Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 1244
Country/Region: Kenya
Year: 2009
Main Partner: Henry M. Jackson Foundation for the Advancement of Military Medicine
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USDOD
Total Funding: $2,091,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $100,000

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

+In the 09 COP, service provision will be limited to the military personnel, their dependants and the civilian

employees only. (In the 08 COP, KDOD was also providing services to the civilian population around the

military barracks).

+Prime partner HJF MRI has been competitively selected to implement the activity.

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

This activity supports key crosscutting attributions in human capacity development through in service

training of nurses in PMTCT. This activity will also support the provision of micronutrient supplements to HIV

infected pregnant women according to WHO guidelines. Facility based therapeutic supplementation of

severely and moderately malnourished mothers in PMTCT setting will be supported.

COP 2008

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Palliative Care: Basic Health Care and Support, Counseling and Testing

and HIV/AIDS Treatment: ARV Services.

2. ACTIVITY DESCRIPTION

The Kenya Department of Defense, (KDOD) medical service provides health care to 100,000 military

personnel, their dependants, and the civilian staff employed by KDOD. In FY 2009, KDOD will continue to

extend Prevention of Mother-To-Child Transmission (PMTCT) services to the military personnel, their

dependants, and the civilian staff employed by KDOD. Currently the KDOD offers PMTCT services in 14 of

the 40 military camps sites nationwide. Of the 2,500 expected pregnancies in KDoD; HIV CT services will

be provided to 1,700 (68 %) pregnant women during the antenatal, intra-partum, and immediate postpartum

period. Additionally of the 192 total expected HIV infected pregnant women, 150 (78%) HIV-infected

pregnant women and all of their babies will receive ARV prophylaxis. All HIV-positive pregnant women will

be staged clinically and immunologically by WHO criteria and CD4 cell count testing respectively. Women in

WHO stage 3 & 4 and all those with CD4 cell count less than 350 will be initiated on ART. Those in WHO

stage 1 & 2 with CD4 cell count greater than 350 will be initiated on AZT from 28 weeks gestation. Of the

targeted 150 HIV-positive pregnant women 45 (30%) will get a minimum of Single dose nevirapine

(SdNVP), 75 (50%) will receive short course AZT from 28 weeks of pregnancy and SdNVP, and 30 (20%)

will get ART. All the HIV-positive pregnant women who receive SdNVP will be given AZT and 3TC

combination for one week post natally to cover the Nevirapine "tail" to reduce the development of NVP

resistance. All exposed babies will receive SdNVP, 3TC for one week and AZT for six weeks. Nevirapine

tablets will be dispensed to all HIV-positive pregnant women at first contact to minimize missed

opportunities. All HIV-positive pregnant women will be started on cotrimoxazole (CTX) prophylaxis. All

pregnant women will be given Malaria Intermittent Presumptive Treatment (IPT) and Insecticide Treated

Nets (ITN). In addition, technical assistance will be provided by 2 additional locally employed staff.

Cotrimoxazole prophylaxis will be provided to all HIV exposed infants and their mothers. Counseling on

infants feeding will also be provided. The PMTCT services will continue to be integrated into all existing

military maternity facilities targeting 500 eligible women who will be served with Family Planning information

and services through wrap around programs, Provider Initiated Testing and Counseling (PITC) in FP and

Child Welfare Clinics (CWC); and improving access to FP services. Emphasis will be placed on primary

prevention for the majority of women identified as HIV -ve through PMTCT programs. We plan to enhance

greater involvement of people living with HIV and AIDS (GIPA) through the facility and community based

psychosocial support groups, Mentor Mothers, Prevention with Positive (PwP) and Men as Partners (MAP).

The KDOD also will continue to offer sexual partner testing targeting 500 (20%) men through the MAPS

initiative. In order to improve on sustainability, KDOD will train 20 additional health care providers in

PMTCT including nutrition. A further 30 health care providers will receive refresher training on PMTCT using

the Ministry of Health (MoH) Guidelines. Quality assurance will be ensured through establishment of a

strategic information and monitoring system that will facilitate data analysis. Regular consultations and

sharing of experiences within the military and with the MOH will be undertaken in an effort to improve

PMTCT services and strengthen follow up of infants born to HIV infected women. The KDOD will undertake

minor site PMTCT repairs as necessary. Linkages with HIV care and treatment services including

antiretroviral treatment (ART) offered by the KDOD will be strengthened to ensure that all those identified as

HIV-infected have access to them. Linkages will also be made to FP services. The KDOD will continue to

receive technical assistance from the United States Department of Defense (USDOD).

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to overall PEPFAR and Kenya government national goal of universal access to

PMTCT services. KDOD PMTCT activity will also contribute to 0.1% of the overall national target of

1,300,000 pregnant women accessing PMTCT services in 2009 COP. The planned activities will also

improve equity in access to HIV prevention and care services of the most at risk populations. These

activities will contribute to the result of increased access to CT services, and those identified, as HIV-

infected will be referred for care, support and treatment.

4. LINKS TO OTHER ACTIVITIES

Linkages between PMTCT service and care outlets will be strengthened to improve utilization of care

opportunities created through PEPFAR funding. The PMTCT activities will relate to KDOD activities in

palliative care, CT, OVC and HIV/AIDS treatment/ART services. PMTCT services include CT which is

largely diagnostic, provision of ARV prophylaxis, and appropriate referrals for the management of

opportunistic infections including TB screening for HIV+ pregnant women and HIV/AIDS treatment.

5. POPULATIONS BEING TARGETED

This activity targets adult of reproductive health age, pregnant women, HIV-exposed/ infected infants, and

HIV positive pregnant women. Strategies to improve quality of services will target health care providers,

doctors, nurses, midwives, clinical officers and KDOD civilian employees.

6. KEY LEGISLATIVE ISSUES ADDRESSED

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

Activity Narrative: pregnant women and their male sexual partners. Identifying the women through PMTCT will give them an

opportunity to access care for themselves, partners, and their children-all resulting in improved pregnancy

outcomes. Increased availability of PMTCT and PMTCT+ services will increase access to HIV care,

treatment and help reduce stigma and discrimination at military community and facility level.

7. EMPHASIS AREAS

The major emphasis areas in this activity will be in training more health care providers to meet the demands

of the improved PMTCT uptake. Minor emphasis will include minor repairs at targeted health facilities as

needed to provide appropriate client privacy and confidentiality. Supportive supervision, quality assurance,

and strategic information planning will also be provided to improve PMTCT service delivery quality.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14892

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14892 4251.08 Department of Kenya Medical 6967 1244.08 Kenya $100,000

Defense Research Institute Department of

Defense

6959 4251.07 Department of Kenya Medical 4248 1244.07 Kenya $75,000

Defense Research Institute Department of

Defense

4251 4251.06 Department of Kenya Medical 3262 1244.06 Kenya $100,000

Defense Research Institute Department of

Defense

Emphasis Areas

Construction/Renovation

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Malaria (PMI)

* Safe Motherhood

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $25,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $10,000

Economic Strengthening

Education

Water

Table 3.3.01:

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $75,000

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

+Target of individuals reached through community outreach that promotes HIV/AIDS prevention through

abstinence and /or being faithful changes to 15,000.

+The number of individuals trained to promote HIV/AIDS prevention through abstinence and/or being faithful

changes to 150.

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

This activity supports key crosscutting attributions in human capacity development through in service

training of military personnel in ABY peer educators in Men as Partners (MAP) with the aim of strengthening

integration of the MAPP curriculum into regular KDOD trainings, both at the basic training stage following

recruitment as well as ongoing military cadre courses/trainings. 26.7% of the total budgetary allocation will

be used to support this activity.

In FY 09 the KDOD will continue to promote AB activity that focus on the dependents of military personnel

between ages of 10 and 18 by strengthening the development of a peer education program which

addresses issue of youth HIV prevention and AB. 28.4% of the total budgetary allocation will be used to

support this activity.

COP 2008

1. LIST OF RELATED ACTIVITIES

This activity is related to activities in Counseling and Testing (#6957) and Condoms and Other Prevention

(#6962).

