PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
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
4251 4251.06 Department of Kenya Medical 3262 1244.06 Kenya $100,000
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:
+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.
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.
This activity is related to activities in Counseling and Testing (#6957) and Condoms and Other Prevention
(#6962).
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.
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.
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.
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.
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.
Continuing Activity: 14893
14893 5272.08 Department of Kenya Medical 6967 1244.08 Kenya $175,000
6966 5272.07 Department of Kenya Medical 4248 1244.07 Kenya $150,000
5272 5272.06 Department of Kenya Medical 3262 1244.06 Kenya $100,000
* Reducing violence and coercion
Estimated amount of funding that is planned for Human Capacity Development $20,000
Estimated amount of funding that is planned for Education $21,286
Table 3.3.02:
+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
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.
This activity is related to activities in Counseling and Testing (#6957), Abstinence and Being Faithful
(#6966), and Prevention of Mother-to-Child Transmission (#6959).
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.
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.
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.
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.
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.
Continuing Activity: 14894
14894 4254.08 Department of Kenya Medical 6967 1244.08 Kenya $75,000
6962 4254.07 Department of Kenya Medical 4248 1244.07 Kenya $100,000
4254 4254.06 Department of Kenya Medical 3262 1244.06 Kenya $100,000
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.03:
+ 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.
+ 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.
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
This activity relates to activities in Counseling and Testing, Prevention of Mother-to-Child Transmission,
ARV Services and Palliative Care: TB/HIV.
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.
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.
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.
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.
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.
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.
Continuing Activity: 14895
14895 4252.08 Department of Kenya Medical 6967 1244.08 Kenya $100,000
6960 4252.07 Department of Kenya Medical 4248 1244.07 Kenya $69,119
4252 4252.06 Department of Kenya Medical 3262 1244.06 Kenya $100,000
Military Populations
Estimated amount of funding that is planned for Human Capacity Development $15,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $30,000
Table 3.3.08:
+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)
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.
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.
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.
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.
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.
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.
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.
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.
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.
Continuing Activity: 14899
14899 4250.08 Department of Kenya Medical 6967 1244.08 Kenya $1,150,000
6958 4250.07 Department of Kenya Medical 4248 1244.07 Kenya $591,715
4250 4250.06 Department of Kenya Medical 3262 1244.06 Kenya $650,000
Table 3.3.09:
ACTIVITY UNCHANGED FROM COP 2008:
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.
+A prevention component has been integrated that is budgeted in this activity and includes the following
+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.
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.
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.
Estimated amount of funding that is planned for Human Capacity Development $5,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $5,000
Table 3.3.10:
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.
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.
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
3. LINKS TO OTHER ACTIVITIES
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.
Table 3.3.11:
+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.
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.
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.
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.
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.
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.
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.
Continuing Activity: 14896
14896 4253.08 Department of Kenya Medical 6967 1244.08 Kenya $200,000
6961 4253.07 Department of Kenya Medical 4248 1244.07 Kenya $104,475
4253 4253.06 Department of Kenya Medical 3262 1244.06 Kenya $155,000
Table 3.3.12:
+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.
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.
This activity is related to activities in Counseling and Testing (#6957), ARV services (#6958) and Palliative
Care: Basic Health Care and Support (#6960).
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.
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.
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.
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.
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.
Continuing Activity: 14897
14897 5099.08 Department of Kenya Medical 6967 1244.08 Kenya $150,000
6964 5099.07 Department of Kenya Medical 4248 1244.07 Kenya $250,000
5099 5099.06 Department of Kenya Medical 3262 1244.06 Kenya $200,000
Estimated amount of funding that is planned for Economic Strengthening $2,280
Estimated amount of funding that is planned for Education $3,800
Estimated amount of funding that is planned for Water $760
Table 3.3.13:
+ 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.
This activity relates to activities in Palliative Care: TB/HIV, Treatment: ARV services, Abstinence/Being
Faithful and Condoms and Other Prevention.
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.
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.
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.
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.
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.
This activity includes major emphasis on commodity procurement and training with minor emphasis in
infrastructure improvement.
Continuing Activity: 14898
14898 4249.08 Department of Kenya Medical 6967 1244.08 Kenya $120,000
6957 4249.07 Department of Kenya Medical 4248 1244.07 Kenya $80,000
4249 4249.06 Department of Kenya Medical 3262 1244.06 Kenya $75,000
Table 3.3.14:
+ 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.
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
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.
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.
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.
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.
Continuing Activity: 14901
14901 5115.08 Department of Kenya Medical 6967 1244.08 Kenya $150,000
6965 5115.07 Department of Kenya Medical 4248 1244.07 Kenya $90,000
5115 5115.06 Department of Kenya Medical 3262 1244.06 Kenya $100,000
Estimated amount of funding that is planned for Human Capacity Development $60,000
Table 3.3.17:
