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:

• Increase the total number of trained student peer educators to 800, providing life skills training for new

peer educators (PEs) and refresher training for continuing PEs;

• Continue to strengthen and expand small behavior change communication (BCC) groups where PEs will

introduce and reinforce ABC messages through ongoing, regular interaction with the students in the group

reaching at least 25,000 students with AB messages;

• Continue to disseminate the radio series developed in 2007 to reach an additional 50,000 individuals with

AB prevention messages;

• Collaborate with the School of Journalism at the University of Nairobi as well as campus theatre groups

and other student clubs and organizations to build their capacity to understand and incorporate ABC

prevention messages into their ongoing work on campuses;

• Synthesize and package lessons learned after nearly four years of implementing the intervention with ICL;

• Develop and implement a transition plan with ICL to promote sustainability, scale-up of the intervention

activities and graduation to a primary partner if possible.

1. LIST OF RELATED ACTIVITIES

As the target population is at risk for sexual activity and it may not be possible to practice abstinence and

faithfulness only, the activity is linked to Condoms and Other Prevention (#6887).

2. ACTIVITY DESCRIPTION

Since FY 2005, FHI/CRTU has collaborated with "I Choose Life" (ICL) to reach youth in special groups with

ABC messages in a balanced way. In FY 2008, ICL will continue to increase the total number of trained

student peer educators to 800 and reach 25,000 students with AB messages on University of Nairobi

campuses including the main campus, KNH campus, Chiromo, Kikuyu and Lower Kabete. Ongoing life skills

training and small behavior change communication (BCC) groups will continue to be further refined and

expanded to ensure additional students are equipped with personal values, attitudes and life skills to

prevent HIV infection and unintended pregnancy. FHI/CRTU and ICL will continue to strengthen life skills

training, particularly to address gender equity issues, and cover all campuses of University of Nairobi to

incorporate information about family planning in the ongoing peer education and BCC program. Radio will

continue to be used to reach students with vital health and ABC prevention messages that resonate with

university youth. The radio series developed in 2007 will continue to be disseminated to reach an additional

50,000 with ABC prevention messages. FHI/CRTU will also collaborate with the School of Journalism at the

University of Nairobi as well as campus theatre groups and other student clubs and organizations to build

their capacity to understand and incorporate ABC prevention messages into their ongoing work on

campuses. FHI/CRTU will conduct a project evaluation to evaluate the effectiveness and costs of the

intervention. Also, FHI/CRTU will synthesize and package lessons learned after nearly four years of

implementing the intervention with ICL. Findings from the evaluation and lessons learned will be

disseminated. Also, FHI/CRTU and ICL will begin developing and implementing a transition plan to promote

sustainability and scale-up of the intervention activities.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

These activities will contribute to prevention targets by targeting special youth groups, i.e. university

students. Behavior change among university students is expected to have a multiplier effect as university

students are viewed as "successful" role models by other youth. These activities are consistent with the

Kenya Five-Year Strategy targeting young people as full partners in defining and delivering programs and

messages.

4. LINKS TO OTHER ACTIVITIES

As the target population is at risk for sexual activity which may not be possible to abstain from, the activity is

linked to OP interventions as well. This activity is also related to Condoms and Other Prevention

implemented by FHI/CRTU (#6887).

5. POPULATIONS BEING TARGETED

This activity targets university students.

6. KEY LEGISLATIVE ISSUES ADDRESSED

Key legislative issues include gender by addressing male norms and behaviors for university students that

will result in reduced violence and coercion against others. Other issues addressed include stigma and

discrimination since it is key for effectiveness of peer educators who are volunteers.

7. EMPHASIS AREAS

The major emphasis area for this activity is project evaluation. Since FHI is also imparting skills to ICL to

carry out these peer education prevention activities, local organization capacity development is a minor

emphasis area. ICL uses a network of peer educators to disseminate prevention messages, making

development of network/linkages/referral systems minor emphasis areas. Gender issues, particularly

addressing male norms and behaviors as well as reducing violence and coercion, are also emphasized.

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

REFERENCES TO TARGETS AND BUDGETS.

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

+ In FY 2008 FHI/CRTU will continue to gather strategic information and identify lessons learned to support

integration of the activity with other partners, in particular APHIA II Nairobi

+ Disseminate lessons learned, including providing technical assistance to APHIA II partners to apply those

findings within their activities; and

+ Begin to develop and implement a transition plan with KU to promote sustainability and scale-up of

activities

1. LIST OF RELATED ACTIVITIES

This activity is related to Condoms and Other Prevention Activities (#8874) and Abstinence and Be Faithful

Programs (#6889) and will lay the groundwork to hand over activities to APHIA II Nairobi in 2008.

2. ACTIVITY DESCRIPTION

Findings from the formative assessment (2005 COP) and lessons learned from the pilot intervention (2006

COP) have been rolled out in 2007 through additional communities in Nairobi to reach more housegirls with

HIV prevention messages. Therefore, FHI/CRTU proposes in FY 2008 to continue to gather strategic

information and identify lessons learned to support integration of the intervention with other partners. The

activity scaled-up the intervention beyond Bahati Church to two additional faith-based institutions in Nairobi.

50 trained peer educators will reach an additional 500 housegirls with HIV and unwanted pregnancy

prevention messages. The 2007 mass media campaign will continue with existing radio stations which will

air HIV and unintended pregnancy prevention messages to reach 10,000 housegirls as well as the

communities in which they work to create awareness of their vulnerability. CRTU will work with Kenyatta

University (KU)'s Linguistics department to develop communications materials to be channeled through the

local radio stations. In order to enhance the quality of the materials, CRTU will continue their sub-contract

with a communications agency (possibly University of Nairobi's School of Journalism) to help design the

messages. FHI will continue to provide technical assistance to five local faith-based organizations (FBOs) to

design interventions to reach housegirls with prevention messages. Kenyatta University will be a sub-

recipient ($135,000) to carry out these activities.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

These activities will contribute to the 2008 prevention targets by targeting special youth groups, i.e.

housegirls. Reaching these hard-to-reach out-of-school youths is consistent with the Kenya Five-Year

Strategy targeting young people as full partners in defining and delivering programs and messages.

4. LINKS TO OTHER ACTIVITIES

This activity also relates to OP activities (#8874) and AB activities (#6889).

5. POPULATIONS BEING TARGETED

This activity targets out-of-school youth (girls) and women working as housegirls/women, as well as

religious leaders and volunteers working in faith-based organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED

Key legislative issues focus on gender, specifically on increasing gender equity in HIV/AIDS programs while

also addressing male norms and behaviors.

7. EMPHASIS AREAS

The major emphasis is on information, education and communication with minor emphases on training,

community mobilization, and local organization capacity development.

PHE CONTINUING STUDY:

Project Title: Understanding Fertility Desires and Demand for Contraceptive Use by Women on

Antiretroviral Therapy at the Nakuru Provincial General Hospital, Rift Valley, Kenya

Name of Local Co- Investigator: This project is being undertaken in collaboration with MOH/DRH and they

did not nominate a co-investigator to work with the FHI investigators

Project Description:

This subproject will provide information on the reproductive health needs of women on anti-retroviral

therapy (ART), as well as important insights into sexual behavior in the era of ART. The subproject

comprises a needs assessment study, an intervention and an evaluation. The needs assessment captures

perceptions on fertility, fertility desires, contraceptive practices, and pregnancy among HIV-infected women

on and not on ART, and HIV-uninfected women. In addition to informing the design of models for provision

of family planning (FP) to HIV-infected women and couples, the information will be used to modify existing

curricula and train 100 ART providers to deliver FP services to women attending ART services.

Timeline:

FY 2008 = Year 2007 of activity

Year started: July 2007

Expected year of completion: September 2009

Funding:

Funds received to date: $ 200,000 ($ 300,000 yet to be received in COP 07)

Funds expended to date: $21,186

Funds requested to complete the study:

FY08: $50,000

Describe funds leveraged/contributed from other sources:

In kind contribution from the MOH (infrastructure and human resources).

Status of Study:

The study is at the needs assessment stage. Research assistants' training was conducted June 18-22,

2007. Pre-test of data collection instruments was conducted July 26, 2007 at the Kenyatta National

Hospital CCC and VCT. June 28-29, 2007, the study team organized and resolved logistic issues for data

collection at the Nakuru Provincial General Hospital CCC and VCT. Data collection began July 2, 2007,

and is projected to be completed November 2, 2007. Data entry screens were revised July 9-10, 2007.

Data entry began July 11, 2007, and is projected to be completed November 9, 2007.

Lessons Learned:

• Protocol approval delays are unavoidable and adversely affect project timelines.

• Recruitment of HIV+ women is slow and dependent on daily client load and contraceptive use at the

CCCs. The needs assessment might require an extension of 20 working days to provide time to achieve

the desired sample size.

Information Dissemination Plan:

The findings will be shared with key stakeholders at both national and regional meetings. APHIA partners

will specifically be targeted for information dissemination and TA provided to apply the evaluated model(s)

in their programs. We will also explore opportunities at various APHIA II trainings and meetings to

disseminate the findings whenever appropriate.

Assessment findings will inform revision of existing curricula to facilitate training of ART providers and

facilitate the intervention design.

Planned FY08 Activities:

• Apply strategic information generated from COP 07 targeted evaluation to adapt global provider tools for

provision of contraception for HIV+ women and couples to the Kenyan context.

• Produce the adopted/adapted provider tools for distribution to APHIA II supported regions.

• Train 20 ToTs ART providers with skills to address family planning needs of HIV-positive individuals and

roll out service provider training in the regions.

• Develop 10 CCCs as centers of excellence for training in provision of FP to HIV+ women and couples.

• Continue to refine models for FP delivery in ART settings

Budget Justification for FY2008 Budget (USD): 50,000

Salaries/ fringe benefits: $10,000

Equipment: $ -

Supplies: $250

Travel: $1,875

Participant Incentives: $375

Laboratory Testing: $ -

Other: (training, adapting and producing intervention materials, M&E) $37,500

Total: $50,000

PHE NEW STUDY:

Project Title: Multiple Enrolment and flow of patient information for ART services

Name of Local Co- Investigator: Gideon Emukule, FHI-Nairobi

Project Description:

This project will be undertaken in Comprehensive Care Centers (CCCs) within the APHIA II program.

Introduction of CCCs has contributed significantly to increasing access to quality ARVs services in Kenya.

High cost, demand and limited supplies are likely to lead to pilferage of ARVs in these centers. Current

client registration does not address the potential for registering non-existent clients, double registration

within a CCC or registration of same clients at multiple CCCs. High mobility of clients requires that records

be maintained using systems that can be accessed by physicians across the centers to ensure quality and

continuity of treatment.

Evaluation Question:

The PHE question to be addressed is whether use of standardized electronic and web based client record

system would be feasible and acceptable to the different programs, clients and would addresses the

challenges of double registration, and facilitate sharing and easy processing of client information across the

different CCCs. There is no experience in Kenya with this approach but use of electronic data capture and

processing is a rapidly growing industry. With improving technology and access to the internet in Kenya, it is

feasible for all CCCS in the country to be linked via internet while ensuring client confidentiality.

Programmatic importance:

SI: The need for continuing recording, tracking and follow-up of patients on ART is critical to successful

ART programs. A coordinated and supportive approach that seeks to assist ART service providers and

patients will ensure that crucial information that gives evidence of services delivered, patient progression,

effectiveness of therapy and areas that need to improve is made available at every service delivery point.

Good quality and timely data, efficient information systems leading to reduced duplication and staff

overload, good health information infrastructure will significantly enhance the program.

Timeline and Funding:

Please describe expected timeframe of study from protocol development to completion (1,2, or 3 years,

please explain if >2 years)

Expected timeframe: 2 years

Preparatory Phase:Project Months: 1 - 3

Baseline Data Collection:Project Months: 4 - 5

Intervention Phase:Project Months: 6 - 17

End-line Data Collection:Project Months: 18 - 19

Data Analysis & Report Writing:Project Months: 20 - 22

DisseminationProject Months: 23 - 24

Total project budget: $300,000

Year 1 (FY 2008) budget request: $150,000

Methods:

Evaluation objectives:

1. To determine the quality of patient records among ART patients within the 3 CCCs.

2. To determine whether simple, affordable mechanisms using technological advances can be used to

ensure records are made available at every service delivery point and still maintain confidentiality, continuity

and networking for client tracking.

3. To determine the costs of implementing these interventions.

Evaluation design:

A time series study design will be used for this PHE. This will involve collection of baseline data on the

types and quality of client records kept at the clinics, the extent of the problems of double registration and

reporting within each CCC and across CCCs. The baseline would also examine the acceptability and

potential challenges of using a web based client record for clients, service providers and program

managers. The four major components of the evaluation will be:

1. Review of existing client record forms and registers to determine quality and possible duplications.

2. Interviews with a sample of providers and program managers to determine their data needs and

challenges in accessing such data using the current strategies. They will also be interviewed about their

knowledge and attitudes toward the use of electron and web based data capture and sharing mechanisms

3. Design an intervention package that will effectively address key challenges identified in component 2.

The package will include web based client record system with a central mechanism for collating, analyzing

and sharing this information with key stakeholders.

4. Evaluate the impact of intervention package on quality of client record, quality of care received by clients

across CCCs, timelines and use of data obtained using the web based approach and determine the cost of

implementing such an approach.

Population of Interest:

Service providers and patients attending ART at the CCCs based in Nairobi, Nakuru and Mombasa.

Information Dissemination Plan:

Experiences and successes documented during the strategic evaluation will be valuable to the CCC

program managers, supervisors and providers at the 3 sites reached as well as other CCC sites in

additional provinces. Results from this evaluation will be disseminated during a national stakeholders

meeting. Targeted meetings with Provincial Management Teams in Nairobi, Coast and Rift Valley

provinces and the other CCCs operated by the FBO hospital of St. Mary's' Mumias and the NGO Mkomani

Clinic Society at Bomu Medical Centre will also be held. The managers and service providers at the

existing CCCs will also be targeted as users of the information generated from this evaluation.

Activity Narrative:

Budget justification for year 1 budget (USD):

Salaries/ fringe benefits: $85,300

Equipment: $ -

Supplies: $23,700

Travel: $32,000

Participant Incentives: $ -

Other: $9,000

Total: $150,000