Detailed Mechanism Funding and Narrative

Years of mechanism: 2007 2008 2009

Details for Mechanism ID: 4914
Country/Region: Kenya
Year: 2008
Main Partner: Johns Hopkins University
Main Partner Program: JHPIEGO
Organizational Type: University
Funding Agency: USAID
Total Funding: $14,500,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $1,300,000

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

REFERENCES TO TARGETS, EMPHASIS AREAS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

The APHIA II Eastern PMTCT activities will relate to HIV/AIDS treatment/ARV services (#8792), counseling

and testing (#8782), Orphans and Vulnerable Children (#9041), Palliative Care (#8863), TB/HIV (#9069)

and Condoms and Other Prevention (#8932) activities in the same region.

2. ACTIVITY DESCRIPTION

APHIA II Eastern will continue to provide technical assistance to a number of health facilities within targeted

districts in Eastern Province, providing PMTCT services. This assistance will increase management, as well

as technical, capacity of staff at these sites improving quality and productivity. The project will also work to

improve PMTCT outcomes, examining ways to increase compliance with infant feeding and treatment

guidelines and to increase the number of women who return to facilities for delivery and post-partum follow-

up. The APHIA II Eastern will train 300 health providers in 130 facilities providing PMTCT services. In 2008,

the APHIA II Eastern will work with several types of partners in Kenya. First, it will continue to support

expansion and quality improvements for PMTCT services through working closely with the faith-based

facilities, with the explicit purpose of building programmatic and administrative capacity to implement HIV

programs. Second, it will expand support for PMTCT services to public sector facilities in 6 districts that lack

other USG support in the province. Supported sites will counsel and test 79,161 pregnant women and

provide ART prophylaxis to 3,349 HIV positive women. Of the HIV positive women, 1,675 will receive AZT,

670 HAART and 1004 single dose nevirapine for prophylaxis. 1,675 exposed infants will receive PCR for

early infant diagnosis. The APHIA II Eastern will continue to participate in the Ministry of Health's (MOH)

Technical Working Group to ensure coordination of site selection, project activities, monitoring and

evaluation and linkages between these sites. They will comply with MOH clinical and reporting guidelines

and will use the WHO/CDC-based national training curriculum. APHIA II Eastern will also help the more

mature facilities to graduate to PMTCT+ sites, providing ART and other care and support services to HIV+

women and their families. It will establish laboratory networks which will provide easy access to CD4 counts

as well as other chemistry tests that often hinder access to ART uptake. It will build on its work already

established in some parts of Eastern province to increase access to these services as well as access to

early infant diagnosis. It will put emphasis on male involvement, psychosocial support, as well as

psychosocial support for health care providers and care givers of HIV infected children.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

APHIA II Eastern activities in the specific geographic regions will contribute to 6.6% of 1,200,000 pregnant

women in COP 2008 PEPFAR goals for PMTCT primary prevention and care. Planned activities will

improve equity in access to HIV prevention and care services since the currently underserved communities

will have better access, and APHIA II Eastern will work to ensure there are adequate networks and linkages

between their sites and medical sites where AIDS care and treatment are available for both adults and

children. On top of this APHIA II Eastern will offer PMTCT+ services in selected sites. These activities will

contribute to the result of increased access to counseling and testing services, particularly among

underserved and high risk populations and the result of increased availability of diagnostic counseling and

testing services in medical settings to identify the large numbers of HIV infected patients who are potential

candidates for ART.

4. LINKS TO OTHER ACTIVITIES

Linkages between PMTCT service and care outlets will be strengthened to improve utilization of care

opportunities created through PEPFAR funding. The APHIA II Eastern PMTCT activities will relate to HTXS,

HVCT, OVC, HBHC, HVTB and HVOP activities in the same region.

5. POPULATIONS BEING TARGETED

This activity targets adults of reproductive health age, pregnant women, family planning clients, infants, and

HIV positive pregnant women. Strategies to improve quality of services will target health care workers in

public, private and faith based facilities such as doctors, nurses, and other health care workers such as

clinical officers, mid wives and public health officers. It will also target host country government workers

such as the National AIDS control program staff.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This APHIA II Eastern activity will increase gender equity in programming through PMTCT services targeted

to pregnant women and their spouses. Women have the highest HIV burden both through infection and as

care givers. Identifying them through PMTCT will give them an opportunity to access care and improved

pregnancy outcomes for themselves their spouses and their infants. Increased availability of PMTCT and

PMTCT+ services will increase access and help reduce stigma at community and facility level.

