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
Updated April 2009 Reprogramming. Increased by $300,000. Funds moved from TBD/Gucha.
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:
+Focus on PwP strategies to strengthen prevention activities.
+ Mentor mother approach to strengthen post natal follow up and care of mothers, their HIV exposed infants
and improving HIV prevention and care to other family members.
+Decentralization of care and treatment to lower level facilities through capacity building and task shifting.
+Strengthening of functional laboratory networks.
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
This activity supports key attributions in human capacity development through the training of health care
service providers on PMTCT and other HIV prevention and care topics in order to equip them with
knowledge and skills to provide quality PMTCT services. These service providers include Doctors, Nurses,
Clinical Officers, Nutrition Officers, and Health Record clerks. Other personnel targeted for training are the
mentor mothers and other peer counselors. This activity will support hiring of health workers and other staffs
to fill critical gaps in delivery of health care services.
COP 2008
The only change to the program since approval in the 2007 COP is rationalization in geographic coverage:
CDC KEMRI is scaling down on the supported sites within Nyanza (from 5 districts to 2) in order to improve
efficiency by not spreading the partner too thin in geographic coverage and while allowing for in-depth
coverage in the selected areas.
1. LIST OF RELATED ACTIVITIES
APHIA II Nyanza ARV Program, Merlin ARV Services and Palliative Care: TB/HIV
2. ACTIVITY DESCRIPTION
The Kenya Medical Research Institute (KEMRI) has been supporting the delivery of PMTCT services since
2004 with Emergency Plan funding. Program activities include counseling and testing of pregnant women in
antenatal clinics (ANC) and in maternity wards, and provision of the more efficacious PMTCT ARV
regimens to HIV+ women and exposed infants. During 2008 COP, KEMRI activities were focused on
support of PMTCT activities in the districts of Nyamira and Masaba following rationalization and redirection
of PEPFAR funded activities in the region in addition to the fact that KEMRI was redirecting activities to
focus on the core function of Research in Health care services. In 2009 COP, KEMRI will continue to
support implementation of PMTCT activities in the two districts of Nyamira and Masaba, and will expand
geographical coverage area to include the greater Kisii and Gucha districts all in Nyanza Province.
Following the recent Government of Kenya revision of administrative boundaries, the names and numbers
of districts may change, however this will not result in change to the geographical area of coverage for
KEMRI or in the target population of an estimated 50,991 pregnancies per year in the region. In 2009,
KEMRI will counsel and test 47,629 (93%) pregnant women and provide antiretroviral prophylaxis for 2937
(91%) of 3242 HIV-positive women; 20% (587) of these women will receive triple Anti Retroviral Therapy
(ART) while 50% (1469) will receive both single dose Nevirapine (sd NVP) and AZT in line with the national
PMTCT guidelines. It is also estimated that 30% (811) of the HIV-positive pregnant women may present to
the ANC clinic for their visit in the late gestational period (beyond 36 weeks gestation). These women will be
given the minimum ARV prophylaxis of sd NVP, thought the program will sensitize all pregnant women to
attend ANC as early as possible (early gestation) so that all HIV-positive pregnant women receive the more
efficacious ARV regimen for PMTCT of HIV. The program will support the WHO clinical staging and CD4
cell count test for all HIV positive pregnant women in order to facilitate assessment for decision making on
the ARV regimen for the women. The national PMTCT guideline provides the criteria for this decision
making. In order to ensure access to CD4 testing, the program will work with other PEPFAR funded
programs, Ministry of Health and other stakeholders at district level to establish and or maintain functional
laboratory network systems. All HIV positive women identified through the PMTCT program will be given
Cotrimoxazole for OI prophylaxis therapy. TB is one of the common opportunistic infection seen in HIV
positive individuals. The program will continue to work with the TB/HIV program to strengthen TB screening
among HIV-positive pregnant women and make referrals for treatment. The program will continue to support
the follow up of HIV-positive women and their infants in the postnatal period through strengthening of
postnatal care services at facility level. The current package of care for the mother includes regular follow
up, linkage to family planning services, OI prophylaxis and counseling on correct infant feeding practices
and psychosocial support through the mentor mothers' model. Additional infant care activities include OI
prophylaxis using Cotrimoxazole starting at six weeks of age, and DBS for HIV- PCR (Early Infant HIV
Diagnosis-EID). The program will target 1,515 HIV exposed infants for DBS, and will work with the
HIV/AIDS treatment program to ensure linkage to pediatric HIV care services for all eligible infants in line
with the national guidelines. The program will also strengthen psychosocial care and support for the HIV-
positive mother and her family at both the facility and community levels through the establishment of
structured support groups and the Prevention with Positives (PwP) strategy. At the facility level,
interventions will include psychosocial counseling with a focus on giving information and skills to the HIV-
positive women to encourage adherence to interventions such as correct use of ARVs and optimal infant
feeding practices. At the community level, the interventions will include establishment of support groups,
dealing with disclosure and encouraging partner and family support and will seek to integrate these
activities with the MoH Community Health Strategy activities. The program will also initiate and support
couple counseling and testing to strengthen HIV prevention incase of discordant couples and will reach at
least 9,525 men with HIV testing and counseling services. The program will collaborate with the Testing and
Counseling team as well as the Care and Treatment to ensure linkage to ongoing care for men who test HIV
-positive. KEMRI will work with the Ministry of Health to support implementation of PMTCT services in 120
health facilities with the goal of achieving universal geographic coverage of services. The program will train
270 service providers on PMTCT and comprehensive HIV management for HIV-positive mothers and their
families. This program will also support DBS for DNA PCR activities through the purchase of the required
supplies, and will support Quality Assurance activities in HIV testing at MCH and maternity settings at
PMTCT sites nationally.
Activity Narrative: 3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute 3.7% of the pregnant women who receive counseling and testing and 3.5% of the
ARV prophylaxis to the 2009 PEPFAR PMTCT target totals. This program will also contribute to the number
of HIV positive women accessing TB screening and treatment services thereby contributing to the PEPFAR
care and treatment goals. Finally, the program will also contribute to pediatric HIV care and treatment goal
through identification of HIV-exposed and infected infants who require care and treatment.
4. LINKS TO OTHER ACTIVIES
This activity relates to the KEMRI ARV Services program, KEMRI TB program in Nyanza Province and
APHIA II Nyanza ARV services. This activity is linked to Palliative Care and HIV/AIDS treatment/ARV
services through the provision of ongoing care to the HIV-positive women in the antenatal and post natal
settings, care of the HIV exposed infant in the post natal period, referral for pediatric HIV diagnosis and
referral to the ART sites for women and infants based on the national guidelines. It also linked to Palliative
Care: TB/HIV through the integration of TB screening services among the HIV positive pregnant women in
PMTCT settings and referral to the TB clinics.
5. POPULATIONS BEING TARGETED
The target population is children under 5 years, pregnant adolescent girls and their partners (15-24 years),
adults, Discordant couples, people living with HIV/AIDS, and pregnant women.
6. EMPHASIS AREAS/KEY LEGISLATIVE ISSUES
Program emphasis areas are increasing gender equity in HIV/AIDS by improving access to HIV testing for
women accessing PMTCT services as well as strengthening couple counseling and testing. Other program
emphasis areas include in-service training, Family Planning, Malaria and safe motherhood which all
contribute to improved reproductive health and malaria prevention and treatment.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14875
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14875 4095.08 HHS/Centers for Kenya Medical 6964 210.08 $1,578,138
Disease Control & Research Institute
Prevention
6949 4095.07 HHS/Centers for Kenya Medical 4246 210.07 $3,462,306
4095 4095.06 HHS/Centers for Kenya Medical 3201 210.06 $900,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Family Planning
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $85,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
This PHE activity, "A Public Health Evaluation of Male Circumcision Service Delivery and Impact on
Population Risk Behaviors and HIV Incidence" was approved for inclusion in the COP. The PHE tracking ID
associated with this activity is KE.08.0204. This PHE is an FY08 Collaborative with Botswana.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Public Health Evaluation $675,380
Table 3.3.07:
+ The activity description has been expanded to include more information on activities
+ Facility-based service delivery of MC will follow Kenya MOH standards. As part of the preparations
KEMRI will enhance the capacity of facilities serving Gem residents to provide MC in response to increased
demand for services likely to result from near-universal awareness of HIV status among DSS participants in
Gem. Men who are uncircumcised, HIV-uninfected and wish to be circumcised will be referred to their
choice of either a facility or community-based MC site. Through this activity, KEMRI will train Health Care
workers and provide 2,000 Male Circumcisions.
+ Community-based MC services will involve high-volume, standardized provision at the local level through
trained mobile teams and will follow MOH guidance. Adolescent boys and men who are uncircumcised, HIV
-uninfected and wish to be circumcised will be referred to their choice of either a facility or community-based
MC site. Mobile teams will work at temporary sites including existing buildings and tents that will be
equipped for minor surgical procedures and pre- and post-operative services.
+ Mobile MC teams will geographically follow the HBVCT teams as they move through the Gem
constituency, relocating approximately every two weeks depending on uptake rates and will provide pre-
operative, surgical, and post-operative services. Pre-operative assessment will follow group education
about MC and HIV risk reduction, including the information that MC is not 100% protective against HIV
acquisition. Standard HIV prevention messages in group educational sessions will include age-appropriate
information about delaying sexual debut, abstinence where appropriate, partner risk reduction and use of
condoms correctly and consistently.
+This activity includes major emphasis in training of health care providers on VMMC skills, development
and distribution of Information, Education and Communication, renovation of health facilities to provide
VMMC services and linkages to appropriate health care services.
The only changes to the program since approval in the 2007 COP are:
+ KEMRI will work closely with NASCOP, the Nyanza Circumcision Consortium, IRDO, and other partners
to deliver a package of MC services in Nyanza Province. KEMRI's service delivery work will involve both
Facility and Mobile approaches to MC service delivery, particularly within the existing Demographic
Surveillance Study (DSS) area in Nyanza Province. Services will target consenting HIV-uninfected men at
high risk of HIV acquisition, including HIV-negative members of discordant couples, with OP messages.
This service delivery of MC complements the PEPFAR PHE evaluating MC uptake and coverage and the
added value of mobile approaches to MC Service delivery.
Through this activity, KEMRI will add 10 more condom outlets, reach 15,000 people with OP messages and
train 40 providers in OP message delivery.
+ in FY 2007 KEMRI received supplementary funds for the expansion of HIV counseling and testing
services in Nyanza province. With these additional resources KEMRI was able to establish a home based
HIV counseling and testing program in the underserved and very high-prevalence areas of Asembo, Gem
and Karemo. These enabled KEMRI to reach an additional 70,000 people with HIV counseling and testing
services. Funds were used to employ additional personnel, especially VCT counselors, as well as data
personnel. It was also used to improve logistics such as transport for outreach personnel, and for the
procurement of essential commodities. A small component was used for community mobilization at various
levels, including mass media and employment of community mobilizers.
This activity is related to activities in AB (#6943), OP (#6948), ART (#6945), PMTCT (#6949), TB/HIV
(#6944), and Lab (#6940).
In FY Kenya Medical Research Institute (KEMRI) will strengthen and expand HIV counseling and testing
(CT) services in Nyanza province, the region with the highest prevalence in the country. CT services in
Nyanza include both client and provider initiated CT approaches, and is provided both in health facilities and
in the community. In FY 2008, KEMRI will put more resources into provider-initiated, couple and home-
based CT. In provider-initiated CT, KEMRI will support dissemination of policies and guidelines, training and
supervision. In the same FY 2008 KEMRI will expand the implementation of home based CT in Asembo,
Gem and Karemo, as part a comprehensive community HIV/AIDS program. Other components of the home
care program will be PMTCT, ART, Lab and TB-HIV. Proper implementation of the home-based CT
program in Nyanza will lead to many previously undiagnosed people knowing their status and being referred
to care and treatment. It will also support community and client education about HIV/AIDS. Special efforts
will be made to promote couples VCT and to provide prevention services for discordant couples. In FY
2008, KEMRI will provide CT services to at least 250,000 people in the region. In order to achieve this, they
will train 300 counselors and health workers. Most of these will be deployed to the home-based CT
program. Currently there are 12 health facilities that provide DTC in both out-patient and in-patient services
in the whole of Nyanza. In FY 2008, this service will be expanded to cover 120 sites in the province. In FY
2007, KEMRI will also facilitate quality assurance for both counseling and testing.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This KEMRI project will contribute to the Male Circumcision policy that envisages adoption of MC as one of
the HIV prevention strategies. It will provide this service to 2,000 individuals in Nyanza province prioritizing
adolescents and young adults.
4. LINKS TO OTHER ACTIVITIES
These will be linked to the Abstinence/be faithful, Condoms and Other prevention to promote health
behaviors and CT. HIV-infected persons identified through this program will be linked to Care and
Treatment activities
This activity targets adolescents and adults living in rural and urban settings. It targets those who are HIV
negative, as identified in home based CT programs or as referred from PMTCT, discordant couple services
or in care and treatment settings. Training activities target public and private based health care workers and
Activity Narrative: other health workers, but with emphasis on public Health Care Workers (HCWs). Community activities will
target community based organizations, faith based organizations, community leaders and religious leaders.
6. KEY LEGISLATIVE ISSUES ADDRESSED
The activity will mainly address gender equity concerns as well as stigma and discrimination issues. This
activity will increase gender equity through family approach to CT, during the home based CT program and
also facilitate women's access to HIV/AIDS services. The much increased availability of CT services in
clinical and community settings will help to reduce stigma and discrimination besides addressing people's
right to access the highest standards of CT and care services. In addition, by focusing on young people in
community outreaches, the program will strengthen gender equity too.
7. EMPHASIS AREAS
This KEMRI activity has a major emphasis on training, quality assurance, and supportive supervision. It also
has a major emphasis on community sensitization
Continuing Activity: 14880
14880 4087.08 HHS/Centers for Kenya Medical 6964 210.08 $3,300,000
6941 4087.07 HHS/Centers for Kenya Medical 4246 210.07 $2,260,000
4087 4087.06 HHS/Centers for Kenya Medical 3201 210.06 $400,000
This PHE activity, "A Retrospective Cohort Study Among HIV-infected Pregnant Women to Measure the
Effectiveness of Daily Cotrimoxazole on Prevention of Placental Malaria" was approved for inclusion in the
COP. The PHE tracking ID associated with this activity is KE.07.0060. A copy of the progress report is
included in the Supporting Documents section.
Continuing Activity: 17842
17842 17842.08 HHS/Centers for Kenya Medical 6964 210.08 $62,000
Estimated amount of funding that is planned for Public Health Evaluation $333,827
Table 3.3.08:
Updated April 2009 Reprogramming. Increased by $850,000. $450,000 reprogrammed from University of
California. Partnership Framework [$400,000]: OI drugs and supplies. This is for the CDC partner transition
that will be taking place after FOA awards. Our experience has been that we need some buffer through
those transitions to ensure continuity of service while new partners establish systems.
+ New activity emphasis on prevention with positives among patients coming for care and treatment
services.
• The only change to the program since approval in the 2007 COP is that geographic coverage has been
revised to include more health facilities in Siaya, Bondo and Nyando districts while transitioning support to
all the other districts to partners highlighted in the activity description below.
This activity relates to activities in ARV Services, pediatric ARV, Pediatric care and support, Counseling and
Testing, TB/HIV, and PMTCT.
This will be an expansion of the existing COP 08 activities. Kenya Medical Research Institute (KEMRI) will
expand ongoing treatment activities to cover 56 health facilities (36 in Siaya, 18 in Bondo, and Nairobi
districts) in Nyanza and Nairobi provinces. These expanded activities include support for provision of facility
based care and support services for 40,000 people with HIV and support for training for 200 health care
workers. Laboratory and clinical network centers will be supported at the District hospitals in Siaya, and
Bondo. Points of service will include all District and Sub-District Hospitals in the regions served by these
referral hospitals, as well as many health centers and dispensaries. Support for PGH will be transitioned to
UCSF.
At each site KEMRI provides technical assistance, equipment and supplies, infrastructure improvement,
improvement of laboratory capacity, laboratory reagents, adherence counseling, assistance with monitoring
and reporting, cotrimoxazole prophylaxis to prevent opportunistic infections, treatment of opportunistic
infections, improved access to safe drinking water, establishment of psychosocial support groups linked to
each clinic and additional community-based services. KEMRI conducts a number of activities that enhance
the development of care services at the national and regional level. These include regular coordination
meetings of HIV care providers in the province in collaboration with the Provincial AIDS and STI co-
coordinating officer, regional quality assurance programs, and specimen transfer networks to optimize the
availability of high quality CD4 cell count determination and national infant diagnostic HIV testing. KEMRI
supports facility-based practical training during which health care workers are invited to join the functioning
clinics and gain experience in all aspects of HIV treatment and clinic management. This activity's scope
includes: identification and treatment of HIV-infected children and adults and provision of care in remote
areas. The latter is facilitated by mobile teams that move between rural health centers and dispensaries,
particularly those providing PMTCT services or TB treatment, an important step towards decentralization.
KEMRI has implemented a data collection system designed to assist health facilities report national and
PEPFAR indicators. In FY 2009, KEMRI will continue supporting initiation of HIV care provision to mentally
ill patients at Mathari Mental Hospital, the national referral hospital for mentally ill patients in Kenya. This
activity will support development of treatment guidelines for the mentally ill patients and training curriculum
for the health workers in Mathari Hospital. This facility will act as a referral center for all other mental health
facilities in the country.
Kenya Medical Research Institute (KEMRI) will also strengthen linkage between facility HIV care clinics and
the community through supporting patient education at the clinics, providing psycho-social support to
PLWAs, facilitating community mobilization, advocacy and HIV education, promoting access to safe water,
supporting referrals, follow up and defaulter tracing. Community support will entail supporting trainings for
PLWHAs, establishing and supporting adult HIV support groups and linkage to microfinance organizations
and other social networks.
The long-standing (>25 years) collaboration between KEMRI and CDC in Kenya was initially research-
based, and then expanded in 1999 to include HIV prevention and treatment activities. By the end of March
2008, this collaboration was supporting care at more than 56 facilities and was supporting palliative care
services for more than 30,000 patients, mainly in Nyanza.
These activities will contribute to the results of expansion of palliative care services for people with HIV,
strengthen human resource capacity to deliver palliative care services, and strengthen the referral network
for these services.
These services link to KEMRI-supported adult ARV treatment services, pediatric care and support, pediatric
ART as well as other ART and non ART services provided by other Emergency Plan Partners like University
of California, San Francisco, Catholic Relief Services and APHIA II in Nyanza Province. They also tie into
well-established referral linkages with local VCT and PMTCT programs.
The target population for this activity is people with HIV. The main geographic regions served by these
activities are Nyando, Bondo and Siaya districts, Nyanza Province.
This activity addresses legislative issues related to stigma and discrimination through involvement of
PLWAs in service provision and community sensitization activities.
Activity Narrative: This activity includes emphasis on greater involvement of PLWA, community mobilization, development of
network/linkages/referral systems, human resources, and supportive supervision.
Continuing Activity: 14878
14878 4088.08 HHS/Centers for Kenya Medical 6964 210.08 $317,944
6942 4088.07 HHS/Centers for Kenya Medical 4246 210.07 $900,000
4088 4088.06 HHS/Centers for Kenya Medical 3201 210.06 $425,000
Updated April 2009 Reprogramming. Increased by $300,000. Reprogrammed from University of California.
ACTIVITY UNCHANGED FROM COP 2008
This activity relates to activities in Adult Care and Support, Pediatric Care and Support, Pediatric Treatment,
Counseling and Testing, TB/HIV, and PMTCT.
Kenya Medical Research Institute (KEMRI) will focus on further improvement in 39 sites (21in Siaya, 16 in
Bondo, and 2 in Nairobi to provide HIV treatment for 18600 patients (including 12,000 new patients) in
Nairobi and Nyanza Provinces. This results in a total of 22,300 ever being treated. This will be
accomplished through decentralization and task shifting, ensuring continuous supply of drugs for treatment
of opportunistic infections (OIs) and antiretroviral (ARV) drugs, support for capacity building and hiring of the
health care workers, commodity management, facility renovation, and purchase of equipment and furniture.
KEMRI will strengthen linkages between the provider initiated testing and counseling services, family and
couple counseling and testing. In addition KEMRI will support implementation of prevention with positives
(PwP).
To enhance collaboration, coordination and supervision, KEMRI will support provincial and district ART
stakeholder meetings and participate in joint district health management visits. In additional, linkages
between the different projects and between the various HIV testing points in a facility (PMTCT, TB, and
VCT) will be strengthened. KEMRI will support the district CD4 network to increase access to basic
laboratory tests for HIV positive clients. KEMRI lab will have primary role of ensuring quality HIV testing,
CD4 count and biochemistry tests are maintained. As the number of treatment experienced patients
increases the number of patients requiring viral load testing will also increase. PEPFAR funds will be used
to support the KEMRI lab to ensure the viral load testing is available to the clients who need the service.
In Nyanza Province KEMRI will support community involvement in HIV care through support of a community
team utilizing liaison officers and peer educators, use of volunteer PLWAs in defaulter tracing and other
nonclinical work. KEMRI will also provide guidance and capacity building to members of the HIV post test
support groups. Laboratory and clinical network centers will be supported in Siaya, Bondo and Nyando.
Point of service will include district and sub-district hospitals in the regions served by these referral
hospitals, as well as many health centers and dispensaries.
laboratory capacity improvement and reagents, adherence counseling, assistance with monitoring and
reporting, cotrimoxazole prophylaxis to prevent opportunistic infections, treatment of opportunistic
meetings of HIV care providers in the province in collaboration with the Provincial ART Officer, joint
supervision with the district health management teams, regional quality assurance programs, and specimen
transfer networks to optimize the availability of high quality CD4 cell count determination and national infant
diagnostic HIV testing. KEMRI supports facility-based practical training during which health care workers
are invited to join the functioning clinics and gain experience in all aspects of HIV treatment and clinic
management. This activity's scope includes: identification and treatment of HIV-infected children and adults
and provision of care in remote areas. The latter is facilitated by mobile teams that move between rural
health centers and dispensaries, particularly those providing PMTCT services or TB treatment, an important
step towards decentralization.
strengthened human resource capacity to deliver palliative care services, and a strengthened referral
network for these services. In addition, these activities will contribute to expansion of care for HIV-infected
children, in particular by supporting infant testing at sites supported both by this partner and other
Emergency Plan partners.
These services link to KEMRI-supported ARV treatment services as well as other ART and non ART
services provided by other Emergency Plan Partners like University of California, San Francisco, Catholic
Relief Services and Columbia University in Nyanza Province. They also tie into well-established referral
linkages with local VCT and PMTCT programs. Practical training supported by KEMRI is linked directly to
classroom training supported by Mild May International.
activities are Nyando, Siaya and Bondo districts, Nyanza Province. Discordant couples are targeted by
behavior change counseling and other prevention activities focused on HIV-infected patients.
This activity includes minor emphasis on commodity procurement, development of network/linkages/referral
systems, human resources, logistics, local organization capacity building, and quality assurance and
supportive supervision, training, and strategic information.
Continuing Activity: 14882
14882 4091.08 HHS/Centers for Kenya Medical 6964 210.08 $3,709,994
6945 4091.07 HHS/Centers for Kenya Medical 4246 210.07 $6,290,265
4091 4091.06 HHS/Centers for Kenya Medical 3201 210.06 $2,404,845
Table 3.3.09:
ACTIVITY UNCHANGED FROM COP 2008:
This activity relates to activities in ARV Services (#6945), pediatric ARV, Pediatric care and support,
Counseling and Testing (#6941), TB/HIV (#6944), and PMTCT (#6949).
expand ongoing pediatric care and support activities to cover 56 health facilities (36 in Siaya, 18 in Bondo,
and Nairobi districts) in Nyanza and Nairobi provinces. These expanded activities include support for
provision of facility based care and support services for 4,000 children below 15 years with HIV and support
for training for 100 health care workers. Laboratory and clinical network centers will be supported at the
District hospitals in Siaya, and Bondo. Points of service will include all District and Sub-District Hospitals in
the regions served by these referral hospitals, as well as many health centers and dispensaries. Support for
PGH will be transitioned to UCSF. At each site KEMRI provides technical assistance, equipment and
supplies, infrastructure improvement, improvement of laboratory capacity, laboratory reagents, adherence
counseling, assistance with monitoring and reporting, cotrimoxazole prophylaxis to prevent opportunistic
infections, treatment of opportunistic infections, improved access to safe drinking water, establishment of
psychosocial support groups linked to each clinic and additional community-based services. KEMRI
conducts a number of activities that enhance the development of care services at the national and regional
level. These include regular coordination meetings of HIV care providers in the province in collaboration
with the Provincial AIDS and STI co-coordinating Officer, regional quality assurance programs, and
specimen transfer networks to optimize the availability of high quality CD4 cell count determination and
national infant diagnostic HIV testing. KEMRI supports facility-based practical training during which health
care workers are invited to join the functioning clinics and gain experience in all aspects of HIV treatment
and clinic management. This activity's scope includes: identification and treatment of HIV-infected children
and adults and provision of care in remote areas. The latter is facilitated by mobile teams that move
between rural health centers and dispensaries, particularly those providing PMTCT services or TB
treatment, an important step towards decentralization. KEMRI has implemented a data collection system
designed to assist health facilities report national and PEPFAR indicators. Kenya Medical Research
Institute (KEMRI) will also strengthen linkage between facility HIV care clinics and the community through
supporting patient education at the clinics, providing psycho-social support to children, facilitating
community mobilization, advocacy and HIV education, promoting access to safe water, supporting referrals,
follow up and defaulter tracing. Community support will entail supporting trainings for PLWHAs, establishing
and supporting pediatric HIV support groups and linkage to microfinance organizations and other social
networks. The long-standing (>25 years) collaboration between KEMRI and CDC in Kenya was initially
research-based, then expanded in 1999 to include HIV prevention and treatment activities. By the end of
March 2008, this collaboration was supporting care at more than 56 facilities and was supporting palliative
care services for more than 30,000 patients including 3000 children, mainly in Nyanza.
These services link to KEMRI-supported adult ARV treatment services (#6945), pediatric ART as well as
other ART and non ART services provided by other Emergency Plan Partners like University of California,
San Francisco, Catholic Relief Services and APHIA II in Nyanza Province. They also tie into well-
established referral linkages with local VCT (#6941) and PMTCT (#6949) programs.
The target population for this activity is children exposed to and infected with HIV. The main geographic
regions served by these activities are Bondo and Siaya in Nyanza Province; Mathare and Tabitha clinic in
Nairobi.
This activity includes emphasis on greater involvement of PLWA, community mobilization, development of
Table 3.3.10:
This activity relates to activities in Adult Care and Support, (#6942), Adult Treatment, Pediatric Care and
Support, Counseling and Testing (#6941), TB/HIV (#6944), and PMTCT (#6949).
Kenya Medical Research Institute (KEMRI) will continue to support treatment activities within 39 health
facilities (21 in Siaya, 16 in Bondo districts) in Nyanza province and 2 facilities in Nairobi Province. These
activities include the provision of antiretroviral treatment (ART) to 3,200 (1,800 new patients) HIV-positive
children, resulting in a total of 3,840 children ever on treatment. Training for 90 health workers related to
ART will also be provided. Laboratory and clinical network centers will be supported at the district hospitals
in Siaya and Bondo. Points of service will include all district and sub-district hospitals in the regions served
by these referral hospitals, as well as many health centers and dispensaries. At each site, KEMRI provides
technical assistance, equipment and supplies, support to improve laboratory capacity, laboratory
reagents/supplies (specifically for PCR for early infant diagnosis, CD4 testing as well as hematology and
biochemistry), support for adherence counseling; assistance with monitoring, and reporting and
infrastructure improvement. KEMRI also conducts training and provides salary support for some staff in
accordance with Emergency Plan guidelines. ARVs are provided at the sites through the Kenya Medical
Supplies Agency (KEMSA), and the Mission for Essential Drugs and Supplies (MEDS). In addition, KEMRI
conducts a substantial number of activities that enhance the development of treatment services at the
national and regional level. KEMRI supports regular meetings of care and treatment providers in the
Province in collaboration with the Provincial AIDS and STI Coordinating Officer. It is also helping to develop
regional quality assurance programs and expand specimen transfer networks to provide high quality CD4
cell count determination and diagnostic HIV testing for infants.
The key focus areas of KEMRI include: identification and treatment of HIV-infected children in the in and out
-patient settings. KEMRI will continue to assist with data collection and national reporting for supported
facilities. By the end of April 2008, KEMRI was contributing to ARV treatment for more than 2,600 children
in 25 facilities, mainly in Nyanza.
These activities will contribute to the results of expansion of ARV treatment for clinically qualified HIV-
positive children, strengthened human resource capacity to deliver pediatric ARV treatment, and improved
referral networks for provision of ART. KEMRI activities also support other programs, for example by
providing training opportunities to staff from other programs and by providing infant diagnostic testing.
This activity links to CT, HBHC, PMTCT and SI services supported by KEMRI and other Emergency Plan
partners (e.g., EngenderHealth, Columbia University, and UCSF). Practical training supported by KEMRI
links directly to classroom training supported by Mildmay International.
The target population for this activity is children with HIV. Nyanza is high priority because of the very high
prevalence of HIV (15.3%).
This activity addresses legislative issues related to stigma and discrimination within children.
This activity includes minor emphases on commodity procurement, development of community
network/linkages/referral systems, human resources, logistics, training, and quality assurance and
supportive supervision. In addition, this activity includes an emphasis on early infant diagnosis and access
to pediatric care.
Table 3.3.11:
Updated April 2009 Reprogramming. Increased by $150,000.
This activity relates to activities in CT, Adult Care and Support, Pediatric Care and Support, Adult and
Pediatric ARV Treatment, and PMTCT activities.
KEMRI will support the expansion of TB/HIV collaborative activities in Nyanza province with a focus in the 2
districts (Bondo and Siaya ) through TB/HIV stakeholders meetings at the province and districts, clinic
renovations, furniture and equipment procurement, and staffing. In FY 2009, approximately 4,000 TB
patients will be identified. We expect that 3,200 (80%) of the TB patients will be counseled and receive the
HIV test results. KEMRI will enhance quality AFBs microscopy and HIV test results through regular joint
supervision, support training on AFB quality assurance for AFB microscopy and dried blood sample
collection. Funds will also be used to supplement the capacity of a KEMRI/CDC TB laboratory in Kisumu
with potential for becoming a western Kenya regional reference laboratory with a capacity to conduct
cultures for the mycobacterium bacilli and drug sensitivity testing (DST).
KEMRI will pilot infection control (IC) activities in selected facilities in Nyanza province. The activities will
include sensitization of the of the provincial and district health management teams and stakeholders both at
the province and the districts, assessment of current IC activities in the facility, support training of health
care workers on infection control and support facilities to develop infection control plans. Lessons learned
will inform the future expansion of the infection control activities. Secondary prevention or Prevention with
positives (PWP) activities in TB settings will be a priority for KEMRI in FY 09. There will be a special focus
on screening for TB in at least 50% of the HIV-infected patients from the PSC/CCC and medical in-patient
wards. The proportion of HIV-positive TB patients on ARVs will be increased from 30% to 60% with 100%
CTX coverage. KEMRI will support the provincial TB program implement PwP activities in the province
through sensitization of the provincial and district health management teams and other stakeholders.
PEPFAR funds will support provincial and district TB/HIV stakeholders meetings, training of health care
workers in PwP, condom promotion, disclosure and partner testing, access to ARVs and management of
STIs. Mechanisms of referral to TB clinics and back-referral to HIV care settings, and referral tracking will
be emphasized. Recording and reporting, including the implementation and evaluation of an electronic TB
monitoring and evaluation system will be implemented. KEMRI in collaboration with other partners will
enhance MDR surveillance in the province. Activities to be undertaken will include dissemination of the
Division of Leprosy, Tuberculosis and Lung Disease (DLTLD) guidelines, liaising with the Central Reference
Laboratory to provide feedback, continuous supply of universal bottles for sputum collection and discussion
of MDR cases during the District TB coordinators quarterly meeting. KEMRI will collaborate closely with
other programs to ensure that HIV-infected children are considered in all TB/HIV policies and programs,
including IPT for HIV-infected children whose parents have active TB.
In collaboration with the new partner, KEMRI will expand the TB/HIV collaborative activities to Siaya prisons
through sensitization of the prison authorities, minor renovation and establishment of comprehensive care
clinic within the prison. In collaboration with the Kenya Association for Prevention of TB and Lung Disease
(KAPTLD), KEMRI will support good clinical and laboratory practice in 6 private clinics located in Nyando,
Bondo and/or Siaya.The six clinics will be identified by the respective District TB Coordinators. Activities will
focus on capacity building, provision of equipment, minor renovation, and procurement of supplies including
cotrimoxazole (CTX), HIV test kits and laboratory reagents.
KEMRI will support the provincial TB monitoring and evaluation system through review of TB/HIV monitoring
tools for completeness, accuracy and completeness; support supervision and provincial district quarterly
review meetings.
These activities will result in strengthened delivery of integrated TB/HIV services, including strengthened
referral systems, improved diagnostics and treatment of TB among HIV-positive patients and of HIV in TB
patients, strengthen capacity of health workers to provide integrated TB/HIV services and strengthen
systems capacity for program monitoring and evaluation and management of commodities. Quality of
laboratory services will be improved through a laboratory renovation in Kisumu to create a regional
reference culture/DST laboratory, recruitment of laboratory technologists and other staff, AFBs microscopy
training and improved supervision.
These activities will be linked to ongoing CT, Adult Care and Support, Pediatric Care and Support, Adult
and Pediatric ARV Treatment , and PMTCT activities in Nyanza and Nairobi Provinces, including linkages
with the private sector and prisons.
TB suspects (adults and children), TB patients, HIV+ persons identified from PSC/CCC/medical inpatient
wards, and PLWHA organizations - deliberate action will be taken to intensify TB screening and TB case
finding among PLWHA.
Provider-initiated HIV testing for all TB patients will be given on an "opt out" principle. Guidelines on HIV
testing based on consent, confidentiality and counseling will be observed as part of standard practice.
Increased availability of CT in clinical settings and increased access to HIV-related care for TB patients will
help reduce stigma and discrimination.
7. EMPHASIS AREAS TB screening, DTC, commodity procurement, quality assurance, infrastructure,
targeted evaluation, network/linkages/ referral systems, treatment for latent TB infection, infection control,
laboratory strengthening, and training.
Continuing Activity: 14879
14879 4090.08 HHS/Centers for Kenya Medical 6964 210.08 $739,386
6944 4090.07 HHS/Centers for Kenya Medical 4246 210.07 $1,950,000
4090 4090.06 HHS/Centers for Kenya Medical 3201 210.06 $424,744
Table 3.3.12:
This PHE activity, "Operational evaluation of a TB screening tool and implementation of the 2006 WHO
guidelines for the diagnosis of smear-negative TB in HIV-infected persons in HIV care settings" was
approved for inclusion in the COP. The PHE tracking ID associated with this activity is KE.07.0041. A copy
of the progress report is included in the Supporting Documents section.
Continuing Activity: 17848
17848 17848.08 HHS/Centers for Kenya Medical 6964 210.08 $75,000
Estimated amount of funding that is planned for Public Health Evaluation $0
This PHE activity, "Prevalence of pulmonary tuberculosis and access to tuberculosis care in HIV infected
and uninfected tuberculosis patients in Asembo and Gem, Western Kenya" was approved for inclusion in
the COP. The PHE tracking ID associated with this activity is KE.07.0042. A copy of the progress report is
Continuing Activity: 17849
17849 17849.08 HHS/Centers for Kenya Medical 6964 210.08 $0
+ The KEMRI Home Based Counseling and Testing activity will expand its geographic area to include
Kibera
+ All references to Diagnostic Testing and Counseling have been changed to Provider Initiated Testing and
Counseling in an attempt to offer HIV testing routinely to everyone that enters a health facility or hospital in
Nyanza.
+ The target population has been expanded) to include a special emphasis on couples and family members
+ In FY 2007 KEMRI received supplementary funds for the expansion of HIV counseling and testing
+ In FY 2008, these activities will be consolidated and expanded. KEMRI will also support couple
counseling and testing services country-wide. For this to succeed, KEMRI will work closely with Partners in
Prevention, which has four satellite centers in Kisumu, Eldoret, Nairobi and Thika. These four sites will be
used as the nuclei for the rapid expansion of couple counseling and testing in the country. These centers
will support training, mentorship, supervision and development of materials for couple counseling and
testing.
This activity is related to activities in AB, OP, ART, PMTCT, TB/HIV, and Lab.
In FY09 Kenya Medical Research Institute (KEMRI) will strengthen and expand HIV counseling and testing
in the community. In FY 2009, KEMRI will put more resources into provider-initiated, couple and home-
supervision. In the same FY 2009 KEMRI will expand the implementation of home based CT in Asembo,
Gem and Karemo, as part of a comprehensive community HIV/AIDS program. Other components of the
home based counseling and testing program will be PMTCT, ART, Lab and TB-HIV. Proper implementation
of the home-based CT program in Nyanza will lead to many previously undiagnosed people knowing their
status and being referred to care and treatment. It will also support community and client education about
HIV/AIDS. Special efforts will be made to promote couples VCT and to provide prevention services for
discordant couples. In FY 2009, KEMRI will provide CT services to at least 240,000 people in the region. In
order to achieve this, they will train 400 counselors and health workers. Most of these will be deployed to
the home-based CT program. Currently there are 12 health facilities that provide PITC in both out-patient
and in-patient services in the whole of Nyanza. In FY 2009, this service will be expanded to cover 120 sites
in the province. In FY 2009, KEMRI will also facilitate quality assurance for both counseling and testing.
CT in this high prevalence area will result in identification of many previously undiagnosed HIV positive
individuals and discordant couples who will benefit from prevention, care and treatment that have been
made available through the President's Emergency Fund. This partner is expected to contribute 7% the total
USG target for CT during FY 2009. These planned activities will contribute to the result of increased access
to CT services, particularly among underserved and high risk populations. In health care settings, increased
availability of diagnostic CT services will lead to identification of many HIV infected patients who are eligible
for ART. The activity also contributes substantively to Kenya's 5-Year Strategy that focuses on encouraging
Kenyans to learn their status and emphasizes HIV testing as standard package of care in medical settings.
The strategy also emphasizes the development of strong links between CT services and care outlets and
also between the community and the heath care system.
KEMRI CT activities in Nyanza province and neighboring areas will refer increased number of HIV positive
patients requiring care to the Emergency fund supported Comprehensive care centers in the three districts
of Kisumu, Bondo and Siaya. Strengthened linkages between CT centers and care outlets will improve
utilization of care opportunities created through the President's Emergency Fund and other partners. This
activity is linked to KEMRI AB activity, KEMRI-ART activity, KEMRI PMTCT activity, KEMRI TB/HIV activity
and KEMRI OP activity. This activity is also linked to KEMRI Lab activity.
This activity will mainly target rural communities in the project site, working together with community and
religious leaders in each community. In this area, the whole population will be targeted, including adults,
youth and children (including infants). The activity will also target symptomatic individuals seeking care at
health facilities especially in medical wards, STI clinics, TB clinics and other service outlets targeting
conditions that are commonly associated with HIV. In addition, health care providers in both public and
private medical settings will be trained to provide CT services to patients as part of routine medical care.
This activity will increase gender equity through family approach to CT, during the home based CT program.
The low CT service uptake by couples and low disclosure rate by partners will be addressed through
vigorous campaigns to educate people of Nyanza on the benefits of couple VCT and mutual disclosure of
HIV status. The much increased availability of CT services in clinical and community settings will help to
reduce stigma and discrimination besides addressing people's right to access the highest standards of CT
Activity Narrative: and care services.
In FY 2009 KEMRI will implement home based CT. Major Emphasis areas for this activity are in the area of
training. In addition, part of the implementation of this activity will involve a minor emphasis on targeted
evaluation activities. But for this to succeed there will be need for other emphasis to be in the areas of
human resource development, community mobilization and development of network/linkages. In some
instances, there may be need for infrastructural support to facilitate referral. Apart from the home based CT
program KEMRI will continue to provide oversight technical support to CT activities in the entire Nyanza
region, for quality assurance and quality improvement.
Table 3.3.14:
+ This activity shifts focus from development of curricula for in-service training to support good laboratory
practice at service delivery points through support supervision for implementation of quality management
systems.
+Support PEPFAR programs in performance of specialized tests including viral loads, early infant diagnosis,
drug resistance testing and QA for surveillance activities.
+This activity will support attachments and mentorship training for laboratory staff from NPLHS, provincial
and district laboratories at highly functioning labs in the country and region.
This activity has strong cross-cutting budget attributions on in-country human capacity development (HCD)
through training and procurement of commodities for HIV testing. Continued provision of in-service training
on emerging techniques like PCR-based diagnosis of early infant infection and HIV-drug resistance testing
will not only help build the laboratory networks but also development critical mass of in country technical
capacity. The activity also has cross-cutting budget attributions relating to public health evaluations that
KEMRI will undertake to improve surveillance, laboratory monitoring of treatment and care.
This activity relates to all activities in PMTCT, HVCT and HVTB , care and treatment and Surveillance.
2. ACTIVITY DESCRIPTION:
The Kenya Medical Research Institute (KEMRI) is a premier Government of Kenya (GOK) biomedical
research institute and home of CDC offices and laboratories. KEMRI has highly trained laboratory staff who
conduct research and assess laboratory technologies. Key KEMRI objectives include: i) Provide highly
technical laboratory services to support HIV testing, and treatment programs. ii) Provide laboratory services
to support surveillance activities iii) Provide supportive supervision iv) Assist with development and
implementation of training curricula and materials required to expand capacity in clinical laboratories; v)
Collaborate with the National Public Health Laboratory Services (NPHLS) to strengthen NHPLS capacities
including the conduct of supportive supervision, referral laboratory services, and local evaluations of
laboratory tests; vi) Support the NPHLS to improve and sustain the national quality assurance (QA) and
Quality Improvement [QI] programs for HIV testing, laboratory monitoring of HIV treatment, and TB testing
in district and provincial/regional hospitals. An important example of technical lab services provided through
the KEMRI labs is DNA PCR assays for early infant diagnosis (EID). The KEMRI laboratories are now
networked over 40 clinical sites through a courier supported transport system for filter paper samples and
results. Although the capacity for infant diagnostic testing is being established /expanded at other sites,
including NPHLS and the MOH Coast Provincial Hospital clinical lab, KEMRI still remains a key provider of
this service. KEMRI already has a working relationship with Kilifi District Hospital in areas of DNA PCR
assays for early infant diagnosis. In FY 2008, KEMRI will build on this relationship to strengthen Coast
region's lab capacity to meet emergency targets. During FY 2004-2007, KEMRI conducted serologic testing
for sentinel surveillance and demographic health surveillance surveys. In 2007, KEMRI was a major player
in the Kenya Aids Indicator survey [KAIS 2007], in terms of training, QA testing and procurement of lab
commodities. These functions are gradually being transferred to the NPHLS with support from KEMRI and
KEMRI will continue to train the NPHLS staff on sample collection, processing, calibration and validation of
instruments. Although various training functions are also being transferred to the NPHLS, KEMRI in
collaboration with other Lab ICC members, will assist with development of training curricula and standard
operating procedures [SOP] and will remain an essential provider of in-service training to clinical lab staff,
particularly in the areas of rapid HIV testing and collection of samples for EID. In addition, KEMRI will also
assist in the procurement of test kit stocks as a back up to those centrally funded and procured through the
SCMS. KEMRI laboratories have conducted most local validations of new laboratory assays. During FY
2007, much of this function was shifted to NPHLS with KEMRI support; KEMRI will continue to assist with
evaluations of highly complex assays such as alternate assays for infant diagnosis (for example ultra-
sensitive p24 antigen assays), Incidence assays [BED Assays] and DBS for Viral Load assays. KEMRI will
collaborate with NPHLS staff in the expansion of a proficiency testing [PT] program for HIV rapid and
confirmatory tests and CD4 cell count determination. KEMRI roles in this expansion will include assistance
in developing national CD4 cell count standards, development of proficiency panels, and assistance with
supportive supervision and oversight of QA/QI procedures.
3. CONTRIBUTION TO OVERALL PROGRAM AREA:
KEMRI laboratory activities play a key role in enhancing capacity of the NPHLS and point-of-service labs to
support surveillance, prevention, and care and treatment of HIV/AIDS and TB. Training/capacity building
focuses on the NPHL will held to build long term sustainable laboratory capacity in Kenya. These activities
will continue to support the training of 300 individuals in the provision of lab-related services and will
continue to contribute to improvement of the capacity of 60 laboratories to perform HIV and CD4 and or
lymphocyte tests.
4. LINKS TO OTHER ACTIVITIES:
This activity relates intimately to NPHLS, APHL and SCMS activities as well as to virtually all counseling
and testing and care and treatment activities.
5. POPULATION BEING TARGETED:
This activity targets the laboratory technologists of the NPHLS throughout the country at sub-district, district
and provincial levels where ARV services are being rolled out. Technologists from institutions outside the
NPHLS will also be trained.
6. EMPHASIS AREAS:
This activity will place major emphasis on technical training on QA/C, new and appropriate technologies.
Minor emphasis areas will include procurement of specialized laboratory commodities and
operationalization of laboratory QA schemes for HIV care and treatment.
Continuing Activity: 14883
14883 4086.08 HHS/Centers for Kenya Medical 6964 210.08 $3,050,000
6940 4086.07 HHS/Centers for Kenya Medical 4246 210.07 $1,600,000
4086 4086.06 HHS/Centers for Kenya Medical 3201 210.06 $600,000
* Malaria (PMI)
* TB
Estimated amount of funding that is planned for Human Capacity Development $500,000
Table 3.3.16:
Updated April 2009 Reprogramming. Decreased by $1,000,000. During FY 07-08, the KEMRI SI team
planned on training staff on computer programming and advanced statistical analysis methods. These were
to be supported through courses organized in country but facilitated by CDC Atlanta. Many of these courses
were conducted by statistical analysts in-country last year to analyze data from KAIS, as well as through
local courses delivered by visiting programmers as well as attendance at local institutions. A number of
vacancies at CDC were never filled due to the ongoing transitioning of activity sites to other implementing
partners. The KEMRI SI section was also restructured, redefining roles and declaring certain positions
redundant. Equipment costs for installing a wireless link between Kisian and KEMRI DSS sites to support
field activities were not incurred since the building is not ready. This, plus carryover funds from the previous
year resulted in availability of $1.1m, which will be reprogrammed to the TBD / PS-09-990 to support
surveillance, informatics and M&E activities nationally. This reprogramming will not impact targets
allocated to KEMRI.
+KEMRI will pilot the development and rollout of the OpenMRS on PDA as a potential technology for
maintaining Electronic Medical Records (EMR) at health facilities with electric power supply problems.
This activity supports key cross-cutting attributions in human capacity development by training health
workers and data handling staff on data management using EPI Info, electronic reporting tools - including
handheld devices, analysis and monitoring and evaluation in support of HMIS activities.
The only changes to the program since the approval in 2007 COP are:
(i) The KAIS analysis and dissemination workshops. The KAIS is expected to provide a rich behavioral and
serological data set. It is therefore expected that there will be ongoing analysis and writing up workshop on
subsets of the data set in response to specific programmatic questions.
(ii) National scaling up of the PDA based TB case finding data management system will be completed. In
addition, this system will be hooked into the Phones for Health infrastructure in areas where the two
systems will have been implemented. This therefore extends the geographical coverage from two provinces
to national.
(iii) Evaluation of the male circumcision trial in Nyanza province, which is linked to prevention activities.
(iv) The use of smart cards will be piloted at health facilities in the DSS area to assess the acceptance and
feasibility of the card for identification and the embedded memory chip as storage of basic health data that
can be transferred with the patient if they move to another health facility within the DSS area.
Recommendations will be made to the Ministry of Health on the scale up to cover a wider area, taking into
account the lessons learn from the pilot and from other countries like Zambia that have implemented similar
Going alongside the smart cards will be another pilot on the use of fingerprint recognition to uniquely identify
patients who seek HIV related services, especially care and treatment. Various products exist in the market
that can support will be evaluated and the best performing one integrated with the data management
systems installed at the health facilities.
This activity relates to activities in HVTB, HVAB, HBHC, HVCT, HVSI and HLAB.
This activity will result in improved HIV surveillance and in the increased capacity for analysis,
dissemination and utilization of strategic information to strengthen HIV/AIDS policies and programs. This
activity has several components: (i) Intervention Evaluation: KEMRI/CDC maintains a jointly funded
Demographic Surveillance System (DSS) that monitors a population of 240,000 in Nyanza Province with
HIV prevalence in adults of approximately 25%. The DSS is being used to capture individual and aggregate-
level data on HIV infection, care and treatment services uptake, and HIV/AIDS-associated mortality. The
DSS is also being used to evaluate both the indirect and direct impact of ARV use on a population level,
including economic impact, impact on land use and impact on mortality. In addition, KEMRI is evaluating the
impact of HIV on orphanhood (approximately 1/3 of children under the age of 15 are orphans). The DSS
has been expanded within Siaya district and will include the Siaya District Hospital. The expanded DSS will
better be able to monitor the impact of the HIV interventions on all-cause mortality, HIV-specific mortality,
and the rates of opportunistic infections through population-based surveys utilizing thrice-yearly census data
and once yearly individual-level data. Mortality data will be collected using verbal autopsy in collaboration
with the Ministry of Health and the Central Bureau of Statistics and improve HIV/AIDS mortality surveillance.
A related sub-activity will entail setting up and maintaining a microwave/radio connection of Siaya District
Hospital and two selected health facilities with KEMRI/CDC Kisian. This will allow real-time connections
between DSS and clinical sites, greatly increasing the utility of DSS data in demonstrating ARV penetration.
This project will also evaluate the feasibility of the use of fingerprint-based ID system vs. a photo ID/barcode
based system for the unique identification of patients. (ii) Training: KEMRI will continue to offer training for
MOH and PEPFAR partners' staff in strategic information and assist in collection, data entry, management,
analysis, and utilization of program information. This continually improves the local human resource
capacity to carry out SI activities. KEMRI data staff will also offer technical support to the national TB
program on Portable Digital Assistant (PDA) data capture. The data management team will support the
rollout of the new NASCOP registers and forms at facilities in Nyanza, Eastern and Central provinces. In
addition to strengthening the national M&E system, PEPFAR reports will also be generated from these data
and facility feedback provided on the scale-up of various services (HTXD, MTCT, HVCT, etc). As part of this
activity, 140 individuals will be trained on data management and analysis. (iii) TB Reporting: To enhance the
HMIS at the National Leprosy and TB Program (NLTP) integrated TB/HIV case reporting system in PDAs
has been piloted in Nyanza and Nairobi. Following the successful pilot, PDA use will be extended to Coast
Activity Narrative: and Eastern provinces. District and Provincial TB coordinators from these provinces will be trained on the
use of PDA and each supplied with the handheld device. A GPRS module will be added to enable direct
submission of data from the field to a central database at the provincial level resulting in fast and secure
data submission. It is expected that the level of reporting for electronic TB data will increase to about 90%.
A total of 80 individuals will be trained. (iv) Integrated AIDS Care Services Evaluation: An evaluation of an
Integrated AIDS Care Services will be undertaken, with the aim of improving clinic-based HIV diagnostic
testing and counseling (DTC), home-based HIV counseling and testing (HBT), and decentralized care and
treatment in the KEMRI/CDC DSS. In order to carry out this evaluation, 50 counselors and health care
workers at health facilities will be cross-trained so that they can offer HIV testing and counseling under a
variety of circumstances (e.g., Home-based VCT, Diagnostic DTC, PMTCT, VCT). DTC will be implemented
in health facilities following national guidelines. PLWHAs will be incorporated into the evaluation staff.
Following HBT, all HIV-positive persons will be linked to a nearby health facility offering HIV services and
receive an HIV "package of care". All HIV patients will be screened for TB and care provided for those who
are dually infected. All persons from the DSS area that test HIV-positive (whether through HBVCT or DTC)
will be treated and managed by MOH clinical staff and/or through community-based lay health workers.
Pregnant women found to be HIV+ will be referred to the closest PMTCT site, and prevention interventions
for discordant couples, as well as HIV+ and HIV- individuals will be delivered. (v) AIS Quality Assurance:
Working in collaboration with the Central Bureau of Statistics and NASCOP on the AIDS Indicator Survey
(AIS), KEMRI will, through its laboratory infrastructure, provide technical oversight and quality assurance for
all laboratory testing using Dried Blood Spots (DBS) samples. Laboratory data will be managed by the
KEMRI data management staff, who will also assist in analysis and report writing. 25 individuals will be
trained (vi) KEMRI Kilifi has developed a DSS covering a 240,000 population that represents an 80%
catchments area for District Hospital admissions. Support for data management at the hospital level will link
routine counseling and testing information with the DSS follow-up system to evaluate outcomes and impact
of CT in the referral for care and treatment. 10 individuals including data managers and health workers will
be trained.
This activity will contribute in numerous ways to overall program area goals, including assessing the
penetration of HIV care and treatment activities, better understanding of orphanhood, TB, AIDS mortality,
and home-based counseling and testing of HIV. It will strengthen the national M&E systems and reporting
though the training of 160 individuals in SI and 20 organizations, including 12 MoH district programs.
The Demographic Surveillance Site targets the general population, sentinel surveillance targets pregnant
women and STI patients, the training and capacity building activities targets health workers and data
managers, and the reports generated by this activity target policy makers. Comprehensive evaluation of MC
service delivery models and population level impact of MC: Leveraging the existing Demographic
Surveillance System (DSS) in Nyanza Province, we will be able to evaluate the impact of MC circumcision
on HIV incidence at the population level. We will also be able to document uptake, coverage and cost-
effectiveness of facility-based MC service delivery and the added value of mobile approaches to MC service
delivery. In addition, we will monitor adverse events as well as risk compensation and disinhibition. The
existing DSS infrastructure provides a unique and excellent platform to assess operational research
questions and identify the most efficient and effective models of MC service delivery. This evaluation will be
conducted in partnership with NASCOP and KEMRI and the results will be used to inform GOK policy and
strategy development. The evaluation will be incorporated in the comprehensive prevention, care, and
treatment activity already planned for the DSS area to ensure that the population has full access to all
Continuing Activity: 14884
14884 4092.08 HHS/Centers for Kenya Medical 6964 210.08 $2,310,000
6946 4092.07 HHS/Centers for Kenya Medical 4246 210.07 $3,310,000
4092 4092.06 HHS/Centers for Kenya Medical 3201 210.06 $2,189,403
Estimated amount of funding that is planned for Human Capacity Development $200,000
Table 3.3.17:
