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:

+geographic coverage has been revised to include expansion in Kitui and Nairobi while transitioning support

to Rachuonyo District in Nyanza Province to APHIA.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in ARV Services (#6985, #8983), Counseling and Testing (#6983), TB/HIV

(#6944), PMTCT (#6949) and HBHC activities (#7043).

2. ACTIVITY DESCRIPTION

Liverpool Voluntary Counseling, Testing and Care Project (LVCT) will expand existing programs to provide

palliative care services to 6,000 people with HIV, including 600 children at 11 sites in Nairobi and Eastern

Provinces. Support for palliative care in Rachuonyo district, Nyanza Province will be transitioned to APHIA.

The package of palliative care services includes cotrimoxazole prophylaxis for opportunistic infections,

treatment of opportunistic infections, multivitamins, improved access to malaria prevention interventions,

and end-of-life care. LVCT will also support implementation of regional activities such as regional quality

assurance and coordination meetings in collaboration with the Provincial ART Officer and the TBD care and

treatment partner for Eastern south. Funds will be used to support salaries for health care providers in

accordance with Emergency Plan guidance, train 80 individuals in the provision of HIV-related palliative

care services, and to procure commodities such as laboratory reagents. Supported activities will also

include sensitization and mobilization of the communities in the areas of the supported facilities and

dissemination of informational brochures. Significant changes from FY 2007 to FY 2008 include geographic

consolidation of activities, expanded support for coordination activities, and an increased emphasis on

support for treatment of children and quality assurance for care through semi-annual audits.

LVCT is a local, Kenyan organization that started as a project under the Liverpool School of Hygiene and

Tropical Medicine. When LVCT became a Kenyan NGO, they retained the name of Liverpool because of its

wide recognition in Kenya. LVCT has been a key provider of VCT services in Kenya and since 2003 has

been supporting implementation of HIV care and treatment programs. In the specific area of palliative care,

Liverpool staff brings substantial medical expertise, and have played a crucial role in development of

national policies and training materials and a desk-top referral manual that has now been made available

throughout Kenya.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

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

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

provision of these services.

4. LINKS TO OTHER ACTIVITIES

These activities link ARV treatment services supported by LVCT in these sites (#6985), LVCT HBHC

activities (#7043)and ART and non ART services supported by other provincial partners, e.g. KEMRI in

Nyanza TB/HIV (#6944), and PMTCT (#6949), University of Nairobi in Kenyatta National Hospital, and

JHPIEGO (#6925) and TBD in Eastern (#8983).

5. POPULATIONS BEING TARGETED

The primary target group for these activities is people living with HIV/AIDS, including HIV positive children

(6 - 14 years). LVCT activities serve high priority, vulnerable, and stigmatized populations, e.g., high risk

slum populations, the deaf, and men who have sex with men. Health care workers are also targeted for

training in care and treatment.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity addresses legislative issues related to stigma and discrimination through involvement of

PLWAs in service provision and community sensitization activities.

7. EMPHASIS AREAS

This activity includes minor emphasis in commodity procurement, community mobilization, development of

networks, human resources, information, education, and communication, local organization capacity

building, policy and guideline development, training, quality assurance and supportive supervision, and

logistics.

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 (# ), Counseling and

Testing (# ) and ARV Services (# ).

2. ACTIVITY DESCRIPTION

Liverpool Voluntary Counseling, Testing and Care (LVCT) will support TB/HIV services for approximately at

11 sites in Nairobi, Eastern and Nyanza Provinces. Intensified TB screening and treatment for 3,000 HIV

patients and HIV screening for 450 TB suspects/patients will be offered as a standard of care in all the

facilities; approximately 225 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. 25 health care workers will be trained to provide clinical

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

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

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

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

Emergency Plan. LVCT is a local, Kenyan organization that started as a project under the Liverpool School

of Hygiene and Tropical Medicine. When LVCT became a Kenyan NGO, they retained the name of

Liverpool because of its wide recognition in Kenya. LVCT has been a key provider of VCT services in Kenya

and since 2003 has been supporting implementation of HIV care and treatment programs. In the specific

area of palliative care, Liverpool staff brings substantial medical expertise, and have played a crucial role in

development of national policies and training materials and a desk-top referral manual that has now been

made available throughout Kenya.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

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

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

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

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

health workers to provide integrated HIV and TB services.

4. LINKS TO OTHER ACTIVITIES

The overall program activity links closely to Palliative Care (#), ARV Services (#) currently supported by this

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

5. POPULATIONS BEING TARGETED

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

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

government guidelines.

6. KEY LEGISLATIVE ISSUES ADDRESSED

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

sensitization activities.

7. EMPHASIS AREAS

This activity includes minor emphasis in commodity procurement, development of

networks/linkages/referral systems, community mobilization, human resources, local organization capacity

development, quality assurance, quality improvement and supportive supervision, and training.

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

REFERENCES TO TARGETS AND BUDGETS.

Other changes:

+ in FY 2007 LVCT piloted home based counseling and testing in a peri-urban settlement in the outskirts of

Nairobi. In FY 2008 LVCT will continue providing this service in this and other regions of the country. The

lessons learnt from the implementation of HBCT will enable LVCT to develop HBCT training and operational

materials. LVCT will also support HBCT training, supervision and quality assurance.

+ in FY 2008 LVCT will facilitate the scale up of Couple CT nationally through training, mentorship and

supervision. It will also involve community education and demand creation. This will be supported by a

national media campaign on couple CT which will be implemented in the same period. LVCT will support

the strengthening of Couple CT in all CT services including PITC, VCT and PMTCT. Couple CT (and family

CT) will be particularly crucial in care and treatment settings, so as to facilitate CT for family members of

patients in care or on treatment.

+ in FY 2008 LVCT will roll out the Work Place VCT program. Under the coordination of the National AIDS

Control Council many private companies in Kenya have developed company HIV/AIDS policies. One of the

strong components in most of these policies is the provision of VCT services to employees. LVCT has in the

past facilitated workplace VCT programs for government, non-government, faith based and commercial

institutions. Because of its experience and organizational capacity LVCT was asked to host the secretariat

(coordinating unit) for this program. In FY 2008 this program will experience further growth and support from

other stakeholders.

1.LIST OF RELATED ACTIVITIES

This activity relates to activities in ARV treatment/services (#6985).

2.ACTIVITY DESCRIPTION

During FY 2007, Liverpool VCT and Care program (LVCT) will continue to improve model programs of CT

and care through technical assistance to non-governmental organizations (NGO), community-based

organizations and faith-based organizations (FBO). Core activities will include provision of CT to 200,000

people in medical and non-medical settings, training of 1,500 service providers and quality assurance

support to partners. CT services will be provided in 110 services outlets and HIV positive clients referred to

comprehensive care centers established through the President's Emergency funds. Specific efforts will be

aimed at promoting couple CT, assisting discordant couples, and assisting HIV infected clients to disclose

their status to their sexual partners. LVCT will continue to address the CT needs of special groups including

men who have sex with men and people with visual and hearing impairments. In FY 2008 LVCT will

continue facilitating prompt and appropriate referrals to care. It will maintain a regional presence in Eastern

province, Central Nairobi and Nyanza provinces and will implement multiple models of CT services

including mobile VCT where appropriate. By the end of FY 2007, 5,000 HIV positive persons tested will be

started on ART at LVCT-operated care outlets. In addition, 10,000 will receive non-ARV treatment including

prophylaxis for opportunistic infections. In keeping with its commitment to enhance local capacity to provide

quality HIV/AIDS services, LVCT will conduct various types of CT trainings including DTC, VCT, couple

counseling and Training of Trainers courses. To enhance service delivery of CT and care to the public,

LVCT will provide technical assistance, capacity building and program support to selected government

institutions. LVCT will also offer ongoing quality assurance trainings for its service providers and those of

collaborating partners to ensure continuous improvement in quality of CT services. LVCT will also continue

to carry out counselor supervision in 14 districts of Nyanza and central provinces in support of QA

improvement. LVCT is a Kenyan NGO widely known for its leading role in providing quality VCT services

and trainings. LVCT has been a CDC Kenya partner since 2002 and was awarded a CDC Cooperative

agreement in September 2004 to continue providing VCT using multiple approaches, to train service

providers in CT and support supervision; and to expand access to both ART and non ART Care for CT

clients who test HIV positive. LVCT will continue to expand these activities during FY 2008.

3.CONTRIBUTIONS TO OVERALL PROGRAM AREA

Through LVCT's efforts, an estimated 200,000 Kenyans will access CT in settings with well-established

linkages to care services created through the president's Emergency fund. LVCT's CT targets will include

significant numbers of counselors trained. LVCT will also provide mobile VCT services in selected

underserved parts of Central, Eastern, Rift valley and Nyanza provinces to improve access to HIV

prevention and care services. Many underserved rural communities will have better access to these

essential services. Linkages between outreach Mobile VCT programs and medical sites where AIDS care

and treatment are available will be enhanced thereby enabling many HIV infected individuals to access

appropriate medical care and prevention services.

4.LINKS TO OTHER ACTIVITIES

HIV positive individuals identified through LVCT's CT activities will be linked to LVCT's Comprehensive

Care Centers whose expansion will be designed to serve geographical clusters of CT sites. The model CT

sites operated by LVCT will continue to be centers for best practice and training of service providers

besides forming a platform to pilot activities that will guide National CT program improvement. Model youth

friendly CT sites operated by LVCT will improve the program's responsiveness to the needs of the youth

thereby improving access to services by this highly vulnerable sub-segment of Kenya's population. LVCT

will also receive President's Emergency Fund to implement other HIV interventions that complement CT

efforts. Such interventions will include direct links to LVCT ARV treatment/services activity (#6985) and

other efforts that can be implemented as integrated packages.

5.POPULATIONS BEING TARGETED

This activity targets multiple high risk groups including people with disabilities, young people, as well as

other most at risk populations especially men who have sex with men and survivors of rape. Public health

care workers as well as leaders of FBOs and NGOs will be trained to address the particular needs of these

groups, which also include widows/widowers, HIV positive pregnant women and mobile populations such as

truck drivers and migrant workers.

6.KEY LEGISLATIVE ISSUES ADDRESSED

Activity Narrative: This activity will increase equity in programming through expansion of CT services that are responsive to

the unique needs of the deaf, blind, men who sex with men, rape survivors, the youth and other

marginalized groups. Increased availability of CT services for these special vulnerable groups will help to

reduce stigma and discrimination amongst them.

7.EMPHASIS AREAS

This activity includes major emphasis in trainings on provider-initiate CT, client-initiated CT and quality

assurance. There will be minor emphasis on development of infrastructure to provide space for CT service

delivery, especially in medical facilities that have not yet institutionalized provider initiated CT. Another

minor emphasis is in the area of quality assurance through LVCT catering to the ncrease in interest in

quality of CT by the Kenyan Ministry of Health has been demonstrated through recent approval of new

National strategy and tools for supervision and quality assurance (QA) for CT. Other minor emphasis areas

are in the area of community mobiliziation and development of network/linkages/referral systems.

N/A (exempt)