PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2007 2008 2009
THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED
REFERENCES TO TARGETS AND BUDGETS.
The narrative is unchanged except for an expansion in geographic coverage to include more facilities and
wrap-around activities with the PMI, family planning and safe motherhood, TB and nutrition programs.
1. LIST OF RELATED ACTIVITIES
This activity relates to Counseling and Testing (#8781), Palliative Care: TB/HIV (#9062) and Palliative Care:
Basic Health Care and Support (#8934), HIV/AIDS Treatment: ARV Services (#8813), Condoms and Other
Prevention Activities (#8930), and Orphans and Vulnerable Children (#9048).
2. ACTIVITY DESCRIPTION
This APHIA II Coast activity will expand PMTCT services in the Coast Province, building on the support
previously provided through USAID's IMPACT and AMKENI EngenderHealth Projects. It aims to provide
universal uptake of counseling and testing (CT) and ARV prophylaxis in the province. In all the facilities
across the six districts, counseling and testing will be provided to 119,138 pregnant women, and ARV
prophylaxis to 7,280 HIV-positive women. Of these, 3,640 will receive AZT, 1456 HAART and 2184 single
dose nevirapine. 3640 exposed infants will receive PCR for early infant diagnosis. Service delivery will
incorporate best practices, namely opt-out approach and rapid testing. Sites will include, or will be linked to,
comprehensive care centers. Opportunistic infection prophylaxis, the use of more efficacious regimens for
ARV prophylaxis and PMTCT plus services will start in selected sites. Improved capacity to carry out
postnatal follow up of infected mothers and exposed babies to include early infant diagnosis especially in
the mother and child health clinics (MCH) are priorities. Cost barriers to ART uptake which include
laboratory costs in its sites will be addressed. Significant changes from 2007 include the universal provision
of PMTCT services in the entire district, provincial hospitals and high volume health centers, and the use of
more efficacious regimens for ARV prophylaxis. Strategies to provide CT in maternity services during labor
and delivery, emphasis on universal uptake of CT and ARV prophylaxis and deployment of additional
counselors to ANC sites are other important changes. Postnatal follow up of infants and mothers will include
infant diagnosis, cotrimoxazole prophylaxis, treatment, and support for infant feeding practices and
appropriate linkages for nutritional support. In 2008, the APHIA II Coast will support 250 sites, train 500
providers and provide logistical support, renovation, supervision and monitoring. Support to PMTCT plus
services will include training of service providers, strengthening of laboratory and commodity logistics
capacity, increased access to HB, FBC and CD4 assays and linkages to comprehensive care centers.
Operations research will focus on improving service delivery. This activity will use the Ministry of Health's
WHO/CDC-based curriculum for training, comply with MOH's clinical and reporting guidelines, and
participate in the MOH's Technical Working Group. Community links in rural areas to provide support
especially to HIV+ pregnant women will be established through national organizations of PLWHA.
Agreements with Provincial Medical Officers will ensure that PMTCT skills are taught to multidisciplinary
treatment and care teams at comprehensive care facilities, and that primary HIV care is integrated into MCH
clinics. HIV counseling and testing services to partners and family members of pregnant women will be
scaled up, thus addressing the fourth prong of the PMTCT program strategy. This prong has remained
largely unaddressed in Kenya. Approximately 4,500 spouses of HIV positive pregnant women and about
35,000 spouses of HIV negative women will be reached. The CT services will be extended to other family
members including children using the pregnant woman as the entry point. This will foster a family centered
approach to care and treatment and help improve post natal follow up of the mother-infant pair.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
PMTCT in this geographical area will significantly support PEPFAR goals for primary prevention and care
by contributing 10% of 2008 overall Emergency Plan PMTCT targets for Kenya. Additional sites contribute
to the program's efforts to achieve district wide coverage for services. Support to high volume health
centers, district and provincial hospitals to provide PMTCT plus services significantly increase opportunities
to identify HIV infected patients and potential candidates for ART. Access to services, medical treatment
and care will encourage rural women in underserved communities to attend antenatal care services. This
will facilitate postnatal follow up of HIV positive women, infants and their family members. This APHIA II
Coast activity also contributes substantively to Kenya's Five-year strategy of encouraging pregnant women
to know their status, availing services to reduce mother-to-child infections and providing HIV/AIDS treatment
as a step towards preserving the family unit. It also contributes to the strategy to integrate services and
improve the referral links.
4. LINKS TO OTHER ACTIVITIES
This activity relates to CT (#8781), OVC (#9048), palliative care (#9062) and (#8934) and other prevention
activities (#8930) described under the APHIA II Coast in other parts of the 07 COP. PMTCT plus services
include counseling and testing which is largely diagnostic, provision of ARV prophylaxis, management of
opportunistic infections and ARV services (#8813). Strengthening laboratory services and improving
commodity logistic systems is a crucial part of HIV/AIDS treatment services. Operations research on
improving service delivery is included.
5. POPULATIONS BEING TARGETED
This APHIA II Coast activity targets adults of reproductive health age, pregnant women, family planning
clients, infants, people living with HIV/AIDS, HIV positive pregnant women and HIV positive infants. BCC
activities will involve community leaders and community based organizations to increase demand for
services. Strategies to improve quality of services will target Ministry of Health staff, doctors, nurses,
midwives, laboratory workers, pharmacists and other health care workers such as clinical officers and public
health officers.
6. KEY LEGISLATAIVE ISSUES ADDRESSED
This APHIA II Coast activity will increase gender equity in programming through partnering with women's
groups in the design and implementation of community mobilization approaches. The behavior change
communication (BCC) activities will promote a family approach to PMTCT. This will address male norms,
encourage male participation and help reduce stigma and discrimination. Increased availability of services
will also reduce stigma.
7. EMPHASIS AREAS
This activity includes emphasis on human capacity development through training, supportive supervision
Activity Narrative: and task shifting, local organization capacity development and improvement in strategic information. Wrap
around program with the PMI, family planning and safe motherhood, TB and nutrition programs will be
linked with this activity.
The only changes to the program since approval in the 2007 COP are:
• Geographic coverage has been expanded to include 3 additional districts in the Coast Province: Kilindini,
Kaloleni and Tana River
• $300,000 of this activity supports the healthy youth initiative and is programmed with funds from the $7
million FY 08 plus up
• Peer education activities will be rolled out with the Kenya Girl Guides Association
• AB funds totaling $23,000 will contribute to the sensitization of teachers as a worksite population linking
with additional OP and OHPS funds for a $150,000 activity to reach 750 teachers and train 20 more
• Most-at-risk populations in Mariakani along the Mombasa-Kampala transport corridor will be targeted with
prevention activities using a "cluster" approach
This activity relates to activities in HIV/AIDS Treatment: ARV Services (#8813), Counseling and Testing
(#8781), Orphans and Vulnerable Children (#9048), Palliative Care: Basic Health Care and Support
(#8934), Palliative Care: TB/HIV (#9062), Condoms and Other Prevention Activities (#8930), Prevention of
Mother-to-Child Transmission (#8764), Strategic Information (#9711).
$300,000 of this activity supports the healthy youth initiative and is programmed with funds from the $7
million FY 08 plus up. In 2008, FHI will implement APHIA II Coast activities to reach 700,000 individuals,
especially youth, and train 3,000 peer educators. AB activities will be expanded to 3 additional districts
(Kilindini, Kaloleni and Tana River) in the Coast Province. This activity will reach 500,000 youth with
abstinence and being faithful messages. They will employ the 360-degree Model of Protection that seeks to
delay first sexual encounter and increase secondary abstinence among youth ages 10 to 24 years, as well
as increase safer sexual practices among sexually active youth, especially mutual fidelity. The model calls
upon families, schools, health facilities and communities to meet the HIV/AIDS and RH needs of youth by
developing activities that build the capacity of young people to establish and maintain healthy behaviors to
avoid HIV and STIs. The model aims to provide young people with a supportive environment that involves
their family, peers, school, and community. Approximately 2,500 people will be trained to provide AB
programs among youth. The activity will be implemented by FBO sub-partners such as Anglican, Seventh
Day Adventist and Catholic churches as well as the Muslim institutions to integrate life skills programs with
their youth programs. These programs have been equipping youth with skills to cope with peer pressure
and help them develop positive norms and values to make appropriate and safe choices in relationships. In
addition, the activity will work with Kenya Girl Guides Association (KGGA) to reach out to more youth in
school with abstinence only messages through a life skills program and the "Sara" communication initiative.
Malindi Education Development Association (MEDA) will target Muslim youth in Malindi with abstinence and
be faithful programs. The activity will also develop, produce and distribute abstinence-specific
communication materials through the various partners and networks implementing the activity in Coast
Province. The activity will expand the youth peer education interventions using the Y-PEER approach
established by YouthNet and UNFPA; work with the Provincial Education Office and KGGA to roll out the
life skills peer education program established under the IMPACT Project for schools in Coast Province. In
addition, the activity will work with the Kenya sign language project (implemented by U.S. Peace Corps) to
introduce HIV/AIDS education to institutions such as computer colleges, driving schools, village
polytechnics, and Shanzu Teachers Training College. The project will also use the AIDS education
approaches of "I Choose Life" who have developed a peer education program for university students and
the National Organization of Peer Educaotors' Ambassadors of Change. Sub awards will be made to the
National Organization for Peer Educators, YouthNet, the Kenya Girl Guides Association, Malindi Education
Development Association, Seventh day Adventist, Anglican and Catholic churches in Coast province.
This APHIA II Coast project will contribute to the Kenya 5-Year Strategy in which youth are a primary target.
This activity will reach 500,000 youth with abstinence and being faithful messages and another 300,000 with
abstinence messages in Coast Province. Targets in this project will also contribute to numbers of HIV
infections averted.
The APHIA II Coast Abstinence and Be Faithful Program activities will relate to HIV/AIDS treatment services
(#8813), counseling and testing (#8781), OVC (#9048), HBHC (#8934), TB/HIV care activities (#9062), OP
(#8930), PMCT (#8764), and strategic information (#9711). This activity will link the target population to
other prevention services especially for the sexually active youth and also encourage all to know their status
by linking to counseling and testing services and treatment for those eligible for ART.
In- and out-of-school youth and community and religious leaders in three districts are the target group. This
target population will be reached through local community, religious leaders, and teachers.
6. KEY LEGISLATIVE ISSUES ADDRESSED
Gender will be addressed through many school programs including those targeting young girls and
specifically work with the Kenya Girl Guide Association. The materials developed under this activity will also
address issues surrounding stigma and discrimination.
Emphasis areas covered by this activity include local organization capacity development as a high
percentage of effort. Activities will include peer education and training teachers and other leaders to
promote AB messages for youth. In addition, the program emphasis includes community mobilization
through religious leaders and teachers, information, education and communication through the development
and printing of materials such as comic books and magazines articles, and curricula targeting youth and
promoting AB.
+ geographic coverage has been expanded to include 4 additional districts in the Coast Province: Kaloleni,
Kinango, Kilindini and Tana River totaling 10 districts
+ $100,000 of this OP activity is programmed with funds from the $7 million FY08 plus-up for the Youth
Prevention Initiative
+ OP funds totaling $29,000 will contribute to the sensitization of teachers as a worksite population linking
with additional AB and OHPS funds for a $150,000 activity to reach 750 teachers and train 20 more
+ APHIA II Coast will work with police, uniformed services, women, opinion leaders and others on issues of
gender-based violence
(#8934), Palliative Care: TB/HIV (#9062), Abstinence and Be Faithful Programs (#8950), Prevention of
Mother-to-Child Transmission (#8764).
In 2008, FHI will implement APHIA II Coast to reach 900,000 individuals through community outreach
programs, train 2,500 individuals and distribute condoms through 150 outlets. The activity will build on
HIV/AIDS Other Prevention activities implemented under the 06 COP. It will reach 700,000 individuals
through community outreach programs and train 1,700 people through existing local NGOs, FBOs and
private sector. The activity will focus on reaching individuals in formal and informal settings. Under the
leadership of the National Organization of Peer Educators (NOPE), the activity will target women and men
at worksites and youth at risk. The local NGO and FBOs will target other high-risk populations including low-
income community women, sex workers, truck drivers, cattle traders, uniformed services, discordant
couples and women in churches and mosques in the Coast Province. Technical assistance partners will
continue to provide assistance and capacity building to partner organizations to implement behavior change
prevention programs. The program will link with and provide referrals to existing networks of HIV/AIDS
counseling and testing, home-based care and ART programs in the program areas, creating
"comprehensive care centers." This intervention will result in reduced HIV risk in the general population,
especially among young adults. They will provide increased access to HIV/AIDS prevention services for
high-risk and under-served populations, and increase awareness of HIV/AIDS preventive behaviors through
the Ministry of Health and other partners. This will also include targeted condom promotion and distribution
to high-risk populations through 100 condom outlets and improved quality of STI services working through
the Ministry of Health and other partners. Prevention activities will include the following: targeting out-of-
school and most at risk youth with prevention information and referral to youth friendly services; supporting
peer education interventions with sex workers in Malindi, Mombasa, Kilifi and Kwale districts and link them
to VCT, PMTCT, care and support services; support prevention efforts among the uniformed services by
working with the provincial police AIDS Control Unit (ACU) to expand the police peer education program to
four districts in the Coast Province; expand the peer education program targeting truck drivers, loaders, and
seafarers and link the activities to the existing ROADS Project; support prevention programs targeting hard-
to-reach MARPS such as the MSM and injection drug users and the geographically hidden populations
such as Orma and Wadei Somalis in Tana River; provide counseling, information and prevention to HIV-
positive individuals through peer and provider education, outreach services and regional mass media. In
addition, the activity will target people with disabilities and assist them to gain access to integrated networks
for care, treatment and support activities. Local implementing partners will integrate prevention messages
into models of care and support for OVC and PLWAs. Technical assistance will continue to be provided to
implementing partners implementing behavior change communication programs in HIV and substance
abuse and develop new print materials addressing alcohol abuse, stigma and discrimination.
This activity will contribute to the Kenya 5-Year Strategy that focuses on HIV prevention targeting high-risk
groups. Targets in this project will contribution to HIV infections averted.
The APHIA II Coast Other Prevention activities will relate to HIV/AIDS treatment services (#8813),
counseling and testing (#8781), OVC (#9048), HBHC (#8934), TB/HIV care activities (#9062), AB (#8950),
PMCT (#8764).
Men and women in the work place, male and female sex workers and their partners and clients, and other
high-risk population including truck drivers and out-of-school youth.
This APHIA II TBD project will have a strong gender component. Activities will target men in the workplace
and low-income women in the community.
Community mobilization/participation will be implemented to reach the communities surrounding worksites.
Individuals will be referred for other HIV/AIDS related services, especially counseling and testing services.
In addition, peer educators in worksites who are also targeting the community will be trained to provide
information related to HIV/AIDS including condom distribution. APHIA II Coast will undertake Prevention
with Positives (PwP) activities working through PLWA support groups linked to the Comprehensive Care
Centers in Coast province. $50,000 of unallocated funds will provide support to patient support groups in
the CCCS and post-test clubs at VCT centers to ensure promotion of faithfulness and condom use by HIV-
infected persons. This will empower 5 HIV+ people in each of 10 patient support groups to become peer
and advocacy leaders in prevention at the community level and will reach 10,000 PLWAs.
The APHIA II Coast HBHC activities will relate to HIV/AIDS treatment services (#8813), counseling and
testing (#8781), Other Prevention (#8930), orphans and vulnerable children (#9048), TB/HIV care activities
(#9062), AB (#8950) and PMTCT (#8764).
2. ACTIVITY NARRATIVE
This activity will provide integrated and comprehensive home and basic health care to 40,000 people with
HIV/AIDS linked to 29 comprehensive care centers and 250 rural health facilities. Through a training of
trainers, primary care facility health workers will be trained to provide comprehensive and integrated care
training to home /community based care workers who in turn train the primary care givers at home, to
complement the facility based services. At the health facility clinics integrated training following
NASCOP/DRH/Malaria/NLTP curricula will be offered to identified staff to offer services for the prevention,
identification and management of OIs, monitoring of the infected adults, children and their families, coupled
with appropriate counseling and education. All babies born and children of HIV infected mothers will be
followed up at the CCCs or MCHs in the 250 facilities and appropriately managed. A case manager will
manage referrals to and from the community. The community based component will include treatment
literacy, basic management of OIs, ART and TB treatment adherence, adequate nutrition, home hygiene
and nursing skills , malaria prevention and treatment, FP and identification and referral of clients suspected
of having HIV and TB. Formal linkages between health facilities and the community-based activities will be
created to enhance effective care, follow-up, and tracking of referrals and assessment of patient satisfaction
with the services. Both formal health care workers and community and home based care volunteer workers
will be trained on effective referral. Lay treatment support volunteers will be recruited and trained, using the
CRS training curricula to provide psychosocial support, adherence support for ART, TB and regular clinic
visits. This activity will also lead to the mobilization and strengthening of organizational and institutional
capacity of 10 District institutions to integrate, plan, lead, monitor and evaluate home and community care
support programs. Quality Assurance and Quality Improvement of this activity for both facility and
community intervention will be key in ensuring that standards of care are met. Care providers will be trained
on the MOH SOPs. Through this activity, the organizational capacity of PLWA groups will be strengthened
so as enable them to be pro-active leaders, advocates and participants in the response to the epidemic. In
addition, this activity will lead to the linkage of 7000 families with economic support programs. Community
members including PLWA and older OVC will be trained on this methodology and also in basic financial and
management and skills for their projects and also linked to other microfinance institutions operating in the
region. To ensure continued support for this effort at the community level, FBOs, CBOs, PLHA groups,
women and youth groups will be trained in basic program and financial management skills as part of
capacity building. Training of paralegals and child counselors will be expanded to the Districts of Kwale,
Taita-Taveta, Lamu and Tana River.
The activity will be implemented by partners such as Catholic Arch Diocese of Mombasa, Catholic Diocese
of Malindi as well as Coast people living with AIDS .With initiation of ART, the number of registered PLHA
groups increased; however, although members of these groups are committed, the organizations are
structurally weak and have not played a key role in HIV/AIDS programming in coast. In order to address
this, the activity will work with National empowerment of networks of people living with HIV/AIDS in Kenya to
build the technical capacity of these organizations and assist them to implement programs in their
communities. Social impact will work intensively with these groups to strengthen their organizational
capacity.
Provision of safe water supply in the homestead will be supported to reach 24,000 families through the use
of approved hypo chloride treatment of water used for drinking and preparation of food. In addition, these
families will be linked to a supply of insecticides treated bed nets targeting especially those with pregnant
women and children under five years. Nutritionally deficient bed ridden patients will be supported with food
supplements. Vulnerable households will be linked to food security and extension services.
This APHIA II Coast project will contribute to the Kenya National HIV/AIDS strategic plan 2005/6-2009/10
priority area 3 on improving the quality of life of people infected and affected by HIV/AIDS through provision
of treatment and care services and promoting and protecting the rights and access to effective services for
infected and affected.
The APHIA II Coast will reach 40,000 clients and 5,000 individuals will be trained to provide palliative care
through 279 service outlets. This APHIA II Coast activity responds to NACC's priority areas #2 "Improve the
quality of life of people infected and affected by HIV/AIDS" and #3 "Mitigation of socio-economic impact". It
is expected that the APHIA II-TBD will adhere to GOK policies and guidelines and participate in national-
level HIV technical working groups.
HIV/AIDS treatment/ARV (#8813), Counseling and Testing (#8781), Condoms and Other Prevention
(#8930), Orphans and Vulnerable Children (#9048), Palliative Care: TB/HIV (#9062), Abstinence and Be
Faithful (#8950) and Prevention of Mother to Child Transmission (#8764). Efforts will also ensure that ARV
and DOTS adherence will be stepped up in FY 2007.
Two populations are being targeted. 1) People affected by HIV/AIDS (including Caregivers, HIV positive
children and infants, HIV/AIDS-affected families and People living with HIV/AIDS) and 2)
Groups/Organizations (including community-based organizations, country coordinating mechanisms and
faith-based organizations. Other populations targeted include community and religious leaders as well as
health workers both in private and public sectors for training.
This activity will address Stigma and Discrimination by providing access to increased resources in order to
address the wide spectrum of problems that are faced by households when dealing with a debilitating
disease in an adult family member. In addition, it will address Wraparounds through the provision of food
Activity Narrative: and microfinance/micro credit.
The main emphasis is on Local Organization Capacity Development through building the capacity of
communities and local organizations to implement community-based care and support to HBC clients and
OVC. There is a minor emphasis on Training, Linkages with Other Sectors and Initiatives (Linkages and
strong collaboration with other public and private sector prevention and treatment efforts will help to
overcome resource limitations and build sustainability. Efforts will also link more clients to ARV and to
ensure ARV and DOTS adherence will be stepped up in the coming year) and Community Mobilization/
Participation (building the capacity of community organizations to assist families).
The APHIA II TB/HIV care activities relate to activities in AB (#8950), CT (#8781), OVC (#9048), Palliative
Care: Basic Health Care and Support (#8934), ARV Services (#8813) , Condoms and Other Prevention
(#8930), PMTCT (#8764), and Strategic Information (#9711).
This activity has in the preceding years received funding from USAID to support TB control activities with
the National Leprosy and Tuberculosis Program (NLTP) in Mombasa and Nairobi. In addition, these
activities have supported strengthening of the Central Reference Laboratory, linkage into the home-care
programs, continued school health education, increased number of TB diagnostic and treatment centers,
development of effective referrals, dissemination of provider job-aides, educational campaigns,
strengthening of management of drug resistance, and surveillance and institutionalization of TB/HIV
collaboration. This activity will support training of HIV and TB care staff on routine diagnostic testing and
counseling of TB suspects and cases using the NLTP/NASCOP curriculum, provide additional staff if
required, screening of HIV cases for TB, upgrading of laboratories with additional equipment, and
renovation of laboratory space, as necessary. In addition, INH prophylaxis will be introduced at select CCCs
and the congregate settings of Shimo-la-Tewa and other prisons. CTX prophylaxis will be introduced for all
HIV infected TB cases. Therapeutic and supplementary nutrition will be provided to eligible TB/HIV patients.
Planning, monitoring and supervisory mechanisms for collaborative activities will be strengthened at
provincial, district and community levels. The capacity of select HIV/AIDS CBOs and local NGOs like
Mkomani Clinic Society will be increased to integrate TB into their on-going HIV/AIDS activities. Low literacy
materials on TB/HIV will be supplied. The private providers who cater for the lower socio-economic groups
will be trained and linked to either the public HIV/AIDS and TB programs or the Gold Star Network whose
target is paying clients in the private sector. An estimated 100 private providers will be trained on TB/HIV. .
Intensified TB screening for 20,000 HIV patients and HIV screening for 2500 TB suspects/patients will be
offered as a standard of care in all the facilities; approximately 1250 TB patients will be identified as being
infected with both TB and HIV.
3. CONTRIBUTION TO OVERALL PROGRAM AREA
This APHIA II Coast TB/HIV care activity will provide clinical prophylaxis and treatment for TB to 2500
people and train 100 health workers in TB/HIV related activities in 50 health care facilities in Coast
Province. These set of activities will contribute to the results of strengthened delivery of integrated HIV and
TB services, including strengthened referral systems, improved diagnostics and treatment of TB among HIV
-positive patients and of HIV in TB patients, and strengthened capacity of health workers to provide
integrated HIV and TB services.
