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

REFERENCES TO TARGETS AND BUDGETS.

The only change in FY08 is a reduction in geographical coverage to consolidate efforts into Siaya district

only.

1. LIST OF RELATED ACTIVITIES

This activity is linked to activities in HIV/AIDS Treatment: ARV Services (#6945), Laboratory Infrastructure

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

2. ACTIVITY DESCRIPTION

CARE International has been supporting the implementation of PMTCT services in Siaya, Migori and Kuria

Districts of Nyanza Province since 2001. In FY 2008 the geographical focus of CARE will be Siaya District.

Siaya district recorded high HIV prevalence among women: 23.6% in the 2003 KDHS. Siaya has 1 district

hospital, 2 sub-district hospitals, 10 health centers, 20 dispensaries, 5 mission and 1 private hospital with

comprehensive PMTCT services. CARE International currently supports PMTCT activities in 34 public

health facilities, 6 mission and 1 private hospital. In FY 08 CARE will extend to 9 new GOK health facilities.

The project is a collaborative effort with the Ministry of Health (MOH). The MOH is responsible for the

provision of health facilities and health workers who are trained to provide comprehensive PMTCT services.

CARE provides technical assistance and advice on effective models of care and provides strategic

oversight. CARE Kenya builds the capacity of the MOH facilities staff to deliver high-quality, efficient and

comprehensive PMTCT services, ensures linkages with other PMTCT service providers and communities,

promotes early infant diagnosis with appropriate guidance on infant nutrition, ensures linkage of mother and

infected infants to care and treatment, and facilitates supportive supervision. In FY 2008, CARE

International will extend PMTCT support to all existing public health facilities, and will refurbish and equip

these as needed. CARE will focus on all the 4 prongs of PMTCT, with emphasis on primary prevention

within the ANC (prong 1), prevention of unwanted pregancies by strengthening linkage to FP (prong 2) and

linkage to care and treatment for mother, partner, infant and other children at home (prong 4). In prong 3,

the main focus will be on routine counseling and testing of pregnant women in antenatal clinics (ANC) and

in maternity units, WHO clinical staging of HIV positive women, provision of cotrimoxazole and antiretroviral

prophylaxis to HIV positive women and exposed infants. Emphasis will be laid on provision of a more

efficacious regimen (sdNVP + AZT) or HAART to eligible women and counseling on infant nutrition. The

program will provide HIV counseling and testing to 20,685 pregnant women, and provide antiretroviral

prophylaxis to 4,185 HIV positive women. Of these, 2,093 will receive sdNVP+AZT, 837 women HAART

and 1,256 sdNVP. HIV infected and exposed infants will be followed up postnatally. The care package for

HIV infected mothers in post-natal follow up will include counseling on appropriate infant feeding practices,

linkage to care and treatment, and linkage to family planning services. The care package for HIV exposed

infants will include early infant diagnosis and initiation of cotrimoxazole from 6 weeks, to a target of 2,093

infants. CARE will train 96 health service providers in comprehensive PMTCT (96 on DBS, 30 on safe water

systems, 48 on post exposure care and post exposure prophylaxis, 48 on family planning (re-orientation)

and 96 on nutritional counseling for exposed babies). Care will train over 300 community members

including youth groups, teachers, CORPS and peer counselors or various skills required for support groups,

disclosure counseling, public speaking and peer education. Additionally, CARE will organize and coordinate

mobile PMTCT and early infant diagnosis services to the facilities without adequate staffing or

infrastructure, and promote linkage from PMTCT to care and treatment. Identified infected infant-mother

pairs will be linked to care and treatment. CARE will initiate pediatric antiretroviral treatment in mature high

volume PMTCT sites, and establish a facility-lab courier network for DBS to improve efficiency in specimen

collection and return of results. Plus up funds will be used within Siaya district to scale up early infant

diagnosis activities, diagnostic testing and counseling (DTC) in the MCH, paediatric clinics and paediatric

wards, TB clinics and adult treatment centers. Funds will also be used for start up of paediatric care and

treatment within the MCH in high volume mature PMTCT sites. This will help increase the number of infants

and children accessing diagnosis, care and antiretroviral therapy, and towards achieving the COP 08 EID

targets of 2,093 and rapid scale up of children on ARTs. Funds will be used to support training on DBS,

dissemination of national algorithm, procurement of test-kits for rapid tests, reagents, supplies and logistics

for EID and DTC, and logistics for administration of paediatric ART and care from the MCH. In FY 2008,

CARE International will consolidate PMTCT activities to enhance male partner involvement using special

invitation cards to the partners. CARE will use PLWHA to form support groups and demand creation for

PMTCT. Within the facilities, CARE International will enhance supervision to achieve the targets for CT and

NVP uptake. In addition, CARE will leverage resources available through their Safe Water Systems (SWS)

program that focuses on making water safe through disinfection and safe storage to avoid contamination.

Safe water vessels and disinfectant will be provided to women in the PMTCT program. This will improve the

safety of infant weaning and reduce diarrhea morbidity. A community mobilization and education component

will be included to increase awareness so that community members can make informed choices on issues

to do with techniques of disinfecting water, proper hygiene behavior and proper use of safe water storage

facilities.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

Community participation and male involvement will significantly contribute to PEPFAR goals for primary

prevention, access to care and treatment, and support of those affected and infected. This activity will

contribute 1.7 % to the 2008 overall Emergency Plan PMTCT targets for Kenya (1.2 million).

4. LINKS TO OTHER ACTIVITIES

This activity is linked to the KEMRI ARV program (#6945), KEMRI laboratory program (#6940), KEMRI

TB/HIV program (#6944), and VCT (#6941). PMTCT services include counseling and testing which is

largely diagnostic, provision of ARV prophylaxis and appropriate referrals for the management of

opportunistic infections and HIV/AIDS treatment. All HIV+ mothers and their family members will be referred

to the ART program for on-going care, treatment and support. DBS samples will be packaged and shipped

to KEMRI laboratories doing PCR, while samples for CD4 will be sent to regional laboratories doing CD4

count. Patients suspected to have TB will be screened and referred for TB treatment. Partners of HIV

positive mothers will be encouraged to come for testing at PMTCT site or to go for VCT.

5. POPULATIONS BEING TARGETED

This activity targets adults, pregnant women, HIV+ pregnant women, HIV exposed and HIV+ infants (0-4

years). The PMTCT+ initiatives will also target HIV affected families through providing mechanism for

Activity Narrative: improving access to care of the family members of the HIV+ women. Public health care workers including

doctors, nurses and other health care workers for example clinical officers, nutritionists, and social workers,

will also be targeted for training using the nationally adopted NASCOP/CDC/WHO approved training

packages, to equip them with knowledge and skills to provide comprehensive HIV prevention and care

services.

6. KEY LEGISLATIVE ISSUES ADDRESSED

Key legislative issues include increasing gender equity in HIV/AIDS programs, reduction of stigma and

discrimination, linking care and support programs to income generation activities, and microfinance

programs for women.

7. EMPHASIS AREAS

Major emphasis will be placed on Quality Assurance and Supportive Supervision; lesser emphasis will be

placed on Commodity procurement, Community Mobilization/Participation, Development of

Network/Linkages/Referral systems and Training.