equity in HIV/AIDS Programs to ensure that women are not left out of these important prevention activities.
The major emphasis will be on training by the continuation of the MAPP program as well as the introduction
of peer education for the youth that live within the military community. Minor emphasis areas include work
place programs, information, education and communication and community youth mobilization/participation.
This activity is related to activities in Counseling and Testing (#6957), Abstinence and Being Faithful
(#6966), and Prevention of Mother-to-Child Transmission (#6959).
The Kenya military recruits 2,500 young men and women in the age group 18 to 24 years old annually. This
group is highly vulnerable to HIV infection and other STIs as well. This activity aims to strengthen HIV
prevention in the Kenya Ministry of Defense (KDOD) and has three components. The first component will
include activities geared to promote prevention of HIV and STIs by focusing on training health care workers
in integrating HIV prevention in their STI diagnosis and treatment. In addition, in FY 2008, KDOD will train
30 individuals to promote HIV/AIDS prevention through behavior change messages that will be
disseminated through seminars and workshops targeting 5,000 military personnel, their dependants and
civilian personnel working in the military. Special forums targeting commercial sex workers (CSWs) with
condoms and other prevention (COP) messages will be implemented in three geographic areas within
Kenya, specifically Gilgil, Nanyuki and Mombasa, all of which are known to have a high concentration of
CSWs due to their position on the major transport corridor through the country. Although STI basic care will
be offered in all the military medical facilities, the program will concentrate on four military regions with a
high population density which includes Thika, Kahawa, Embakasi and Moi Air Base. Liaisons will be
developed between the KDOD and National AIDS and STI Control Program (NASCOP) to ensure high
quality care and training in STI and HIV prevention and education for KDOD health personnel assigned at
the military health facilities. The second component of the KDOD COP program will involve activities to
promote correct and consistent use of condoms among the military personnel. Measures will be put in place
to ensure availability of condoms in all the military stations country-wide by maintaining 50 condom outlets
throughout the military communities. Regular monitoring of condom uptake by military personnel will be
done on a monthly basis. The final component in FY 2008 will focus on the young recruits entering the
military. Though this group is being targeted through the youth focused program referred to as "Men as
Partners in Prevention" (MAPP) under the AB program area, this funding will support condom education and
promotion as a supplement to the AB program activities in order to provide a comprehensive prevention
program. This activity also intends to incorporate scaling-up of command involvement and support in
promoting behavior change activities by conducting regular trainings and organizing seminars/workshops
for the military personnel under their respective commands in order to ensure consistent and correct
messages regarding prevention.
3. CONTRIBUTION TO OVERALL PROGRAM AREA
KDOD services targeting 5,000 people will contribute to the FY 2008 prevention targets for Kenya among at
-risk adult populations. This activity contributes to Kenya's 5-year strategy of reducing the risk of HIV
transmission among high risk occupational settings by promoting the knowledge of correct and consistent
condom use among this high-risk group as well as STI education/prevention. The KDOD will integrate their
OP program with other sexual transmitted infection (STI) clinics and reproductive health clinics at the
various military health facilities.
This activity is linked to KEMRI-KDOD counseling and testing (CT) (#6957) and prevention of mother-to-
child HIV transmission (PMTCT) (#6959). This OP activity is also linked to KEMRI-KDOD AB activity
(#6966) by partnering with other prevention activities that promote a comprehensive approach to prevention
for the military population.
The KDOD OP activity will reach the most at-risk population by targeting the military personnel and their
dependants as well as CSWs that live adjacent to four barracks in Kenya. It will also reach the civilian
population working in the barracks and the general population living in the neighborhoods of the barracks.
The program intends to capture all STI cases and offer comprehensive treatment to those infected as well
as provide them prevention messages as part of their STI treatment.
This activity will address the issues of male norms and behaviors which promotes HIV risk behavior,
especially in this high-risk community of the military. These activities will challenge traditional male norms
that have been identified as contributing to sexual coercion and multiple sexual partners. The KDOD OP
program will also address stigma and discrimination that often is a significant obstacle to routine CT
services and the use of condoms.