4. LINKS TO OTHER ACTIVITIES The APHIA II TB/HIV care activities relate to other APHIA II- Coast
activities in AB, CT, OVC, Palliative Care: BHCS, ARV Services, Condom and Other Prevention, PMTCT,
and strategic information.TB patients will be linked to HIV counseling and testing, prevention and treatment
services.
General population, health workers, and PLWHA with dual TB/HIV infections.
6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address gender, stigma and discrimination
through its community activities.
7. EMPHASIS AREAS Major emphasis is training, with minor emphases in community
mobilization/participation, development referral systems, local organizations capacity development,
workplace programs, and IEC. APHIA II Coast with these additional Plus Up funds will intensify provider-
driven DCT in health care settings seeking to enhance testing in TB diagnostic centres that currently do not
provide ART services. These facilities are largely health centres and dispensaries that offer TB diagnostic
services but are not providing ART. HIV positive patients identified via these activities will be referred to
nearby treatment sites. This will complement the current DCT program that has intensified testing in
facilities where both TB and ART services are provided
The APHIA II Coast orphans and vulnerable children activities will relate to HIV/AIDS treatment services
(#8813), counseling and testing (#8781), Other Prevention (#8930), HBHC (#8934), TB/HIV care activities
This activity will lead to provision of comprehensive support to 53,000 OVC and their households both
directly and through leveraged resources from other partners in the region. There are existing programs
responding to the needs of OVC but this is, in most cases, a scattered and an uncoordinated response.
Initial activities will therefore focus on strengthening that and ensuring it is comprehensive package as laid
out in the USG guidelines. Through the technical leadership of CRS (Catholic Relief Services) and Social
Impact the capacity of NGOs CBOs, FBOs will be strengthened through training of trainers so as to enable
them train at least 5,300 care givers provide a high quality comprehensive care to OVC. Recognizing the
role that they play in the response to taking care of their own, key community stakeholders who include civic
leaders, parents, care givers, community leaders, religious leaders and community groups will be engaged
through capacity development activities to survey vulnerable children and their needs, assess existing
community resources and gaps, establish a coordination and referral mechanism, plan and monitor a joint
response to the OVC. CLUSA, who are one of the strategic Partners for APHIA Coast will provide technical
leadership in mobilizing the community to lead the response to OVC.
This activity will contribute to the Kenya 5-year strategy and will increase the number of OVC receiving
HIV/AIDS care and support, and will reach 53,000 OVC with comprehensive quality services and train 5,300
caregivers.
The APHIA II Coast OVC activities will relate to HIV/AIDS treatment services (#8813) , counseling and
testing (#8781), Other Prevention (#8930), home based care services (#8934), abstinence and be faithful
(#8950), prevention of mother to child transmission (#8764) and TB/HIV (#9062). This activity will provide
referral, as appropriate, to OVC and their community to necessary HIV/AIDS services especially counseling
and testing and treatment.
This activity targets orphans and vulnerable children, caregivers of OVC, and community health workers.
The local capacity of each organization will be strengthened by working with community leaders, religious
leaders, volunteers as well as partnering with other existing community-based and faith-based organizations
that exist in the same community.
The key legislative issues being addressed is stigma and discrimination through close links in building the
capacity of the community to address the local needs of the OVC in each community as well as in training
the caregivers of the OVC. This activity also addresses the wrap around issue of food and education.
Ensuring the needs of the girl child will also be addressed as the needs relate to being an OVC.
Major emphasis is in community mobilization/participation and minor emphasis areas in developing
network/linkages, local organization capacity development and training.
+ geographic coverage has been revised and expanded to include additional districts in the Coast Province
+ target population will be expanded to include OVCs
+ APHIA II Coast will expand counseling services within the province and include outreach services
provided through existing and new VCT sites that are integrated within health facilities. The CT services will
include door to door VCT and testing of family members of the infected individuals receiving care and
treatment within the facility.
1.LIST OF RELATED ACTIVITIES
This activity is related to activities in TB/HIV care activities (#9062), HIV/AIDS treatment services (#8813),
abstinence and be faithful (#8950), OVC (#9048), HBHC (#8934), other prevention (#8930) and PMCT
(#8764).
2.ACTIVITY DESCRIPTION
In 2008, this activity will reach 250,000 individuals with Counseling and Testing services including PITC,
VCT, and HBCT through 75 sites and 500 providers will be trained. In 2007, this activity will provide
counseling and testing services to 100,000 people through the broadened entry points which include the
clinical care settings through the provider initiated testing (PIT) and the traditional VCT sites, both integrated
and free standing. The MOH already has an approved HIV testing serial testing protocol using whole blood
and simple rapid tests. Previous efforts concentrated on diagnostic testing mainly of patients who had
clinical indications of AIDS. This will be strengthened further through routine counseling and testing of TB
and STI patients. Also previous efforts concentrated on integrating HIV testing in level III and IV health care
facilities. This will be scaled up to the lower level health facilities especially in Districts where CC-ART sites
have been decentralized. This activity will target 50 sites and train 150 counselors. The coast region has
already established counseling and testing services but some Districts have hard to reach populations.
Outreach mobile teams will be facilitated to conduct CT services to these communities. Home/family based
CT services will be initiated in Mombasa, Malindi and Kilifi who already have index clientele enrolled in care.
This will require the recruitment, training or orientation of lay counselors to support this activity. Voluntary
counseling and testing will be scaled up through community mobilization and outreach services for youth
and adolescents in the region. This will be done in collaboration with National organization for Peer
Educators (NOPE) who is one of the Strategic Partners to promote the culture of the need to know one's
sero status among the youth. Building on NOPE's work with workplace HIV/AIDS programs, CT and testing
will be integrated in workplace programs that already have HIV/AIDS policies and care and treatment
programs so that there is an active linkages for those testing HIV positive. The broadening of entry points to
counseling and testing will require that at least 150 service providers are trained in routine and diagnostic
counselling and testing especially at lower levels of health care provision. The training will encompass
aspects of care and treatment and the need for systematic referral. Training in couple counseling and youth
and adolescent counseling for all existing counselors will also be conducted. Through the collaboration with
(CLUSA) and using the FHI model for SBC, community mobilization campaigns for couple counseling and
testing will be conducted. Quality assurance and Quality Improvement are key to the fulfillment of the
government objectives and the Districts will be supported to provide supervision to the service providers
including training of more people in support supervision. Sub agreements in this program will be awarded to
National organization for Peer Educators (NOPE) and the Ministry of Health. Amounts and other sub
agreements TBD.
3.CONTRIBUTIONS TO OVERALL PROGRAM AREA
This APHIA II Coast project will contribute to the Kenya 5-Year Strategy which focuses on HIV prevention.
Targets in this project will contribute to numbers counseled and tested for HIV/AIDS. The proposed program
contributes to COP 2007 targets, and is consistent with the PEPFAR 5-Year Strategy, in the following
manner: Increased access to counseling and testing clinical services, and increased availability of
counseling and testing clinical services.
4.LINKS TO OTHER ACTIVITIES
The APHIA II Coast Counseling and Testing activities will relate to HIV/AIDS treatment services (#8813),
Abstinence and Be Faithful Program (#8950), OVC (#9048), HBHC (#8934), TB/HIV care activities (#9062),
OP (#8930), and PMCT (#8764). This activity will ensure referral for services for those that test positive
especially to prevention services and post test clubs and to care services such as TB, and treatment while
others will be referred to post test clubs.
5.POPULATIONS BEING TARGETED
This activity will target the general population including adults (Men,Women, FP clients,Youth), People
affected by HIV/AIDS (Children born of HIV infected mothers, Spouses of HIV infected persons, Family
members of an HIV infected person), Community members including Faith based organizations, Non-
governmental organizations, and Community based organizations. Health providers both in the private and
public sector providers will be targeted.
6.KEY LEGISLATIVE ISSUES ADDRESSED
Gender is a key legislative issue addressed in this activity. This includes activities supporting counseling
that challenges norms about masculinity, delayed sexual activity and reduced multiple sex partners for boys
and men and transactional sex. The activity also include support for testing and support services for victims
of sexual abuse and violence, training on couple counseling, risk assessment, stigma reduction, and
supporting women to mitigate potential violence.
7.EMPHASIS AREAS
This activity supports the development and implementation of referral systems, quality assurance and
supportive supervision for CT counselors. The activity will also support the training of additional counselors
especially targeting testing for youth and in clinical setting. The activity will also work with local
organizations and MOH in Coast province to strengthen their capacity to implement programs.
N/A (exempt)
THIS IS AN ONGOING ACTIVITY AND THE NARRATIVE IS UNCHANGED EXCEPT FOR CHANGES IN
TARGETS AND FUNDING LEVEL.
+The planned documentation of best practices in each program area and dissemination to stakeholders in
the region to improve program efficiency and effectiveness, and planned Behavioral Monitoring Surveys
(BMS) and dissemination of findings to stakeholders for improved HIV/AIDS programming. This activity also
includes the development of data quality improvement plan, training data point persons on DQA tools and
implementation of regular data quality audits at sampled health facilities and community level programs.
This activity is related to other activities in Strategic Information (#7098, #7002 and #9220).
This activity will strengthen the provincial and district level Health Management Information Systems
(HMIS) currently in use by MOH at health facilities and Community Based Program Activity Reporting
(COBPAR) currently being rolled out at Constituency AIDS Control Committee (CACC) levels by the
National AIDS Control Council (NACC) through three key components. Component 1: Support APHIA II
Coast/FHI and MOH program data collection processes for performance reporting needs (quarterly, semi-
annual, annual). This component will support participatory, coordinated and efficient data collection,
analysis, use and provision of information to track achievement of APHIA II Coast/FHI and MOH's district
level Annual Operation Plan II objectives. This process will also inform decisions at the local, district and
provincial levels, using standardized M&E/HMIS tools approved by the MOH. Component 2: Strengthen
community and facility based reporting systems being rolled out by NACC and NASCOP. The component
will support APHIA II Coast/FHI and MOH to measure progress towards its overall contribution to the
country's Emergency Plan, National Health Sector Strategic Plan II and Kenya's National HIV/AIDS
Strategic Plan goals and results frameworks. Specific activities will include building capacity of 40 local
organisations and facilities to collect, report, analyse, and use both routine facility and non-facility data for
planning and program improvement. Component 3: Take the lead role in coordinating M&E activities in the
province to meet the information needs of the Emergency Plan, MOH, NACC and other stakeholders, in line
with the "three ones" principle. APHIA II Coast/FHI will organize district-level consensus building forums on
M&E issues, distribute standardized data collection and reporting tools, conduct regular data quality
assurance processes at all data generation points, train 140 facility and community based data point staff
on the new data collection/reporting tools and data use for improving program performance, and hold
provincial level quarterly and annual stakeholders' information dissemination meetings. APHIA II Coast/FHI
will be held accountable for tangible results, especially in increased use of harmonized data collection and
reporting tools at health facilities developed by MOH, increased data use in planning and at dissemination
workshops to various stakeholders, increased supportive-supervisory visits and routine data quality
assessments at all data collection points by M&E/HMIS officers, and improved coordination of M&E
activities in Coast province. These efforts should result into demonstrated evidence in increased national
level reporting by up to 60% from health facilities to NASCOP national database.
The activity builds on the FY 2006 activities that support the national M&E systems as well as contributing
to the Emergency Plan's training outputs. In overall, the activity will provide technical assistance to twenty
five local organizations/health facilities in strategic information in addition to supporting the training of 75 SI
and program managers in M&E/HMIS, reporting and data use for program management.
This activity is related to the strategic information activity to be carried out by MEASURE Evaluation
(#7098), where MEASURE Evaluation will be supporting NACC in rolling out COBPAR system for
community level reporting. It is also related to the strategic information to be carried out by NASCOP
(#7002), where NASCOP will rolling out Form 726, Form 727 and program specific client registers for data
collection and reporting at health facilities. It is also related to SI TE/TBD (#9220), that will attempt to
investigate the causes for low reporting rate by health facilities and recommend strategies for achieving
100% reporting level by health facilities.
This activity targets host government workers and other health care workers like M&E and HMIS officers for
data collection, analysis, reporting and use at both health facilities and community level. Program managers
are as well targeted for orientation on the role M&E program management.
6. EMPHASIS AREAS
The major emphasis area is Health Management Information Systems (HMIS) and minor areas include
Monitoring, evaluation, or reporting (or program level data collection) and Other SI Activities.
THIS IS A NEW ACTIVITY.
1. ACTIVITY DESCRIPTION
USAID APHIA II Coast began activities in Coast in FY 2006. In FY 2008 APHIA II Coast will work to
strengthen the dissemination of key Government of Kenya (GOK) policies and guidelines, developed at
national level, to the district level. In FY 2008 this will include working with the Ministry of Education and
other stakeholders to sensitize teachers about HIV/AIDS prevention and the AIDS policy for the education
sector.
In addition APHIA II Coast will support provincial and district health systems strengthening by convening
consultative meetings and various stakeholders' forums. The activity will target to reach at least four of the
seven districts in the province and train 50 individuals on HIV-related policy development.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute to strengthening Government of Kenya systems on policy, planning and
budgeting. This will be done by enhancing dissemination and understanding of key government policies
and guidelines, which will be developed or reviewed nationally, out to the districts through provincial
channels.
3. LINKS TO OTHER ACTIVITIES
This activity will link to other APHIA II Coast activities, particularly in AB and OP as well as USAID-OHPS-
HPI-TBD-2008 that will be developing and reviewing key policies and guidelines nationally.
4. POPULATIONS BEING TARGETED
This activity will target teachers through activities guided by the Ministry of Education particularly as regards
the dissemination of the AIDS policy for the education sector.
5. EMPHASIS AREAS / KEY LEGISLATIVE ISSUES ADDRESSED
The main emphasis area for this activity will be local organization capacity building via serving to enhance
the management and coordination capacity of district and provincial health management teams in at least
half of the districts in the province served by the implementer.