7. EMPHASIS AREAS

This activity includes major emphasis on human capacity development through training and supportive

supervision of health care workers in PMTCT service provision, support to strategic information, linkage to

family planning, malaria initiative and safe motherhood programs as well as local organization capacity

development to manage PMTCT services, quality assurance and infrastructure development.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $2,300,000

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 expanded to include Kitui, Makueni, Mwingi and Tharaka districts;

• $100,000 of this activity supports the Youth Prevention Initiative programmed with funds from the $7

million FY 08 plus up;

• 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;

• The KARHP methodology will be rolled out in collaboration with the Ministry of Education at approximately

$250,000;

• Peer education activities will be rolled out with the Kenya Girl Guides Association;

• Communities surrounding Mlolongo along the Mombasa-Kampala transport corridor will be targeted with

AB, OP, OVC and CT activities

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Counseling and Testing (#8782), HIV/AIDS Treatment: ARV Services

(#8792), Orphans and Vulnerable Children (#9041), Condoms and Other Prevention (#8932), and Palliative

Care: Basic Health Care and Support (#8863).

2. ACTIVITY DESCRIPTION

$100,000 of this activity supports the Youth Prevention Initiative programmed with funds from the $7 million

FY 08 plus up. Although the Initiative will primarily be targeting urban areas, A2E will be able to implement

related activities in the peri-urban areas of the province.

After a pilot project in two districts, in FY 2006 PATH and Population Council Frontiers project implemented

the Kenya Adolescents Reproductive Health Project (KARHP) in Western province. Together with local staff

of three Ministries: Health (MOH), Education (MOE), and Gender, Culture and Social Services (MOGCSS),

PATH and Frontiers covered all the districts of the province. This methodology will be rolled out throughout

the country in FY 2007-08. Although messages need to be tailored to specific target groups, all of them

include reducing stigma associated with HIV/AIDS, the protective effects of abstinence and faithfulness to a

partner of known HIV status, and the importance of knowing one's HIV status and taking appropriate action.

These actions could include starting and adhering to ART if HIV-positive, and practicing healthy behaviors,

including condom use when appropriate, regardless of serostatus. Providing appropriate messages and

services to pre-adolescents and their families will also continue to be a priority. The grant-making process,

including the formation of the technical review committee, establishing criteria, and identifying local partner

capacity-building needs started in FY 2007, as did community entry activities to mobilize village health

committees (VHCs). These serve as a link between the needs of communities and available services

provided by existing health facilities and comprehensive care centers. In FY 2008, the process will be

expanded to provide VHCs with ongoing training and support project-based animators. Communities will

conduct health self-assessments and develop action plans, assisted by "quick-win" grants to operationalize

the necessary structures and enlist widespread support. Health management committees will receive

mentorship and training to introduce transparency into their programmatic and financial operations. Using

the key messages already known and accepted by the community, outreach and health action days will be

implemented as will appropriate activities to reach youth, such as the Youth Sports Initiative, to build life

skills and disseminate HIV/AIDS information focusing on abstinence and being faithful. These sub-grantees

will, depending on the focus of the organization, conduct mobilization activities to engage youth and their

families in ways that will minimize their risk of engaging in unsafe behaviors, reduce stigma associated with

HIV/AIDS, and encourage community members to access local services. Selected groups will be provided

with both structured capacity-building support as well as reinforcement through mentorship. This ongoing

relationship will include assisting sub-grantees to better access local services, to participate in community

mobilization, and to share the results of their work with other local groups. To complement the sub-grants

program, APHIA II Eastern will undertake advocacy with groups including religious leaders, elected officials

and other opinion leaders. In FY 2008, the process will be expanded to reach a larger number of community

members. Organizations that will be selected for grants will, as part of this training and the ongoing

mentoring through supportive supervision that constitutes an essential program activity, be updated on

national policy and international standards.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will reach 500,000 individuals, especially youth, with abstinence and being faithful messages.

2,500 hundred individuals will also be trained to promote HIV/AIDS prevention through abstinence and/or

being faithful. This will greatly contribute to USG's 5-year strategy in support of Kenya's integrated

HIV/AIDS programs, by developing strong networks at the community level for a sustained response.

Activities will link sub-grantees to other groups undertaking age-appropriate community outreach activities

that deliver prevention messages, involve them in youth sports initiatives, encourage them to participate in

message development, and facilitate reaching them through community-based radio programs.

4. LINKS TO OTHER ACTIVITIES

This activity relates to activities in counseling and testing (#8782), ART (#8792), OVC (#9041), OP (#8932),

and home-based care services (#8863). Capacity development of partners currently engaged in community

mobilization to support the needs of community members using key messages that conform to national

priorities and strategies targeted to local conditions and specific target populations will be addressed.

5. POPULATIONS BEING TARGETED

This activity directly targets in-school youth and their parents to support increased positive communication.

Secondary targets are groups that serve out-of-school youth, as these groups will be supported to better

serve their constituencies using approaches and messages based on state-of-the-art knowledge and

approaches. It also indirectly targets adults in the general population through its efforts to reduce the stigma

surrounding HIV/AIDS and to promote gender equity. Strategies to improve the use of services will target

policy makers, the general population, and Ministry of Health staff working as program managers in the

DRH at provincial and district level, and local community leaders.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will reduce stigma associated with being affected by HIV/AIDS, increase gender equity in

programming through the delivery of key messages and wrap around in education.

Activity Narrative:

7. EMPHASIS AREAS

Major emphasis is capacity building of local organizations and minor emphasis on information, education

and communication and strategic information.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $1,200,000

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

REFERENCES TO TARGETS AND BUDGETS.

EARLY FUNDING IS REQUIRED FOR THIS ACTIVITY; $500,000

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

+ geographic coverage has been expanded to include Kitui, Makueni, and Mwingi

+ OP funds totaling $29,000 will contribute to the sensitization of teachers as a worksite population linking

with AB and OPHS funds for a $150,000 activity to reach 750 teachers and train 20 more.

+APHIA II Eastern will work with select health facilities, police, uniformed services, opinion leaders and

others on issues of gender-based violence.

+ The OP activity will include Prevention with Positives (PwP) activities working through PLWA support

groups linked to the Comprehensive Care Centers in Eastern province.

+ APHIA II Eastern will also expand their activities with CSWs and MSMs in Eastern province

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Counseling and Testing (#8782), Prevention of Mother-to-Child

Transmission (#8752), Orphans and Vulnerable Children (#9041), Abstinence and Be Faithful Programs

(#8725), HIV/AIDS Treatment: ARV Services (#8792), Palliative Care: TB/HIV (#9069) and Palliative Care:

Basic Health Care Support (#8863).

2. ACTIVITY DESCRIPTION

In FY08, APHIA II Eastern will reach 200,000 individuals, train 2,000 people and distribute condoms through

100 outlets. Civil society activities are crucial to promoting healthy behaviors. Significant and sustained

behavior change requires not only information transmission, but attitudinal change and sustained

reinforcement that increases levels of perceived self-efficacy that ultimately results in normative change.

Although messages need to be tailored to specific target groups, all of them, developed in harmony with

National AIDS and Sexually Transmitted Infection Control Program (NASCOP) and the Division of

Reproductive Health (DRH), include reducing stigma associated with HIV/AIDS, the protective effects of

abstinence and faithfulness to a partner of known HIV status, and the importance of knowing one's HIV

status and taking appropriate action. These actions could be starting and adhering to antiretroviral treatment

(ART) if HIV positive, and practicing health behaviors, (including condom use and use of MCH/FP services)

regardless of serostatus. In FY 2006, a grant-making process was established through PATH and CLUSA,

who have used this approach in other areas of Kenya. A first set of grants was made and activities started

up. In FY 2007 this program will be expanded to reach more families and communities. Work will include

implementing prevention interventions through civic group partners, and through men's and women's

groups. Activities will integrate prevention messages about parent-child communication, gender-based

violence, and youth participation. Other avenues used will include working through the Youth Sports

Initiative as a means to building life skills. Communities will conduct health self-assessments and develop

action plans, assisted by "quick-win" grants to operationalize the necessary structures and enlist

widespread support. Village health committees (VHCs) within a facility catchment area will form sub-location

health coordination committees, which in turn will serve as forums for sharing among VHCs and for

coordinating activities that affect multiple VHCs. Health management committees will receive mentorship

and training to introduce transparency into their programmatic and financial operations. This ongoing

relationship will include assisting sub-grantees to better access local services, to participate in community

mobilization, and to share the results of their work with other local groups. Key messages and strategies

developed by National AIDS and Sexually Transmitted Infection (STI) Control Program (NASCOP), and

local DHMTs will form part of all social mobilization activities. In FY 2007 the program will also be expanded

to include identification of workplaces- including those in non-health sectors such as agriculture, banking,

transportation, trade, food and hospitality, fuel service and education- for dissemination of information and

counseling and testing service delivery. For example, due to the long distance travel associated with

commercial trade, truckers often frequent hotels and transient lodges along the highway that runs along the

southeast border of Eastern province. These lodgings are excellent settings for information dissemination

that will build on and complement programs such as the regional Corridors program. Police posts, hotels,

and will also be reached through the program. Peer coordinators will be trained through a cascading

trainers program. Informal workplaces will also form part of the program. PATH will work with youth as a

cross-cutting population that has access to other groups within families. Youth will function both as

advocates during interventions, and as a means of reaching their peers. Using the overall behavior change

communication (BCC) strategy and key messages developed in FY 2006, activities this year will include

community outreach activities that are youth-centered, including production and distribution of Nuru comic,

Magnet theater (a technique already in use elsewhere in Kenya that targets a whole community on a

repeated basis), youth murals, and contest of various types. The team will also train faith-based and non-

governmental organizations (FBOs and NGOs) to deliver ABC messages to high-risk groups, men's groups

to disseminate accurate and appropriate information and promote the use of voluntary counseling and

testing (VCT), prevention of mother-to-child HIV transmission (PMTCT) and antiretroviral treatment (ART)

services, and will expand message reach through community radio programs. Messages will also aim to

reduce stigma. People living with AIDS (PLWAs) will be involved in the design and implementation of

outreach programs. To complement the prevention program, JHPIEGO and its partners (particularly the

DHMT) will undertake advocacy with groups including religious leaders, elected officials and other opinion

leaders.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

Activities being carried out will contribute directly to USG's 5-year strategy in support of Kenya's integrated

HIV/AIDS programs, by developing strong networks at the community level for a sustained response. The

activity will serve 100 condom service outlets and 200,000 individuals will be reached through community

outreach that promotes HIV/AIDS prevention through other behavior change beyond abstinence and being

faithful. A total of 2000 individuals will be trained to promote HIV/AIDS prevention programs.

4. LINKS TO OTHER ACTIVITIES

This activity relates to activities in orphans and vulnerable children (#9041), counseling and testing (#8782),

abstinence/be faithful to promote health behaviors amongst youth and reduce stigma by encouraging

individuals to know their HIV status (#8725). It also relates to PMTCT (#8752), Palliative Care: TB/HIV and

HBHC (#9069) and (#8863) and ARV services (#8792) expanding HIV prevention in care and treatment

settings.

Activity Narrative:

5. POPULATIONS BEING TARGETED

This activity directly targets the general population as well as youth and their parents, as well as at-risk

groups to support increased positive communication and increased use of services. Secondary targets are

groups that serve youth, as these groups will be supported to better serve their constituencies using

approaches and messages based on state-of-the-art knowledge and approaches. Strategies to improve the

use of services will target policy makers as well as the general population, Ministry of Health staff working

as program managers in the DRH at provincial and district level, and local community leaders.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity addresses stigma reduction associated with being affected by HIV/AIDS, increase gender

equity in programming through the delivery of key messages.

7. EMPHASIS AREAS

Major emphasis addressed in this activity is community mobilization/participation and minor emphasis on

development of network/linkages/referral systems, training and linkages with other sectors.

Funding for Care: Adult Care and Support (HBHC): $700,000

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

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

The APHIA II Eastern HBHC activities relate to HIV/AIDS treatment/ARV services (#8792), Counseling and

Testing (#8782), Other Prevention (#8932), Orphans and Vulnerable Children (#9041), TB/HIV care

activities (#9069), AB (#8725), PMTCT (#8752) and Strategic Information (#8875).

