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

REFERENCES TO TARGETS, BUDGETS AND EMPHASIS AREAS.

1. LIST OF RELATED ACTIVITIES

This activity relates to counseling and testing (#8776), ARV services (#8797), palliative care: home based

care and support (#8929), abstinence and be faithful (#9070) and other prevention (#9040) activities.

2. ACTIVITY DESCRIPTION

This APHIA II Rift Valley activity will expand PMTCT services in the Rift Valley province, building on the

support previously provided through USAID's IMPACT and AMKENI Projects. It aims to increase the uptake

of counseling, testing (CT) and ARV prophylaxis to at least 80% of pregnant women in selected sites. In 150

facilities across several districts in Rift Valley Province CT will be provided to 178,372 pregnant women,

ARV prophylaxis to 8,797 HIV-positive women. Of these 4399 HIV positive women will receive AZT

prophylaxis, 2,639 will receive single dose nevirapine while 1,759 will be put on HAART. Service delivery

will incorporate best practices namely opt-out approach and rapid testing. Sites will include, or 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 including early infant diagnosis to reach 4,399

exposed infants in the mother and child health clinics (MCH) are priorities. Cost barriers to ART uptake

especially laboratory costs in its sites will be addressed. Significant changes from 2007 include the

provision of universal and more comprehensive PMTCT services in Rift Valley. Strategies to provide CT in

maternity services during labor and delivery, emphasis on early infant diagnosis, male involvement, and

greater involvement of people living with HIV/AIDS 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 APHIA II Rift Valley will support 300 sites, train 600 additional health care

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.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

PMTCT in this geographical area will significantly support PEPFAR goals for primary prevention and care

by contributing 14.7% 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 who are potential candidates for ART. Access to services, medical

treatment and care will encourage rural women in underserved communities to attend ante natal care

services. This will facilitate postnatal follow up of HIV positive women, infants and their family members.

This APHIA II Rift Valley activity also contributes substantively to Kenya's 5-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, ARV services, Palliative care, OVC, AB and other prevention activities described

in the APHIA II Rift Valley in other areas of the COP. PMTCT plus services include counseling and testing

which is largely diagnostic, provision of ARV prophylaxis, management of opportunistic infections and ARV

services. Strengthening laboratory services and improving commodity logistic systems is a crucial part of

HIV/AIDS treatment services.

5. POPULATIONS BEING TARGETED

This APHIA II Rift Valley 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 Rift Valley PMTCT 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 and task shifting,

development of network/linkages/referral systems to wrap around programs in malaria, family planning, safe

motherhood, TB and nutrition programs. Support to strategic information will be provided.

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:

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

million FY 08 plus up

• geographic coverage has been expanded to include Pokot West, Pokot East, Trans Nzoia South, Trans

Nzoia North, Baringo North, Baringo Central, Turkana North, Turkana South, Marakwet and Keiyo districts.

• the target population has been expanded to include the disabled population, Kenya Girl Guides

Association and teachers at the worksite.

• $23,000 in AB funds will go toward this worksite activity complemented by allocations in OP and OHPS

totaling $150,000 to reach 750 teachers and train 20 more

• in response to the Ministry of Education's request the KARHP methodology will be rolled out targeting

teachers and in-school youth

• APHIA II RV will expand to include activities of the former TCI in at least one community (Salgaa) along

the Mombasa/Kampala highway

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in HVCT (#8776), HBHC (#8929), HTXS (#8797), HVOP (#9040), HKID

(#9029), MTCT (#8733) and HVTB (#9065).

2. ACTIVITY DESCRIPTION

APHIA II Rift Valley (A2RV) will reach 700,000 individuals with abstinence and being faithful messages in

the Rift Valley. They will employ a 360 degree Model of Protection that seeks to delay first sex and

increase secondary abstinence among youth between the ages of 10-24 years and increase safer sexual

practices among sexually active youth as well as promote fidelity and monogamous relationships among the

general population of Rift Valley. They will also seek to reach community women in low resource settings,

teachers, health care providers, the clergy and religious leaders with a special and specific focus on

PLWHA and provide the targeted populations with comprehensive skills for prevention of infection by STIs

in general and HIV in particular. The model calls upon families, schools, health facilities, places of worship

and communities to meet the HIV/AIDS needs of the populations by developing activities that build the

capacity of the populations to establish and maintain healthy behaviors to avoid HIV and STIs and to

advocate for cultural changes that promote low-risk behavior. The model aims to encompass individuals

with a supportive environment at every level of their lives (family, peers, school and community). 3,000

individuals will be trained to provide AB programs in the different groups. The AB program will be

implemented by FBO sub-partners and other NGO/CBOs to integrate life skills programs for HIV/AIDS

prevention, drug and alcohol abuse. In addition, A2RV will work with the Kenya Girl Guides Association

(KGGA), the Ministry of Education and the Kenya Network of Positive Teachers, utilizing the Kenya

Adolescent Reproductive Health (KARHP) methodology, to reach out to more youth in and out of learning

institutions. Young Mens Christian Association (YMCA) will target underserved populations with Abstinence

and Being Faithful programs targeting Christian and Muslim faithful in Naivasha and Gilgil. The activity will

work with Islamic leaders like Imams and Madrassa teachers to reach the Muslim faithful. Partners for

Progress (PfP) will target youth out of school in Nakuru North, Nakuru South, Molo, Naivasha, Narok North,

Narok South, Kajiado, Loitokitok, Laikipia East and Laikipia West districts as well as target young female

sex workers in all the districts with livelihood skills to provide them an alternative to sex work. SWAK will

work with community women and their partners in low resource settings to promote mutual fidelity. The

activity will engage the Girl Guides in community outreach to deliver messages on prevention. The activity

will also develop, produce and distribute prevention communication material through the various partners

and networks implementing the activities in the Rift Valley province. Adolescent OVC's will be targeted by

integrating prevention education and life skills into the OVC support activities and by involving KGGA in

community outreach programs to target such vulnerable peers.

The activity will expand the youth peer education interventions using the Y-Peer approach established by

Youth-Net and UNFPA; work with the Provincial Education Office, Kenya National Union of Teachers

(KNUT) and KGGA to roll out life-skills peer education programs to schools in Rift Valley Province; and work

with tertiary training colleges, polytechnics and universities to integrate HIV/AIDS education using the ‘I

Choose Life' approach and NOPE's Ambassadors of Change (AOC) approach. APHIA II Rift Valley will

collaborate with more local youth groups and partners to implement the program.

The activity will link to counseling and testing, RH/FP, and other facility based services that enable the

reached populations to access treatment and other services. Particular attention will be given to creating

linkage with Gender based violence prevention and mitigation

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will reach 950,000 people through AB messages, contributing significantly to the overall 2007

PEPFAR goals. The activity will seek to integrate prevention with all community outreach for treatment and

care with a special emphasis on youth. It will significantly contribute to PEPFAR's goals for primary

prevention.

4. LINKS TO OTHER ACTIVITIES The activity will link to other APHIA Rift Valley activities in CT (#8776),

HBHC (#8929), ART (#8797), OP (#9040), OVC (#9029), PMTCT (#8733) and TB/HIV (#9065) that all seek

to provide comprehensive, district-based services coordinated at the provincial level.

5. POPULATIONS BEING TARGETED This activity targets adults, children and youth, particularly girls,

boys, primary and secondary school students.

6. KEY LEGISLATIVE ISSUE ADDRESSED Key legislative issues which will be addressed include gender,

addressing male norms and behaviors, volunteers, stigma and discrimination, and education at primary and

secondary levels.

7. EMPHASIS AREAS The activity will have a major emphasis on local organizational capacity development

with lesser emphases on information, education and communication, training and community mobilization

and participation.

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 to include Pokot West, Pokot East, Trans Nzoia South, Trans

Nzoia North, Baringo North, Baringo Central, Turkana North, Turkana South, Marakwet and Keiyo

+ $100,000 of this OP activity is programmed with funds from the $7million 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 AB and OPHS funds for a $150,000 activity to reach 750 teachers and train 20 more.

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

others on issues of gender-based violence.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Counseling and Testing (#8776), Palliative Care: Basic Health Care and

Support (#8929), HIV/AIDS Treatment: ARV Services (#8797), Abstinence and Be Faithful Programs

(#9070), Orphans and Vulnerable Children (#9029), Prevention of Mother-to-Child Transmission (#8733)

and Palliative Care: TB/HIV (#9065).

2. ACTIVITY DESCRIPTION

In FY08, this activity will build on HIV/AIDS prevention activities implemented under FY 2007 in the area of

"other prevention." Additionally the activities will also create linkages with STIs, Malaria, RH/FP, MCH and

TB services. The activities will reach 1,000,000 individuals through multifaceted community outreach

programs and train 2,500 people through existing local NGOs, CBOs, FBOs, Professional associations and

trade unions and the private sector and distribute condoms through 100 condom outlets. The activities will

reach target populations in Nakuru North, Nakuru South, Molo, Naivasha, Narok North, Narok South,

Kajiado, Koibatek, Baringo, Transoia West, Transoia East, Uasin Gishu, Nandi North, Nandi South, Keiyo,

West Pokot, Samburu, Laikipia, Turkana, and Samburu districts in Rift Valley Province. Under the

leadership of National Organization of Peer Educators (NOPE) the activities will target to reach both men

and women in the formal and informal workplaces; their extended families and also most at risk youth-out-of

-learning institutions with HIV/AIDS prevention messages. Local NGOs, CBOs, professional associations,

trade unions and FBOs will target the other high risk populations including low-income community women,

persons with disability, sex workers (with young female sex workers as special focus), long-distance truck

drivers and other men in the transport sector such as matatu/ tour van drivers, touts and bicycle taxi (boda-

boda and Tuk-Tuk) drivers, cattle traders and cattle drivers and the women who provide them services at

cattle markets or en route, street families, uniformed services - the Kenya Police, Armed Forces, NYS,

KWS, Prisons Service and their families, discordant couples and women in churches and mosques in Rift

Valley Province. Professional associations, trade associations and labour unions will target teachers and

health care providers and their families. Kenya National Union of Teachers (KNUT) and Kenya Association

of Positive Teachers will reach teachers in primary and secondary schools as well as tertiary training

colleges. Technical assistance partners will continue to provide assistance and capacity building to partner

organisations to implement strategic behaviour change preventive programs. The activity will work and link

with and provide referrals to existing networks of HIV counselling and testing as well as facilitate mobile and

home based testing, TB screening, home based care and ART programs in the program areas. Prevention

activities will include the following: community theatre targeting both in school and out-of-school and at-risk

youth with prevention information leading to behaviour change and referral to youth friendly services;

supporting peer education and peer counselling interventions with community women in low resource

settings, sex workers in Nakuru, Naivasha, Gilgil, Mai-Mahiu, Salgaa, Narok and support the setting up of

drop-in-centres; link them to VCT, PMTCT, care and support services; support prevention activities among

teachers, health care providers, support prevention efforts among the uniformed services and their family

members by supporting peer education among the ranks and working with provincial police Aids Control

Units (ACU); support prevention activities among people in confinement e.g. prisons, remand homes,

borstal institutions, promote advocacy among cultural gatekeepers and law enforcement agencies leading

to greater sensitivity to gender based violence and exploitation, expand the peer education program. 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 (MOH) and other

partners. This will also include targeted condom promotion and distribution to high-risk populations and

referral for STI services by the MOH and other partners. Local implementing partners will integrate

prevention messages into models of care and support for orphans and vulnerable children (OVCs) and

people living with AIDS (PLWA). Technical assistance will continue to be provided to partners implementing

behavior change communication (BCC) programs in HIV and substance abuse and develop new print

materials addressing alcohol abuse, stigma and discrimination.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to the overall 2007 Emergency Prevention Plan for Kenya target reaching

individuals through other behavior change beyond abstinence and/or being faithful. The activity will seek to

integrate prevention with positives into all community outreach for treatment and care with special

emphases on youth. It will significantly contribute to PEPFAR's goals for primary prevention.

4. LINKS TO OTHER ACTIVITIES

The activity will link APHIA Rift Valley to other activities in CT (#8776), HBHC (#8929), ART (#8797), AB

(#9070), OVC (#9029), PMTCT (#8733), and TB/HIV (#9065) that all seek to provide comprehensive district

-based services coordinated at the provincial level. It will also link with the comprehensive cluster projects of

the FHI-TCI project along the major Mombasa-Busia highway.

