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:
+Increased emphasis on provision of comprehensive PMTCT services in the lower level facilities and
strategies to increase the uptake of HIV testing and counseling to male partners of women attending ANC
services.
+NASCOP will take leadership in spearheading relevant policies that support decentralization and task
shifting.
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,
counselors, clinical officers, nutrition officers, social workers and health record clerks.
COP 2008
1. LIST OF RELATED ACTIVITIES
This activity relates to activities in Palliative Care: Basic Health Care and Support, HIV/AIDS Treatment:
ARV Services, Prevention of Mother-to-Child Transmission and Strategic Information.
2. ACTIVITY DESCRIPTION
The Ministry of Health's National AIDS and STI Control Program (NASCOP) will continue to provide
leadership and coordination to the national PMTCT program towards the goal of universal access to
comprehensive integrated PMTCT services. In collaboration with the MOH's Division of Reproductive
Health and Medical Training College (MTC), NASCOP will strengthen its stewardship, regulatory and
supervisory functions and quality assurance to ensure delivery of high quality comprehensive integrated
PMTCT services that reflect current scientifically proven interventions and in accordance to the National
Comprehensive PMTCT guidelines. NASCOP will guide establishment of systems and mechanisms for
stronger linkages and coordination between PMTCT and other HIV treatment and care programs to ensure
comprehensive care and support to the HIV-positive woman, infant and family members within maternal and
child health care settings. In FY 2009, this activity will continue with strengthening of the stewardship
function of NASCOP by improving coordination across ministries of health (Ministry of Public Helath
Services (MOPHS) and Ministry of Medical Services MOMS) programs supporting MCH services at the
national provincial and district levels with decentralization to the district level. NASCOP, through the
Technical Working Groups (TWGs), will provide the framework and guidance for the national roll out of
comprehensive integrated PMTCT services in addressing all the four PMTCT prongs including provision of
FP services within PMTCT programs and couple counseling and testing. NASCOP will facilitate the
functioning of the Provincial PMTCT TWGs that will work at district level to enhance active community
participation, coordinate various partner activities, review district micro plans and use program data for
improving specific regional performance. Other significant activities include developing models to ensure
improved access to HAART for eligible mothers either within the MCH setting or through linkage with
existing ART programs. Additionally, the program will continue working at strengthening the referral systems
for the continuum of care for successful referral of mothers to antiretroviral therapy centers and early infant
diagnosis and referral to appropriate care to enhance maternal and child survival. This program will also
adopt a training package for the training of community groups to provide HIV prevention, treatment, care
and support services at the community level.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
NASCOP has the mandate to provide leadership and policy guidance, direction and support for national
PMTCT efforts. The NASCOP PMTCT activities will significantly contribute to PEPFAR goals for primary
prevention of HIV and identifying and referring HIV-positive individuals to treatment and care by providing
the national framework for strategic comprehensive to PMTCT programming including strengthening couple
counseling and Testing and Family Planning services within the PMTCT program. Strong and effective
linkages between PMTCT and other HIV care programs and Reproductive services at national level will
significantly improve access to ART including pediatric HIV care and treatment services at facility level,
improved access to FP services and prevention for discordant couples thereby ensuring comprehensive
HIV services in PMTCT sites. With Emergency Plan funds, NASCOP led the national process in adapting
the WHO/CDC generic curriculum into the Kenya National PMTCT Training Curriculum. In FY 2008,
NASCOP will continue to provide national direction for staff capacity building to strengthen PMTCT service
delivery. NASCOP will also continue to improve PMTCT management information system in order to
develop a dynamic data flow system to inform national gaps, coverage rates, and program uptake and
monitor national targets. NASCOP will continue to support the development and roll out of the national
training plan based on identified needs, maintain a national data base on service providers trained with
details of cadre of staff trained, training type, duration of training etc that will be used to inform the nation on
staffing needs. NASCOP will work with DRH and MTC to support integration of pre-service and in-service
training and supervision of PMTCT services within other maternal, child health and family planning
supervisory structures at the district levels. In '08, the program will also develop and roll out "on the job
training" strategy for service providers, and support the production of a bi-annual technical news letter to the
field.
4. LINKS TO OTHER ACTIVITIES
This activity relates to the following: NASCOP ART, NASCOP SI, and PMTCT JHPIEGO DRH. This activity
is most immediately linked to palliative care and HIV/AIDS treatment/ARV services through the provision of
ongoing care to the HIV-positive woman in the antenatal and post natal settings, care of the HIV exposed
infant in the post natal period and referral to the ART sites for women and infants. In collaboration with the
DRH, this activity will strengthen support supervision efforts for integrated comprehensive PMTCT service
delivery including improved data management and utilization at facility level.
5. POPULATIONS BEING TARGETED
This activity targets pregnant adolescent pregnant women aged 15-24 year and their partners, adults,
discordant couples, people living with HIV/AIDS, and pregnant women.
Activity Narrative: 6. EMPHASIS AREAS/ KEY LEGISLATIVE ISSUES ADDRESSED
This activity will increase gender equity in HIV/AIDS programs through providing national policy guidelines
and operational guidelines for the provision of PMTCT of HIV services to pregnant women and their
partners. Other emphasis areas include providing guidance and direction in training of service providers in
both pre service and in service settings, and working with other Ministries of Health departments to
strengthen integration of service delivery that will contribute to achieving delivery of comprehensive PMTCT
care package at all ANC and Maternity facilities through wrap around programming. This includes
programs such as Family Planning, Malaria (PMI), and TB programs. In all the programmes NASCOP will
promote equity through identification of vulnerable groups and factors that make specific groups particularly
vulnerable. Gender-related vulnerabilities will be identified and analyzed and described and incorporated
into all interventions. This includes MAP, gender-based violence and cultural barriers that are related to
gender norms. NASCOP will also encourage and actively facilitate implementing partners to work with
PLWHA in PMTCT and other HIV prevention and care programmes through initiatives such as PwP, M2M
programs.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14930
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14930 4225.08 HHS/Centers for National AIDS & 6981 3465.08 $550,000
Disease Control & STD Control
Prevention Program
7006 4225.07 HHS/Centers for National AIDS & 4266 3465.07 $300,000
4225 4225.06 HHS/Centers for National AIDS & 3465 3465.06 $437,500
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Family Planning
* Malaria (PMI)
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $50,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY UNCHANGED FROM COP 2008
1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#7009),
Prevention of Mother-to-Child Transmission (#7006), Palliative Care: Basic Health Care and Support
(#7005), Palliative Care: TB/HIV (#7001), Condoms and Other Prevention (#7008), HIV/AIDS Treatment:
ARV Services (#7004) and Strategic Information (#7002).
The Kenya National AIDS and STI Control Program (NASCOP) will support, supervise and monitor
abstinence and faithfulness programs targeting youth in Kenya. It will also take the lead in developing
policies and guidelines as needed. NASCOP will continue to strengthen a coordination mechanism for youth
HIV prevention in Kenya. It will continue to explore feasible avenues of strengthening HIV prevention
programs such as the integration of alcohol prevention efforts with HIV prevention work. NASCOP will
coordinate the development and distribution of print materials as needed in support of abstinence and
faithfulness programs for youth as well as youth-friendly services. NASCOP will also partner with the Kenya
Medical Training college (KMTC) to help develop in-service training guidelines to KMTC trainees on broad
behavioral prevention issues for youth and the provision of youth-friendly services. This element will be in
response to the need identified in 2005 by the Kenya Service Provision Assessment (KESPA) which pointed
to huge gaps in the provision of youth friendly services. This training will help sensitize health workers on
the need to offer appropriate information and counseling to young people to help them adopt healthy
behavior and safer sexual practices. These will contribute to improved HIV preventive behaviors among
young people, changed social and community norms to promote HIV preventive behaviors among youth
and young adults as well as reduced HIV/AIDS stigma and discrimination. NASCOP will play a key role in
ensuring that epidemiological data is captured, analyzed and presented for use in implementation of
prevention programs. NASCOP was established within the Ministry of Health (MOH) to conduct
surveillance, develop policies and coordinate activities in HIV/AIDS prevention, care and treatment. It will
also provide essential linkages that will ensure young people have improved access to related HIV services
including youth-friendly counseling and testing, palliative care, care and treatment among others. Since
2001, the USG has been a major supporter of operational activities of NASCOP through a cooperative
agreement with CDC that has resulted in the development of VCT, PMCT, ARV, TB-HIV care, HIV testing in
clinical settings and other policies; improved support supervision and field coordination with provincial,
district and local facilities; and improved surveillance, monitoring and evaluation. This has resulted in
increased capacity for the MOH that serves as a platform for the services necessary to reach Emergency
Plan targets.
This activity will contribute towards the achievement of the Emergency Plan prevention targets in AB. It will
promote the ability of implementing partners to reach their varied emergency plan targets for the year and
will guide the implementation of targeted interventions for greater efficacy in behavior change. This activity
also includes the training of 227 individuals in the promotion of HIV/AIDS prevention messages through
abstinence and/or being faithful.
This project will establish essential linkages with other NASCOP coordinated national programs including
CT activity (#7009), PMCT activity (#7006), ARV services activity (#7004), Palliative Care: Basic Health
Care and Support activity (#7005), TB/HIV (#7001), OP (#7008) and strategic information activity (#7002).
NASCOP will build on its involvement with the faith-based and non-governmental sectors in Kenya and
ensure that abstinence messages for youth are integrated with other services and that a supportive adult
environment is cultivated.
The activities implemented by NASCOP in this area will target men and women as well as children and
youth to be served through the guidelines. National AIDS Control staff and other MOH staff such as the
Kenya Medical Training college staff as well as various cadres of public health care workers will be
targeted.
6. KEY LEGISLATIVE ISSUES ADDRESSED
The primary legislative issue addressed in this project is increasing gender equity in HIV/AIDS programs
and reducing stigma and discrimination.
7. EMPHASIS AREAS
This activity includes major emphasis on quality assurance, quality improvement and supportive
supervision. It will also result in the development of guidelines for health workers on working with youth.
Information, Education and communication materials will be developed and distributed to service providers.
Linkages and networks for youth programs to health care services will be established and guidelines on
training will be developed.
Continuing Activity: 14931
14931 4226.08 HHS/Centers for National AIDS & 6981 3465.08 $210,000
7007 4226.07 HHS/Centers for National AIDS & 4266 3465.07 $200,000
4226 4226.06 HHS/Centers for National AIDS & 3465 3465.06 $100,000
Table 3.3.02:
Updated April 2009 Reprogramming. Increased by $100,000. Partnership Framework: Support Prevention
with Positives stakeholders/dissemination Meetings at National and Regional level, M&E Activities and
Support supervision.
This activity relates to activities in Abstinence and Be Faithful Programs (#7007), Counseling and Testing
(#7009), Prevention of Mother-to-Child Transmission (#7006), Palliative Care: Basic Health Care and
Support (#7005), Palliative Care: TB/HIV (#7001), HIV/AIDS Treatment: ARV Services (#7004) and
Strategic Information (#7002).
condoms promotion and prevention activities targeting at-risk youth and vulnerable populations in Kenya.
NASCOP will also support the training of 300 individuals in the promotion of HIV/AIDS prevention through
OP messages. In addition, STI management will be strengthened to provide a special focus on Positive
prevention. This will entail educating health workers on the need to intensify STI screening and treatment
for individuals with HIV. Guidelines for health service providers will be developed to assure they focus on
important aspects such as positive prevention and the provision of youth-friendly services, a gap highlighted
in the 2004 Kenya Service Provision Assessment Survey. Training updates for health workers will be done
through the Kenya Medical Training College. NASCOP will also take the lead in developing policies and
guidelines as needed to ensure a reasonable standard of practice in delivering prevention programs for
vulnerable populations. NASCOP will continue strengthening a coordination mechanism for condom
promotion, information and education to vulnerable populations in Kenya. It will continue to explore feasible
avenues of strengthening HIV prevention programs such as the integration of alcohol prevention efforts with
HIV prevention work. NASCOP will coordinate the development and distribution of print materials as needed
in support of condoms and other prevention programs for young people and most-at-risk populations. It will
support increased condom access through increasing the number of condom outlets country wide. These
will contribute to improved HIV preventive behaviors among young people, changed social and community
norms to promote HIV preventive behaviors among youth and young adults as well as reduced HIV/AIDS
stigma and discrimination. Significant changes from 2006 to 2007 will be that NASCOP will play a key role
in ensuring that epidemiological data is captured, analyzed and presented for use in implementation of
surveillance, develop policies and coordinate activities in HIV/AIDS prevention, care and treatment. Since
This activity will contribute towards the achievement of the Emergency Plan prevention targets. It will
will guide the implementation of targeted interventions for greater efficacy in behavior change. NASCOP will
also support the training of 300 individuals in the promotion of HIV/AIDS prevention through OP messages.
NASCOP CT activity (#7009); NASCOP AB activity (#7007), NASCOP PMTCT activity (#7006); NASCOP
ARV services activity (#7004); NASCOP palliative care: basic health care and support activity (#7005),
NASCOP palliative care: TB/HIV (#7001) and NASCOP strategic information activity (#7002).
Activities implemented by NASCOP in this area will target partners working towards the reduction of HIV
prevalence through prevention of new and secondary infections. Efforts in this activity will target out of
school and street youth, children and youth, adults, people living with HIV/AIDS and most at risk
populations. Community organizations including FBOs, NGOs, implementing organizations and rural
communities will be indirectly targeted by NASCOP.
This activity includes major emphasis on quality assurance, Quality improvement and supportive
supervision. Minor emphasis will be on commodity procurement, development of linkages and referrals and
the development of guidelines and information, education and communication.
Continuing Activity: 14933
14933 4228.08 HHS/Centers for National AIDS & 6981 3465.08 $90,000
7008 4228.07 HHS/Centers for National AIDS & 4266 3465.07 $100,000
4228 4228.06 HHS/Centers for National AIDS & 3465 3465.06 $200,000
Table 3.3.03:
This activity relates to injection safety activities implemented through John Snow, Inc/Making Medical
Injections Safer (#8985), Supply Chain Management System (#8817), Danya International (#8824), and
JHPIEGO (#8821); NASCOP activities in ART (#7004), CT (#7009), and Palliative Care (#7005); and
PEPFAR partners in care, prevention, laboratory and treatment.
The Ministry of Public Health, in conjunction with the Division of Curative Services, Division of Preventive
and Promotive Health and National AIDS Control Program (NASCOP), will continue to coordinate and
monitor the implementation of the national policy and standards, guidelines and strategic plan for injection
safety and health care waste management launched in FY 2006. NASCOP will lead the scale up of injection
safety by various partners country-wide and the integration of Injection Safety and infection prevention and
Control. In partnership with the private sector, sharp injuries surveillance will be strengthened to identify
practices and procedures that pose risks to health workers and patients. Uptake of post exposure
prophylaxis by health care workers will be assessed and linkages to Care and Treatment services
established. In addition, in FY09 particular emphasis will be given to enhancing safe phlebotomy practice.
Every year, close to five million blood draws and finger pricks for blood collection are performed within the
public health care sector in Kenya. The expansion of HIV testing and care has resulted in a dramatic
increase in blood collection for the purpose of HIV testing and monitoring of those with HIV infection.
Policies, guidelines, Standard Operating Procedures (SOPs) for phlebotomy, other blood collection
procedures and specimen handling will be developed. Appropriate monitoring tools will be used to assess
the success of the program in rationalizing injection use and ensuring continuous availability of commodities
for safe injection practice. Transmission of HIV and hepatitis in health care settings can occur through
unsafe injections and other unsafe medical practices, including poor disposal of contaminated medical
wastes. The persons most at risk of infection through unsafe injection practices are the recipients, health
care workers and the wider community through exposure to contaminated sharps waste. Estimates of the
global burden of disease from unsafe injections suggests that, in the year 2000, unsafe injections around
the world accounted for five percent of HIV infections, 32 percent of hepatitis B virus infections, 40 percent
of hepatitis C virus infections, 28 percent of liver cancers, and 24 percent of cirrhosis cases (World Health
Organization, 2003). A Health workers survey in 2005 in Kenya reported that 12% of health care workers
had experienced needle stick injury in the previous 12 months. The data suggests that injection overuse
and unsafe injection practices contribute to contaminated and often unnecessary injections in the formal
and informal health sector, and therefore constitute a significant mode of transmission for HIV and hepatitis.
NASCOP will coordinate safer injection and waste management activities implemented through other
PEPFAR partners including Danya Int., JSI-MMIS, University of Nairobi and JHPIEGO. An increased
number of injections are being used in the informal health care sector, where the re-use of injections and
the occurrence of needle stick injuries result to HIV transmission and are more highly probable. IEC material
will be developed in different languages based on the HIV/AIDS prevalence, population density and
population groups affected by the epidemic. NASCOP will monitor injection practices country-wide and give
supportive supervision that will strengthen performance at all levels of health delivery. Infection Prevention
Committees (IPC) at hospitals will be reactivated to oversee infection control, safe injection and waste
management practices. These will be comprised of a core team of a senior nurse, a public health officer, a
clinician and a lab technologist. The lessons learned from these initial hospitals will be used to enhance the
functions of IPCs at all hospitals in the country. These committees will serve to ensure sustainability of safe
injection practices in years to come. Potential partners such as the National Nurses Association of Kenya,
National Environmental Management Authority (NEMA), National AIDS Control Council (NACC), WHO and
JHPIEGO will be identified to work with NASCOP to improve injection safety. NASCOP will coordinate
quarterly meetings to discuss the outcomes and plan for Safe injection practice and sharps waste
management. Lastly, the injection safety program will support the Kenya Medical College to integrate safe
injection practices into all its pre-service training curricula.
As the HIV treatment program is scaled up and brings more HIV/AIDS patients to health care facilities,
measures are being put in to place to protect health care workers and other patients from nosocomial
infections. This program will contribute to averting up to 5% new cases of HIV in the country. The injection
safety and waste management program under the Ministry of Health will guide the development of policy
and support implementing partners with the aim of achieving national coverage by 2009 and sustainable
safe practices thereafter.
4. LINKED ACTIVITIES
PEPFAR partners in care, prevention, laboratory and treatment. The injection safety initiative is linked to the
Kenya Expanded Program for Immunization (KEPI), which already procures non re-use injection devices for
its program. Other Kenyan stakeholders in the area of injection safety have been mobilized, including the
Ministry of Health Infection Prevention and Control Committee and the Nosocomial TB/HIV Prevention Unit
of NASCOP. A National Injection Safety Steering Committee has been established at the Ministry of Health
chaired by the Deputy Director of Medical Services and Head of Preventive Health Services. Membership to
this committee is drawn from all the programs at the MOH and incorporates the National Environmental
Management Authority (NEMA), World Health Organization (WHO), National AIDS Control Council (NACC),
CDC and USAID.
This activity targets policy-makers, all health care workers (nurses, doctors, clinical officers, pharmacists,
lab personnel, health care waste handlers), medical training institutions, the public, and the community.
6. EMPHASIS AREAS COVERED
Activity Narrative: This activity has a major emphasis on policy and guidelines development, with a minor emphasis on quality
assurance, quality improvement and supportive supervision to monitor improved skills, knowledge and
attitudes regarding safe injection practices of healthcare workers, waste handlers and the community. This
activity will also coordinate the development of policies to ensure adequate supplies of appropriate injection
supplies at health care facilities.
Continuing Activity: 14932
14932 7010.08 HHS/Centers for National AIDS & 6981 3465.08 $120,000
Table 3.3.05:
+ A decrease in FY08 funding levels since approval in the 2008 COP. This is because development of the
MC policy document has been completed and dissemination partially done. In addition, funding from other
stakeholders (Gates Foundation) will also be used to support NASCOP in implementing the MC policy and
related activities. Adequate copies for distribution of the MC policy document will be produced and used
during dissemination especially in areas with low MC rates. NASCOP will also print adequate copies of MC
guidelines, distribute and disseminate the same to ensure that VMMC is done in safe sterile conditions a
without coercion for the clients to optimize the benefits of the minimum package for VMMC. NASCOP will
also provide support supervision to the Provincial Health Management Teams (PHMTs) to ensure prompt
reporting of the MC services and in monitoring for any adverse events and complications. Funds will also
support the continued engagement with the Luo Council of Elders (LCE) and the Jaramogi Odinga
Foundation (JOOF) in a meaningful way to ensure their support.
+The major emphasis will be Policy and Guidelines development and review, quality assurance, quality
improvement and supportive supervision.
The only changes to the program since approval in the 2007 COP are:
• A decrease in FY 07 funding levels for the MC-related policy activities. This is because of anticipated
funding from other stakeholders which will also help to support this activity. Funding for FY 08 for this
activity will only be $100,000.
• In addition, NASCOP's work in FY 08 will expand to include implementations of some of the
recommendations from the recent HW Survey and guidelines. Support will address issues of HW burn-out
as well as task-shifting in line with the new MOH Community Health Strategy and other emerging policy
guidance to address health worker shortages in Kenya.
1. ACTIVITY DESCRIPTION
Funding will support NASCOP and other key stakeholders to develop and disseminate STI and Prevention
with Positive policies and guidelines for service providers throughout Kenya. Technical training and support
for service providers will ensure strengthened service delivery for STI control, particularly within sexually
active HIV-infected populations. Circumcision Policy Development and Dissemination: PEPFAR will support
the Ministry of Health in the rapid development of Male Circumcision policy guidelines. This will involve the
development of policy, implementation and technical guidelines by NASCOP. Funding will include support
for technical assistance, dissemination and sensitization costs. A regional consultation prior to policy
finalization will also be supported in Nyanza Province given the focus on implementation in this high
prevalence, low-circumcising area. WHO/UNAIDS normative guidance for countries regarding male
circumcision will be evaluated in the context of Kenya as a component of HIV prevention, tool kits for rapid
assessment, and guidance on training will be adapted. Funding will also support education and mobilization
work with Luo elders and key stakeholders in Nyanza Province to address cultural and communication
issues to prepare for programmatic scale-up.
Continuing Activity: 14941
14941 12509.08 HHS/Centers for National AIDS & 6981 3465.08 $50,000
12509 12509.07 HHS/Centers for National AIDS & 4266 3465.07 $100,000
Table 3.3.07:
+ New activity emphasis on prevention with positives among patients coming for care and treatment
Partner will support development /revision of nutrition policy, guidelines and tools at $100,000.
This activity relates to activities in Counseling and Testing, PMTCT, ARV Services, Pediatric care and
support, Pediatric ARV, services Strategic Information and TB/HIV.
This will be an expansion of 2008 activities as described in the COP. The National AIDS and STD Control
Program (NASCOP) is the arm of the Ministry of Health (MOH) that is responsible for implementation of
medical interventions related to treatment and prevention of HIV/AIDS. NASCOP will oversee the
implementation of all HIV care programs in Kenya. These activities will also result in the training of 240
health care workers. Emphasis will be placed on developing regional trainers who will provide classroom
training and mentorship of health care workers at the facility level. Specific NASCOP-supported activities
will continue to include the coordination of all partners in the provision of care for people with HIV (through
national level meetings such as the National ART task force), and supervision of treatment in MOH and
other facilities. Specific guidelines for prevention and treatment of opportunistic infections, including sexually
transmitted illness, HIV prevention in care settings, and management of nutrition interventions will be
updated, printed, and distributed as needed. The national system for tracking the numbers of people
enrolled in patient support centers (i.e., HIV clinics) will continue to be improved. Funds will also be used to
provide administrative support and transport for the Provincial/Regional ART coordinators so that they can
coordinate, track, and provide supportive supervision to sites in their areas as well as supporting regular
regional meetings of care providers.
The supervisory structure at NASCOP includes a core staff at a national level that consists of a small
technical and administrative staff and an expanding staff responsible for M&E. A system of regional
supervision of HIV/AIDS treatment activities has been established using Provincial AIDS and STI
Coordinating Officers (PASCOS) who are responsible for assisting with the establishment of care and
treatment services at additional sites, conducting site evaluations and accreditation, and supervision of care
programs. NASCOP will distribute HIV prevention materials for health care providers that incorporate
consistent messages regarding HIV status disclosure, partner testing, and condom use to prevent sexual
transmission. Other activities will include the development of referral systems and care linkages for HIV
positive mothers identified through the PMTCT programs, decentralization of care and treatment services to
lower level health facilities to increase access and reduce the waiting list at the provincial and district
hospitals, and improved coordination with other sources of support such as the Global Fund for AIDS,
Tuberculosis, and Malaria.
These activities are essential to the overall implementation and coordination of HIV care and treatment
programs in Kenya. NASCOP supported activities are essential to the formation/strengthening of the
linkages needed in the network model and to the development of a sustainable system of HIV care in
Kenya.
There are strong linkages between these activities and virtually all HIV prevention and treatment activities in
Kenya. All Emergency Plan partners have been encouraged to extend efforts to further strengthen these
linkages by coordinating with and supporting the activities of the PASCOS and by participating in national
efforts such as policy/guideline revision and national stakeholders meetings. Activities are closely linked to
the Management Systems of Health (MSH) supported logistics/systems strengthening particularly for the
Kenya Medical Supplies Agency. Other linkages include Counseling and Testing, PMTCT, ARV Services,
Strategic Information and TB/HIV.
Populations targeted by these activities include people living with HIV/AIDS including health care workers
and others providing services to people with HIV.
This activity addresses legislative issues related to stigma and discrimination through community
sensitization activities.
This activity includes minor emphases in quality assurance and supportive supervision, development of
networks/linkages/referral systems, logistics, human resources, policy and guidelines, strategic information
(M&E, IT, Reporting) and training.
Continuing Activity: 14934
14934 4224.08 HHS/Centers for National AIDS & 6981 3465.08 $500,000
7005 4224.07 HHS/Centers for National AIDS & 4266 3465.07 $700,000
4224 4224.06 HHS/Centers for National AIDS & 3465 3465.06 $422,500
Estimated amount of funding that is planned for Food and Nutrition: Commodities $100,000
Table 3.3.08:
The only change to this activity since approval in the 2008 COP is that the partner will support the
development and implementation of a TB screening tool in HIV settings.
This activity relates to activities in Counseling and Testing, PMTCT, Palliative Care, Strategic Information
and TB/HIV.
The National AIDS and STD Control Program (NASCOP) is the arm of the Ministry of Health (MOH) that is
responsible for implementation of medical interventions related to treatment and prevention of HIV/AIDS.
NASCOP will oversee the implementation of all HIV care and antiretroviral treatment (ART) programs in
Kenya. These activities will also result in the training of 240 health care workers not included in other
targets. Specific activities supported by NASCOP will include the coordination of all partners in the area of
ART provision (through national level meetings such as the National ART task force), and supervision of
treatment in MOH supported and other facilities. NASCOP will also continue to coordinate with other
sources of support such as Global fund for AIDS, Tuberculosis and Malaria, and Clinton Foundation.
NASCOP will improve the national system for tracking the number of people receiving ART, and provide
financial and administrative support to the Provincial AIDS and STI coordinating Officer (PASCO) so that
they can coordinate, track and provide supportive supervision to area sites. Funds will also be used to
support regular regional meetings of care providers. The supervisory structure at NASCOP includes a core
staff at a national level that consists of a small technical and administrative staff, and an expanding staff
responsible for monitoring and evaluation activities. A system of regional supervision of HIV/AIDS treatment
activities has been established, with Provincial ART Coordinators (PARTOs) that are responsible for
assisting with the establishment of services at additional sites, conducting site evaluations and
accreditations, and the supervision for ART programs. All activities are closely linked to other MOH and
PEPFAR supported HIV treatment and prevention activities, the networks of care in the Private and Mission
sectors, and Management System for Health (MSH) supported logistics/systems strengthening (particularly
for the Kenya Medical Supplies Association). Emphasis will be placed on developing regional trainers who
will provide classroom training and mentorship of health care workers at the facility level.
NASCOP will continue to support implementation of HIV prevention activities in clinical care settings, the
development of referral systems and care linkages for HIV positive mothers and infants identified through
the PMTCT programs, decentralization of care and treatment services to lower level health facilities to
increase access and reduce the waiting list at the provincial and district hospitals, and improved
coordination with other sources of support such as the Global Fund for AIDS, Tuberculosis, and Malaria. A
significant change from 2008 is the development and implementation of a national TB screening tool for use
in HIV clinical settings.
These activities are essential to the overall implementation and coordination of HIV treatment programs in
Kenya. NASCOP supported activities are essential to the formation/strengthening of the linkages needed in
the network model and to the development of a sustainable system to provide HIV treatment in Kenya.
Since NASCOP coordinates HIV prevention and treatment activities throughout Kenya, there are strong
linkages between these activities and virtually all HIV prevention and treatment activities in Kenya. All
Emergency Plan partners have been encouraged to extend efforts to further strengthen these linkages by
coordinating with and supporting the activities of the Provincial ART coordinators and by participating in
national efforts such as policy/guideline revision and national stakeholders meetings.
Populations targeted by these activities include people living with HIV/AIDS, health care workers and others
providing services to people with HIV.
This activity includes minor emphases in development of networks, human resources, policy and guidance
development, quality assurance and supportive supervision, training, and strategic information.
Continuing Activity: 14937
14937 4223.08 HHS/Centers for National AIDS & 6981 3465.08 $1,600,000
7004 4223.07 HHS/Centers for National AIDS & 4266 3465.07 $1,300,000
4223 4223.06 HHS/Centers for National AIDS & 3465 3465.06 $1,594,042
Table 3.3.09:
ACTIVITY UNCHANGED FROM COP 2008:
This activity relates to activities in Counseling and Testing (#7009), PMTCT (#7006), ARV Services (#7004),
Strategic Information (#7002) and TB/HIV (#7001).
NASCOP will oversee the implementation of all pediatric HIV care programs in Kenya. These activities will
also result in the training of 150 health care workers in pediatric HIV care. Emphasis will be placed on
developing regional trainers who will provide classroom training and mentorship of health care workers at
the facility level. Specific NASCOP-supported activities will include the coordination of all partners in the
provision of care for children HIV (through national level meetings such as the National ART task force), and
supervision of treatment in MOH and other facilities. Specific guidelines for the prevention and treatment of
opportunistic infections, HIV prevention in care settings, and management of nutrition interventions will be
kept, updated, printed, and distributed. The national system for tracking the numbers of children enrolled in
patient support centers (HIV clinics) will also be improved. Funds will be used to provide administrative
support and transport for the Provincial AIDS and STI coordinating Officer (PASCO) so that they can
coordinate, track, and provide supportive supervision to sites in their areas as well as support regular
supervision of HIV/AIDS treatment activities has been established with PASCOS who are responsible to
assist with the establishment of pediatrics care and treatment services at additional sites, conduct site
evaluations and accreditations, and supervision for care programs. NASCOP will develop and implement
materials on HIV testing for children in clinical settings. Other activities will include the development of
referral systems and care linkages for infants identified through the PMTCT programs, decentralization of
pediatric care and treatment services to lower level health facilities to increase access and reduce the
waiting list at the provincial and district hospitals, an intensified focus on pediatric provision of care, and
improved coordination with other sources of support such as the Global Fund for AIDS, Tuberculosis, and
Malaria.
linkages needed in the network model and to the development of a sustainable system to provide HIV care
in Kenya.
Management systems of Health (MSH) supported logistics/systems strengthening particularly for the Kenya
Medical Supplies Agency (#8401). Other linkages include Counseling and Testing (#7009), PMTCT
(#7006), ARV Services (#7004), Strategic Information (#7002) and TB/HIV (#7001)
Populations targeted by these activities include HIV positive children (6 - 14 years) and health care workers
Table 3.3.10:
This activity relates to activities in Counseling and Testing (#7009), PMTCT (#7006), Palliative Care
(#7005), Strategic Information (#7002) and TB/HIV (#7001).
NASCOP will oversee the implementation of all pediatric HIV care and antiretroviral treatment programs in
Kenya. These activities will result in the training of 100 health care workers not included in other targets.
Specific activities supported by NASCOP will include the coordination of all partners in the area of pediatric
antiretroviral treatment (ART) provision (through national level meetings such as the National ART task
force), and supervision of pediatric treatment in MOH-supported and other facilities. NASCOP will also
continue to coordinate with other sources of support such as Global fund for AIDS, Tuberculosis and
Malaria, and Clinton Foundation. NASCOP will improve the national system for tracking the number of
children receiving ART, and provide financial and administrative support to the Provincial AIDS and STI
coordinating officers(PASCO) so that they can coordinate, track and provide supportive supervision to area
sites. Funds will also be used to support regular regional meetings of care providers. The supervisory
structure at NASCOP includes a core staff at a national level that consists of a small technical and
administrative staff, and an expanding staff responsible for monitoring and evaluation activities. A system of
regional supervision of HIV/AIDS treatment activities has been established, with Provincial ART
Coordinators (PARTOS) who are responsible to assist with establishment of services at additional sites,
conducting site evaluations and accreditations, and supervising for ART programs. All activities are closely
linked to other MOH and PEPFAR supported HIV treatment and prevention activities, the networks of care
in the Private and Mission sectors, and Management System for health (MSH) supported logistics/systems
strengthening (particularly for KEMSA, the Kenya Medical Supplies Association). Emphasis will be placed
on developing regional trainers who will provide classroom training and mentorship of health care workers
at the facility level. NASCOP will continue to support development and implementation of HIV prevention
activities in clinical care settings, the development of referral systems and care linkages for HIV positive
mothers and infants identified through the PMTCT programs, decentralization of care and treatment
services to lower level health facilities to increase access and reduce the waiting list at the provincial and
district hospitals, an intensified focus on pediatric provision of care, and improved coordination with other
sources of support such as the Global Fund for AIDS, Tuberculosis, and Malaria.
coordinating with and supporting the activities of the PARTOS and by participating in national efforts such
as policy/guideline revision and national stakeholders meetings.
Populations targeted by these activities include people living with HIV/AIDS including HIV positive children
(6 - 14 years) and health care workers and others providing services to people with HIV.
Table 3.3.11:
+updated references to the new MOH's Division of Leprosy Tuberculosis and Lung Disease (DLTLD),
previously the National Leprosy and Tuberculosis Program (NLTP). This expanded mandate opens
opportunity, in future, for additional collaboration in prevention and treatment of HIV-driven non TB lung
disease.
This activity relates to activities in CT, PMTCT , Adult/Pediatric Care and Support, Adult /Pediatric ARV
services, ARV Treatment, Laboratory infrastructure and SI.
DLTLD is responsible for establishing TB policy and provides overall coordination, implementation and
evaluation oversight for all TB/HIV activities in Kenya. TB/HIV is a priority program area for DLTLD and the
National AIDS and STI Control Program (NASCOP) with which collaborative activities will be strengthened
and expanded in FY 09. As part of their national mandates, DLTLD and NASCOP coordinate
implementation of collaborative activities through national, regional and district coordinating bodies. Since
2004, TB/HIV activities have advanced on the national agenda and are well articulated in the National TB
Strategic Plan. National, provincial and district TB/HIV coordinating bodies have been formed and
guidelines on HIV testing for TB patients have been widely distributed and implemented. From 2005 -2008,
DLTLD has expanded TB treatment points from 1600 to 1909 and TB diagnostic points from 619 to 930. In
FY 2009, the Emergency Plan will continue to provide essential support towards the achievement of targets
set in the National TB Strategic Plan. National roll-out of collaborative TB/HIV activities is coordinated by the
National TB/HIV Steering Committee (NTHSC) established jointly by the DLTLD and NASCOP, both of
which previously operated as separate delivery systems. TB services in Kenya have been decentralized to
the health center level; drug supplies are consistent, and are provided free to all TB patients attending
public and mission health facilities. The DLTLD has a well-deserved reputation for widespread coverage,
good diagnostic facilities, and for provision of free high-quality TB drugs. In FY 09, the DLTLD will build on
gains already made to consolidate and further increase access to integrated TB/HIV services nationwide. In
FY 09, the DLTLD will concentrate on getting more eligible TB patients onto ART and intensify, in
collaboration with NASCOP and other partners, TB screening for HIV-infected persons identified in HIV care
settings, TB infection control in HIV care settings and expand access to TB preventive treatment (IPT) in
selected sites. The DLTLD is coordinating efforts to optimize MDR-TB surveillance and expand access to
treatment. Apart from Emergency Plan, the DLTLD receives complementary funding from several partners
including WHO and the Global Fund. Previously centrally funded OGAC/WHO TB/HIV activities in 30
districts will be mainstreamed into FY 09 PEPFAR and non PEPFAR support. DLTLD has received Round 6
Global Fund support to strengthen TB diagnostic capacity at dispensary level and has applied for expanded
support through Round 8. In FY09, the DLTLD will receive funding from the TB Control Assistance Program
(TB-CAP) will provide additional support for TB/HIV collaborative activities, DOTS expansion and increased
public-private partnership. Additional activities will include roll-out of prevention with positives in TB settings,
sustained TB/HIV media campaigns and expanded private-public partnerships. In addition to required
PEPFAR TB/HIV indicators, the DLTLD will support reporting of selected custom indicators to assist with
program management and evaluation and monitoring of new activities. The DLTLD, in next phase, will
ensure that consistent and quality counseling and testing messages for TB patients/ suspects continue to
be improved.
These activities will result in strengthened delivery of integrated HIV and TB services, including
strengthened referral systems, improved diagnostics and treatment of TB among HIV-positive patients and
of HIV in TB patients, strengthened capacity of health workers to provide integrated HIV and TB services
and strengthened systems capacity for program monitoring and evaluation and management of
commodities.
These activities will be linked with ongoing VCT, PMTCT, STI and ARV treatment services supported by
NASCOP and other implementing partners. In addition, the DLTLD will work collaboratively with other
programs implementing TB/HIV activities among special populations such as the prisons and refugees. The
DLTLD will lead all partners in the formulation and reviews of TB/HIV policy guidelines.
5. EMPHASIS AREAS
These include facility renovations, local organization capacity development, workplace programs, health-
related wrap arounds (TB, malaria) and human capacity development (in-service training, task shifting, and
staff retention activities).
Continuing Activity: 14935
14935 4126.08 HHS/Centers for National AIDS & 6981 3465.08 $1,075,000
7001 4126.07 HHS/Centers for National AIDS & 4266 3465.07 $3,200,000
4126 4126.06 HHS/Centers for National AIDS & 3465 3465.06 $900,000
Table 3.3.12:
+ In 2009 NASCOP will use additional resources to coordinate the national HIV testing campaign. This
campaign will be held in October and November 2009 in the whole country. The resources will be used to
strengthen monitoring and evaluation during the campaign. They will also be used to support national and
field coordination.
+ The target population has been revised. NASCOP will hand over the model VCT site; therefore there will
be no direct CT targets. But in the other broad objectives that will have national coverage will remain as
they were in 2007.
+ Other (NON-SUBSTANTIVE) change:
• In FY 2007 NASCOP coordinated the review and harmonization of CT policies and guidelines. In FY 2008
the completed guidelines will be disseminated
• In FY 2008 will support an accelerated CT campaign using the Rapid Results Initiative strategy. This will
be a national activity and all CT partners in the country will be involved but NASCOP will supervise and
coordinate the exercise.
• In FY 2008 NASCOP will participate in workplace VCT. In the past NASCOP has received requests for
mobile VCT from other government ministries and departments, as well as from the private sector. In FY
2008, NASCOP will acquire basic supplies and materials for this purpose. NASCOP will also work closely
with other PEPFAR supported MVCT providers.
• In 2008, NASCOP will hand over the model VCT to an implementing partner that is yet to be determined
(TBD). This will reduce the burden of direct implementation from the national program. In 2008 therefore
NASCOP will not have any direct CT targets.
This activity relates to activities in PMTCT, ART, Palliative care: Basic Health Care, TB-HIV, AB, OP, SI,
and HLAB.
The National AIDS/STI Control Program (NASCOP) is the section in the Ministry of Health that coordinates
all health sector based HIV/AIDS activities. NASCOP is responsible for developing and promoting the use of
national policies, guidelines and standards for all HIV prevention and care activities in the country. In CT
NASCOP coordinates the implementation of all types of HIV counseling and Testing (CT) approaches,
including provider-initiated and client-initiated CT. The Client-initiated approach (also known as voluntary
counseling and testing -VCT) has been highly successful in Kenya, since its launch by NASCOP in 2000.
By December 2005, there were 680 registered VCT sites in Kenya, and in that calendar year, at least
500,000 people are counseled and tested in these sites. In VCT NASCOP is currently mainly involved in
supervision and quality assurance. NASCOP has in the past developed guidelines, training curricula and
operational tools for VCT in Kenya, tools which are used by all partners. In FY 2005, NASCOP published
the Guidelines for HIV testing in Clinical Settings. These guidelines were developed in order to provide for
the all types of HIV testing approaches possible in health care facilities. These efforts led to considerable
increase in HIV testing within clinical settings in FY 2005 and FY 2006. Despite this growth in both DTC and
VCT, many Kenyans still do not know their HIV status, as seen in the Kenya Demographic and Health
Survey in 2003. In FY 2008, NASCOP will mobilize and facilitate stakeholders to provide all types of CT.
Through planned activities in FY 2007, NASCOP will promote health workers' participation in testing and
counseling and streamline referral linkages between CT and care in government facilities. Increased health
worker participation in CT shall be achieved through dissemination of relevant policies and guidelines in CT
and through training in all types of CT. The national guidelines and training curricula on CT will be reviewed
and updated as necessary. NASCOP will continue to strengthen the capacity of its national and regional
staff to monitor and evaluate CT activities, including proper data collection
NASCOP is in a unique position to provide leadership and support for CT activities of all partners in the
country. NASCOP will receive Emergency Plan resources to develop policies and guidelines for the whole
country. They will also ensure that the CT services in Kenya meet national and international standards.
NASCOP is the only agency with that mandate and opportunity. The contribution of NASCOP to the goal is
therefore largely broad and strategic, and in a small way it is also direct, since the NASCOP VCT site will
provide CT services to a small number of people.
NASCOP is supported to coordinate HIV/AIDS services in almost all the components. The planned
NASCOP CT activities in FY2007 will increase knowledge of HIV status both for primary prevention and
linkage to care services for HIV positive individuals. The NASCOP CT program will therefore relate to other
NASCOP led programs like ART, PMTCT and Palliative care. This activity is also linked to NASCOP TB-
HIV activity, AB activity, OP activity, SI activity, and HLAB activity.
This activity targets the general adult population as well as symptomatic individuals served in public health
facilities, especially in Medical wards, TB wards and STI clinics. The primary goal is universal knowledge of
HIV status, as well as timely identification of those who would benefit from care and treatment services. In
client initiated CT sites existing sites will be strengthened and supported to provide quality services. And for
the provider initiated CT services, the new sites will mainly be public health facilities that have not previously
provided CT as part of diagnostic work up of symptomatic patients seeking treatment.
This activity will help reduce HIV related stigma and discrimination by promoting routine HIV testing in
clinical settings and linking HIV infected individuals to care. Patients will be sensitized to expect HIV testing
as a standard package of good medical care in health facilities. Health care providers will be sensitized to
understand patients' basic right to the best diagnostic services including being offered HIV test.
Activity Narrative: 7. EMPHASIS AREAS
Major Emphasis area for this activity is in the development of policy and guidelines at a national level for all
CT activities. Minor emphasis areas are in the area of information, education and communication, quality
assurance, strategic information and training. The Plus Up funds will be used to facilitate an accelerated
HIV counseling and testing campaign in Kenya, which is an expansion of the International HIV testing day.
The Government of Kenya, led by the National AIDS Council and National AIDS/STD Control Program has
adopted the Rapid Results Initiative program of scaling up HIV counseling and testing with a goal of testing
300,000 people in three months. Plus up funds will complement funds from other donors and the
Government of Kenya. Funds will be used for employment of short-term CT counselors, and for Mobile VCT
services in the hard to reach areas of Kenya. Funds will also be used to coordination and supervision
(quality assurance).
Continuing Activity: 14936
14936 4787.08 HHS/Centers for National AIDS & 6981 3465.08 $700,000
7009 4787.07 HHS/Centers for National AIDS & 4266 3465.07 $1,260,000
4787 4787.06 HHS/Centers for National AIDS & 3465 3465.06 $450,000
Table 3.3.14:
+Support laboratory supervision by provincial and district laboratory medical laboratory technologists.
+Establish EID and viral load testing capacity at public national and regional health facilities.
+Expansion of QA capacity for HIV testing, CD4, clinical chemistry and hematology testing through high-
performing regional /partner laboratories.
+Promote utilization of data from the laboratory information system at central lab and peripheral laboratory
levels.
+Establish a network through which proficiency panels will be distributed.
+Provision of oversight to the operations of the lab stakeholder meetings and regional laboratory networks.
This activity relates to activities in laboratory services, particularly Counseling and Testing TB/HIV and all
activities in MTCT.
Laboratory systems in Kenya consist of Division of Laboratory Diagnostic Services within the Ministry of
Health, a National Reference Laboratory (with responsibility for conducting reference laboratory testing
related to HIV serology, biochemistry and hematology, CD4 testing and other services in support of HIV
treatment as well as testing for surveillance activities), a Central TB reference laboratory, a Central
Microbiology Laboratory, and a network of 2 referral hospital labs, 8 Provincial Hospital Labs, more than 20
high volume district hospital labs, more than 60 labs at other health facilities, and more than 1500 sites
providing rapid testing for HIV. Several laboratories outside of this network have been supporting the
national and regional labs, including laboratories at the Kenya Medical Research Institute and laboratories
that also support research programs, for example the Indiana University supported laboratory in Eldoret, a
DOD supported laboratory in Kericho, and a CDC-supported laboratory in Kisumu.
Key accomplishments to date have included the development of a national laboratory strategic plan,
renovation and equipping of the National Reference laboratory, infrastructure improvements in 16 provincial
and high-volume district hospital labs, support for training in various aspects of laboratory capacity (for
example in general laboratory management, quality systems and lab safety and capacity building for
specific activities such as CD4, haematology and chemistry testing In addition, a computerized laboratory
information management system has been started at the national public health laboratory and this
laboratory has supported/is supporting key surveillance activities such as the 2003 demographic health
survey and the 2007 AIDS indicator survey. By 2007, the Kenya Medical Supplies Agency (KEMSA) was
successfully distributing the national supply of rapid test kits and several important elements of a
comprehensive quality assurance program had been established, including enrolment of 4 laboratories in an
EQA program for qualitative PCR for early infant diagnosis, and enrolment of 20 laboratories in an
international EQA program for CD4 cell count testing, and 8 provincial laboratories enrolled in haematology
and chemistry EQA program. Local EQA programs like inter-laboratory comparison of lab results , dry blood
spot validation and PT for HIV serology has been ongoing. A long-term training program has provided a
small number of highly qualified laboratorians to take on key management functions; a USG supported
capacity building program supported hiring of 30 laboratory technologists in key MOH lab sites. Laboratory
networks for sample transport, testing, and quality assurance have been established in key locations, for
example in Nyanza Province, Western, Central and South Rift Valley Provinces. Important additional
infrastructure improvements (for the central TB reference laboratory, central data unit and the central
microbiology laboratory) are being undertaken with FY 2007 plus up funds.
NPHLS will continue to implement laboratory strategic plan with emphasis on:
1.Coordinate laboratory policy formulation through development of laboratory policy guidelines and
stakeholder meetings
2.Expansion of QA capacity for HIV testing(rapid, ELISA, EID) and ART monitoring (CD4, chemistry,
haematology, viral load) through training, support supervision, networking, and external quality assurance
3.Establishment of early infant diagnosis (EID) and viral loads testing capacity at public facilities
4.Establish a monitoring system to ensure laboratory equipment, reagents and kits conform to nationally
established standards.
5.Utilize central data unit (data collection and reporting tools) to ensure data generated from facilities are
used for decision making
6.Upgrading skills of laboratory workforce through short courses, long courses, seminars and conferences
7.Support HIV surveillance to ensure quality laboratory data is generated for program planning
3. CONTRIBUTION TO OVERALL PROGRAM AREA
These activities will help strengthen the laboratory component of HIV program. It will enable laboratory to
check quality of services and support to the programmatic expansion of HIV prevention, surveillance, care
and treatment activities.
This activity is linked to activities in laboratory services, particularly Counseling and Testing supported by all
partners, especially TB/HIV activities, particularly, and all activities in PMTCT. The supported services are
further linked to ART services carried out by NASCOP and other treatment partners.
5. POPULATION BEING TARGETTED
Laboratory workers, PLWHIV
6. EMPHASIS AREAS
This activity involves major emphasis in areas of quality assurance, and coordination of laboratory policy
formulation. There is minor emphasis in the areas of laboratory infrastructure procurement of specialized
reagents, infrastructure, monitoring and evaluation, laboratory information , surveillance, training and
development and strengthening of networks/linkages.
Continuing Activity: 14938
14938 4222.08 HHS/Centers for National AIDS & 6981 3465.08 $1,200,000
7003 4222.07 HHS/Centers for National AIDS & 4266 3465.07 $900,000
4222 4222.06 HHS/Centers for National AIDS & 3465 3465.06 $1,150,000
* Safe Motherhood
Estimated amount of funding that is planned for Human Capacity Development $500,000
Table 3.3.16:
Updated April 2009 Reprogramming. Increased by $190,000.
Partnership Framework [$40,000]: Funds needed for a systematic evaluation of data quality is planned for
the transition of using PMTCT program data instead of ANC sentinel sites for HIV surveillance. The
assessment of PMTCT data quality and comparison with surveillance results will be a joint undertaking of
the NASCOP Monitoring and Evaluation (M&E), PMTCT and Laboratory programs, conducted with the
support of CDC. The assessment may utilize an existing generic protocol to compare PMTCT and
surveillance data, and the PMTCT data quality assessment will be undertaken in conjunction with an
assessment of ART data quality using standardized DQA methodology. The assessment will include
collection of information on uptake of PMTCT testing, completeness of ANC SS sampling, and facility
characteristics.
Other Reprogramming [$150,000]: Funds needed for reactivation of STI surveillance activities and revision
of MOH STI clinical guidelines.
+ Informatics and data management capacity will be strengthened through the hiring of a Technical Advisor
who will lead the establishment of a database for the programmatic data which will link to the national
Electronic Medical records, Phones for Health and HIV Quality of Care data among others.
+ The USG SI and PMTCT teams will pilot the use of PMTCT program level data for national HIV
prevalence among pregnant women. Technical assistance will be sought from Surveillance TWG at OGAC
on the planning and implementation of this strategy including priority areas to strengthen along side the
ANC sentinel surveillance.
+ The integration of the second generation PEPFAR indicators into the national M&E framework and
development and rollout of the corresponding data capture tools.
This activity supports key cross-cutting attributions in human capacity development by training health
workers and data handling staff on data management, reporting tools, analysis and monitoring and
evaluation in support of HMIS activities.
The only change to the program since approval in the 2007 COP is:
+The HIVDR threshold surveillance system intends to examine whether standard first-line antiretroviral
drugs regimens will continue to be effective in settings where they are widely available. Because of the high
mutation rate of HIV-1 and the necessity for lifelong treatment, it is expected that HIVDR will emerge in
treated populations where antiretroviral treatment (ART) is being rapidly scaled up. USG Kenya will support
HIVDR threshold surveys in a few sites alongside the 2007/08 round of ANC surveillance. Samples will be
leftover blood obtained through the ANC survey using unlinked anonymous strategy. For each site, 60-70
consecutive HIV positive blood specimens from persons meeting eligibility criteria will be identified to ensure
that amplification and genotyping are successful in 47 specimens (the survey sample size). The number of
specimens with mutation consistent with HIVDR will be used to determine the prevalence of transmitted
HIVDR for each drug and drug category in the standard initial ART regimen(s). Using the binomial
sequential sampling and classification plan, HIVDR prevalence will be categorized as: low prevalence
(<5%), moderate prevalence (5-15%), or high prevalence (>15%). The first component of this strategy is to
obtain baseline estimate of the prevalence of HIVDR, followed by repeat surveys to assess the frequency of
transmission of HIV drug resistant strains within a geographic area
This activity relates to HTXS (#7004), MTCT (#7006), HVCT (#7009), HLAB (#7003 and #6940), and HVSI
(#6988, #6824, #6946, #9012, and #7098).
2. ACTIVITY DESCRIPTION The National AIDS/STI Control Programme (NASCOP) is the department in
the Ministry of Health responsible for coordinating all HIV/AIDS related activities. NASCOP continues to
provide leadership in surveillance, program monitoring and HMIS, and in conducting national surveys and
targeted evaluations. FY 2007 funds for NASCOP will support several activities. (ii) Sentinel Surveillance:
FY 2007 funding will also continue to support Kenya's national sentinel surveillance system which now
includes 46 representative rural and urban sites that measure trends in HIV infection over time. PMTCT test
acceptance and results are recorded in order to evaluate uptake and quality of testing. NASCOP trains
health workers in these facilities, works with the National Public Health Laboratory Services and CDC to test
samples for HIV and recent infection by BED assay. Data will be double-entered at regional and central
levels, analyzed for prevalence and incidence trends, and reported to policy-makers and program managers
to improve programs. (iii) Monitoring and Evaluation Support: The implementation of a decentralized
monitoring and evaluation system is essential to measuring the progress of EP implementation activities.
The national rollout has begun and will continue in the next fiscal year. In order for the health facility based
data to flow to the national level, the harmonized M&E registers and patient cards will be printed for all
facilities and distributed. There will be ongoing training of health care workers, data clerks, district and
provincial health management teams as well as M&E officers at the national office. Support supervision will
be devolved to provincial level to facilitate faster collation and reporting of data as well as feedback to the
health facilities. Motorbikes will be purchased to enable district level supervision in all the 114 districts. The
integrated HIV/AIDS reporting of PMTCT, CT, ART and other HIV service indicators in a single paper-based
form at facility level that will be computerized at the district level (MOH Form 727) to assist with national and
Emergency Plan reporting of care, treatment and prevention indicators, including PMTCT, CT, care, and
ART. Through this activity NASCOP will complete the implementation and use of an integrated Heath
Management Information System to capture facility-level HIV service indicators. (iv) As part following up the
management of HIV/AIDS patients, NASCOP will oversee the implementation of an Electronic Medical
Records (EMR) system at MOH facilities, with the assistance of the PHR+. The number of patients enrolled
at comprehensive care clinics continues to grow as HIV-related mortality declines. Maintaining patient
records on paper based systems is proving to be a big challenge to health care providers due to the
volumes of paper they have to deal with. A pilot testing of the EMRs has been completed in Eastern
Activity Narrative: province and this will now be scaled up nationally. The activity will provide detailed long term electronic data
on follow-up of patients on treatment and provide easy mechanism of transfer of patient records whenever
they change facility of treatment. It will also provide ready longitudinal data on treatment for program
evaluation.
3.CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute by training 400 personnel in strategic information (sentinel surveillance,
monitoring and evaluation, survey methodology) and by providing supportive supervision and improvement
to the 46 sentinel surveillance sites, 74 District Health Management Teams and 10 Provincial/subprovincial
MoH AIDS control offices. In addition, the activities will generate important data for EP program evaluation
and policy formulation.
4. LINKS TO OTHER ACTIVIITES
This activity relates to other NASCOP activities across multiple program areas: HTXS (#7004), MTCT
(#7006]), HVCT (#7009), HLAB (#7003), HVSI (#6988), HLAB (#6940), HVSI (#6824), HVSI (#6946), HVSI
(#9012) and HVSI (#7098).
The HIV/AIDS indicator survey will target the general population, sentinel surveillance targets pregnant
women and STI patients, the training and capacity building activities targets health workers, data managers,
and the reports generated by this activity target policy makers.
This activity has four emphasis areas, none of which are over 50% of the activity, including an AIS
population survey , HMIS, surveillance systems, and the USG database and reporting system, which relies
heavily on facility data produced by NASCOP.
Continuing Activity: 14939
14939 4221.08 HHS/Centers for National AIDS & 6981 3465.08 $2,000,000
7002 4221.07 HHS/Centers for National AIDS & 4266 3465.07 $1,550,000
4221 4221.06 HHS/Centers for National AIDS & 3465 3465.06 $1,600,000
Estimated amount of funding that is planned for Human Capacity Development $550,000
Table 3.3.17:
