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 target population has been revised (or expanded) to include out-of-school girls in urban areas,

including domestic workers and married adolescents;

• Other changes include: mobilization of girls-only groups through additional female FOYs, focusing on out-

of-school girls in urban areas, including domestic workers and married adolescents.

• $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 Condoms and Other Prevention Activities (#7027) and Counseling and

Testing (#8753).

2. ACTIVITY DESCRIPTION

Population Council's (PC) ‘Friends of Youth' (FOY) Project, working in partnership with the Family Health

Options Kenya (FHOK) will reach 60,000 youth with abstinence and faithfulness messages through training

fifty new adult mentors and providing update trainings to all 250 Friends of Youth (FOYs), some of whom

will receive update training in counseling and testing. It builds on tested interventions that are consistent

with local cultures of adult-youth mentoring by enlisting the involvement of trusted adults and older youth in

the community to act as friends of youth. These FOYs will help to positively influencing safer sexual

behavior and changing community and social norms. The intervention employs a behavior change model

whose effectiveness has demonstrated effectiveness in delaying sexual initiation, increasing secondary

abstinence and reducing the number of sex partners among adolescents. The program links youth with a

trained adult mentor at village level. The program will work with 250 FOYs who will use an informal

curriculum-based approach using the ‘Life Skills Plus' curriculum. Each of the 250 FOYs will reach at least

twenty new youths each month to encourage abstinence and behavior change activities. Additionally, the

FOY project will train 50 youth in participatory theatre to enhance their involvement in community HIV

education activities. The project will expand its activities to the Embu municipality, which bears close

proximity to Nyeri and shares similar cultural practices. These activities will contribute to our results of HIV

preventive behaviors among youth improved, changed social and community norms to promote HIV

preventive behaviors in youth, and models for effective youth interventions tested. Significant changes from

FY 2006 to FY 2007 include scaling up to a new project site, Embu municipality as well as integration of

alcohol and substance abuse education and related services. This expansion will also enable the FOY

project to undertake baseline studies for a subsequent targeted evaluation. Data management will be

strengthened through establishing more effective linkages with other service delivery partners. An important

addition to the project will be establishing linkages for adolescent care and treatment in both private and

public heath care facilities. PC has done extensive work on effective youth interventions and this project will

scale up a successful youth-adult behavior change model in selected urban areas in Kenya. Population

Council will study the results of this project so that lessons can be learned about this approach to youth HIV

prevention. To help improve health services for young people, young people will be served through selected

private service providers through a coupon system in which referrals will be made particularly through the

youth center for free health services. This activity also includes support to the Family Health Options Kenya

who implements activities integral to the program for $80,000.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

During the 2007 project period, a total of 60,000 individuals will be reached with an intensive curriculum-

based life skills training program through 250 FOYS/adult mentors trained. Community outreach programs

that promote abstinence and/or being faithful through five project sites namely Nyeri, Nyahururu, Thika,

Embu and Huruma slums in Nairobi will contribute to the Emergency Plan prevention targets.

4. LINKS TO OTHER ACTIVITIES

This activity relates to PC (FOY) other program areas, FOY AB activities will contribute to achievement of

targets in OP activity (#7027), CT activity (#8753). PC-FOY will continue strengthening the referral system

that encourages youth to adopt good health-seeking behavior by eliminating treatment cost barriers.

5. POPULATIONS BEING TARGETED

This activity will target young men and women of reproductive age who are mainly the FOYs as well as

youth including primary and secondary school students. It will continue to identify community leaders who

will be instrumental in the recruitment of friends of youth. Religious leaders and program managers will be

actively involved in this activity and the trusted adults selected will serve in a volunteer capacity and

continue to receive only a minimal honorarium and occasional incentives such as training. This activity will

continue to intensively involve teachers through its' in-school programs. The project will extend its coverage

to rural communities.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address gender issues by increasing gender equity in its HIV/AIDS programs and will

continue to address male norms and behaviors, particularly ensuring that there is a greater involvement of

male youth in abstinence campaigns in its Life Skills training. It will work largely with volunteers.

7. EMPHASIS AREAS

Major emphasis will be on community mobilization. Minor emphasis will be on information, education and

communication. Through its partnership with FHOK, quality assurance and supportive supervision will be

offered alongside training. Human resources is a minor emphasis as the project has a thin staff structure

and relies heavily on the volunteer friends of youth to drive its implementation.

