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 extension of the PMTCT

supervisory model from district to lower level facilities (Health centers) to sustain provider performance

through continuous on the job (OTJ) cascade training and support supervision. Subsequently all facility-

level supervisors will be encouraged to regularly provide on-the-job orientation and support to PMTCT

frontline workers using a cascade on-the-job (OTJ) approach. The activity also strives to strengthen

linkages between PMTCT, CCCs and PLHA support groups in order to increase access to HIV prevention

and ART for adults, adolescents and children who are most likely to benefit.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Prevention of Mother-to-Child Transmission (#7006).

2. ACTIVITY DESCRIPTION

In FY 2006 USAID's ACCESS Project implemented by JHPIEGO supported the DRH to strengthen its

supervisory function, quality assurance program and referral systems to ensure the delivery of high quality

PMTCT services at public sector and faith-based facilities. Because the linkages between PMTCT and

CCCs are still weak, HIV-free survival of infants born to HIV infected mothers cannot be guaranteed. In FY

2007, JHPIEGO will continue to build upon FY 2006 initiatives by further supporting the MOH's Division of

Reproductive Health, to develop the capacity of 16 provincial and 120 district level DRH and NASCOP

officers to oversee the integration of reproductive health (RH) with HIV services and assure better referrals

and linkages between PMTCT and ART services. In FY 2008 the DRH with NASCOP will provide guidance

on how to strengthen PMTCT/FP/ART integration to 500 provincial and district level DRH and NASCOP

officers using the standard-based management and recognition approach. Through regular support to the

district and provincial PMTCT training and supervision teams, DRH with NASCOP will ensure a coordinated

scale up of integrated HIV care and treatment, family planning, postnatal care including psychosocial

support while assuring effective linkages between PMTCT, PMTCT plus services and HIV care and

treatment services for HIV positive women, their infants and family members. In FY 2008 JHPIEGO will

participate in the MOH's Technical Working Group for PMTCT (jointly led by DRH and NASCOP) to ensure

coordination of activities and compliance with MOH guidelines for service delivery.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA:

The MOH's division of reproductive health provides leadership, coordination and advocacy for national

reproductive health programs and NASCOP. By supporting the provision of integrated PMTCT/FP/ART

services the DRH will significantly contribute to the PEPFAR goals for primary prevention, care and

treatment. The decentralized training and supervision system will build capacity of provincial and district

DRH and NASCOP officers in managing comprehensive PMTCT with HIV and RH services and universal

access to ARV prophylaxis across provinces. This activity also contributes substantively to Kenya's Five-

Year strategy of availing services, which can reduce mother-to-child infections, and providing critical links to

HIV/AIDS treatment as a step towards preserving the family unit. It also contributes to the strategy to

integrate testing with other health services and improving the referral links among all of these services.

4. LINKS TO OTHER ACTIVITIES

This activity relates to activities in PMTCT though NASCOP (#7006) to improve the quality and supervision

of integrated prevention care and treatment services. It also enhances referral linkages within HIV services.

5. POPULATIONS BEING TARGETED

Strategies to improve quality of services will directly target policy makers, National AIDS control program

staff, other Ministry of Health staff working as program managers in the DRH at provincial and district level.

Service providers such as doctors, nurses, mid wives, other health care workers including clinical officers

and public health officers working in both public and faith based facilities, as well as infants and pregnant

women in rural and urban communities will also benefit from support supervision. The PMTCT TWG works

with faith-based organizations, non-governmental organizations and implementing organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED

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

pregnant women and their spouses. Increased availability of PMTCT and PMTCT+ services and the BCC

program for infant feeding will increase access and help reduce stigma at community and facility level. This

activity has a wrap around component namely supporting linkages between HIV/AIDS and RH services

7. EMPHASIS AREAS

The activity includes a major emphasis on quality assurance and supportive supervision. There is a minor

emphasis on development of network/linkages/referral systems and information, education and

communication. The activity will support strategic information through printing and dissemination of data

collection tools

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:

+ geographic coverage has been revised and expanded to include Eastern, North Eastern, and Nairobi and

Central provinces

+ to provide Provider Initiated Counseling and Testing.

1. LIST OF RELATED ACTIVITIES

This activity is related to activities in counseling and testing [#8760, #8776, #8777, #8778, #8781, #8782,

and #8976] and counseling and testing [#8009]. This activity is also related to activities in injection safety

[#8821].

2. ACTIVITY DESCRIPTION

In FY 2008 USAID'S ACCESS project implemented by JHPIEGO will continue to promote the availability

and delivery of high quality counseling and testing services in public Ministry of Health (MOH) facilities, an

essential element of clinical and preventive care. The guidelines will be disseminated in additional districts

nationally and orientation provided to 400 health workers. Subsequently these health workers will give

service orientation to 8,000 health workers using a cascade on-the-job (OJT) approach. This activity will

continue to monitor activities initiated in FY 2006 and FY 2005 in Western, Coast, Nyanza and Rift Valley

Province This activity will also promote the availability of diagnostic counseling and testing (DCT) in Ministry

of Health facilities, a vital entry point to prevention, treatment and care. Strengthening referrals and linkages

to care, treatment, and prevention will continue to be a priority for FY 2008. This activity will enable health

workers to reach individuals who are most likely to benefit from ARV treatment, through integration with STI,

TB, and in patient services. Effective linkages to comprehensive care centers (CCC) for HIV treatment will

be established. The activity also focuses on increasing linkages between STI, TB and in patient services

with HIV treatment services. The increased availability of DCT will help to reduce stigma associated with

HIV testing. Significant changes from initiated in 2006 include the advancement of training for health

workers through on the job (OJT) cascade training. The activity also focuses on increasing linkages

between STI, TB and in patient services with HIV treatment services. The increased availability of DCT will

help to reduce stigma associated with HIV testing. In FY 2005 JHPIEGO supported the National AIDS and

STI Control Program (NASCOP) to develop an orientation package for health workers to build skills in

counseling and testing in medical settings as defined in the National Guidelines. This orientation for health

workers helped to improve the quality of DCT in 8 districts in Central, Eastern and Nairobi Province. In FY

2006 this activity advanced the DCT skills of health workers in Western, Nyanza, Rift Valley, and Coast

Province and improve the quality of prevention, palliative and HIV treatment services. JHPIEGO will

participate in the MOH's Technical Working Group to ensure coordination of activities and compliance with

MOH guidelines for service delivery. JHPIEGO will also collaborate with local non-governmental

organizations for people living with HIV/AIDS and community healthcare workers to reduce stigma towards

DCT. At the planning stage, both central and appropriate peripheral levels of the ministry of health will be

involved along with other stakeholders.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to the 2008 Emergency Plan result for increased availability of diagnostic

counseling and testing through training of health workers. It will enable service providers to identify the large

numbers of HIV infected patients who are potential candidates for ART. This activity will increase access to

prevention and treatment services particularly among underserved and high risk populations. It also

contributes to Kenya's 5-year strategy emphases of encouraging Kenyans to learn their status and

developing strong links between counseling and testing and HIV services for those who are HIV positive

and in need of health care.

4. LINKS TO OTHER ACTIVITIES

JHPIEGO/ACCESS activities are focused on trainings and are therefore linked to counseling and testing

activities conducted by the APHIA II partners in counseling and testing in the different provinces: Coast

(#8781), Rift Valley (#8776), Western (#8777), NEP (#8778), Eastern (#8782), Nairobi/Central (#8976),

Nyanza (#8760). It is also related to NASCOP/MOH (#7009) counseling and testing. This activity is also

related to JHPIEGO/ACCESS activities in Injection safety (#8821).

5. POPULATIONS BEING TARGETED

This activity targets MOH staff including program managers in the NASCOP, public health care doctors and

nurses, other health care workers including community health workers.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will help to reduce stigma associated with HIV status by increasing the availability of routine

testing for diagnosis in medical settings.

7. EMPHASIS AREAS COVERED

This activity includes major emphasis on training and minor emphasis in development of

network/linkages/referral systems as detailed in the activity description in Section 1 above as well as minor

emphasis on policy and guidelines.

N/A (exempt)