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 (#7005), HIV/AIDS

Treatment: ARV Services (#7004), Prevention of Mother-to-Child Transmission (#6925) and Strategic

Information (#7002).

2. ACTIVITY DESCRIPTION

The Ministry of Health's National AIDS and STI Control Program (NASCOP) will continue to provide

leadership and coordination to the national PMTCT program towards the goal of universal access to

comprehensive integrated PMTCT services. In collaboration with the MOH's Division of Reproductive

Health and Medical Training College (MTC), NASCOP will strengthen its stewardship, regulatory and

supervisory functions and quality assurance to ensure delivery of high quality comprehensive integrated

PMTCT services that reflect current scientifically proven interventions and in accordance to the National

Comprehensive PMTCT guidelines. NASCOP will guide establishment of systems and mechanisms for

stronger linkages and coordination between PMTCT and other HIV treatment and care programs to ensure

comprehensive care and support to the HIV-positive woman, infant and family members within maternal and

child health care settings. In FY 2008, this activity will continue with strengthening of the stewardship

function of NASCOP by improving coordination across MOH programs supporting MCH services at the

national provincial and district levels with decentralization to the district level. NASCOP, through the

Technical Working Group (TWG), will provide the framework and guidance for the national roll out of

comprehensive integrated PMTCT services in addressing all the four PMTCT prongs including provision of

FP services within PMTCT programs and couple counseling and testing. NASCOP will facilitate the

functioning of the Provincial PMTCT TWGs that will work at district level to enhance active community

participation, coordinate various partner activities, review district micro plans and use program data for

improving specific regional performance. Other significant activities include developing models to ensure

improved access to HAART for eligible mothers either within the MCH setting or through linkage with

existing ART programs. Additionally, the program will continue working at strengthening the referral systems

for the continuum of care for successful referral of mothers to antiretroviral therapy centers and early infant

diagnosis and referral to appropriate care to enhance maternal and child survival. This program will also

adopt a training package for the training of community groups to provide HIV prevention, treatment, care

and support services at the community level.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

NASCOP has the mandate to provide leadership and policy guidance, direction and support for national

PMTCT efforts. The NASCOP PMTCT activities will significantly contribute to PEPFAR goals for primary

prevention of HIV and identifying and referring HIV-positive individuals to treatment and care by providing

the national framework for strategic comprehensive to PMTCT programming including strengthening couple

counseling and Testing and Family Planning services within the PMTCT program. Strong and effective

linkages between PMTCT and other HIV care programs and Reproductive services at national level will

significantly improve access to ART including pediatric HIV care and treatment services at facility level,

improved access to FP services and prevention for discordant couples thereby ensuring comprehensive

HIV services in PMTCT sites. With Emergency Plan funds, NASCOP led the national process in adapting

the WHO/CDC generic curriculum into the Kenya National PMTCT Training Curriculum. In FY 2008,

NASCOP will continue to provide national direction for staff capacity building to strengthen PMTCT service

delivery. NASCOP will also continue to improve PMTCT management information system in order to

develop a dynamic data flow system to inform national gaps, coverage rates, and program uptake and

monitor national targets. NASCOP will continue to support the development and roll out of the national

training plan based on identified needs, maintain a national data base on service providers trained with

details of cadre of staff trained, training type, duration of training etc that will be used to inform the nation on

staffing needs. NASCOP will work with DRH and MTC to support integration of pre-service and in-service

training and supervision of PMTCT services within other maternal, child health and family planning

supervisory structures at the district levels. In '08, the program will also develop and roll out "on the job

training" strategy for service providers, and support the production of a bi-annual technical news letter to the

field.

4. LINKS TO OTHER ACTIVITIES

This activity relates to the following: NASCOP ART (#7004), NASCOP SI (#7002), and PMTCT JHPIEGO

DRH (#6925). This activity is most immediately linked to palliative care (#7005) and HIV/AIDS

treatment/ARV services through the provision of ongoing care to the HIV+ woman in the antenatal and post

natal settings, care of the HIV exposed infant in the post natal period and referral to the ART sites for

women and infants. In collaboration with the DRH, this activity will strengthen support supervision efforts for

integrated comprehensive PMTCT service delivery including improved data management and utilization at

facility level.

5. POPULATIONS BEING TARGETED

This activity targets pregnant adolescent pregnant women aged 15-24 year and their partners, adults,

discordant couples, people living with HIV/AIDS, and pregnant women.

6. EMPHASIS AREAS/ KEY LEGISLATIVE ISSUES ADDRESSED

This activity will increase gender equity in HIV/AIDS programs through providing national policy guidelines

and operational guidelines for the provision of PMTCT of HIV services to pregnant women and their

partners. Other emphasis areas include providing guidance and direction in training of service providers in

both pre service and in service settings, and working with other Ministry of Health departments to

strengthen integration of service delivery that will contribute to achieving delivery of comprehensive PMTCT

care package at all ANC and Maternity facilities through wrap around programming. This includes

programs such as Family Planning, Malaria (PMI), and TB programs.

PHE Continuing Study

Project Title: Integration of medical services for HIV-exposed infants into routine immunization services: a

pilot project and evaluation

This is part of a multi-country study, include Zimbabwe. Proposal has been modified to fit in the Kenyan

context.

Name of Local Co- Investigator: KEMRI and CDC-Kenya staff

Project Description:

This project evaluates two main questions 1) impact of integration of HIV and EPI services on the

percentage of HIV-exposed infants that receive appropriate follow-up care, an initial EPI visit and linkage to

care and treatment and 2) impact of integration of HIV and EPI services on vaccine coverage in the district.

HIV exposed infants will be identified in selected routine immunization services in Kenya when they come

for routine immunization and growth monitoring from 6 weeks of age.

