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 UNCHANGED FROM COP 2008:
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS:
This activity supports key cross-cutting attributions in Economic Strengthening by empowering of caregivers
through the self help groups and then referring them for micro credit services in K-REP Development
Agency (KDA).
1. LIST OF RELATED ACTIVITIES
This activity is linked to CT (#4848) and pediatric ART (#5092) activities implemented by COGRI / Lea Toto
and also linked to other USG ART activities in the ARV Services program area.
2. ACTIVITY DESCRIPTION
The goal of the Lea Toto Project is to mitigate the impact of HIV/AIDS and decrease the risk of HIV
transmission through the provision of a comprehensive home based care package. The project was started
in September 1999, and implements programs in selected slums in Nairobi in Kangemi, Kariobangi, Kibera,
Kawangware Dandora and Mukuru. Services will be extended to four other areas (three in Nairobi and one
in Kitui). This activity will result in 25,000 family members and 5,000 children receiving with high quality
facility and home based care and other support services. The facility-based activities will include
strengthening of facilities that are already serving as network referral centers for pediatric HIV care.
Activities will include payment laboratory services for HIV related tests, OI prophylaxis (cotrimoxazole,
fluconazole) and strengthening pharmaceutical management. Lea Toto will also strengthen the ability of
targeted local communities to prioritize needs of HIV+ children and their families and carry out activities to
meet these needs. Some of the activities include group therapy sessions include life skills training, post
disclosure clubs, recreational activities, coping skills, disclosure meetings, support group meetings and
follow up counseling sessions. Life skills training sessions which are held with adults and children aged
between 7 and 16 years address issues related to drug adherence basic hygiene and nutrition. The activity
will also improve the organizational capacity of the Lea Toto program to deliver high quality care and
counseling and other support services for HIV+ children and their families. Other program activities include
nutritional support, empowering of caregivers through the self help groups and then referring them for micro
credit services in K-REP Development Agency (KDA).
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute to the Kenya 5-year strategy and increase the number of people receiving
HIV/AIDS care and support. Specifically, 5,000 children will be provided with HIV-related palliative care, 200
trained to provide palliative care and 10 service outlets will provide care. This activity will contribute to
increasing the number of HIV positive children receiving medical care, and accounts for all persons in care
for this program area.
4. LINKS TO OTHER ACTIVITIES
5. POPULATIONS BEING TARGETED
This activity will target children infected with HIV/AIDS including Caregivers, HIV positive infants and
children, OVCs and PLWHA. Community health care workers will be targeted for training and
Groups/Organizations that will be worked through include Community-based organizations, Faith-based
organizations and NGOs in Nairobi.
6. EMPHASIS AREA:
The main area of emphasis will be Community Mobilization/Participation as Lea Toto strengthens the ability
of targeted local communities to prioritize needs of HIV+ children and their families and carry out activities to
meet these needs. Minor emphasis will be in training of care providers and providing IEC in HIV/AIDS
awareness and prevention.
7. KEY LEGISLATIVE ISSUES ADDRESSED
By meeting the needs of vulnerable children and their care providers, Stigma and Discrimination will
decrease and allow children to return to school and parents/providers improve in health and earn income to
contribute to the family's welfare.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14749
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14749 5105.08 U.S. Agency for Children of God 6936 3543.08 Lea Toto $150,000
International Relief Institute
Development
6863 5105.07 U.S. Agency for Children of God 4216 3543.07 Lea Toto $150,000
5105 5105.06 U.S. Agency for Children of God 3543 3543.06 Lea Toto $190,000
Emphasis Areas
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $30,000
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Estimated amount of funding that is planned for Economic Strengthening $10,000
Education
Water
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Total Planned Funding for Program Budget Code: $12,185,002
Total Planned Funding for Program Budget Code: $0
Table 3.3.11:
This activity supports key cross-cutting attributions in human capacity development through its training
program for health workers ($50,000) and Food and Nutrition by providing nutritional assessments and
food/nutritional supplements directly to project beneficiaries and/or linking them to other programs as
appropriate ($50,000).
This activity is linked to COGRI's activities in Pediatric HIV Care (#5105) and CT (#4848), and it is also
linked to other USG ART activities in the ARV Services program area, PMTCT, efforts for early infant
diagnosis and training health workers.
This activity will expand established programs in targeted slums in Nairobi to include 10 centers (9 in
Nairobi and 1 in Kitui). As a result of these activities, 2,500 individuals will receive antiretroviral therapy
(1,000 will initiate treatment, with the total of people ever treated reaching 2,500, and those active on ARVs
being 2,200), and 160 health care workers will be trained in the provision of antiretroviral therapy (ART).
These activities will include strengthening of facilities that are already serving as network referral centers.
Activities will include procurement of laboratory services and strengthening rational pharmaceutical
management. COGRI will track numbers of children served and will report nationally and through the
Emergency Plan. The Children of God Relief Institute (COGRI)/Lea Toto Project was started in September
1999, and the first phase was implemented for 2 years in Kangemi. Following evaluations that were
conducted in May 2001 and May 2006, further extensions were granted. In the present extension phase, the
program seeks to provide treatment services for 2,500 HIV+ children in 10 centers; 9 in Nairobi and one in
Kitui.
This activity will contribute to the Kenya 5-year strategy and increase the number of children on ART,
responds to OGAC objectives of increasing the number of children on ART.
4. LINKS WITH OTHER ACTIVITIES
HIV positive infants and children, care givers, community health workers
6. EMPHASIS AREAS
The major emphasis area is training, with a minor emphasis on community mobilization and participation
Continuing Activity: 14753
14753 5092.08 U.S. Agency for Children of God 6936 3543.08 Lea Toto $1,000,000
6862 5092.07 U.S. Agency for Children of God 4216 3543.07 Lea Toto $800,000
5092 5092.06 U.S. Agency for Children of God 3543 3543.06 Lea Toto $540,000
Estimated amount of funding that is planned for Human Capacity Development $50,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $50,000
ACTIVITY UNCHANGED FROM COP 2008
The COGRI Lea Toto TB/HIV activities are related to their Pediatric Care activities, Pediatric treatment
services, counseling and testing, and orphans and vulnerable children .
The goal of the Lea Toto Project is to mitigate the impact of HIV/AIDS and reduce the risk of HIV
transmission through the provision of a comprehensive HIV prevention, care and treatment package. The
project was started in September 1999, and has implemented programs in selected slums of Nairobi,
namely Kangemi, Kariobangi, Kibera, Kawangware. In FY 2009 Children of God Relief Institute/Lea Toto
Project will use these funds to intensify provider-initiated HIV counseling and testing in health care settings,
seeking to enhance HIV testing among children presenting with TB symptoms across their network of 6
sites. Intensified TB screening for 100 HIV patients and HIV screening for 100 TB suspects/patients will be
offered as a standard of care in all the facilities. A total of 150 HIV patients will be treated for TB. A total of
300 TB patients will receive counseling and testing for HIV. Other activities supported will include intensified
TB case finding among household contacts of confirmed TB cases, as well as community-level contact
tracing of TB suspects. HIV positive children and family members identified via these activities will be
offered ART treatment in the Lea Toto network of clinics. This will complement the current PITC program
that has intensified testing in facilities where both TB and ART services are provided.
This activity will contribute to intensified TB/HIV case finding among co-infected children in the slums of
Nairobi. Through this activity, an additional 100 TB/HIV infected children will be identified and provided with
care services.
The COGRI Lea Toto TB/HIV activities are related to their Pediatric HIV Care activities , Pediatric treatment
services , counseling and testing, and orphans and vulnerable children.
This activity will target people affected by HIV/AIDS including Caregivers, HIV positive infants and children,
OVC and PLWHA. The activity will also target community and religious leaders as well as community
volunteers.
6. KEY LEGISLATIVE ISSUES ADDRESSED
By meeting the needs of vulnerable children and their care providers, stigma and discrimination will
contribute to the family's welfare. Gender issues will also be addressed to increase women's access to
income and productive resources.
7. EMPHASIS AREA
of targeted local communities to prioritize needs of HIV+ children and their families.
Continuing Activity: 14750
14750 12455.08 U.S. Agency for Children of God 6936 3543.08 Lea Toto $50,000
12455 12455.07 U.S. Agency for Children of God 4216 3543.07 Lea Toto $50,000
Program Budget Code: 13 - HKID Care: OVC
Total Planned Funding for Program Budget Code: $48,025,532
Program Area Narrative:
Key Result 1: 550,000 Orphans and Vulnerable Children (OVC) provided with appropriate care.
Key Result 2: 49,000 providers/caregivers trained in provision of quality care services for OVC.
CURRENT PROGRAM CONTEXT AND STATISTICS
It is estimated that approximately 11% of Kenyan children below 15 years of age (2.4 million) are orphans (Kenya Demographic
and Health Survey, 2003); approximately 1 million of these (42%) have been orphaned due to AIDS (estimated from KNASP
2005/6-2009/10). In addition, approximately 100,000 children are HIV-positive, of whom 32% are receiving care and nearly one-
third of those who require antiretroviral therapy (ART) are receiving it.
As of the FY 2008 SAPR, 25 Emergency Plan (EP) supported implementing partners were providing direct OVC services to
410,150 children. Of these OVC enrolled and reached in 2008, 54% received three or more services, compared to 34% reached
with three or more services as of the 2007 APR. Educational support was the most commonly provided service, followed by
psycho-social support. The EP in Kenya continues to work with its partners and with the Government of Kenya (GoK) to ensure
these children and their households are able to access age-appropriate prevention services to reduce their vulnerability to HIV.
SERVICES
In 2009, EP partners will continue to strengthen the capacity of families to protect and care for OVC by prolonging the lives of
parents and providing economic, psycho-social, and other services, as well as mobilizing and supporting community-based
responses to provide both immediate and long-term support to vulnerable households. OVC supported under the EP will continue
to receive the range of essential services in line with the National Plan of Action for OVC and the USG Guidance for OVC
programming. With support from the EP, implementing partners have been able to provide an increased number of services to
individual children. In 2009, the EP will target a total of 550,000 OVC, with 75% of those enrolled benefiting from three or more
essential OVC services.
A key emphasis area for 2009 will be supporting partners in HIV testing and counseling (HTC) of children. The lack of pediatric
HTC guidelines remains a barrier to early identification of HIV-positive children. In 2009, the EP will support the development of
updated HTC guidelines for HIV-exposed children, suspected cases, and their families. The EP will make the testing of children a
priority through provider-initiated home and community-based testing as an entry for care and support services to children. Using
appropriate linkages to HTC services, the EP will test 90% of OVC enrolled, targeting approximately 500,000. Of those tested, it is
estimated that 40,000 will be identified as HIV- positive and enrolled into facility-based HIV care and treatment services, receiving
cotrimoxazole (CTX), and being evaluated for ART eligibility and other basic services. In 2008, the EP supported five partners to
continue the Muangalizi (accompagnateurs) program initiated in 2007 as a pilot. The EP will prioritize HIV-positive OVC in their
programs as well as support an evaluation of the Muangalizi pilot project to facilitate scale-up. The identification of HIV-positive
children will be assisted through rollout of the GOK Community Strategy.
Adolescents aged 13-18 comprise the majority of the OVC population; however, evidence from Kenya and elsewhere suggests
that the bulk of OVC programs primarily reach younger youth. EP funds will support a program evaluation of the specific
vulnerabilities of this particular age group as well as identify and disseminate key program priorities and best practices for serving
these youth. The evaluation will inform the development and scale-up of adolescent OVC interventions.
In 2008, the EP supported development of life-skills education curriculum for children in upper primary schools. In close
collaboration with the Ministry of Education, the EP will support implementation of this curriculum via printing, launch, and training
of teachers. The EP will identify strategies for integrating gender program goals in OVC programs; continue support for activities
focused on gender equity in OVC service delivery; work to build the capacity of partners to address cross-generational sex,
designing strategies for addressing male norms that impact negatively on OVC; and, strengthen partners' capacity to enhance
women and OVC legal rights and protection. The EP will support a gender assessment of OVC programs to facilitate a systematic
approach to mainstreaming gender.
Food security needs of OVC in Kenya are increasingly being met through community programs, but links between these programs
and clinical services remain weak. In 2009, the EP will support the expansion of the Nutrition and HIV Program (NHP) to work with
CBOs that are supporting OVC to provide food supplementation. EP will also support CBO capacity to link with other donors that
provide food supplements.
The EP supported the training of GoK provincial and district-based children officers in quality improvement standards and
sensitization activities. In 2009, EP funds will support the development of OVC standards for Kenya and new approaches for
monitoring and improving the quality of OVC programs.
REFERRAL AND LINKAGES
HIV-positive children, especially those who are orphans, will continue to be considered the most vulnerable category of children
and will receive the highest priority for service delivery. OVC implementing partners will be encouraged to prioritize enrollment of
HIV-positive children into care and treatment programs. In 2009, paediatric care and treatment will be scaled up to reach 75,000
HIV-positive children, most of whom will be enrolled in OVC programs. All children enrolled in paediatric ART will be linked to
community-based programs for other OVC essential services.
In 2009, the EP will continue to integrate prevention activities into OVC programs. EP-supported OVC programs will integrate
prevention with positives for adolescents, in- and out-of-school prevention programs and voluntary medical male circumcision as
well counseling and testing for OVC.
Kenya is a focus country for both the EP and the President's Malaria Initiative (PMI). In 2009, the EP will establish linkages with
PMI and ensure OVC being supported by EP are also able to benefit from insecticide-treated bed nets (ITNs) being procured by
PMI. It is estimated that a total of 670,000 ITNs will be procured by PMI in 2009, of which approximately 100,000 will be
earmarked for OVC.
To ensure coordinated quality care and comprehensiveness of service delivery, EP partners will facilitate appropriate linkages
with the GoK's cash-transfer program and education bursaries as well as continue its collaboration with the World Food Program
(WFP) to facilitate support of OVC referred to WFP-supported facilities for food supplements by EP partners.
POLICY
The draft National Plan of Action (NPA) for OVC in Kenya for 2005/6-2009/10 provides the framework for a coordinated multi-
sectoral and sustainable approach to supporting OVC in Kenya. As part of the seven key strategies laid out in the plan, the GoK
emphasizes the need for OVC programs to ensure access for OVC to essential services, including but not limited to education,
health care, and birth registration. This emphasis aligns with EP support to OVC through the six core program areas, which is
inclusive of the NPA service package. In 2009, the EP will support transition of the NPA from its current draft form to final policy
and will also support its printing and dissemination.
The EP will continue to indirectly support OVC by working on improvements to policies and legislation that protect vulnerable
children. In particular, the EP will advocate for a review of the current National Counseling and Testing Guidelines to facilitate an
enabling environment for the testing of children as an entry point to HIV prevention, care, treatment, and support.
SUSTAINABILITY
Capacity building and systems strengthening of local indigenous partners in OVC will remain an important part of EP-supported
activities. The EP will continue to work closely with GoK to ensure services are fully integrated into the Ministry of Gender and
Children Affairs (MGCA) work plans. EP will support the meaningful engagement and participation of children officers at the
provincial and district levels to ensure sustainability. EP funds will also support the development and implementation of a
comprehensive capacity building plan that will target children officers stationed country-wide, in line with priorities identified jointly
with the MGCA.
MONITORING AND EVALUATION
The EP will work with GoK and relevant stakeholders to design a national database on children, which will be housed at the
MGCA, while ensuring appropriate linkages with NACC.
To enhance strategic decision-making for OVC programming, the EP will strengthen the capacity of its partners to collect, store,
retrieve, report on, and analyze data stratified by age group, single/double orphan hood, and type of vulnerability.
WORK OF HOST GOVERNMENT AND OTHER PARTNERS
The EP will continue to work with the GoK to ensure services being provided by EP partners are in line with the NPA for OVC and
that OVC are directly served either through primary or supplemental support. Through continued participation at the National
Steering Committee for OVC, the USG will continue to work closely with GoK and other stakeholders, and provide technical
assistance and leadership to guide OVC work in Kenya. The GoK, UNICEF, World Bank, and DFID will continue to provide cash
transfers to OVC caregivers, while the EP will continue to support its partners to ensure appropriate linkages with the cash-
transfer program.
ACHIEVEMENTS AND OUTSTANDING CHALLENGES
Key remaining barriers include (i) lack of enabling environment to support HTC services among OVC; (ii) inadequate programming
for adolescent OVC; and iii) insufficient EP partner capacity in ensuring quality service delivery to OVC. In 2009, the EP will
support the development of updated HTC guidelines for HIV-exposed children, support a program evaluation of the specific
vulnerabilities of adolescent OVC and build the capacity of EP partners in OVC service standards and quality improvement
measures in line with GoK priorities. The greatest achievement of the Kenya OVC program has been its ability to rapidly scale up
services. In its first year, the EP was providing direct support to 155,352; as of FY 2008, the EP was reaching 410,150 OVC with
essential services.
Table 3.3.13:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:
+ Prime partner Children of God has been competitively selected to implement the activity.
+ Activity will expand to include 4 more centers; 3 in Nairobi and 1 in Kitui.
+activity will also focus on empowering of caregivers through self-help groups and eventually facilitate
referrals to micro-business training for family income support and other micro-credit services.
+The activity will place an emphasis on the HIV counseling and testing of children with a focus on provider-
initiated home and community-based testing as an entry for care and support services to children. Using the
opt-out approach; the activity will test 90% of OVC enrolled; targeting approximately 5,400 with testing and
counseling. Of those tested, approximately 430 will be identified as HIV-exposed or infected and enrolled
into facility-based HIV care and treatment services to receive cotrimoxazole (CTX), evaluation for ART
eligibility and other basic HIV care services.
+ In 2009, the activity will support the referral of particularly vulnerable OVC to the Nutrition and HIV/AIDS
Program and ensure that an increased number of OVC requiring food and nutritional services will be
reached with food supplements procured through the NHP.
+ In 2009, the activity will be used to support the development of OVC standards for Kenya and in
supporting quality improvement approaches for monitoring and improving the quality of OVC programs at
the provincial level.
+ In FY09, the activity will also focus on integrating prevention activities. The activity will link with prevention
programs to support male circumcision and counseling and testing for OVC as well as prevention with
positives for adolescents.
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
This activity will support key cross cutting attributions of the budget amounting to $18,000 towards
Economic Strengthening through the support of income generating activities to support increased
household food security and technical support to savings led activities. The activity will also attribute a
portion of its budget to supporting educational activities targeting OVC enrolled in the program in the
amount of $30,000. A further $6,000 will be attributed to provision of safe water guards for households
looking after OVC.
COP 2008
This activity relates to an activity in Counseling and Testing (#6894).
Children of God Relief Institute/Lea Toto Project will provide care and support services to 6,000 orphans
and vulnerable children (OVC) with high quality home based care and other support services. This activity is
a continuation of the project which started in September 1999, and implemented in selected slums in
Nairobi in Kangemi, Kariobangi, Kibera, Kawangware. Lea Toto will work with trained community workers at
the activity sites and will provide or facilitate access to a range of services for families and OVC caregivers.
It is anticipated that these two services will include training for family income support and psycho-social
support, including succession planning. Other program activities include nutritional support, micro-finance
an empowering of caregivers through self help groups. Lea Toto will also strengthen the ability of targeted
meet these needs. Lea Toto will work with trained community workers at the activity level and will provide or
facilitate access to a range of services for OVC The goal of the Lea Toto project is to mitigate the impact of
HIV/AIDS and decrease the risk oh HIV transmission through the provision of a comprehensive home based
care package. Some of the activities include group therapy sessions, life skills training, disclosure meetings,
support groups meetings and follow up counseling sessions. Life skills training sessions which are held with
adults and children aged between 7 and 16 years address issues related to drug adherence, basic hygiene
and nutrition. The activity will also improve the organizational capacity of the Lea Toto program to deliver
high quality care and counseling and other support services for HIV+ children and their families. Other
program activities include nutritional support, micro-finance and empowering of caregivers through self help
groups.
This activity will contribute to the Kenya 5-Year strategy, will increase the number of OVC receiving
HIV/AIDS care and support, and will reach 6,000 OVC with comprehensive quality services and train 540
caregivers.
This activity is linked to ARV treatment (#6862), counseling and testing services (#6860) and palliative care
(#6863) implemented by COGRI and also linked to USG CT programs managing test kits procurement and
distribution.
This activity targets orphans and vulnerable children, caregivers of OVC, community leaders as well as
community based Faith-Based organizations.
The key legislative issues being addressed is stigma and discrimination through enhanced medical and
psychological well-being and demonstrated improved quality of life. This activity also addresses the wrap
around issues of food.
7. EMPHASIS AREAS
Major emphasis is Community Mobilization and participation and a minor emphasis in Training.
Continuing Activity: 14751
14751 4918.08 U.S. Agency for Children of God 6936 3543.08 Lea Toto $600,000
6861 4918.07 U.S. Agency for Children of God 4216 3543.07 Lea Toto $400,000
4918 4918.06 U.S. Agency for Children of God 3543 3543.06 Lea Toto $100,000
Gender
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Malaria (PMI)
* TB
Estimated amount of funding that is planned for Economic Strengthening $18,000
Estimated amount of funding that is planned for Education $30,000
Estimated amount of funding that is planned for Water $6,000
This activity is related to activities in TB/HIV care activities, HIV/AIDS treatment services, OVC, HBHC
This activity will result in counseling and testing of 10,000 children and at least 5,000 adults in 10 existing
voluntary counseling and testing centers situated near the project centers selected slums of Nairobi and one
in Kitui Eastern Province. In addition, 30 VCT counselors will be trained. The activity will also improve the
organizational capacity of the Lea Toto program to deliver high quality care and counseling services for
HIV+ children and their families. Referrals for VCT services which are mainly through CHWs, caregivers,
community leaders and other institutions within the program area will be strengthened. Program Counselors
and Community Based Counselors (CBCs) will carry out continuous dissemination of prevention information
both during Voluntary Counseling and Testing and in any other counseling and / or group therapy session
organized by the project. These group therapy sessions include life skills training, disclosure meetings,
support group meetings and follow up counseling sessions.
3. CONTRIBUTION TO OVERALL PROGRAM AREA
This activity will contribute to the Kenya 5-year strategy and increase the number of people counseled and
tested for HIV/AIDS by training 30 VCT counselors and testing 6,000 children and 3,000 adults.
This activity is linked to: COGRI-Lea Toto ART activity; COGRI-Lea Toto Palliative care activity; COGRI-Lea
Toto OVC activity. This activity is also linked to other USG CT program on CT promotion and procurement
of test kits.
Targeted population include the General population (men and women), Families affected by HIV/AIDS
including HIV positive infants and children, care givers, community health workers and Community Based
Counselors
6. LEGISLATIVE ISSUES ADDRESSED
This activity will work to reduce stigma and address discrimination faced by individuals infected or affected
by HIV/AIDS. This activity will address issues on disclosure of one's status to partner and family members.
7. EMPHASIS AREAS Training of VCT counselors to enhance their ability to provide quality HIV/AIDS
services that are responsive to the clients' needs is the major emphasis area while community mobilization
and participation are the minor emphasis areas
Continuing Activity: 14752
14752 4848.08 U.S. Agency for Children of God 6936 3543.08 Lea Toto $200,000
6860 4848.07 U.S. Agency for Children of God 4216 3543.07 Lea Toto $100,000
4848 4848.06 U.S. Agency for Children of God 3543 3543.06 Lea Toto $40,000
Program Budget Code: 15 - HTXD ARV Drugs
Total Planned Funding for Program Budget Code: $83,500,000
Key Result 1: Sufficient quantities of ARV drug procured by USG and supplied to support treatment for 190,000 people, including
25,000 adults on second-line regimens.
Key Result 2: Resources from the Government of Kenya and other donors leveraged to expand HIV treatment to an additional
160,000 patients.
Key Result 3: Public sector commodity forecasting, procurement and distribution systems strengthened to ensure uninterrupted
supplies of critical HIV commodities.
CURRENT PROGRAM CONTEXT
Since 2004, the pharmaceutical forecasting system in Kenya has steadily improved. No antiretroviral (ARV) stock-out has been
experienced despite rapid scale-up in treatment services. Public sector ARV commodity reporting has improved in terms of
timeliness and completeness of the reports. Monthly reporting rates on consumption of Emergency Plan (EP) and public sector
ARV stocks has been 100% and 80% respectively, as re-supplies are based on actual consumption data reported by sites.
Computerized ARV dispensing tools are now available in over 100 of 500 antiretroviral treatment (ART) centers. These tools -
accompanied by regular training in rational drug selection, use, and storage - have contributed to improved reporting rates in the
national ART program. Since 2007, nearly 5,000 new patients initiated ART every month, 10% of whom are children.
Since the EP initiated ART support, the majority of ARV commodity procurement for EP-supported partners has been achieved
through a contract with the Mission for Essential Drugs and Supplies (MEDS), an FBO that supports a network of mission, NGO,
public, and community health care facilities. Columbia University, Catholic Relief Services (CRS), and the Kenya Medical
Research Institute (KEMRI) have also procured limited quantities of ARVs and distributed them through the MEDS system. MEDS
has a central receiving warehouse that has capacity for storage, sorting, and packaging operations. It also maintains a well-
developed quality assurance system that includes site visits to pharmaceutical manufacturers and other suppliers and on-site
chemical analysis capability to assess the quality of received products. MEDS operates a zonal transportation system for product
delivery, which ensures quick turn-around times for site ARV orders.
Management Sciences for Health (MSH) through the Strengthening Pharmaceutical Systems (SPS) project, has been the main
USG technical partner supporting drug supply chain activities. In partnership with MEDS and other stakeholders, MSH/SPS
coordinates forecasting and quantification of antiretroviral drugs and other pharmaceuticals, and manages the logistics
management information systems (LMIS) to track procurement, warehousing, and distribution of these commodities. MSH/SPS
assists with provision of strategic information from ART and other commodity sources including importers and manufacturers. At
the national level, MSH/SPS provides technical assistance in commodity management to MEDS, Kenya Medical Supplies Agency
(KEMSA), NASCOP, and the Department of Pharmaceutical Services to strengthen commodity supply-chain systems supporting
ART and other medical and pharmaceutical commodities related to HIV. To assist in capacity building for commodity
management, SPS implements curricula for training ART healthcare workers at all levels of care. SPS also strengthens systems
by developing and applying standard operating procedures for commodity management tools. In the previous year, SPS
continued to work directly with KEMSA and its staff at the Logistics Management Unit (LMU) to support activities that were
previously supported under the MSH/RPM+ project.
The public sector counterpart to MEDS is KEMSA, which has been a key EP partner for HIV-related commodities. KEMSA
distributes ARVs purchased with Global Fund (GFATM), Clinton Foundation (CF), and GOK resources, as well as HIV test kits,
laboratory reagents, and drugs for opportunistic infections. KEMSA has three central warehouses in Nairobi, which have capacity
to store large volumes of medical supplies. There are eight additional provincial warehouses that cater for re-supply needs of local
facilities. KEMSA has contracted transporters to distribute HIV products directly to the treatment centres. Under the Millennium
Challenge Account (MCA) threshold program, USAID is working with KEMSA to improve procurement practices in the health
sector. The overall MCA objective is to reform public procurement and to improve healthcare service delivery. This is a two-year
project that will end in 2009.
Due to rapid scale-up and heavy demand for triple fixed-dose combinations (FDC) worldwide, coupled with limited USFDA
approved stavudine FDC formulations, the supplier capacity was exceeded leading to delays in delivery of the stavudine-based
FDCs. Kenya had to procure additional individual formulations to avert treatment interruptions; however, this has since been
remedied by procuring from newly approved sources.
STATISTICS
As of July 2008, EP-purchased ARVs supported 117,000 patients. The COP 2007 target of 110,000 patients was exceeded six
months ahead of schedule, and with current rates of scale-up, an expected 130,000 patients will be on EP-purchased ARVs by
September 2008. Over 380 ART centers across the country receive EP-purchased ARVs; public sector/GOK facilities constitute
70% of these sites. In 2008 the total value of ARVs purchased was $29,054,257, of which $23,835,485 (82%) went to generic
ARVs. Purchase of generic ARVs has resulted in huge cost savings and enabled the EP to exceed set ARV treatment targets. In
2009, the EP will provide ARVs for 190,000 patients, of whom at least 25,000 will require second-line or alternate regimens. The
estimated EP drug procurement budget will be in the region of $70,500,000. Drug storage, distribution, and systems
strengthening costs will be additional to this amount.
In 2009, USG Kenya will continue to purchase more USFDA-approved generic ARVs, especially FDCs. FDCs will simplify
quantification and procurement, reduce pill burden for patients, and promote better adherence. FDC use in EP-supported
programs will closely mirror formulations already available in public sector facilities from GFATM and GOK resources.
EP-procured ARVs will be mainly adult first- and second-line drugs based on Kenya's National Treatment Guidelines (NTG). The
CF will be responsible for the procurement of all pediatric first- and second-line formulations. Specific USG-procured drugs will be
(1) lamivudine 150mg/zidovudine 300mg/nevirapine 200mg FDC tabs as well as the individual formulations where needed, (2)
abacavir 300mg tabs, (3) didanosine 250/400mg tabs, (4) efavirenz 600mg tabs, (5) lopinavir 200mg/ritonavir 50mg tabs, (6)
tenofovir 300mg tabs, and (7) stavudine 30mg based FDC (if still recommended in the NTG at that time).
As of August 2008, 60 of 94 USFDA approved or tentatively approved ARV formulations have been registered for use in-country
by the Kenya Ministry of Health (MOH). Most of these ARVs are already in the Kenyan market from PEPFAR, GOK, GFATM, CF
and other procurement agencies. A significant number of other USFDA approved or tentatively approved companies have also
lodged their application with the Kenya MOH authorities and will soon be available in the local market. Registration pace for the
USFDA approved ARVs has been acceptable, and the USG will continue to work with the MOH to expedite local registration of
these products.
Although well-developed systems for drug registration exist in Kenya, post-market surveillance is weak, albeit improving. The
capacity of the National Quality Control Laboratory (NQCL) is limited by available resources. Ongoing and expanded activities
proposed in the 2008 COP will broadly support improvement in pharmaceutical management and pharmaco-vigilance in Kenya.
The USG will continue to strengthen NQCL to assure post-market surveillance.
At the moment, most EP-purchased ARVs do not require cold storage, and heat-stable boosted lopinavir formulations have been
available for over a year in the local market. However, for the pediatric formulation of this product, and other such products that
have cold-chain requirements, the current contractor has adequate capacity to handle, store, and transport them without breaking
the cold chain. In addition, most health facilities in the country also have capacity for cold storage.
The USG team, in partnership with GOK, GFATM, CF, and other development partners and stakeholders, have regularly held
national quantification meetings to ensure adequate ARV stocks to meet national needs are procured; however, planned GFATM
procurements rarely arrive on time, so USG and the CF are often requested to fill critical gaps.
In early 2009, a new bilateral ARV procurement contract will be awarded through a solicitation process that is currently nearing
completion. The contractor will distribute EP-procured ARVs and improve the distribution of drugs purchased by GOK and
GFATM. A small fraction of drug procurement funds are allocated to CDC's cooperative agreement with AIDSRelief to provide
flexibility for contingencies.
SPS will continue to work directly with KEMSA and its staff at the LMU. This includes managing the LMIS system of parallel
commodities for reproductive health, malaria, and the national TB program. MSH/SPS will maintain the database and help
distribute reports to relevant MOH Divisions and agencies on stock status. The LMU will gradually transition to KEMSA, and this
will entail expansion of the LMIS database to include all products warehoused and distributed by KEMSA.
WORK OF HOST GOVERNMENT AND OTHER IMPLEMENTING PARTNERS
In FY 2007-08, GOK allocated $7 million for ARVs and will support the same in FY 2008-09. The EP will work closely with the
MOH to ensure an expanding allocation to ARV drug procurement continues in future GOK budgets and this commitment is
reflected in the Concept Note for Kenya's Partnership Compact. Two other significant partners in ARV procurement are MSF and
CF. MSF currently supports ARVs for 14,000 patients in selected sites. Since 2006, the CF has been purchasing pediatric ARV
formulations, plus adult second-line from 2007; however, in 2009, CF will only purchase first-line and second-line pediatric ARVs.
Since CF support for adult second-line ARVs will cease in the COP 2008 period, the EP will purchase the additional ARVs for
approximately 25,000 patients in the COP 2009 period. USG will continue to work with GOK and other development partners,
especially the GFATM, to identify more resources for second-line ARV purchase.
REFERRALS AND LINKAGES
The USG-supported drug procurement and distribution system closely links with the public sector system through KEMSA. USG
has provided resources to strengthen KEMSA through both MCA and PEPFAR. About 60% of all facilities receive ARVs from both
KEMSA and MEDS, and this has averted stock outs when GFATM procurements are delayed.
In line with recent WHO recommendations, Kenya is currently revising national pediatric and adult ART guidelines. If adopted,
these new guidelines will be put into use during 2009 and should result in the use of more recent and safer regimens, especially
those containing tenofovir. The most immediate implication of the policy shift will be increased costs of treating (new) patients, as
stavudine-based regimens will likely be phased out and only two tenofovir formulations are currently USFDA-approved and
registered in Kenya.
Although there are no PEPFAR indicators in this program area, the USG has continued to monitor and support routine reporting
on drug consumption through monthly reports from ordering points to central stores. This data is used in forecasting and
quantification of future ARV needs, and helps ensure uninterrupted supplies.
A recent EP-supported innovation adopted by NASCOP is production of a monthly "40,000 foot" snapshot of current and projected
ART stocks for principal adult and pediatric regimens. It assists policy-makers and those responsible for resource allocation to
mitigate the possibility of stock-outs, modulate rates of scale-up if necessary, and ensure adequate funding for future demand.
OUTSTANDING CHALLENGES AND GAPS
While dual drug sources impose additional reporting burdens on treatment sites, dual supply is considered advantageous in
preventing treatment interruptions. Efforts will be made to fully standardize reporting while maintaining the "safety net" of dual
sources.
Failure to maintain timely and accurate reporting has compromised Kenya's ability to make optimal use of drug donation
programs. In 2009, assistance will be provided to NASCOP to address this problem.
Finally, although the GOK continues to allocate resources for ARVs, the amounts are minimal and limit any real scale-up of
programs or the ability to transition to safer but more expensive regimens. Moreover, delays in GFATM procurements continue to
hamper adequate ARV availability in the public sector, and on multiple occasions USG has supplied ARVs to KEMSA to avoid
stock-outs in public sites that are solely dependent on KEMSA. Many ART centers receiving dual supply have substantially
increased the proportion of their ARVs that are EP-procured given their far greater reliability.
Table 3.3.15:
