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 evaluation of Families Matter! in Gem as part of a community based study;

• The evaluation of Healthy Choices in Asembo;

• The preparation of a toolkit for Healthy Choices;

• The development of a prevention intervention for adolescents living with HIV.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Condoms and Other Prevention (#6948), Counseling and Testing,

(#8746).

2. ACTIVITY DESCRIPTION

The Institute of Tropical Medicine (ITM) will continue to assess a comprehensive youth intervention program

in the Asembo and Gem areas of Nyanza Province, which has the highest HIV prevalence rates in the

country. In Kisumu, the capital of Nyanza Province, a previous ITM study found very high rates of HIV

infection among young women. Young women, aged 15 to 19 years, had a 23% HIV prevalence rate in

contrast to their male counterparts with a 3.5% prevalence. A multi component program targeting

adolescents directly and through their families and the community, was begun in 2002 to adapt evidence

based interventions an African rural setting and to test these interventions in order to assess their

effectiveness in reducing HIV and STI infection and teen pregnancy. In this project, 20,000 individuals will

be reached with targeted HIV prevention messages and 500 people trained. Activities promoting abstinence

and delay of sexual debut in young people have been key in a multi-component intervention program to

improve adolescents' sexual and reproductive health. This comprehensive youth intervention program

includes two AB activities. One activity being conducted by ITM is the implementation of a "Families Matter"

curriculum targeting parents or guardians of 9 to 12 year olds. It is an adaptation of "Parents Matter"

curriculum which CDC has evaluated in the US. The program brings together small groups of parents and

aims to promote positive parenting practices and improve effective communication about sexuality and

sexual risk reduction between parents and their children. Preliminary analysis of a recent assessment of

Families Matter, 15 months post-intervention, seems to indicate a sustained positive effect in terms of

parenting and communication skills reported by participants and their children separately. To date, parents,

community and religious leaders in Asembo and Gem are very supportive of this approach of enabling

parents to take a more active role in HIV prevention for their adolescent children. The program has been

scaled-up and 1,800 families have participated in the intervention so far. Another activity is an abstinence

based curriculum targeting school-going children aged 10 to 14 years old. "Healthy choices for a better

future" is an adaptation of "Making A Difference", a curriculum that was selected by CDC as an effective

intervention. The adapted curriculum has been piloted, and ITM is currently developing a proposal to

evaluate this component as well. Efforts to change the social norms which contribute to this high risk for

young girls are part of this intervention. The project has also found that the lack of skills and employment

opportunities contributes to high risk behavior among girls and boys, so one aspect of the project is the

provision of vocational skills and opportunities for income generating activities for these youth.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This project will contribute to the Kenya Five-Year Strategy which focuses on HIV prevention in youth, since

the primary target group is young people, including children aged 10 to 14. Targets in this project will

contribution to HIV infections averted through reaching 20,000 youth and parents and training 500

community leaders and facilitators.

4. LINKS TO OTHER ACTIVITIES

This activity will be linked to KEMRI AB activity (#6943), KEMRI OP activities in Kisumu (#6948) and ITM

CT activities (#8746). KEMRI and ITM work together on this program and KEMRI provides the bulk of the

human resource who implement this program. Referral linkages between these programs have also been

established.

5. POPULATIONS BEING TARGETED

The primary population being targeted is primarily a rural community including both in-school and out-of-

school youth. Ages of youth targeted range from 10 to the early 20's. Age-appropriate curricula are used

with each group. In addition, their parents and family members, mainly men and women of reproductive

age, and HIV/AIDS affected families are targeted. Community and religious leaders as well as volunteers

are targeted by the project. The project will work with teachers in in-school programs.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This project will have a strong gender component, including increasing young women's access to income

and productive resources, addressing male norms and behaviors and increasing gender equity in HIV/AIDS

programs.

7. EMPHASIS AREAS

The primary emphasis area is human resources, as the project has a large staff needed to implement and

assess the impact of these interventions. IEC activities to educate the youth and their parents about

abstinence and faithfulness as well as training are minor emphasis. The project will train implementers and

provide very close Quality Assurance, Quality improvement and Supportive Supervision in the curricula

adaptation process.

(formerly listed as PHE)

Project Title: Evaluation of a multi-component adolescent HIV prevention intervention in rural western

Kenya

Name of Local Co- Investigators:

Institute of Tropical Medicine Antwerp and KEMRI/CDC-Kenya staff

Project Description:

This project will evaluate a multi-component HIV-prevention program to reduce transmission of HIV and STI

and the number of unintended pregnancies among adolescents aged 10-20 years in Kenya. The evaluation

addresses 4 main questions: 1) acceptability of the intervention in the community 2) access to adolescent

health promotion, prevention and care 3) impact on parenting and communication practices and 4) impact

on adolescent risk behavior, STI syndromes and unintended pregnancies. These questions will be

investigated using qualitative and quantitative methods as well as quasi-experimental before and after

designs, as well as a control group.

Timeline:

Year of activity: FY 08

Year started: 2002 (intervention started in 2002 but received PEPFAR funding from 2004) onwards.

Expected year of completion: 2010

Funding:

Funds received to date: $1,200,000

Funds expended to date: approximately $900,000

Funds requested to complete the study:

FY 08: $ 300,000

Beyond FY08: $ 500,000

Describe funds leveraged/contributed from other sources:

Up to date received $ 235,000 from the Belgian Development Cooperation to fund a livelihood intervention

for youth out-of-school in rural Nyanza and salary is being paid for a full time anthropologist who is

conducting ethnographic research on adolescents.

Status of Study:

In 2006, Families Matter! was evaluated through a pre- and post-intervention assessment. 321 of 375 (86%)

parent-child pairs completed baseline, intervention and 15 months post-assessment evaluation. Parents

and children separately reported significant increases in outcome measures regarding parent-child

relationship, parental monitoring, reinforcement of positive behaviour, and communication about sexuality

and sexual risk reduction (P<0.001), except for parents' report of parent-child relationship (P=0.087). These

families will be assessed at 27 months pos-intervention in 2007.

Scale up efforts conducted from March 06 to May 07 reached an additional 3928 families (77% of all

targeted families).

These data are indicative that Families Matter! is acceptable to rural western Kenya (evaluation question 1),

and that change in parenting and communication practices is effected by the intervention (evaluation

question 2).

Lessons Learned:

1. ACASI can successfully be used in rural settings with a lower literate population, including children and

elderly people

2. Children and caregivers are willing to participate in PHE if they are consulted during protocol

development and study procedures are discussed and negotiated with the community;

3. A two phased consenting process of parental permission and minor's assent works well in this area

Information Dissemination Plan:

• To share data with the Ministry of Health, PEPFAR implementing partners, and partners at the annual

Collaborative meeting of the Nairobi University in January 2008

• To share data and lessons learned at ICASA conference in 2008 and other regional conference

• To publish findings about baseline survey and Families Matter! Evaluation in peer -reviewed journals

Planned FY08 Activities:

1. In light of the current scale up activities beyond Asembo and |Kenya, a more rigorous evaluation design

to measure the effect of the Families Matter! intervention on adolescent behaviour becomes necessary.

Qualitative research that will inform the development of a community intervention trial is planned for 2008,

in collaboration with WHO. Also in 2008 a protocol will be developed for a community intervention trial,

including assessment of suitable sites in Western Kenya where the trial can be conducted.

2. Assess the effect of Healthy Choices, an evaluation protocol using a quasi-experimental design will be

developed in the coming months and executed in 2008, pending IRB approval. This will allow us to answer

evaluation question 3 and 4.

3. A protocol is currently being developed to assess the quality of youth friendly services in the project area.

(related to question 5 and 6)

4. A repeat cross-sectional survey is planned for 2009, and a protocol will need to be developed in 2008.

(question 7)

Budget Justification for FY2008 Budget (USD):

Salaries/ fringe benefits: $200,000

Equipment: $15,000

Supplies: $15,000

Travel: $20,000

Participant Incentives: $10,000

Laboratory Testing: $ -

Activity Narrative: Other: $40,000

Total: $300,000

PHE CONTINUING STUDY:

Project Title: Evaluation of prevention and care services for sex workers in Kisumu

Name of Local Co- Investigators:

Institute of Tropical Medicine Antwerp and KEMRI/CDC-Kenya staff

Project Description:

This project will evaluate a package of integrated HIV prevention and care services for reducing the risk of

HIV transmission between sex workers and their clients in Kisumu, Kenya. The evaluation addresses 4

main questions: 1) size, distribution and characteristics of the sex worker population 2) self-reported

prevention and care needs 3) self-reported uptake of prevention and care services and 4) impact of services

on risk behavior, STI syndromes and HIV prevalence. These questions will be investigated through a

baseline and repeat cross-sectional surveys, in combination with formative work, and client exit interviews.

Timeline:

FY 2008 = Year 3 of activity

Year started: '06; Expected year of completion: 2010

Funds received to date: $ 200,000

Funds expended to date: approximately $100,000

Funds requested to complete the study:

FY 08: $200,000

Beyond FY08: $ 300,000

Describe funds leveraged/contributed from other sources:

FACES, a PEPFAR funded program (a collaborative effort of KEMRI and UCSF) that provides care and

treatment for HIV-positive family members, contributes to the project by providing ART, and technical

assistance to the local implementing organization (FHOK).

Status of Study:

A protocol to conduct a baseline survey has been submitted to CDC in 2006, and was approved by ITM

(July 06) and by KEMRI (March 07). We are still awaiting protocol approval from CDC.

An amendment to this protocol will be developed to include a needs assessment among clients of sex

workers, and a qualitative assessment of risk behavior and transaction sex through the completion of sex

worker diaries.

Lessons Learned:

N/A at this time

Information Dissemination Plan:

To share the baseline data with partners in Kisumu, the Ministry of Health, and PEPFAR implementing

partners

To draft a manuscript with the main outcome data by end of 2008

Planned FY08 Activities:

1. To conduct/complete the formative work and the baseline survey in Kisumu while service delivery is

ongoing, including:

a. Mapping and census, focus group discussions and cross-sectional survey of HIV, STI, and sexual

behavior among sex workers

b. Exit interviews of sex workers at the FHOK clinics (static and during mobile outreach services) to assess

the level of satisfaction with the services

c. Measuring transactional sex through the use of detailed diaries by sex workers

d. Assessing the needs of clients of sex workers with regard to HIV prevention and care, which will lead to

the development of a tailored intervention

2. The analysis of the baseline data will give us an idea about current coverage of services, level of condom

use, and HIV- and STI prevalence; it will also help to develop, refine and improve the quality of the services

for sex workers and their clients based on their feedback;

3. To disseminate the data of the baseline survey

Budget Justification for FY2008 Budget (USD):

Salaries/ fringe benefits: $110,000

Equipment: $10,000

Supplies: $15,000

Travel: $20,000

Participant Incentives: $5,000

Laboratory Testing: $10,000

Other: $30,000

Total: $200,000

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 (or expanded) to include 3-4 other clinics of Family Health

Options Kenya (Nakuru, Nairobi and 2 others);

+ Other changes include the development of prevention interventions for sex workers living with HIV

+ $56,000 of this activity is programmed with funds from the $7 million FY 2008 plus up for the Healthy

Youth Programs Initiative.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Abstinence and Be Faithful Programs (#6903) and Counseling and

Testing (#8746), (#6941).

2. ACTIVITY DESCRIPTION

This activity is being implemented by the Institute of Tropical Medicine (ITM) in collaboration with Family

Health Options Kenya, a local partner. ITM is already implementing a project targeting youth, their families,

and the local community in several rural areas of Nyanza province. In June 2006, ITM expanded its

activities to Kisumu town to target young vulnerable women, including sex workers, with HIV prevention and

care services. Free health services are offered at an integrated clinic, including management of STIs, HIV

testing and ART for HIV-positive clients. A network of peer educators is being established to promote safer

sex practices. Towards the end of 2006, ITM, in collaboration with CDC and the Kenya Medical Research

Institute, plans to conduct a needs assessment and baseline survey of HIV, STI and associated risk

behavior. The findings of this assessment will be used to refine the interventions; Nyanza Province is the

area of Kenya with the highest HIV incidence and prevalence, and therefore this activity with highly at-risk

populations is of great urgency. In this project, 100 people will be trained to deliver the intervention. 17,000

individuals will be reached with targeted HIV prevention messages. ITM will also integrate an alcohol and

HIV prevention initiative that will reach 500 men. 7 condom outlets will be established.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This project will contribute to the Kenya Five-Year Strategy which focuses on HIV prevention in youth, as

the primary target group will be young women. Targets in this project will contribution to HIV infections

averted among 17,000 at-risk individuals. 100 people will be trained, and 7 condom outlets will be

established.

4. LINKS TO OTHER ACTIVITIES

This activity will be linked to KEMRI CT activity (#6941) implemented by other CDC partners in Kisumu

(KEMRI) and will be linked to the Institute of Tropical Medicine AB activity (#6903) and CT activity (#8746)

already being implemented by ITM in Nyanza province.

5. POPULATIONS BEING TARGETED

Young male and female adults, both those already engaged in CSW and out-of-school young girls and

women living in the environs of Kisumu who are vulnerable to beginning CSW, will be targeted by these

activities. This project will also work with PLWHAs and a mainly most at risk populations including

commercial sex workers. Important entry points to this work will be through targeting brothel owners,

community leaders and community as well as NGO organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This project will have a strong gender component, including increasing women's access to income and

productive resources as an alternative to engaging in full time or part time commercial sex work. Services

will be provided to these women, including detection and treatment of both HIV and other STIs, counseling

for behavior change, and services to help these vulnerable young women with alternate sources of

employment and income. This will also address gender equity in HIV/AIDS programs and male norms and

behavior through targeting at risk men. Stigma and discrimination will be addressed through these efforts.

7. EMPHASIS AREAS

The main emphasis area covered by this activity is Human resources. Minor emphases include the

development and implementation of Information, Education and Communication activities, conducting

needs assessment, training and providing quality assurance, quality improvement and supportive

supervision. This will support an expansion of existing 07 COP activities implemented by the Institute of

Tropical Medicine (ITM)'s Pambazuko project. The expansion will cover additional areas of Kisumu hotspots

targeting young vulnerable women, including sex workers and their clients. It will also target at-risk men,

including MSM. An important addition to this intervention will be provision of lubricant gels alongside

condom promotion to increase condom use, efficiency and acceptability. This expanded activity will also

provide interventions for Positive Prevention among positive people and their partners including linkages to

partner counseling and testing, increased access to treatment of STIs for HIV-positive patients and their

partners and an active involvement of PLWHA in spearheading PWP activities. There will also be increased

support to the sub-partner, Family Health Options Kenya to allow the project develop an autonomous

management structure through co-location with the implementing agency.

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 AB (#6903) and OP (#6904).

2.ACTIVITY DESCRIPTION

The Institute of Tropical Medicine (ITM) has a long international history of operational research on HIV in

Africa including Kenya. In previous years, they have received Emergency Plan funds, through CDC, for the

implementation of AB and OP activities in Nyanza Province, the region that has the highest HIV prevalence

in Kenya. The main of strength of ITM has been their work with youth in HIV prevention and evaluation. In

FY 2007 they will continue to work with youth to support HIV in prevention, but they will also carry out

specific CT activities in the same region. This includes expanding the scope of the two stand-alone VCT

sites and facilitating mobile and outreach VCT services in areas where VCT services are not available.

Mobile VCT will be provided in markets, beaches, near schools and during community events. Mobile VCT

will be preceded with extensive community mobilization and awareness creation. In the past, ITM has

facilitated the establishment of support groups for HIV positive youth. In FY 2007 these established groups

will be used to disseminate information about CT in the community. This will improve uptake of CT services

as well as reduce HIV-related stigma in the area. All these efforts should lead to at least 10,000 being

counseled and tested for HIV. This will require an additional 20 counselors to be trained, both for the 10

stand-alone and the mobile VCT services.

3.CONTRIBUTIONS TO OVERALL PROGRAM AREA

As stated above, Nyanza province has the highest HIV prevalence in Kenya. The Kenya Demographic and

Health Survey of 2003 showed that majority of the HIV positive Kenyans (including those in Nyanza) do not

know their HIV status. Despite the relatively small numbers of people projected to receive CT services in FY

07, by working with the youth, ITM will be working towards achievement of national CT targets. They will

also be working towards the realization of Kenya's five-year strategy of preventing infections among the

youth. But apart from this longer term contribution, ITM will promote greater access to comprehensive

HIV/AIDS care, through increased knowledge of status.

4.LINKS TO OTHER ACTIVITIES

This activity will be linked to AB (#6903) and OP (#6904) activities implemented by the Institute of Tropical

Medicine in Nyanza province. Personnel that carry out community mobilization can pool resources to

maximize the benefit. Also, the OP and AB activities can be used to increased uptake of CT.

5. POPULATIONS BEING TARGETED

The primary population being targeted is rural youth, including both in-school and out-of-school youth. Ages

of youth targeted range from 13 to the early 20's. In addition, their parents and community and religious

leaders are targeted by the project.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This project will have a strong gender component, including increasing young women's access to income

and productive resources. The activity will also facilitate stigma reduction through community mobilization

and through widespread CT activities.

7. EMPHASIS AREAS

The primary emphasis area is human resources, as the project has a large staff needed to implement and

assess the impact of these interventions. Community mobilization to change social norms which encourage

delay in sexual debut is also an important component of this project, along with IEC activities to educate the

youth and their parents about abstinence, faithfulness and safer sex practices.