2. ACTIVITY NARRATIVE

USAID-APHIA II Eastern will continue to facilitate strengthened, improved and expanded care and support

for Persons living with HIV/AIDS (PLWAs), their families and caregivers. In collaboration with the Ministry of

Health, the Department of Social Services and existing structures at district and constituency levels, local

implementing partners from among MOH facilities, FBOs, NGOs and CBOs will be identified within the

targeted areas and supported with capacity strengthening and referrals strengthening to provide integrated

and comprehensive home and basic health care for the target group.

This activity will provide integrated and comprehensive home and basic health care to 15,000 PLWAs.

These patients will be linked to 35 health facilities providing care. Through a cascaded training of trainers,

150 primary care facility health workers will be trained to provide comprehensive and integrated care

training to 1,000 home /community based care workers who in turn train the primary care givers at home, to

complement the facility based services. At 35 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 35 facilities and appropriately managed. A case manager will

manage referrals to and from the community. The community based component will include The community

based component will include provision of small grants to approved CSOs and capacity building for the

funded CSOs (CBOs, FBOs and NGOs, PLWA support groups) in the technical areas of palliative care,

system strengthening in programming and management, continuous technical mentoring and monitoring

through supportive supervision and quarterly review meetings, strengthening linkages and referral

mechanisms for better access to services (both facility & other community services), sensitization on

community mobilization, and to share results of their work and strategies with other local groups.

The capacity of PLWA support groups and older OVC will be strengthened so as enable them to be pro-

active leaders, advocates and participants in the response to the epidemic and will also be linked to other

microfinance institutions operating in the region and or trained on how to run IGAs.

The Community care & support component will continue to provide the following services: psychosocial

support, treatment literacy, basic management of OIs, ART and TB treatment adherence, adequate

nutrition, home hygiene and nursing care, malaria prevention and treatment sensitization, FP and

identification and referral of clients to health facility for services in the areas of HIV, TB, RH and other

related health care issues. The identified local, partner CSOs will use USAID-APHIA II Eastern tools for

assessment to identify the neediest PLWAs households and type of needs for each PLWA and household.

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.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

The APHIA II Eastern will reach 15,000 clients. 1,150 individuals, including 150 facility-based health

workers and 1,000 community-based caregivers, will be trained to provide palliative care through 35 service

outlets. This APHIA II Eastern 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-Eastern will adhere to GOK policies and guidelines and participate in national-level HIV

technical working groups.

4. LINKS TO OTHER ACTIVITIES

The APHIA II Eastern HBHC activities will relate to HIV/AIDS treatment/ARV services (#8792), Counseling

and Testing (#8782), Other Prevention (#8932), Orphans and Vulnerable Children (#9041), Palliative Care:

TB/HIV (#9069), AB (APHIA II Eastern), PMTCT (#8752), Strategic Information (#8875). Efforts will also link

more clients to HIV counseling and testing, ARV and to ensure ARV and DOTS adherence will be stepped

up in FY 2008.

5. POPULATIONS BEING TARGETED

Populations are being targeted are: 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 other health workers for training.

6. KEY LEGISLATIVE ISSUES ADDRESSED

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.

7. EMPHASIS AREAS

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).

Funding for Care: TB/HIV (HVTB): $300,000

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

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

The activity will link to APHIA Eastern other activities in CT (#8782), HBHC (#8863), ART (#8792), OP

(#8932), OVC (#9041), PMTCT (#8752) and AB (#8725).

2. ACTIVITY DESCRIPTION

In FY 2007 USAID'S APHIA II Eastern project (implemented by JHPIEGO and its Implementing Partners)

will provide support to TB control activities with the National Leprosy and Tuberculosis Program (NLTP) and

continue to build the capacity of health workers in Ministry of Health (MOH) facilities in Northern region of

Eastern Province, to provide for TB and HIV treatment and care services. In FY 2006 JHPIEGO supported

the training of 250 health workers in ART across twenty districts in Eastern and Nairobi province, which

helped to improve the quality of TB/HIV services in 20 sites. Over FY 2006-2007, APHIA II Eastern

supported the training of nearly 400 health workers in provider-initiated HIV testing and counseling (PITC)

across 7 districts in Eastern province, which improved the quality of TB/HIV services. JHPIEGO will

continue to participate in the MOH's Technical Working Group to ensure coordination of TB and HIV

activities and compliance with MOH guidelines. APHIA II Eastern will increase the number of providers and

sites that can offer effective TB care, which will in turn increase the number of individuals provided with HIV

and TB services, as well as the number of HIV infected clients given TB preventive therapy. This activity

seeks to provide TB treatment to 2,000 HIV infected clients attending HIV care/treatment services and

increase the number of service outlets providing clinical prophylaxis and/or treatment for TB for HIV infected

individuals to 20.

Intensified TB screening for 7500 HIV patients and HIV screening for 2000 TB suspects/patients will be

offered as a standard of care in all the facilities; approximately 1000 TB patients will be identified as being

infected with both TB and HIV. The activity will support training of HIV and TB care staffs on routine

diagnostic testing and counseling of TB suspects and cases using the NLTP/NASCOP curriculum, provide

additional staff as required, screen HIV cases for TB, upgrade laboratories with additional equipment, and

renovate laboratory space, as necessary. CTX prophylaxis will be introduced for all HIV infected TB cases

and referrals for ART made to all CCCs. 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 will be increased to integrate TB into their on-going HIV/AIDS activities. Low literacy

materials on TB/HIV will be reproduced and supplied. The private providers will be trained and linked to the

public HIV/AIDS and TB programs.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This APHIA II

Eastern TB/HIV care activity will provide clinical prophylaxis and treatment for TB to 2,000 people and train

500 health workers in TB/HIV related activities in 20 health care facilities in Eastern Province. It also

contributes to Kenya's 5-year strategy emphases of developing effective linkages between prevention, care

and treatment services within an integrated network.

4. LINKS TO OTHER ACTIVITIES

The activity will link to APHIA Eastern other activities in CT (#8782), HBHC (#8863), ART (#8792), OP

(#8932), OVC(#9041), PMTCT (#8752) and AB (#8725) that all seek to provide comprehensive district

based services coordinated at the provincial level. This partner will also work closely with CDC supported

partners in the Southern region of Eastern Province.

5. POPULATIONS BEING TARGETED

This activity targets people living with HIV/AIDS, including infants and children. It also targets other MOH

staff including program managers in the NASCOP, and public health care doctors and nurses.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will help to reduce stigma and discrimination.

7. EMPHASIS AREAS

This activity includes major emphasis on training and minor emphasis on development of

network/linkages/referral systems. APHIA II Eastern 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.

Funding for Care: Orphans and Vulnerable Children (HKID): $5,500,000

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 Counseling and Testing (#8782), ARV services (#8792), Palliative Care:

Basic Health Care and Support (#8863).

2. ACTIVITY DESCRIPTION

The Ministry of Home Affairs, particularly the Children's Department, in partnership with the Ministries of

Health and Education, provide leadership and coordination to the National OVC program. Part of the GOK's

role has been the development of a policy on OVC. The APHIA II-Eastern project will use this policy as a

framework to support locally based NGOs, CBOs and FBOs to provide services to OVC as part of a

comprehensive care system. In FY 2006, APHIAII Eastern worked with PMO staff, the District Children's

Officers and the DHMT to adapt a grant-making process and cycle modeled after the Maanisha model that

has been in place in Nyanza and Western for several years. With AMREF, the developer and successful

implementer of the model, taking the lead on this activity, the grant-making process, including the formation

of the technical review committee, establishing criteria, and identifying local partner capacity-building needs

has commenced. In FY 2008, the process will be expanded to reach a larger number of OVC. Organizations

that will be selected for grants will identify OVC and families and support communities to support OVC in

non-institutional settings in a variety of ways, depending on the focus of the organization. Examples include

working to keep OVC in school (paying for school fees and uniforms), providing them with vocational

training, providing psycho-social support assisting them to obtain health services and/or nutritional support,

and otherwise engaging them in ways that will minimize their risk of engaging in unsafe behaviors. All sub-

grantees will, as part of this training and the ongoing mentoring through supportive supervision that

constitutes an essential program activity, be updated on national policy and international standards.

Selected groups are not simply given funds and asked for reports, but they are provided with both

structured capacity-building support as well on on-the-job type training and reinforcement. This ongoing

relationship will include assisting sub-grantees to better access local services, to participate in community

mobilization, and to share the results of their work with other local groups.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

The 2008 activities will serve 45,000 OVC and train 4,500 caregivers. APHIA II Eastern will also train 650

Area Advisory Council members and strengthen capacity of CBOs, and FBOs that will serve as outlets for

OVC. Through its activities APHIA II Eastern will emphasize strengthening community-level capacity to

develop, implement and sustain appropriate responses to the HIV/AIDS crisis.

4. LINKS TO OTHER ACTIVITIES

This activity is linked to the counseling and testing (#8782) and efforts to prevent future HIV infections,

home based care (#8863) community services and provision of care for those already infected, and creating

a positive image of VCT. Efforts will link to work being done on offering effective ART (#8792) and provision

of care to HIV infected children so that families with affected and infected children can benefit from

appropriate care.

5. POPULATIONS BEING TARGETED

This activity directly targets OVC and adults that are involved in providing them with care. It also indirectly

targets adults in the general population through its efforts to reduce the stigma surrounding OVC and policy

makers. Building the local capacity of these communities will rely on closely working with community and

religious leaders as well as local community based and faith based organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will reduce stigma associated with being affected by HIV/AIDS as well as increasing gender

equity in programming through the delivery of key messages. Linkages will be created with systems/groups

offering support in food, microfinance, education, and as appropriate, reproductive health.

7. EMPHASIS AREAS

Major emphasis will be development of networks/linkages and referral systems while minor emphasis is

information, education and communication, and strategic information.

Funding for Prevention: HIV Testing and Counseling (HVCT): $1,200,000

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 and expanded to include additional districts in the Eastern

Province

+ target population will be expanded to include OVCs

+ APHIA II Eastern 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 relates to activities in PMTCT (#8752), TB (#9069), AB (#8725) and OP (#8932), and ART

(#8792).

2. ACTIVITY DESCRIPTION

In 2008, this activity will reach 100,000 individuals with CT services including PITC, VCT and HBCT through

30 outlets and will train 300 providers. In FY 2007 USAID's APHIA II Eastern Project - JHPIEGO will

continue to promote the availability and delivery of high quality counseling and testing (CT) services in

public Ministry of Health (MOH) facilities, an essential element of clinical and preventive care. JHPIEGO

and other organizations such as EGPAF have found that ART initiation is increased where the diagnostic

testing and counseling program was established in 2006. APHIA II Eastern project will collaborate with the

Ministry of Health's (MOH) National AIDS and STI Control Program (NASCOP) and National TB and

Leprosy program (NLTP) to strengthen provincial level management and coordination of Counseling and

Testing in the clinical setting related to in-service training at all levels of health care delivery. This will be

done through the following strategies; strengthen planning, implementation and coordination of CT in-

service training; develop a provincial core team of trainers by conducting a training of trainers course (TOT)

for NASCOP/NLTP / and Provincial Health Management team (PHMT). In FY 2007 this activity will continue

to expand the geographical coverage of this service to increase access for couples and families. A total of

25 new VCT sites will be established in public and faith based health facilities. Training in VCT and DCT will

be provided for 150 counselors and health care workers respectively. As a result 20,000 individuals will be

counseled and tested and referred to care, treatment and other services as required. Increasing access to

antiretroviral therapy dictates that CT efforts quickly transform to accommodate active case finding through

provider initiated testing, PIT, in clinical settings, in addition to the more passive client initiated testing, CIT.

Existing integrated VCT sites are particularly well placed to support these efforts; they will be strengthened

to support DTC efforts e.g. supporting start up activities, providing testing for partners and other family

members of index patients, and providing ongoing counseling. Testing in clinical settings will require support

for logistics, creation and renovation of space especially at inpatient facilities, supportive supervision,

ongoing monitoring, and mainstream CT reporting. Existing supported VCT sites already serve a large

population of young people aged 24 and younger. In addition to existing dedicated youth VCT services,

counselors at general VCT sites will be trained to work with young people. Targeted outreaches to youth

centers and tertiary institutions, will also reach young people. Experiences with comprehensive counseling

services at existing youth VCT centers including alcohol and substance abuse prevention counseling;

gender based violence prevention and counseling, pregnancy prevention/FP; STI prevention, diagnosis and

treatment; and referral to addiction treatment services; will be documented and used to scale up these

efforts at existing general VCT sites. Outreach services, health action days, will require effective

supervision, sessional staff, supplies, data collection and other logistics. BCC strategies supported by

CBOs, FBOs, churches and mosques will encourage people to know their HIV status, and develop

discordant couples support groups.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This program will contribute to 2007 emergency plan result for increased availability of counseling and

testing through training of health workers. A total of 20,000 individuals will receive CT services.

4. LINKS TO OTHER ACTIVITIES

This activity is linked to the prevention of mother to child transmission (#8752), TB (#9069), AB (#8725), OP

(#8932) and other care programs including treatment (#8792). The proposed CT training and supervision

activities by NASCOP will link with APHIA II Eastern Program activities.

5. POPULATIONS BEING TARGETED

This activity targets adolescents and adults, including HIV positive pregnant women. It also targets Ministry

of Health staff working as provincial ART Program Officers, physicians, pediatricians as well as clinical

officers, nurses, midwives and other health care workers in public and faith based facilities. Most at risk

populations will also be a target for this activity with a focus on commercial sex workers, discordant couples

and street youth.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will help reduce stigma associated with HIV status by increasing the availability of routine

testing for diagnosis in medical settings.

7. EMPHASIS AREAS

The activity includes a major emphasis on training. Minor emphasis will be in quality assurance and

supportive supervision and development of network/linkages/referral systems. Minor emphasis on

community mobilization activities as the activity will be integrated to the prevention program.

Funding for Treatment: Adult Treatment (HTXS): $1,700,000

N/A (exempt)

Funding for Strategic Information (HVSI): $200,000

THIS IS AN ONGOING ACTIVITY.

The only changes to the program since approval in the 2007 COP include +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. Targets and funding level have also

changed.

1.LIST OF RELATED ACTIVITIES

This activity is related to strategic information activities to be carried out by University of North

Carolina/MEASURE Evaluation (#7098), NASCOP (#7002), and SI Targeted Evaluation/TBD (#9220).

2. ACTIVITY DESCRIPTION

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 Committees (CACC) levels by NACC through three

key components. Component 1: Support APHIA II EASTERN/JHPIEGO and MOH program data collection

processes for performance reporting needs (quarterly, semi-annual, annual). This component will support a

participatory, coordinated and efficient data collection, analysis, use and provision of information to track

achievement of APHIA II EASTERN/JHPIEGO and MOH's district level Annual Operation Plan II objectives,

and 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 EASTERN/JHPIEGO and MOH to

measure progress towards its contribution to the overall country's Emergency plan, National Health Sector

Strategic Plan II and Kenya 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

lead role in coordinating M&E activities in the province to meet the information needs of USAID/Kenya, the

Emergency Plan, MOH, NACC and other stakeholders, in line with the "three ones" principle. APHIA II

EASTERN/JHPIEGO 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 100 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 Eastern/JHPIEGO 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 Eastern province. These efforts should result into demonstrated evidence in increased national

level reporting by up to 60% from health facilities to NASCOP national database.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

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

local organizations/health facilities in strategic information in addition to supporting the training of 55 SI and

program managers in M&E/HMIS, reporting and data use for program management

4. LINKS TO OTHER ACTIVITIES

This activity is related to the strategic information activity to be carried out by University of North

Carolina/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 be 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.

5. POPULATIONS BEING TARGETED

This activity targets host government and other health care workers like M&E and HMIS officers

responsible 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 in 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.

Funding for Health Systems Strengthening (OHSS): $100,000

THIS IS A NEW ACTIVITY.

1. ACTIVITY DESCRIPTION

USAID APHIA II Eastern began activities in Eastern in FY 2006. In FY 2008 APHIA II Eastern 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 Eastern will support provincial and district health systems strengthening by convening

consultative meetings and various stakeholders' forums. The activity will target to reach at least seven of

the thirteen districts in the province and train approximately 70 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 Eastern 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.

Subpartners Total: $0
Pepo la Tumaini: NA
Ripples International: NA
Cooperative League of the USA: NA
Hope Worldwide: NA
Tumaini Awareness Group: NA
Elizabeth Glaser Pediatric AIDS Foundation: NA
Liverpool VCT, Care and Treatment: NA
Program for Appropriate Technology in Health: NA
Amref Health Africa: NA
FHI 360: NA