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:
+ Reaching Men As Partners by targeting 4,893 spouses of pregnant women
+ Providing Antiretroviral treatment for all infants and young children below 18 months who test HIV positive
by DNA PCR and initiating pregnant women in WHO stage 3 & 4 and those with CD 4 count of less than
350 on HAART.
+ The program will support and strengthen functional lab networks, decentralization and task shifting in
initiation and provision of ART within MCH for mothers and their HIV infected infants in an effort to improve
access to HIV care and treatment services including ART and will pilot extended HAART to cover the
breastfeeding period.
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
This activity supports key attributions in human capacity development through the training of health care
service providers on PMTCT and other HIV prevention and care topics in order to equip them with
knowledge and skills to provide quality PMTCT services. These service providers include Doctors, Nurses,
Clinical Officers, Nutrition Officers and Health Record clerks. Other personnel targeted for training are the
mentor mothers and other peer counselors.
COP 2008
1. LIST OF RELATED ACTIVITIES
This activity relates to activities in HIV/AIDS treatment/ARV services and, TB/HIV.
2. ACTIVITY DESCRIPTION
University of California at San Francisco (UCSF) has been supporting palliative care and treatment services
in Nairobi and Nyanza provinces. The UCSF approach through its FACES program promotes family-
centered care for HIV rather than individuals with HIV. This innovative approach has ensured equity and
greater disclosure within families. Current PMTCT coverage is 33 out of 68 sites in Migori and 4 sites in
Kisumu. UCSF will implement comprehensive integrated PMTCT services in all facilities in Migori district
starting with high volume facilities offering Antenatal care, delivery and postnatal services, and will take up
some private facilities in Kisumu. Community peer support groups involving People Living with HIV (PLHIV)
will be formed and supported. In FY 2009, UCSF will implement integrated comprehensive PMTCT service
in accordance with the National Comprehensive PMTCT guidelines. Comprehensive integrated PMTCT
services include, but are not limited to counseling and testing of pregnant women and their partners in
antenatal clinics, delivery units and postnatal clinics using the opt-out approach, clinical staging of all HIV
positive women using WHO guidelines, CD4 testing of all HIV positive pregnant women, use of appropriate
antiretroviral regimens including HAART for maternal health, extended HAART to make breast feeding
safer, combined ARV prophylaxis in accordance to the National Antiretroviral therapy guidelines, postnatal
follow-up for the mother and exposed infants, initiation of cotrimoxazole prophylaxis to all exposed infants at
6 weeks, Early Infant Diagnosis (EID) at six weeks via PCR on Dry Blood Spots (DBS) from all exposed
infants and successful antiretroviral treatment of HIV-positive mothers, and infected infants. All infants who
test HIV positive by DNA PCR below 18 months of age will be started on antiretroviral treatment. UCSF will
provide counseling and testing to 24,463 (93%) of 26,189 pregnant women and provide antiretroviral
prophylaxis to 4,341 (93%) of 4647 HIV-positive women identified. Of the 4,341 HIV infected women 868
will be put on HAART, 2,171 on AZT+sdNVP and 1,302 sdNVP. Early Infant Diagnosis (EID) using Dry
Blood Spots (DBS) at six weeks and cotrimoxazole prophylaxis will target 2,605 HIV exposed infants. UCSF
will counsel and test 5,436 Men as Partners targeting 4893 spouses of pregnant women and Prevention
with Positives will be rolled out in health facilities to encourage knowledge of status, partner testing and
identification of discordant couples, supporting disclosure, risk reduction counseling and encouraging
condom use, adherence counseling, supporting STI diagnosis and treatment. Some PLWHAs who have
successfully gone through PMTCT will be trained as "Mother to Mothers" to enhance PMTCT advocacy and
community follow up of women and their infant to promote adherence, return for EID, FP and exclusive
breastfeeding for 6 months. In FY 09, 90 health care providers will be trained on comprehensive PMTCT,
and some health workers will be trained on PITC, family planning and counseling (numbers trained
depending on availability of funds). In total, UCSF will train and update skills of 120 service providers in
comprehensive HIV management for HIV-positive pregnant mothers, their infants and their families.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute to 1.9% of the overall 2009 Emergency Plan PMTCT targets for Kenya.