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 Thika and Nyeri;

+ The target population has been revised (or expanded) to include men who have sex with men; extremely

vulnerable girls and young women in urban areas;

+ Other changes include: 1) programmatic assessments of MSM populations in regional towns of Thika and

Nyeri, where HIV prevalence is considerable and where the FOY program has a network of collaborating

service providers and outreach workers. 2) a programmatic assessment will be conducted in low income

and slum areas of Nairobi, where little MSM work has been undertaken but where transactional same sex

interactions are likely. Findings from the assessments will identify patterns of MSM behavior in regional

town and cities, inform context-appropriate programs, and provide direction for further surveillance surveys

among this population. Based on results from the assessments in three urban sites, the Council will work

collaborating service providers to make existing services responsive to the needs of MSM. 3) sensitization

of providers to the HIV prevention and RH needs of MSM and working with Liverpool VCT—who have

developed MSM services in Nairobi—to train providers. The Council will monitor and document the

experience of strengthening existing service providers in urban areas to meet the needs of MSM.

Documentation will include monitoring of performance, post training interviews with service providers and

interviews with clients. 4)Also, during the coming year, the Friends of Youth program will increase its focus

on the most vulnerable subsets of adolescent girls and young women, and will conduct exploratory program

assessments on non-formal transactional sex among girls and young women in urban areas, leading to

programmatic content addressing transactional sex.

+ FY 2007 PLUS UP ADDITIONS: This plus-up will support the expansion of activities currently supported

as per the 2007 COP. Population Council's Friends of Youth (FOY) project will expand the scope of

working with high-risk youth with prevention interventions in its five major locations - Nyeri, Nyahururu,

Thika, Huruma/Mathare and Embu. The FOY project will target high-risk behaviors among youth in the said

locations to include working with youth in post-test clubs, youth groups with community education activities,

youth living on the streets and other young people engaged in high-risk behavior. This activity will also

allow increased support to the Family Health Options Kenya who facilitates increasing access to STI

treatment through a coupon referral system to local health providers. This activity will be closely linked with

counseling and testing and will target mobilizing young people with high-risk behaviors to improve

prevention of HIV transmission through self and partner testing.

+ $100,000 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 (#7026) and Counseling and

Testing (#8753).

2. ACTIVITY DESCRIPTION

Population Council's (PC) ‘Friends of Youth' (FOY) Project working in partnership with the Family Health

Options Kenya (FHOK) will reach 30,000 youth with condoms and other prevention education and services.

It will train an additional 75 FOYs. It will expand its scope of the Friends of Youth (FOYs) to include using

the adult mentors (FOYs) to reach sexually active and at-risk youth education and service that focus on

sexual risk reduction. The effectiveness of the FOY activity in achieving behavior change for youth through

close adult mentorship has been evaluated for effectiveness and shown to result in adoption of safer sexual

behavior and is now being scaled up to previous control sites and other feasible areas. The program links

youth with a trained adult mentor at village level. The program will work with the existing 100 FOYs who will

use participatory approaches to involve youth in risk-reduction education, including condom promotion and

distribution. The project will therefore identify and target sexually active youth and other high-risk groups

within their target locations. They will increase support to STI treatment for youth by linking them to service

providers through an established coupon system that offers youth a significantly subsidized treatment cost

and hence eliminates the cost barrier to treatment. STI screening and treatment for individuals with HIV will

be intensified. It will also provide reproductive health information for young women testing positive to

prevent unintended pregnancies. Referral systems to HIV care and treatment services, including ART will

be improved to reduce viral load and the risk of HIV transmission. In addition, behavioral interventions

targeting individuals with HIV will be developed to help reduce the risk of transmission. These and other

efforts will ensure that Positive Prevention is a key focus among this high-risk group. Additionally, the FOY

project will provide update trainings for 200 youth in participatory theatre to enhance their involvement in

community HIV education activities. The project content will be further enriched to include intensified

education on alcohol and substance abuse. The project will expand its activities to the Embu municipality,

which bears close proximity to Nyeri and shares similar cultural practices upon which the project is

developed. Data management will be strengthened through establishing more effective linkages with other

service delivery partners. An important addition to the project will be establishing linkages for adolescent

care and treatment in both private and public heath care facilities. PC has done extensive work on effective

youth interventions and this project will scale up a successful youth-adult behavior change model in

selected urban areas in Kenya. This activity also includes support to the Family Health Options Kenya for

activities integral to the program for an amount of US$50,000.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

During the 2007 project period, a total of 30,000 individuals will be reached with an intensive curriculum-

based life skills training program through an additional 75 FOYS/ adult mentors trained. 40 condom outlets

will be established.

4. LINKS TO OTHER ACTIVITIES

This activity relates to PC-FOY other program areas: FOY AB activities (#7026) will contribute to

achievement of targets in this program activity and CT activity (#8753). PC-FOY will continue strengthening

the referral system that encourages youth to adopt good health-seeking behavior for STIs and subsequently

care as need may be. Linkages will be established with public health care facilities to supplement current

linkages that exist with private health service providers.

5. POPULATIONS BEING TARGETED

This activity will target young men and women of reproductive age as well as out-of-school youth and

Activity Narrative: partners/clients of CSWs. It will continue to identify community leaders who will be instrumental in the

recruitment of friends of youth. Religious leaders will be actively involved in this activity and the trusted

adults selected will serve in a volunteer capacity and continue to receive only a minimal honorarium and

occasional incentives such as training. Linkages will be established with health care providers in both the

private and public sector, particularly nurses. Support from community-based organizations mainly at sub-

locational level will continue to be enlisted to ensure that both parents and youth continue to be supportive

of this condoms and other prevention activity.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address gender issues by increasing gender equity in its HIV/AIDS programs and will

continue to address male norms and behaviors, particularly ensuring that there is a greater involvement of

male youth in condoms and other prevention campaigns. It will also work at reducing violence and coercion

through reinforcing desirable behavior in its life skills training. Stigma and discrimination will be addressed

through all program activities.

7. EMPHASIS AREAS

Major emphasis will be on human resource. Minor emphasis will be made on community mobilization and

participation as well as on Information, Education and Communication. Linkages with other sectors,

especially the health sector and the development of referral systems will be enhanced. Training of FOYs

and youth will be other minor emphases.

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:

+ the geographical coverage has been expanded to include Mobile VCT outreaches which will be provided

from each of the VCT static sites.

1.LIST OF RELATED ACTIVITIES

This activity relates to activities in AB (#7026) and OP (#7027).

2.ACTIVITY DESCRIPTION

In FY 2008, Population Council's (PC) ‘Friends of Youth' (FOY) Project working in partnership with the

Family Health Options Kenya (FHOK) will provide counseling and testing services to 5,000 individuals and

train 10 counselors to work in 10 sites. The Friends of Youth project initiated CT activities in the previous

year and will therefore strengthen the CT activities in the areas where they have Emergency Plan supported

AB and OP activities. These sites include Huruma in Nairobi, Nyeri, Nyahururu, Thika and Embu. The FOY

project also works in close collaboration with existing VCT sites. In its OP activities, the FOY project works

with a network of private health service providers to offer STI and reproductive health services to young

people. These health providers will receive training in DTC so that they can integrate CT into the other

health services, such as STI treatment. This activity will be closely linked with the AB and OP activities in

the same region. The project was evaluated in a previous phase and it was found that this adult mentorship

model was an effective strategy in transforming behavior among the youth. This activity is now being

expanded in scope and geographic coverage within the limits of feasibility. The program will work with 100

youth organizations, and will use participatory approaches to involve youth and adults in risk-reduction

education, including education and promotion of the need for counseling and testing. The FOY approach is

organized along the Central Bureau of Statistics mapping and each youth organization covers a well defined

catchment area to assure a comprehensive coverage. Building on this strategy, the FOY project will explore

the feasibility of undertaking door to door testing, under the close guidance of trained counselors. Through

the close interaction between FOY and young people, the project will therefore identify and target sexually

active youth and other high-risk groups within their target locations and encourage them to learn their

status. PC has done extensive work on effective youth interventions and this project will scale up a

successful youth-adult behavior change model in selected urban areas in Kenya which now includes

counseling and testing. It builds on tested interventions that are consistent with local cultures of adult-youth

mentoring by enlisting the involvement of trusted adults and older youth in the community to act as friends

of youth by promoting safer sexual behavior and changing community and social norms. Population Council

will carefully study the results of this project so that lessons can be learned about this approach to youth

HIV prevention.

3.CONTRIBUTION TO OVERALL PROGRAM AREA

The work of FOY will be comprehensive with an important emphasis on youth. Beyond providing VCT and

DTC, they will also provide reproductive health and adult mentorship. Impartation of life skills will support

HIV prevention efforts.

4. LINKS TO OTHER ACTIVITIES

The CT activities that will be implemented by FOY will be linked to other Emergency Plan supported HIV

prevention activities of Population Council (Friends of Youth). These include AB (#7026) and OP (#7027).

Community mobilization and IEC activities will be done jointly. The youth programs will be used to

encourage clients to have an HIV test.

5.POPULATION BEING TARGETED

This activity will target out-of-school youth including street youth.

6. KEY LEGISLATIVE ISSSUES ADDRESED

This activity will mainly address gender equity in access to information and health care. It will also address

stigma and discrimination through increased information and awareness.

7. EMPHASIS AREAS

This activity will have a major emphasis on community mobilization and a minor emphasis in production of

IEC materials. FOY will work with adult mentors and youth leaders to enable the youth to access CT and

reproductive health services. They will integrate OP and AB information with CT so as to provide a

comprehensive package of services. Other minor emphasis areas are in training and human resources.

PHE CONTINUING STUDY:

Project Title: Assessing the feasibility of HIV self-testing among health workers in Kenya

Name of Local Co- Investigator: Peter Cherutich, Isaiah Tanui, Rebecca Bunnell, Mary Mwangi, Lawrence

Marum, Karusa Kiragu, Waimar Tun, Wilson Liambila

Project Description:

The PHE seeks to assess the feasibility of HIV home self-testing (HST) among health care workers

(HCWs). Previous studies have shown that majority of HCWs would like to test themselves for HIV; indeed

many already do. The study is being conducted in 10 districts. During the first phase, FGDs/IDIs were

conducted, which gave insight on the practicality of providing HST including training, logistics and the social

concerns around HST. All the relevant materials have been developed and pre-tested. Phase II, for which

funding is now sought, will facilitate the full implementation of the study.

Timeline:

FY 2008 = Year 2 of activity

Year started: FY 2007

Expected year of completion: FY 2008

Funding:

Funds received to date: $200,000

Funds expended to date: $170,000

Funds requested to complete the study:

FY 08: $200,000

Beyond FY08: 0

Describe funds leveraged/contributed from other sources:

None.

Status of Study:

• Project Advisory Committee formed. Membership comprises of NASCOP and health worker associations

such as Kenya Nurses Association and others.

• Formative research conducted; a total of 161 HCWs interviewed through FGDs and IDIs. Draft report

prepared.

• BCC materials and training manual drafted.

• All data collection tools drafted and pretested

• Evaluation of cell phone companies and utilities conducted; contacts and decisions made; awaiting go-

ahead.

Lessons Learned:

• High stigma among health workers deters many from seeking HIV testing even if accidentally exposed at

work

• Many health workers feel they would lose respect if they are HIV positive

• HCWs reported they had been neglected in provision of information

• HCWs were interested in oral fluid based testing but raised many questions about sensitivity and

specificity

• HCWs preferred to test themselves in privacy first before offering the HST to their spouses

• HCWs would only purchase a kit if it cost Ksh 50 or less

• The management team in the facilities should be trained along with the HST counselors before the

implementation of the program

• Solid and clear referral mechanisms should be laid down for the health workers who test positive

Information Dissemination Plan:

• Data interpretation workshop with PAC planned

• Once pilot completed and evaluation conducted, results will be disseminated to the PAC.

• Results also to be disseminated to other stakeholders specifically HCWs through their professional

association

• Summary reports and full report to be prepared and disseminated electronically and hard copies.

Planned FY08 Activities:

In COP08, Population Council has requested funds to build on the self-test study and implement a provider-

centered workplace program in the ten hospitals. In half of the hospitals the HWs will be trained and

supported in self-testing, and in the other half they will be trained in self-testing plus peer education and

other standard workplace components adapted for health workers (indicator 6.1). It is anticipated that

approximately 400 health workers will undertake self-testing and so know their results (indicators 6.2 and

6.3). These models will build on lessons from a similar initiative implemented by Population Council in

Zambia, which was associated with an increase in HIV status awareness among hospital staff. The two

approaches will be compared after 10 months, by providing technical assistance to each of the ten hospitals

to undertake strategic information activities (indicator 11.1).

Budget Justification for FY2008 Budget (USD):

Salaries/ fringe benefits: $80,000

Equipment: $20,000

Supplies (including office space): $30,000

Travel: $10,000

Participant Incentives: $ -

Laboratory Testing: $ -

Other (research costs) $60,000

Total: $200,000

1.ACTIVITY DESCRIPTION

In the 2007 COP, Kenya undertook the implementation of a national, population-based household survey.

This survey, which is in the field from July-October 2007 will provide uniquely valuable information for

prevention program planning and policy development within Kenya. The Kenya AIDS Indicator Survey

(KAIS) will capture information on a great swath of the population, however sub-groups of great importance

to the HIV epidemic will be missed by the KAIS because they do not reside in homes that can be mapped

and enumerated for the sampling scheme. Or their behaviors of interest are stigmatized and go unreported

during household interviews. The groups of greatest interest include men who have sex with men (MSM),

injection drug users (IDU), female sex workers (FSW) and truckers, who are often clients of FSW.

Epidemiologically, a temporally similar survey of these high risk groups will provide a better profile of the

HIV epidemic in Kenya and shed a brighter light on the transmission dynamics. Of equal importance is the

assessment of the many prevention programs funded in Kenya targeting some of these groups. In 2007,

the USG funded the ROADS project, Hope World Wide, and KANCO's RAY project to provide prevention

services for long distance truckers. Behavioral and biological surveillance of truckers will provide key

indicators specific to this group and allow the estimation of coverage by these projects. In a worrisome

development, Kenya and other East African states have become transshipment points for heroin and

cocaine. Seizures of illegal drugs have increased in each of the past 3 years. UNODC reported a >10%

increase in seizures in east Africa from 2000-2004. Few efforts to quantitatively measure the impact that

injection drug use may have on the Kenyan HIV epidemic have been reported. Current available

information comes from a rapid assessment and analysis and a mapping exercise along the coast. A single

survey of 120 IDU in Mombasa is reported and 1.7% were HIV infected. In Nairobi survey of 101 injectors,

52.5% were infected. More recent assessments indicate a rise in injection among heroin users which could

lead to increased transmission. A recent survey in Zanzibar, which is culturally similar, revealed an HIV

prevalence of 26% among IDU. We propose to survey IDU in 3 towns along the coast and into the interior

to assess the magnitude of the IDU problem and the potential transmission dynamics and contribution to the

epidemic and whether Kenya needs to increase focus on both prevention of injection drug use and HIV

among IDUs. Prevention services for FSW programmed in COP '07 included one program targeting women

who serve truckers (HWW) and another offering mobile VCT at night called Mobile and Moonlight VCT.

Male sex workers who have sex with men were recently surveyed in Mombasa by Population Council. The

findings indicated an exceedingly low level of knowledge about how to prevent HIV transmission including

the broad use of Vaseline as a lubricant with condoms. Little is known about the men who have sex with

men (MSM) population in Kenya.

For FY '08, the USG Kenya team proposes a set of behavioral and biological surveys of most at-risk

populations in about 3 towns with a focus on the coast, Nairobi and the Rift Valley provinces. The surveys

will be carried out by an NGO partner in collaboration the MOH. A standardized protocol will be developed

in collaboration with the funded partners and the USG/CDC team. Formative research will be conducted in

several locations to determine the best survey sites, to assure community buy-in and pilot some questions.

The surveys will use respondent driven sampling (RDS) to gather a probability-based sample, to enhance

the validity of findings. RDS is increasingly being used to sample hard to reach populations in sub-Saharan

Africa with recent success in Kampala (MSM), Uganda, Zanzibar (MSM, IDU, FSW), Tanzania, and Lusaka,

Zambia (MSM). The survey instrument will provide estimates for the target populations' risk and prevention

behaviors, knowledge, attitudes and access to HIV prevention services and/or treatment. Additionally, the

role the subpopulations play in the epidemic will be examined. At a minimum, respondents will be asked to

provide a blood specimen for HIV testing and they will receive pre- and post-test counseling with

appropriate referrals and their test results. Sample sizes will be calculated to provide sufficient power to

detect a change of 15% in preventive behaviors between this baseline survey and a future round in 2-3

years. A capture-recapture component will be built in to the protocol to permit estimates of the size of the

respective at-risk populations surveyed. Analyses will be reported to the surveyed communities as well as

the MOH and used to better target prevention services to important at-risk groups.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This activity will provide additional information to previous studies that have been carried out among MSM

and IDU along the Swahili coast and female sex workers in numerous parts of the country. A better

understanding of these populations will help determine if additional resources need to be focused on these

potentially high frequency "transmitters" of HIV. It is possible that, as a proportion of new infections, these

groups are underrepresented in prevention allocations.

3. LINKS TO OTHER ACTIVITIES:

The surveys will include HVCT (###) HIV counseling and testing for populations with reduced likelihood of

testing. This offers the opportunity to assess counseling modalities for hard to reach groups that require

difference messages from the general population such as injection drug users and men who have sex with

men. Linkage to prevention, care and treatment services will be provided. Additional prevention messages

can be delivered within the context of the survey from peer to peer, taking advantage of the contact with

populations that usually shy away from public health.

4. POPULATIONS BEING TARGETED:

The activity targets most at risk populations, mainly MSMs, FSW and IDU in five towns in Kenya.

5. EMPHASIS AREAS:

The major emphasis is strategic information (Survey/Surveillance), while the minor emphases include

counseling and testing and HIV prevention for MARPs.