The major emphasis area for this workplace program will be community mobilization/participation in order to
ensure that military personnel receive quality and specific prevention programs. Other emphasis areas will
be information, education and communication in order to de-stigmatize treatment for STIs as well as the
development of network/linkages/referral systems with other prevention activities. These areas will assist in
the systems integration approach that will successfully link information with behavior change. Training will
comprise another key emphasis area, and this will all be developed within the military work place program.
REFERENCES TO TARGETS AND BUDGETS
The only changes to the program since approval in the 2007 COP are:
+a prevention component has been integrated that is budgeted in this activity and includes the following
elements:
>Positive Prevention in Clinical Settings
This activity relates to activities in Counseling and Testing (#6957), Prevention of Mother-to-Child
Transmission(#6959), ARV Services (#6958) and Palliative Care: TB/HIV (#6961).
The Kenyan Department of Defense (KDOD) will provide basic health care and support to over 3,500 HIV-
positive military personnel, their dependents and civilian population residing near the military barracks at 8
KDOD medical facilities. In FY 2008, KDOD intends to focus upon improving the quality of life of those who
are HIV positive by improving on the delivery of care to these individuals. The package of palliative care
services will include cotrimoxazole prophylaxis, treatment of opportunistic infections, nutritional
supplementation, de-worming of children, TB screening, sexually transmitted infection (STI) management
and improved access to malaria prevention interventions. Other activities will include support of HIV positive
OVCs of the military to ensure they are provided with palliative care and linked to ART services, providing
support to post test clubs, strengthening of logistics capacity (particularly pharmacy management), and
procurement of commodities such OI medications and laboratory reagents. In FY 2008, this activity plans to
intensify palliative care in 8 existing military palliative care centers to reach a total of 3,500 patients with
palliative care services and screen at least 1,750 of them for TB. The treatment centers are well distributed
nationally to ensure fair geographical distribution thus ensuring the services are accessible for the
population who may require this support. Referral systems and networking among smaller and larger
military clinics will be developed to ensure continuity in care. A total of 40 health care workers, 5 for each
site, will be trained to offer services in the 8 centers. Adherence to care will be supported through extensive
involvement of PLWHA who will be trained as peer counselors to provide psychosocial support, ART and
TB adherence support for both clinic patients and at the community/barrack level. Part of the FY 2008 funds
will be used to role out the Prevention with positives (PWPs) initiative through procurement of
supplies/materials e.g. flow charts, hand outs, posters, counselor support and evaluation. In partnership
with the USDOD Walter Reed Project, the KDOD in the last 4 years has been successful in encouraging
KDOD military to come forward for testing so that those who need care can be assisted. Over 26,000
people have been tested and as a result 1660 have been registered in an HIV comprehensive care clinic.
As per August 2007, 1025 people were on antiretroviral therapy, and the remaining 635 were receiving
basic health care and support. FY 2008 activities will build upon the success of this program to ensure that
HIV positive patients are directly linked to health care and support services. Even though treatment sites are
decentralized from the main military hospital in Nairobi (AFMH) to other military regions, the care and
treatment of KDOD HIV/AIDS patients will continue to be closely monitored by staff from the main military
hospital in liaison with the Ministry of Health to ensure maintenance of standards of care as per national
guidelines. The human resource requirements will be reviewed as necessary. Data on the epidemic will be
collected systematically and shared openly to facilitate in monitoring of the epidemic and to assess the
services provided.
By providing care and support to over 3500 patients as described, the KDOD basic health care and support
program will contribute to the overall number of people under care in Kenya. Capacity building of PLWHA to
act as peer educators will contribute to mobilization and strengthening of the KDOD program capacity to
plan integrate and evaluate facility and community care support programs. The trainings and guidelines for
this activity will be in accordance with the national guidelines as outlined by the National AIDS/STI Control
Program.
These activities will link closely with KDOD's counseling and testing (#6957), ARV services (#6958), and
TB/HIV services (#6961). Through the KDOD PMTCT program (#6959) family members of mothers testing
positive will be identified and offered opportunity for care and treatment. KDOD's BHCS and ART will
constitute a continuum of care for HIV positive individuals as part of a comprehensive approach to care and
treatment.
This activity targets most at risk populations consisting of military personnel and their dependants as well as
the civilian population residing close to the barracks where treatment is otherwise unavailable (that is the
population in the Kenyan administrative location within which the military treatment and care centers are
located). Health care providers will also be targeted by increased ARV training, thus increasing the amount
of clients able to be served more efficiently.
This activity will address gender equity by ensuring that both males and females are targeted as receiving
services if required. This activity will also address stigma and discrimination through community education
and mobilization on issues related to living positively with HIV-AIDS.
This activity includes emphasis on minor construction/renovation of health facilities to ensure adequate
space to offer basic care services; human capacity development including training and empowering the
health workers to provide basic health care and support services by supporting necessary commodities;
data collection, analysis and dissemination, which will further support program monitoring and evaluation;
and increasing gender equity in HIV/AIDS programs, by ensuring that equitable number of women and
children are receiving treatment, and targeting increased access of services by men.
+other (NON-SUBSTANTIVE CHANGE): implementation of TB contact tracing through door to door sputum
testing
1. LIST OF RELATED ACTIVITIES:
This activity is related to activities in Counseling and Testing (#6957), Prevention of Mother-to-Child
Transmission (#6959), Palliative Care: Basic Health Care and Support (#6960) and ARV Services (#6958).
The Kenya Department of Defense (KDOD) will continue to intensify the diagnosis, care and treatment of
military patients with co-infections of TB and HIV (TB/HIV) by promoting screening activities of all HIV
infected patients for TB as well as ensuring all TB infected patients are offered HIV testing, STI screening,
HIV prevention messages including condom distribution. Those found to be co-infected will be given anti-
TB, Cotrimoxazole prophylaxis treatment (CPT) and ART as per the Kenya's National Leprosy and
Tuberculosis Program (NLTP) guidelines. Through this concerted effort, in FY08, the program will provide
HIV testing to 300 TB patients; and offer TB and HIV services to 150 TB/HIV co-infected patients.
Additionally, 1,750 patients accessing HIV services in the region will be screened for TB, and those found
positive provided with TB treatment. The program will intensify efforts of contact tracing by conducting door
to door sputum testing of TB contacts. This will lead to more cases being identified and appropriate care
being given in a timely manner. In order to achieve this, KDOD intends to continue improving the laboratory
capacity for TB/HIV and improving capacity of the health personnel through training in management of
TB/HIV. Refresher training for integrated TB/HIV activities for KDOD health professionals will be undertaken
by training of additional 36 health workers on TB and DTC using NASCOP/NLTP curriculum to support the
expected increased workload. TB/HIV services will continue to be supported in the 8 care and treatment
centers in Armed Forces Memorial Hospital (AFMH), Moi Air Base in Nairobi, Mombasa, Nanyuki, Nakuru,
Gilgil, Eldoret and Thika. In FY2007, funds were used to develop an integrated TB/HIV clinic within the
AFMH with marked success. In FY 2008, funds will be used to replicate the integrated clinic in the other 7
treatment centers so as to facilitate effective care of TB/HIV co-infected patients. KDOD will also continue
extending TB/HIV services to the neighboring civil population. AFMH remains the referral for all patients
requiring specialized diagnosis, treatment and in-patient care including patients suspected to have failed
treatment. In FY 2008, efforts to improve the capacity in the laboratory at AFMH to perform QA in smear
microscopy (florescent microscopy) will be continued. In line with the national guidelines, the AFMH lab will
continue to send samples to the National reference laboratory for TB cultures, drug sensitivity and
resistance testing. In line with National guidelines, the program will continue to ensure efficient and timely
supply of TB drugs to all treatment sites while maintaining regular supervision of all TB/HIV treatment
activities. Strengthening of community based adherence/follow up of patients in this program will be
promoted through telephone tracking of defaulters and the use of social workers. TB laboratories in the
military will continue to serve civilian patients and will be contingency for the district and provincial hospitals
in the regions in which they are located (that is the population in the Kenyan administrative location within
which the military treatment and care centres are located). In terms of reporting for TB, the KDOD is
recognized as Kenyan Province equivalent. This recognition by the NLTP will be exploited to ensure that the
KDOD tuberculosis program is developed further under the President's Emergency Plan.
Activities in this program area will contribute to the results of expansion of ART for clinically qualified HIV
infected patients. This activity will also care for those who have TB/HIV co-infection as well, thus improving
the level of care offered to the patients in KDOD. Human capacity to deliver TB/HIV treatment will be
strengthened as well as the referral network for provision of ART and TB/HIV care. Effort will be made to
ensure that all patients in KDOD and in the neighborhood of military barracks who deserve care in the area
of TB/HIV access this care.
This activity is part of a comprehensive program and is linked to other KDOD HIV care and treatment
activities in the area of Counseling and Testing (#6957), Prevention of Mother-to-Child Transmission
(#6959), Palliative Care: Basic Health Care and Support (#6960) and ARV Services (#6958). Linkages
between KDOD CT and Diagnostic Counseling and Testing (DTC) centers and care outlets will be
harmonized and strengthened to improve utilization of care opportunities in the nearest KDOD health facility
created through PEFAR funding. The KDOD will seek closer collaboration between the various services
with a view to sharing the facilities.
This activity targets military personnel, their families and members of the general population in the
immediate neighborhoods around the military facilities. The KDOD young men and women often serve
away from their homes, thus being vulnerable to risky behaviors thus exposing them to HIV and TB. The
stations have significant numbers of young families and continue to be popular heath service delivery points
for the surrounding communities benefiting from TB/HIV services. The 8 sites will include improved
laboratory services for handling TB/HIV, thus helping support staff, families and community members.
6. KEY LEGISLATIVE ISSUES
KDOD TB/HIV program will increase gender equity in HIV programming by ensuring that equitable numbers
of women including children are receiving treatment. The activities will address stigma associated with
TB/HIV status through information, education, and communication materials targeted to health care
providers, caregivers, and communities while addressing male norms and behaviors.
This activity includes emphasis on human capacity development including training and empowering the
This activity is related to activities in Counseling and Testing (#6957), ARV services (#6958) and Palliative
Care: Basic Health Care and Support (#6960).
KDOD initiated the orphans and vulnerable children (OVC) activity in FY 2006 following the recent trend of
an increased number of deaths among military personnel resulting from HIV/AIDS. It is estimated that 75%
of the deaths in the military are HIV related. The result of increased number of deaths in the military has
directly increased the number of OVC left without care and support to approximately 5,000 children. Prior to
the KDOD OVC program, these children orphaned by HIV/AIDS had no support from the KDOD as a
government institution. With funding in FY 2006, the KDOD has been able to establish a program that
focuses on care and general support to 800 OVC located through the assistance of Ministry of Home Affairs
(MOHA) children's department. The military OVC population has created close links with community
organizations and Government of Kenya offices to identify and ensure that each child enrolled in the
program receives a comprehensive care package that addresses the essential services required of
Emergency Plan OVC activities. The OVC in the KDOD program are collectively monitored and cared for
through the establishment of the OVC military coordination offices in 5 existing KDOD sites throughout the
country. In FY 2008, the KDOD will continue to provide the 1,000 OVC of the military with components of
Primary support. The program will continue to take the lead in ensuring that the survivors of the servicemen
and women are identified and given preference in this unique OVC military activity. The KDOD will ensure
increased access to education for their OVC through relevant district Ministry of Education (MOE) offices in
the identification and subsequent provision of bursary funds and vocational training opportunities. The
KDOD will also continue to implement the care and support of these OVC by strengthening the capacity of
the current caregivers in the local community and continue the tradition of communal and familial support of
the OVC. 100 additional caregivers will be trained in basic care and support of the OVC as well as on issues
regarding the psychosocial health of the child. The KDOD will hire continue to support the services of 6
social workers to maintain the regional OVC military coordination offices for better de-centralized service
delivery. The KDOD OVC program will continue to work with the existing community services or government
children agencies to augment the level of community and family based support already available to the OVC
through the wrap-around approach. This approach is supported by the Emergency Plan in which the needs
of the OVC are identified at the community level and subsequently cared for by strengthening existing
structures already in place to tend to the needs of the OVC in the various regions throughout the country.
The KDOD will work closely with other government systems and structures as well as local community and
faith based organizations in the wrap-around approach to caring for OVC which is the foundation to the
sustainability of all EP OVC activities. The 1,000 children that will be cared for by KDOD will contribute to
the national target of identifying and caring for over 288,000 OVC as well as the training of 100 caregivers.
This activity is linked to KDOD CT services (#6957) that are established throughout the country. Through
the early identification and subsequent care and treatment of those servicemen and women in the KDOD
identified as HIV positive, early support and care can also be provided to their dependents. This activity is
also linked to KDOD ART program (#6958) by ensuring that all OVC receive subsequent care and treatment
from the KDOD medical facilities. The palliative care program (#6960) under KDOD will also be linked to the
OVC activity by ensuring the provision of care and support for all HIV+ OVC in the military community.
This activity targets people affected by HIV/AIDS including military personnel and caregivers of OVC by
ensuring they are actively supported and linked to services. This activity is also targeting the OVC by
ensuring that they are protected, their rights are guarded and basic needs are met. The KDOD in this
activity will also directly take a leading role to ensure that the OVC that have been diagnosed as HIV
positive receive psychosocial support and medical care required as early interventions for quality care.
This activity will actively address issues surrounding stigma and discrimination by encouraging the
formation of psychosocial support groups for the OVC. By focusing on many of the adolescent OVC, the
KDOD hopes to establish a youth friendly support network that can work on tackling many of the issues
surrounding stigma and discrimination faced by the OVC. The KDOD OVC program will also be an integral
part of a wrap around approach to caring and supporting for the OVC through establishing links with other
community or religious organizations in ensuring the needs of the OVC are met fully.
The major emphasis area of this activity is focused on providing the Primary and Supplementary needs of
the OVC. Minor emphasis areas will be in maintaining adequate staff in the regional OVC military
coordination offices through human resources as well as training needs for the caregivers of the OVC. The
other emphasis area will be on developing appropriate information, education, and communication for the
OVC and their caregivers.
1.LIST OF RELATED ACTIVITIES
This activity relates to activities in Palliative Care: TB/HIV [#6961], Treatment: ARV services [#6958],
Abstinence/Being Faithful [#6966] and Condoms and Other Prevention [#6962].
2.ACTIVITY DESCRIPTION
Kenya's Department of Defense (KDOD) has received support from the Emergency Plan to implement a
comprehensive HIV/AIDS program since FY 2004. One of the key components of this program is HIV
counseling and testing (CT), which is useful, both for prevention and for access to care. A large majority of
the military personnel and their families are young people. Also, a sizable proportion of the actual military
personnel can be classified as high-risk, given that they often travel far away from their families. A
comprehensive HIV/AIDS program, including CT is essential in the military. In FY 2008 KDOD will expand
its CT activities in both the static sites and through community and military mobile (outreach) activities. 2
new VCT sites will be created to make a total of 30 VCT sites. Core activities will include training and
continued support to the existing 28 VCT sites. By so doing KDOD will have adequate capacity to provide
CT to an additional estimated 10,000 people, including military personnel and their dependants, KDOD
civilian employees, and the general population living near the barracks. All those who test HIV positive will
be referred to the nearest military clinics for care. In terms of training, 100 people (mostly health care
workers) will be trained and retrained in Provider-Initiated Testing and Counseling (PITC), lay counselors
including PLWHA will be trained in VCT and 20 counselors will be trained as supervisors. In FY 2008, the
KDOD program will intensify mobile VCT services targeting the Military Hot spots and high density non
military communities around the 4 major military regions (Nairobi, Central, Rift Valley and Coast). It will also
take advantage of the military logistics support to provide CT services to the underserved areas in the North
Eastern Province. In addition, greater involvement of people living with HIV/AIDS (GIPA) will be sought and
encouraged as one of the ways of reducing the stigma associated with CT. Quality assurance (QA) for both
counseling and testing will be expanded to cope with increased service uptake during the planned scale up
in FY 2008. The QA program will be done in keeping with national and international standards. QA for
counseling will involve monthly support supervision to practicing counselors.
3.CONTRIBUTIONS TO OVERALL PROGRAM AREA
KDOD'S CT program will contribute to the overall national CT target by providing CT services to the
military, which is a special, high risk population. The mobile VCT services will improve access to HIV
prevention and care services in remote areas that do not have fixed VCT sites, thus ensuring better access
to CT services. This activity will also contribute substantively to Kenya's 5-year strategy that emphasizes
universal knowledge of HIV status amongst Kenyans. Links between CT services and care will be
enhanced.
This activity is part of a comprehensive HIV care and treatment program within the KDOD linked to other
services such as AB (#6966), OP (#6962), TB/HIV (#6961) and ART (#6958). Linkages between CT
services and care outlets will be strengthened to improve utilization of care opportunities that have been
created in KDOD's health infrastructure through PEPFAR funding.
This activity will mainly target the Military personnel, their dependants, KDOD Civilian personnel and adult
members of the general population. Trainings will target health care workers, lay people and PLWHA
This activity will empower and increase awareness through counseling and targeted messages for the
military personnel. Vigorous campaigns to educate them on the benefits of VCT services, couple VCT and
mutual disclosure of HIV status will be undertaken. Testing and counseling will also be promoted in clinical
setting, especially TB, STD, PMTCT Clinics and medical wards to enhance identification and timely referral
of those requiring care. It will also seek to empower and inform the KDOD staff, families and communities
through counseling and targeted messages. The increased availability of CT services and their
popularization among the Military personnel will reduce stigma and ensure equitable access to CT services
across gender.
This activity includes major emphasis on commodity procurement and training with minor emphasis in
infrastructure improvement.
N/A (exempt)
The only changes to the program since approval in the 2007 COP are
+ other (NON-SUBSTANTIVE) change:
>One doctor will be trained at MSc level on molecular diagnostics and one laboratory technologist will be
trained on Immunology at a National Higher Diploma level
>The significant portion of constructions/renovations mentioned in FY07 will have been completed, no
further funding will be used at these sites for further renovations.
This activity is related to activities in Treatment: ARV services (#6958), Palliative Care: TB/HIV (#6961),
Prevention of Mother-to-Child Transmission (#6959) and Counseling and Testing (#6957).
This activity represents an important component which was funded under the Emergency Plan in FY 2006.
In FY 2007, the Kenya Department of Defense (KDOD) intends to complete the development of the
necessary laboratory infrastructure initiated in FY 2006 while strengthening laboratory facilities to support
HIV/AIDS-related activities. The funding for this activity will go towards infrastructure development for three
laboratories intended to support treatment and care at three new sites - Thika, Eldoret and Moi Air Base.
Each laboratory facility will have cytometry, hematology and chemistry monitoring equipment necessary for
accurate diagnosis, monitoring and follow up of HIV- infected patients at each of the eight KMOD medical
treatment facilities including the main military hospital - Armed Forces Military Hospital (AFMH) and the Air
Force medical centre at Moi Air Base in Nairobi, as well as eight outlying hospitals in Nanyuki (Laikipia Air
Base), Mombasa (Mtongwe Naval Hospital), Gilgil regional Military Hospital (GRMH), Nakuru area (Lanet
Army Barracks hospital), Eldoret, and Thika (Center of Excellence). The equipment of these military labs will
enable on-site staff to effectively provide laboratory services to 30-40 patients per day. In addition the eight
military laboratories will serve as back up for medical facilities in the neighborhood of the military barracks
which are often lacking in the basic laboratory facilities critical for ART initiation and monitoring. In FY 2007
KDOD activities will also be used at the AFMH for procurement of specialized microbiology equipment
which will include a culture unit, incubators, centrifuges, a fridge and hoods; reagents necessary for the
diagnosis of opportunistic infections including TB and STIs; a PCR machine for pediatric diagnosis;
development of protocols for quality assurance schemes and strengthening of networks and referral
systems between the AFMH and the 8 peripheral laboratories. The AFMH laboratory will be enrolled with
external QA/QC program and will be the point of reference for all the 8 peripheral labs. In addition, this
activity will continue to provide links to TB/HIV services by continuing to provide the necessary basic
equipment for evaluation of tuberculosis (TB) in all HIV-positive patients with provision of equipment such
as microscopes. The development of this laboratory infrastructure in FY 2007 will continue to result in the
provision of improved quality of medical care and reliable patient monitoring.
These activities will contribute to the results of expansion of ARV treatment for clinically qualified HIV
positive patients by providing the vital laboratory support for the follow up of 6500 HIV positive patients, thus
contributing to overall national target of treating 250,000 people by the year 2008. Further, these activities
will strengthen human resource capacity to render this laboratory support by training 25 laboratory workers
in lab related activities, supporting peripheral laboratories to perform HIV, CD4 and /or lymphocyte tests and
strengthen referral network for provision of laboratory services through the proposed Center of Excellence
(CoE) in Thika.
4.LINKS TO OTHER ACTIVITIES
This activity also relates to activities on HIV/AIDS Treatment/ARV and TB/HIV services and also to activities
to be implemented by KEMRI-KDOD in the areas of general health services, HVTB, HVCT and MTCT.
5.POPULATIONS BEING TARGETED
As ART is introduced as part of the basic HIV/AIDS care to military personnel, their dependents and civilian
personnel, the military laboratories will serve as a contingency and support lab for the health care facilities
located in the neighborhood of the 8 KMOD laboratories. KDOD intends to provide local medical personnel
with reliable equipment which will allow them to maintain an accurate and up-to-date patient treatment data
and laboratory parameter treatment monitoring and lab evaluations such as Elisa, CD4 counts, hematology
indices, viral load and chemistry (liver function tests and renal function) which are crucial for ART
management and yet often unavailable in most public health facilities in Kenya. Availability of this minimum
laboratory equipment is an utmost necessity in order to be able to provide quality medical care and
appropriate medical support to HIV-infected patients in the military population and civil population in the
neighborhood of the military barracks.
6.EMPHASIS AREAS
This activity includes emphasis on equipment acquisition for 8 laboratories and development of phase 2 of
the proposed COE, as well as capacity building of laboratory personnel for all the 8 centers namely Armed
Forces Memorial Hospital, Laikipia Air Base Medical Center, Gilgil & Lanet Army Hospital, the Mtongwe
Naval Hospital, and the CoE at Thika, Moi Air Base and Eldoret. Minor emphasis in the areas of laboratory
infrastructure development and development of protocols for quality assurance schemes and strengthening
of networks/linkages and referral systems.
This activity is related to activities in Prevention of Mother-to-Child Transmission (#6959), Counseling and
Testing (#6957), Treatment: ARV Services (#6958) and Laboratory Infrastructure (#7003).
In FY 2005, Kenya Department of Defense (KDOD) initiated the development of a basic data system for
documentation of individual patient data collection, analysis and dissemination of HIV/AIDS behavioral and
biological surveillance and monitoring information as required by the Kenya Ministry of Health (MOH) as
well as the Office of the Global AIDS Coordinator (OGAC). For the purpose of ART patient monitoring and
assessment of treatment success and drug resistance the KDOD will continue to develop a unified HMIS at
all its sites. In FY 2008, KDOD will continue supporting all the HIV program areas of HTXS, HVCT, MTCT,
HKID, HLAB and HVTB at each of 8 KDOD Comprehensive Care Clinics, including the Armed Forces
Memorial Hospital (AFMH) in Nairobi, the Airforce Base Medical centre in Laikipia, Gilgil Regional Military
Hospital (GRMH), Lanet Army Barracks hospital, Naval Sick Bay at Mombasa, the Airforce Base Medical
centre in Nairobi(Moi Air Base), as well the outlying military hospitals in Eldoret and Thika and. In addition,
all the stations will continue to be provided with the necessary data automation computerized system and
other communication equipment required for electronic entry of patient-specific encounter data required by
the National AIDS/STI Control Program (NASCOP) as well as entry of the targets set by OGAC as
Emergency Plan indicators for SI on a monthly basis. The data center will continue receiving support as the
central monitoring and evaluation point for all the 8 treatment stations in the military and the neighboring
satellite clinics. As data systems scale up there is need to train more staff in Data management, Monitoring
and Evaluation, Surveillance and HMIS. To improve the local human resource capacity to carry out SI
activities a total of 27 individuals will be trained in strategic information and data management (includes
M&E, surveillance, health systems research, epidemiology and/or HMIS). In FY 2008 an effective and
efficient planning, monitoring and evaluation system including a functioning MIS will continue to be
developed and ICT capacity at DHQ and all the stations will be enhanced. The KDOD will continue to
develop a unified health management information system for all its stations. The KDOD will also develop
and expand its capacity to carry out public health evaluations. 3. CONTRIBUTIONS TO OVERALL
PROGRAM The development of the SI system will largely contribute to the expansion of an effective and
efficient ART program that will result in the provision of quality care to all HIV-positive patients under the
KDOD program and result to improved patient management. The resulting expansion of care will play a
critical role towards achieving the PEPFAR goals for KDOD as well as for the needs of the national
HIV/AIDS care and treatment program. It will also result to improved data gathering, reporting, data quality
and accessibility.
This activity links to KDOD-KEMRI activities in the areas of MTCT, HVCT, HVTB, HTXS and HKID by
providing linkages between the patient data monitoring system and PEPFAR national reporting systems
through better data generated at each of these clinics within each of the 8 treatment sites and its satellite
clinics. It will link to other activities by providing a broad range of technology that allows sharing of
information and development of strategies for promotion of better health. In addition, this activity will link to
the HVSI and HLAB activities to be carried out by NASCOP and the SI activity to be carried out by Abt
Associates-PHR+ (#6824) in utilizing national software for reporting.
As ART is introduced as part of the basic care available to military, dependents and surrounding community
civilian personnel, the KDOD will need to provide local medical personnel with a reliable computerized
system which will allow them to maintain an accurate and up-to-date patient treatment data and laboratory
and pharmacy drug treatment monitoring, to include compliance markers, recording of any side effects, and
monitoring of minimum laboratory evaluations such as CD4 counts, hematology indices and chemistry (liver
function tests and renal function). Maintenance of this data system at each location will be invaluable in
facilitating and adequately providing medical support to HIV-infected patients.
6. EMPHASIS AREAS
The major emphasis for this activity will go towards development of the information technology and
communications infrastructure by directing resources in acquiring computer hardware and software
development as well as networking equipment and supplies. The KDOD will continue to support the 8 data
clerks (one for each station), who will administer, supervise the Health Management Information systems
(HMIS) and manage the ICT resources. Training of data automation workers and maintenance of the Data
Management Unit (DMU) at the central AFMH referral facility as well as capacity enhancing of the data
center at Defense Headquarters will be undertaken .Thus, the development of this SI initiative will result in
the provision of improved quality of care and reliable maintenance and reporting of program specific EP
program SI markers on a consistent basis. It will also result to improved level of reporting that is timely,
consistent, and accurate.