Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 4076
Country/Region: Kenya
Year: 2008
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $4,043,416

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $153,600

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED, BUT THIS YEAR'S CDC M&S IS

SPLIT BETWEEN GAP AND GHAI.

1. LIST OF RELATED ACTIVITIES

This activity relates to all activities in PMTCT.

2. ACTIVITY DESCRIPTION

The CDC PMTCT program has continued to support the up scaling of PMTCT services in the country by

providing technical support and guidance to the national program. Key areas of program focus include the

introduction of Comprehensive PMTCT that encompass a package of care to ensure that the HIV-positive

pregnant mother, her infant and family receive the full range of HIV care and treatment services as well as

linkage to Family Planning services. The approach also includes a strong emphasis on primary prevention-

providing skills to the mother who is HIV- to protect herself and her family from HIV infection. In FY 2008,

the CDC PMTCT section will continue supporting these activities under the expanded or comprehensive

PMTCT package that includes the following key components: expansion in geographic coverage in all CDC

supported sites to ensure universal access to services; Integration of counseling and HIV testing of women

in the antenatal clinics and maternity units; Clinical staging of all HIV-positive pregnant women to identify

the appropriate PMTCT ARV intervention in line with National guidelines (this includes use of HAART where

eligible, or use of combination AZT and sd Nevirapine for early presenters, or use of sd Nevirapine);

Administration of the appropriate PMTCT ARV as well as OI prophylaxis for all HIV-positive pregnant

women; Early Infant HIV diagnosis for all HIV exposed infants through DNA Polymerase Chain Reaction

(PCR) testing; Linkage of eligible infants to pediatric HIV care and treatment services; strengthened post-

natal care package; Linkage to family planning services and counseling and testing services for the

woman's partner and other family members. This will lead to more women and their partners and infants

knowing their HIV status and hence accessing ART, thereby increasing the number of people on ARVs. All

these activities will contribute to the Emergency Plan in Kenya goals of HIV prevention and treatment.

During FY 2008 CDC will continue to work with government of Kenya agencies and non-governmental

partners to support implementation of these services in the country. CDC Kenya's multi-disciplinary PMTCT

team will continue to provide technical guidance that includes the development and review of guidelines,

operational procedures and manuals, educational materials and teaching modules for implementing

comprehensive PMTCT programs in Kenya. CDC Kenya staff work with local partners to ensure activities

are based on the latest relevant science and that scientific knowledge is translated into program guidelines

and practices both at national policy and service delivery levels. In collaboration with other partners, CDC

staff conducts monitoring and evaluation activities including operational research for the PMTCT program,

and ensure that information generated informs national PMTCT policy and practice. CDC Kenya staff also

support PMTCT activities at multiple service delivery sites to conform to national guidelines and technical

strategies concerning all aspects of PMTCT including models of HIV testing in the antenatal and maternity

units, provision of ARVs for prophylaxis and treatment, care and support of the HIV+ woman, her infant and

partner and Early Infant diagnosis for HIV exposed infants and linkage to treatment and care for all eligible

infants. The CDC Kenya PMTCT technical team includes six professional staff, one program assistant and

three support staff. The technical staff includes one senior technical advisor working 80% of the time; this

staff member, an Associate Professor of Pediatrics has extensive national and international experience in

clinical and programmatic HIV research including PMTCT, and works directly with the government of Kenya

and other partners to ensure the technical soundness of the program. Other technical staff include two

medical doctors with experience and expertise in Pediatrics, and Obstetrics and Gynecology respectively,

who work directly with programs to ensure technical and up-to-date interventions, in particular the care of

the HIV+ woman and pediatric HIV care; two program managers with nursing and public health experience

who work directly with the sites in 34 districts to provide guidance on both technical and effective program

management approaches at the service delivery sites, a behavioral scientist and a program assistant. The

program assistant is engaged in a variety of tasks to provide logistics support to the team. The team is

supported by three drivers, who enable the technical staff to conduct regular field visits and technical

supervision. This budget includes costs for contractual services, printing of the curriculum and other post-

held account funds.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $61,600

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

REFERENCES TO TARGETS AND BUDGETS. THIS YEAR'S CDC M&S FUNDS ARE SPLIT BETWEEN

GAP AND GHAI.

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

+ In FY 08 CDC technical staff will dedicate time and expertise to work on the multi-agency efforts to

design, develop and implement the new Youth Prevention Initiative. In addition, technical staff will work with

partners to streamline development of a comprehensive AB package for adolescents as part of new male

circumcision service delivery, particularly with faith-based organizations. CDC Kenya staff will provide an

intensive level of technical assistance and programmatic guidance on prevention activities guided by the

PEPFAR ABC programming. During FY 2008 CDC will reorganize its existing staff in line with staffing for

results objectives and to support FY 2008 AB program strategic priorities.

1. LIST OF RELATED ACTIVITIES

This activity relates to all activities in Abstinence and Be Faithful Programs.

2. ACTIVITY DESCRIPTION

During FY 2007 CDC will continue to work with Government of Kenya agencies and non-governmental

partners to promote abstinence and faithfulness as an HIV prevention strategy. CDC Kenya now has a wide

range of AB activities and partners, including 11 cooperative agreements designed to promote AB activities

with young people. CDC continually identifies and continues to provide an intense level of technical

assistance and guidance to ensure that partner activities are focused on behavior change. CDC provides

technical support through a close program mentorship of staff at the National Youth Service, a uniformed

national training service serving up to 10,000 youth each year. In addition, CDC provides technical

assistance to number of local FBOs and CBOs through a capacity building project with CHF International.

The sub-grantees working in this area include the Africa Inland Church, the Baptist AIDS Response Agency,

Kenya Episcopal Secretariat-Catholic Secretariat, and many others. CDC Kenya staff also have a strong

partnership with the non-military uniformed services of Kenya, including the Kenya Prisons, Kenya Wildlife

Service, and the police. They have had a key role in introducing the Men as Partners (MAP) curriculum into

the training offered to young recruits in the National Youth Service and will introduce this curriculum, which

emphasizes changes in male behaviors and attitudes, to young recruits into the non-millitary uniformed

services. The types of activities CDC technical staff engage in include training in workplan development,

assistance with monitoring and evaluation plans, training to bring local CBO and NGO staff up to date in

technical areas of HIV and AIDS, reviewing technical proposals for funding, making technical presentations

and supervising partners working through the Cooperative Agreements. CDC Atlanta staff come to Kenya

on a regular basis to assist the local partners in developing identified technical areas. The CDC Kenya AB

technical team includes one Direct Hire (USDH) working 25% in AB. This staff member has extensive

international experience in working with FBOs implementing HIV prevention programs, and the incumbent

works directly with implementing partners to ensure the technical soundness of the program. CDC has one

locally employed technical staff member working on AB and youth programs on full-time basis. She also has

extensive experience in this programmatic area, and spends most of her time working directly with local

partners. This team will be supported by two locally employed drivers, one in Nairobi and one in Nyanza,

whose work is devoted to supporting AB and youth interventions.

Funding for Biomedical Prevention: Blood Safety (HMBL): $0

Updated August 2008 reprogramming.

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

REFERENCES TO TARGETS AND BUDGETS.

1. ACTIVITY DESCRIPTION

Thousands of lives are saved in Kenya each year through blood transfusion. Shortcomings in the way blood

is tested for infectious agents such as HIV means that transfusion recipients are at risk of acquiring HIV. It is

estimated that between 5% and 10% of all HIV infections worldwide have been acquired through transfusion

of contaminated blood and blood products. A study in Kenya in 1994 found that 4% of transfusions

transmitted HIV. If proper quality systems are put in place, such infections can be prevented. The National

Blood Transfusion service collects about 160,000 blood units each year. These are tested using combined

HIV1/HIV2 antigen and antibody detection test kits by ELISA methodology. The window period for this

method is 16 days meaning that recently infected persons albeit infectious may fail to be detected and thus

contaminate the blood supply. The proportion of persons in the window period can be significantly high in

regions with high HIV prevalence. This activity will involve provision of quality assurance testing by NAT for

routinely ELISA tested blood. Randomly selected samples from each of the regional transfusion centers will

be pooled and tested. Feedback will be given to the centers so as to improve quality of testing and reduce

transmission of HIV through transfusion. Corrective measures may require retraining of laboratory

personnel and review of national policies for testing algorithms and testing methods in blood transfusion.

The NBTS has recently started producing blood components so as to improve blood utilization. This activity

will provide QA testing for the components ensuring that they are free of infectious agents and are of

appropriate composition. Equipment will be procured to monitor the quality of blood and blood products

including cell counts on platelet concentrates, haemoglobin estimation in packed cells and concentration of

coagulation factors in cryoprecipitate.

2. CONTRIBUTION TO OVERALL PROGRAM AREA

Ascertainment of quality testing for HIV in blood transfusion will play a key role in enhancing capacity of the

NBTS and transfusing hospitals to support prevention of HIV/AIDS through blood transfusion.

3. LINKS TO OTHER ACTIVITIES

This activity relates to all HIV prevention activities but most specifically the blood Safety program. After

donor selection blood testing is the most important step in ensuring safety of the blood supply.

4. POPULATIONS BEING TARGETED

This activity targets laboratory workers.

5. EMPHASIS AREAS

This activity will place major emphasis on technical training on Quality Assurance and quality control, new

and appropriate technologies for ensuring blood safety. Minor emphasis areas will include procurement of

specialized laboratory commodities and operationalization of laboratory QA schemes for transfusion

transmissible infections.

Funding for Biomedical Prevention: Blood Safety (HMBL): $127,850

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED, BUT THIS YEAR'S CDC M&S

FUNDS ARE SPLIT BETWEEN GAP AND GHAI.

1. LIST OF RELATED ACTIVITIES

This activity links to all other activities in blood safety.

2. ACTIVITY DESCRIPTION

This activity relates to the prevention of HIV transmission through blood transfusion in health care settings.

The National Blood Transfusion Service (NBTS) was established in the year 2000 with the goal of ensuring

safe and sufficient blood supplies for the country. Previously blood was obtained solely from family

replacement donors at fragmented hospital-based transfusion units that lacked a standardization of

procedures. A national survey in 1994 estimated that 2% of transfusions transmitted HIV. At least 130,000

transfusions take place each year. This activity will avail staff to give technical support to the national blood

transfusion service for the establishment of goals and objectives and best practices in donor recruitment,

blood collection, processing, storage and use. This will be achieved through regular meetings with the

National Blood transfusion service, Ministry of Health, Kenya Red Cross Society and other stakeholders,

support supervision of transfusion activities in blood banks and health facilities, preparation of procedural

guidelines and data collection tools and the review and analysis of quarterly reports. Support supervision

will involve travel to the six regional blood transfusion centres located in Kisumu, Eldoret, Nairobi, Nakuru,

Embu and Mombasa and satellite centres in Voi, Naivasha and Kericho as well as international travel for

blood safety related workshops, seminars and conferences. These staff will also liaise with and coordinate

the various organizations that support blood donor mobilization for the NBTS so as to avoid conflict and

achieve synergy in meeting the blood collection target. These organizations include: Kenya Red Cross,

Hope Worldwide, Africa Society for Blood transfusion (K) and Bloodlink Foundation. Direct support will be

given to the hospital transfusion committees. This activity also includes participation in various Ministry of

Health committees that impact on blood transfusion policy and practices in the country. These include:

Blood Safety Committee, Blood Safety Interagency Committee, Laboratory Interagency Committee, HIV Lab

Committee and World Blood Donor's Day Committee. The staff will additionally give in-country support to

international groups supporting blood safety activities in Kenya such as the American Association of Blood

banks (AABB), Internews and Community Housing Foundation (CHF).

Funding for Biomedical Prevention: Injection Safety (HMIN): $204,850

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED, BUT THIS YEAR'S CDC M&S

FUNDS ARE SPLIT BETWEEN GAP AND GHAI.

A prevention component has been integrated that has a budget of less than $10,000 and includes the

following elements:

• Evaluation of HIV risk through sharps injuries in mortuary personnel ($9,000). Mortuary staff have not

been targeted in Injection Safety program activities, but it is now suspected that they are exposed to HIV

infection due to an increasing trend of embalming bodies prior to burial. Embalming is performed by

untrained mortuary attendants.

1. LIST OF RELATED ACTIVITIES

This activity relates to all other activities in injection safety.

