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

REFERENCES TO TARGETS AND BUDGETS. THE CURRENT AGREEMENT WITH INDIANA

UNIVERSITY HAS COME TO AN END AND THE PRIME PARTNER MAY CHANGE ONCE THE

COMPETITION PROCESS IS CONCLUDED. THE FUNDING MECHANISM WILL BE MOI UNIVERSITY

SCHOOL OF MEDICINE NETWORK (MUSM) TBD

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in MUSM Network TBD Palliative Care: TB/HIV, Palliative Care: Basic

Health Care and Support, MUSM Network TBD HIV/AIDS Treatment: ARV Services, and MUSM Network

TBD Counseling and Testing.

2. ACTIVITY DESCRIPTION

The Moi University School of Medicine (MUSM) Network TBD is a broad initiative by Moi University Faculty

of Health Sciences (MUFHS) and Moi Teaching and Referral Hospital (MTRH) in collaboration with Indiana

University School of Medicine (IUSM) and other academic centers. MUSM Network TBD is a

comprehensive program of HIV treatment, prevention, community mobilization, Counseling and Testing

(CT), Prevention of Mother-To-Child HIV transmission infection (PMTCT), PMTCT-Plus, nutritional support,

on the job training, and outreach activities. The Emergency Plan (EP) and private foundations fund this

project. Through this project, 90% of all pregnant women in the targeted sub-locations will receive

counseling and testing and 80% of HIV-infected pregnant women will be enrolled in the PMTCT+ program.

More effort will be put towards monitoring and evaluation of the PMTCT program. Additionally, at least 50%

of spouses of HIV-infected pregnant women will be offered CT in an effort to treat entire families. This is a

key outcome of successful PMTCT. MUSM Network TBD, MUFHS, and MTRH will use Emergency Plan

funds to expand PMTCT services and teach the skills to medical students. In 2008 this program will be

continued and expanded to additional health facilities under MUSM Network TBD within Rift Valley, Nyanza

and Western Provinces to a total 30 health facilities. These facilities will counsel and test 34,282 pregnant

women and provide antiretroviral prophylaxis for 1772 HIV-positive women. Of these, 886 will receive AZT,

354 HAART and 532 single dose nevirapine. 886 exposed infants will be reached with PCR for early infant

diagnosis. 75 health workers will be trained to provide PMTCT services.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

MUSM Network TBD in the Rift Valley region will contribute 3% of the PEPFAR target of 1,200,000 for

PMTCT primary prevention and care. Planned activities will improve equity in access to HIV prevention and

care services in underserved rural communities. MUSM Network TBD will help ensure there are adequate

networks and linkages between their sites and other medical sites where AIDS care and treatment are

available for both adults and children. These activities will contribute to increased access to CT services,

particularly among underserved and high risk populations and result in 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

The PMTCT activities of the MUSM Network TBD in the Rift Valley region relate to MUSM Network TBD

Palliative Care: TB/HIV, Palliative Care: Basic Health Care and Support, MUSM Network TBD HIV/AIDS

Treatment: ARV Services, and MUSM Network TBD Counseling and Testing. PMTCT services include

counseling and testing which is largely diagnostic, provision of ARV prophylaxis, and appropriate referrals

for the management of opportunistic infections and HIV/AIDS treatment.

5. POPULATIONS BEING TARGETED:

This activity targets the general population, adults of reproductive health age, pregnant women, family

planning clients, University students, infants, and HIV positive pregnant women and special populations

such as discordant couples. Behavior Change and Communication (BCC) activities will involve community

leaders and community based organizations to increase demand for services amongst community

members. Strategies to improve quality of services will target health care providers in public health facilities

including doctors, nurses, mid wives and other health care workers such as clinical officers and public

health officers. The program will also target traditional birth attendants.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will increase gender equity in programming through PMTCT services targeted to pregnant

women and their spouses. MUSM Network TBD will continue providing nutritional support through its HIV

farm as well as microfinance and micro credit activities. Increased availability of PMTCT services will help

reduce stigma and discrimination at community and facility level.

7. EMPHASIS AREAS

This activity includes emphasis on human capacity development through training, supportive supervision

and task shifting. Minor emphasis will be placed on community mobilization, development of

networks/linkages systems such as the nutritional programs, and local MUFHS, and MTRH organizational

capacity development and quality assurance, quality improvement and supportive supervision.

THIS IS AN ONGOING ACTIVITY. HOWEVER, THE NARRATIVE HAS BEEN SUBSTANTIALLY

CHANGED TO REFLECT THE FACT THAT THIS ACTIVITY IS UNDER COMPETITION AND NO

AWARDS HAVE BEEN MADE YET

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Counseling and Testing (#8758), ARV Services (#6899, #7004), Palliative

Care: TB/HIV(#6900) and PMTCT (#6898).

2. ACTIVITY DESCRIPTION

This activity will support the services previously implemented by the Academic Model for the Prevention and

Treatment of HIV/AIDS (AMPATH). AMPATH was a broad initiative by Moi University School of Medicine

(MUSM), Moi Teaching and Referral Hospital (MTRH), Indiana University School of Medicine (IUSM) and

other US academic medical centers. Moi University Faculty of Health Sciences (MUFHS) is one of two

schools of medicine, nursing and public health in Kenya, now providing medical and health education to

over 700 students. Indiana University School of Medicine collaborated with MUFHS since its inception in

1990. By July 2007, AMPATH had a total of 19 HIV/AIDS care clinics and screening programs, including

Moi Teaching and Referral Hospital, six district hospitals (Kabarnet, Busia, Webuye, Teso, Kapenguria, and

Kitale), and eleven rural health centers (Mosoriot, Turbo, Burnt Forest, Amukura, Chulaimbo, Naitiri,

Khunyangu, Port Victoria, and Mount Elgon). In COP 2008 supported activities will include: strengthening of

the regional referral center (Moi Teaching and Referral Hospital) to serve as a referral center for HIV/AIDS

care, including strengthening of laboratory capacity and management of complicated medical cases, and

establishment of quality and best practice standards for HIV care. Patient referrals and linkages with other

services such as TB, VCT and PMTCT programs will be supported through this partner and other

Emergency Plan partners. During this period, more patients will be enrolled into care in the 19 care and

treatment sites.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

By September 30, 2009, this activity will provide treatment to more than 75,000 patients, thus contributing to

14% of the USG targets for this program area. This activity will support the expansion of palliative care

services to 19 service outlets and the training of 200 individuals in the provision of HIV-related palliative

care services.

4. LINKS TO OTHER ACTIVITIES

These activities support and link to the network center at Moi Teaching and Referral Hospital, and link to

other services such as TB/HIV (#6900), PMTCT (#6898), CT (#8758) and ARV Services (#6899) programs

supported primarily by this partner. There are well-established links with other services supported by this

and other partners for example, diagnostic testing for HIV among TB patients, orphan support programs and

other community services.

5. POPULATIONS BEING TARGETED

The main populations targeted by this activity are people affected by HIV/AIDS such as people living with

HIV/ AIDS, HIV positive pregnant women and their families. Other populations targeted are health workers

who will benefit from training in order to enhance service provision.

6. KEY LEGISLATIVE ISSUES

The main legislative issues addressed in this activity are stigma and discrimination and gender. The

program uses novel approaches to the support of treatment, and provides business skills training and

promotes micro-enterprise for HIV infected patients, especially women. These approaches are designed to

reduce stigma against persons living with AIDS and increase gender equity.

7. EMPHASIS AREAS

The major emphasis area in this activity is training of health workers, with two minor emphasis areas being

infrastructure improvement and community mobilization/ participation by use of PLWHA in care activities.

THIS IS AN ONGOING ACTIVITY. HOWEVER, THE NARRATIVE HAS BEEN SUBSTANTIALLY

CHANGED TO REFLECT THE FACT THAT THIS ACTIVITY IS UNDER COMPETITION AND NO

AWARDS HAVE BEEN MADE YET

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Counseling and Testing (#8758), ARV Services (#6899, #7004),

Palliative Care: Basic Health Care and Support (#6901) and PMTCT (#6898).

2. ACTIVITY DESCRIPTION

This activity will support the services previously implemented by the Academic Model for the Prevention and

Treatment of HIV/AIDS (AMPATH). AMPATH was a broad initiative by Moi University School of Medicine

(MUSM), Moi Teaching and Referral Hospital (MTRH), Indiana University School of Medicine (IUSM) and

other US academic medical centers. Moi University Faculty of Health Sciences (MUFHS) is one of two

schools of medicine, nursing and public health in Kenya, now providing medical and health education to

over 700 students. Indiana University School of Medicine collaborated with MUFHS since its inception in

1990. By July 2007, AMPATH had a total of 19 HIV/AIDS care clinics and screening programs, including

Moi Teaching and Referral Hospital, six district hospitals (Kabarnet, Busia, Webuye, Teso, Kapenguria, and

Kitale), and eleven rural health centers (Mosoriot, Turbo, Burnt Forest, Amukura, Chulaimbo, Naitiri,

Khunyangu, Port Victoria, and Mount Elgon). The overall objective of the HIV/TB care project is to

demonstrate a decreased prevalence of TB in all areas served and integrate care of co-infected patients

into a comprehensive program that meets the objectives of the National Tuberculosis and Leprosy Program

[NLTP] and NASCOP. To meet these objectives, the activity will implement the following interventions; a)

Case Finding: Expand the very successful case finding model just completed in Uasin Gishu District to all

clinic communities. The model deploys community-based cough monitors who are dually trained at sputum

collection and diagnostic counseling and testing (DTC) for HIV. Intensified TB screening for 37500 HIV

patients and HIV screening for 8000 TB suspects/patients will be offered as a standard of care in all the

facilities; approximately 4000 TB patients will be identified as being infected with both TB and HIV. In

combination with improved training of MOH laboratory personnel and patient follow up, this model has

demonstrated very cost-effective case finding and over 90% adherence through completion of TB treatment.

In addition, DTC is provided to all TB infected patients. All co-infected patients are referred to the nearest

HIV/TB clinic for care. b) Care of the co-infected: project physicians and clinical officers will provide

comprehensive HIV/TB management in all clinics. All providers will undergo additional training on NLTP

guidelines and all national registration and reporting procedures will be observed. NLTP staff will be

integrated into the clinic in an effort to improve reporting and patient convenience. Providers with additional

expertise in managing the co-infected patient will be available to all clinics for consultation. The project is

expected to implement a Medical Record System that provides electronically generated patient care

reminders and alerts in an effort to assure uniform performance and adherence to national guidelines for

both HIV and TB care. c) Contact tracing and outreach: In an effort to further reduce the prevalence of

active TB surrounding project service areas, an active program of contact tracing will be initiated. Home

visits will be offered to all co-infected patients and a dually trained DTC/cough monitor to perform home

rapid testing for HIV and sputa collection for AFB smear will do the visit. In addition, a cough monitor in the

field will visit the index patient every two weeks to check on adherence and provide health information.

Where necessary, the cough monitor will provide transport support for all HIV infected patients and their

children to the nearest TB/HIV clinic.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will lead to the identification and care of 8,000 TB/HIV co-infected patients in the MUSM service

areas by September 2009, thus contributing to 9% of the national target in this program area. These

activities will contribute to the results of expansion of ARV treatment for clinically qualified TB/HIV co-

infected patients, as well as regular screening of HIV positive patients for TB infection.

4. LINKS TO OTHER ACTIVITIES

These activities support and link to the network center at Moi Teaching and Referral Hospital, and link to

other services such as Counseling and Testing (#8758), ARV Services (#6899, #7004), Palliative Care:

Basic Health Care and Support (#6901) and PMTCT (#6898) supported primarily by this partner.

5. POPULATIONS BEING TARGETED

The main populations being targeted by this activity are TB/ HIV co-infected patients and health workers.

6. EMPHASIS AREAS

The main emphasis areas are task shifting by use of community-based cough monitors who are dually

trained at sputum collection and diagnostic counseling and testing (DTC) for HIV. A minor emphasis area is

training for health workers.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE HAS BEEN UPDATED TO REFLECT CHANGES.

This activity was begun with 2007 plus-up funds and is part of a five-site effort to strengthen the link

between clinical and household settings for HIV+ children. All sites meet regularly with a sixth entity,

AED/Capable Partners, for real-time sharing of lessons learned and review the effectiveness of different

approaches in preparation for scale-up.

The Mwangalizi model is being tested in response to concern expressed by clinicians that assuring optimal

care for HIV+ OVC was difficult in many instance because they were accompanied to different clinic visits

by different relatives or community members, necessitating constant re-education of adults managing care

of children.

Central to the approach is recruitment of adult patients who are successfully managing their own care to

accompany pediatric patients to all clinic visits when a consistent caregiver from the household is not

available. These "accompagnateurs" will be trained to be on watch for development of side effects or

complications, remunerated for their time, and expected to perform home visits to monitor medication

consumption. They will also be expected to develop an ongoing and supportive relationship with the OVC

household, assess the social environment and refer for needed services, and seek wherever possible to

identify a household or community contact who can be prepared to assume the long-term responsibility of

being a treatment advocate for the child.

Sites were carefully selected to represent a cross section of Nairobi and coastal urban slum (Eastern

Deanery, Coptic, and Bomu), peri-urban (AMPATH/Eldoret, Bomu) and rural (Kericho District Hospital)

communities. Standard measures of household and clinician satisfaction with the value-added by the

accompagnateur, accompagnatuer satisfaction with the experience, and clinical progress of OVC

participating in the program will be tracked. Numbers of OVC served are captured under care and

treatment activities.

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

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

This activity is related to activities in PMTCT (#6898), Palliative Care: Basic Health Care (#6901), TB/HIV

(#6900) and ARV (#6899).

2. ACTIVITY DESCRIPTION

In 2008 this activity will reach 200,000 individuals with counseling and testing services through 25 outlets

and train 200 providers in PITC, VCT and HBCT. The Academic Model for the Prevention and Treatment of

HIV/AIDS (AMPATH) is a broad initiative by Moi University Faculty of Health Sciences and Moi Teaching

and Referral Hospital in collaboration with Indiana University School of Medicine (IUSM) and other

academic centers. AMPATH is a comprehensive program of HIV treatment, prevention, community

mobilization, Counseling and Testing (CT), Prevention of Mother-To-Child HIV transmission infection

(PMTCT), PMTCT-Plus, nutritional support, on the job training, and outreach activities. The Emergency

Plan (EP) and private foundations fund this project. In 2006, AMPATH initiated aggressive community

mobilization activities around their geographical area of operation. These community mobilization activities

have traditionally targeted audiences with BCC messages, and CT has been incorporated as an important

prevention and care entry point. In addition, DTC programs are just beginning to ramp up in each of the 18

AMPATH sites, and through both VCT and DTC, it is expected that a total of 100,000 persons will learn their

HIV status in 2007. For those clients that will be diagnosed with HIV, appropriate referrals are planned for

the management of opportunistic infections and HIV/AIDS treatment using the existing AMPATH network of

HIV care and treatment sites. This activity will train 250 people in CT in 2007.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

Through AMPATH's efforts, a total of 100,000 HIV infected persons will receive counseling and testing, thus

contributing to over 30% of persons reached in this program area. These activities will contribute to

increased access to CT services, particularly among underserved and high risk populations and result in

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

The CT activities of the AMPATH in the Rift Valley region relate to AMPATH's Palliative Care activities

(#6901), ARV services (#6899), PMTCT (#6898) and TB/HIV (#6900) services.

5. POPULATIONS BEING TARGETED

This activity targets the general population, adults of reproductive health age, pregnant women, family

planning clients, University students, infants, and HIV positive pregnant women. Behavior Change and

Communication (BCC) activities will involve community leaders and community based organizations to

increase demand for services amongst community members. Strategies to improve quality of services will

target health care providers in public health and private facilities including lay counselors, nurses, mid wives

and other health care workers such as clinical officers and public health officers. This activity will also target

most at risk populations like commercial sex worker, discordant couples and street youth.

6. KEY LEGISLATIVE ISSUES ADDRESSED

It is envisaged that increased availability of Counseling and Testing services will help reduce stigma and

discrimination at community and facility level.

7. EMPHASIS AREAS

The major emphasis for this activity is in quality assurance and supportive supervision. This activity

supports the development and implementation quality assurance and supportive supervision for CT

counselors. Other minor emphasis areas in this activity will be in the support of training of additional

counselors especially targeting testing in clinical setting. The activity will also work with the MOH in the

program area to strengthen their capacity to implement programs.

N/A (exempt)