2. ACTIVITY DESCRIPTION

In FY 2007, Kenya Department of Defense (KDOD) trained 25 personnel as master trainers for the Men as

Partners in Prevention program (MAPP): five from each barrack (Lanet Army Barracks, Eldoret Recruits

Training College, Embakasi Garrison, Moi Air Base and Mtongwe Naval Base). The MAPP program focused

on the recruits and young dependents of military personnel living in the camps. Using lessons learned from

this experience, the KDOD intends to continue to expand on these activities in FY 2008. This activity aims

at identifying young people early at the entry point of their military careers and targeting specific behaviors

that are consistent with ensuring the prevention of HIV. This program has proven to be a success in building

skills that protect the military personnel against HIV infection. In FY 2008, the program will also focus and

address pervasive gender stereotypes and male behaviors that are relevant to uniformed personnel which

continue to be risk factors for HIV transmission. Due to the wide distribution of KDOD personnel in remote

areas of the country, the program will train 250 additional staff including 20 peer educators with the aim of

strengthening the integration of the curriculum into regular KDOD training not only at the basic training

stage following recruitment but also into the ongoing cadre course training of the KDOD program. In FY

2008, the KDOD AB activity will also focus on the dependents of the military personnel that are between the

ages of 10 and 18 with the development of a peer education program which addresses issues of youth

prevention and AB. In FY 2008, KDOD intends to promote greater command-level involvement in all

aspects of HIV prevention in the military through seminars and workshops to enhance their ownership and

participation in the prevention program. The major emphasis of the AB component of the program will

contribute to the outcome of changed social norms to promote HIV prevention behaviors among youth who

constitute a part of the population highly vulnerable to HIV infection. This will ensure that larger numbers are

reached with HIV prevention efforts and adults become actively involved as supportive mentors for youth. A

total of 1,157 caregivers will be trained to support this effort. A total 26,608 additional individuals in the

KDOD community and its environs are expected to be reached with messages that promote HIV/AIDS

prevention through abstinence and/or being faithful.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

AB activities within the KDOD program will contribute to FY 2008 prevention targets for Kenya, especially

among young recruits who are entering the military. The activities will also focus on youthful dependents

within the military community and young people living in the neighborhood of the military barracks in order

to address the prevention needs of the whole military community.

4 LINKS TO OTHER ACTIVITIES

This activity is linked to KDOD counseling and testing (CT) activity (#6957) by promoting VCT services as a

way of promoting secondary abstinence. This activity also links to the KDOD Condoms and Other

Prevention activity (#6962) by offering comprehensive prevention messages for the military community.

5. POPULATIONS BEING TARGETED

This activity targets young adults, both men and women of reproductive age. It will have a special focus on

the KDOD military personnel who, due to the nature of their duties, are vulnerable to HIV transmission.

Particular emphasis will be placed on young military recruits and young dependants of military personnel

residing inside the barracks as well as young people living in the neighborhood of the military barracks.

Leaders within the KDOD will have their capacity strengthened to provide leadership in this area.

6. KEY LEGISLATIVE ISSUES ADDRESSED

Through the skill building and behavior change that occurs as a part of the men as partners program, this

activity will address male norms and behavior and reduction of violence and coercion as well as stigma and

discrimination. The involvement of both male and female in AB activities will promote increased gender

equity in HIV/AIDS Programs to ensure that women are not left out of these important prevention activities.

7. EMPHASIS AREAS

The major emphasis will be on training by the continuation of the MAPP program as well as the introduction

of peer education for the youth that live within the military community. Minor emphasis areas include work

place programs, information, education and communication and community youth mobilization/participation.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14893

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14893 5272.08 Department of Kenya Medical 6967 1244.08 Kenya $175,000

Defense Research Institute Department of

Defense

6966 5272.07 Department of Kenya Medical 4248 1244.07 Kenya $150,000

Defense Research Institute Department of

Defense

5272 5272.06 Department of Kenya Medical 3262 1244.06 Kenya $100,000

Defense Research Institute Department of

Defense

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $20,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $21,286

Water

Table 3.3.02:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $100,000

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

+Number of targeted condom service outlets changes to 460

+Number of individuals reached through community outreach that promotes HIV/AIDS prevention through

other behavior change beyond abstinence and/or being faithful changes to 10,000

+Number of individuals trained to promote HIV/AIDS prevention through other behavior change, changes to

50

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

This activity supports key crosscutting attributions in human capacity development through in-service

training of doctors and registered clinical officers on diagnosis and management of Sexually Transmitted

Infections (STI) in line with MOH guidelines. 40% of the total budgetary allocation will be used to support

this activity.

COP 2008

1. LIST OF RELATED ACTIVITIES

This activity is related to activities in Counseling and Testing (#6957), Abstinence and Being Faithful

(#6966), and Prevention of Mother-to-Child Transmission (#6959).

2. ACTIVITY DESCRIPTION

The Kenya military recruits 2,500 young men and women in the age group 18 to 24 years old annually. This

group is highly vulnerable to HIV infection and other STIs as well. This activity aims to strengthen HIV

prevention in the Kenya Department of Defense (KDOD) and has three components. The first component

will include activities geared to promote prevention of HIV and STIs by focusing on training health care

workers in integrating HIV prevention in their STI diagnosis and treatment. In addition, in FY 2008, KDOD

will train 30 individuals to promote HIV/AIDS prevention through behavior change messages that will be

disseminated through seminars and workshops targeting 5,300 military personnel, their dependants and

civilian personnel working in the military. Special forums targeting commercial sex workers (CSWs) with

condoms and other prevention (COP) messages will be implemented in three geographical areas within

Kenya, specifically Gilgil, Nanyuki, Isiolo and Mombasa, all of which are known to have a high concentration

of CSWs due to their location on the major transport corridor through the country. Although STI basic care

will be offered in all the military medical facilities, the program will concentrate on four military regions with a

high population density which includes Thika, Kahawa, Embakasi and Moi Air Base. Liaison will be

continued between the KDOD and National AIDS and STI Control Program (NASCOP) to ensure high

quality care and training in STI. The second component of the KDOD COP program will involve activities to

promote correct and consistent use of condoms among the military personnel. Measures will be put in place

to ensure availability of condoms in all the military stations country-wide by maintaining 40 condom outlets

throughout the military communities. Regular monitoring of condom uptake by military personnel will be

done on a monthly basis. The final component in FY 2008 will focus on the young recruits entering the

military. Though this group is being targeted through the youth focused program referred to as "Men as

Partners" (MAP) under the ABY program area, this funding will support condom education and promotion as

a supplement to the ABY program activities in order to provide a comprehensive prevention program. This

activity also intends to continue scaling-up of command involvement and support in promoting behavior

change activities by conducting regular trainings, organizing seminars and workshops for the military

personnel under their respective commands.

3. CONTRIBUTION TO OVERALL PROGRAM AREA KDOD

This activity contributes to Kenya's 5-year strategy of reducing the risk of HIV transmission among high risk

occupational settings by promoting the knowledge on correct and consistent condom use among this high-

risk group.

4. LINKS TO OTHER ACTIVITIES

This activity is linked to KEMRI-KDOD counseling and testing (CT) (#6957) and prevention of mother-to-

child HIV transmission (PMTCT) (#6959). This OP activity is also linked to KEMRI-KDOD ABY activity

(#6966) by partnering with other prevention activities that promote a comprehensive approach to prevention

for the military population.

5. POPULATIONS BEING TARGETED

The KDOD OP activity will reach the most at-risk population by targeting the military personnel and their

dependants as well as CSWs that live adjacent to the military barracks in Kenya. It will also reach the

civilian population working in the barracks and the general population living in the neighborhoods of the

barracks. The program intends to capture all STI cases and offer comprehensive treatment to those infected

as well as provide them with prevention messages.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address the issues of male norms and behaviors which promote HIV risk behavior,

especially in this high-risk community of the military. These activities will challenge traditional male norms

that have been identified as contributing to sexual coercion and multiple sexual partners. The KDOD OP

program will also address stigma and discrimination that often is a significant obstacle to routine CT

services and the use of condoms.

7. EMPHASIS AREAS

The major emphasis area for this workplace program will be community mobilization/participation in order to

ensure that military personnel receive quality and specific prevention programs. Other emphasis areas will

be information, education and communication in order to de-stigmatize treatment for STIs as well as the

development of network/linkages/referral systems with other prevention activities. These areas will assist in

the systems integration approach that will successfully link information with behavior change. Training will

comprise another key emphasis area, and this will all be developed within the military work place program.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14894

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14894 4254.08 Department of Kenya Medical 6967 1244.08 Kenya $75,000

Defense Research Institute Department of

Defense

6962 4254.07 Department of Kenya Medical 4248 1244.07 Kenya $100,000

Defense Research Institute Department of

Defense

4254 4254.06 Department of Kenya Medical 3262 1244.06 Kenya $100,000

Defense Research Institute Department of

Defense

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $40,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

Funding for Care: Adult Care and Support (HBHC): $160,000

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

+ The prime partner changes from KEMRI to HJF-MRI.

+ All sections referring to pediatric care and support have been moved from this narrative to a new program

area Pediatric Care and Support.

+ In FY 09 the KDOD program shifts focus from civil outreach to concentrate on reaching military personnel

and their dependants with basic health care and support services within the military setting. Support for

civilian focused activities has been transitioned to other USG implementing partners.

+ The number of individuals provided with HIV-related palliative care (excluding TB/HIV) changes to 2,000.

+ The number of individuals trained to provide HIV related palliative care (excluding TB/HIV) changes to 20.

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

+ This activity supports key cross-cutting attributions in human capacity development through in service

training of health care workers including clinical officers, nurses and doctors in the provision of basic health

care and support services. 16.7% of the budgetary allocation will be attributed to this activity.

+ Provision of micronutrient supplementation according to WHO guidelines will be supported. Therapeutic,

supplementary and supplemental feeding will be done for severely and moderately malnourished PLWHA.

33% of the budgetary allocation will be attributed to this activity.

COP 2008

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

+a prevention component has been integrated that is budgeted in this activity and includes the following

elements:

>Positive Prevention in Clinical Settings

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Counseling and Testing, Prevention of Mother-to-Child Transmission,

ARV Services and Palliative Care: TB/HIV.

2. ACTIVITY DESCRIPTION

The Kenyan Department of Defense (KDOD) will provide basic health care and support to over 3,500 HIV-

positive military personnel, their dependents and civilian population residing near the military barracks at 8

KDOD medical facilities. In FY 2008, KDOD intends to focus upon improving the quality of life of those who

are HIV positive by improving on the delivery of care to these individuals. The package of palliative care

services will include cotrimoxazole prophylaxis, treatment of opportunistic infections, nutritional

supplementation, de-worming of children, TB screening, sexually transmitted infection (STI) management

and improved access to malaria prevention interventions. Other activities will include support of HIV positive

OVCs of the military to ensure they are provided with palliative care and linked to ART services, providing

support to post test clubs, strengthening of logistics capacity (particularly pharmacy management), and

procurement of commodities such OI medications and laboratory reagents. In FY 2008, this activity plans to

intensify palliative care in 8 existing military palliative care centers to reach a total of 3,500 patients with

palliative care services and screen at least 1,750 of them for TB. The treatment centers are well distributed

nationally to ensure fair geographical distribution thus ensuring the services are accessible for the

population who may require this support. Referral systems and networking among smaller and larger

military clinics will be developed to ensure continuity in care. A total of 40 health care workers, 5 for each

site, will be trained to offer services in the 8 centers. Adherence to care will be supported through extensive

involvement of PLWHA who will be trained as peer counselors to provide psychosocial support, ART and

TB adherence support for both clinic patients and at the community/barrack level. Part of the FY 2008 funds

will be used to role out the Prevention with positives (PWPs) initiative through procurement of

supplies/materials e.g. flow charts, hand outs, posters, counselor support and evaluation. In partnership

with the USDOD Walter Reed Project, the KDOD in the last 4 years has been successful in encouraging

KDOD military to come forward for testing so that those who need care can be assisted. Over 26,000

people have been tested and as a result 1660 have been registered in an HIV comprehensive care clinic.

As per August 2007, 1025 people were on antiretroviral therapy, and the remaining 635 were receiving

basic health care and support. FY 2008 activities will build upon the success of this program to ensure that

HIV positive patients are directly linked to health care and support services. Even though treatment sites are

decentralized from the main military hospital in Nairobi (AFMH) to other military regions, the care and

treatment of KDOD HIV/AIDS patients will continue to be closely monitored by staff from the main military

hospital in liaison with the Ministry of Health to ensure maintenance of standards of care as per national

guidelines. The human resource requirements will be reviewed as necessary. Data on the epidemic will be

collected systematically and shared openly to facilitate in monitoring of the epidemic and to assess the

services provided.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

By providing care and support to over 3500 patients as described, the KDOD basic health care and support

program will contribute to the overall number of people under care in Kenya. Capacity building of PLWHA to

act as peer educators will contribute to mobilization and strengthening of the KDOD program capacity to

plan integrate and evaluate facility and community care support programs. The trainings and guidelines for

this activity will be in accordance with the national guidelines as outlined by the National AIDS/STI Control

Program.

4. LINKS TO OTHER ACTIVITIES

These activities will link closely with KDOD's counseling and testing, ARV services, and TB/HIV services.

Through the KDOD PMTCT program family members of mothers testing positive will be identified and

offered opportunity for care and treatment. KDOD's BHCS and ART will constitute a continuum of care for

HIV positive individuals as part of a comprehensive approach to care and treatment.

5. POPULATIONS BEING TARGETED

This activity targets most at risk populations consisting of military personnel and their dependants as well as

the civilian population residing close to the barracks where treatment is otherwise unavailable (that is the

population in the Kenyan administrative location within which the military treatment and care centers are

Activity Narrative: located). Health care providers will also be targeted by increased ARV training, thus increasing the amount

of clients able to be served more efficiently.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address gender equity by ensuring that both males and females are targeted as receiving

services if required. This activity will also address stigma and discrimination through community education

and mobilization on issues related to living positively with HIV-AIDS.

7. EMPHASIS AREAS

This activity includes major emphasis in commodity procurement (drugs for opportunistic infections,

nutritional supplements and pain relief) with minor emphasis in the areas of human resources, training and

infrastructure. KDOD will renovate the comprehensive care clinics to create more space in the new sites,

purchase diagnostic and medical supplies, hire additional health staff to help manage the increasing

workload as more patients are recruited into the comprehensive are clinics.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14895

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14895 4252.08 Department of Kenya Medical 6967 1244.08 Kenya $100,000

Defense Research Institute Department of

Defense

6960 4252.07 Department of Kenya Medical 4248 1244.07 Kenya $69,119

Defense Research Institute Department of

Defense

4252 4252.06 Department of Kenya Medical 3262 1244.06 Kenya $100,000

Defense Research Institute Department of

Defense

Emphasis Areas

Gender

* Addressing male norms and behaviors

Health-related Wraparound Programs

* TB

Military Populations

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $15,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $30,000

Economic Strengthening

Education

Water

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $1,000,000

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

+The prime partner changes from KEMRI to HJF-MRI

+ All sections referring to pediatric ART have been moved from this narrative to a new program area

(PDTX Treatment)

+ In FY 09 the KDOD program shifts focus from civil outreach to concentrate on reaching military personnel

and their dependants within the military settings with ART services. Support for civilian focused activities

has been transitioned to other USG implementing partners.

+ The number of individuals newly initiating therapy during the reporting period changes to 250.

+ The number of individuals receiving antiretroviral therapy by the end of the reporting period changes to

1,600

+ The number of health workers trained to deliver ART services, according to national and / or international

standards changes to 20.

+ The number of individuals who ever received antiretroviral therapy by the end of the reporting period

changes to 2000

+ Funds under this activity will be used to support related laboratory services and barrack based adherence

activities.

+ Prevention with Positives interventions will be a component of routine adult treatment activities within the

clinic setting.

+ Creation of strong linkages and referral mechanisms between the lower level medical care provision

centers (Medical Reception Stations, Sick Bays and Base Medical Centers) and the higher level medical

facilities will be supported.

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

This activity supports key cross-cutting attributions in human capacity development through in service

training of health care workers including clinical officers, nurses and doctors in the management of patients

on ART. Training of volunteer PLWHA on adherence counseling and patient follow up will be supported for

task shifting. 1.4% of the budgetary allocation will be attributed to this activity.

The activity will additionally supports nutrition commodities by leveraging on the INSTA Food By

Prescription Support program, which is to be implemented in five clinics as follows: Armed Forces Memorial

Hospital, Gilgil Regional Hospital, 3KR Lanet Clinic, Laikipia Air Base Hospital and Kenya Naval Base

hospital.

COP 2008

1. LIST OF RELATED ACTIVITIES

This activity is related to activities in Counseling and Testing, Palliative Care: TB/HIV, Palliative Care: Basic

Health Care and Support, Prevention of Mother-to-Child Transmission, Laboratory infrastructure and

Strategic Information.

2. ACTIVITY DESCRIPTION

Under FY 2008 Emergency Plan funding, the Kenyan Department of Defense (KDOD) will continue to

support eight military Antiretroviral Therapy (ART) in Kenya (Armed Forces Memorial Hospital (AFMH) and

its satellite at KEMRI Campus in Nairobi, The Air Force Medical Centre in Laikipia and its annex at the 4th

Brigade, Kenyatta barracks - Gilgil, Lanet barracks and its satellite at 81 Tank in Nakuru, Naval Medical

centre and its satellite at Mtongwe municipal clinic in Mombasa, Thika, Eldoret and the Air Force Medical

centre in Nairobi at Moi Air Base). In FY 08, funds will continue to be used to provide ART to soldiers, their

dependants, KDOD civilian employees and civilians in the neighboring communities. In addition special

emphasis will be put on patient follow up and adherence monitoring by use of social workers and telephone

tracking. Treatment outcomes will be monitored at 3,6,12 and 24 monthly. The target is to bring the total

ever treated to 3500(1850 new) including 500 children. In FY 2008, the KDOD HIV program intends to

extend treatment and care services to a target population of 600,000 people these will include 100,000

military personnel, their dependants, civilian personnel and the neighboring underserved civilian population

estimated at 500,000.With the support of US Army Medical Research Unit-Kenya, the KDOD has

developed capacity to manage and run successfully 5 HIV/AIDS comprehensive care clinics as follows;

AFMH, in Nairobi, Lanet, Gilgil , Laikipia and Mtongwe. To date a total of 1,650 HIV-infected patients have

been registered. Out of which, over 1,035 are on ART and over 300 patients continue to receive treatment

for tuberculosis (TB). In FY 2008, support activities will include strengthening of the AFMH to serve as a

referral center for HIV/AIDS care through improvement of existing laboratory capacity, management of

Sexually Transmitted Infections (STIs), management of complicated medical cases such as ARV drug

resistance and strengthening of the SI capacity to implement Public Health Evaluations. . AFMH will also

continue providing pediatric HIV-AIDS care and treatment. Infrastructural expansion of the other 7 CCCs will

be undertaken in order to accommodate the expanded program. In order to maintain and improve on

achievements already attained, the KDOD will need to train additional staff to run the 8 CCCs and their

satellites. Over the last four years more than 75 KDOD medical personnel have received basic orientation

on Antiretroviral (ARV) administration and treatment of tuberculosis (TB). However due to competing

medical and other military duties, only a few remain available to run the clinic on a day to day basis. In FY

2008, staff of various cadres will be trained including 36 health care workers to be trained on

comprehensive adult and pediatric HIV/AIDS treatment and care. In addition, manpower requirements will

be reviewed and hired as necessary to ensure that KDOD HIV Program maintains at least 1 registered

clinical officer, 1 pharmaceutical technologist, 1 laboratory technologist and 1 data clerk at each of the 8

treatment centers at any one time. Part of 2008 funds will be used to procure drugs for opportunistic

infections and nutritional supplements, staffing, diagnosis of HIV, STIs and various opportunistic infections,

safety monitoring equipment and supplies. These funds will also be used to continue and/or initiate

technical assistance from locally employed staff.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

By putting 3,500 people on treatment through the KDOD program, this will contribute to the result of

increased number of people on ARVs nationally. Improvement of the infrastructure and of the laboratory

services will also lead to better quality of services rendered to the HIV infected patients. Even though

treatment sites are decentralized from AFMH to 7 other sites covering the main military regions (namely the

Activity Narrative: Coast, Mount Kenya, 3 sites in central Rift Valley and Central province), the care and treatment of KDOD

HIV/AIDS patients will continue to be closely monitored by staff from the AFMH hospital in liaison with the

Ministry of Health (MOH) to ensure maintenance of standards of care as per national guidelines. Data on

the epidemic will be collected systematically and shared openly to facilitate in monitoring of the epidemic

and to assess the services provided.

4. LINKS TO OTHER ACTIVITIES

These activities will link closely with KDOD's counseling and testing, basic health care and support, TB/HIV,

OVC, PMTCT and laboratory services. Through the KDOD PMTCT program family members of mothers

testing positive will be identified and offered opportunity for care and treatment. ART activities will be linked

to KDOD BHCS. Thus KDOD's ART and BHCS will constitute a continuum of care for HIV infected

individuals.

5. POPULATIONS BEING TARGETED

This activity targets a population of 600,000 people consisting of most at risk Populations of military

personnel and their dependants, as well as the civilian population residing close to the barracks where

treatment is otherwise unavailable. The satellite clinics will be open to the civilians in order to increase

coverage and access to all these targeted populations. Health care providers will also be targeted by

increased ART training, thus increasing the amount of clients able to be served more efficiently.

6. KEY LEGISLATIVE ISSUES ADDRESSED

Increasing gender equity in HIV/AIDS programs, dealing with male norms and behaviors, and reducing

stigma and discrimination are all areas in which this activity will address. ART services that will be provided

will be given equitably across genders. Information and education on ART will be done for the public and

the medical staff to target stigma.

7. EMPHASIS AREAS

This activity includes major emphasis on commodity procurement, human resources and training and minor

emphasis on infrastructure. KDOD will purchase diagnostic and medical supplies, train staff on ART and

hire additional health staff to help manage the increasing workload as more patients are recruited into the

comprehensive care clinics.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14899

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14899 4250.08 Department of Kenya Medical 6967 1244.08 Kenya $1,150,000

Defense Research Institute Department of

Defense

6958 4250.07 Department of Kenya Medical 4248 1244.07 Kenya $591,715

Defense Research Institute Department of

Defense

4250 4250.06 Department of Kenya Medical 3262 1244.06 Kenya $650,000

Defense Research Institute Department of

Defense

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $15,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $20,000

ACTIVITY UNCHANGED FROM COP 2008:

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

This activity supports key cross-cutting attributions in human capacity development through in service

training of health care workers including clinical officers, nurses and doctors in the provision of pediatric

basic health care and support services as well as early infant diagnosis. This activity will also support

pediatric nutritional assessment and counseling before and during ART. Procurement of pediatric weighing

scales, stadiometers, MUAC tapes and other equipment required to carry out effective nutritional

assessment will be supported. Micronutrient supplementation according to WHO guidance will be provided.

COP 2008

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

+A prevention component has been integrated that is budgeted in this activity and includes the following

elements:

+Positive Prevention in Clinical Settings

1. ACTIVITY DESCRIPTION

The Kenyan Department of Defense (KDOD) will provide basic health care and support to 150 HIV-positive

children at 8 KDOD medical facilities namely, Armed Forces Memorial hospital, Lanet clinic, Gilgil Regional

Hospital, Kenya Naval Base clinic, Laikipia Air Base clinic, Thika 12 Engineers clinic, Moi Air Base clinic and

Eldoret RTS clinic. The treatment centers are well distributed nationally to ensure fair geographical

distribution thus ensuring the services are accessible for the population who may require this support. In FY

2009, KDOD intends to focus upon improving the quality of life of these children who are HIV positive by

improving on the delivery of care. The package of the pediatric basic health care and support will include

provision of cotrimoxazole prophylaxis, nutritional assessment and support including supplementation, de-

worming, and provision of psychological and spiritual counseling for children and their families. Clinical care

will include early infant diagnosis, clinical monitoring, prevention and treatment of OIs and other HIV/AIDS

related complications including Malaria, pneumonia and diarrhea, pain and symptom management. In order

to rapidly increase the number of HIV positive children receiving life saving antiretroviral treatment and care,

KDOD will strengthen the linkages between PMTCT Programs and pediatric follow up including pediatric

treatment, pediatric training for early infant diagnosis, routine testing of children, laboratory capacity building

and system strengthening for Early Infant Diagnosis (EID).HIV diagnosis in babies will be done at six weeks

after birth by collecting Dry Blood Samples (DBS). A new focus will be on routine testing of sick children in

pediatric medical setting which is expected to rapidly identify large numbers of HIV positive children and

provide possibility of direct links to treatment and care. A total of 20 health care workers will be trained to

offer pediatric basic care and support services including EID in the 8 treatment centers. Adherence to care

will be supported through extensive training of health care providers on pediatric psychosocial counseling

and support. As per August 2008, 118 children were receiving basic health care and support. Even though

pediatric care and support sites are decentralized from the main military hospital in Nairobi (AFMH) to other

military regions, the care and treatment of KDOD HIV/AIDS pediatric patients will continue to be closely

monitored by staff from the main military hospital in liaison with the Ministry of Health to ensure

maintenance of standards of care as per national guidelines. The human resource requirements will be

reviewed as necessary. Data on the epidemic will be collected systematically and shared to facilitate in

monitoring of the epidemic and to assess the services provided.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to Kenya's FY 09 goal of providing basic care and support to 76,900 children by

providing services to 150 children (0.2% of the overall Emergency Plan national target). Capacity building of

health workers on pediatric health care and support will contribute to mobilization and strengthening of the

KDOD program capacity to plan integrate and evaluate pediatric HIV care and support programs. The

trainings and guidelines for this activity will be in accordance with the national guidelines as outlined by the

National AIDS/STI Control Program.

4. LINKS TO OTHER ACTIVITIES

These activities will link closely with KDOD's counseling and testing (#6957), Pediatrics ARV services and

TB/HIV services (#6961). Through the KDOD PMTCT program children born of HIV positive mothers will be

identified tested and linked to care.

5. POPULATIONS BEING TARGETED

KDOD's Pediatric BHCS and ART will constitute a continuum of care for HIV positive children. This activity

targets children of military personnel. Health care providers will also be targeted by increased pediatric care

and support training including Early Infant Diagnosis.

6. EMPHASIS AREAS

Major emphasis is on commodity procurement (drugs for opportunistic infections, nutritional supplements

and pain relief) with minor emphasis in the areas of human resources, training and infrastructure.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14895

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14895 4252.08 Department of Kenya Medical 6967 1244.08 Kenya $100,000

Defense Research Institute Department of

Defense

6960 4252.07 Department of Kenya Medical 4248 1244.07 Kenya $69,119

Defense Research Institute Department of

Defense

4252 4252.06 Department of Kenya Medical 3262 1244.06 Kenya $100,000

Defense Research Institute Department of

Defense

Emphasis Areas

Construction/Renovation

Health-related Wraparound Programs

* Child Survival Activities

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $5,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $5,000

Economic Strengthening

Education

Water

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $110,000

ACTIVITY UNCHANGED FROM COP 2008:

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

This activity supports key cross-cutting attributions in human capacity development through in-service

training of health care providers including nurses, clinical officers and nurses on Pediatric ART

management. 15% of the budgetary allocation will be attributed to this activity. This activity will also support

pediatric nutritional assessment and counseling before and during ART. 10% of the budgetary allocation will

be attributed to this activity. Procurement of pediatric weighing scales, stadiometers, MUAC tapes and other

equipment required to carry out effective nutritional assessment will be supported. Micronutrient

supplementation according to WHO guidance will be provided. 10% of the budgetary allocation will be

attributed to this activity.

1. ACTIVITY DESCRIPTION

Under FY 2009 Emergency Plan funding, the Kenyan Department of Defense (KDOD) will support pediatric

Antiretroviral Therapy (ART) at 8 treatment sites namely; (Armed Forces Memorial Hospital (AFMH) in

Nairobi, The Air Force Medical Centre in Laikipia, Kenyatta barracks - Gilgil, Lanet barracks, Naval Medical

centre in Mombasa, Thika, Eldoret and the Air Force Medical centre in Nairobi at Moi Air Base). In FY 09,

funds will be used to provide ART to children of military personnel and KDOD civilian employees. In addition

special emphasis will be put on patient follow up and adherence monitoring by use of social workers and

telephone tracking. Treatment outcomes will be monitored at 3,6,12 and 24 months. With the support of US

Army Medical Research Unit-Kenya, the KDOD has developed capacity to manage and run successfully 5

HIV/AIDS comprehensive care clinics as follows; AFMH, in Nairobi, Lanet, Gilgil , Laikipia and Mtongwe. By

August 2008, a total of 159 HIV-infected children had been registered out of which 80 were on ART. The

target is to bring the total number of children on ART to 120(40 new). In FY 2009, pediatric treatment

activities will include strengthening of the AFMH to serve as a referral center for HIV/AIDS treatment and

management of complicated pediatric cases such as ARV drug resistance, infrastructural expansion of the 8

CCCs will be undertaken in order to create a pediatric friendly environment, training of health care workers

on pediatric ART management, clinical monitoring and support of ART related laboratory services. In FY

2009, staff of various cadres will be trained including 20 health care workers to be trained on

comprehensive pediatric HIV/AIDS treatment and care.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to Kenya's FY 09 goal of providing ART to 43,092 children, by providing services

to 120 individuals (0.3% of the overall FY 2009 Emergency Plan national target). Improvement of the

infrastructure and of the laboratory services will also lead to better quality of services rendered to the HIV

infected children. Even though treatment sites are decentralized from AFMH to 7 other sites covering the

main military regions (namely the Coast, Mount Kenya, 3 sites in central Rift Valley and Central province),

the care and treatment of KDOD HIV/AIDS patients will continue to be closely monitored by staff from the

AFMH hospital in liaison with the Ministry of Health (MOH) to ensure maintenance of standards of care as

per national guidelines. Data on the epidemic will be collected systematically and shared to facilitate in

monitoring of the epidemic and to assess the services provided.

3. LINKS TO OTHER ACTIVITIES

These activities will link closely with KDOD's counseling and testing, basic health care and support, TB/HIV,

OVC, PMTCT and laboratory services. Through the KDOD PMTCT program family members of mothers

testing positive will be identified and offered opportunity for care and treatment. Thus KDOD's Pediatric ART

and Pediatric BHCS will constitute a continuum of care for HIV infected individuals.

4. POPULATIONS BEING TARGETED

This activity targets military personnel and their dependants. Health care providers will also be targeted

through Pediatric ART training, thus increasing the amount of clients able to be served more efficiently.

5. EMPHASIS AREAS

This activity includes major emphasis on training and minor emphasis on infrastructure. KDOD will also

provide related laboratory tests and medical supplies.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14899

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14899 4250.08 Department of Kenya Medical 6967 1244.08 Kenya $1,150,000

Defense Research Institute Department of

Defense

6958 4250.07 Department of Kenya Medical 4248 1244.07 Kenya $591,715

Defense Research Institute Department of

Defense

4250 4250.06 Department of Kenya Medical 3262 1244.06 Kenya $650,000

Defense Research Institute Department of

Defense

Emphasis Areas

Construction/Renovation

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Child Survival Activities

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $15,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $200,000

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

+Prime partner was changed from Kenya Medical Research Institute to Henry Jackson Foundation (HJF)

which was competitively selected to implement the activity.

+In FY 09 the KDOD program shifts focus from civil outreach to concentrate on reaching military personnel

and their dependants with clinical prophylaxis and treatment for tuberculosis within the military setting.

Support for civilian focused activities has been transitioned to other USG implementing partners.

+The number of service outlets providing clinical prophylaxis and/or treatment for tuberculosis (TB) to HIV-

infected changes to 8.

+The number of HIV-infected clients receiving treatment for TB disease changes to 200.

+The number of individuals trained to provide clinical prophylaxis and/or treatment for TB to HIV-infected

individuals changes to 20.

+Number of registered TB patients who received HIV counseling, testing, and their test results changes to

300.

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

This activity supports key cross-cutting attributions in human capacity development through in service

training of health care workers including clinical officers, nurses and doctors in the management of TB

patients. 7.5% of the budgetary allocation will be attributed to this activity.

1. LIST OF RELATED ACTIVITIES:

This activity is related to activities in Counseling and Testing , Prevention of Mother-to-Child Transmission

Palliative Care: Basic Health Care and Support and ARV Services.

2. ACTIVITY DESCRIPTION

The Kenya Department of Defense (KDOD) will continue to intensify the diagnosis, care and treatment of

military patients with co-infections of TB and HIV (TB/HIV) by promoting screening activities of all HIV

infected patients for TB as well as ensuring all TB infected patients are offered HIV testing, STI screening,

HIV prevention messages including condom distribution. Those found to be co-infected will be given anti-

TB, Cotrimoxazole prophylaxis treatment (CPT) and ART as per the Kenya's National Leprosy and

Tuberculosis Program (NLTP) guidelines. Through this concerted effort, in FY08, the program will provide

HIV testing to 300 TB patients; and offer TB and HIV services to 150 TB/HIV co-infected patients.

Additionally, 1,750 patients accessing HIV services in the region will be screened for TB, and those found

positive provided with TB treatment. The program will intensify efforts of contact tracing by conducting door

to door sputum testing of TB contacts. This will lead to more cases being identified and appropriate care

being given in a timely manner. In order to achieve this, KDOD intends to continue improving the laboratory

capacity for TB/HIV and improving capacity of the health personnel through training in management of

TB/HIV. Refresher training for integrated TB/HIV activities for KDOD health professionals will be undertaken

by training of additional 36 health workers on TB and DTC using NASCOP/NLTP curriculum to support the

expected increased workload. TB/HIV services will continue to be supported in the 8 care and treatment

centers in Armed Forces Memorial Hospital (AFMH), Moi Air Base in Nairobi, Mombasa, Nanyuki, Nakuru,

Gilgil, Eldoret and Thika. In FY2007, funds were used to develop an integrated TB/HIV clinic within the

AFMH with marked success. In FY 2008, funds will be used to replicate the integrated clinic in the other 7

treatment centers so as to facilitate effective care of TB/HIV co-infected patients. KDOD will also continue

extending TB/HIV services to the neighboring civil population. AFMH remains the referral for all patients

requiring specialized diagnosis, treatment and in-patient care including patients suspected to have failed

treatment. In FY 2008, efforts to improve the capacity in the laboratory at AFMH to perform QA in smear

microscopy (florescent microscopy) will be continued. In line with the national guidelines, the AFMH lab will

continue to send samples to the National reference laboratory for TB cultures, drug sensitivity and

resistance testing. In line with National guidelines, the program will continue to ensure efficient and timely

supply of TB drugs to all treatment sites while maintaining regular supervision of all TB/HIV treatment

activities. Strengthening of community based adherence/follow up of patients in this program will be

promoted through telephone tracking of defaulters and the use of social workers. TB laboratories in the

military will continue to serve civilian patients and will be contingency for the district and provincial hospitals

in the regions in which they are located (that is the population in the Kenyan administrative location within

which the military treatment and care centres are located). In terms of reporting for TB, the KDOD is

recognized as Kenyan Province equivalent. This recognition by the NLTP will be exploited to ensure that the

KDOD tuberculosis program is developed further under the President's Emergency Plan.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

Activities in this program area will contribute to the results of expansion of ART for clinically qualified HIV

infected patients. This activity will also care for those who have TB/HIV co-infection as well, thus improving

the level of care offered to the patients in KDOD. Human capacity to deliver TB/HIV treatment will be

strengthened as well as the referral network for provision of ART and TB/HIV care. Effort will be made to

ensure that all patients in KDOD and in the neighborhood of military barracks who deserve care in the area

of TB/HIV access this care.

4. LINKS TO OTHER ACTIVITIES

This activity is part of a comprehensive program and is linked to other KDOD HIV care and treatment

activities in the area of Counseling and Testing , Prevention of Mother-to-Child Transmission, Palliative

Care: Basic Health Care and Support and ARV Services. Linkages between KDOD CT and Diagnostic

Counseling and Testing (DTC) centers and care outlets will be harmonized and strengthened to improve

utilization of care opportunities in the nearest KDOD health facility created through PEFAR funding. The

KDOD will seek closer collaboration between the various services with a view to sharing the facilities.

5. POPULATIONS BEING TARGETED

This activity targets military personnel, their families and members of the general population in the

immediate neighborhoods around the military facilities. The KDOD young men and women often serve

away from their homes, thus being vulnerable to risky behaviors thus exposing them to HIV and TB. The

stations have significant numbers of young families and continue to be popular heath service delivery points

for the surrounding communities benefiting from TB/HIV services. The 8 sites will include improved

Activity Narrative: laboratory services for handling TB/HIV, thus helping support staff, families and community members.

6. KEY LEGISLATIVE ISSUES

KDOD TB/HIV program will increase gender equity in HIV programming by ensuring that equitable numbers

of women including children are receiving treatment. The activities will address stigma associated with

TB/HIV status through information, education, and communication materials targeted to health care

providers, caregivers, and communities while addressing male norms and behaviors.

7. EMPHASIS AREAS

This activity includes emphasis on human capacity development including training and empowering the

health workers to provide basic health care and support services by supporting necessary commodities;

data collection, analysis and dissemination, which will further support program monitoring and evaluation;

and increasing gender equity in HIV/AIDS programs, by ensuring that equitable number of women and

children are receiving treatment, and targeting increased access of services by men.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14896

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14896 4253.08 Department of Kenya Medical 6967 1244.08 Kenya $200,000

Defense Research Institute Department of

Defense

6961 4253.07 Department of Kenya Medical 4248 1244.07 Kenya $104,475

Defense Research Institute Department of

Defense

4253 4253.06 Department of Kenya Medical 3262 1244.06 Kenya $155,000

Defense Research Institute Department of

Defense

Emphasis Areas

Construction/Renovation

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Military Populations

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $15,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

Funding for Care: Orphans and Vulnerable Children (HKID): $76,000

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

+The focus for KDOD OVC program has shifted from service provision to identification, tracking and linking

the OVC to the local agencies offering services within their respective locality.

+The target number of the KDOD OVC to be identified tracked and linked local OVC program agencies

changes to 1000.

+The target for social workers intended to be hired changes to 2. The social workers will be responsible for

identifying, tracking and linking the OVC as appropriate and follow-up to ensure the intended services are

adequately delivered.

+The activity will place an emphasis on the HIV counseling and testing of children with a focus on provider-

initiated home and community-based testing as an entry for care and support services to children. Using the

opt-out approach; the activity will test 90% of OVC enrolled; targeting approximately 900 with testing and

counseling. Of those tested, approximately 72 will be identified as HIV-exposed or infected and enrolled into

facility-based HIV care and treatment services to receive cotrimoxazole (CTX), evaluation for ART eligibility

and other basic HIV care services.

+ In 2009, the activity will be used to support the development of OVC standards for Kenya and in

supporting quality improvement approaches for monitoring and improving the quality of OVC programs at

the provincial level.

+ In FY09, the activity will also focus on integrating prevention activities. The activity will link with prevention

programs to support male circumcision and counseling and testing for OVC as well as prevention with

positives for adolescents.

+In 2009, the activity will also focus on establishing appropriate linkages with PMI and ensure that OVC

being supported by this activity are also able to benefit from mosquito nets procured by PMI.

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

This activity will support key cross cutting attributions of the budget amounting to $2,280 towards Economic

Strengthening through the support of income generating activities to support increased household food

security. The activity will also attribute a portion of its budget to supporting educational activities targeting

OVC enrolled in the program in the amount of $3,800. A further $760 will be attributed to provision of safe

water guards for households looking after OVC.

COP 2008

1. LIST OF RELATED ACTIVITIES

This activity is related to activities in Counseling and Testing (#6957), ARV services (#6958) and Palliative

Care: Basic Health Care and Support (#6960).

2. ACTIVITY DESCRIPTION

KDOD initiated the orphans and vulnerable children (OVC) activity in FY 2006 following the recent trend of

an increased number of deaths among military personnel resulting from HIV/AIDS. It is estimated that 75%

of the deaths in the military are HIV related. The result of increased number of deaths in the military has

directly increased the number of OVC left without care and support to approximately 5,000 children. Prior to

the KDOD OVC program, these children orphaned by HIV/AIDS had no support from the KDOD as a

government institution. With funding in FY 2006, the KDOD has been able to establish a program that

focuses on care and general support to 800 OVC located through the assistance of Ministry of Home Affairs

(MOHA) children's department. The military OVC population has created close links with community

organizations and Government of Kenya offices to identify and ensure that each child enrolled in the

program receives a comprehensive care package that addresses the essential services required of

Emergency Plan OVC activities. The OVC in the KDOD program are collectively monitored and cared for

through the establishment of the OVC military coordination offices in 5 existing KDOD sites throughout the

country. In FY 2009, the KDOD will continue to provide the 1,000 OVC of the military with both components

of Primary and Supplementary support. The program will continue to take the lead in ensuring that the

survivors of the servicemen and women are identified and given preference in this unique OVC military

activity. The KDOD will ensure increased access to education for their OVC through relevant district Ministry

of Education (MOE) offices in the identification and subsequent provision of bursary funds and vocational

training opportunities. The KDOD will also continue to implement the care and support of these OVC by

strengthening the capacity of the current caregivers in the local community and continue the tradition of

communal and familial support of the OVC. 100 additional caregivers will be trained in basic care and

support of the OVC as well as on issues regarding the psychosocial health of the child. The KDOD will hire

continue to support the services of 6 social workers to maintain the regional OVC military coordination

offices for better de-centralized service delivery. The KDOD OVC program will continue to work with the

existing community services or government children agencies to augment the level of community and family

based support already available to the OVC through the wrap-around approach. This approach is supported

by the Emergency Plan in which the needs of the OVC are identified at the community level and

subsequently cared for by strengthening existing structures already in place to tend to the needs of the OVC

in the various regions throughout the country.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

The KDOD will work closely with other government systems and structures as well as local community and

faith based organizations in the wrap-around approach to caring for OVC which is the foundation to the

sustainability of all EP OVC activities. The 1,000 children and 90 caregivers that will be reached by KDOD

will contribute to the EP national target of identifying and caring for 550,000 OVC and 53,900 caregivers in

FY2009.

4. LINKS TO OTHER ACTIVITIES

This activity is linked to KDOD CT services (#6957) that are established throughout the country. Through

the early identification and subsequent care and treatment of those servicemen and women in the KDOD

identified as HIV positive, early support and care can also be provided to their dependents. This activity is

also linked to KDOD ART program (#6958) by ensuring that all OVC receive subsequent care and treatment

from the KDOD medical facilities. The palliative care program (#6960) under KDOD will also be linked to the

OVC activity by ensuring the provision of care and support for all HIV+ OVC in the military community.

Activity Narrative: 5. POPULATIONS BEING TARGETED

This activity targets people affected by HIV/AIDS including military personnel and caregivers of OVC by

ensuring they are actively supported and linked to services. This activity is also targeting the OVC by

ensuring that they are protected, their rights are guarded and basic needs are met. The KDOD in this

activity will also directly take a leading role to ensure that the OVC that have been diagnosed as HIV

positive receive psychosocial support and medical care required as early interventions for quality care.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will actively address issues surrounding stigma and discrimination by encouraging the

formation of psychosocial support groups for the OVC. By focusing on many of the adolescent OVC, the

KDOD hopes to establish a youth friendly support network that can work on tackling many of the issues

surrounding stigma and discrimination faced by the OVC. The KDOD OVC program will also be an integral

part of a wrap around approach to caring and supporting for the OVC through establishing links with other

community or religious organizations in ensuring the needs of the OVC are met fully.

7. EMPHASIS AREAS

The major emphasis area of this activity is focused on providing the Primary and Supplementary needs of

the OVC. Minor emphasis areas will be in maintaining adequate staff in the regional OVC military

coordination offices through human resources as well as training needs for the caregivers of the OVC. The

other emphasis area will be on developing appropriate information, education, and communication for the

OVC and their caregivers.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14897

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14897 5099.08 Department of Kenya Medical 6967 1244.08 Kenya $150,000

Defense Research Institute Department of

Defense

6964 5099.07 Department of Kenya Medical 4248 1244.07 Kenya $250,000

Defense Research Institute Department of

Defense

5099 5099.06 Department of Kenya Medical 3262 1244.06 Kenya $200,000

Defense Research Institute Department of

Defense

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Malaria (PMI)

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $2,280

Education

Estimated amount of funding that is planned for Education $3,800

Water

Estimated amount of funding that is planned for Water $760

Table 3.3.13:

Funding for Prevention: HIV Testing and Counseling (HVCT): $100,000

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

+ Number of service outlets providing counseling and testing according to national and international

standards changes to 17

+ Number of individuals who received counseling and testing for HIV and received their test results changes

to 7,500

+ Number of individuals trained in counseling and testing (CT) /Providers Initiated Testing and Counseling

(PITC) according to national and international standards changes to 25.

COP 2008

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Palliative Care: TB/HIV, Treatment: ARV services, Abstinence/Being

Faithful and Condoms and Other Prevention.

2. ACTIVITY DESCRIPTION

Kenya's Department of Defense (KDOD) has received support from the Emergency Plan to implement a

comprehensive HIV/AIDS program since FY 2004. One of the key components of this program is HIV

counseling and testing (CT), which is useful, both for prevention and for access to care. A large majority of

the military personnel and their families are young people. Also, a sizable proportion of the actual military

personnel can be classified as high-risk, given that they often travel far away from their families. A

comprehensive HIV/AIDS program, including CT is essential in the military. In FY 2008 KDOD expanded its

CT activities in both the static sites and through community and military mobile (outreach) activities. Two

new VCT sites will be created to make a total of 30 VCT sites. Core activities included training and

continued support to the existing 28 VCT sites. With these activities on ground, in FY 2009 the KDOD has

adequate capacity to provide CT to an additional estimated 7,500 people, including military personnel and

their dependants, KDOD civilian employees, and the general population living near the barracks. All those

who test HIV positive will be referred to the nearest military clinics for care. In terms of training, 25 people

(mostly health care workers) will be trained and retrained in Provider-Initiated Testing and Counseling

(PITC). In FY 2009, the KDOD program will intensify mobile VCT services targeting the Military Hot spots

and high density non military communities around the 4 major military regions (Nairobi, Central, Rift Valley

and Coast). It will also take advantage of the military logistics support to provide CT services to the

underserved areas in the North Eastern Province. In addition, greater involvement of people living with

HIV/AIDS (GIPA) will be sought and encouraged as one of the ways of reducing the stigma associated with

CT. Quality assurance (QA) for both counseling and testing will be expanded to cope with increased service

uptake during the planned scale up in FY 2009. The QA program will be done in keeping with national and

international standards. QA for counseling will involve monthly support supervision to practicing counselors.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

KDOD'S CT program will contribute to the overall national CT target by providing CT services to the military,

which is a special, high risk population. The mobile VCT services will improve access to HIV prevention and

care services in remote areas that do not have fixed VCT sites, thus ensuring better access to CT services.

This activity will also contribute substantively to Kenya's 5-year strategy that emphasizes universal

knowledge of HIV status amongst Kenyans. Links between CT services and care will be enhanced.

4. LINKS TO OTHER ACTIVITIES

This activity is part of a comprehensive HIV care and treatment program within the KDOD linked to other

services such as AB, OP, TB/HIV and ART. Linkages between CT services and care outlets will be

strengthened to improve utilization of care opportunities that have been created in KDOD's health

infrastructure through PEPFAR funding.

5. POPULATIONS BEING TARGETED

This activity will mainly target the Military personnel, their dependants, KDOD Civilian personnel and adult

members of the general population. Trainings will target health care workers, lay people and PLWHA.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will empower and increase awareness through counseling and targeted messages for the

military personnel. Vigorous campaigns to educate them on the benefits of VCT services, couple VCT and

mutual disclosure of HIV status will be undertaken. Testing and counseling will also be promoted in clinical

setting, especially TB, STD, PMTCT Clinics and medical wards to enhance identification and timely referral

of those requiring care. It will also seek to empower and inform the KDOD staff, families and communities

through counseling and targeted messages. The increased availability of CT services and their

popularization among the Military personnel will reduce stigma and ensure equitable access to CT services

across gender.

7. EMPHASIS AREAS

This activity includes major emphasis on commodity procurement and training with minor emphasis in

infrastructure improvement.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14898

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14898 4249.08 Department of Kenya Medical 6967 1244.08 Kenya $120,000

Defense Research Institute Department of

Defense

6957 4249.07 Department of Kenya Medical 4248 1244.07 Kenya $80,000

Defense Research Institute Department of

Defense

4249 4249.06 Department of Kenya Medical 3262 1244.06 Kenya $75,000

Defense Research Institute Department of

Defense

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14:

Funding for Strategic Information (HVSI): $150,000

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

+ The prime partner changes from KEMRI to HJF-MRI.

+ To phase in a data collection, recording, monitoring, reporting and QA/QC system to all other treatment

and prevention sites and link it to AFMH and DOD data headquarters.

+ Employing data clerks who will be responsible for managing program monitoring data, and IT resources.

+ Enhancement of a functional Health Management Information System at Data headquarters (DHQ) to

help improve reporting and utilization of data and information through use of District Health Information

System (DHIS). The DHQ will continue to act as the central monitoring and evaluation point for all the

treatment and prevention sites in the military HIV/ AIDS program as well as other medical reception

stations.

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

This activity supports key cross-cutting attributions in human capacity development through training of data

handling personnel in data management, health management information system, data collection, reporting

tools, analysis, monitoring and evaluation in support of HMIS for program data, and building the capacity of

the KDOD to analyze and utilize surveillance, survey and other strategic information. The data handling

personnel will work closely with program managers and health care workers to help in monitoring of

activities, prepare work plans, make field visits to assess implementation progress and evaluate the rate of

activity scale up and prepare and submit timely reports

COP 2008

1. LIST OF RELATED ACTIVITIES

This activity is related to activities in Prevention of Mother-to-Child Transmission (#6959), Counseling and

Testing (#6957), Treatment: ARV Services (#6958) and Laboratory Infrastructure (#7003).

2.ACTIVITY DESCRIPTION

In FY 2005, Kenya Department of Defense (KDOD) initiated the development of a basic data system for

documentation of individual patient data collection, analysis and dissemination of HIV/AIDS behavioral and

biological surveillance and monitoring information as required by the Kenya Ministry of Health (MOH) as

well as the Office of the Global AIDS Coordinator (OGAC). For the purpose of ART patient monitoring and

assessment of treatment success and drug resistance the KDOD will continue to develop a unified HMIS at

all its sites. In FY 2008, KDOD will continue supporting all the HIV program areas of HTXS, HVCT, MTCT,

HKID, HLAB and HVTB at each of 8 KDOD Comprehensive Care Clinics, including the Armed Forces

Memorial Hospital (AFMH) in Nairobi, the Airforce Base Medical centre in Laikipia, Gilgil Regional Military

Hospital (GRMH), Lanet Army Barracks hospital, Naval Sick Bay at Mombasa, the Airforce Base Medical

centre in Nairobi(Moi Air Base), as well the outlying military hospitals in Eldoret and Thika and. In addition,

all the stations will continue to be provided with the necessary data automation computerized system and

other communication equipment required for electronic entry of patient-specific encounter data required by

the National AIDS/STI Control Program (NASCOP) as well as entry of the targets set by OGAC as

Emergency Plan indicators for SI on a monthly basis. The data center will continue receiving support as the

central monitoring and evaluation point for all the 8 treatment stations in the military and the neighboring

satellite clinics. As data systems scale up there is need to train more staff in Data management, Monitoring

and Evaluation, Surveillance and HMIS. To improve the local human resource capacity to carry out SI

activities a total of 27 individuals will be trained in strategic information and data management (includes

M&E, surveillance, health systems research, epidemiology and/or HMIS). In FY 2008 an effective and

efficient planning, monitoring and evaluation system including a functioning MIS will continue to be

developed and ICT capacity at DHQ and all the stations will be enhanced. The KDOD will continue to

develop a unified health management information system for all its stations. The KDOD will also develop

and expand its capacity to carry out public health evaluations. 3. CONTRIBUTIONS TO OVERALL

PROGRAM The development of the SI system will largely contribute to the expansion of an effective and

efficient ART program that will result in the provision of quality care to all HIV-positive patients under the

KDOD program and result to improved patient management. The resulting expansion of care will play a

critical role towards achieving the PEPFAR goals for KDOD as well as for the needs of the national

HIV/AIDS care and treatment program. It will also result to improved data gathering, reporting, data quality

and accessibility.

3. LINKS TO OTHER ACTIVITIES

This activity links to KDOD-KEMRI activities in the areas of MTCT, HVCT, HVTB, HTXS and HKID by

providing linkages between the patient data monitoring system and PEPFAR national reporting systems

through better data generated at each of these clinics within each of the 8 treatment sites and its satellite

clinics. It will link to other activities by providing a broad range of technology that allows sharing of

information and development of strategies for promotion of better health. In addition, this activity will link to

the HVSI and HLAB activities to be carried out by NASCOP and the SI activity to be carried out by Abt

Associates-PHR+ (#6824) in utilizing national software for reporting.

4. POPULATIONS BEING TARGETED

As ART is introduced as part of the basic care available to military, dependents and surrounding community

civilian personnel, the KDOD will need to provide local medical personnel with a reliable computerized

system which will allow them to maintain an accurate and up-to-date patient treatment data and laboratory

and pharmacy drug treatment monitoring, to include compliance markers, recording of any side effects, and

monitoring of minimum laboratory evaluations such as CD4 counts, hematology indices and chemistry (liver

function tests and renal function). Maintenance of this data system at each location will be invaluable in

facilitating and adequately providing medical support to HIV-infected patients.

5. EMPHASIS AREAS

The major emphasis for this activity will go towards development of the information technology and

communications infrastructure by directing resources in acquiring computer hardware and software

development as well as networking equipment and supplies. The KDOD will continue to support the 8 data

clerks (one for each station), who will administer, supervise the Health Management Information systems

(HMIS) and manage the ICT resources. Training of data automation workers and maintenance of the Data

Activity Narrative: Management Unit (DMU) at the central AFMH referral facility as well as capacity enhancing of the data

center at Defense Headquarters will be undertaken .Thus, the development of this SI initiative will result in

the provision of improved quality of care and reliable maintenance and reporting of program specific EP

program SI markers on a consistent basis. It will also result to improved level of reporting that is timely,

consistent, and accurate.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14901

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14901 5115.08 Department of Kenya Medical 6967 1244.08 Kenya $150,000

Defense Research Institute Department of

Defense

6965 5115.07 Department of Kenya Medical 4248 1244.07 Kenya $90,000

Defense Research Institute Department of

Defense

5115 5115.06 Department of Kenya Medical 3262 1244.06 Kenya $100,000

Defense Research Institute Department of

Defense

Emphasis Areas

Military Populations

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $60,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

Cross Cutting Budget Categories and Known Amounts Total: $283,126
Human Resources for Health $25,000
Food and Nutrition: Commodities $10,000
Human Resources for Health $20,000
Education $21,286
Human Resources for Health $40,000
Human Resources for Health $15,000
Food and Nutrition: Commodities $30,000
Human Resources for Health $15,000
Human Resources for Health $5,000
Food and Nutrition: Commodities $5,000
Human Resources for Health $15,000
Human Resources for Health $15,000
Economic Strengthening $2,280
Education $3,800
Water $760
Human Resources for Health $60,000