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

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

These activities relate to HIV/AIDS Treatment: ARV Services (#6836), (#6945) Laboratory Infrastructure

(#6940), Counseling and Testing (#6941) and Palliative Care: TB/HIV services (#6944).

2. ACTIVITY DESCRIPTION

African Medical Research and Educational Foundation (AMREF) has supported the introduction of PMTCT

services since 2004 and will continue to support the implementation and expansion of PMTCT program in

Machakos district in Eastern Province and in the Kibera Slum area in Nairobi City. These areas recorded

high HIV prevalence rates of 6% and 12%, respectively, among women. AMREF currently supports PMTCT

activities in 102 health facilities. Initially, the focus was on district and sub-district hospitals. In the FY 2007

semiannual report, AMREF counseled and tested 4,670 women. In FY 2008, the program will consolidate

activities to expand the scope of services to 68 new public health facilities starting with the high volume

health centers and eventually the dispensaries. AMREF will also provide counseling and testing to 30,305

pregnant women, and provide ARV prophylaxis to a total of 1,639 HIV positive women: sdNVP and AZT to

820 HIV positive women, HAART to 328 HIV positive women and sdNVP to 492 women. Early infant

diagnosis will be provided to 820 infants exposed to HIV. AMREF will develop models of providing

comprehensive PMTCT services to HIV positive women and their families, and provide care and follow up

to a total of 820 HIV infected-exposed mother- infant pairs. Postnatally, mothers will be counseled on infant

feeding practices, linked to family planning services and to care and treatment. The HIV exposed infant will

have DBS for early infant diagnosis and will be started on cotrimoxazole at the age of six weeks. All HIV

positive women and their families identified through the PMTCT program will be linked to Care and ARV

treatment programs. In FY 2008, AMREF will train 400 service providers on PMTCT and comprehensive

PMTCT which includes DBS (dry blood spot) sample collection technique in 170 facilities. Significant

changes from FY 2007 to FY 2008 for this activity include increasing the uptake of counseling and testing in

the ANC to 90%, and maternity testing to 80% from the current 60% increasing the uptake of ANC mother

NVP from the current 40% to 80%, increase of maternity NVP from the current 30% to 80%, and infant NVP

uptake from the current 20% to 80%. AMREF will strengthen the Health Management Information System at

district level through staff training and computerization of the data management. AMREF will support the

district to effectively use the national MOH/NASCOP data collection tools. AMREF will also develop

innovative strategies for stigma reduction and will use the local radio station channel to reach a wider local

audience. In particular, AMREF will improve support supervision to health facilities. This will contribute to

increase in uptake of services at facility level, as well as contribute to community support to PMTCT

activities.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

PMTCT activities in Machakos and Kibera slum will contribute to approximately 2.5% of 2008 overall

Emergency PMTCT targets for Kenya. The increase in number of sites contributes to the program's efforts

to achieve district-wide coverage for improving equity and access particularly in these underserved areas.

The provision of PMTCT+ services to the women, infants and other members of the family provides an entry

point for HIV positive individuals to access comprehensive HIV care and other HIV care and support

services including safe infant feeding practices. The improved district Health Management Information

System will identify gaps in coverage that will be addressed to increase district wide coverage. This activity

contributes substantively to Kenya's Five-year strategy of providing HIV counseling and testing services to

pregnant women thus increasing the number of women who learn their HIV status, as well as improving

access of the HIV+ pregnant women to interventions for reducing HIV infection to infants.

4. LINKS TO OTHER ACTIVITIES

The PMTCT activities in Machakos district and Kibera slum relate to AMREF ARV Services (#6836) and

CDC KEMRI ARV Services (#6945), CDC/KEMRI laboratory (#6940), VCT (#6941) and TB/HIV services

(#6944). AMREF has been supporting a successful ART site in Kibera, and will use this site to test the

appropriate model for strengthening the linkages between the PMTCT program and ART program in the

providing PMTCT+ services to the women, the infants and members of the woman's family. Further, women

identified through the PMTCT program will be referred to the ART program for care and treatment.

5. POPULATIONS BEING TARGETED

This activity targets children under five years, adolescents of reproductive age 15-24, 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 CDC/WHO based curriculum.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will increase gender equity in HIV/AIDS programming through provision of HIV counseling and

testing services of pregnant women, and improved access to other HIV care programs for the HIV infected

woman, her infant and other family members. It will also reduce violence and coercion through stigma at the

community level.

7. EMPHASIS AREAS

This activity includes emphasis on quality assurance and supportive supervision as well as emphasis on

Development of Network/Linkages/Referral Systems; Community Mobilization/Participation, wrap around

programs with Food/Nutrition, PMI through distribution of insecticide treated nets at the MCH, safe

motherhood through focused antenatal care, other Family planning initiatives and TB screening and referral

for treatment and care

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 (#6836), ARV services (#7095), Palliative Care: Basic

Health Care and Support (#7096) and PMTCT(#6837).

2. ACTIVITY DESCRIPTION

The African Medical Research Foundation (AMREF) will continue a successful HIV treatment program

operating in 3 sites in Kibera, a very large informal settlement in Nairobi, Kenya, and expand activities to 1

additional area site, providing a package of basic health services to 2500 people with HIV, including 250

children. AMREF will support staff salaries, training of 30 health providers, laboratory evaluation, adherence

counseling, and monitoring, provide drugs for prevention and treatment of opportunistic infections, and

expand access to safe drinking water and malaria prevention interventions. Funding will include provision of

HIV care. Patient care is managed by multidisciplinary teams, and care interventions are supported through

extensive involvement of community health workers and peer educators, including many people who

themselves have HIV/AIDS. The community health workers and peer educators work in both the clinics and

communities to support adherence, provide counseling and education about nutrition and other key aspects

of care, and assist with recognition of adverse drug reactions and early referral. AMREF staff conducts

extensive activities in the community that educate and sensitize church, political, and administrative leaders

as well as all members of the community. Activities are implemented in collaboration with the Provincial

ART officer for Nairobi. This activity will be primarily an expansion of the existing program to increase both

the number of sites and number of people reached. Provision of care for children including psychosocial

support, and expansion of HIV prevention activities in care settings will be emphasized. The central AMREF

laboratory will be strengthened to continue supporting quality assurance for labs at the satellite sites.

AMREF has extensive experience and expertise in implementing community-based HIV/AIDS prevention

and care programs throughout Africa. The HIV treatment program in Kibera has been recognized as a

model of community-based care for PLWAs. By April 2007, the program was providing palliative care

services to more than 1500 patients. Rates of adherence to care are very high. The community sensitization

activities have already contributed substantially to a reduction in stigma and discrimination in this

community and are expected to continue to do so.

3. CONTRIBUTIONS TO OVERALL PROGRAM

These activities will contribute to the results of expansion of palliative care services for people with HIV,

strengthened human resource capacity to deliver palliative care services for HIV, and a strengthened

referral network for HIV care.

4. LINKS TO OTHER ACTIVITIES

AMREF's palliative care activities link closely to community services supported by CBOs such as Kibera

Community Self Help Program (KICOSHEP), AMREF-supported PMTCT services (#6837), AMREF-

supported ARV services (#6836), and to the established network referral center at Kenyatta Hospital

(#7096) through the referral of complicated cases.

5. POPULATIONS BEING TARGETED

The population targeted with this activity are the HIV-infected Kibera adult and pediatric residents that will

be served by these programs and have great need for HIV treatment that relates not only to high HIV

prevalence, but also very severe poverty and lack of basic services such as clean water, food, and

education. The associated community sensitization activities raise awareness among men, women and

children living in the slums. Other targeted populations include public health workers and NGOs/private

voluntary organizations.

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 emphases in commodity procurement, community mobilization, human

resources, quality assurance and supportive supervision, and training.

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

REFERENCES TO TARGETS AND BUDGETS.

1. ACTIVITY DESCRIPTION

African Medical Research Foundation (AMREF) will support TB/HIV services for at 4 sites in Nairobi

Province. Intensified TB screening for 1250 HIV patients and HIV screening for 300 TB suspects/patients

will be offered as a standard of care in all the facilities; approximately 150 TB 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. Funds 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. AMREF will maintain data concerning the numbers of

people served and will report both nationally and through the Emergency Plan. " AMREF has extensive

experience and expertise in implementing community-based HIV/AIDS prevention and care programs

throughout Africa. The HIV treatment program in Kibera has been recognized as a model of community-

based care for PLWAs. By April 2007, the program was providing palliative care services to more than 1500

patients. Rates of adherence to care are very high. The community sensitization activities have already

contributed substantially to a reduction in stigma and discrimination in this community and are expected to

continue to do so.

2. 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.

3. LINKS TO OTHER ACTIVITIES

The overall program activity links closely to Palliative Care (#7096), ARV Services (#7095) and PMTCT

Services ((#6837) currently supported by this partner as well as HIV/TB services supported by NLTP.

4. 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.

5. KEY LEGISLATIVE ISSUES ADDRESSED

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

sensitization activities.

6. 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.

N/A (exempt)