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

REFERENCES TO TARGETS AND BUDGETS.

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

• Geographic coverage has been revised (or expanded) to include other low income settlements adjacent to

Kisumu City, namely, Mamboleo, Kisian, Kibos and Nyamasaria, as well as one new division in Suba district

(Magunga);

• The target population has been or expanded to include parents, pre-pubescent and early adolescents

(through the Families Matter! Curriculum) and school-going youth in Suba district;

• Other changes include: $103,600 of this activity is programmed with funds from the $7 million FY 2008

plus up for the Healthy Youth Programs Initiative (HYPE), which will be integrated into the Tuungane site.

• FY07 PLUS UP ADDITIONS: This plus-up allocation will support an expansion of current 07 COP

activities. The Tuungane project will strengthen the scope of its current prevention program by targeting

parents through implementation of the Families Matter! intervention. Tuungane will train parents drawn

from the Kisumu slums within which the youth program targets. These will include parents of children in

and out of schools targeted by the project within the 6 main slum neighborhoods of Kisumu. This activity

will be integrated into the home-based counseling and testing and general prevention. It will help accelerate

prevention through the involvement of parents; both to target them with prevention education focusing on

faithfulness with knowledge of serostatus, as well as improve their ability to discuss HIV prevention with

their young pre-adolescents and adolescents. Tuungane will expand activities in Suba to work with parents

and adults to ensure a supportive environment for youth. It will also help to enhance faithfulness and

knowledge of HIV status among adults and their partners, including fisherfolk and migrant business workers

in selected beaches of Suba district.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Counseling and Testing (#8751), Condoms and Other Prevention (#6897)

and HIV/AIDS Treatment: ARV Services (#7090).

2. ACTIVITY DESCRIPTION

Impact Research & Development Organization (Impact Research) will reach 100,000 youth, including young

HIV-negative men receiving circumcision, under the Tuungane behavior change project through providing

Abstinence and Faithfulness education and related services through seven youth-friendly centers in six

major slum neighborhoods of Kisumu, Nyanza Province. Tuungane will also step up activities with the Suba

community. A central referral and coordination center will continue to serve as the hub of all AB youth

activities and at least 300 youth with receive a curriculum-based training on life planning skills. 130 service

providers will also receive training in Medical Male circumcision. The Tuungane project will enhance adult

involvement in the AB program through training 200 adults, including parents, teachers and religious

leaders as supportive adults for the youth. The project will intensify its efforts to reach out to at least 3,000

at-risk girls with behavior change interventions and improve the involvement of girls in all elements of the

project. This will be done through forming reproductive health clubs for out of school girls and teen mothers.

An important need identified by the project in the previous year is addressing sexual violence through

integrating it into the education for behavior change activities. This will be coupled with educating youth on

the increased HIV vulnerability in the context of alcohol and substance abuse. Tuungane has demonstrated

a remarkable strength in implementing intensive and quality interventions in the community and has useful

lessons which will be scaled up to the underserved and highly vulnerable population of Suba district in

Nyanza. Tuungane will work with schools in Suba as well as with out of school youth including the beach

community and the general community of youth and young adults to provide comprehensive AB education.

These activities will contribute to our results of improved HIV preventive behaviors among youth, changed

social and community norms to promote HIV preventive behaviors in youth and young adults, and models

for effective youth interventions tested. The Tuungane project was funded under a CDC Cooperative

Agreement in October 2004 and works within Kisumu urban slums whose estimated youth population is

80,000. The project and the specific interventions will be studied for effectiveness by Kenyan evaluators

who are part of the staff of Impact Research and Development Organization. Youth will be continually

involved in activities that help sustain HIV preventive behavior through periodic training in life skills. To

provide a supportive environment for young people's adoption and maintenance of HIV preventive behavior,

parents, religious and community leaders will be reached with targeted activities. These changes will

contribute to testing a model of effective youth interventions. It will also improve social and community

norms to promote HIV preventive behaviors in youth and young adults. Most importantly, it will make

significant contributions to improved HIV preventive behaviors for youth through strengthening life skills.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

Abstinence and faithfulness activities will target youth in the slum areas of Kisumu and selected sites in

Suba District. This will significantly contribute to the PEPFAR goals of averting HIV infections among youth.

Specifically, this project will train 430 leaders and health service providers to reach 100,000 youth with AB

messages.

4. LINKS TO OTHER ACTIVITIES

Tuungane's AB activities in Kisumu slums relate to activities in CT (#8751), OP (#6897) ART UCSF/FACES

(#7090). Linkages between existing youth service providers include the Family Health Options Kenya, the

Network for Adolescents and Youth in Africa, local youth groups, and the Municipal Council of Kisumu. A

strong referral linkage will be strengthened for young people who test positive. Currently, referrals for young

couples are made to the KEMRI/CDC PEPFAR-supported patient support center of the Nyanza provincial

general hospital as well as the FACES project.

5. POPULATIONS BEING TARGETED

This activity targets the general population including men and women of reproductive age as well as youth,

especially young girls and boys in and out of school. It will target PLWHAs and incorporate them into their

education program. It will also work with street youth and out-of-school youth. It will strengthen its

community involvement through working with community, program, religious leaders and volunteers. In-

school programs will involve training teachers on communication skills with youth on sexual and

reproductive health issues. Existing community structures will be utilized including youth and community

organizations as well as faith-based organizations. The proposed work in Suba will serve rural communities.

6. KEY LEGISLATIVE ISSUES ADDRESSED

Activity Narrative: This project will address key legislative issues particularly gender issues. The project will work at increasing

gender equity in its programming, particularly enhancing the participation of young women in the AB

activities. Participatory approaches such as magnet theatre will be employed to address male norms and

behaviors as well as the reduction of violence and coercion through the life skills training. Stigma and

discrimination will be addressed through intensive community education and sensitization forums.

7. EMPHASIS AREAS

This program will have a major emphasis in community mobilization/participation. Minor emphasis will be

place on development of network/linkages/referral systems, information education and communication,

training, needs assessment and human resources. Another component will be Service Delivery in Facilities

and through Mobile approaches: In collaboration with the MOH, the Nyanza Circumcision Consortium,

through IRDO, will work on targeted roll-out of MC services in Nyanza. Service delivery capacity-building

will be rolled out in government district hospitals and some private facilities where providers have been

trained and where other USG PEPFAR partners, including KEMRI, are currently working. In addition to

training, support will be provided for non-consumable commodities (i.e. autoclaves, instrument packs,

surgical lamps, etc…) personnel and other infrastructure that will be necessary for MC service delivery.

Service roll-out will initially target areas with high existing demand for MC services and will be integrated

into discordant couples services for discordant male partners of women in care and treatment programs.

Mobile service provision will be provided by mobile teams consisting of approximately seven people

(including 2 clinical officers, 1 VCT/behavioral counselor, 2 surgical nurses, 1 sterilizer/cleaner and 1 driver)

targeting high risk groups, such as STI patients, beach populations, young men in the public transport

sector, jua kali artisans, and truck drivers, as well as areas of very high HIV prevalence. For example,

mobile services will be provided in Suba District, Kenya's highest HIV prevalence district, to complement the

current door-to-door VCT program that PEPFAR is supporting there. In addition, services will be provided

within areas such as the Demographic Surveillance Study area where operational evaluation can be

conducted and in other areas where PEPFAR services exist. A critical component of this activity will be the

provision of AB counseling and interventions for men undergoing both VCT and circumcision. This activity

will help to develop several AB interventions that can be used to help reduce any sexual disinhibition which

may come as a result of programmatic scale-up of MC.

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

REFERENCES TO TARGETS AND BUDGETS.

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

+ Geographic coverage has been revised (or expanded) to include the Sugar Belt region (Miwani, Chemelil,

Kibos and Muhoroni), characterized by transactional and commercial sex work and vulnerable mobile

populations. Additionally, FY 08 MC funds will allow IRDO's circumcision services to expanded to multiple

areas in Siaya and within the DSS, as well as other health facilities in Suba District.

+ The target population has been revised (or expanded) to include sex workers in the Sugar Belt region

adjacent to Kisumu, young men in high risk occupations such as transport sector (bus/matatu touts and

drivers, bicycle taxis, and beach populations especially in Suba district).

+ Other changes include: In collaboration with the MOH, the Nyanza Circumcision Consortium, through

IRDO, will work on targeted roll-out of MC services in Nyanza. Service roll-out will initially target areas with

high existing demand for MC services and will be integrated into discordant couples services for discordant

male partners of women in care and treatment programs. Mobile service provision will be provided by

mobile teams consisting of approximately five people (including 2 clinical officer, 2 VCT counselor, 1

surgical nurse, 1 sterilizer/cleaner and 1 driver) targeting high risk groups, such as uniformed services

personnel and truck drivers, and areas of very high HIV prevalence. For example, mobile services will be

provided in Suba district, Kenya's highest HIV prevalence district, to complement the current door-to-door

VCT program that PEPFAR is supporting there. In addition, services will be provided within areas such as

the Demographic Surveillance Study area where operational evaluation can be conducted and in other

areas where PEPFAR services exist. Service delivery capacity building will be rolled out in district hospitals

and some private facilities where providers have been trained and where other USG PEPFAR partners,

including KEMRI, are currently working. In addition to training, support will be provided for non-consumable

commodities (i.e. autoclaves, instrument packs, surgical lamps, etc…) personnel and other infrastructure

that will be necessary for MC service delivery. Additionally, the funds will enable the piloting of provision of

circumcision to infants as well as further expansion of training and service provision based on leveraging

ability of funds from other sources, including the Ministry of Health and the Gates Foundation.

+ $50,000 of this activity is programmed with funds from the $7 million FY 2008 plus up for the Healthy

Youth Programs Initiative.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Abstinence and Be Faithful Programs (#6896), Counseling and Testing

(#8751) and HIV/AIDS Treatment/ARV Services (#7090) and Palliative Care: Basic Health Care and

Support (#6870).

2. ACTIVITY DESCRIPTION

Impact Research & Development Organization (IRDO) will reach 120,000 at-risk and vulnerable youth and

other persons engaged in risky sexual behavior under the Tuungane behavior change project with condoms

and other prevention activities. It will continue to work through the seven youth-friendly centers in six major

slum neighborhoods of Kisumu City, in Nyanza Province and a central referral and coordination center at

Tuungane central. Tuungane will continue to encourage the involvement of adolescent girls and young

mothers through targeted activities for girls. This project will also target various high-risk groups including

bodaboda and matatu operators, street youth, out of school youth, partners and clients of sex workers, bar

workers and discordant couples identified through their CT services. Most importantly, Tuungane will

develop interventions for positive prevention among individuals with HIV. These will include behavioral

interventions targeting PLWAs. Given Tuungane's focus on girls and young women, another intervention

will entail prevention of unintended pregnancies among girls and young women. In addition to the existing

STI prevention services offered by this project, Tuungane will intensify STI screening and treatment for

individuals with HIV and their partners. Through its linkage with USCF's FACES project, Tuungane will

ensure access to care and treatment, including ART for positive people identified through the project.

Overall, this project will promote leadership by individuals with HIV in the positive prevention efforts. An

important need identified by the project in the previous year is addressing sexual violence through

integrating it into the education for behavior change activities and providing Post Exposure prophylaxis.

Education and sensitization on alcohol and substance abuse will be integrated into the condoms and other

prevention activities whenever appropriate. Tuungane has demonstrated a remarkable strength in

implementing intensive and quality interventions in the community and has useful lessons which will be

scaled up to the underserved and highly vulnerable population of Suba district in Nyanza. Tuungane will

work with youth in Suba as well as with identified high-risk groups, including the beach community to

provide comprehensive OP education. Given IRDO's technical capacity, specific interventions will be

evaluated for effectiveness by the Kenyan researchers who are part of the staff of Impact Research and

Development Organization. Significant changes from 2006 to 2007 for this activity include the scale up to

Suba. Another important addition in FY 2007 is the focus on positive prevention. This project will actively

involve existing youth community groups to enable it to rapidly expand behavior change activities for youth

in the slums. Service delivery will be improved through mobile integrated services including provision of free

counseling services for youth, including street youth and referrals for free STI treatment.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

Abstinence and faithfulness activities and information on correct and consistent use of condoms targeting

youth in the slum areas of Kisumu will significantly contribute to the PEPFAR goals of averting HIV

infections. Specifically, this project will train 300 youth leaders to reach 120,000 individuals with condoms

and other prevention services. 50 condom outlets will be established.

4. LINKS TO OTHER ACTIVITIES

Tuungane's OP activities in Kisumu slums relate to activities in CT (#8751), ART (#7090), AB (#6896) and

STI treatment. Linkages between existing youth service providers include the Family Health Options of

Kenya, the Network for Adolescents and Youth in Africa, local youth groups, and the Municipal Council of

Kisumu. A strong referral linkage will be strengthened for individuals with HIV. Currently, referrals for young

couples are made to the KEMRI/CDC PEPFAR-supported patient support center of the Nyanza provincial

general hospital as well as the FACES project. PLWHAs who are aged 21 years and above are referred for

psychosocial support to FACES and most of those aged 21 years or below enroll in Tuungane's support

group.

5. POPULATIONS BEING TARGETED

Activity Narrative: This activity targets the general population including men and women of reproductive age as well as youth.

It also targets special populations, mainly most at risk populations such as discordant couples, street youth

(many of whom are men who have sex with men) and out-of-school youth. At community level, this program

will target community and religious leaders, most of whom will work in a volunteer capacity in their

respective areas of work. Through its alcohol intervention, brothel owners and bar workers will be targeted.

Existing community structures will be utilized including youth and community organizations as well as faith-

based organizations. It will also work with private and public health care providers to strengthen STI

screening and treatment and referrals for HIV/AIDS care and treatment.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This project will address key legislative issues particularly gender issues. The project will work at increasing

gender equity in its programming, particularly enhancing the participation of young women in the Other

Prevention activities. Participatory approaches will be employed to address male norms and behaviors as

well as the reduction of violence and coercion through participatory education and training. Stigma and

discrimination will be addressed through intensive community education and sensitization forums.

7. EMPHASIS AREAS

This program will have a major emphasis in Community mobilization/participation. Minor emphasis will be in

development of network/linkages/referral systems, Information Education and Communication, training and

needs assessment. This is an expansion to the existing COP 2007 activity. Impact Research and

Development Organization's Tuungane project will expand its support to at-risk youth in the Kisumu slums

and youth/young people involved in alcohol and substance abuse. This expansion will also allow for a

minimal start up in a selected location in Suba district, where the Tuungane project has recently set up new

project activities focusing on the fisherfolk community of Suba District, Nyanza province. The expansion in

Kisumu will allow for an increase in scope to allow coverage of new locations adjacent to the five major

Kisumu slums. These will include Mamboleo, Kibos, Nyamasaria and Kisian areas. Additionally, the

Tuungane project will intensify its campaigns against sexual violence, which is a rampart practice

significantly affecting adolescent girls. These activities will be integrated into the existing broader prevention

program, including increasing linkages and referrals to counseling and testing

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

REFERENCES TO TARGETS AND BUDGETS.

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

+ in FY 2008 IRDO will implement home-based HIV counseling and testing (HBCT) for urban slum dwellers

in Kisumu city. This is an expansion of the CT activities from FY 07, which were mainly site-based. In FY

08, IRDO will establish a fully fledged HBCT program including a communication strategy. This will lead to a

large increase in the number of people counseled and tested and accessing care and treatment with the

support of IRDO.

+ they have also successfully implemented youth prevention programs that included counseling and testing.

They will therefore use their experience and community structures to promote CT as a primary activity.

IRDO will receive support in training of CT providers including supervisors. Since home based CT in urban

slums is a new concept, this activity will be evaluated from time to time.

1.LIST OF RELATED ACTIVITIES

This activity relates to activities in AB (#6896) and OP (#6897).

2.ACTIVITY DESCRPTION

In FY 2008, Impact Research & Development Organization's (Impact Research) Tuungane project will

provide HIV counseling and testing (CT) services to 30,000 individuals in Kisumu's slums and underserved

areas in Suba District. This activity will respond to the high demand for counseling and testing created

through Tuungane's behavior change activities targeting youth and at-risk populations. Tuungane will work

through the 10 youth-friendly satellite centers in 5 major slums of Kisumu, in Nyanza Province and a central

referral and coordination center. They will train at least 100 counselors to support their fixed, mobile and

Home Based CT services. Tuungane has made remarkable strides in targeting hard to reach and

underserved populations such as adolescent girls and young mothers through targeted activities. Other high

risk subpopulations to be targeted include bodaboda and matatu operators, street youth, out of school

youth, partners and clients of sex workers, bar workers and discordant couples. Most importantly, Tuungane

will implement a prevention-with-positives program, working with PLWHAs. Additionally, Tuungane will

support couples counseling and disclosure. Communities will be educated on couple discordance and the

importance of couples knowing their HIV status together. Tuungane will also incorporate CT into their

community outreach activities. Tuungane will also introduce diagnostic HIV testing and counseling (DTC) at

its clinic at the Tuungane central youth facility where STI treatment is provided. Nurses and clinical officers

currently working in the clinic will be trained and supported to provide DTC. Tuungane will continue

providing youth-friendly services and addressing barriers that hinder access to counseling and testing. A

coupon referral system and free boda boda transportation will ensure that transportation costs do not hinder

people from seeking services. Through its linkage with USCF's FACES project, Tuungane will ensure

access to care and treatment, including ART for positive people identified through the project. This far,

Tuungane has demonstrated a remarkable strength in implementing intensive and quality interventions in

the community and has useful lessons which will be scaled up to the underserved and highly vulnerable

population of Suba district in Nyanza. Tuungane will work with high-risk groups in a site in Suba including

the beach community to provide counseling and testing services, alongside its behavioral interventions of

condoms and other prevention services. This project will actively involve existing youth community groups

to enable it make rapid scale up of services. Service delivery will be improved through mobile integrated

services including provision of free counseling services for youth and high-risk groups and referrals for free

STI treatment.

3.CONTRIBUTION TO OVERALL PROGRAM AREA

The Tuungane's CT program will contribute not only to the overall CT portfolio in Kenya, but will also target

a special and vulnerable population. They will target the youth, especially young girls in a slum area in

Kisumu town. Kisumu town is in Nyanza region, which has the highest HIV prevalence in Kenya. They will

also work in the beaches of Suba district, which is also a high risk population. Through this work Tuungane

will help implement operational models which can be replicated elsewhere in Kenya with vulnerable

populations. Thus Tuungane's contribution is very strategic and should help with future PEPFAR

programming. 4. LINKS TO OTHER ACTIVITIES In the past Tuungane has implemented several prevention

activities. These will be linked to the CT activity. Some of these programs include; AB (#6896), OP (#6897)

and STI treatment. HIV-infected persons identified through this program will be linked to Care and

Treatment activities.

5. POPULATION BEING TARGETED The activity will mainly target both the street and out-of-school youth,

both male and female. It will also target discordant couples in stable relationships, who will benefit from

couple counseling support. It will also target commercial sex workers and some migrant workers among the

beach population in Suba.

6. KEY LEGISLATIVE ISSUES ADDRESSED The activity will mainly address gender equity concerns as

well as stigma and discrimination issues. By focusing on young people, especially girls, Tuungane will

strengthen gender equity and facilitate women's access to HIV/AIDS services.

7. EMPHASIS AREA

Tuungane's CT program will focus mainly on community mobilization and participation. To a lesser extent

they will focus on human resource and training to support the continuity of the program. Service Delivery in

Facilities and through Mobile approaches: In collaboration with the MOH, the Nyanza Circumcision

Consortium, through IRDO, will work on targeted roll-out of MC services in Nyanza. Service delivery

capacity-building will be rolled out in district hospitals and some private facilities where providers have been

trained and where other USG PEPFAR partners, including KEMRI, are currently working. In addition to

training, support will be provided for non-consumable commodities (i.e. autoclaves, instrument packs,

surgical lamps, etc…) personnel and other infrastructure that will be necessary for MC service delivery.

Service roll-out will initially target areas with high existing demand for MC services and will be integrated

into discordant couples services for discordant male partners of women in care and treatment programs.

Mobile service provision will be provided by mobile teams consisting of approximately five people (including

1 clinical officer, 1 VCT counselor, 1 surgical nurse, 1 sterilizer/cleaner and 1 driver) targeting high risk

groups, such as uniformed services personnel and truck drivers, and areas of very high HIV prevalence. For

example, mobile services will be provided in Suba District, Kenya's highest HIV prevalence district, to

Activity Narrative: complement the current door-to-door VCT program that PEPFAR is supporting there. In addition, services

will be provided within areas such as the Demographic Surveillance Study area where operational

evaluation can be conducted and in other areas where PEPFAR services exist. A critical component of this

acitvity will be the provision of VCT services.

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 the prevention (####) activities.

2. ACTIVITY DESCRIPTION:

This activity will be implemented through a MC Consortium comprising of Impact Research Development

Organization as prime partner, with the following sub-partners: UNIM (Universities of Nairobi, Illinois and

Manitoba), Tuungane Project, Nyanza Reproductive Health Society (NRHS), and Partners in Reproductive

Health (PIRH). Both Tuungane, administered by IRDO and PIRH, administered by NRHS, will be involved in

community education and mobilization. UNIM will be a training Center, IRDO will administer the funds from

PEPFAR/CDC and sub-contract NRHS (a registered Kenyan NGO) to oversee performance of UNIM and

PIRH. For this specific activity, UNIM will work closely with NASCOP, the National MC Task Force and other

key stakeholders to develop appropriate routine monitoring tools for MC programmatic efforts in Kenya. As

a core component of UNIM's MC service delivery, all clinicians (public and private) trained by UNIM will

record key monitoring data on NASCOP-approved data collection forms that will be adapted from UNIM's

clinical trial protocol. Key data elements will include: adverse events, surgical outcomes, client satisfaction,

age of client, consent of client or guardian, and outcomes at post-surgical visits. During year one, closer

monitoring of programmatic outcomes will be important. A random sample of approximately 10% of clients,

stratified by age group and rural versus urban/periurban residence will be selected for follow-up 30-40 days

post-surgery by 2 trained nurses to observe the surgical outcomes and to administer a questionnaire to

assess level of satisfaction, history of adverse events, history of clinical visits, and sexual history since

surgery. Data will be entered at selected health facilities and transmitted to the UNIM Training Centre. Data

will be aggregated and provided to the District Medical Office, the Provincial Medical Office, NASCOP and

the National Male Circumcision Task Force.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will provide vital data needed to monitor the progress and outcome of this key prevention

intervention. The data generated will inform further scale up and provide outcome indicators needed to

evaluate the intervention.

4. LINKS TO OTHER ACTIVITIES

The activity is closely linked to prevention (###) initiatives

5. POPULATIONS BEING TARGETED

The targeted population is the health workers who will be trained on recording the relevant data on the MC

Task Force approved form. However, the long term beneficiary of this intervention will be the eligible male.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS EXPANDED INCLUDING UPDATED

REFERENCES TO TARGETS AND BUDGETS

1. ACTIVITY DESCRIPTION:

This activity will be implemented through a MC Consortium comprising of Impact Research Development

Organization as prime partner, with the following sub-partners: UNIM (Universities of Nairobi, Illinois and

Manitoba), Tuungane Project, Nyanza Reproductive Health Society (NRHS), and Partners in Reproductive

Health (PIRH).

In collaboration with the MOH, the Nyanza Circumcision Consortium, through IRDO, will work on targeted

roll-out of MC services in Nyanza. Systems strengthening and service delivery capacity-building for 250

personnel will be rolled out in district hospitals and some private facilities where providers have been trained

and where other USG PEPFAR partners, including KEMRI, are currently working. In addition to training,

systems strengthening support will be provided for assuring quality and efficient access to non-consumable

commodities (i.e. autoclaves, instrument packs, surgical lamps, etc…) personnel and other infrastructure

that will be necessary for MC service delivery. Service roll-out will initially target areas with high existing

demand for MC services and will be integrated into discordant couples services for discordant male partners

of women in care and treatment programs, both of which will have a strengthened system of service

delivery. This systems strengthening function will assure a close collaborative relationship between both

Tuungane, administered by IRDO, and PIRH, administered by NRHS, who will be involved in community

education and mobilization and will train 500 people in community mobilization. UNIM will be a training

Center, IRDO will administer the funds from PEPFAR/CDC and sub-contract NRHS (a registered Kenyan

NGO) to oversee performance of UNIM and PIRH. This activity will therefore establish and monitor quality

service delivery and adherence to national guidelines. This activity will also support systems strengthening

at the facility level and through training of a professional cadre of Kenyans.

2. CONTRIBUTIONS TO OVERALL PROGRAM

The IRDO Systems Strengthening activity will guide and strengthen the capacity of all program personnel

and service systems in providing high quality medical male circumcision services through an efficient

system. It will identify key staff requiring training and establish effective health service delivery systems.

The program will help program personnel in identifying efficient ways of service delivery thus optimizing

resource utilization and maximizing outputs. Through this work IRDO will establish a package of service

delivery which will be used for quality control in all service delivery sites in Nyanza and other locations.

3. LINKS TO OTHER ACTIVITIES

This activity links to prevention activities implemented by the Tuungane Project targeting youth and most-at-

risk groups in the Kisumu slums and Suba district, including STI treatment. Other linkages include facility-

based and mobile VCT and Provider-initiated counseling and testing services provided by Tuungane and

which may include door-to-door counseling and testing in the five major Kisumu slums. There will also be a

linkage with the UCSF/FACES care and treatment program that serves HIV-infected youth in their ART

program.

4. POPULATIONS BEING TARGETED

For the MC systems strengthening component, personnel including health care workers and lay counselors

serving in service delivery sites will be targeted. Staff of other affiliate agencies in the consortium providing

community education and other services will be targeted. MOH personnel at National, Provincial and

district levels will be involved in the development of service delivery systems, training, implementation and

quality assurance processes.

5. EMPHASIS AREAS / KEY LEGISLATIVE ISSUES ADDRESSED

IRDO's Policy and systems strengthening will focus mainly on developing and strengthening systems to

support the Medical Male Circumcision program. Behavioral interventions will include addressing male

norms and behaviors, particularly relating to behavior disinhibition following circumcision. Training will be

conducted for health service providers, particularly in-service training. The activity will also entail building

the capacity of local organizations collecting such as PIRH and NRHS. To some extent, staff of the

Ministry of Health (MoH) and other partners will be trained systems and quality assurance.