5. POPULATIONS BEING TARGETED

The activity targets special populations particularly the most-at-risk populations of commercial sex workers,

military personnel, discordant couples and truck drivers. The activity also targets adult men and women.

6. KEY LEGISLATIVE ISSUE ADDRESSED

The activity addresses both gender and stigma and discrimination.

7. EMPHASIS AREAS

Activity Narrative: The major emphasis area for this activity is training with minor emphases on information, education and

communication and community mobilization/participation. APHIA II Rift Valley will undertake (1) prevention

activities with HIV positives (PwP) working through PLWA support groups linked to the Comprehensive

Care Centers in Nakuru and Naivasha. $50,000 of unallocated funds will provide support to patient support

groups and post-test clubs in VCT centers to ensure promotion of faithfulness and condom use by HIV-

infected persons. This will empower 5 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.

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 Rift Valley HBHC activities will relate to HIV/AIDS treatment services (#8797), Counselling

and Testing (#8776), Other Prevention (#9040), OVC (#9029), TB/HIV care activities (#9065), AB (#9070),

PMTCT (#8733) and Strategic Information (#8895).

2. ACTIVITY DESCRIPTION

This activity will provide integrated and a comprehensive home and basic health care package to 22,000

people with HIV/AIDS linked to 100 comprehensive care centers and a network of 202 Rural Health

Facilities (RHFs). Through a cascaded training of trainers, primary care facility health workers will be trained

to provide comprehensive and integrated care training to the 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

clinic, 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 counselling and education. All babies and children of

HIV infected mothers will be followed up at the CCCs or MCHs 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. The main link to and from the health facility will be the CHWs many of

whom will be treatment supporters. Formal linkages between health facilities and the community-based

activities will be strengthened to enhance effective care, follow-up, and tracking of referrals and assessment

of patient response and satisfaction with the services. Both formal health care workers and community and

home-based volunteer care workers will be trained on effective referrals. In some instances, 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 25 districts and relevant

DHMTs institutions to integrate, plan, lead, monitor and evaluate home and community care support

programs. This activity will lead to the linkage of 15,000 families with economic support programs using the

CRS SILC model. Community members including PLWA and some 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. 30,000 PLWH and their family members will receive

nutritional and food support and through collaboration with AGRI, 3,000 people will be trained on improved

agricultural techniques for food production. APHIA will tap into other USAID/FFP program to provide

supplementary nutrition to families caring for OVC. 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. Paralegal and child counsellor training will be

strengthened and through active monitoring and follow-up to assess its impact to the children and PLWA.

Provision of safe water supply in the homestead will be supported to reach 64,803 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.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

The APHIA II Rift Valley will reach 22,000 clients and 3,000 individuals will be trained to provide palliative

care through 302 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.

4. LINKS TO OTHER ACTIVITIES

The activity will link to APHIA Rift Valley other activities in PMTCT (#8733), TB/HIV HIV/AIDS treatment

services (#8797), Counselling and Testing (#8776), Other Prevention (#9040), OVC (#9029), TB/HIV care

activities (#9065), AB (#9070) that all seek to provide comprehensive district based services coordinated at

the provincial level.

5. POPULATIONS BEING TARGETED

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

other health workers.

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. In addition, it will address Wrap Arounds through the provision of food

and microfinance/micro credit.

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).

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 Rift Valley other activities in CT (#8776), Palliative Care: Basic Health Care

and Support (#8929), ARV services (#8797), Condoms and Other Prevention (#9040), Orphans and

Vulnerable Chiildren (#9029), Prevention of Mother to Child Transmission (#8733) and Abstinence and Be

Faithful (#9070).

2. ACTIVITY DESCRIPTION

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 urban, poor populations in Mombasa and

Nairobi. In addition, these activities have supported strengthening of the Central Reference Laboratory,

linkage into the home-care programs to introduce/strengthen community-based DOTS, 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. In the nomadic pastoralist

population of Samburu district, this activity funded the SADIA Project that strengthened ‘manyatta' TB care

and introduced community-based DOTS and HIV care to nomadic populations. This activity seeks to

provide 2,000 HIV infected clients attending HIV care/treatment services treatment for TB disease and

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

individuals to 40.

Intensified TB screening for 11000 HIV patients and HIV screening for 2000 TB suspects/patients will be

offered as a standard of care in all the facilities; approximately 1500 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. In addition, INH prophylaxis will be introduced at select

Comprehensive Care Clinics (CCCs) and the congregate settings of Naivasha GK Prison and other prisons.

CTX prophylaxis will be introduced for all HIV infected TB cases and referrals for ART made to all CCCs.

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 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 either the public HIV/AIDS and TB programs or the Gold

Star Network whose target is paying clients in the private sector.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This APHIA II RV TB/HIV care activity will provide

clinical prophylaxis and treatment for TB to 2000 people and train 100 health workers in TB/HIV related

activities in 40 health care facilities in Rift Valley Province.

4. LINKS TO OTHER ACTIVITIES The activity will link to APHIA Rift Valley other activities in CT (#8776),

Palliative Care: Basic Health Care and Support (#8929), ARV services (#8797), Condoms and Other

Prevention (#9040), Orphans and Vulnerable Chiildren (#9029), Prevention of Mother to Child Transmission

(#8733) and Abstinence and Be Faithful (#9070) that all seek to provide comprehensive district based

services coordinated at the provincial level.

5. POPULATIONS BEING TARGETED This activity targets People Living with HIV/AIDS and also HIV/AIDS

affected families.

6. EMPHASIS AREAS This activity has a major emphasis on networks/linkages/referral systems and minor

emphases in supportive supervision, development of referral systems, IEC, and linkages with other sectors

and initiatives.

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 Abstinence and Be Faithful (#9070), Counseling and Testing (#8776), Palliative Care:

basic health care (#9065), PMTCT (#8733),TB/HIV (#9065), Other Prevention (#9040), and ARV (#8797).

2. ACTIVITY DESCRIPTION

Orphans and Vulnerable children remain a key challenge in the provision of care and support and Rift

Valley Province faces huge challenges in this area as it is estimated to have the second highest number of

OVC in Kenya after Nyanza Province. There are already existing programs responding to the needs of OVC

but these are in most cases providing a scattered and uncoordinated response. A corresponded response

will be achieved by provision of a comprehensive package of support by APHIA Rift Valley directly but also

work to coordinate partners to ensure that a comprehensive package of support to OVC is provided by all

partners. Through the technical leadership of World Vision and Social Impact the capacity of NGOs, CBOs,

FBOs will be strengthened through training of trainers so as to enable them train caregivers to 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, caregivers, 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 (Cooperative

League of the USA), one of the APHIA Rift Valley technical partners will provide support in mobilizing the

community to lead the response to OVC.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity therefore seeks to provide comprehensive support to 45,000 orphans and vulnerable children

and their households directly and through leveraged resources from other partners in the region and also

train 4,500 caregivers. This will contribute significantly to the overall 2008 emergency plan targets for

Kenya.

4. LINKS TO OTHER ACTIVITIES

This activity links to APHIA Rift Valley other activities in Abstinence and Be Faithful (#9070), Counseling

and Testing (#8776), Palliative Care: basic health care (#9065), PMTCT (#8733), TB/HIV (#9065), Other

Prevention (#9040), and ARV (#8797) that are intended to enhance service delivery and linkages between

the community and service delivery sites as well as strengthening the referral network for care.

5. POPULATIONS BEING TARGETED

This activity targets people affected by HIV/AIDS and specifically orphans and vulnerable children and also

caregivers of OVC. In addition this activity will target the community including community leaders and

religious leaders as well as community based and faith based organizations in the capacity development of

the community to serve the needs of the OVC.

6. KEY LEGISLATIVE ISSUE ADDRESSED

This activity will address mainly issues in gender, particularly for the girl child, as they relate to issues of

child labor, increasing women and girls access to income and productive resources and addressing the

issues of inheritance rights and protection of property rights for children and women. Wrap- around issues

as they relate to food and education will also be addressed.

7. EMPHASIS AREAS

The major emphasis area will be in community mobilization/participation with minor emphasis in the area of

local organization capacity development.

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 Rift Valley

Province

+ target population will be expanded to include OVCs

+ APHIA II Rift Valley 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 HIV/AIDS treatment services (#8797), abstinence and be faithful (#9070),

OVC (#9029), HBHC (#8929), TB/HIV care activities (#9065), other prevention (#9040), PMCT (#8733) and

strategic information (#8857).

2. ACTIVITY DESCRIPTION

In 2008, this activity will reach 200,000 individuals with CT services provided through 70 sites and will train

400 providers in VCT, PITC, and Home based testing. 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.

GOK, through the MOH already approved HIV testing protocol of serial testing of whole blood and simple

rapid HIV tests. Previous efforts concentrated on diagnostic testing mainly of patients who had signs and

symptoms of HIV disease and clinical indications of AIDS. This will be strengthened further through routine

testing of TB suspects and cases, pregnant women 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. Recognizing the important

role that dispensaries play in the provision of health services in the Rift Valley Province, outreach services

will be provided from selected static sites to high volume dispensaries. Home-based / family CT will also be

initiated in Nakuru, Naivasha and Molo Districts starting with the families of index patients who are enrolled

in home based care programs. This will require the recruitment and training or orientation of support or

session staff and community counselors who will work closely with mobile/outreach teams. Through

partnership with Family Health options, the IMPACT project had established VCT services for young people.

This will be scaled up through community mobilization and outreach services for young people in the region

together with NOPE and other local youth service organizations. Building on NOPE's work with workplace

HIV/AIDS programs, CT will be integrated in workplace programs in Naivasha and other workplaces and

actively link those that are infected to care and treatment either through the public program or the Gold Star

Network. The broadening of entry points to counseling and testing will require that at least 200 service

providers are trained in Routine and diagnostic counseling 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 Sub agreements in this program

will be awarded to National organization for Peer Educators (NOPE), CLUSA and the Ministry of Health.

Amounts and other sub agreements TBD.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This APHIA II Rift Valley 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 Rift Valley Counseling and Testing activities will relate to HIV/AIDS treatment services

(#8797), Abstinence and Be Faithful Program Abstinence and Be Faithful Program (#9070), OVC (#9029),

HBHC (#8929), TB/HIV care activities (#9065), OP (#9040)), PMCT (#8733) and strategic information

(#8857). 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. This activity will also target most at risk populations like commercial

sex workers, discordant cuoples, street youth, truck drivers, migrant workers, out-of-school youth and

partners of CSWs.

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 has a major emphasis in the development and implementation of referral systems and minor

emphasis in quality assurance and supportive supervision for CT counselors. This 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 Rify Valley province to strengthen their capacity to

implement programs.

Activity Narrative: THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED REFERE

N/A (exempt)

THIS IS AN ONGOING ACTIVITY.

The only change to the program since approval in 2007 COP includes

+plans to conduct group workshops centred on data use, one on one feedback sessions during supportive

supervision rounds focussing on data use to improve program and patient management, plans to improve

quality of data through increased frequency of data quality audit rounds will be increased and data

management capacity improved through workshops, on-job-trainings and through support supervision,

planned rapid assessment, mapping and zoning for the new districts as well as conducting Behavioural

Monitoring Survey for the new districts of north Rift valley. Computer needs assessment will be conducted

and subsequently, 12 computers will be procured and distributed for data management in selected sites.

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. Targets and funding level have also changed.

1.LIST OF RELATED ACTIVITIES

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

Carolina/MEASURE Evaluation (#7098), NASCOP (#7002), and TE/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 Rift Valley/FHI 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 Rift Valley/FHI 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 Rift Valley/FHI 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 Rift

Valley/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 200 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 Rift Valley/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 Rift Valley 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

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.

4. LINKS TO OTHER ACTIVITIES

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 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 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 Rift Valley began activities in Rift Valley in FY 2006. In FY 2008 APHIA II Rift Valley 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 Rift Valley will support provincial and district health systems

strengthening by convening consultative meetings and various stakeholders' forums.

The activity will target to reach at least nine of the nineteen districts in the province and seek to train at least

90 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 Rift Valley 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.