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: 2007 2008 2009
Updated April 2009 Reprogramming. Increased by $150,000. Partnership Framework: Scale up - improved
and standardized integration of HIV services into MCH and improved and standardized models of follow up
care and referrals. These activities will be implemented through various APHIA partners.
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:
+ More emphasis on decentralization of HIV care and treatment as well as TB services through capacity
building and task shifting
+Male involvement through targeted couple counseling
+Greater involvement of HIV+ mentor mothers
+ Quality improvement through standards based management and recognition
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
This activity supports key attributions in human capacity development through the training of health care
service providers on PMTCT and other HIV prevention and care topics in order to equip them with
knowledge and skills to provide quality PMTCT services. These service providers include Doctors, Nurses,
Clinical Officers, Nutrition Officers and Health Record clerks. The activity will also support hiring of health
workers to fill critical gaps in service delivery.
COP 2008
1. LIST OF RELATED ACTIVITIES
This activity relates to Counseling and Testing, Palliative Care: TB/HIV and Palliative Care: Basic Health
Care and Support, HIV/AIDS Treatment: ARV Services, Condoms and Other Prevention Activities, and
Orphans and Vulnerable Children.
2. ACTIVITY DESCRIPTION
This APHIA II Coast activity will expand PMTCT services in the Coast Province, building on the support
previously provided through USAID's IMPACT and AMKENI EngenderHealth Projects. It aims to provide
universal uptake of counseling and testing (CT) and ARV prophylaxis in the province. In all the facilities
across the six districts, counseling and testing will be provided to 118,584 (94%) of 126,166 pregnant
women, and ARV prophylaxis to 6,326 (94%) of 6,726 HIV-positive women. Of these 3,164 will receive
AZT/NVP 1,265 HAART and 1897 single dose nevirapine only. 3,164 exposed infants will receive PCR for
early infant diagnosis. Service delivery will incorporate best practices, namely opt-out approach and rapid
testing. Sites will include, or will be linked to, comprehensive care centers. Opportunistic infection
prophylaxis, the use of more efficacious regimens for ARV prophylaxis and PMTCT plus services will start in
selected sites. Improved capacity to carry out postnatal follow up of infected mothers and exposed babies to
include early infant diagnosis especially in the mother and child health clinics (MCH) are priorities. Cost
barriers to ART uptake which include laboratory costs in its sites will be addressed. Significant changes
from 2008 include the universal provision of PMTCT services in the entire district, provincial hospitals and
high volume health centers, and the use of more efficacious regimens for ARV prophylaxis. Strategies to
provide CT in maternity services during labor and delivery, emphasis on complete ANC profile and birth
planning, improved obstetric care, HIV staging in both ANC and delivery units, ARV and OI prophylaxis,
ART for eligible women, access to HIV care and treatment and TB services for HIV+ pregnant women, their
infants, and family members through decentralization; extending CT services to include couples to reach
23,717 (20%) male partners, Provider Initiated Testing and Counseling (PITC) in family planning (FP) and
Child Welfare Clinics (CWC), improving access to FP services and deployment of additional counselors to
ANC sites are other important changes. Postnatal follow up of infants and mothers will include infant
diagnosis, cotrimoxazole prophylaxis, treatment, and counseling and support on maternal, infant and young
child nutrition and appropriate linkages for nutritional support. In 2009, the APHIA II Coast will support 350
sites, train 350 providers and provide logistical support, renovation, supervision and monitoring. Support to
PMTCT plus services will include training of service providers, strengthening of laboratory and commodity
logistics capacity, increased access to HB, FBC and CD4 assays and linkages to comprehensive care
centers. The program will support and strengthen functional lab networks, decentralization and task shifting
in initiation and provision of ART within MCH for mothers and their HIV infected infants in an effort to
improve access to HIV care and treatment services including ART. Operations research will focus on
improving service delivery. This activity will use the Ministry of Health's WHO/CDC-based curriculum for
training, comply with MOH's clinical and reporting guidelines, and participate in the MOH's Technical
Working Group. Community links in rural areas to provide support especially to HIV+ pregnant women will
be established through national organizations of PLWHA. Agreements with Provincial Medical Officers will
ensure that PMTCT skills are taught to multidisciplinary treatment and care teams at comprehensive care
facilities, and that primary HIV care is integrated into MCH clinics. HIV counseling and testing services to
partners and family members of pregnant women will be scaled up, thus addressing the fourth prong of the
PMTCT program strategy. This prong has remained largely unaddressed in Kenya. Emphasis will also be
placed on primary prevention for the majority of women identified as HIV negative through the PMTCT
program.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
PMTCT in this geographical area will significantly support PEPFAR goals for primary prevention and care
by contributing 9.1% of 2009 overall Emergency Plan PMTCT targets for Kenya. Additional sites contribute
to the program's efforts to achieve district wide coverage for services. Support to high volume health
centers, district and provincial hospitals to provide PMTCT plus services significantly increase opportunities
to identify HIV infected patients and potential candidates for ART. Access to services, medical treatment
and care will encourage rural women in underserved communities to attend antenatal care services. This
will facilitate postnatal follow up of HIV positive women, infants and their family members. This APHIA II
Coast activity also contributes substantively to Kenya's Five-year strategy of encouraging pregnant women
to know their status, availing services to reduce mother-to-child infections and providing HIV/AIDS treatment
as a step towards preserving the family unit. It also contributes to the strategy to integrate services and
improve the referral links.
4. LINKS TO OTHER ACTIVITIES
This activity relates to CT, OVC, palliative care and and other prevention activities described under the
Activity Narrative: APHIA II Coast in other parts of the 09 COP. PMTCT plus services include counseling and testing which is
largely diagnostic, provision of ARV prophylaxis, management of opportunistic infections and ARV services.
Strengthening laboratory services and improving commodity logistic systems is a crucial part of HIV/AIDS
treatment services. Operations research on improving service delivery is included.
5. POPULATIONS BEING TARGETED
This APHIA II Coast activity targets adults of reproductive health age, pregnant women, family planning
clients, infants, people living with HIV/AIDS, HIV positive pregnant women and HIV positive infants. BCC
activities will involve community leaders and community based organizations to increase demand for
services. Strategies to improve quality of services will target Ministry of Health staff, doctors, nurses,
midwives, laboratory workers, pharmacists and other health care workers such as clinical officers and public
health officers.
6. KEY LEGISLATAIVE ISSUES ADDRESSED
This APHIA II Coast activity will increase gender equity in programming through partnering with women's
groups in the design and implementation of community mobilization approaches. The behavior change
communication (BCC) activities will promote a family approach to PMTCT. This will address male norms,
encourage male participation and help reduce stigma and discrimination. Increased availability of services
will also reduce stigma.
7. EMPHASIS AREAS
This activity includes emphasis on human capacity development through training, supportive supervision
and task shifting, local organization capacity development and improvement in strategic information. Wrap
around program with the PMI, family planning and safe motherhood, TB and nutrition programs will be
linked with this activity.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14806
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14806 8764.08 U.S. Agency for Family Health 6948 4913.08 APHIA II - Coast $2,000,000
International International
Development
8764 8764.07 U.S. Agency for Family Health 4913 4913.07 APHIA II - Coast $950,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $156,450
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
+ Geographic coverage has been expanded to include three additional districts in the Coast Province:
Taveta, Lamu, and Tana Delta
+ Peer education activities will be rolled out with the Kenya Girl Guides Association
+ Most-at-risk populations in beaches will be targeted with combination prevention messaging
+ Specific AB messages will target both adult men and women with the aim to reduce multiple concurrent
partners
+ This activity will incorporate $300,000 for HIV Free Generation activities targeting youth
The only changes to the program since approval in the 2007 COP are:
• Geographic coverage has been expanded to include 3 additional districts in the Coast Province: Kilindini,
Kaloleni and Tana River
• $300,000 of this activity supports the healthy youth initiative and is programmed with funds from the $7
million FY 08 plus up
• Peer education activities will be rolled out with the Kenya Girl Guides Association
• AB funds totaling $23,000 will contribute to the sensitization of teachers as a worksite population linking
with additional OP and OHPS funds for a $150,000 activity to reach 750 teachers and train 20 more
• Most-at-risk populations in Mariakani along the Mombasa-Kampala transport corridor will be targeted with
prevention activities using a "cluster" approach
This activity relates to activities in HIV/AIDS Treatment: ARV Services (#8813), Counseling and Testing
(#8781), Orphans and Vulnerable Children (#9048), Palliative Care: Basic Health Care and Support
(#8934), Palliative Care: TB/HIV (#9062), Condoms and Other Prevention Activities (#8930), Prevention of
Mother-to-Child Transmission (#8764), Strategic Information (#9711).
$300,000 of this activity supports the HIV Free Generation activities. In 2009, FHI will implement APHIA II
Coast activities to reach 347,870 individuals, especially youth, and train 2,416 peer educators. AB activities
will be expanded to 3 additional districts in the Coast Province. They will employ the 360-degree Model of
Protection that seeks to delay first sexual encounter and increase secondary abstinence among youth ages
10 to 24 years, as well as increase safer sexual practices among sexually active youth, especially mutual
fidelity. The model calls upon families, schools, health facilities and communities to meet the HIV/AIDS and
RH needs of youth by developing activities that build the capacity of young people to establish and maintain
healthy behaviors to avoid HIV and STIs. The model aims to provide young people with a supportive
environment that involves their family, peers, school, and community. The activity will be implemented by
FBO sub-partners such as Anglican, Seventh Day Adventist and Catholic churches as well as the Muslim
institutions to integrate life skills programs with their youth programs. These programs have been equipping
youth with skills to cope with peer pressure and help them develop positive norms and values to make
appropriate and safe choices in relationships. In addition, the activity will work with Kenya Girl Guides
Association (KGGA) to reach out to more youth in school with abstinence only messages through a life skills
program and the "Sara" communication initiative. Malindi Education Development Association (MEDA) will
target Muslim youth in Malindi with abstinence and be faithful programs. The activity will also develop,
produce and distribute abstinence-specific communication materials through the various partners and
networks implementing the activity in Coast Province. The activity will expand the youth peer education
interventions using the Y-PEER approach established by YouthNet and UNFPA; work with the Provincial
Education Office and KGGA to roll out the life skills peer education program established under the IMPACT
Project for schools in Coast Province. In addition, the activity will work with the Kenya sign language project
(implemented by U.S. Peace Corps) to introduce HIV/AIDS education to institutions such as computer
colleges, driving schools, village polytechnics, and Shanzu Teachers Training College. The project will also
use the AIDS education approaches of "I Choose Life" who have developed a peer education program for
university students and the National Organization of Peer Educaotors' Ambassadors of Change. Sub
awards will be made to the National Organization for Peer Educators, YouthNet, the Kenya Girl Guides
Association, Malindi Education Development Association, Seventh day Adventist, Anglican and Catholic
churches in Coast province.
This APHIA II Coast project will contribute to the Kenya 5-Year Strategy in which youth are a primary target.
This activity will reach 347,870 youth and adults with abstinence and being faithful messages in Coast
Province. Targets in this project will also contribute to numbers of HIV infections averted.
The APHIA II Coast Abstinence and Be Faithful Program activities will relate to HIV/AIDS treatment services
(#8813), counseling and testing (#8781), OVC (#9048), HBHC (#8934), TB/HIV care activities (#9062), OP
(#8930), PMCT (#8764), and strategic information (#9711). This activity will link the target population to
other prevention services especially for the sexually active youth and also encourage all to know their status
by linking to counseling and testing services and treatment for those eligible for ART.
In- and out-of-school youth and community and religious leaders in coast province are the target group. This
target population will be reached through local community, religious leaders, and teachers.
6. KEY LEGISLATIVE ISSUES ADDRESSED
Gender will be addressed through many school programs including those targeting young girls and
specifically work with the Kenya Girl Guide Association. The materials developed under this activity will also
address issues surrounding stigma and discrimination.
Emphasis areas covered by this activity include local organization capacity development as a high
Activity Narrative: percentage of effort. Activities will include peer education and training teachers and other leaders to
promote AB messages for youth. In addition, the program emphasis includes community mobilization
through religious leaders and teachers, information, education and communication through the development
and printing of materials such as comic books and magazines articles, and curricula targeting youth and
promoting AB.
Continuing Activity: 14807
14807 8950.08 U.S. Agency for Family Health 6948 4913.08 APHIA II - Coast $2,000,000
8950 8950.07 U.S. Agency for Family Health 4913 4913.07 APHIA II - Coast $1,675,000
* Addressing male norms and behaviors
Workplace Programs
Table 3.3.02:
+ Geographic coverage has been expanded to include Taveta, Tana Delta and Lamu.
+ Clients of sex workers will be targeted with specific interventions that focus on consistent condom use and
knowing of status.
+ Specific prevention messaging targeting women, men and discordant couples will be incorporated into CT
interventions. Specific messages will be developed for each target group.
+ This activity will incorporate $300,000 for HIV Free Generation activities focusing on youth.
+ This activity will target police, uniformed services, women, opinion leaders, and others on issues of
gender-based violence.
•Geographic coverage has been expanded to include 4 additional districts in the Coast Province: Kaloleni,
Kinango, Kilindini and Tana River totaling 10 districts
•$100,000 of this OP activity is programmed with funds from the $7 million FY08 plus-up for the Youth
Prevention Initiative
•OP funds totaling $29,000 will contribute to the sensitization of teachers as a worksite population linking
with additional AB and OHPS funds for a $150,000 activity to reach 750 teachers and train 20 more
•APHIA II Coast will work with police, uniformed services, women, opinion leaders and others on issues of
gender-based violence
(#8934), Palliative Care: TB/HIV (#9062), Abstinence and Be Faithful Programs (#8950), Prevention of
Mother-to-Child Transmission (#8764).
In 2009, FHI will implement APHIA II Coast to reach 880,787 individuals through community outreach
programs, train 2,617 individuals and distribute condoms through 2282 outlets. The activity will build on
HIV/AIDS Other Prevention activities implemented under the 06 COP. It will reach 880,787 individuals
through community outreach programs and train 2,617 people through existing local NGOs, FBOs and
private sector. The activity will focus on reaching individuals in formal and informal settings. Under the
leadership of the National Organization of Peer Educators (NOPE), the activity will target women and men
at worksites and youth at risk. The local NGO and FBOs will target other high-risk populations including low-
income community women, sex workers, truck drivers, cattle traders, uniformed services, discordant
couples and women in churches and mosques in the Coast Province. Technical assistance partners will
continue to provide assistance and capacity building to partner organizations to implement behavior change
prevention programs. The program will link with and provide referrals to existing networks of HIV/AIDS
counseling and testing, home-based care and ART programs in the program areas, creating
"comprehensive care centers." This intervention will result in reduced HIV risk in the general population,
especially among young adults. They will provide increased access to HIV/AIDS prevention services for
high-risk and under-served populations, and increase awareness of HIV/AIDS preventive behaviors through
the Ministry of Health and other partners. This will also include targeted condom promotion and distribution
to high-risk populations through 2282 condom outlets and improved quality of STI services working through
the Ministry of Health and other partners. Prevention activities will include the following: targeting out-of-
school and most at risk youth with prevention information and referral to youth friendly services; supporting
peer education interventions with sex workers in Malindi, Mombasa, Kilifi and Kwale districts and link them
to VCT, PMTCT, care and support services; support prevention efforts among the uniformed services by
working with the provincial police AIDS Control Unit (ACU) to expand the police peer education program to
four districts in the Coast Province; expand the peer education program targeting truck drivers, loaders, and
seafarers and link the activities to the existing ROADS Project; support prevention programs targeting hard-
to-reach MARPS such as the MSM and injection drug users and the geographically hidden populations
such as Orma and Wadei Somalis in Tana River; provide counseling, information and prevention to HIV-
positive individuals through peer and provider education, outreach services and regional mass media. In
addition, the activity will target people with disabilities and assist them to gain access to integrated networks
for care, treatment and support activities. Local implementing partners will integrate prevention messages
into models of care and support for OVC and PLWAs. Technical assistance will continue to be provided to
implementing partners implementing behavior change communication programs in HIV and substance
abuse and develop new print materials addressing alcohol abuse, stigma and discrimination.
This activity will contribute to the Kenya 5-Year Strategy that focuses on HIV prevention targeting high-risk
groups. Targets in this project will contribution to HIV infections averted.
The APHIA II Coast Other Prevention activities will relate to HIV/AIDS treatment services (#8813),
counseling and testing (#8781), OVC (#9048), HBHC (#8934), TB/HIV care activities (#9062), AB (#8950),
PMCT (#8764).
Men and women in the work place, male and female sex workers and their partners and clients, and other
high-risk population including truck drivers and out-of-school youth.
This APHIA II TBD project will have a strong gender component. Activities will target men in the workplace
and low-income women in the community.
Community mobilization/participation will be implemented to reach the communities surrounding worksites.
Activity Narrative: Individuals will be referred for other HIV/AIDS related services, especially counseling and testing services.
In addition, peer educators in worksites who are also targeting the community will be trained to provide
information related to HIV/AIDS including condom distribution. APHIA II Coast will undertake Prevention
with Positives (PwP) activities working through PLWA support groups linked to the Comprehensive Care
Centers in Coast province. $50,000 of unallocated funds will provide support to patient support groups in
the CCCS and post-test clubs at VCT centers to ensure promotion of faithfulness and condom use by HIV-
infected persons. This will empower 5 HIV+ people in each of 10 patient support groups to become peer
and advocacy leaders in prevention at the community level and will reach 10,000 PLWAs.
Continuing Activity: 14808
14808 8930.08 U.S. Agency for Family Health 6948 4913.08 APHIA II - Coast $1,800,000
8930 8930.07 U.S. Agency for Family Health 4913 4913.07 APHIA II - Coast $2,190,000
Table 3.3.03:
This PHE activity, "Alcohol Harm Reduction Intervention Among Female Sex Workers In The Coast
Province In Kenya" was approved for inclusion in the COP. The PHE tracking ID associated with this
activity is KE.09.0235. This PHE is NEW in COP 09.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Public Health Evaluation $239,882
+ Geographic coverage has been expanded to include three additional districts in the Coast Province: Tana
Delta, Lamu and Taveta totaling 13 districts
+ APHIA II will collaborate with community based organizations working with IDUs to integrate HIV
prevention among IDUs in the Coast region. This activity will contribute to outreach educational programs
targeting IDUs.
+ This activity was previously undertaken through other prevention programs.
In 2009, FHI will reach 6,000 IDUS through outreach programs, train 500 individuals on IDU and HIV and
distribute condoms to IDU through 200 outlets. The activity will build on HIV/AIDS Other Prevention
activities implemented under the 08 COP. It will reach IDUs through community outreach programs and
train people through existing local NGOs, FBOs and the private sector. The activity will focus on reaching
individuals in though their peer Networks in Mombasa, Kwale, Kilifi, Malindi and Lamu and drug
rehabilitation centers in Mombasa and Malindi.
FHI will work to improve the capacity of local organizations in the Coast Province working with IDUs to
implement effective HIV prevention interventions among IDUs. These include the Muslim Education and
Welfare Association (MEWA), Reach Out, Darat, Omari Project and Tawfiq hospital in Malindi. APHIA II
Coast will target IDUs in the community and at rehabilitation centres.
APHIA II program will develop comprehensive programs targeting IDUs which will include risk reduction
counseling, condom distribution, community based outreach, information and education that will address
HIV prevention and risk reduction. IDUs will be referred for other services such as counseling and testing,
ART, palliative care services, STI and TB treatment.
Technical assistance partners will continue to provide assistance and capacity building to partner
organizations to implement HIV Prevention interventions among IDUs. The program will link with and
provide referrals to existing networks of HIV/AIDS counseling and testing, home-based care and ART
programs in the program areas, creating "comprehensive care centers." This intervention will result in
reduced HIV risk among IDUs and the general population, especially among young adults. The intervention
will provide increased access to HIV/AIDS prevention services for high-risk and under-served populations,
and increase awareness of HIV/AIDS preventive behaviors through the Ministry of Health and other
partners. This will also include targeted condom promotion and distribution to this high-risk populations
through 200 condom outlets and improved quality of STI services working through the Ministry of Health
and other partners.
PMTCT (#8764).
IDUs in the community and rehabilitation centers and their partners and clients.
This APHIA II project will have a strong gender component. Activities will target both men and women IDUs
in the community.
Community mobilization/participation will be implemented to reach the IDUs in identified locations in the
community. Individuals will be referred for other HIV/AIDS related services, especially counseling and
testing services. In addition, peer educators will be trained to provide information related to HIV/AIDS
including condom distribution and referral. APHIA II Coast will undertake Prevention with Positives (PwP)
among the IDUs through PLWA support groups linked to the Comprehensive Care Centers in Coast
province.
Table 3.3.06:
ACTIVITY UNCHANGED FROM COP 2008
This activity supports key cross-cutting attributions in human capacity development through its training
program for health workers ($80,000).
1. ACTIVITY DESCRIPTION
This activity will provide integrated and comprehensive home and basic health care to 45,000 people with
HIV/AIDS linked to 58 comprehensive care centers. Through a training of trainers, primary care facility
health workers will be trained to provide comprehensive and integrated care training to home /community
based care workers. They in turn will train the primary care givers at home, which will complement the
facility based services. At the health facility clinics integrated training following NASCOP/DRH/Malaria/NLTP
curricula will be offered to some identified staff so that they may offer services for the prevention,
identification and management of OIs, monitoring of the infected adults, children and their families, coupled
with appropriate counseling and education. All babies born and children of HIV infected mothers will be
followed up at the CCCs or MCHs and appropriately managed. A HBC desk will be established to manage
referrals to and from the community. The community based component will include treatment literacy, basic
management of OIs, antiretroviral treatment (ART) and TB treatment adherence, adequate nutrition, home
hygiene and nursing skills , malaria prevention and treatment, FP and identification and referral of clients
suspected of having HIV and TB. Formal linkages between health facilities and the community-based
activities will be created to enhance effective care, follow-up, and tracking of referrals and assessment of
patient satisfaction with the services. Both formal health care workers and community and home based care
volunteer workers will be trained on effective referral. Lay treatment support volunteers will be recruited and
trained, using the curricula to provide psychosocial support, adherence support for ART, TB and regular
clinic visits. This activity will also lead to the mobilization and strengthening of organizational and
institutional capacity of ten District institutions to integrate, plan, lead, monitor and evaluate home and
community care support programs. Quality assurance and quality improvement of this activity, for both
facility and community interventions will be key in ensuring that standards of care are met. Care providers
will be trained on the Ministry of Health SOPs. Through this activity, the organizational capacity of PLWA
groups will be strengthened so as enable them to be pro-active leaders, advocates and participants in the
response to the epidemic. In addition, this activity will lead to the linkage of 7,000 families with economic
support programs. Community members including PLWA and older OVC will be trained on this methodology
and also in basic financial management and skills for their projects and also linked to other microfinance
institutions operating in the region. To ensure continued support for this effort at the community level, FBOs,
CBOs, PLHA groups, women and youth groups will be trained in basic program and financial management
skills as part of capacity building. Training of paralegals and child counselors will be expanded to the
Districts of Kwale, Taita-Taveta, Lamu and Tana River.
The activity will be implemented by partners such as Catholic Arch Diocese of Mombasa, Catholic Diocese
of Malindi as well as Coast people living with AIDS (COPE). With initiation of ART, the number of registered
PLHA groups increased. However, in spite of the commitment of members of these groups, the
organizations are structurally weak and have not played a key role in HIV/AIDS programming in coast. In
order to address this, the activity will work with National empowerment of networks of people living with
HIV/AIDS in Kenya (NEPHAK) and women fighting AIDS in Kenya (WOFAK) to build the technical capacity
of these organizations and assist them to implement programs in their communities. Social impact will work
intensively with these groups to strengthen their organizational capacity.
Provision of safe water supply in the homestead will be supported to reach 20,000 families through the use
of approved hypo chloride treatment of water used for drinking and preparation of food. In addition, these
families will be linked to a supply of insecticides treated bed nets targeting especially those with pregnant
women and children less than five years. Nutritionally deficient bed ridden patients will be supported with
food supplements. Vulnerable households will be linked to food security and extension services.
2. CONTRIBUTIONS TO OVERALL PROGRAME AREAS
The APHIA II Coast will reach 45,000 clients through the home based care program and 1,500 individuals
will be trained to provide palliative care at home. This APHIA II Coast activity responds to NACC's priority
areas #2 "Improve the quality of life of people infected and affected by HIV/AIDS" and #3 "Mitigation of socio
-economic impact". It is expected that the APHIA II Coast will adhere to GOK policies and guidelines and
participate in national-level HIV technical working groups.
3. LINKS TO OTHER ACTIVITIES
These APHIA II Coast activities will be tightly linked to the FY 2009 activities across the spectrum of care
including programmes of Orphans and vulnerable children, Prevention of Mother to child HIV transmission,
TB/HIV, RH/FP services, Abstinence and Behavior change and Counseling and testing. It will also link with
programs providing appropriate nutrition for PLWHA.
4. POPULATIONS BEING TARGETED
These APHIA II Coast activities target people living with HIV/AIDS, HIV/AIDS affected families, and
caregivers of OVC and PLWHA. It also targets the community, in order to improve community support and
the health care providers in public, private and faith based health facilities.
5. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will address Stigma and Discrimination associated with people infected and affected by HIV, as
well as increasing gender equity in programming through the delivery of key messages, Linkages will be
created with systems/groups offering support in health, psychosocial aspects, food, microfinance, and
reproductive health. Also to provide access to increased resources in order to address the wide spectrum of
problems that is faced by households when dealing with a debilitating disease in an adult family member.
6. EMPHASIS AREAS
The main Emphasis Areas for these activities will be workplace HIV prevention; care and treatment
Activity Narrative: programs that target both adults and children, as well as Health Related Wraparound Programs addressing
Family Planning and Safe Motherhood needs of adults.
Continuing Activity: 14809
14809 8934.08 U.S. Agency for Family Health 6948 4913.08 APHIA II - Coast $1,205,000
8934 8934.07 U.S. Agency for Family Health 4913 4913.07 APHIA II - Coast $300,000
Estimated amount of funding that is planned for Human Capacity Development $80,000
Table 3.3.08:
The narrative has been split to reflect adult and pediatric care and support and treatment. References to
targets have been updated including emphasis areas and budgets.
program for health workers ($400,000).
These APHIA II Coast activities will be tightly linked to the FY 2008 activities and across the continuum of
care with other services supported by APHIA II Coast in basic HIV care and support, Orphans and
vulnerable children, Prevention of Mother to child HIV transmission, TB/HIV, RH/FP services, Abstinence
and Behavior change and Counseling.
This APHIA II Coast activity will be carried in all the districts through consolidating established HIV
treatment programs and expanding the activities to include all health centers and high volume dispensaries
(both private and GOK facilities). As a result of these activities, 10,000 people with HIV will initiate
antiretroviral therapy and 20,000 will be receiving antiretroviral therapy and follow-up at 130 central and
satellite ART sites at the end of the period. A total of 300 health care workers will be trained in the provision
of antiretroviral therapy (ART). This includes 120 staff being trained on rational use of ART and 180 trained
on IMAI - Integrated Management of Adult and adolescent illness for the rural health facility based health
care workers). Other activities will include infrastructure improvements for the service delivery areas and
laboratories, supply of equipments and commodities such as laboratory reagents and pharmaceuticals,
production and dissemination of patient education materials addressing adherence to antiretroviral therapy,
prevention among positives, strengthening the clinical mentorship, QA/QI and supervision structure.
In addition to supporting outpatient provision of ARVs specific activities will increase the opportunities to
identify eligible patients for ART in key areas, such as the in-patient wards, TB clinics (TB-HIV co-infected
patients) and from MCH-FP services. The laboratory networks for CD4 count tests, involving all health
facilities offering HIV care & treatment, will be strengthened and improved to ensure that all HIV-infected
patients have access to CD4 tests and are evaluated for eligibility for ART. All services will be tightly linked
across the spectrum of care with other services in basic home-based care and community support in
conjunction with systems strengthening. District based mentorship teams will support the effective
decentralization of quality HIV care and treatment services. Health care workers and PLHIV who have
openly disclosed their HIV status will be trained and appropriately deployed at the ART sites to advocate for
ART adherence at health facility and community level.
The above activity will also target the private sector through the Gold Star Network (GSN) initiative, which
involves working with private medical practitioners (medical doctors, clinical officers, nurses), private
hospitals and nursing homes and workplace clinics. An additional 45 providers in the private sector will be
recruited and trained to offer comprehensive HIV care and treatment in the Coast through GSN. The
providers within the network will be linked with the public sector through the GSN support centers to access
laboratory facilities and PEPFAR drugs for patients who can not afford to purchase the ARV.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREAS
These APHIA II Coast activities will greatly contribute to USG's 5-year strategy in support of Kenya's
integrated HIV/AIDS programs by expanding established ART programs to include new areas in Coast
province. As a result of these activities, 10,000 new patients will receive ARVs, contribute to the results of
expansion of ART treatment for clinically qualified HIV positive patients, strengthen human resource
capacity to deliver ART treatment, and strengthen referral network for provision of ART. The number of
individuals who ever received ARVs by the end of reporting period will be 24,000.
and Behavior change and Counseling and testing. It will also link with programs providing appropriate
Nutrition for PLWHA.
These APHIA II Coast activities target people affected by HIV/AIDS, people living with HIV/AIDS, HIV/AIDS
affected families, and caregivers of OVC and PLWHA. It also targets the community, in order to improve
community support and the health care providers in public, private and faith based health facilities.
programs that target both adults and children, as well as Health Related Wraparound Programs addressing
Family Planning and Safe Motherhood needs of adults
Continuing Activity: 14813
14813 8813.08 U.S. Agency for Family Health 6948 4913.08 APHIA II - Coast $4,900,000
8813 8813.07 U.S. Agency for Family Health 4913 4913.07 APHIA II - Coast $2,960,000
Estimated amount of funding that is planned for Human Capacity Development $400,000
Table 3.3.09:
ACTIVITY UNCHANGED FROM COP 2008:
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS:
program for health workers ($15,000)
These activities will be tightly linked to the FY 2008 activities and to other APHIA II Coast activities including
HIV treatment, orphans and vulnerable children, Prevention of Mother to Child HIV Transmission, TB/HIV,
RH/FP services, Abstinence and Behavior change and counseling and testing. It will also link with programs
providing appropriate Nutrition for PLWHA.
This APHIA II Coast activity will be carried out in all districts of Coast Province. This activity will provide an
integrated and comprehensive home and basic health care package to 5,000 children with HIV/AIDS that is
linked to 100 comprehensive care centers and a network of Rural Health Facilities (RHFs). The activities will
involve the intensified identification of HIV-exposed and infected children both at the facility and community
level. In MCH settings, 6,400 blood samples for DBS will be collected for early infant diagnosis from HIV-
exposed infants and those accompanied by mothers with unknown HIV status. The DBS networks will be
strengthened to include all facilities offering PMTCT services in the supported areas. Health care workers
from these sites will be orientated on the standard operating procedures for effective collection of samples
and timely retrieval of results. All babies and children of HIV infected mothers will be followed up at the
CCCs or MCHs and appropriately managed. A case manager will manage referrals to and from the
community. DBS collection will be closely linked to Cotrimoxazole prophylaxis, immunization schedule and
regular growth & nutritional monitoring. A total of 200 health care workers will be trained on infant and
young child feeding (IYCF) in order to strengthen the care components. The laboratory networks for CD4
count tests will be strengthened and improved to ensure that all infected Children are screened to assess
eligibility for ART. Provision of safe water supply in the homestead will be supported to reach clients
households. In addition, these families will be linked to a supply of insecticides treated bed nets targeting
especially those with pregnant women and children under five years. The above activity will also target the
private sector approach through the Gold Star Network (GSN) initiative working with private medical
practitioners (medical doctors, clinical officers, nurses), private hospitals and nursing homes and workplace
clinics.
These APHIA II Coast activities will expand established pediatric care and support sites within the HIV
programs to include new areas in Coast province. As a result of these activities, 5,000 children will be
offered facility based care and support; they will have clinical, psychological, social, spiritual and nutritional
care during both specific clinics and the support groups, led by child peers.
These APHIA II Coast activities targets people affected by HIV/AIDS, orphans and vulnerable children,
people living with HIV/AIDS, HIV/AIDS affected families, HIV positive infants and children and caregivers of
OVC and PLWHA. It also targets the community, in order to improve community support and the health care
providers in public, private and faith based health facilities.
Estimated amount of funding that is planned for Human Capacity Development $15,000
Table 3.3.10:
program for health workers ($50,000)
This activity relates to activities in Counselling and Testing, Paediatric Care and Support, Adult care and
Treatment, TB/HIV, and PMTCT.
This APHIA II Coast activity will be carried in all the districts by consolidating established HIV treatment
programs and expanding the Pediatric ART activities to all health centers and high volume dispensaries
offering adult ART (both private and GOK facilities). As a result of these activities, 1,470 new pediatric
patients will initiate antiretroviral therapy (ART) and 2,600 will be receiving ART at the end of the period,
which will bring the total ever treated to 3,120. These services will be provided at 100 central and satellite
ART sites. A total of 60 health care workers will be trained in pediatric HIV management and psychosocial
care. Other activities will include infrastructure improvements for the service delivery areas and
prevention among positives, strengthening the clinical mentorship, QA-QI and supervision structure. In
addition to supporting outpatient provision of Pediatric ARVs, specific activities will increase the
opportunities to identify eligible patients for ART in the key areas such as the in-patient wards, TB clinics
(TB-HIV co-infected patients) and from MCH-FP services and other community support services i.e. OVC
and home based care program client families. All infants with positive DBS results will be started on ART.
The laboratory networks for CD4 count tests, involving all health facilities offering HIV care and treatment,
will be strengthened and improved to ensure that all HIV-infected patients have access to CD4 tests and are
evaluated for eligibility for ART. All services will be closely linked across the spectrum of care with other
services in basic home-based care and community support in conjunction with systems strengthening.
District based mentorship teams will support the effective decentralization of quality HIV care and treatment
services. Health care workers and PLHIV who have openly disclosed their HIV status will be trained on
pediatric psychosocial support and appropriately deployed at the ART sites to advocate for ART adherence
at health facility and community level. Relevant pediatric IEC materials will disseminated to educate
patients, parents and guardians attending ART clinics to enhance adherence to the ARV. The above activity
will also target the private sector approach through the Gold Star Network (GSN) initiative working with
private medical practitioners (medical doctors, clinical officers, nurses), private hospitals and nursing homes
and workplace clinics; additional 15 providers in the private sector will be recruited and will be trained to
offer Comprehensive Pediatric HIV Management in Coast through GSN. The providers within the network
will be linked with the public sector through the GSN support centers to access laboratory facilities and
PEPFAR drugs for patients who can not afford to purchase the ARV.
These APHIA II Coast activities will expand established pediatric ART programs to include new areas in
Coast province. As a result of these activities, 1,470 new patients will receive ARVs, contributing to the
results of expansion of ART treatment for clinically qualified HIV positive, pediatric patients, strengthen
human resource capacity to deliver pediatric ART treatment, and strengthen referral network for provision of
pediatric ART.
These APHIA II Coast activities will be tightly linked to the FY 2009 activities and across the spectrum of
care with other services supported by APHIA II Coast in Palliative care, Orphans and vulnerable children,
Prevention of Mother to child HIV transmission, TB/HIV, RH/FP services, Abstinence and Behavior change
and counseling and testing. It will also link with programs providing appropriate nutrition for PLWHA.
These APHIA II Coast activities target people affected by HIV/AIDS, Orphans and vulnerable children,
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.11:
program that targets health workers ($35,000).
The activity will link to APHIA Coast other activities in CT, Palliative Care: Basic Health Care and Support ,
ARV services , Condoms and Other Prevention , Orphans and Vulnerable Children , Prevention of Mother
to Child Transmission and Abstinence and Be Faithful.
2. ACTIVITY NARRATIVE
This APHIA II Coast activity has been supported in 9 out of 13 districts of Coast Province. Intensified HIV
screening of TB patients will be part of the institutionalized TB/HIV collaboration and PITC in all TB
diagnostic and continuation centers. This activity will provide clinical prophylaxis and treatment for TB to
500 HIV patients and HIV counseling and testing to 1,000 TB patients. It will also support training of HIV
and TB care staff on routine PITC of TB suspects and cases using the TB-HIV curriculum. The project will
provide additional staff if required, support intensified screening of HIV cases for TB, support upgrading of
laboratories with additional equipment, and renovation of laboratory space, as necessary. CTX prophylaxis
will be introduced for all HIV infected TB cases. Therapeutic and supplementary nutrition will be provided to
eligible TB/HIV patients. Planning, monitoring and supervisory mechanisms for collaborative activities will
be strengthened at provincial, district and TB zone levels. Isoniazide (INH) prophylaxis will be provided for
six months to HIV infected infants identified through PCR testing from DBS samples. The capacity of select
HIV/AIDS CBOs and local NGOs like Mkomani Clinic Society will be increased to integrate TB into their on-
going HIV/AIDS activities. Low literacy materials on TB/HIV will be supplied. The private providers who
cater for the lower socio-economic groups will be trained and linked to either the public HIV/AIDS and TB
programs or the Gold Star Network whose target is paying clients in the private sector. An estimated 90
public and private sector providers will be trained on TB-HIV. Intensified TB screening for HIV patients and
HIV screening for TB suspects/patients will be offered as a standard of care in all the facilities;
approximately 500 TB patients will be identified as being infected with both TB and HIV.
This APHIA II Coast TB/HIV care activity will provide clinical prophylaxis and treatment for TB to 500 HIV
patients, HIV counseling and testing to 1,000 TB patients and train 90 health workers in TB/HIV related
activities in 14 health care facilities in Coast Province.
4. LINKS TO OTHER ACTIVITIES The activity will link to APHIA Coast other activities in CT, Palliative
Care: Basic Health Care and Support , ARV services , Condoms and Other Prevention , Orphans and
Vulnerable Children , Prevention of Mother to Child Transmission and Abstinence and Be Faithful that all
seek to provide comprehensive district based services coordinated at the provincial level.
This activity targets People Living with HIV/AIDS, HIV/AIDS affected families and individuals diagnosed with
TB.
Project emphasis is intensified TB screening and prevention for the HIV infected patients at health facility
level, but with enhanced emphases in community mobilization/participation, development referral systems,
local organizations' capacity development, workplace programs, and IEC materials provision. APHIA II
Coast will intensify provider-driven PITC in health care settings seeking to enhance testing in TB diagnostic
centers that currently do not provide ART services. These facilities are largely health centers and
dispensaries that offer TB diagnostic services but are not providing ART. HIV positive patients identified via
these activities will be referred to nearby treatment sites. This will complement the current PITC program
that has intensified testing in facilities where both TB and ART services are provided.
Continuing Activity: 14810
14810 9062.08 U.S. Agency for Family Health 6948 4913.08 APHIA II - Coast $390,000
9062 9062.07 U.S. Agency for Family Health 4913 4913.07 APHIA II - Coast $400,000
Estimated amount of funding that is planned for Human Capacity Development $35,000
Table 3.3.12:
+ Prime partner Family Health International has been competitively selected to implement the activity.
+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 22,500 with testing and
counseling. Of those tested, approximately 1,800 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 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.
+In 2009, the activity will also focus on establishing appropriate linkages with PMI and ensure that OVC
being supported are also able to benefit from mosquito nets procured by PMI.
This activity will support key cross cutting attributions of the budget amounting to $60,000 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 $100,000. A further $20,000 will be attributed to provision of safe water guards for households
looking after OVC.
The APHIA II Coast orphans and vulnerable children activities will relate to HIV/AIDS treatment services
(#8813), counseling and testing (#8781), Other Prevention (#8930), HBHC (#8934), TB/HIV care activities
(#9062), AB (#8950) and PMTCT (#8764).
This activity will lead to provision of comprehensive support to 25,000 OVC and their households both
directly and through leveraged resources from other partners in the region. There are existing programs
responding to the needs of OVC but this is, in most cases, a scattered and an uncoordinated response.
Initial activities will therefore focus on strengthening that and ensuring it is comprehensive package as laid
out in the USG guidelines. Through the technical leadership of CRS (Catholic Relief Services) and Social
Impact the capacity of NGOs CBOs, FBOs will be strengthened through training of trainers so as to enable
them train at least 2,250 care givers provide a high quality comprehensive care to OVC. Recognizing the
role that they play in the response to taking care of their own, key community stakeholders who include civic
leaders, parents, care givers, community leaders, religious leaders and community groups will be engaged
through capacity development activities to survey vulnerable children and their needs, assess existing
community resources and gaps, establish a coordination and referral mechanism, plan and monitor a joint
response to the OVC. CLUSA, who are one of the strategic Partners for APHIA Coast will provide technical
leadership in mobilizing the community to lead the response to OVC.
This activity will contribute to the Kenya 5-year strategy and will increase the number of OVC receiving
HIV/AIDS care and support, and will reach 25,000 OVC with comprehensive quality services and train 2,250
caregivers.
The APHIA II Coast OVC activities will relate to HIV/AIDS treatment services (#8813) , counseling and
testing (#8781), Other Prevention (#8930), home based care services (#8934), abstinence and be faithful
(#8950), prevention of mother to child transmission (#8764) and TB/HIV (#9062). This activity will provide
referral, as appropriate, to OVC and their community to necessary HIV/AIDS services especially counseling
and testing and treatment.
This activity targets orphans and vulnerable children, caregivers of OVC, and community health workers.
The local capacity of each organization will be strengthened by working with community leaders, religious
leaders, volunteers as well as partnering with other existing community-based and faith-based organizations
that exist in the same community.
The key legislative issues being addressed is stigma and discrimination through close links in building the
capacity of the community to address the local needs of the OVC in each community as well as in training
the caregivers of the OVC. This activity also addresses the wrap around issue of food and education.
Ensuring the needs of the girl child will also be addressed as the needs relate to being an OVC.
Major emphasis is in community mobilization/participation and minor emphasis areas in developing
network/linkages, local organization capacity development and training.
Continuing Activity: 14811
14811 9048.08 U.S. Agency for Family Health 6948 4913.08 APHIA II - Coast $4,950,000
9048 9048.07 U.S. Agency for Family Health 4913 4913.07 APHIA II - Coast $1,700,000
* Increasing women's access to income and productive resources
* Increasing women's legal rights
Estimated amount of funding that is planned for Economic Strengthening $60,000
Estimated amount of funding that is planned for Education $100,000
Estimated amount of funding that is planned for Water $20,000
Table 3.3.13:
+ Geographic coverage has been revised and expanded to include additional districts in the Coast Province
+ Target population will be expanded to include testing for OVCs
+ APHIA II Coast will expand counseling services within the province and include outreach services
provided through existing and new VCT sites that are integrated within health facilities. The CT services will
include door to door CT and testing of family members of the infected individuals receiving care and
treatment within the facility and other outreaches like moonlight VCT as well as institutionalizing testing and
counseling in health care settings. PITC services will be scaled up.
+ HBCT services will be provided in Mombasa town beginning in the slum areas and HBCT will be initiated
in Kwale district.
+ This activity will also provide support at the provincial and district levels for the annual national HIV testing
campaigns
+ geographic coverage has been revised and expanded to include additional districts in the Coast Province
+ target population will be expanded to include OVCs
include door to door VCT and testing of family members of the infected individuals receiving care and
treatment within the facility.
This activity is related to activities in TB/HIV care activities, HIV/AIDS treatment services, abstinence and be
faithful, OVC, HBHC, other prevention and PMCT.
In 2009, this activity will reach 250,000 individuals with Counseling and Testing services including PITC,
VCT, and HBCT. 500 providers will be trained in counseling and testing according to national standards. In
2009, this activity will provide counseling and testing services to 250,000 people through the broadened
entry points which include the clinical care settings through the provider initiated testing (PIT) and the
traditional VCT sites, both integrated and free standing. The MOH already has an approved HIV testing
serial testing protocol using whole blood and simple rapid tests. Previous efforts concentrated on diagnostic
testing mainly of patients who had clinical indications of AIDS. This time, all clients visiting health facilities
for different services will be given an opportunity to know their HIV status as a routine test in the package of
care. This will be strengthened further through routine counseling and testing of TB and STI patients. Also
previous efforts concentrated on integrating HIV testing in level III and IV health care facilities. This will be
scaled up to the lower level health facilities especially in Districts where CC-ART sites have been
decentralized. The coast region has already established counseling and testing services but some Districts
have hard to reach populations. Outreach mobile teams will be facilitated to conduct CT services to these
communities. Home/family based CT services will be initiated in Mombasa, Malindi and Kilifi who already
have index clientele enrolled in care. This will require the recruitment, training or orientation of lay
counselors to support this activity. Voluntary counseling and testing will be scaled up through community
mobilization and outreach services for youth and adolescents in the region. This will be done in
collaboration with National organization for Peer Educators (NOPE) who is one of the Strategic Partners to
promote the culture of the need to know one's sero status among the youth. Building on NOPE's work with
workplace HIV/AIDS programs, CT and testing will be integrated in workplace programs that already have
HIV/AIDS policies and care and treatment programs so that there is an active linkages for those testing HIV
positive. The broadening of entry points to counseling and testing will require that at least 150 service
providers are trained in routine and diagnostic counseling and testing especially at lower levels of health
care provision. The training will encompass aspects of care and treatment and the need for systematic
referral. In addition, CT services will targeted to reach most at risk populations such as sex workers,
truckers, couples, OVCs, substance abusers and training in couple counseling and youth and adolescent
counseling for all existing counselors will also be conducted. Through the collaboration with (CLUSA) and
using the FHI model for SBC, community mobilization campaigns for couple counseling and testing will be
conducted. Quality assurance and quality improvement are key to the fulfillment of the government
objectives and the Districts will be supported to provide supervision to the service providers including
training of more people in support supervision. Sub agreements in this program will be awarded to National
Organization for Peer Educators (NOPE) and the Ministry of Health.
This APHIA II Coast project will contribute to the Kenya 5-Year Strategy which focuses on HIV prevention.
Targets in this project will contribute to numbers counseled and tested for HIV/AIDS. The proposed program
contributes to COP 2008 targets, and is consistent with the PEPFAR 5-Year Strategy, in the following
manner: Increased access to counseling and testing clinical services, and increased availability of
counseling and testing clinical services.
The APHIA II Coast Counseling and Testing activities will relate to HIV/AIDS treatment services, Abstinence
and Be Faithful Program, OVC, HBHC, TB/HIV care activities, OP, and PMCT. This activity will ensure
referral for services for those that test positive especially to prevention services and post test clubs and to
care services such as TB, and treatment while others will be referred to post test clubs.
This activity will target the general population including adults (men, women, FP clients, youth), People
affected by HIV/AIDS (children born of HIV infected mothers, spouses of HIV infected persons, family
members of an HIV infected person), community members including faith based organizations, non-
governmental organizations, and community based organizations. Health providers both in the private and
public sector providers will be targeted.
Activity Narrative: 6. KEY LEGISLATIVE ISSUES ADDRESSED
Gender is a key legislative issue addressed in this activity. This includes activities supporting counseling
that challenges norms about masculinity, delayed sexual activity and reduced multiple sex partners for boys
and men and transactional sex. The activity also include support for testing and support services for victims
of sexual abuse and violence, training on couple counseling, risk assessment, stigma reduction, and
supporting women to mitigate potential violence.
This activity supports the development and implementation of referral systems, quality assurance and
supportive supervision for CT counselors. The activity will also support the training of additional counselors
especially targeting testing for youth and in clinical setting. The activity will also work with local
organizations and MOH in Coast province to strengthen their capacity to implement programs.
Continuing Activity: 14812
14812 8781.08 U.S. Agency for Family Health 6948 4913.08 APHIA II - Coast $2,000,000
8781 8781.07 U.S. Agency for Family Health 4913 4913.07 APHIA II - Coast $900,000
Table 3.3.14:
+ Jointly with program and MOH technical staff strengthen integration, linkages and/or referral systems
between facility-based and community-based monitoring and reporting systems especially with regard to
enrollment and retention of HIV+ clients on care and support (PMTCT, CT, TB, OVC and ART)
+ Increasingly, shift focus to quality of prevention care and treatment through planned and regular analysis,
feedback and use of data on quality indicators at facility/community, district and provincial data review
meetings.
+ Support MOH/PMO/PHRIO in strengthening HMIS functions especially on overall reporting rates, records
keeping, structured supportive supervision using M&E focused supervisory checklists, data use and hiring
of data clerks to reduce increased data management burden on health care workers in the province.
+ Conduct basic program evaluations (process evaluations, assessments, program reviews and some
outcome level evaluations) in prevention, care and treatment programs to document implementation and
short-term effectiveness of programs.
This activity supports key cross-cutting attributions in human capacity development through training of GOK
and USG partner personnel in HMIS, M&E and Surveillance both at national and regional level.
The only changes since approval in 2007 COP are:
+The planned documentation of best practices in each program area and dissemination to stakeholders in
the region to improve program efficiency and effectiveness, and planned Behavioral Monitoring Surveys
(BMS) and dissemination of findings to stakeholders for improved HIV/AIDS programming. This activity also
includes the development of data quality improvement plan, training data point persons on DQA tools and
implementation of regular data quality audits at sampled health facilities and community level programs.
This activity is related to other activities in Strategic Information (#7098, #7002 and #9220).
This activity will strengthen the provincial and district level Health Management Information Systems (HMIS)
currently in use by MOH at health facilities and Community Based Program Activity Reporting (COBPAR)
currently being rolled out at Constituency AIDS Control Committee (CACC) levels by the National AIDS
Control Council (NACC) through three key components. Component 1: Support APHIA II Coast/FHI and
MOH program data collection processes for performance reporting needs (quarterly, semi-annual, annual).
This component will support participatory, coordinated and efficient data collection, analysis, use and
provision of information to track achievement of APHIA II Coast/FHI and MOH's district level Annual
Operation Plan II objectives. This process will also inform decisions at the local, district and provincial
levels, using standardized M&E/HMIS tools approved by the MOH. Component 2: Strengthen community
and facility based reporting systems being rolled out by NACC and NASCOP. The component will support
APHIA II Coast/FHI and MOH to measure progress towards its overall contribution to the country's
Emergency Plan, National Health Sector Strategic Plan II and Kenya's National HIV/AIDS Strategic Plan
goals and results frameworks. Specific activities will include building capacity of 40 local organisations and
facilities to collect, report, analyse, and use both routine facility and non-facility data for planning and
program improvement. Component 3: Take the lead role in coordinating M&E activities in the province to
meet the information needs of the Emergency Plan, MOH, NACC and other stakeholders, in line with the
"three ones" principle. APHIA II Coast/FHI will organize district-level consensus building forums on M&E
issues, distribute standardized data collection and reporting tools, conduct regular data quality assurance
processes at all data generation points, train 140 facility and community based data point staff on the new
data collection/reporting tools and data use for improving program performance, and hold provincial level
quarterly and annual stakeholders' information dissemination meetings. APHIA II Coast/FHI will be held
accountable for tangible results, especially in increased use of harmonized data collection and reporting
tools at health facilities developed by MOH, increased data use in planning and at dissemination workshops
to various stakeholders, increased supportive-supervisory visits and routine data quality assessments at all
data collection points by M&E/HMIS officers, and improved coordination of M&E activities in Coast province.
These efforts should result into demonstrated evidence in increased national level reporting by up to 60%
from health facilities to NASCOP national database.
The activity builds on the FY 2006 activities that support the national M&E systems as well as contributing
to the Emergency Plan's training outputs. In overall, the activity will provide technical assistance to twenty
five local organizations/health facilities in strategic information in addition to supporting the training of 75 SI
and program managers in M&E/HMIS, reporting and data use for program management.
This activity is related to the strategic information activity to be carried out by MEASURE Evaluation
(#7098), where MEASURE Evaluation will be supporting NACC in rolling out COBPAR system for
community level reporting. It is also related to the strategic information to be carried out by NASCOP
(#7002), where NASCOP will rolling out Form 726, Form 727 and program specific client registers for data
collection and reporting at health facilities. It is also related to SI TE/TBD (#9220), that will attempt to
investigate the causes for low reporting rate by health facilities and recommend strategies for achieving
100% reporting level by health facilities.
This activity targets host government workers and other health care workers like M&E and HMIS officers for
data collection, analysis, reporting and use at both health facilities and community level. Program managers
are as well targeted for orientation on the role M&E program management.
The major emphasis area is Health Management Information Systems (HMIS) and minor areas include
Activity Narrative: monitoring, evaluation, or reporting (or program level data collection) and Other SI Activities.
Continuing Activity: 14814
14814 9711.08 U.S. Agency for Family Health 6948 4913.08 APHIA II - Coast $300,000
9711 9711.07 U.S. Agency for Family Health 4913 4913.07 APHIA II - Coast $90,000
Estimated amount of funding that is planned for Human Capacity Development $150,000
Table 3.3.17:
In 2009 APHIA II Coast will continue to strengthen the dissemination of key Government of Kenya (GOK)
policies and guidelines, developed at national level, to the district level. In addition APHIA II Coast will
continue to support provincial and district health systems strengthening by convening consultative meetings
and various stakeholders' forums.
In addition, APHIA II Coast will continue to strengthen the institutional capacity of various local partners at
grassroots level using very participatory methodologies. This will include institutional strengthening for 15
organizations. APHIA will also build the management and supervisory capacity of District Health
Management Boards (DHMTs) to effectively carry out their roles. All persons trained under APHIA will also
be equipped with skills for stigma mitigation. The prevention peer educators and community health workers
will engage the community on dialogue on stigma with the aim of enabling people to identify stigma in their
community and work towards stigma reduction, other approaches to be utilized will include community
theatre and outreaches.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute to strengthening Government of Kenya systems on policy, planning and
budgeting. This will be done by enhancing dissemination and understanding of key government policies
and guidelines, which will be developed or reviewed nationally, out to the districts through provincial
channels and building the capacity of local APHIA implementing partners.
This activity will link to other APHIA II Coast activities, particularly in AB and OP.
This activity will target all population of Coast province including youth, women, and men.
5. EMPHASIS AREAS / KEY LEGISLATIVE ISSUES ADDRESSED
The main emphasis area for this activity will be local organization capacity building via serving to enhance
the management and coordination capacity of district and provincial health management teams in at least ¾
of the districts in the province served by the implementer.
Continuing Activity: 16331
16331 16331.08 U.S. Agency for Family Health 6948 4913.08 APHIA II - Coast $100,000
Table 3.3.18:
