THIS IS A NEW ACTIVITY.

1. ACTIVITY DESCRIPTION

With PEPFAR New Partners Initiative's (PEPFAR-NPI) support, mothers2mothers (m2m) will increase the

effectiveness of PMTCT services through a comprehensive program of facility-based, peer education and

psychosocial support for pregnant women, new mothers and caregivers living with HIV/AIDS in Kenya.

There are four components to the activity that contribute to support of PMTCT: curriculum-based training

and education programs; psychosocial support and empowerment services; programs to increase uptake

for counseling and testing; and bridging services linking PMTCT treatment and care to anti-retroviral

treatment (ARV) and other health services. The first component is training. FY 2008 PEPFAR funding will

be used to deliver a comprehensive curriculum-based training for approximately 108 m2m paid site staff,

Site Coordinators (SC) and Mentor Mothers (MM), (all of whom are PLWHA) who will provide education

programs designed to improve PMTCT outcomes of pregnant women and new mothers with HIV and AIDS.

The training curriculum given to m2m staff provides guidance about PMTCT and ARV treatment, as well as

disclosure, safer feeding options, family planning, nutrition, couples counseling, and prevention guidance for

these PLWHA and their partners. Annual trainings are given to all staff, inclusive of new staff and retraining

for existing staff (two weeks for MM and three weeks for SC). m2m does not provide formal training on

direct PMTCT service provision for healthcare providers, including doctors and nurses. The second

component is providing psychosocial support and empowerment programs to HIV-positive pregnant women

and new mothers to improve pediatric and maternal outcomes. PEPFAR funding will be used to provide

individual and group psychosocial support and empowerment programs for pregnant women and new

mothers with HIV/AIDS to help issues including stigma and discrimination, disclosure, reducing risky

behavior and pediatric support. The outcome of both group and individual support is knowledge transfer

around issues that women living with HIV and AIDS face in navigating the PMTCT process. Another

outcome is empowering the women to focus on and take responsibility for the health of their babies, and

their own health. Nutritional education and support is also part of the program; and there is a provision for

specific support programs for the m2m staff. The third component is increasing PMTCT services through

encouragement of HIV testing and uptake of prophylaxis for PMTCT. PEPFAR funds will help m2m staff

work as part of the antenatal care team at facilities in Kenya. In this role, the m2m staff focuses on

increasing counseling and testing uptake by working with women like themselves and drawing on their

training and their own personal experience. The program also encourages pediatric counseling and testing

efforts by counseling women to return to clinics post-delivery to test their infants, supporting the women in

the post-delivery period, and providing information about pediatric treatment programs. The fourth

component is assisting HIV-positive women to access linkages and referral systems to bridge PMTCT and

other health services. In active collaboration with local and provincial health officials, PEPFAR funding will

be used to link women and infants with AIDS defining conditions to ARV therapy programs, and to refer all

ante/post natal women to clinics providing wellness care for themselves and their infants. While m2m does

not provide formal referrals for healthcare, the staff is well informed about where services are available and

can inform women about how to access both medical and social services.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA

All activities, which began in 2007, have been and will continue to be coordinated with local PMTCT service

providers and their partners and will also be carried out in conjunction with provincial, district and municipal

health authorities. The program implementing partner is Catholic Medical Mission Board (CMMB), an

international NGO. Implementation will be facilitated through CMMB's relationships with its partner

organizations, the Christian Health Alliance for Kenya (CHAK) and the Kenya Episcopal Conference (KEC)

for in-country program implementation. The above results contribute to the PEPFAR 2-7-10 goals by

increasing the number of women cared for by PMTCT programs; by improving prevention (PMTCT)

outcomes, thus reducing the number of infected children; and by increasing the number of pregnant women,

new mothers, and infants receiving treatment by providing a referral system from PMTCT to ARV services.

As providers of indirect services to established PEPFAR supported PMTCT programs; with PEPFAR-NPI

funds m2m and CMMB will strengthen and enhance PMTCT services at 6 sites in Central Province (Kiambu

District) and Nairobi Province (district to be determined) and initiate service in 30 additional sites in:

Southern Rift Province (Nakuru District, around Lake Naivasha); Nyanza Province (district TBD) and

Coastal Province (district TBD). As an indirect service provider, m2m will report indicators and set targets

that demonstrate the outcomes of the program. PEPFAR PMTCT indicators will be collected; however these

numbers will duplicate those reported by the direct PEPFAR service provider at the site. Additional targets

that measure the work and impact of the m2m program specifically will be reported in addition, including the

number of new women who received m2m health talks in clinic waiting rooms; the number of HIV-positive

women who received services from m2m; the number of return visits to m2m; as well as additional

indicators that m2m is working to formulate in coordination with the NPI secretariat in Washington DC.

Targets for the number of women receive m2m services have not been formulated as site selection for FY

2008 has not taken place and estimates cannot be made. Targets for the PEPFAR PMTCT indicators

(counseling and testing / ARVs for PMTCT), cannot be established until site selection is complete.

3. LINKS TO OTHER ACTIVITIES

In support of PMTCT services, m2m provides linkages to other critical components of HIV care and

prevention efforts. The program works directly with Counseling and Testing (VCT) programs by encouraging

women to learn their HIV status during pregnancy. m2m also provides women with information about

programs that provide treatment with ARVs (ART) for pregnant women who are eligible during pregnancy.

The program also helps increase uptake of infant testing by educating and encouraging women to bring

their babies back after delivery for HIV tests and bactrim prophylaxis. By encouraging behaviors that can

help mothers sustain their well-being, the program aims to reduce the potential that children could become

Orphans and/or Vulnerable Children (OVC).

4. POPULATIONS TARGETED

The specific target populations that benefit from the m2m package of care at PMTCT services sites include

the pregnant women, primarily HIV-positive pregnant women who receive m2m educational and

psychosocial support; people living with HIV/AIDS (PLWHA) which includes both the women who receive

the services and the HIV-positive women who are employed by the program. The HIV-exposed infants who

are born to the women who receive m2m services are also beneficiaries of the m2m program activities.

5. EMPHASIS AREAS/KEY LEGISLATIVE ISSUES

The primary emphasis areas for these activities are Human Capacity Development (IST); and Local

Activity Narrative: Organization Capacity Development and Sustainability. Key legislative issues addressed include Prevention

with Positives, Reducing Stigma and Discrimination; Care for Caregivers and support of PLWHA.