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:
+This year's CDC M&S is split between GAP And GHCS.
+This activity will also providing national guidance in the development of the Men as Partners initiative in
PMTCT settings to articulate strategies for increasing male partner testing and participation in PMTCT
settings.
+Expansion in technical areas to include the Mentor Mothers and Prevention with Positives (PwP)
strategies.
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
This activity supports key attributions in human capacity development through support of the national
program in the development and review of training curricular, Information Education and Information (IEC)
materials, guidelines, instructional manuals and other documents for the training of service providers on
PMTCT and other HIV prevention, care and treatment services.
COP 2008
1. LIST OF RELATED ACTIVITIES
This activity relates to all activities in PMTCT, Adult ART services, Adult and Pediatric Palliative Care
Services, Pediatric HIV Care and Treatment Services, Laboratory and Strategic Information program.
2. ACTIVITY DESCRIPTION
The CDC PMTCT program has continued to support the up scaling of PMTCT services in the country by
providing technical support and guidance to the national program. Key areas of program focus include the
introduction of Comprehensive PMTCT that encompass a package of care to ensure that the HIV-positive
pregnant mother, her infant and family receive the full range of HIV care and treatment services as well as
linkage to Family Planning services. The approach also includes a strong emphasis on primary prevention-
providing skills to the mother who is HIV- to protect herself and her family from HIV infection. In 2009 COP,
the CDC PMTCT section will continue supporting these activities under the expanded or comprehensive
PMTCT package that includes the following key components: expansion in geographic coverage in all CDC
supported sites to ensure universal access to services; Integration of counseling and HIV testing of women
in the antenatal clinics and maternity units; Clinical staging and CD4 cell count testing of all HIV-positive
pregnant women to identify the appropriate PMTCT ARV intervention in line with National guidelines (this
includes use of HAART where eligible, or use of combination AZT and sd Nevirapine for early presenters, or
use of sd Nevirapine); Administration of the appropriate PMTCT ARV as well as OI prophylaxis for all HIV-
positive pregnant women; Early Infant HIV diagnosis for all HIV exposed infants through DNA Polymerase
Chain Reaction (PCR) testing; Linkage of eligible infants to pediatric HIV care and treatment services;
strengthened post-natal care package; Linkage to family planning services and counseling and testing
services for the woman's partner and other family members. This will lead to more women and their
partners and infants knowing their HIV status and hence accessing ART, thereby increasing the number of
people on ARVs. The program will also provide national technical leadership and guidance in the new
strategies aimed at increasing male participation, Greater Involvement of People Living with HIV/AIDS and
increased involvement of HIV-positive women who have gone through the PMTCT program. These
strategies include Men as Partners Initiative, PwP and Mentor Mothers. All these activities will contribute to
the Emergency Plan in Kenya goals of HIV prevention and treatment. During FY 2009 CDC will continue to
work with Government of Kenya agencies, other USG agencies (USAID, WRP and Peace Corps) and non-
governmental partners to support implementation of these services in the country. CDC Kenya's multi-
disciplinary PMTCT team will continue to provide technical guidance that includes the development and
review of guidelines, operational procedures and manuals, educational materials and teaching modules for
implementing comprehensive PMTCT programs in Kenya. CDC Kenya staff work with local partners to
ensure activities are based on the latest relevant science and that scientific knowledge is translated into
program guidelines and practices both at national policy and service delivery levels. In collaboration with
other partners, CDC staff conducts monitoring and evaluation activities including operational research for
the PMTCT program, and ensure that information generated informs national PMTCT policy and practice.
CDC Kenya staff also support PMTCT activities at multiple service delivery sites to conform to national
guidelines and technical strategies concerning all aspects of PMTCT including models of HIV testing in the
antenatal and maternity units, provision of ARVs for prophylaxis and treatment, care and support of the HIV-
positive woman, her infant and partner and Early Infant Diagnosis for HIV exposed infants and linkage to
treatment and care for all eligible infants. The CDC Kenya PMTCT technical team includes six professional
staff, one program assistant and three support staff. The technical staff includes one senior technical
advisor working 80% of the time; this staff member, an Associate Professor of Pediatrics has extensive
national and international experience in clinical and programmatic HIV research including PMTCT, and
works directly with the Government of Kenya and other partners to ensure the technical soundness of the
program. Other technical staff include two medical doctors with experience and expertise in Pediatrics, and
Obstetrics and Gynecology respectively, who work directly with programs to ensure technical and up-to-
date interventions, in particular the care of the HIV-positive woman and pediatric HIV care; one program
manager with nursing and public health experience who works directly with the sites in the respective
districts to provide guidance on both technical and effective program management approaches at the
service delivery sites, a behavioral scientist and a program assistant. The program assistant is engaged in a
variety of tasks to provide logistics support to the team. The team is supported by three drivers, who enable
the technical staff to conduct regular field visits and technical supervision. This budget includes costs for
contractual services, printing of the curriculum and other post-held account funds.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15048
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15048 4301.08 HHS/Centers for US Centers for 7025 1501.08 $437,700
Disease Control & Disease Control
Prevention and Prevention
7107 4301.07 HHS/Centers for US Centers for 4303 1501.07 $574,054
4301 4301.06 HHS/Centers for US Centers for 3292 1501.06 $470,000
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $429,708
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY UNCHANGED FROM COP 2008
THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED
REFERENCES TO TARGETS AND BUDGETS. THIS YEAR'S CDC M&S FUNDS ARE SPLIT BETWEEN
GAP AND GHAI.