2. ACTIVITY DESCRIPTION

This activity relates to the prevention of HIV transmission among health care workers, medical waste

handlers and the community. These funding will enable HHS/CDC staff to give technical support to six

implementers of injection safety initiatives in Kenya. This will involve joint planning meetings, review of

guidelines, standards and training material and support supervision at intervention sites and at training

workshops. These staff will participate in the MOH injection safety steering committee and the injection

safety stakeholders meetings to influence policy decisions in this arena. Activities are currently being scaled

up to achieve national coverage by 2008. Staff will be involved in frequent travel across the country and will

attend international conferences for dissemination of latest findings. One staff will dedicate 100% of their

time to this activity while another will commit 40% time. The world Health Organization (WHO) estimates of

global burden of disease suggest that unsafe injections around the world account for 5% of HIV infections,

32% of hepatitis B virus infections and 40% of hepatitis C virus infections. A 2004 survey by JSI-MMIS in

Kenya revealed that over 70% of respondents received an average of 1.5 injections per year. Needle stick

injuries within the previous six months were reported by 58% of health care workers. These findings

supported those of an earlier study by the University of Nairobi among 214 nurses in Nairobi, which

reported 61% needle stick injuries in health care workers over a three-month period. Needle recapping

accounted for 46% of the injuries while 12% occurred in the process of sharps disposal. A majority of health

facilities surveyed reported having experienced a shortage of disposable injection supplies in the 12 months

prior to the survey, particularly in the curative sector. This reflected a less than optimal logistics system for

forecasting, procurement, distribution and stock monitoring that may contribute to re-use of injections.

Analysis of the status of injection logistics in the country revealed that there was no data to support rational

forecasting of injection requirements. Procurement was based on previous consumptions. Appropriate

product selection was poor due to lack of national standards for injection devices, registered suppliers of

injection equipment and an appropriate board to handle non-pharmaceutical equipment. Track 1 funds were

awarded to JSI-MMIS in 2004 to implement injection safety activities in Kenya and other PEPFAR focus

countries. The activity aims to:1) improve training of health workers and managers on safe injection

practices, infection control and disposal procedures; 2) institute an advocacy strategy to decrease demand

for injections by the population; 3) establish reliable estimates of re-use prevention injection device

equipment requirements, minimum stock levels and effective supply and distribution systems for re-use

prevention injection device equipment; 4) institute monitoring and supervision procedures to ensure

adequate supplies at all levels and correct practices by health workers; 5) ensure safe disposal of used

injection equipment through the progressive introduction of appropriate incinerators; 6) secure the required

budget for injection safety and infection control including safe disposal of used equipment. To date safe

injection practices have been implemented in three districts, five of eight provincial hospitals and one of

three university teaching hospitals. In FY 2006 the Ministry of Health, through the National AIDS and STD

Control Program, received country funds to facilitate development of policy documents and coordinate

injection safety initiatives countrywide. In the FY07 COP, additional partners will include the University of

Nairobi, Danya International and USAID APHIA II implementing partners.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $105,200

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

REFERENCES TO TARGETS AND BUDGETS. THIS YEAR'S CDC M&S FUNDS ARE SPLIT BETWEEN

GAP AND GHAI.

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

+ In FY 08 CDC a new technical advisor FSN position is proposed who can assist the USG team with new

approaches to HIV prevention, including male circumcision. This advisor will work with all USG

implementing partners across agencies to ensure careful coordination with MOH plans and other donor

funding. In line with our '08 OP strategy and our staffing for results approach, CDC technical OP staff will

play a lead role in coordinating the multi-agency efforts to develop a comprehensive prevention package for

CSWs and for Positive Prevention. CDC Kenya staff will provide an intensive level of technical assistance

and programmatic guidance on prevention activities guided by the PEPFAR condoms and other prevention

programming. During FY 2008 CDC will reorganize its existing staff in line with staffing for results

objectives and to support FY 2008 OP program strategic priorities.

1. LIST OF RELATED ACTIVITIES This activity relates to all activities in Condoms and Other Prevention.

2. ACTIVITY DESCRIPTION In FY 2007 CDC will continue to work with Government of Kenya agencies

and non-governmental partners to assist in the implementation of a wide range of HIV prevention services

covered under Condoms and Other Prevention. CDC Kenya staff will provide technical assistance and

guidance to local partners to ensure the technical soundness of these programs, adherence to Emergency

Plan guidelines, and to ensure that these programs receive appropriate monitoring and evaluation. CDC

Kenya has a close partnership with the International Rescue Committee to implement OP activities in the

Kakuma refugee camp and will provide technical support to the State Department-funded UNHCR for

activities in Dadaab refugee camp. The provision of technical guidance is a key element of this partnership.

CDC staff will work closely with the Institute of Tropical Medicine (ITM) to ensure the technical and

programmatic soundness of the young vulnerable women project in Kisumu. In addition, CDC provides

intensive day to day support to over fifteen local FBOs and CBOs through a capacity building project with

CHF International. The sub-grantees working in this area serve a broad range of at-risk groups including

sugar plantation workers, sex workers, matatu and transport workers and those in the ‘jua kali' informal

sector. CDC will provide technical guidance in FY 2007 to help partners in this program area focus on

Positive Prevention. This important behavioral approach has already been incorporated in the activity

narratives for a majority of HVOP CDC partners. A new project to be supported by this mechanism will be

one providing behavioral interventions for young men enrolling in the Kisumu male circumcision project (non

-PEPFAR funded). The types of activities CDC technical staff engage in include training in workplan

development, assistance with monitoring and evaluation plans, training to bring local CBO and NGO staff up

to date in technical areas of HIV and AIDS, and other technical services. CDC Kenya staff also provide

technical assistance to the non-military uniformed services of Kenya, including the National Youth Service,

Kenya Prisons, Kenya Wildlife Service, and the police. The CDC Kenya OP technical team includes one

Direct Hire (USDH) who has extensive international experience in implementation of behavioral HIV

prevention programs and will provide 5% of time to OP. One locally employed staff works 50% of her time

on this program and proposes to add one locally employed technical staff member to share the increasing

workload. In addition, CDC Kenya will draw on technical expertise from other CDC prevention experts in

Africa and in Atlanta. CDC also supports two local staff through the KEMRI COAG to coordinate the

uniformed services project. This team OP team will be supported by two locally employed drivers whose

work is devoted to supporting HIV prevention interventions.

Funding for Care: TB/HIV (HVTB): $190,000

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED, BUT THIS YEAR'S CDC M&S

FUNDS ARE SPLIT BETWEEN GAP AND GHAI.

1.LIST OF RELATED ACTIVITIES

This activity relates to all other activities in the Palliative Care (HBHC): TB/HIV program area

2.ACTIVITY DESCRIPTION

CDC Kenya staff provide an intensive level of technical assistance and programmatic guidance on the

integration of TB and HIV activities in partnership with the National Leprosy and TB Program (NLTP), the

National AIDS and STI Control Program (NASCOP), other USG agencies (USAID and DOD), WHO, non-

governmental organizations, faith-based organizations, private practitioners and other implementing

partners involved in TB/HIV activities. CDC staff re active leaders in the National TB/HIV coordinating

committee and are assisting the Ministry of Health to coordinate the roll-out of routine HIV testing for TB

patients/suspects, TB screening for HIV+ individuals and provision of additional HIV-related care

(prevention of opportunistic infections, ARV therapy) for HIV+ TB patients. In FY 08, there will be greater

involvement of technical staff in promoting greater horizontal collaboration across all Emergency Plan

programs in the context of identified key themes: universal access to HIV prevention, universal access to

basic HIV care package (this includes TB screening for PLWHA, universal access to HIV counseling and

testing, greater attention to quality of care and the needs of the child either infected or affected by HIV.

TB/HIV section staff, who include three Kenyan physicians, one laboratory technologist (funded separately

under the Laboratory Program), and three support staff, are instrumental in developing project protocols and

conducting public health evaluations designed to improve care and prevention of HIV-related TB in

collaboration with the above partners. There will be greater involvement of the same staff in assisting Kenya

adequately respond to the emerging threat of MDR-TB through improvement of infrastructure,

establishment of a strong MDR-TB surveillance system and promotion of best clinical, laboratory and

information management practices. The same staff will continue to provide technical support to TB/HIV

programs in Southern Sudan and elsewhere depending on need. CDC Kenya staff also provide best

practice training and guidance to medical staff, including assistance to the Ministry of Health in developing

and evaluating TB/HIV training curricula and guiding the agenda for the national, regional and more

localized TB/HIV coordinating bodies. Other technical assistance to the NLTP includes collection, analysis,

and dissemination of national TB/HIV data. The same staff are involved in the piloting of electronic TB/HIV

registers, the development and evaluation of data collection instruments (e.g. use of personal data

assistance (PDA), and monitoring and evaluation of TB/HIV collaborative activities across the country. CDC

Kenya professionals assist with the formulation of national policies and guidelines on HIV/TB matters. This

budget includes support for 7 CDC Kenya staff, 6 weeks of technical assistance from CDC Atlanta and

other African countries in the coming financial year, and a considerable amount of in-country travel for

supervision of project activities and supply of essential commodities such as HIV test kits and

cotrimoxazole. CDC Kenya staff supervise and monitor the use of USG funds in all CDC supported projects

dealing with TB/HIV activities.

Funding for Prevention: HIV Testing and Counseling (HVCT): $25,000

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED, BUT THIS YEAR'S CDC M&S

FUNDS ARE SPLIT BETWEEN GAP AND GHAI.

Other changes:

+ two additional personnel will be hired in FY 08. One will support counseling and testing in health facilities,

while the other will support home-based counseling and testing. These two new CT approaches are

expected to grow rapidly in FY 08 and this will need strong, regular technical support. Although these

personnel will be based in CDC, they will be available for the entire US government team in Kenya.

1.LIST OF RELATED ACTIVITIES

This activity relates to all activities in the Counseling and Testing program area.

2.ACTIVITY DESCRIPTION

HIV Counseling and Testing (CT) has a central role in both prevention and treatment of HIV infection. With

support from CDC and other partners, Kenya has achieved great success in implementing Voluntary

Counseling and Testing since 2000. Recent scale up of ART services in the country, made possible largely

through Presidential Emergency Fund, now means that CT clients found to be HIV+ can be readily referred

for care and treatment services. But these emerging care opportunities are not fully utilized because

majority of Kenyans (86%) don't know their HIV status and yet knowledge of status is the entry point to

comprehensive HIV/AIDS care. Personal knowledge of HIV status is a priority intervention in the Kenya 5

Year Strategy, and increasing access to CT services continues to be a high priority for the Emergency Plan

in Kenya. During FY 2008 CDC will continue to work with government of Kenya and non-governmental

partners to promote CT in both clinical and non clinical settings including STI clinics, TB clinics, medical and

pediatric wards, antenatal clinics as well as integrated, stand alone and mobile VCT sites. In FY 2008 there

will be an effort to encourage the government and other partners to implement home based VCT, especially

in high prevalence regions, as this will lead to the identification of many patients who would benefit from

care and treatment. The CDC Kenya's multidisciplinary CT team will continue to provide technical guidance

for these activities. This technical support involves consolidating and disseminating the most up-to-date

technical information relating to CT, working with the government of Kenya to ensure that policies relating to

CT are appropriate and technically sound and monitoring CT activities of local partners to ensure adherence

to national and international standards. Technical activities of the CT team also involves collecting and

analyzing performance information to track progress toward planned results; using performance information

to inform program decision-making and resource allocation; and communicating results achieved. The CDC

CT team has three technical staff and one program assistant working in CT on full-time basis in CDC's

Nairobi office. The technical staff includes a medical officer with expertise in both VCT and CT in medical

settings, a counselor who works directly with the counseling staff of implementing partners and a mobile

VCT coordinator who works with local partners to deliver mobile VCT services. In addition to these, there is

a new technical advisor position to provide technical guidance to VCT and CT partners in Nyanza province,

the part of Kenya with the highest HIV prevalence and the principal geographic focus area for CDC Kenya.

The program assistant is engaged in a variety of tasks to support the technical team, such as reviewing and

assembling training curricula and other technical materials, organizing training programs, and other duties

to support the technical work of the CT staff. This team will be supported by seven locally employed regular

drivers whose work is devoted to supporting CT activities. Four drivers will drive mobile VCT trucks

operated by CDC to address CT needs of remote Kenyan communities; these vehicles have been

purchased with Emergency Plan funds in previous fiscal years. The other drivers will enable the technical

staff to conduct regular field visits and technical supervision. The total proposed CT management budget for

FY 2008 is US$ 700,000.

Funding for Treatment: Adult Treatment (HTXS): $199,450

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED, BUT THIS YEAR'S CDC M&S

FUNDS ARE SPLIT BETWEEN GAP AND GHAI.

1. LIST OF RELATED ACTIVITIES

This activity relates to all activities in the HTXS program area.

2. ACTIVITY DESCRIPTION

Access to treatment with antiretroviral drugs in Kenya has expanded dramatically during the past few years.

Established HIV treatment services have improved the quality of life and prolonged the lives of many HIV-

infected individuals. During this phase of rapid scale up, there is substantial need for supportive supervision

of both partners and local Kenyan health care workers. Although the latter is the mandate of the ministry of

health, the responsibility for this important function has been shared with partners and donors, including the

technical staff of the US government agencies. CDC staff has contributed by assisting with the development

of policies and guidelines, assisting implementing partners to improve the technical quality of their care and

treatment programs, and by providing direct technical assistance to sites and geographic areas not yet fully

supported by other partners.

During FY 07 CDC will continue to work with government of Kenya agencies and non-governmental

partners to initiate, maintain, and decentralize antiretroviral treatment programs. These services will include

a broad range of activities including capacity building for health care workers, laboratory and pharmacy

management, support for adherence, and for management of advanced HIV disease and toxicities. These

services are very closely linked to palliative care services provided at the same sites. Technical activities of

the CDC team include assisting with the development of appropriate monitoring tools, analyzing

performance information to track progress toward planned results; using performance information to inform

program decision-making and resource allocation; and communicating results achieved.

The CDC Kenya care and treatment technical team includes one Direct Hire (USDH), five locally employed

technical staff and one program assistant. The team is supported by locally employed drivers whose work is

devoted to supporting care and treatment activities. In addition to enabling the technical staff to conduct

regular field visits and technical supervision, the drivers participate in activities such as demonstration of

point of use chlorination systems used to improve access to safe water, and assist with delivery of

equipment and supplies required by the supported programs. The total proposed HTXS management

budget for FY 2007 is US $ 900,000 and will be distributed across expenditure categories.

Funding for Laboratory Infrastructure (HLAB): $489,345

THIS IS AN ONGOING ACTIVITY. THIS YEAR'S CDC M&S FUNDS ARE SPLIT BETWEEN GAP AND

GHAI. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED REFERENCES TO:

+Hiring of two expatriate senior technical laboratory scientists to assist in the programmatic and operational

work of the GAP lab section

+Hiring of three laboratory technologists to supervise HIV, TB/HIV, and OI testing and training in the

Nairobi and Kisumu laboratories

1.LIST OF RELATED ACTIVITIES

This activity relates to activities in Counseling and Testing (#7009) and TB/HIV (#7001) and all other Lab

Infrastructure activities.

2.ACTIVITY DESCRIPTION

Through this management and staffing activity the Centers for Disease Control and Prevention (CDC)

provides laboratory technical support to the National Public Health Laboratory Services (NPHLS) of the

Ministry of Health and other laboratory service providers in Kenya. The CDC laboratory technical team

works in collaboration with NASCOP, NPHLS, and other laboratory service providers in Kenya to develop,

strengthen and implement the delivery of effective and quality laboratory services to support all the HIV and

TB programs supported by PEPFAR. Key achievements in FY 2005 through FY 2006 included contribution

to development of National Laboratory Policy Guidelines, the National Strategic Plan for the laboratory,

Standard Operating Procedures [SOPs], National training curricula for testing and Quality Assurance

Schemes, upon which lab practices that support expansion of ART services are based. The team also trains

laboratory supervisors to offer support supervisory visits to peripheral HIV/TB testing sites. Four provincial

based quality assurance laboratories have been established, another four are planned. The CDC laboratory

technical team currently consists of: a PhD immunologist and 2 Technical Advisors with specialist

experience in the areas of training in HIV, TB, CD4, viral load testing, early infant diagnosis and quality

assurance (QA) measures. Funds are requested from GHAI for a contractor laboratory expert to operate

from Nairobi and assist the team on issues related to quality assurance and laboratory accreditation, 3

additional technical advisors to focus on expansion of laboratory services in specific regions and program

areas, a program assistant to offer technical organizational support to the laboratory team and drivers

based in Nairobi will facilitate field travels of the team for training sessions, Quality Assurance activities,

support of laboratory networks with common standards and support supervisory visits to testing sites

throughout the country. Due to expanded care and treatment activities in Kenya, and Nyanza in particular,

the GAP lab team is expected to provide technical support for high quality lab service delivery including QA,

training, mentorship and logistic support. Funds are included in this activity to support an expatriate position

of lab advisor in Nairobi to help in articulating national issues and those of partners across the laboratory

infrastructure program area. The lab advisor will work under the Nairobi team and also supervise the

Kisumu-based GAP lab activities and personnel. This activity also includes support to CDC-GAP lab in

Nairobi for the procurement of minor equipment, back up lab reagents and/or supplies and contractual

services for maintenance of CDC lab equipment which is used by the lab team for training and providing

clinical lab services to CDC supported HIV/TB sites. This funding will also be used to purchase reagents for

specific assays not included in the planned SCMS procurements, such as long ELISAs and other reagents

and supplies for use in External Quality Assurance of the NPHLS laboratories, evaluation of new

technologies, and printing of national SOPs, manuals and other guidelines for quality assurance schemes.

Some funds are also included to support technical assistance visits from CDC Atlanta laboratory staff; these

staff are involved in providing technical support for activities and partner's across the laboratory

infrastructure program area.

Funding for Strategic Information (HVSI): $131,387

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED, BUT THIS YEAR'S CDC M&S

FUNDS ARE SPLIT BETWEEN GAP AND GHAI.

1. LIST OF RELATED ACTIVITIES

This activity relates to all activities in SI.

2. ACTIVITY DESCRIPTION

CDC professional staff dedicated to strategic information includes a team of medical epidemiologists,

behavioral scientists, senior data managers, and statisticians, a Monitoring and Evaluation (M&E) specialist

and additional support staff. The senior data manager, who serves as the SI in-country liaison, works with

the Ministry of Health, National AIDS/STI Control Programme (NASCOP), National AIDS Control Council

(NACC), Kenya Medical Research Institute (KEMRI), NGO partners and other USG agencies to coordinate

SI activities, lead Emergency Plan reporting, and guide dissemination of strategic information. He is also

responsible for the CDC and KEMRI data management team, assists in design of Health Management

Information Systems, develops model systems for reporting for the Emergency Plan, and guides training in

SI. The behavioral scientist also assists these organizations in the design, training of personnel, and

conduct of surveys and targeted evaluations and serves as a training coordinator with expertise in adult

learning and curriculum design. The epidemiologist works with NASCOP to conduct surveillance, support

HMIS for program data, and build the capacity of the Ministry of Health to analyze and utilize surveillance,

survey and other strategic information. An M&E officer will work closely with program managers and funded

partners to help set targets in line with PEPFAR's country level targets, prepare workplans, make field visits

to assess implementation progress and evaluate the rate of activity scale up. Three drivers and one

administrative assistant support this team in fieldwork and links to other program areas. Included in this

budget is support for printing forms and reports for dissemination of strategic information.

issemination of strategic information.

Funding for Management and Operations (HVMS): $2,355,134

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE HAS BEEN UPDATED TO REFLECT CHANGES.

The management and staffing budget for CDC is used to ensure that there is adequate staffing and

administrative support for CDC's PEPFAR-related activities detailed in the COP. This budget covers the

core operating costs for CDC's PEPFAR-related activities as well as cross-cutting management costs not

accounted for in the individual program areas. In this activity area, senior CDC staff provide cross-cutting

technical and managerial supervision for PEPFAR activities and the Ministry of Health receives technical

support with development and distribution of policies, guidelines and plans for implementation of HIV

prevention and treatment programs. More than one hundred local and international Non Governmental

Organizations, Faith Based Organizations and Community Based Organizations implementing HIV

prevention and treatment programs will receive technical and administrative support. A team of 11

personnel engaged full time at CDC-Kenya carries out this support. The 11 positions include 4 direct-hire

United States government staff, 1 Personal Services Contractor, and 6 locally hired staff. One of the direct

hires is in a Technical leadership/management position; another two are in Technical Advisors/Program

manager's positions. The fourth direct hire will be a full-time senior technical advisor stationed in NASCOP.

The Personal Services Contractor serves as the Deputy Director for Science, and is responsible for

assuring quality of PEPFAR programs, compliance with regulations concerning research involving human

subjects, as well as non-research determinations for operational activities. Of the locally hired staff, 2 are

Financial/Budget staff and 5 are administrative/Support staff. Two of the five finance and budget staff are

engaged in day-to-day monitoring and training of the cooperative agreement partners that are funded

through PEPFAR. Collectively, this team provides high level technical, managerial and administrative

support for our partner activities and helps to ensure high quality PEPFAR programs.

CDC-Kenya's staff includes high level Kenyan and international technical experts in HIV programmatic

areas, program evaluation, laboratory science, statistics, and behavioral science. The team works

collaboratively across USG agencies to support a high quality, evidence-based approach to PEPFAR

programs.