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 Counseling and Testing (#6950), Palliative Care: TB/HIV (#6951), and

HIV/AIDS Treatment: ARV Services (#6954).

2. ACTIVITY DESCRIPTION

The Uniformed Services is comprised of Non-Military Services such as the Prison Services (KPS), National

Youth Service (NYS), Kenya Police Department (KPD), Kenya Wildlife Services (KWS), and Administration

Police (AP). With Emergency Plan funding, KEMRI U/S project has been supporting implementation of

PMTCT activities in the non-military Uniformed Services as part of the HIV/AIDS program. This was done

through training of service providers, minor infrastructure renovations, logistics supply, and management

and technical assistance. These services have many similarities; the young men and women working there

often serve away from their homes and are thus vulnerable to risky sexual behaviors. The various camps

and stations have significant numbers of young families. Health services in these camps are also accessed

by the surrounding civilian communities who benefit from the PMTCT services. In FY 2008, CDC will

continue supporting KPS and NYS, and AP and the non-military Uniformed Services, with the following

objectives: (i) increase access to quality PMCTC services to both members of staff, families and

neighboring communities, (ii) integrate quality PMCT service into routine maternal and child health services,

(iii) increase awareness, benefits and availability of PMTCT services within the selected sites. CT services

will be offered to 1,500 pregnant women and will target to provide a complete course of ARV prophylaxis to

90 HIV-positive pregnant women. All HIV-positive pregnant women eligible for HAART will be linked to the

ART program. Postnatal care and follow up of all HIV-positive women and their infants will be strengthened.

The care package for the mothers will include regular follow up, linkage to family planning services, OI

prophylaxis and counseling on correct infant feeding practices; while infant additional care activities will

include OI prophylaxis using Cotrimoxazole starting at six weeks of age, and DBS for HIV- PCR (Early

Infant HIV Diagnosis-EID). The program will target 90 for DBS and will link all eligible infants to the ART

program (for pediatric HIV care). The program will also encourage male partner HIV testing as well as male

involvement and support. The program will also support the training of 30 service providers on PMTCT.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

The planned activities will improve equity in access to HIV prevention and care services to the uniformed

services under "Special Population" category. These activities will contribute to the result of increased

access by pregnant women and their families to HIV counseling and testing services, and those identified

as HIV infected will be referred for care and treatment.

4. LINKS TO OTHER ACTIVITIES

This activity relates to KEMRI U/S ARV services program (#6954), KEMRI U/S counseling and testing

(#6950) and KEMRI U/S TB/HIV services (#6951). Linkages between PMTCT service and care outlets will

be strengthened to improve utilization of care opportunities created through PEPFAR funding.

5. POPULATIONS BEING TARGETED

This activity targets children under 5 years, adolescents aged 15-24 years, adults, people living with

HIV/AIDS and pregnant women.

6. EMPHASIS AREAS/KEY LEGISLATIVE ISSUES ADDRESSED

This activity will increase gender equity in programming through PMTCT services targeted to pregnant

women and their male sexual partners. Identifying the women through PMTCT will give them an opportunity

to access care, improve pregnancy outcomes, and access services for their partners and family members.

Other emphasis areas include in service training, and wrap around health programs to include Family

Planning, Malaria (PMI) and safe motherhood through the provision of comprehensive PMTCT care

package at the maternal and child health facilities.

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 ARV Services (#6954), Counseling and Testing (#6950), TB/HIV(#6951),

and PMTCT (#6953).

2. ACTIVITY DESCRIPTION

The Kenya Medical Research Institute (KEMRI) in collaboration with the Kenya Uniformed Services

Program (USP), comprising the National Youth Service (NYS), Kenya Wildlife Services (KWS), Kenya

Prison Services (KPS), Administration Police (AP) and Kenya Police Department (KPD), will provide basic

health care and support to over 1500 HIV-positive service personnel, their dependents, prisoners and

surrounding communities at 8 health centers in Nairobi, Coast, Nyanza, and Rift Valley Provinces,

Additionally, 30 individuals will receive training in the provision of HIV care services. Activities will focus

upon improving the quality of life of Kenya Uniformed Service personnel, their families, prisoners and

surrounding communities infected with HIV and needing care. At these sites, KEMRI will provide technical

assistance, equipment and supplies and infrastructure improvement. In addition, KEMRI will provide basic

health care, in line with the national guidelines which includes; cotrimoxazole prophylaxis for prevention of

opportunistic infections, treatment of opportunistic infections and psychosocial support. Prevention of

spread of HIV from those infected will also be emphasized. These centers are already providing HIV/TB

clinical care for staff and the local populations, including HIV testing for TB patients/suspects and TB

screening for those HIV-positive. Referral systems and networking will be developed to ensure care. The

Kenya USP will manage data on people served and will report both nationally and through Emergency plan.

Over the last four years, USP, in partnership with CDC, has been encouraging VCT testing among

uniformed personnel to identify those requiring HIV care. Over 20,000 people are targeted to receive VCT

services in 2008/2009, with an anticipated 600 (3%) HIV infected individuals to be offered care services.

The USP medical services are limited and can only provide palliative care within the catchment areas of the

above health centers. The referral system for referring HIV+ individuals to care and treatment services

developed last year will be scaled up to continue to address the rest of the HIV infected people identified. A

follow-up network system will also be expanded to cover transferred staff as well as inmates on drug

therapy who get discharged from prison.

3. CONTRIBUTION TO OVERALL PROGRAM AREA

These activities will contribute to the expansion of care services for HIV infected individuals among special

populations, strengthen human resource capacity to deliver care services, and strengthen referral networks

for the provision of HIV services.

4. LINKS TO OTHER ACTIVITIES

These activities will link closely with counseling and testing services (#6950), PMTCT (#6953), ARV

services (#6954) and Palliative Care: TB/HIV (#6951).

5. POPULATIONS BEING TARGETED

The target populations for this activity are HIV-infected prisoners, Uniformed Services staff, their families,

and residents in the neighborhoods where prisons are located. The activity also targets public health

workers.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity addresses legislative issues related to stigma and discrimination through community

sensitization activities.

7. EMPHASIS AREAS

This activity includes minor emphasis in workplace programs, training, commodity procurement, logistics,

development of networks, infrastructure, quality assurance and supportive supervision, and strategic

information.

THIS IS AN ONGOING ACTIVITY.

+ The only change to the program since approval in the 2007 COP is that geographic coverage has been

expanded to include integrated HIV/TB services to additional 9 prisons.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in CT (#6950), Palliative Care: Basic Health Care and Support (#6956) and

ARV Treatment (#6954) and PMTCT (#6953).

2. ACTIVITY DESCRIPTION The Uniformed Services Project will support TB/HIV services in prisons.

Activities include TB screening for 750 HIV patients and HIV screening for 5,000 TB suspects/patients will

be offered as a standard of care in all the facilities; approximately 2500 patients will be identified as being

infected with both TB and HIV. TB and AIDS are the leading causes of deaths in overcrowded Kenyan

prisons, the majority of which remain underserved. Failure to contain TB and HIV in the prisons is failure to

contain TB and HIV in the civilian population from which the prisoners come and to which they are released.

Controlling TB/HIV in the prisons is one of the priorities of the Government of Kenya and constitutes a multi-

faceted reform agenda being implemented to decongest and improve prison living conditions. In partnership

with the National Leprosy and TB Program (NLTP) and Kenya Prisons Services (KPS), CDC's Uniformed

Services Program (USP) will coordinate a phased support for collaborative TB/HIV services in the prisons.

This activity will leverage additional support through partnerships with other programs and with other donor

agencies, such as WHO and the Futures Group.

In order to achieve a more efficient and coordinated response, the USP channeled FY 2007 funding for

prison TB/HIV activities through the KEMRI/CDC cooperative agreement (CoAg). In FY 2007, USG

supported KPS and the NLTP to develop a new medical tool for screening new inmates for TB, HIV and

other medical conditions. This tool will be used to monitor the scope and trend of diseases new inmates

come with or acquire during their incarceration. FY 2008 activities will focus on additional investment in

prisons' TB/HIV infrastructure and HR capacity. These efforts, which also support ART services in selected

prisons, will be strengthened and expanded through partnerships with other programs. Positive prevention

activities will be initiated and expanded at selected prison sites. The key TB/HIV activities that target the

inmates, prison staff and host communities alike include: expanded HIV testing of TB patients/ suspects for

HIV, screening HIV-infected persons for TB, ensuring that symptomatic patients access TB diagnostic

services, and those with confirmed disease receive TB treatment and are reported to the NLTP, providing

HIV-infected TB patients with additional care (cotrimoxazole, ART), risk reduction counseling and psycho-

social support, training of prison health workers to build capacity to deliver TB/HIV services, and supporting

infrastructure and supply of HIV test kits and medicines. In addition, activities in TB infection control will be

initiated in FY08. Additional activities will include production and distribution of TB screening protocols and

ICF tools for the prisons, support for essential staff and supply of additional 5 X-ray units and 20

microscopes to enhance TB diagnostic capacity in prisons not catered for previously.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

These activities will result in strengthened capacity to deliver integrated HIV and TB services in the Kenya

prisons, including strengthened referral systems, improved diagnostics and treatment of TB among HIV-

positive patients and of HIV in TB patients, strengthened capacity of health workers to provide integrated

HIV and TB services and strengthened systems capacity for program monitoring and evaluation and

management of commodities.

4. LINKS TO OTHER ACTIVITIES

These TB/HIV activities will be linked to ongoing VCT, PMTCT, STI and ARV treatment services in some

prisons and will be mainstreamed into the national network of services coordinated by the NLTP and

NASCOP (#7001)) and supported by KEMRI (#6944), Kenya Prisons Services, PLWHA organizations and

other partners.

5. POPULATIONS BEING TARGETED

TB suspects and PLWHA among all prisoners, prison staff and host communities.

6. KEY LEGISLATIVE ISSUES ADDRESSED

Diagnostic HIV testing for all TB patients will be on an "opt out" principle. Guidelines on HIV testing based

on consent, confidentiality and counseling will be observed as part of standard practice. Increased

availability of CT in the prisons and increased access to HIV care for TB patients will help reduce stigma

and discrimination. This program serves the needs and rights of prisoners as a special risk population

7. EMPHASIS AREAS

Emphasis areas include commodity procurement, development of network/linkages/referral systems, IEC,

infrastructure, local organization capacity development, quality assurance, supportive supervision, and

training.

updated August 2008 reprogramming

Updated August 2008 reprogramming

N/A (exempt)