Community participation, male involvement, prevention with positives and mentor mother initiatives will
significantly contribute to PEPFAR goals for primary prevention, access to care and treatment, and support
of those affected and infected. Technical assistance to the Ministry of health facilities will contribute to
improvement of the quality of services. UCSF will facilitate capacity building of DHMTs for improved
management of health services and set up of referral networks and linkages for a continuum of care from
facilities to Home-based care within the community and among various programs within the district. This
activity will contribute to increased awareness, demand creation and stigma reduction leading to increased
utilization of services towards the goal of universal access to prevention, care and treatment services.
3. LINKS TO OTHER ACTIVITIES
This activity relates to KEMRI activities in HIV/AIDS treatment/ARV services and, TB/HIV. Linkages to HIV
care and treatment and to Family Planning services will be strengthened, to ensure immediate appropriate
care for the woman and exposed infants, and family members and thus optimize utilization of
complementary services created through Emergency Plan funding.
4. POPULATIONS BEING TARGETED
This activity targets children less than five years, adolescents of reproductive age 15-24, adults, pregnant
women and people living with HIV. Health care providers including doctors, nurses, and other health care
workers will be targeted for training on PMTCT using the national NASCOP CDC/WHO based curriculum.
5. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will increase gender equity in HIV/AIDS programming through provision of HIV counseling and
testing services of pregnant women, and improved access to other HIV care programs for the HIV infected
Activity Narrative: woman, her infant and other family members. It will also reduce violence and coercion through stigma at the
community level.
6. EMPHASIS AREAS This activity includes emphasis on quality assurance and supportive supervision as
well as emphasis on Development of Network/Linkages/Referral Systems; Community
Mobilization/Participation, wrap around programs with Food/Nutrition, PMI through distribution of insecticide
treated nets at the MCH, safe motherhood through focused antenatal care, other Family planning initiatives
and TB screening and referral for treatment and care.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15020
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15020 8653.08 HHS/Centers for University of 7011 288.08 $550,000
Disease Control & California at San
Prevention Francisco
8653 8653.07 HHS/Centers for University of 4295 288.07 $340,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $30,000
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,"Integration of HIV Care and Treatment into MCH in Migori District, Kenya," was approved
for inclusion in the COP. The PHE tracking ID associated with this activity is KE.07.0055. A copy of the
progress report is included in the Supporting Documents section.
Continuing Activity: 17821
17821 17821.08 HHS/Centers for University of 7011 288.08 $100,000
Estimated amount of funding that is planned for Public Health Evaluation $100,000
Updated April 2009 Reprogramming. Increased by $270,000. Partnership Framework: UCSF is currently in
2 district hospital and 3 health centers. However, with additional support they can scale up outreach MC
services to outlying health centers and dispensaries.
+Specific AB messages will target both adult men and women with the aim to reduce multiple concurrent
partners.
1. ACTIVITY DESCRIPTION
University of California San Francisco (UCSF) has been supporting palliative care and treatment services in
Nairobi and Nyanza provinces, and PMTCT in Nyanza province. The UCSF approach through its FACES
program promotes family-centered care for HIV rather than individuals with HIV. This innovative approach
has ensured equity and greater disclosure within families. Current PMTCT coverage is 28 out of 68 sites in
Migori and 4 sites in Kisumu. In FY 2008, UCSF, in collaboration with the Kenya Ministry of Health (MOH)
will implement service delivery of male circumcision (MC) services in Migori and Rongo Districts in
accordance with the National and International Male Circumcision guidelines. FACES will roll out an
expanded pilot program to circumcise eligible men and boys, as well as neonatal infant boys. In addition to
medical service provision, MC services will include, but are not limited to linking with HIV counseling and
testing services for young men as a means to identify HIV-uninfected men who might choose male
circumcision, promotion of male circumcision at the clinic, and in the community as a means to prevent HIV
acquisition, promotion of other preventive methods for men (e.g. male condom, limiting number of sexual
partners, etc.), and promotion of infant male circumcision as a long-term strategy to decrease HIV incidence
in the population. Pregnant women presenting for ANC services will be counseled on the risk and benefits
of infant male circumcision. Printed materials will be given to expectant mothers to be shared with the
father. The materials will also outline the risk and benefits of male circumcision for the father. All men who
undergo male circumcision will be given information about the risk and benefits of having their sons undergo
the procedure, in addition to other risk reduction messages. Additional information will be available post-
natal at the MCH clinics where most children come for well-baby check-ups and vaccinations, and male
circumcision services will be provided for children whose parents consent. In FY 2008, 90 health care
providers will be trained to counsel parents about the risk and benefits of male circumcision, and 20
nurse/clinical officer teams will be trained to perform adult and infant male circumcision. 3,000 individuals
will be reached through this intervention. 10 condom outlets will be established.
Community participation and male involvement will significantly contribute to PEPFAR goals for primary
prevention, access to care and treatment, and support of those affected and infected. Technical assistance
to the Ministry of Health facilities will contribute to improvement of the quality of services. UCSF will facilitate
capacity building of DHMTs for improved management of health services and set up of referral networks
and linkages to ensure integration of prevention and care services at facilities, within the community and
among various related programs within the districts. This activity will contribute to increased awareness,
demand creation and stigma reduction leading to increased utilization of services towards the goal of
universal access to prevention, care and treatment services.
Linkages to PMTCT and VCT, in particular, and HIV care and treatment services will be strengthened, to
increase demand for male circumcision and thus optimize utilization of complementary services created
through Emergency Plan funding. This activity relates to activities in HIV/AIDS treatment/ARV services
(#6945), PMTCT (#6949) and, TB/HIV (#6944). This activity will also link closely with IMPACT Research
programs in HVAB, HVOP, HVCT, HVSI, and OPHS, and will leverage training provided by IMPACT to
complement FACES' service delivery interventions.
This activity targets adults, pregnant women, HIV-positive pregnant women, HIV affected families, men and
boys, with a particular focus on adolescent males, and all male infants. Health care providers including
doctors, nurses and other health care workers will be targeted for training on prevention (including male
circumcision) counseling and performance of adult and infant male circumcision using the national
guidelines.
5. EMPHASIS AREAS / KEY LEGISLATIVE ISSUES ADDRESSED
This activity will address gender equity in HIV/AIDS programs through improved prevention service delivery
at health care facilities including ANC and MCH clinics. Male norms and behaviors will be addressed by
encouraging men to take responsibility in their sexual behavior, as well as by encouraging the participation
of men in helping to make decisions regarding their infant son's health. Community Health workers will
conduct community mobilization activities regarding prevention that will help increase uptake of male
circumcision and other prevention methods as well as address issues of stigma and discrimination at
community level. Human capacity development will be addressed through training of health workers; and
local organization capacity building will occur through technical assistance to the Ministry of Health to
strengthen the quality of their service delivery.
Continuing Activity: 17296
17296 17296.08 HHS/Centers for University of 7011 288.08 $200,000
* Addressing male norms and behaviors
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.07:
Updated April 2009 Reprogramming. Decreased by $450,000. Funds moved to KEMRI (HBHC).
+ New activity emphasis on prevention with positives among patients coming for care and treatment
services.
This activity relates to activities in ARV Services, Counseling and Testing, TB/HIV, ART training, PMTCT,
pediatric care and support and pediatric ARV services.