Timeline:

FY 2008 = Year 2 of activity

Year started: 2007

Expected year of completion: 2008

Funding:

Funds received to date: $ 200,000

Funds expended to date: $0

Still in protocol clearance phase.

Funds requested to complete the study:

FY 08: $ 200,000

Beyond FY08: Nil

Describe funds leveraged/contributed from other sources:

NIL.

Status of Study:

Protocol is developed, is currently under scientific review for NRD. Once cleared and NRD obtained and

funds released we move to the next step: Meeting stakeholders, visiting study sites and recruiting project

assistants.

Lessons Learned:

While it takes time to develop a proposal and get started with a project, proposed project interventions

gradually become routine medical interventions and the PHE can be easily overtaken by events. Job aids

already developed which will be useful in this project include National Algorithm for early infant diagnosis

and combined Mother/Child Screening Card.

Information Dissemination Plan:

Once project complete, data analyzed and conclusions derived, the outcome of this study will be made

known to the Ministry of Health and to CDC, and recommendations used to advise policy on service

delivery.

Planned FY08 Activities:

• Debriefing: meeting to discuss survey and any preliminary results

• Data entry/cleaning

• Data analysis, coverage report and manuscript writing.

Budget Justification for Year 2 Budget (USD):

Salaries/ fringe benefits: $106,000

Equipment: $10,000

Supplies: $30,000

Travel: $15,000

Participant Incentives: $12,000

Laboratory Testing: $25,000

Other/Miscellaneous: $2,000

Total: $200,000

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 Counseling and Testing (#7009),

Prevention of Mother-to-Child Transmission (#7006), Palliative Care: Basic Health Care and Support

(#7005), Palliative Care: TB/HIV (#7001), Condoms and Other Prevention (#7008), HIV/AIDS Treatment:

ARV Services (#7004) and Strategic Information (#7002).

2. ACTIVITY DESCRIPTION

The Kenya National AIDS and STI Control Program (NASCOP) will support, supervise and monitor

abstinence and faithfulness programs targeting youth in Kenya. It will also take the lead in developing

policies and guidelines as needed. NASCOP will continue to strengthen a coordination mechanism for youth

HIV prevention in Kenya. It will continue to explore feasible avenues of strengthening HIV prevention

programs such as the integration of alcohol prevention efforts with HIV prevention work. NASCOP will

coordinate the development and distribution of print materials as needed in support of abstinence and

faithfulness programs for youth as well as youth-friendly services. NASCOP will also partner with the Kenya

Medical Training college (KMTC) to help develop in-service training guidelines to KMTC trainees on broad

behavioral prevention issues for youth and the provision of youth-friendly services. This element will be in

response to the need identified in 2005 by the Kenya Service Provision Assessment (KESPA) which pointed

to huge gaps in the provision of youth friendly services. This training will help sensitize health workers on

the need to offer appropriate information and counseling to young people to help them adopt healthy

behavior and safer sexual practices. These will contribute to improved HIV preventive behaviors among

young people, changed social and community norms to promote HIV preventive behaviors among youth

and young adults as well as reduced HIV/AIDS stigma and discrimination. NASCOP will play a key role in

ensuring that epidemiological data is captured, analyzed and presented for use in implementation of

prevention programs. NASCOP was established within the Ministry of Health (MOH) to conduct

surveillance, develop policies and coordinate activities in HIV/AIDS prevention, care and treatment. It will

also provide essential linkages that will ensure young people have improved access to related HIV services

including youth-friendly counseling and testing, palliative care, care and treatment among others. Since

2001, the USG has been a major supporter of operational activities of NASCOP through a cooperative

agreement with CDC that has resulted in the development of VCT, PMCT, ARV, TB-HIV care, HIV testing in

clinical settings and other policies; improved support supervision and field coordination with provincial,

district and local facilities; and improved surveillance, monitoring and evaluation. This has resulted in

increased capacity for the MOH that serves as a platform for the services necessary to reach Emergency

Plan targets.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute towards the achievement of the Emergency Plan prevention targets in AB. It will

promote the ability of implementing partners to reach their varied emergency plan targets for the year and

will guide the implementation of targeted interventions for greater efficacy in behavior change. This activity

also includes the training of 300 individuals in the promotion of HIV/AIDS prevention messages through

abstinence and/or being faithful.

4. LINKS TO OTHER ACTIVITIES

This project will establish essential linkages with other NASCOP coordinated national programs including

CT activity (#7009), PMCT activity (#7006), ARV services activity (#7004), Palliative Care: Basic Health

Care and Support activity (#7005), TB/HIV (#7001), OP (#7008) and strategic information activity (#7002).

NASCOP will build on its involvement with the faith-based and non-governmental sectors in Kenya and

ensure that abstinence messages for youth are integrated with other services and that a supportive adult

environment is cultivated.

5. POPULATIONS BEING TARGETED

The activities implemented by NASCOP in this area will target men and women as well as children and

youth to be served through the guidelines. National AIDS Control staff and other MOH staff such as the

Kenya Medical Training college staff as well as various cadres of public health care workers will be

targeted.

6. KEY LEGISLATIVE ISSUES ADDRESSED

The primary legislative issue addressed in this project is increasing gender equity in HIV/AIDS programs

and reducing stigma and discrimination.

7. EMPHASIS AREAS

This activity includes major emphasis on quality assurance, quality improvement and supportive

supervision. It will also result in the development of guidelines for health workers on working with youth.

Information, Education and communication materials will be developed and distributed to service providers.

Linkages and networks for youth programs to health care services will be established and guidelines on

training will be developed.

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 injection safety activities implemented through John Snow, Inc/Making Medical

Injections Safer (#8985), Supply Chain Management System (#8817), Danya International (#8824), and

JHPIEGO (#8821); NASCOP activities in ART (#7004), CT (#7009), and Palliative Care (#7005); and

PEPFAR partners in care, prevention, laboratory and treatment.

2. ACTIVITY DESCRIPTION

The Ministry of Health, in conjunction with the Division of Curative Services, Division of Preventive and

Promotive Health and National AIDS Control Program (NASCOP), will review, develop and monitor the

implementation of the national standards, guidelines and strategic plan for injection safety and health care

waste management completed in FY 2006 and coordinate the scale up of injection safety by various

partners country-wide to ensure coverage of 5 provincial hospitals and 5 provinces by 2008 and national

coverage by 2009. Appropriate monitoring tools will be developed and used to determine the impact of

these actvities. This activity includes the coordination of the above-mentioned activities to impart improved

attitudes and behavior change among health care workers and the general public regarding the role of

proper disposal of medical wastes, especially sharps, that contribute to the transmission of HIV/AIDS in

hospital settings and the surrounding communities. Transmission of HIV and hepatitis in health care settings

can occur through unsafe injections and other unsafe medical practices, including poor disposal of

contaminated medical wastes. The persons most at risk of infection through unsafe injection practices are

the recipients, health care workers and the wider community through exposure to contaminated sharps

waste.

Estimates of the global burden of disease from unsafe injections suggests that, in the year 2000, unsafe

injections around the world accounted for five percent of HIV infections, 32 percent of hepatitis B virus

infections, 40 percent of hepatitis C virus infections, 28 percent of liver cancers, and 24 percent of cirrhosis

cases (World Health Organization, 2003). A Health workers survey in 2005 in Kenya reported that 12% of

health care workers had experienced needle stick injury in the previous 12 months. The data suggests that

injection overuse and unsafe injection practices contribute to contaminated and often unnecessary

injections in the formal and informal health sector, and therefore constitute a significant mode of

transmission for HIV and hepatitis.

Secondly, NASCOP will advocate for safer injection practices through collaboration with other partners

including Danya Int. and JHPIEGO to guide the development of country-specific information, education and

communication (IEC) material and media messages targeted at health care waste handlers, injection

prescribers and the community at large. The injection safety program will outsource the sensitization and

dissemination of IEC materials and policy document to JHPIEGO who are a partner to NASCOP. These will

be aimed at reducing the demand for injections, rationalizing prescription of injectables and increasing

awareness about the risks to the community of improperly disposed injection waste. An increased number

of injections are being used in the informal health care sector, where the re-use of injections and the

occurrence of needle stick injuries result to HIV transmission and are more highly probable. IEC material will

be developed in different languages based on the HIV/AIDS prevalence, population density and population

groups affected by the epidemic.

The third objective is to monitor injection practices country-wide and give supportive supervision that will

strengthen performance at all levels including that of implementing partners. Infection Prevention

Committees (IPC) at five major hospitals will be reactivated to oversee safe injection and waste

management practices. These will be comprised of a core team of a senior nurse, a public health officer, a

clinician and a lab technologist. The lessons learned from these initial hospitals will be used to enhance the

functions of IPCs at all hospitals in the country. These committees will serve to ensure sustainability of safe

injection practices in years to come.

Potential partners such as the National Nurses Association of Kenya, National Environmental Management

Authority (NEMA), National AIDS Control Council (NACC), WHO and JHPIEGO will be identified to work

with NASCOP to improve injection safety. These groups will hold quarterly meetings to discuss the

outcomes and plan for the way forward.

Lastly, the injection safety program will provide funding for the Kenya Medical College to hold various

trainings for the post-graduate and the pre-service students on injection safety, PEP and waste

management in the prevention of nosocomial transmission infections. The college will incorporate safe

injection practice into their curriculum.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

As the HIV treatment program is scaled up and brings more HIV/AIDS patients to health care facilities,

measures should be put in to place to protect health care workers and other patients from nosocomial

infections. This program will contribute to averting up to 5% new cases of HIV in the country. The injection

safety and waste management program under the Ministry of Health will guide the development of policy

and support implementing partners with the aim of achieving national coverage by 2009 and sustainable

safe practices thereafter.

4. LINKED ACTIVITIES

This activity relates to injection safety activities implemented through John Snow, Inc/Making Medical

Injections Safer (#8985), Supply Chain Management System (#8817), Danya International (#8824), and

JHPIEGO (#8821); NASCOP activities in ART (#7004), CT (#7009), and Palliative Care (#7005); and

PEPFAR partners in care, prevention, laboratory and treatment.

The injection safety initiative is linked to the Kenya Expanded Program for Immunization (KEPI), which

already procures non re-use injection devices for its program. Other Kenyan stakeholders in the area of

injection safety have been mobilized, including the Ministry of Health Infection Prevention and Control

Committee and the Nosocomial TB/HIV Prevention Unit of NASCOP. A National Injection Safety Steering

Committee has been established at the Ministry of Health chaired by the Deputy Director of Medical

Services and Head of Preventive Health Services. Membership to this committee is drawn from all the

Activity Narrative: programs at the MOH and incorporates the National Environmental Management Authority (NEMA), World

Health Organization (WHO), National AIDS Control Council (NACC), CDC and USAID.

5. POPULATIONS BEING TARGETED

This activity targets policy-makers, all health care workers (nurses, doctors, clinical officers, pharmacists,

lab personnel, health care waste handlers), medical training institutions, the public, and the community.

6. EMPHASIS AREAS COVERED

This activity has a major emphasis on policy and guidelines development, with a minor emphasis on quality

assurance, quality improvement and supportive supervision to monitor improved skills, knowledge and

attitudes regarding safe injection practices of healthcare workers, waste handlers and the community. This

activity will also coordinate the development of policies to ensure adequate supplies of appropriate injection

supplies at health care 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 Abstinence and Be Faithful Programs (#7007), Counseling and Testing

(#7009), Prevention of Mother-to-Child Transmission (#7006), Palliative Care: Basic Health Care and

Support (#7005), Palliative Care: TB/HIV (#7001), HIV/AIDS Treatment: ARV Services (#7004) and

Strategic Information (#7002).

2. ACTIVITY DESCRIPTION

The Kenya National AIDS and STI Control Program (NASCOP) will support, supervise and monitor

condoms promotion and prevention activities targeting at-risk youth and vulnerable populations in Kenya.

NASCOP will also support the training of 300 individuals in the promotion of HIV/AIDS prevention through

OP messages. In addition, STI management will be strengthened to provide a special focus on Positive

prevention. This will entail educating health workers on the need to intensify STI screening and treatment

for individuals with HIV. Guidelines for health service providers will be developed to assure they focus on

important aspects such as positive prevention and the provision of youth-friendly services, a gap highlighted

in the 2004 Kenya Service Provision Assessment Survey. Training updates for health workers will be done

through the Kenya Medical Training College. NASCOP will also take the lead in developing policies and

guidelines as needed to ensure a reasonable standard of practice in delivering prevention programs for

vulnerable populations. NASCOP will continue strengthening a coordination mechanism for condom

promotion, information and education to vulnerable populations in Kenya. It will continue to explore feasible

avenues of strengthening HIV prevention programs such as the integration of alcohol prevention efforts with

HIV prevention work. NASCOP will coordinate the development and distribution of print materials as needed

in support of condoms and other prevention programs for young people and most-at-risk populations. It will

support increased condom access through increasing the number of condom outlets country wide. These

will contribute to improved HIV preventive behaviors among young people, changed social and community

norms to promote HIV preventive behaviors among youth and young adults as well as reduced HIV/AIDS

stigma and discrimination. Significant changes from 2006 to 2007 will be that NASCOP will play a key role

in ensuring that epidemiological data is captured, analyzed and presented for use in implementation of

prevention programs. NASCOP was established within the Ministry of Health (MOH) to conduct

surveillance, develop policies and coordinate activities in HIV/AIDS prevention, care and treatment. Since

2001, the USG has been a major supporter of operational activities of NASCOP through a cooperative

agreement with CDC that has resulted in the development of VCT, PMCT, ARV, TB-HIV care, HIV testing in

clinical settings and other policies; improved support supervision and field coordination with provincial,

district and local facilities; and improved surveillance, monitoring and evaluation. This has resulted in

increased capacity for the MOH that serves as a platform for the services necessary to reach Emergency

Plan targets.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute towards the achievement of the Emergency Plan prevention targets. It will

promote the ability of implementing partners to reach their varied emergency plan targets for the year and

will guide the implementation of targeted interventions for greater efficacy in behavior change. NASCOP will

also support the training of 300 individuals in the promotion of HIV/AIDS prevention through OP messages.

4. LINKS TO OTHER ACTIVITIES

This project will establish essential linkages with other NASCOP coordinated national programs including

NASCOP CT activity (#7009); NASCOP AB activity (#7007), NASCOP PMTCT activity (#7006); NASCOP

ARV services activity (#7004); NASCOP palliative care: basic health care and support activity (#7005),

NASCOP palliative care: TB/HIV (#7001) and NASCOP strategic information activity (#7002).

5. POPULATIONS BEING TARGETED

Activities implemented by NASCOP in this area will target partners working towards the reduction of HIV

prevalence through prevention of new and secondary infections. Efforts in this activity will target out of

school and street youth, children and youth, adults, people living with HIV/AIDS and most at risk

populations. Community organizations including FBOs, NGOs, implementing organizations and rural

communities will be indirectly targeted by NASCOP.

6. KEY LEGISLATIVE ISSUES ADDRESSED

The primary legislative issue addressed in this project is increasing gender equity in HIV/AIDS programs

and reducing stigma and discrimination.

7. EMPHASIS AREAS

This activity includes major emphasis on quality assurance, Quality improvement and supportive

supervision. Minor emphasis will be on commodity procurement, development of linkages and referrals and

the development of guidelines and information, education and communication.

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 (#7009), PMTCT (#7006), ARV Services (#7004),

Strategic Information (#7002) and TB/HIV (#7001).

2. ACTIVITY DESCRIPTION

This will be an expansion of the 07 activities as described in the COP. The National AIDS and STD Control

Program (NASCOP) is the arm of the Ministry of Health that is responsible for implementation of medical

interventions related to treatment and prevention of HIV/AIDS. NASCOP will oversee the implementation of

all HIV care programs in Kenya. Specific activities supported by NASCOP will result in provision of palliative

care services to 7,000 people with HIV (including 700 children) not included in other reported targets at

approximately 25 sites not otherwise supported by the Emergency Plan. These activities will also result in

the training of 350 health care workers. Emphasis will be placed on developing regional trainers who will

provide classroom training and mentorship of health care workers at the facility level. Specific NASCOP-

supported activities will include the coordination of all partners in the provision of care for people with HIV

(through national level meetings such as the National ART task force), and supervision of treatment in

Ministry of Health and other facilities. Specific guidelines for prevention and treatment of opportunistic

infections including sexually transmitted illness, HIV prevention in care settings, and management of

nutrition interventions will be kept updated, printed, and distributed. The national system for tracking the

numbers of people enrolled in patient support centers (HIV clinics) will be improved. Funds will be used to

provide administrative support and transport for the Provincial/Regional ART coordinators so that they can

coordinate, track, and provide supportive supervision to sites in their areas and to support regular regional

meetings of care providers. The supervisory structure at NASCOP includes a core staff at a national level

that consists of a small technical and administrative staff and an expanding staff responsible for M&E. A

system of regional supervision of HIV/AIDS treatment activities has been established with Provincial ART

Coordinators ("PARTOS") who are responsible to assist with establishment of care and treatment services

at additional sites, site evaluations, accreditation, and supervision for care program. NASCOP will distribute

HIV prevention materials for health care providers incorporating consistent messages regarding HIV status

disclosure, partner testing, and condom use to prevent sexual transmission. Other activities will include, the

development of referral systems and care linkages for HIV positive mothers and infants identified through

the PMTCT programs, decentralization of care and treatment services to lower level health facilities to

increase access and reduce the waiting list at the provincial and district hospitals, an intensified focus on

pediatric provision of care, and improved coordination with other sources of support such as the Global

Fund for AIDS, Tuberculosis, and Malaria.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

These activities are essential to the overall implementation and coordination of HIV care and treatment

programs in Kenya. NASCOP supported activities are essential to the formation/strengthening of the

linkages needed in the network model and to the development of a sustainable system to provide HIV care

in Kenya.

4. LINKS TO OTHER ACTIVITIES

There are strong linkages between these activities and virtually all HIV prevention and treatment activities in

Kenya. All Emergency Plan partners have been encouraged to extend efforts to further strengthen these

linkages by coordinating with and supporting the activities of the Provincial ART coordinators and by

participating in national efforts such as policy/guideline revision and national stakeholders meetings.

Activities are closely linked to Management systems of Health (MSH) supported logistics/systems

strengthening particularly for the Kenya Medical Supplies Agency (#8401). Other linkages include

Counseling and Testing (#7009), PMTCT (#7006), ARV Services (#7004), Strategic Information (#7002)

and TB/HIV (#7001)

5. POPULATIONS BEING TARGETED

Populations targeted by these activities include people living with HIV/AIDS including HIV positive children

(6 - 14 years) and health care workers and others providing services to people with HIV.

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 quality assurance and supportive supervision, development of

networks/linkages/referral systems, logistics, human resources, policy and guidelines, strategic information

(M&E, IT, Reporting) and training.

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 CT (#7009), PMTCT (#7006), Palliative Care: Basic Health Care and

Support (#7005), ARV Treatment (#7004), Laboratory infrastructure(#7003) and SI (#7002).

2. ACTIVITY DESCRIPTION

The National Leprosy and TB Program (NLTP) under the National STD and AIDS Control Program

(NASCOP) is responsible for establishing TB policy and provides overall coordination, implementation and

evaluation oversight for all TB/HIV activities in Kenya. NASCOP will support TB/HIV services at

approximately 1,400 sites which are otherwise not supported by other Emergency Plan Partners. TB

screening will be offered to 7,000 HIV patients and HIV screening to 75,000 TB patients as a standard of

care. It is estimated that 37,500 patients will be HIV/TB co-infected. In FY 2008, the Emergency Plan will

provide essential support towards the achievement of targets set in the current NLTP Five-Year (2006 -

2010) Strategic Plan. National roll-out of collaborative TB/HIV activities is being coordinated by the National

TB/HIV Steering Committee (NTHSC) established jointly by the NLTP and NASCOP, both of which

previously operated as separate delivery systems. TB services in Kenya have been decentralized to the

health center level; drug supplies are consistent, and are provided free to all TB patients attending public

and mission health facilities. The NLTP has a well-deserved reputation for widespread coverage, good

diagnostic facilities, and for provision of free high-quality TB drugs. In FY 2007, the NLTP will build on gains

made in FY 2006 to consolidate and further increase access to integrated TB/HIV services nationwide. In

FY 2007, the NLTP will concentrate on getting more eligible TB patients onto ART and intensify, with

collaborating partners, TB screening for HIV-infected persons identified in HIV care settings. Apart from

Emergency Plan, the NLTP receives complementary funding from several partners including WHO and the

Global Fund. OGAC/WHO cooperation will continue to support TB/HIV activities in 15 districts that had

previously received inadequate coverage. Kenya has been awarded Round 5 TB funding by the Global

Fund to support efforts to control MDR-TB through surveillance and treatment. Emergency funds will be

used to support efforts to prevent and manage drug-resistant TB among HIV/TB co-infected patients. Kenya

has also applied for Round 6 Global Fund support to strengthen TB diagnostic capacity at dispensary level.

In order to decrease the burden of HIV among TB patients, the NLTP will promote diagnostic HIV testing for

all TB patients and TB suspects (where feasible) and will provide OI prophylaxis, nutritional and

psychosocial support to co-infected patients. In order to decrease the burden of TB in PLWHA, the NLTP

will intensify TB screening for affected persons, provide quality TB treatment for those with active disease,

TB preventive treatment for those who qualify and intensify TB infection prevention measures in health care

facilities and congregate settings, such as prisons. Additional activities will include increased attention to

prevention with positives in TB settings, sustained TB/HIV media campaigns and increased private-public

partnerships in TB/HIV services. In addition to required PEPFAR TB/HIV indicators, the NLTP will support

reporting of the following custom indicators to assist with TB/HIV program management and evaluation:

number and percentage of HIV+ patients in care screened for TB, number and percentage of HIV+

registered TB patients, number and percentage of HIV+ TB patients receiving CTX and number and

percentage of HIV+ TB patients receiving ART.

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

These activities will be linked with ongoing VCT, PMTCT, STI and ARV treatment services supported by

NASCOP and other implementing partners. In addition, the NLTP will work collaboratively with other

programs implementing TB/HIV activities among special populations such as the prisons and refugees. The

NLTP will lead all partners in the development, formulation and approval of national TB/HIV policy

guidelines. For instance, while TB preventive treatment is advocated by the Emergency Plans, the NLTP is

proceeding cautiously on IPT given recent reports of potential perverse effects of this intervention. Through

CDC's support, the NLTP and all partners now have a new TB/HIV training curriculum.

5. POPULATIONS BEING TARGETED

TB suspects (adults and children) from whom the 154,000 TB patients in 2008 will be drawn. The TB

suspects will be seen at various clinical settings - both public and private health facilities at different levels

of care ranging from hospitals, health centers, dispensaries, faith-based health facilities, the prisons, private

hospitals and others. The other populations targeted are HIV+ persons identified from VCT, PMTCT, STI,

and ARV clinics and PLWHA organizations - TB screening will be intensified for all PLWHA.

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

Emphasis areas include policy/guidelines, commodity procurement, development of networks / linkages /

referral systems, IEC, infrastructure, local organization capacity development, quality assurance /

supportive supervision, infrastructure and training.

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

the target population has been revised. NASCOP will hand over the model VCT site; therefore there will be

no direct CT targets. But in the other broad objectives that will have national coverage will remain as they

were in 2007.

+ other (NON-SUBSTANTIVE) change

•In FY 2007 NASCOP coordinated the review and harmonization of CT policies and guidelines. In FY 2008

the completed guidelines will be disseminated

•In FY 2008 will support an accelerated CT campaign using the Rapid Results Initiative strategy. This will be

a national activity and all CT partners in the country will be involved but NASCOP will supervise and

coordinate the exercise.

•In FY 2008 NASCOP will participate in workplace VCT. In the past NASCOP has received requests for

mobile VCT from other government ministries and departments, as well as from the private sector. In FY

2008, NASCOP will acquire basic supplies and materials for this purpose. NASCOP will also work closely

with other PEPFAR supported MVCT providers.

•In 2008, NASCOP will hand over the model VCT to an implementing partner that is yet to be determined

(TBD). This will reduce the burden of direct implementation from the national program. In 2008 therefore

NASCOP will not have any direct CT targets.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in PMTCT (#7006), ART(#7004), Palliative care: Basic Health Care (#7005),

TB-HIV (#7001), AB (#7007), OP (##7008), SI (#7002), HLAB (#7003).

2. ACTIVITY DESCRIPTION

The National AIDS/STI Control Program (NASCOP) is the section in the Ministry of Health that coordinates

all health sector based HIV/AIDS activities. NASCOP is responsible for developing and promoting the use of

national policies, guidelines and standards for all HIV prevention and care activities in the country. In CT

NASCOP coordinates the implementation of all types of HIV counseling and Testing (CT) approaches,

including provider-initiated and client-initiated CT. The Client-initiated approach (also known as voluntary

counseling and testing -VCT) has been highly successful in Kenya, since its launch by NASCOP in 2000.

By December 2005, there were 680 registered VCT sites in Kenya, and in that calendar year, at least

500,000 people are counseled and tested in these sites. In VCT NASCOP is currently mainly involved in

supervision and quality assurance. NASCOP has in the past developed guidelines, training curricula and

operational tools for VCT in Kenya, tools which are used by all partners. In FY 2005, NASCOP published

the Guidelines for HIV testing in Clinical Settings. These guidelines were developed in order to provide for

the all types of HIV testing approaches possible in health care facilities. These efforts led to considerable

increase in HIV testing within clinical settings in FY 2005 and FY 2006. Despite this growth in both DTC and

VCT, many Kenyans still do not know their HIV status, as seen in the Kenya Demographic and Health

Survey in 2003. In FY 2008, NASCOP will mobilize and facilitate stakeholders to provide all types of CT.

Through planned activities in FY 2007, NASCOP will promote health workers' participation in testing and

counseling and streamline referral linkages between CT and care in government facilities. Increased health

worker participation in CT shall be achieved through dissemination of relevant policies and guidelines in CT

and through training in all types of CT. The national guidelines and training curricula on CT will be reviewed

and updated as necessary. NASCOP will continue to strengthen the capacity of its national and regional

staff to monitor and evaluate CT activities, including proper data collection

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

NASCOP is in a unique position to provide leadership and support for CT activities of all partners in the

country. NASCOP will receive Emergency Plan resources to develop policies and guidelines for the whole

country. They will also ensure that the CT services in Kenya meet national and international standards.

NASCOP is the only agency with that mandate and opportunity. The contribution of NASCOP to the goal is

therefore largely broad and strategic, and in a small way it is also direct, since the NASCOP VCT site will

provide CT services to a small number of people.

4. LINKS TO OTHER ACTIVITIES

NASCOP is supported to coordinate HIV/AIDS services in almost all the components. The planned

NASCOP CT activities in FY2007 will increase knowledge of HIV status both for primary prevention and

linkage to care services for HIV positive individuals. The NASCOP CT program will therefore relate to other

NASCOP led programs like ART (#7004), PMTCT (#7006) and Palliative care (#7005). This activity is also

linked to NASCOP TB-HIV activity (#7001), AB activity (#7007), OP activity (#7008), SI activity (#7002), and

HLAB activity (#7003).

5. POPULATIONS BEING TARGETED

This activity targets the general adult population as well as symptomatic individuals served in public health

facilities, especially in Medical wards, TB wards and STI clinics. The primary goal is universal knowledge of

HIV status, as well as timely identification of those who would benefit from care and treatment services. In

client initiated CT sites existing sites will be strengthened and supported to provide quality services. And for

the provider initiated CT services, the new sites will mainly be public health facilities that have not previously

provided CT as part of diagnostic work up of symptomatic patients seeking treatment.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will help reduce HIV related stigma and discrimination by promoting routine HIV testing in

clinical settings and linking HIV infected individuals to care. Patients will be sensitized to expect HIV testing

as a standard package of good medical care in health facilities. Health care providers will be sensitized to

understand patients' basic right to the best diagnostic services including being offered HIV test.

7. EMPHASIS AREAS

Major emphasis areas for this activity is in the development of policy and guidelines at a national level for all

Activity Narrative: CT activities. Minor emphasis areas are in the area of information, education and communication, quality

assurance, strategic information and training. The Plus Up funds will be used to facilitate an accelerated

HIV counseling and testing campaign in Kenya, which is an expansion of the International HIV testing day.

The Government of Kenya, led by the National AIDS Council and National AIDS/STD Control Program has

adopted the Rapid Results Initiative program of scaling up HIV counseling and testing. with a goal of testing

300,000 people in three months. Plus up funds will complement funds from other donors and the

Government of Kenya. Funds will be used for employment of short-term CT counselors, and for Mobile VCT

services in the hard to reach areas of Kenya. Funds will also be used to coordination and supervision

(quality assurance).

N/A (exempt)

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

REFERENCES TO:

+Expansion of QA capacity and enrollment of labs into national and international QA programs for rapid

testing, CD4, clinical chemistry and hematology testing through high-performing regional /partner

laboratories.

+Establishment of a laboratory information system both for the central lab and provincial labs and establish

a network through which proficiency panels will be distributed

+Provision of oversight to the operations of the lab stakeholder meetings e.g. Lab Inter Agency coordinating

committee (ICC).

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in laboratory services, particularly (#6845, #7113 and #8763) Counseling

and Testing (#6941), TB/HIV (#6944), and all activities in MTCT.

2. ACTIVITY DESCRIPTION

Laboratory systems in Kenya consist of Division of Laboratory Diagnostic Services within the Ministry of

Health, a National Reference Laboratory (with responsibility for conducting reference laboratory testing

related to HIV serology, biochemistry and hematology, CD4 testing and other services in support of HIV

treatment as well as testing for surveillance activities), a Central TB reference laboratory, a Central

Microbiology Laboratory, and a network of 2 referral hospital labs, 8 Provincial Hospital Labs, more than 20

high volume district hospital labs, more than 60 labs at other health facilities, and more than 1500 sites

providing rapid testing for HIV. Several laboratories outside of this network have been supporting the

national and regional labs, including laboratories at the Kenya Medical Research Institute and laboratories

that also support research programs, for example the Indiana University supported laboratory in Eldoret, a

DOD supported laboratory in Kericho, and a CDC-supported laboratory in Kisumu.

Key accomplishments to date have included the development of a national laboratory strategic plan,

renovation and equipping of the National Reference laboratory, infrastructure improvements in 16 provincial

and high-volume district hospital labs, support for training in various aspects of laboratory capacity (for

example in general laboratory management, quality systems and lab safety and capacity building for

specific activities such as CD4 testing and collection of dried blood spot samples for diagnostic testing of

infants). In addition, a computerized laboratory information management system has been established and

the national public health laboratory and this laboratory has supported/is supporting key surveillance

activities such as the 2003 demographic health survey and the 2007 AIDS indicator survey. By 2007, the

Kenya Medical Supplies Agency (KEMSA) was successfully distributing the national supply of rapid test kits

and several important elements of a comprehensive quality assurance program had been established,

including enrolment of 4 laboratories in an EQA program for qualitative PCR for early infant diagnosis, and

enrolment of 20 laboratories in an international EQA program for CD4 cell count testing. A long-term

training program has provided a small number of highly qualified laboratorians to take on key management

functions; a USG supported capacity building program supported hiring of 30 laboratory technologists in key

MOH lab sites. Laboratory networks for sample transport, testing, and quality assurance have been

established in key locations, for example in Nyanza Province and in South Rift Valley Province. Important

additional infrastructure improvements (for the central TB reference laboratory and the central microbiology

laboratory) are being undertaken with FY2007 plus up funds.

3. CONTRIBUTION TO OVERALL PROGRAM AREA

This activity will contribute to training of 1,200 individuals in lab-related services and to improvement in the

capacity of 507 laboratories to perform HIV, CD4, and/or lymphocyte tests, allowing focused prevention

efforts or referral to HIV treatment, and appropriate monitoring of people receiving treatment for HIV.

4. LINKS TO OTHER ACTIVITIES

This activity is linked to activities in laboratory services, particularly (#6845, #7113 and #8763), Counseling

and Testing supported by all partners, especially (#6941), TB/HIV activities, particularly (#6944), and all

activities in PMTCT. The supported services are further linked to ART services carried out by NASCOP and

other treatment partners.

5. POPULATION BEING TARGETTED

Laboratory workers, people with HIV/AIDS.

6. EMPHASIS AREAS

The major emphasis area for this activity is in infrastructure, with minor areas in quality assurance and

support supervision, commodity procurement, training, policy and guidelines (specifically to develop and

implement Standard Operating Procedures).

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

REFERENCES TO TARGETS AND BUDGETS.

The only change to the program since approval in the 2007 COP is:

+The HIVDR threshold surveillance system intends to examine whether standard first-line antiretroviral

drugs regimens will continue to be effective in settings where they are widely available. Because of the high

mutation rate of HIV-1 and the necessity for lifelong treatment, it is expected that HIVDR will emerge in

treated populations where antiretroviral treatment (ART) is being rapidly scaled up. USG Kenya will support

HIVDR threshold surveys in a few sites alongside the 2007/08 round of ANC surveillance. Samples will be

leftover blood obtained through the ANC survey using unlinked anonymous strategy. For each site, 60-70

consecutive HIV positive blood specimens from persons meeting eligibility criteria will be identified to ensure

that amplification and genotyping are successful in 47 specimens (the survey sample size). The number of

specimens with mutation consistent with HIVDR will be used to determine the prevalence of transmitted

HIVDR for each drug and drug category in the standard initial ART regimen(s). Using the binomial

sequential sampling and classification plan, HIVDR prevalence will be categorized as: low prevalence

(<5%), moderate prevalence (5-15%), or high prevalence (>15%). The first component of this strategy is to

obtain baseline estimate of the prevalence of HIVDR, followed by repeat surveys to assess the frequency of

transmission of HIV drug resistant strains within a geographic area

1.LIST OF RELATED ACTIVITIES

This activity relates to HTXS (#7004), MTCT (#7006), HVCT (#7009), HLAB (#7003 and #6940), and HVSI

(#6988, #6824, #6946, #9012, and #7098). 2. ACTIVITY DESCRIPTION The National AIDS/STI Control

Programme (NASCOP) is the department in the Ministry of Health responsible for coordinating all HIV/AIDS

related activities. NASCOP continues to provide leadership in surveillance, program monitoring and HMIS,

and in conducting national surveys and targeted evaluations. FY 2007 funds for NASCOP will support

several activities. (ii) Sentinel Surveillance: FY 2007 funding will also continue to support Kenya's national

sentinel surveillance system which now includes 46 representative rural and urban sites that measure

trends in HIV infection over time. PMTCT test acceptance and results are recorded in order to evaluate

uptake and quality of testing. NASCOP trains health workers in these facilities, works with the National

Public Health Laboratory Services and CDC to test samples for HIV and recent infection by BED assay.

Data will be double-entered at regional and central levels, analyzed for prevalence and incidence trends,

and reported to policy-makers and program managers to improve programs. (iii) Monitoring and Evaluation

Support: The implementation of a decentralized monitoring and evaluation system is essential to measuring

the progress of EP implementation activities. The national rollout has begun and will continue in the next

fiscal year. In order for the health facility based data to flow to the national level, the harmonized M&E

registers and patient cards will be printed for all facilities and distributed. There will be ongoing training of

health care workers, data clerks, district and provincial health management teams as well as M&E officers

at the national office. Support supervision will be devolved to provincial level to facilitate faster collation and

reporting of data as well as feedback to the health facilities. Motorbikes will be purchased to enable district

level supervision in all the 114 districts. The integrated HIV/AIDS reporting of PMTCT, CT, ART and other

HIV service indicators in a single paper-based form at facility level that will be computerized at the district

level (MOH Form 727) to assist with national and Emergency Plan reporting of care, treatment and

prevention indicators, including PMTCT, CT, care, and ART. Through this activity NASCOP will complete

the implementation and use of an integrated Heath Management Information System to capture facility-level

HIV service indicators. (iv) As part following up the management of HIV/AIDS patients, NASCOP will

oversee the implementation of an Electronic Medical Records (EMR) system at MOH facilities, with the

assistance of the PHR+. The number of patients enrolled at comprehensive care clinics continues to grow

as HIV-related mortality declines. Maintaining patient records on paper based systems is proving to be a big

challenge to health care providers due to the volumes of paper they have to deal with. A pilot testing of the

EMRs has been completed in Eastern province and this will now be scaled up nationally. The activity will

provide detailed long term electronic data on follow-up of patients on treatment and provide easy

mechanism of transfer of patient records whenever they change facility of treatment. It will also provide

ready longitudinal data on treatment for program evaluation.

2.CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute by training 400 personnel in strategic information (sentinel surveillance,

monitoring and evaluation, survey methodology) and by providing supportive supervision and improvement

to the 46 sentinel surveillance sites, 74 District Health Management Teams and 10 Provincial/subprovincial

MoH AIDS control offices. In addition, the activities will generate important data for EP program evaluation

and policy formulation.

3.LINKS TO OTHER ACTIVIITES

This activity relates to other NASCOP activities across multiple program areas: HTXS (#7004), MTCT

(#7006]), HVCT (#7009), HLAB (#7003), HVSI (#6988), HLAB (#6940), HVSI (#6824), HVSI (#6946), HVSI

(#9012) and HVSI (#7098).

4.POPULATIONS BEING TARGETED

The HIV/AIDS indicator survey will target the general population, sentinel surveillance targets pregnant

women and STI patients, the training and capacity building activities targets health workers, data managers,

and the reports generated by this activity target policy makers.

5.EMPHASIS AREAS

This activity has four emphasis areas, none of which are over 50% of the activity, including an AIS

population survey , HMIS, surveillance systems, and the USG database and reporting system, which relies

heavily on facility data produced by NASCOP.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE CONSOLIDATES THREE ONGOING ACTIVITIES

FUNDED THROUGH NASCOP WITHIN THIS PROGRAM AREA BUT IS OTHERWISE UNCHANGED

EXCEPT FOR UPDATED REFERENCES TO TARGETS AND BUDGETS.

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

• A decrease in FY 07 funding levels for the MC-related policy activities. This is because of anticipated

funding from other stakeholders which will also help to support this activity. Funding for FY 08 for this

activity will only be $100,000.

• In addition, NASCOP's work in FY 08 will expand to include implementations of some of the

recommendations from the recent HW Survey and guidelines. Support will address issues of HW burn-out

as well as task-shifting in line with the new MOH Community Health Strategy and other emerging policy

guidance to address health worker shortages in Kenya.

1. ACTIVITY DESCRIPTION

Funding will support NASCOP and other key stakeholders to develop and disseminate STI and Prevention

with Positive policies and guidelines for service providers throughout Kenya. Technical training and support

for service providers will ensure strengthened service delivery for STI control, particularly within sexually

active HIV-infected populations. Circumcision Policy Development and Dissemination: PEPFAR will support

the Ministry of Health in the rapid development of Male Circumcision policy guidelines. This will involve the

development of policy, implementation and technical guidelines by NASCOP. Funding will include support

for technical assistance, dissemination and sensitization costs. A regional consultation prior to policy

finalization will also be supported in Nyanza Province given the focus on implementation in this high

prevalence, low-circumcizing area. WHO/UNAIDS normative guidance for countries regarding male

circumcision will be evaluated in the context of Kenya as a component of HIV prevention, tool kits for rapid

assessment, and guidance on training will be adapted. Funding will also support education and mobilization

work with Luo elders and key stakeholders in Nyanza Province to address cultural and communication

issues to prepare for programmatic scale-up.