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 (#7015, #8813), PMTCT #8649), and Palliative Care: Basic

Health Care and Support (#8934).

2. ACTIVITY DESCRIPTION

New York University (NYU) will support palliative care services for 6000 people with HIV/AIDS including 350

children, at Bomu Clinic and two satellite sites in Mombasa. This will be accomplished by continuing to offer

on-site material and technical support to build the capacity of this local facility to provide the services. The

package of palliative care services will include cotrimoxazole prophylaxis, treatment of opportunistic

infections, nutritional supplementation, TB screening, and sexually transmitted infection (STI) diagnosis and

treatment, improved access to malaria prevention interventions, and safe water for pediatric households.

Funds will provide salary support for health care workers in accordance with Emergency Plan guidance and

training for 25 health care workers to deliver HIV palliative care. Activities will include community

mobilization, strengthening of logistics capacity (particularly pharmacy management), and procurement of

commodities such as laboratory reagents. Data concerning the numbers of patients receiving services will

be collected and reported both nationally and through the Emergency Plan. Activities will be conducted in

close collaboration with the ART Officer for Coast Province. NYU has a long history of providing quality

AIDS care in a variety of settings and over the past several years has expanded capacity and expertise

related to provision of care and treatment in resource limited settings like Africa. The AIDS Research and

Family Care Clinic (ARFCC) was established in May 2001 and provides a comprehensive range of free

medical and psychosocial services to families living with HIV in and around Mombasa. The clinic is served

by a dedicated laboratory that offers HIV tests, basic hematology and chemistry tests, and CD4 counts. The

Bomu clinic is a private clinic that provides general medical services to thousands of patients and has

recently expanded their capacity to provide specialized HIV services. NYU has supported development of a

program that was providing palliative care services for more than 700 patients by June 2006, including more

than 100 children. Given that NYU has particular expertise in pediatric care and treatment, this site is

expected to rapidly expand care and treatment for children. A key barrier to expansion of the program at the

moment is space. NYU has received grant funding from other sources to establish an annex to the main

clinic building that will allow substantial expansion of pediatric care and treatment, and Emergency Plan

funding will be used for renovations and refurbishment.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

These activities will contribute to the results of expansion of access to palliative care services for more than

3000 people with HIV/AIDS, strengthened human resource capacity, and a strengthened referral network

for provision of these services.

4. LINKS TO OTHER ACTIVITIES

These activities link closely to ART services supported by NYU and FHI (#7015, #8813), and through

referral to adult and pediatric HIV services provided at Coast Provincial Hospital, a network center

supported by FHI (#8649). There are further links to area VCT and community-based activities currently

supported by FHI including Palliative Care: Basic Health Care and Support (#8934).

5. POPULATIONS BEING TARGETED

These activities target people (adults, children, infants) living with HIV/AIDS. A key focus of the family clinic

is the provision of services to children with HIV, and the identification of children with HIV as a way of

reaching entire families that are affected by HIV. Public health care providers, including doctors, nurses,

pharmacists, and laboratory workers are targeted for increased HIV care and treatment knowledge and

skills. Included among the populations served by these services will be participants in US government

funded research programs.

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 commodity procurement, community mobilization, development of

networks/linkages/referral systems, human resources, logistics, quality assurance and supportive

supervision, strategic information and training.

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

REFERENCES TO TARGETS AND BUDGETS.

1. ACTIVITY DESCRIPTION

New York University (NYU) will support TB/HIV services for approximately 6,000 patients, at Bomu Clinic

and two satellite sites in Mombasa, Coast Province. Intensified TB screening and treatment for 3000 HIV

patients and HIV screening for 250 TB suspects/patients will be offered as a standard of care in all the

facilities; approximately 125 patients will be identified as being infected with both TB and HIV. Funds will

support refresher training of laboratory staff and improvement of basic laboratory microbiology capacity in

order to meet the increased needs for TB testing. 10 health care workers will be trained to provide clinical

prophylaxis and/or treatment for TB to HIV-infected individuals. Fund will support expanded and

strengthened delivery of integrated HIV and TB services including strengthened referral systems. Additional

activities will include community mobilization and dissemination of educational materials to patients. NYU

will maintain data concerning the numbers of people served and will report both nationally and through the

Emergency Plan. " NYU has a long history of providing quality AIDS care in a variety of settings and over

the past several years has expanded capacity and expertise related to provision of care and treatment in

resource limited settings like Africa. The AIDS Research and Family Care Clinic (ARFCC) was established

in May 2001 and provides a comprehensive range of free medical and psychosocial services to families

living with HIV in and around Mombasa. The clinic is served by a dedicated laboratory that offers HIV tests,

basic hematology and chemistry tests, and CD4 counts. The Bomu clinic is a private clinic that provides

general medical services to thousands of patients and has recently expanded their capacity to provide

specialized HIV services. NYU has supported development of a program that was providing palliative care

services for more than 700 patients by June 2006, including more than 100 children. Given that NYU has

particular expertise in pediatric care and treatment, this site is expected to rapidly expand care and

treatment for children. A key barrier to expansion of the program at the moment is space. NYU has received

grant funding from other sources to establish an annex to the main clinic building that will allow substantial

expansion of pediatric care and treatment, and Emergency Plan funding will be used for renovations and

refurbishment.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

These activities will contribute towards the provision of integrated HIV/TB services for dually infected

patients care by reducing TB morbidity and mortality in HIV-infected individuals and also reducing HIV

related morbidity and mortality in TB patients co-infected with HIV. These activities will strengthen referral

systems, improve diagnostics and treatment of TB among HIV-positive patients and strengthen capacity of

health workers to provide integrated HIV and TB services.

4. LINKS TO OTHER ACTIVITIES

The overall program activity links closely to Palliative Care (#7014), ARV Services (#7015,8813) currently

supported by this partner as well as HIV/TB services supported by NLTP.

5. POPULATIONS BEING TARGETED

These activities target people living with HIV/AIDS. Public health care providers, including doctors, nurses,

pharmacists, laboratory workers will receive training in the diagnosis and management of TB using

government guidelines.

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 commodity procurement, development of networks/linkages/referral

systems, community mobilization, human resources, local organization capacity development, quality

assurance, quality improvement and supportive supervision, and training.

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.

N/A (exempt)