The University of California at San Francisco (UCSF) will increase and strengthen its support at its existing
sites in Nairobi and Nyanza, as well as substantially expand services in 4 districts in Nyanza to include 10
sites in Kisumu East, 16 in Suba, 6 in Rongo and 14 in Migori. These activities will support palliative care
services for 46,500 people with HIV. Services will include diagnostic testing, ongoing counseling with a
particular focus on counseling for couples (including those with discordant HIV results), and prevention,
diagnosis, and management of opportunistic infections. Funds will support salaries for health care workers
and infrastructure through renovation in accordance with Emergency Plan guidance. In addition 50
individuals will be trained to provide HIV-related palliative care services. An area of emphasis for the UCSF
supported program is to manage families rather than individuals with HIV. The programs supported by
UCSF make extensive efforts to identify and provide treatment to family members of enrolled patients and
have structured care provision to optimize the provision of care to families. UCSF also works closely with
partners providing HIV prevention services to youth, and will provide youth-friendly HIV treatment services
to individuals referred from those programs. Other areas of focus include identification and provision of care
for children; integration of treatment with other services like TB, MCH and family planning, greater
involvement of PLWHAs as peer educators and strengthening commodity management system. UCSF is
collaborating with the National AIDS and STD Control Program (NASCOP) to develop a system for
telephone consultation that will allow care providers in rural areas to access HIV expertise. Additional
activities will include community mobilization and dissemination of informational materials to patients. UCSF
will maintain data concerning the numbers of people served and will report both nationally and through the
Emergency Plan.
Because of the geographic foci of the HIV epidemic in the United States, UCSF has vast experience
providing HIV care and has long been recognized as one of the premier institutions providing HIV care in
the United States (U.S.). The faculty of UCSF also has extensive experience developing training materials
and implementing HIV care and treatment programs in resource limited settings, including Kenya. Given
that UCSF has a long-standing research presence in Kenya, these activities will capitalize on the resulting
knowledge of Kenya as well as technical expertise in care and treatment. By March 2008, the established
patient care centers in Nairobi and Nyanza were providing palliative care services to more than 28,703
people with HIV.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
These activities will contribute to the expansion of palliative care services for clinically qualified HIV-positive
patients, strengthened human resource capacity to deliver care services, and a strengthened referral
network for provision of those services. The activities will specifically support improved quality of care,
particularly for difficult to manage patients.
4. LINKS TO OTHER ACTIVITIES
This activity relates to Adult treatment, pediatric care and treatment activities, Counseling and Testing,
TB/HIV, PMTCT programs, OVC and to ART training.
5. POPULATIONS BEING TARGETED
These activities target people (adults, children, infants) living with HIV/AIDS, including participants in U.S.
government sponsored research programs, couples with HIV, discordant couples, and families. Services for
children with HIV are being established or expanded at all sites. Public health care providers, including
doctors, nurses, pharmacists, and laboratory workers are targeted for increased HIV care and treatment
knowledge and skills.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This activity addresses legislative issues related to stigma and discrimination through involvement of
PLWHAs in service provision and community sensitization activities.
7. EMPHASIS AREAS
This activity includes minor emphasis in commodity procurement, development of networks, human
resources, local organization capacity building, logistics, community mobilization, information, education,
and communication, quality assurance and supportive supervision, and training.
Continuing Activity: 15021
15021 4137.08 HHS/Centers for University of 7011 288.08 $732,056
7089 4137.07 HHS/Centers for University of 4295 288.07 $250,000
4137 4137.06 HHS/Centers for University of 3219 288.06 $105,000
Table 3.3.08:
Updated April 2009 Reprogramming. Decreased by $300,000. Funds moved to KEMRI (HTXS).
ACTIVITY UNCHANGED FROM COP 2008
This activity relates to activities in Basic Care and Support, Counseling and Testing, TB/HIV, pediatric care
and support, pediatric ARV services, and PMTCT.
sites in Nairobi and Nyanza Province. It will also substantially expand services within 4 districts in Nyanza to
include 10 sites in Kisumu East, 6 in Rongo, 16 in Suba and 14 in Migori. These activities and expansion
will support adult treatment services for 20,000 people with HIV (10,000 new patients). Services will include
diagnostic testing, ongoing counseling with a focus on counseling for couples (including those with
discordant HIV results), prevention, diagnosis, management of opportunistic infections and community
activities that strengthen the linkage between community care and treatment facilities. Funds will support
salaries for health care workers in accordance with Emergency Plan guidance, and will improve
infrastructure through renovation. An area of emphasis for the UCSF supported program is to manage
families rather than individuals with HIV. The programs supported by UCSF make extensive efforts to
identify and provide treatment to family members of enrolled patients, and are structured to optimize the
provision of care to families. UCSF also works closely with partners providing HIV prevention services to
youth and will provide youth-friendly HIV treatment services to individuals referred from those programs.
Other areas of focus include integration of treatment with other facility services like TB and OPD,
decentralization of services, greater involvement of PLWAs as peer educators, and strengthening the
commodity management system. In addition, UCSF will provide high-level technical assistance to sites in
Nyanza Province and will collaborate with the National AIDS and STD Control Program (NASCOP) in the
development of a system for telephone consultation that will allow care providers in rural areas to access
HIV expertise. Funding will be used to provide 50 health care workers with antiretroviral treatment (ART)
training. Additional activities will include community mobilization and dissemination of educational materials
to patients. UCSF will maintain data concerning the numbers of people served and will report both nationally
and through the Emergency Plan.
Because of the geographic distribution of the HIV epidemic in the United States (U.S.), UCSF has vast
experience in providing HIV care and has long been recognized as one of the premier institutions providing
HIV care in the U.S. The faculty of UCSF also has extensive experience in developing training materials
and implementing HIV treatment programs in resource limited settings, including Kenya. UCSF has a long-
standing research presence in Kenya and these activities will capitalize on their technical expertise in
treatment. By March 2008, the established centers in Nairobi and Nyanza were providing ARV treatment to
more than 9,000 people.
These activities will contribute to expansion of ART for clinically qualified HIV-positive patients,
strengthened human resource capacity to deliver ART, and an improved referral network for the provision of
ART. The activities will specifically support improved quality of care, particularly for difficult to manage
patients.
This activity relates to other UCSF, KEMRI and International Medical Corps activities in Palliative Care,
Counseling and Testing, TB/HIV and PMTCT Pediatric care and support and Pediatric ARV services.
This activity addresses legislative issues related to stigma and discrimination through community
sensitization activities.
resources, local organization capacity building, logistics, quality assurance and supportive supervision and
targeted evaluation.
Continuing Activity: 15023
15023 4138.08 HHS/Centers for University of 7011 288.08 $4,500,006
7090 4138.07 HHS/Centers for University of 4295 288.07 $2,572,607
4138 4138.06 HHS/Centers for University of 3219 288.06 $1,680,825
Table 3.3.09:
ACTIVITY UNCHANGED FROM COP 2008:
This activity relates to activities in Adult treatment, pediatric care and treatment, Counseling and Testing,
TB/HIV, and PMTCT.
sites in Kisumu, 16 in Suba, 6 in Rongo and 14 in Migori. These activities will support palliative care
services for 5,200 children exposed or with HIV. Services will include diagnostic testing; ongoing
counseling; and prevention, diagnosis, and management of opportunistic infections. Funds will support
salaries for health care workers and infrastructure through renovation in accordance with Emergency Plan
guidance, in addition to training 50 individuals to provide HIV-related care and support services. An area of
emphasis for the UCSF supported program is to manage families rather than individuals with HIV. The
programs supported by UCSF make extensive efforts to identify and provide treatment to family members of
enrolled patients and have structured care provision to optimize the provision of care to families. UCSF also
works closely with partners providing HIV prevention services to youth, and will provide youth-friendly HIV
treatment services to individuals referred from those programs. Other areas of focus include identification
and provision of care for children; integration of treatment with other services like TB, Pediatric filter clinics,
MCH and family planning; greater involvement of PLWHAs as peer educators and strengthening commodity
management system. UCSF is collaborating with the National AIDS and STD Control Program (NASCOP)
to develop a system for telephone consultation that will allow care providers in rural areas to access HIV
expertise. Additional activities will include community mobilization and dissemination of informational
materials to patients. UCSF will maintain data concerning the numbers of people served and will report both
nationally and through the Emergency Plan. Because of the geographic foci of the HIV epidemic in the
United States, UCSF has vast experience providing HIV care and has long been recognized as one of the
premier institutions providing HIV care in the United States. The faculty of UCSF also has extensive
experience developing training materials and implementing HIV care and treatment programs in resource
limited settings, including Kenya. Given that UCSF has a long-standing research presence in Kenya, these
activities will capitalize on the resulting knowledge of Kenya as well as technical expertise in care and
treatment. By March 2008, the established patient care centers in Nairobi and Nyanza were providing care
and support services to over 700 children exposed or with HIV.
These activities target people (adults, children, infants) living with HIV/AIDS, including participants in US
Table 3.3.10:
This activity relates to activities in ARV Services (#7090, #6945), Counseling and Testing (#6941, #6907),
TB/HIV (#9054, #6944), ART training (#6991), PMTCT (#6949), pediatric care and support and pediatric
ARV services.
sites in Nairobi and Nyanza provinces. It will also substantially expand services in 4 districts in Nyanza to
include 10 sites in Kisumu East, 2 Rongo, 13 in Suba and 7 in Migori. These activities will support pediatric
treatment services for 1,500 children (810 new patients) exposed and/or with HIV. This results in a total of
1,800 ever receiving treatment. Services will include diagnostic testing, prevention, diagnosis, management
of opportunistic infections and community activities that strengthen the linkage between community care
and treatment facilities. Funds will support salaries for health care workers in accordance with Emergency
Plan guidance, and will improve infrastructure through renovation. An area of emphasis for the UCSF
UCSF make extensive efforts to identify and provide treatment to family members of enrolled patients, and
are structured to optimize the provision of care to families. UCSF also works closely with partners providing
HIV prevention services to youth and will provide youth-friendly HIV treatment services to individuals
referred from those programs. Other areas of focus include integration of treatment with other facility
services like TB and OPD, decentralization of services, greater involvement of PLWAs as peer educators,
and strengthening the commodity management system. In addition, UCSF will provide high-level technical
assistance to sites in Nyanza Province and will collaborate with the National AIDS and STD Control
Program (NASCOP) in the development of a system for telephone consultation that will allow care providers
in rural areas to access HIV expertise. Funding will be used to provide 50 health care workers with
antiretroviral treatment (ART) training. Additional activities will include community mobilization and
dissemination of educational materials to patients. UCSF will maintain data concerning the numbers of
people served and will report both nationally and through the Emergency Plan. Because of the geographic
distribution of the HIV epidemic in the United States (U.S.), UCSF has vast experience in providing HIV care
and has long been recognized as one of the premier institutions in providing HIV care in the U.S. The
faculty of UCSF also has extensive experience developing training materials and implementing HIV
treatment programs in resource limited settings, including Kenya. UCSF has a long-standing research
presence in Kenya and the activities will capitalize on their technical expertise in treatment. By April 2008,
the established centers in Nairobi and Nyanza were providing ART to more than 700 children.
This activity relates to other UCSF, KEMRI and International Medical Corps activities in care and support,
Counseling and Testing, TB/HIV, and PMTCT.
government sponsored research programs, couples with HIV, discordant couples, and families. Services
for children with HIV are being established or expanded at all sites. Public health care providers, including
Table 3.3.11:
Updated April 2009 Reprogramming. Decreased by $150,000. Funds moved to KEMRI (HVTB).
This activity relates to activities in Adult ARV Services , Counseling and Testing , and PMTCT , pediatric
care and support, Pediatric ARV services.
University of California at San Francisco (UCSF) will support TB/HIV services at 6 sites in Nairobi and
Nyanza Provinces. TB screening for 12,000 HIV patients and HIV screening for 1,600 TB suspects/patients
will be offered as a standard of care in all the facilities; approximately 1,000 patients will be identified as
being infected with both TB and HIV. Funds will support refresher training of laboratory staff and
improvement of basic laboratory microbiology capacity in order to meet the increased needs for TB testing.
Twenty-five health care workers will be trained to provide clinical prophylaxis and/or treatment for TB to HIV
-infected individuals. Additional activities will include community mobilization and follow up, dissemination of
educational materials to patients. UCSF will maintain data concerning the numbers of people served and
will report both nationally and through the Emergency Plan. Because of the geographic foci of the HIV
epidemic in the United States, UCSF has vast experience providing HIV care and has long been recognized
as one of the premier institutions providing HIV care in the US. The faculty of UCSF also has extensive
experience developing training materials and implementing HIV treatment programs in resource limited
settings, including Kenya. UCSF has a long-standing research presence in Kenya whose activities will
capitalize on their technical expertise in treatment.
These activities will contribute towards the provision of integrated HIV/TB services for dually infected
patients care by reducing TB morbidity and mortality in HIV-infected individuals and also reducing HIV
related morbidity and mortality in TB patients co-infected with HIV. These activities will strengthen referral
systems, improve diagnostics and treatment of TB among HIV-positive patients and strengthen capacity of
health workers to provide integrated HIV and TB service.
The overall program activity links closely to Adult Care and Support, Pediatric Care and Support, Adult and
Pediatric ARV Services currently supported by this partner, Counseling and Testing provided by KEMRI and
IMC, and PMTCT.
These activities target people living with HIV/AIDS. Public health care providers, including doctors, nurses,
pharmacists, laboratory workers will receive training in the diagnosis and management of TB using
government guidelines.
This activity includes minor emphasis in commodity procurement, development of networks/linkages/referral
systems, community mobilization, human resources, local organization capacity development, quality
assurance, quality improvement and supportive supervision, and training.
Continuing Activity: 15022
15022 9054.08 HHS/Centers for University of 7011 288.08 $350,614
9054 9054.07 HHS/Centers for University of 4295 288.07 $175,000
Table 3.3.12:
1. ACTIVITY DESCRIPTION & EMPHASIS AREAS
University of California San Francisco (UCSF), through its Family AIDS Care and Education Services
(FACES) program, promotes family-centered, comprehensive HIV/AIDS care in Nyanza and parts of
Nairobi. UCSF partners with the Ministry of Health and other local health facilities to provide services with
an emphasis on strengthening local capacity for long-term local sustainability. In 2008, UCSF received
PEPFAR funding though the US Centers for Disease Control and Prevention (CDC) to initiate provider
initiated HIV testing and counseling (PITC) in Migori, Rongo and Kisumu districts of Nyanza province and in
Nairobi.
PITC will be provided as part of routine care within outpatient and inpatients departments in all the health
facilities in the said districts. Also, USCF will promote HIV counseling and testing for the sexual partners
and family members of the patients enrolled in the care and treatment services in the facility. UCSF will aim
to offer HIV testing to every patient visiting a health facility regardless of the attending illness. This will lead
to an increase in HIV case identification, HIV status knowledge, and enrollment into care and treatment
services. UCSF will encourage HIV counseling and testing in TB, OPD, in-patient wards, male circumcision
service departments, and in the community in keeping with the Kenya MOH community strategy. They will
strengthen linkages between testing sites and HIV care and treatment. PLWHA will be involved in patient
counseling, HIV education, and non-medical clinic work to inspire testing, positive living, and reduce
perceived stigma.
Linkages from PITC to palliative care and treatment will optimize utilization of complementary services
created through Emergency Plan funding. Patients testing positive in integrated care and treatment sites will
enroll in palliative care within that department to streamline services and prevent unmet referral loss. At
non-integrated HIV sites, HIV positive patients will be referred to the closest care and treatment department
or facility for palliative care enrollment. When possible, staff will escort patients to the HIV care service
point.
As part of the family model of care, the Family Information Table will be used at HIV care encounters with
index patients to boost recruitment for testing, and to identify and enroll partners and family members at HIV
risk. Counseling and Prevention with Positives activities will emphasize partner and child testing, provide
assisted disclosure counseling, as well as provide risk reduction services. Concentrated pediatric
counseling and testing strategies will increase pediatric case identification and uptake of services.
UCSF will also provide training, mentorship, and supportive supervision for all the PITC providers in the
respective regions. Health care providers previously trained in HIV counseling and testing will receive
sensitization training on PITC to update, sensitize, and increase PITC skills. UCSF will support MOH
supportive supervision, allowing a nurse counselor to visit sites three days per month for structured
mentorship.
By March 2010, the UCSF Counseling and Testing support will provide PITC services to more than 25,000
individuals in 50 health facilities in Nyanza and Nairobi. To facilitate this, UCSF will train at least 300 health
care workers.
These activities will significantly contribute to national prevention and treatment goals by averting new
infections and pro-longing life through palliative care enrollment and ART treatment; strengthen local human
resource capacity to provide quality health care services; and strengthen referral networks and linkages for
integration of prevention and care services at facilities.
This activity is associated with ART (adult and pediatric), Prevention of Mother to Child Transmission, Male
Circumcision and TB-HIV.
These activities target infants, children, and adults living with HIV/AIDS, including participants in U.S.
government sponsored research programs, couples with HIV, discordant couples, and families. HIV testing
services for exposed infants and children are emphasized at all supported sites. Public health care
providers, including doctors, nurses, and lay health workers are targeted for increased HIV care and
treatment knowledge and skills.
5. SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
There are no secondary cross-cutting budget attributions in this activity.
Continuing Activity: 19411
19411 19411.08 HHS/Centers for University of 7011 288.08 $100,000
Table 3.3.14:
+ Revision of the protocol in compliance with the OGAC guidelines on conducting multi-country targeted
evaluations. This SI component of this activity remains the same as indicated in COP 2008.
This activity supports key cross-cutting attributions in human capacity development by training health
workers and data handling staff on the use of reporting tools and monitoring and evaluation.
The only changes since approval in 2007 COP are:
+Activities initiated in '07 will continue in '08, but this will be transitioned to UCSF since the UTAP
mechanism is no longer available in '08.
+Technical assistance in cost-effectiveness analyses will be an expanded component of this activity in '08,
together with the translation of evaluation findings into relevant policy.
+In addition to technical support for the comprehensive trial, this activity will involve capacity building in data
analysis, writing, and policy translation support. This activity will support current PEPFAR partners to
analyze and use existing program data to improve program quality and inform policy development. Through
a series of trainings and workshops, this activity will help to develop Kenyan professional capacity for
epidemiological analysis and translation into policy.
+In '08 this activity will also involve the translation of study instruments, particularly Standard Operating
Procedures (SOPs) into programmatic tools that implementing partners can use.
This activity will continue work initiated in '07 under the UCSF/UTAP mechanism to provide technical
assistance for several plus-up activities. To support development and implementation of the Comprehensive
Package Study, UCSF is supporting KEMRI, NASCOP and CDC-Kenya to develop a study protocol, study
instruments, and procedure manual for this important Public Health Evaluation. This evaluation, which is a
collaboration of KEMRI, NASCOP, and the USG PEPFAR team will assess the population-level impact on
HIV incidence of a prevention package that includes VCT and Male Circumcision. The evaluation will also
assess the population-level impact on mortality and morbidity of widespread provision of care and treatment
within the CDC/KEMRI Demographic Surveillance System. In addition, UCSF staff are providing technical
assistance for training and supervision of study staff and overall supervision of the project. A key
component of the technical assistance will be the training of Kenyan counterparts in all components of
epidemiological evaluation. This human capacity development is a key component of this project.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA [
This program will provide important information needed to assess the effectiveness of the prevention
interventions on HIV incidence in the DSS area. The epidemiological data will inform the design of
prevention packages and referral mechanism to care and treatment.
This activity will link to SI support to NASCOP and KEMRI as well as to Public Health Evaluation activities.
This activity will provide training for adult men and women.
Emphasis areas for this national activity include human capacity development, training, in-service training,
retention strategies, local organization capacity building and strategic information strengthening.
6. TARGETS
Number of organizations offered TA- 3
Number of individuals trained on surveillance, HMIS and/or M&E - 20
Continuing Activity: 19426
19426 19426.08 HHS/Centers for University of 11996 11996.08 UTAP $635,000
Estimated amount of funding that is planned for Human Capacity Development $75,000
Table 3.3.17:
