Updated April 2009 Reprogramming. Decreased by $300,000. Funding moved to KEMRI.

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:

+ Gucha district was previously supported through Network of AIDS Researchers in East and Southern

Africa. In 09COP the district will be supported under a new partner who is yet to be determined under CDC

Gucha TBD.

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

This activity supports key attributions in human capacity development through the training of health care

service providers on PMTCT and other HIV prevention and care topics in order to equip them with

knowledge and skills to provide quality PMTCT services. These service providers include doctors, nurses,

clinical officers, nutrition officers and health record clerks. Other personnel targeted for training are the

mentor mothers and other peer counselors.

COP 2008

1. LIST OF RELATED ACTIVITIES

APHIA II Nyanza Program; KEMRI PMTCT.

2. ACTIVITY DESCRIPTION AND EMPHASIS AREAS

Gucha and Gucha South District are located in Nyanza Province. The estimated number of pregnancies in

these districts is 25,126 with an ANC HIV prevalence of 4.5 %. With Emergency Plan funding,

implementation of PMTCT activities in these districts was supported by KEMRI starting 2004 and later by

NETWORK OF AIDS RESEARCHERS IN EASTERN AND SOUTHERN AFRICA (NARESA). Over the

years, these districts have achieved an uptake rate of over 80 % in all the PMTCT interventions of HIV

Testing and Counseling of pregnant mothers attending MCH and Maternity facilities as well as

administration of maternal and infant ARV prophylaxis to HIV +ve mothers and their HIV exposed infants

respectively. In 2008 COP, these two districts were supported by NARESA to implement PMTCT activities

in a total of 21 facilities. During the period October 2007 and August 2008, a total of 7,983 women received

HIV testing and counseling. Of these 479 tested HIV positive. Of these 333 HIV +ve mothers received a

complete course of ARV prophylaxis. In 2009, these activities will be supported by a new partner yet To Be

Determined (TBD). The program will counsel and test 22,296 (93%) of 23,869 pregnant women and provide

antiretroviral prophylaxis for 966 (93%) of 1,034 HIV-positive women; 20% (193) of these women will

receive triple Anti Retroviral Therapy (ART) while 50% (483) will receive both single dose Nevirapine (sd

NVP) and AZT in line with the national PMTCT guidelines. It is also estimated that 30% (290) of the HIV +ve

pregnant women may present to the ANC clinic for their visit in the late gestational period (beyond 36 weeks

gestation). These women will be given the minimum ARV prophylaxis of sd NVP, though the program will

sensitize all pregnant women to attend ANC as early as possible (early gestation) so that all HIV-positive

pregnant women receive the more efficacious ARV regimen for PMTCT of HIV. The program will support

the WHO clinical staging and CD4 cell count test for all HIV positive pregnant women in order to facilitate

assessment for decision making on the ARV regimen for the women. The national PMTCT guideline

provides the criteria for this decision making. In order to ensure access to CD4 testing, the program will

work with other PEPFAR funded programs, Ministry of Health and other stakeholders at district level to

establish and or maintain functional laboratory network systems. All HIV positive women identified through

the PMTCT program will be given Cotrimoxazole for OI prophylaxis therapy. TB is one of the common

opportunistic infection seen in HIV positive individuals. The program will continue to work with the TB/HIV

program to strengthen TB screening among HIV-positive pregnant women and make referrals for treatment.

The program will continue to support the follow up of HIV-positive women and their infants in the postnatal

period through strengthening of postnatal care services at facility level. The current package of care for the

mother includes regular follow up, linkage to family planning services, OI prophylaxis and counseling on

correct infant feeding practices and psychosocial support through the mentor mothers' model. Infant

additional care activities include OI prophylaxis using Cotrimoxazole starting at six weeks of age, and DBS

for HIV- PCR (Early Infant HIV Diagnosis-EID). The program will target 966 HIV exposed infants for DBS,

and will work with the HIV/AIDS treatment program to ensure linkage to pediatric HIV care services for all

eligible infants in line with the national guidelines. The program will also strengthen psychosocial care and

support for the HIV-positive mother and her family at both the facility and community levels through the

establishment of structured support groups and the Prevention with Positives (PwP) strategy. At the facility

level, interventions will include psychosocial counseling with a focus on giving information and skills to the

HIV-positive women to encourage adherence to interventions such as correct use of ARVs and optimal

infant feeding practices. At the community level, the interventions will include establishment of support

groups, dealing with disclosure and encouraging partner and family support and will seek to integrate these

activities with the MoH Community Health Strategy activities. The program will also initiate and support

couple counseling and testing to strengthen HIV prevention incase of discordant couples and will reach at

least 4,459 men with HIV testing and counseling services. The program will collaborate with the Testing and

Counseling team as well as the Care and Treatment to ensure linkage to ongoing care for men who test HIV

-positive. The partner will work with the Ministry of Health to support implementation of PMTCT services in

25 health facilities with the goal of achieving universal geographic coverage of services. The program will

train 60 service providers on PMTCT and comprehensive HIV management for HIV-positive mothers and

their families. Program emphasis areas are increasing gender equity in HIV/AIDS by improving access to

HIV testing for women accessing PMTCT services, strengthening couple counseling and testing and in

particular increasing access to HIV testing for the male partners. Other program emphasis areas include

health related wrap around programs that contribute to improved health outcomes of both mother and baby.

These include Malaria and safe motherhood, immunization and growth monitoring.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute 1.7% of the pregnant women who receive counseling and testing and 1.1% of the

ARV prophylaxis to the 2009 PEPFAR PMTCT target totals. This program will also contribute to the number

of HIV positive women accessing TB screening and treatment services thereby contributing to the PEPFAR

care and treatment goals. Finally, the program will also contribute to pediatric HIV care and treatment goal

through identification of HIV-exposed and infected infants who require care and treatment.

Activity Narrative: 4. LINKS TO OTHER ACTIVIES

This activity relates to the KEMRI ARV Services program, KEMRI TB program in Nyanza Province and

APHIA II Nyanza ARV services. This activity is linked to Palliative Care and HIV/AIDS treatment/ARV

services through the provision of ongoing care to the HIV-positive women in the antenatal and post natal

settings, care of the HIV exposed infant in the post natal period, referral for pediatric HIV diagnosis and

referral to the ART sites for women and infants based on the national guidelines. It also linked to Palliative

Care: TB/HIV through the integration of TB screening services among the HIV positive pregnant women in

PMTCT settings and referral to the TB clinics.

5. POPULATIONS BEING TARGETED

The target population is children under 5 years, pregnant adolescent girls and their partners (15-24 years),

adults, Discordant couples, people living with HIV/AIDS, and pregnant women.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Reducing violence and coercion

Health-related Wraparound Programs

* Child Survival Activities

* Malaria (PMI)

* Safe Motherhood

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01: