Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 282
Country/Region: Kenya
Year: 2008
Main Partner: Eastern Deanery AIDS Relief Program
Main Partner Program: NA
Organizational Type: FBO
Funding Agency: HHS/CDC
Total Funding: $6,590,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $110,000

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 HIV/AIDS treatment/ARV services (#6880), (#7094) and Palliative Care:

TB/HIV (#6879).

2. ACTIVITY DESCRIPTION

The Eastern Deanery AIDS Relief Program (EDARP) is a faith-based organization under the Roman

Catholic Archdiocese of Nairobi that was established in 1993 as a response to the HIV pandemic affecting

the people living in a slum setting in the Eastlands area of Nairobi. A network of community health workers

and clinical sites has been established, and now provides a variety of HIV prevention and treatment

services to many thousands of people with HIV. EDARP has one site that has been offering comprehensive

PMTCT since 2005, providing HIV counseling and testing to women accessing ANC services as well as

ARV prophylaxis to HIV positive women and their exposed infants. In addition referral linkages have been

established to centers providing antiretroviral therapy for continuum of care for the mother, male partner

and, infant. In FY 2008, EDARP will consolidate its PMTCT services at the seven existing sites. EDARP will

implement integrated comprehensive PMTCT service in accordance with the National Comprehensive

PMTCT guidelines. Comprehensive integrated PMTCT services include, but are not limited to counseling

and testing of pregnant women and their partners in antenatal clinics, delivery units and postnatal clinics

using the opt-out approach, clinical staging of all HIV-positive women using WHO guidelines, use of

appropriate antiretroviral regimens including HAART for maternal health in accordance to the National

Antiretroviral therapy guidelines, use of zidovudine plus single dose nevirapine or use of single dose

nevirapine for women presenting late in pregnancy, postnatal follow-up for the mother and exposed infants,

initiation of cotrimoxazole prophylaxis to all exposed infants at 6 weeks, Early Infant Diagnosis (EID) at six

weeks via PCR on Dry Blood Spots (DBS) from all exposed infants and successful referral of HIV-positive

mothers, their male partners and infected infants to antiretroviral treatment centers. EDARP targets

counseling and testing to 600 pregnant women and provide antiretroviral prophylaxis for 80 HIV-positive

women. All HIV-positive pregnant women eligible for treatment will be initiated on HAART, all the other

women will be given the more efficacious PMTCT regimen of AZT and sd Nevirapine. Early Infant Diagnosis

(EID) using Dry Blood Spots (DBS) at six weeks and co-trimoxazole prophylaxis will target all HIV exposed

infants. The program will support the training of 30 service providers on comprehensive PMTCT using the

national PMTCT training package.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to 0.05 % of the overall 2008 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. EDARP will continue

to facilitate capacity building of facility management teams for improved management of health services and

set up of referral networks and linkages for a continuum of care from facilities to Home-based care within

the community and among various programs within the Eastleigh area. This activity contribute to increased

awareness, demand creation and stigma reduction leading to increased utilization of services towards the

goal of universal access to prevention, care and treatment 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 of EDARP and University of Manitoba ARV services.

5. POPULATIONS BEING TARGETED

This activity targets children under five years, adolescents of reproductive age 15-24 years, adults, pregnant

women, and people living with HIV. 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. EMPHASIS AREAS /KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address gender equity in HIV/AIDS programs through improved PMTCT service delivery at

antenatal clinics and maternity units. This activity includes emphasis on In service training for service

providers, and wrap around programming to include Malaria (PMI) through distribution of ITNs to all

pregnant women at the ANC as well as Intermittent Presumptive Malaria treatment, safe mother hood

through the provision of focused ante-natal care as well as improved TB screening among pregnant women

and linkage to TB treatment for all identified TB cases.

Funding for Care: Adult Care and Support (HBHC): $550,000

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 the following activities: HVTB (#6879), HTXS (#6880), HVCT (#6881) and PMTCT

(#8654).

2. ACTIVITY DESCRIPTION

The Eastern Deanery AIDS Relief Program (EDARP) is a faith-based organization (FBO) under the Roman

Catholic Archdiocese of Nairobi established in 1993 in response to the HIV pandemic affecting

predominantly poor people living in the eastern slums of Nairobi. Key elements of the program have been

expanded in recent years to include HIV counseling and testing targeting entire communities, routine HIV

testing among TB patients / suspects, ART and PMTCT services. Through a network of community health

workers and clinical sites, EDARP provides both facility and community based palliative care to thousands

of PLWHA. Palliative care covers a wide spectrum of both community and facility based interventions that

include HIV testing, HIV status disclosure, HIV prevention, clinical monitoring. adherence counseling and

monitoring, management of opportunistic infections, psychosocial and spiritual support, pain management,

terminal care, provision of safe water, multivitamins and supplementary food. Other activities include

provision of emotional support to health care workers who face enormous emotional challenges in providing

services in this poverty-stricken area. In FY 08, EDARP will expand palliative care services to reach 16,000

people with HIV, including approximately 1,600 children, through 12 service outlets. Emergency Funds will

also be used to provide training in palliative care services for 50 health care workers in a setting

characterized by widespread poverty and limited services.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

These activities will expand access to palliative care services for PLWHA, strengthen human resource

capacity to deliver HIV services, and a strengthen referral network to provide these services.

4. LINKS TO OTHER ACTIVITIES

This activity links to other services listed above and provides essential complementary support to Kenya

Government HIV and TB program activities

5. POPULATIONS BEING TARGETED

These activities target all PLWHA- adults, children and infants; MARPS e.g. sex workers, street youth,

pregnant women.

6. KEY LEGISLATIVE ISSUES ADDRESSED

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

sensitization activities.

7. EMPHASIS AREAS

These include renovation of infrastructure, human capacity development, local organization capacity

building, TB, safe motherhood, child survival activities, strategic information development and support for

food.

Funding for Care: TB/HIV (HVTB): $780,000

THIS IS AN ONGOING ACTIVITY. The narrative is unchanged except for updated reference to targets and

budgets.

1.LIST OF RELATED ACTIVITIES

This activity relates to activities in HVCT (#6881), HBHC and HTXS (#6880).

2.ACTIVITY DESCRIPTION

The Eastern Deanery AIDS Relief Program (EDARP) is a faith-based organization (FBO) under the Roman

Catholic Archdiocese of Nairobi established in 1993 in response to the HIV pandemic affecting

predominantly poor people living in the eastern slums of Nairobi. Through a network of community health

workers and clinical sites, EDARP provides services to thousands of PLWHA. EDARP routinely tests TB

suspects for HIV and has underscored the importance of this approach by demonstrating higher HIV rates

in suspects without TB at first contact (64%) compared to those with TB (58%). This finding shows that

targeting only patients with confirmed TB represents a missed opportunity for identifying large numbers of

individuals who need additional HIV-related care. EDARP's TB/HIV activity will continue to partner closely

with its ARV program, funded as an HTXS activity. HIV testing for TB suspects identifies large numbers of

clients who are eligible for cotrimoxazole (CTX) and ART. This program continues to serve as a model for

the scale up of TB/HIV activities nationally. EDARP will continue to deliver TB preventive treatment (IPT) to

eligible PLWHA as one of few pilot sites previously designated by the TB program. The populations served

have high rates of HIV and TB and suffer widespread poverty and limited access to quality health services.

In FY 2008, due to increased demand, EDARP will further expand collaborative TB/HIV services at existing

TB/HIV service outlets and establish new ones.

To achieve this, EDARP will expand and strengthen HIV counseling and testing for all TB suspects/patients,

screen at least 50% of PLWHA served in all EDARP HIV care settings for TB and further strengthen patient

referral systems between TB and HIV programs. TB screening for 8,000 HIV patients and HIV screening for

5,000 TB patients will be offered. It is estimated that 2,500 patients will be HIV/TB co-infected. Using FY 08

and FY 07 plus-up funding, EDARP will promote HIV prevention through, for those carrying the HIV virus,

partner notification, partner testing and, where appropriate, use of condoms. All eligible HIV+ TB

patients /suspects will be place on cotrimoxazole and ART. To increase capacity to deliver TB/HIV services,

EDARP will hire, retain and train new and existing health workers, improve infrastructure and support supply

of HIV test kits and essential commodities and medicines. Other activities will include expansion of the

network of community health workers through which EDARP has developed a strong patient tracking

systems invaluable for TB/HIV case finding and case holding. FY 2008 Emergency Plan funds will also be

used to support laboratory and X-ray services, salaries for part of existing and new staff in accordance with

Emergency Plan guidelines.

3.CONTRIBUTIONS TO OVERALL PROGRAM AREA

These activities will result in strengthened delivery of integrated HIV and TB services, 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

The TB/HIV activities will be linked to a variety of services, including CT, PMTCT, STI and ART. EDARP

also runs a successful feeding program for needy HIV and TB patients. These services are also linked to

the network center at Kenyatta National Referral Hospital and to TB/HIV services provided by the Nairobi

City Council facilities in the Eastern Deanery.

5.POPULATIONS BEING TARGETTED

TB suspects (both adults and children) and PLWHA identified from VCT (adults), PMTCT (pregnant

women), STI (adults), ARV clinics (children and adults) and PLWHA organizations - TB screening among

PLWHA identified at these sites will be intensified.

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 clinical settings and increased access to HIV-related care for TB patients will help

reduce stigma and discrimination.

7.EMPHASIS AREAS

These include facility renovations, local organization capacity development and human capacity

development (in-service training, task shifting, staff retention activities).

Funding for Care: Orphans and Vulnerable Children (HKID): $250,000

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE HAS BEEN UPDATED TO REFLECT CHANGES.

This activity was begun with 2007 plus-up funds and is part of a five-site effort to strengthen the link

between clinical and household settings for HIV+ children. All sites meet regularly with a sixth entity,

AED/Capable Partners, for real-time sharing of lessons learned and review the effectiveness of different

approaches in preparation for scale-up.

The Mwangalizi model is being tested in response to concern expressed by clinicians that assuring optimal

care for HIV+ OVC was difficult in many instance because they were accompanied to different clinic visits

by different relatives or community members, necessitating constant re-education of adults managing care

of children.

Central to the approach is recruitment of adult patients who are successfully managing their own care to

accompany pediatric patients to all clinic visits when a consistent caregiver from the household is not

available. These "accompagnateurs" will be trained to be on watch for development of side effects or

complications, remunerated for their time, and expected to perform home visits to monitor medication

consumption. They will also be expected to develop an ongoing and supportive relationship with the OVC

household, assess the social environment and refer for needed services, and seek wherever possible to

identify a household or community contact who can be prepared to assume the long-term responsibility of

being a treatment advocate for the child.

Sites were carefully selected to represent a cross section of Nairobi and coastal urban slum (Eastern

Deanery, Coptic, and Bomu), peri-urban (AMPATH/Eldoret, Bomu) and rural (Kericho District Hospital)

communities. Standard measures of household and clinician satisfaction with the value-added by the

accompagnateur, accompagnatuer satisfaction with the experience, and clinical progress of OVC

participating in the program will be tracked. Numbers of OVC served are captured under care and

treatment activities.

Funding for Testing: HIV Testing and Counseling (HVCT): $600,000

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

The only changes to the program since approval in the 2007 COP are:

+ in FY08 EDARP will expand the CT program to include Home Based CT activities in the slums. This

strategy will work through the community health strategy which EDARP has developed over the years.

Mobilization, recruitment and follow up will be carried out by community health volunteers, whereas CT will

be provided by trained VCT counselors. Those who will be found to be HIV positive will be enrolled in the

PEPFAR supported care and treatment program. EDARP will therefore train more CT providers and

community volunteers.

1.LIST OF RELATED ACTIVITIES

This activity relates to activities with Eastern Deanery AIDS Relief Program in other HIV/AIDS activities of

ARV treatment (#6880), PMTCT (#8654) and TB-HIV (#6879)

2. ACTIVITY DESCRIPTION

The Eastern Deanery AIDS Relief Program (EDARP) is a faith-based organization (FBO) under the Roman

Catholic Archdiocese of Nairobi established in 1993 in response to the HIV/AIDS pandemic. It works

primarily among the very poor people dwelling in slum areas in the eastern part of Nairobi. In terms of HIV

counseling and testing (CT), EDARP has in the past provided mainly the client initiated CT in static sites

and in community outreach programs. In FY 2005, it began to expand this mandate by commencing the

provider-initiated CT, starting with TB patients and later with TB suspects. In FY 2006 and FY 2007, this

was further enhanced through the provision of pediatric HIV testing and family support. Because of their

broad type training, counselors in EDARP are highly qualified and able to provide different types of CT

services. The training they receive includes VCT, Provider Initiated Test and Counseling (PITC), couples

counseling and CT in children. In FY 2008 EDARP will continue providing all types of CT services in all the

previous sites, as well as in the outreach program. To facilitate the provision of all the CT services in FY

2008, EDARP will train 200 health workers and counselors on both VCT and PITC. This will lead to over

60,000 people being counseled and tested in at least 20 CT outlets. Because EDARP already has a vibrant

comprehensive care and treatment program, with the support of the Emergency Plan, those who will be

found to be eligible will receive appropriate care within the same facility, which should minimize loss to

follow up. CT services and prevention information will also be provided for family members of patients on

treatment. As part of the CT program, EDARP will also carry out community mobilization and education

activities in the same area, for the purpose of increasing uptake of CT and other HIV/AIDS services and

also in order to reduce the social stigma.

3. CONTRIBUTION TO OVERALL PROGRAM AREA

The services provided by EDARP will contribute less than 5% of the USG supported CT services in Kenya

in FY 2008. However, EDARP will be working in a unique environment with very innovative CT programs.

They have in the past and will in FY 2008 continue to consolidate provider initiated CT as well as the unique

VCT programs. They will also provide CT for children, which is an underdeveloped program area in Kenya.

4. LINKS TO OTHER ACTIVITIES

This activity will be linked to the other PEPFAR supported EDARP activities, such as ARV treatment

(#6880), PMTCT (#8654), STI, and TB-HIV (#6879) activities. Diagnostic HIV testing, which is part of the

provider initiated CT will be made available largely in TB and STI clinics. Those who will be found to be

eligible will be referred to ARV services.

5. POPULATION BEING TARGETTED

EDARP works in a highly populated slum area of Nairobi. In this area EDARP serves the entire population,

including all adults and children. Most of the people who live in these slums are of very low socio-economic

status. CT services will be provided to patients in the health institutions as well as to the general community

in the outreach program. The program will follow a family approach to CT service provision, both for adults

and children, be it in health settings or in the community.

6. KEY LEGISLATIVE ISSUES

This activity will particularly address the gender disparities, as well as help reduce stigma and discrimination

in HIV/AIDS.

7. EMPHASIS AREA

Major emphasis will be placed on human resource development for quality service provision. They will also

undertake community mobilization and development of networks and referral systems. Another minor

emphasis will be in the area of information, education and communication in an effort to reduce stigma

around testing in the community and on improvement of infrastructure for CT service provision. EDARP will

focus mainly on building the capacity of local organizations to implement high quality HIV/AIDS

interventions responsive to the needs of target communities. The training component of the planned

activities will result into increased human resource capacity to provide both diagnostic and voluntary

counseling and testing at grassroots level. In settings where infrastructure for CT service provision is

underdeveloped or lacking, resources will be committed for minor alterations, improvements and furnishings

to create decent CT service outlets.

Funding for Treatment: Adult Treatment (HTXS): $4,300,000

N/A (exempt)