The only changes to the program since approval in the 2007 COP are:
+ In FY 08 CDC technical staff will dedicate time and expertise to work on the multi-agency efforts to
design, develop and implement the new Youth Prevention Initiative. In addition, technical staff will work with
partners to streamline development of a comprehensive AB package for adolescents as part of new male
circumcision service delivery, particularly with faith-based organizations. CDC Kenya staff will provide an
intensive level of technical assistance and programmatic guidance on prevention activities guided by the
PEPFAR ABC programming. During FY 2008 CDC will reorganize its existing staff in line with staffing for
results objectives and to support FY 2008 AB program strategic priorities.
This activity relates to all activities in Abstinence and Be Faithful Programs.
During FY 2007 CDC will continue to work with Government of Kenya agencies and non-governmental
partners to promote abstinence and faithfulness as an HIV prevention strategy. CDC Kenya now has a wide
range of AB activities and partners, including 11 cooperative agreements designed to promote AB activities
with young people. CDC continually identifies and continues to provide an intense level of technical
assistance and guidance to ensure that partner activities are focused on behavior change. CDC provides
technical support through a close program mentorship of staff at the National Youth Service, a uniformed
national training service serving up to 10,000 youth each year. In addition, CDC provides technical
assistance to number of local FBOs and CBOs through a capacity building project with CHF International.
The sub-grantees working in this area include the Africa Inland Church, the Baptist AIDS Response Agency,
Kenya Episcopal Secretariat-Catholic Secretariat, and many others. CDC Kenya staff also have a strong
partnership with the non-military uniformed services of Kenya, including the Kenya Prisons, Kenya Wildlife
Service, and the police. They have had a key role in introducing the Men as Partners (MAP) curriculum into
the training offered to young recruits in the National Youth Service and will introduce this curriculum, which
emphasizes changes in male behaviors and attitudes, to young recruits into the non-millitary uniformed
services. The types of activities CDC technical staff engage in include training in workplan development,
assistance with monitoring and evaluation plans, training to bring local CBO and NGO staff up to date in
technical areas of HIV and AIDS, reviewing technical proposals for funding, making technical presentations
and supervising partners working through the Cooperative Agreements. CDC Atlanta staff come to Kenya
on a regular basis to assist the local partners in developing identified technical areas. The CDC Kenya AB
technical team includes one Direct Hire (USDH) working 25% in AB. This staff member has extensive
international experience in working with FBOs implementing HIV prevention programs, and the incumbent
works directly with implementing partners to ensure the technical soundness of the program. CDC has one
locally employed technical staff member working on AB and youth programs on full-time basis. She also has
extensive experience in this programmatic area, and spends most of her time working directly with local
partners. This team will be supported by two locally employed drivers, one in Nairobi and one in Nyanza,
whose work is devoted to supporting AB and youth interventions.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.02:
+ In FY 09 CDC will add an advisor to provide technical assistance on activities related to People Living with
HIV/AIDS (PLWHA).
+ In FY 08 CDC a new technical advisor FSN position is proposed who can assist the USG team with new
approaches to HIV prevention, including male circumcision. This advisor will work with all USG
implementing partners across agencies to ensure careful coordination with MOH plans and other donor
funding. In line with our '08 OP strategy and our staffing for results approach, CDC technical OP staff will
play a lead role in coordinating the multi-agency efforts to develop a comprehensive prevention package for
CSWs and for Positive Prevention. CDC Kenya staff will provide an intensive level of technical assistance
and programmatic guidance on prevention activities guided by the PEPFAR condoms and other prevention
programming. During FY 2008 CDC will reorganize its existing staff in line with staffing for results
objectives and to support FY 2008 OP program strategic priorities.
This activity relates to all activities in Condoms and Other Prevention.
2. ACTIVITY DESCRIPTION In FY 2007
CDC will continue to work with Government of Kenya agencies and non-governmental partners to assist in
the implementation of a wide range of HIV prevention services covered under Condoms and Other
Prevention. CDC Kenya staff will provide technical assistance and guidance to local partners to ensure the
technical soundness of these programs, adherence to Emergency Plan guidelines, and to ensure that these
programs receive appropriate monitoring and evaluation. CDC Kenya has a close partnership with the
International Rescue Committee to implement OP activities in the Kakuma refugee camp and will provide
technical support to the State Department-funded UNHCR for activities in Dadaab refugee camp. The
provision of technical guidance is a key element of this partnership. CDC staff will work closely with the
Institute of Tropical Medicine (ITM) to ensure the technical and programmatic soundness of the young
vulnerable women project in Kisumu. In addition, CDC provides intensive day to day support to over fifteen
local FBOs and CBOs through a capacity building project with CHF International. The sub-grantees working
in this area serve a broad range of at-risk groups including sugar plantation workers, sex workers, matatu
and transport workers and those in the ‘jua kali' informal sector. CDC will provide technical guidance in FY
2007 to help partners in this program area focus on Positive Prevention. This important behavioral approach
has already been incorporated in the activity narratives for a majority of HVOP CDC partners. A new project
to be supported by this mechanism will be one providing behavioral interventions for young men enrolling in
the Kisumu male circumcision project (non-PEPFAR funded). The types of activities CDC technical staff
engage in include training in workplan development, assistance with monitoring and evaluation plans,
training to bring local CBO and NGO staff up to date in technical areas of HIV and AIDS, and other technical
services. CDC Kenya staff also provide technical assistance to the non-military uniformed services of
Kenya, including the National Youth Service, Kenya Prisons, Kenya Wildlife Service, and the police. The
CDC Kenya OP technical team includes one Direct Hire (USDH) who has extensive international
experience in implementation of behavioral HIV prevention programs and will provide 5% of time to OP.
One locally employed staff works 50% of her time on this program and proposes to add one locally
employed technical staff member to share the increasing workload. In addition, CDC Kenya will draw on
technical expertise from other CDC prevention experts in Africa and in Atlanta. CDC also supports two local
staff through the KEMRI COAG to coordinate the uniformed services project. This OP team will be
supported by two locally employed drivers whose work is devoted to supporting HIV prevention
interventions.
Table 3.3.03:
This activity links to all other activities in blood safety.
This activity relates to the prevention of HIV transmission through blood transfusion in health care settings.
The National Blood Transfusion Service (NBTS) was established in the year 2000 with the goal of ensuring
safe and sufficient blood supplies for the country. Previously blood was obtained solely from family
replacement donors at fragmented hospital-based transfusion units that lacked a standardization of
procedures. A national survey in 1994 estimated that 2% of transfusions transmitted HIV. At least 130,000
transfusions take place each year. This activity will avail staff to give technical support to the national blood
transfusion service for the establishment of goals and objectives and best practices in donor recruitment,
blood collection, processing, storage and use. This will be achieved through regular meetings with the
National Blood transfusion service, Ministry of Health, Kenya Red Cross Society and other stakeholders,
support supervision of transfusion activities in blood banks and health facilities, preparation of procedural
guidelines and data collection tools and the review and analysis of quarterly reports. Support supervision
will involve travel to the six regional blood transfusion centres located in Kisumu, Eldoret, Nairobi, Nakuru,
Embu and Mombasa and satellite centres in Voi, Naivasha and Kericho as well as international travel for
blood safety related workshops, seminars and conferences. These staff will also liaise with and coordinate
the various organizations that support blood donor mobilization for the NBTS so as to avoid conflict and
achieve synergy in meeting the blood collection target. These organizations include: Kenya Red Cross,
Hope Worldwide, Africa Society for Blood transfusion (K) and Bloodlink Foundation. Direct support will be
given to the hospital transfusion committees. This activity also includes participation in various Ministry of
Health committees that impact on blood transfusion policy and practices in the country. These include:
Blood Safety Committee, Blood Safety Interagency Committee, Laboratory Interagency Committee, HIV Lab
Committee and World Blood Donor's Day Committee. The staff will additionally give in-country support to
international groups supporting blood safety activities in Kenya such as the American Association of Blood
banks (AABB), Internews and Community Housing Foundation (CHF).
Continuing Activity: 15050
15050 4302.08 HHS/Centers for US Centers for 7025 1501.08 $177,150
7108 4302.07 HHS/Centers for US Centers for 4303 1501.07 $260,000
4302 4302.06 HHS/Centers for US Centers for 3292 1501.06 $190,000
Program Budget Code: 05 - HMIN Biomedical Prevention: Injection Safety
Total Planned Funding for Program Budget Code: $2,970,376
Total Planned Funding for Program Budget Code: $0
Table 3.3.05:
THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED, BUT THIS YEAR'S CDC M&S
FUNDS ARE SPLIT BETWEEN GAP AND GHAI.
A prevention component has been integrated that has a budget of less than $10,000 and includes the
following elements:
• Evaluation of HIV risk through sharps injuries in mortuary personnel ($9,000). Mortuary staff have not
been targeted in Injection Safety program activities, but it is now suspected that they are exposed to HIV
infection due to an increasing trend of embalming bodies prior to burial. Embalming is performed by
untrained mortuary attendants.
This activity relates to all other activities in injection safety.
This activity relates to the prevention of HIV transmission among health care workers, medical waste
handlers and the community. These funding will enable HHS/CDC staff to give technical support to six
implementers of injection safety initiatives in Kenya. This will involve joint planning meetings, review of
guidelines, standards and training material and support supervision at intervention sites and at training
workshops. These staff will participate in the MOH injection safety steering committee and the injection
safety stakeholders meetings to influence policy decisions in this arena. Activities are currently being scaled
up to achieve national coverage by 2008. Staff will be involved in frequent travel across the country and will
attend international conferences for dissemination of latest findings. One staff will dedicate 100% of their
time to this activity while another will commit 40% time. The world Health Organization (WHO) estimates of
global burden of disease suggest that unsafe injections around the world account for 5% of HIV infections,
32% of hepatitis B virus infections and 40% of hepatitis C virus infections. A 2004 survey by JSI-MMIS in
Kenya revealed that over 70% of respondents received an average of 1.5 injections per year. Needle stick
injuries within the previous six months were reported by 58% of health care workers. These findings
supported those of an earlier study by the University of Nairobi among 214 nurses in Nairobi, which
reported 61% needle stick injuries in health care workers over a three-month period. Needle recapping
accounted for 46% of the injuries while 12% occurred in the process of sharps disposal. A majority of health
facilities surveyed reported having experienced a shortage of disposable injection supplies in the 12 months
prior to the survey, particularly in the curative sector. This reflected a less than optimal logistics system for
forecasting, procurement, distribution and stock monitoring that may contribute to re-use of injections.
Analysis of the status of injection logistics in the country revealed that there was no data to support rational
forecasting of injection requirements. Procurement was based on previous consumptions. Appropriate
product selection was poor due to lack of national standards for injection devices, registered suppliers of
injection equipment and an appropriate board to handle non-pharmaceutical equipment. Track 1 funds were
awarded to JSI-MMIS in 2004 to implement injection safety activities in Kenya and other PEPFAR focus
countries. The activity aims to:1) improve training of health workers and managers on safe injection
practices, infection control and disposal procedures; 2) institute an advocacy strategy to decrease demand
for injections by the population; 3) establish reliable estimates of re-use prevention injection device
equipment requirements, minimum stock levels and effective supply and distribution systems for re-use
prevention injection device equipment; 4) institute monitoring and supervision procedures to ensure
adequate supplies at all levels and correct practices by health workers; 5) ensure safe disposal of used
injection equipment through the progressive introduction of appropriate incinerators; 6) secure the required
budget for injection safety and infection control including safe disposal of used equipment. To date safe
injection practices have been implemented in three districts, five of eight provincial hospitals and one of
three university teaching hospitals. In FY 2006 the Ministry of Health, through the National AIDS and STD
Control Program, received country funds to facilitate development of policy documents and coordinate
injection safety initiatives countrywide. In the FY07 COP, additional partners will include the University of
Nairobi, Danya International and USAID APHIA II implementing partners.
Continuing Activity: 15051
15051 7111.08 HHS/Centers for US Centers for 7025 1501.08 $100,150
+ This year's CDC M&S funds are split between GAP and GHCS.
This activity relates to all activities in the HTXS program area.
Access to treatment with antiretroviral drugs in Kenya has expanded dramatically during the past few years.
Established HIV treatment services have improved the quality of life and prolonged the lives of many HIV-
infected individuals. During this phase of rapid scale up, there is substantial need for supportive supervision
of both partners and local Kenyan health care workers. Although the latter is the mandate of the ministry of
health, the responsibility for this important function has been shared with partners and donors, including the
technical staff of the US government agencies. CDC staff has contributed by assisting with the development
of policies and guidelines, assisting implementing partners to improve the technical quality of their care and
treatment programs, and by providing direct technical assistance to sites and geographic areas not yet fully
supported by other partners.
During FY 09 CDC will continue to work with government of Kenya agencies and non-governmental
partners to initiate, maintain, and decentralize antiretroviral treatment programs. These services will include
a broad range of activities including capacity building for health care workers, laboratory and pharmacy
management, support for adherence, and for management of advanced HIV disease and toxicities. These
services are very closely linked to basic care and support services provided at the same sites. Technical
activities of the CDC team include assisting with the development of appropriate monitoring tools, analyzing
performance information to track progress toward planned results; using performance information to inform
program decision-making and resource allocation; and communicating results achieved.
The CDC Kenya care and treatment technical team includes one Direct Hire (USDH), five locally employed
technical staff and one program assistant. The team is supported by locally employed drivers whose work is
devoted to supporting care and treatment activities. In addition to enabling the technical staff to conduct
regular field visits and technical supervision, the drivers assist with delivery of equipment and supplies
required by the supported programs. The total proposed HTXS management budget for FY 2009 is US
$990,560 and will be distributed across expenditure categories.
Continuing Activity: 15055
15055 4297.08 HHS/Centers for US Centers for 7025 1501.08 $725,550
7104 4297.07 HHS/Centers for US Centers for 4303 1501.07 $900,000
4297 4297.06 HHS/Centers for US Centers for 3292 1501.06 $555,895
Table 3.3.09:
+THIS YEARS CDC M&S FUNDS ARE SPLIT BETWEEN GAP AND GHCS.
This activity relates to all other activities in the Palliative Care: TB/HIV program area
CDC Kenya staff provide an intensive level of technical assistance and programmatic guidance on the
integration of TB and HIV activities in partnership with the Division of Leprosy, TB and Lung Disease
(DLTLD), the National AIDS and STI Control Program (NASCOP), other USG agencies (USAID and DOD),
WHO, non-governmental organizations, faith-based organizations, private practitioners and other
implementing partners involved in TB/HIV activities. CDC technical staff participate in policy work groups
and provide technical assistance to implementing partners with the goal of assisting the Ministry of Health
deliver improved and more integrated TB and HIV services based on best practice. In FY 09, there will be
greater involvement of technical staff in promoting greater horizontal collaboration across all Emergency
Plan programs with special focus on key themes: universal access to HIV prevention, universal access to
basic HIV care package (this includes TB screening for PLWHA, universal access to HIV counseling and
testing, greater attention to the needs of co-infected children). CDC TB/HIV staff are now part of expanded
care and treatment team that will provide technical support to partners on several cross-cutting issues. In
FY09, USG funds will support the placement of a TB/HIV staff member at NASCOP to improve TB/HIV
coordination. HIV testing for TB patients is the standard of care and efforts will be made to ensure that
consistent and quality counseling and testing messages continue to be improved. Efforts will be made to
incorporate and expand HIV prevention activities as part of strengthening contact tracing practices in TB
control and contributing to the overall national strategy to achieve HIV control. These activities involve
extensive local travel, selected international travel and technical collaboration with CDC Atlanta. CDC will
continue to contribute to the expansion of fluorescence microscopy (FM) - a more efficient TB diagnostic
tool, especially in high volume settings. CDC staff will assist Kenya implement international standards for
TB care intended to facilitate effective engagement of all providers in accepted levels of care in both public
and private practice. With the goal of establishing a joint TB/HIV co-management review, CDC will assist to
improve referral linkages between HIV and TB services to reconcile referrals and provide adequate
feedback mechanisms. CDC will work closely with national and HIV/AIDS programs and other USG
agencies to achieve improved leverage of ongoing or planned supplementary TB/HIV funding from WHO,
Global Fund and TB Control Assistance Program (TB-CAP).
Continuing Activity: 15053
15053 4299.08 HHS/Centers for US Centers for 7025 1501.08 $375,150
7105 4299.07 HHS/Centers for US Centers for 4303 1501.07 $520,000
4299 4299.06 HHS/Centers for US Centers for 3292 1501.06 $485,420
Table 3.3.12:
Other changes:
+ two additional personnel will be hired in FY 08. One will support counseling and testing in health facilities,
while the other will support home-based counseling and testing. These two new CT approaches are
expected to grow rapidly in FY 08 and this will need strong, regular technical support. Although these
personnel will be based in CDC, they will be available for the entire US government team in Kenya.
This activity relates to all activities in the Counseling and Testing program area.
HIV Counseling and Testing (CT) has a central role in both prevention and treatment of HIV infection. With
support from CDC and other partners, Kenya has achieved great success in implementing Voluntary
Counseling and Testing since 2000. Recent scale up of ART services in the country, made possible largely
through Presidential Emergency Fund, now means that CT clients found to be HIV+ can be readily referred
for care and treatment services. But these emerging care opportunities are not fully utilized because
majority of Kenyans (86%) don't know their HIV status and yet knowledge of status is the entry point to
comprehensive HIV/AIDS care. Personal knowledge of HIV status is a priority intervention in the Kenya 5
Year Strategy, and increasing access to CT services continues to be a high priority for the Emergency Plan
in Kenya. During FY 2008 CDC will continue to work with government of Kenya and non-governmental
partners to promote CT in both clinical and non clinical settings including STI clinics, TB clinics, medical and
pediatric wards, antenatal clinics as well as integrated, stand alone and mobile VCT sites. In FY 2008 there
will be an effort to encourage the government and other partners to implement home based VCT, especially
in high prevalence regions, as this will lead to the identification of many patients who would benefit from
care and treatment. The CDC Kenya's multidisciplinary CT team will continue to provide technical guidance
for these activities. This technical support involves consolidating and disseminating the most up-to-date
technical information relating to CT, working with the government of Kenya to ensure that policies relating to
CT are appropriate and technically sound and monitoring CT activities of local partners to ensure adherence
to national and international standards. Technical activities of the CT team also involves collecting and
analyzing performance information to track progress toward planned results; using performance information
to inform program decision-making and resource allocation; and communicating results achieved. The CDC
CT team has three technical staff and one program assistant working in CT on full-time basis in CDC's
Nairobi office. The technical staff includes a medical officer with expertise in both VCT and CT in medical
settings, a counselor who works directly with the counseling staff of implementing partners and a mobile
VCT coordinator who works with local partners to deliver mobile VCT services. In addition to these, there is
a new technical advisor position to provide technical guidance to VCT and CT partners in Nyanza province,
the part of Kenya with the highest HIV prevalence and the principal geographic focus area for CDC Kenya.
The program assistant is engaged in a variety of tasks to support the technical team, such as reviewing and
assembling training curricula and other technical materials, organizing training programs, and other duties
to support the technical work of the CT staff. This team will be supported by seven locally employed regular
drivers whose work is devoted to supporting CT activities. Four drivers will drive mobile VCT trucks
operated by CDC to address CT needs of remote Kenyan communities; these vehicles have been
purchased with Emergency Plan funds in previous fiscal years. The other drivers will enable the technical
staff to conduct regular field visits and technical supervision. The total proposed CT management budget for
FY 2008 is US$ 700,000.
Continuing Activity: 15054
15054 4788.08 HHS/Centers for US Centers for 7025 1501.08 $639,900
7112 4788.07 HHS/Centers for US Centers for 4303 1501.07 $400,000
4788 4788.06 HHS/Centers for US Centers for 3292 1501.06 $402,100
Table 3.3.14:
+ A laboratory program manager will be hired to support reagent, equipment and infrastructure development
activities.
+ Lab stakeholders meeting will be organized
+ GAP Lab Staff will be trained in QMS
+ Lab information management system will be procured for the GAP lab
THIS IS AN ONGOING ACTIVITY. THIS YEAR'S CDC M&S FUNDS ARE SPLIT BETWEEN GAP AND
GHAI. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED REFERENCES TO:
+Hiring of two expatriate senior technical laboratory scientists to assist in the programmatic and operational
work of the GAP lab section
+Hiring of three laboratory technologists to supervise HIV, TB/HIV, and OI testing and training in the Nairobi
and Kisumu laboratories
This activity relates to activities in Counseling and Testing (#7009) and TB/HIV (#7001) and all other Lab
Infrastructure activities.
Through this management and staffing activity the Centers for Disease Control and Prevention (CDC)
provides laboratory technical support to the National Public Health Laboratory Services (NPHLS) of the
Ministry of Health and other laboratory service providers in Kenya. The CDC laboratory technical team
works in collaboration with NASCOP, NPHLS, and other laboratory service providers in Kenya to develop,
strengthen and implement the delivery of effective and quality laboratory services to support all the HIV and
TB programs supported by PEPFAR. Key achievements in FY 2005 through FY 2006 included contribution
to development of National Laboratory Policy Guidelines, the National Strategic Plan for the laboratory,
Standard Operating Procedures [SOPs], National training curricula for testing and Quality Assurance
Schemes, upon which lab practices that support expansion of ART services are based. The team also trains
laboratory supervisors to offer support supervisory visits to peripheral HIV/TB testing sites. Four provincial
based quality assurance laboratories have been established, another four are planned. The CDC laboratory
technical team currently consists of: three senior technical advisors, 2 technical advisors with specialist
experience in the areas of training in HIV, TB, CD4, viral load testing, early infant diagnosis and quality
assurance (QA) measures. Funds are requested from GHAI for a contractor laboratory expert to operate
from Nairobi and assist the team on issues related to quality assurance and laboratory accreditation, 2
additional technical advisors to focus on expansion of laboratory services in specific regions and program
areas, a program manager to offer technical organizational support to the laboratory team in training
sessions, Quality Assurance activities, support of laboratory networks with common standards and support
supervisory visits to testing sites throughout the country. Due to expanded care and treatment activities in
Kenya, and Nyanza in particular, the GAP lab team is expected to provide technical support for high quality
lab service delivery including QA, training, mentorship and logistic support. Funds are included in this
activity to support an expatriate position of lab advisor in Nairobi to help in articulating national issues and
those of partners in the development of laboratory quality management systems. This activity also includes
support to CDC-GAP lab in Nairobi for the procurement of minor equipment, back up lab reagents and/or
supplies, a lab information management system and contractual services for maintenance of CDC lab
equipment which is used by the lab team for training and providing clinical lab services to CDC supported
HIV/TB sites. This funding will also be used to purchase reagents for specific assays not included in the
planned SCMS procurements, such as long ELISAs and other reagents and supplies for use in External
Quality Assurance of the NPHLS laboratories, evaluation of new technologies, and printing of national
SOPs, manuals and other guidelines for quality assurance schemes. Some funds are also included to
support technical assistance visits from CDC Atlanta laboratory staff; these staff are involved in providing
technical support for activities and partner's across the laboratory infrastructure program area. GAP Lab
staff will also be trained in quality management systems as the lab aims for ISO 15189 accreditation.
Significant in-country travel will occur for site visits to support delivery of quality lab services. A laboratory
stakeholders meeting will be held for the first time to crystallize objectives and harmonize activities in this
sector.
Continuing Activity: 15056
15056 4923.08 HHS/Centers for US Centers for 7025 1501.08 $1,218,900
7113 4923.07 HHS/Centers for US Centers for 4303 1501.07 $1,246,000
4923 4923.06 HHS/Centers for US Centers for 3292 1501.06 $477,170
Table 3.3.16:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP2008:
+ The vacant position of Chief of Strategic Information will be filled. This incumbent will be the in-country SI
liaison and provide leadership for the expanded SI portfolio. An HMIS Advisor (Informatics) will be recruited
and seconded to NASCOP to strengthen their capacity to lead the national rollout of Electronic Medical
Records (EMR) and Phones-for-Health project.
+ The SI team will contribute towards a central budget for the expansion of CDC-Kenya office space to
accommodate the SI country team.
COP2008
This activity relates to all activities in SI.
CDC professional staff dedicated to strategic information includes a team of medical epidemiologists,
behavioral scientists, senior data managers, and statisticians, a Monitoring and Evaluation (M&E) specialist
and additional support staff. The senior data manager, who serves as the SI in-country liaison, works with
the Ministry of Health, National AIDS/STI Control Programme (NASCOP), National AIDS Control Council
(NACC), Kenya Medical Research Institute (KEMRI), NGO partners and other USG agencies to coordinate
SI activities, lead Emergency Plan reporting, and guide dissemination of strategic information. He is also
responsible for the CDC and KEMRI data management team, assists in design of Health Management
Information Systems, develops model systems for reporting for the Emergency Plan, and guides training in
SI. The behavioral scientist also assists these organizations in the design, training of personnel, and
conduct of surveys and targeted evaluations and serves as a training coordinator with expertise in adult
learning and curriculum design. The epidemiologist works with NASCOP to conduct surveillance, support
HMIS for program data, and build the capacity of the Ministry of Health to analyze and utilize surveillance,
survey and other strategic information. An M&E officer will work closely with program managers and funded
partners to help set targets in line with PEPFAR's country level targets, prepare workplans, make field visits
to assess implementation progress and evaluate the rate of activity scale up. Three drivers and one
administrative assistant support this team in fieldwork and links to other program areas. Included in this
budget is support for printing forms and reports for dissemination of strategic information.
issemination of strategic information.
Continuing Activity: 15057
15057 4304.08 HHS/Centers for US Centers for 7025 1501.08 $663,100
7110 4304.07 HHS/Centers for US Centers for 4303 1501.07 $690,000
4304 4304.06 HHS/Centers for US Centers for 3292 1501.06 $350,000
Table 3.3.17:
+ Transfer of Care & Treatment Chief (USDH) to HVMS budget, as position is now responsible for
oversight of HBHC, HTXS, HTXD, PDCS, PDTX and HVTB
+ Transfer of Lab Chief (LES) to HVMS budget, as position is now responsible for oversight of HLAB,
HMBL and HMIN
+ Transfer of Prevention Chief (LES) to HVMS budget, as position is now responsible for oversight of
HVAB, HVOP MTCT and HVMC
+ Transfer of two behavioral scientists (LES) to HVMS budget from HVSI and HTXS/MTCT to reflect
formation of new science unit.
+ Addition of 2 new USDH positions: a Public Health Advisor for CoAg Management and a Senior
Technical Advisor to support Prevention Programs.
+ Addition of 5 new LES positions: a Civil Engineer to manage RPSO-contracted building and renovation
projects on behalf of CDC, two CoAg Specialists, a CoAg Auditor, and an ADS Assistant
+ Addition of a 50% time PSC to provide cross-cutting technical assistance in scientific and statistical
analysis.
The management and staffing budget for CDC is used to ensure that there is adequate staffing and
administrative support for CDC's PEPFAR-related activities detailed in the COP. This budget covers the
core operating costs for CDC's PEPFAR-related activities as well as cross-cutting management costs not
accounted for in the individual program areas. In this activity area, senior CDC staff provide cross-cutting
technical and managerial supervision for PEPFAR activities and the Ministry of Health receives technical
support with development and distribution of policies, guidelines and plans for implementation of HIV
prevention and treatment programs. More than one hundred local and international Non Governmental
Organizations, Faith Based Organizations and Community Based Organizations implementing HIV
prevention and treatment programs will receive technical and administrative support. A team of 26
personnel engaged full time at CDC-Kenya carries out this support. The 26 positions include 7 direct-hire
United States government staff, 2 Personal Services Contractors, and 17 locally hired staff. One of the
direct hires is in a Technical leadership/management position; another two are in Technical
Advisors/Program manager's positions. The fourth direct hire is a full-time senior technical advisor stationed
in NASCOP. Two additional direct hires are requested in COP 2009. The first will be a senior technical
advisor working to support the Prevention (HVAB, HVOP, MTCT, CIRC) and HVCT programs. The second
will be an additional management position, responsible for oversight and coordination of CDC's portfolio of
over 50 cooperative agreement partners. Additionally, an existing direct hire position previously supported
by HTXS will be reallocated to the HVMS budget; this reflects a change in the work assigned, which
includes management of HTXS, HXTD, HBHC, HVTB, PDCS and PDTX. The Personal Services
Contractor serves as the Deputy Director for Science, and is responsible for assuring quality of PEPFAR
programs, compliance with regulations concerning research involving human subjects, as well as non-
research determinations for operational activities. An additional Personal Services contractor will be
supported at 50% time to provide technical assistance in scientific and statistical analysis.
Of the 17 locally hired staff, 6 are cross-cutting technical staff. These include a Kenyan Deputy Director of
Programs. In FY 2009, the previously approved Laboratory Director position was reallocated from HLAB to
the HVMS budget to reflect responsibilities in management for HLAB, HMIN and HMBL. The previously
approved Prevention Chief was also transferred to the HVMS budget to reflect responsibilities in
management for HVAB, HVOP MTCT and HVMC. Two existing LES (behavioral scientists) were
transferred to the HVMS budget from HVSI and HTXS/MTCT to reflect the formation of a cross-cutting
science unit. In FY 2009, a new LES Assistant to the Associate Director of Science will be hired, to provide
additional oversight and technical assistance in human subjects compliance for cooperative agreement
partners.
There are 7 Financial/Budget staff and 4 administrative/Support staff. Of the seven finance and budget
staff, five (Financial analyst, 3 CoAg Specialists and 1 CoAg Auditor) are engaged in day-to-day monitoring
and training of the cooperative agreement partners that are funded through PEPFAR. Two of the CoAg
Specialists and the COAg Auditor will be new positions in FY 2009. Collectively, this team provides high
level technical, managerial and administrative support for our partner activities and helps to ensure high
quality PEPFAR programs.
CDC-Kenya's staff includes high level Kenyan and international technical experts in HIV programmatic
areas, program evaluation, laboratory science, statistics, and behavioral science. The team works
collaboratively across USG agencies to support a high quality, evidence-based approach to PEPFAR
programs.
Continuing Activity: 15058
15058 4294.08 HHS/Centers for US Centers for 7025 1501.08 $450,743
7103 4294.07 HHS/Centers for US Centers for 4303 1501.07 $2,728,946
4294 4294.06 HHS/Centers for US Centers for 3292 1501.06 $3,388,448
Table 3.3.19:
