PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
Updated April 2009 Reprogramming. Increased by $105,000. Funds moved from ITM (HVAB).
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:
+ This activity will incorporate $103,600 to partner with HIV Free Generation activities that focus on youth.
It will be programmed with funds from the $7 million FY 2008 plus up for HIV-Free, which will be integrated
into the Tuungane site.
+All VMMC (Voluntary Medical Male Circumcision) activities described in the FY08 narrative are now
incorporated in their own narratives in FY09 under VMMC
+The geographic coverage has been revised (or expanded) to include Bondo, Rarieda and Nyando districts
with their comprehensive youth program as well as their Families Matter! Intervention. Geographic
coverage has been revised (or expanded) to include other low income settlements adjacent to Kisumu City,
namely, Mamboleo, Kisian, Kibos and Nyamasaria, as well as one new division in Suba district (Magunga)
+Specific prevention messaging targeting adult women, men and discordant couples will be incorporated
into the Home Based Counseling and Testing interventions currently being implemented in Kisumu East
District with also a new focus on integrating CT with older adults above the age of 45.
COP 2008
FY07 PLUS UP ADDITIONS: This plus-up allocation will support an expansion of current 07 COP activities.
The Tuungane project will strengthen the scope of its current prevention program by targeting parents
through implementation of the Families Matter! intervention. Tuungane will train parents drawn from the
Kisumu slums within which the youth program targets. These will include parents of children in and out of
schools targeted by the project within the 6 main slum neighborhoods of Kisumu. This activity will be
integrated into the home-based counseling and testing and general prevention. It will help accelerate
prevention through the involvement of parents; both to target them with prevention education focusing on
faithfulness with knowledge of serostatus, as well as improve their ability to discuss HIV prevention with
their young pre-adolescents and adolescents. Tuungane will expand activities in Suba to work with parents
and adults to ensure a supportive environment for youth. It will also help to enhance faithfulness and
knowledge of HIV status among adults and their partners, including fisherfolk and migrant business workers
in selected beaches of Suba district.
1. LIST OF RELATED ACTIVITIES
This activity relates to activities in Counseling and Testing (#8751), Condoms and Other Prevention (#6897)
and HIV/AIDS Treatment: ARV Services (#7090).
2. ACTIVITY DESCRIPTION
Impact Research & Development Organization (Impact Research) will reach 250,237 youth, including young
HIV-negative men receiving circumcision, under the Tuungane behavior change project through providing
Abstinence and Faithfulness education and related services through seven youth-friendly centers in six
major slum neighborhoods of Kisumu, Nyanza Province. Tuungane will also step up activities with the Suba
community. A central referral and coordination center will continue to serve as the hub of all AB youth
activities and at least 800 youth will receive a curriculum-based training on life planning skills. The
Tuungane project will enhance adult involvement in the AB program through training an additional 400
adults, including parents, teachers and religious leaders as supportive adults for the youth. The project will
intensify its efforts to reach out to at least 5,000 at-risk girls with behavior change interventions and improve
the involvement of girls in all elements of the project. This will be done through forming reproductive health
clubs for out of school girls and teen mothers. An important need identified by the project in the previous
year is addressing sexual violence through integrating it into the education for behavior change activities.
This will be coupled with educating youth on the increased HIV vulnerability in the context of alcohol and
substance abuse. Tuungane has demonstrated a remarkable strength in implementing intensive and quality
interventions in the community and has useful lessons which will be scaled up to the underserved and
highly vulnerable population of Suba district in Nyanza. Tuungane will work with schools in Suba as well as
with out of school youth including the beach community and the general community of youth and young
adults to provide comprehensive AB education. These activities will contribute to our results of improved
HIV preventive behaviors among youth, changed social and community norms to promote HIV preventive
behaviors in youth and young adults, and models for effective youth interventions tested. The Tuungane
project was funded under a CDC Cooperative Agreement in October 2004 and works within Kisumu urban
slums whose estimated youth population is 80,000. The project and the specific interventions will be studied
for effectiveness by Kenyan evaluators who are part of the staff of Impact Research and Development
Organization. Youth will be continually involved in activities that help sustain HIV preventive behavior
through periodic training in life skills. To provide a supportive environment for young people's adoption and
maintenance of HIV preventive behavior, parents, religious and community leaders will be reached with
targeted activities. These changes will contribute to testing a model of effective youth interventions. It will
also improve social and community norms to promote HIV preventive behaviors in youth and young adults.
Most importantly, it will make significant contributions to improved HIV preventive behaviors for youth
through strengthening life skills.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
Abstinence and faithfulness activities will target youth in the slum areas of Kisumu and selected sites in
Suba District. This will significantly contribute to the PEPFAR goals of averting HIV infections among youth.
Specifically, this project will train 1200 leaders and health service providers to reach 250,237 youth with AB
messages.
4. LINKS TO OTHER ACTIVITIES
Tuungane's AB activities in Kisumu slums relate to activities in CT (#8751), OP (#6897) ART UCSF/FACES
(#7090). Linkages between existing youth service providers include the Family Health Options Kenya, the
Network for Adolescents and Youth in Africa, local youth groups, and the Municipal Council of Kisumu. A
strong referral linkage will be strengthened for young people who test positive. Currently, referrals for young
couples are made to the KEMRI/CDC PEPFAR-supported patient support center of the Nyanza provincial
general hospital as well as the FACES project.
Activity Narrative: 5. POPULATIONS BEING TARGETED
This activity targets the general population including men and women of reproductive age as well as youth,
especially young girls and boys in and out of school. It will target PLWHAs and incorporate them into their
education program. It will also work with street youth and out-of-school youth. It will strengthen its
community involvement through working with community, program, religious leaders and volunteers. In-
school programs will involve training teachers on communication skills with youth on sexual and
reproductive health issues. Existing community structures will be utilized including youth and community
organizations as well as faith-based organizations. The proposed work in Suba will serve rural communities.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This project will address key legislative issues particularly gender issues. The project will work at increasing
gender equity in its programming, particularly enhancing the participation of young women in the AB
activities. Participatory approaches such as magnet theatre will be employed to address male norms and
behaviors as well as the reduction of violence and coercion through the life skills training. Stigma and
discrimination will be addressed through intensive community education and sensitization forums.
7. EMPHASIS AREAS
This program will have a major emphasis in community mobilization/participation. Minor emphasis will be
place on development of network/linkages/referral systems, information education and communication,
training, needs assessment and human resources. Another component will be Service Delivery in Facilities
and through Mobile approaches: In collaboration with the MOH, the Nyanza Circumcision Consortium,
through IRDO, will work on targeted roll-out of MC services in Nyanza. Service delivery capacity-building
will be rolled out in government district hospitals and some private facilities where providers have been
trained and where other USG PEPFAR partners, including KEMRI, are currently working. In addition to
training, support will be provided for non-consumable commodities (i.e. autoclaves, instrument packs,
surgical lamps, etc) personnel and other infrastructure that will be necessary for MC service delivery.
Service roll-out will initially target areas with high existing demand for MC services and will be integrated
into discordant couples services for discordant male partners of women in care and treatment programs.
Mobile service provision will be provided by mobile teams consisting of approximately seven people
(including 2 clinical officers, 1 VCT/behavioral counselor, 2 surgical nurses, 1 sterilizer/cleaner and 1 driver)
targeting high risk groups, such as STI patients, beach populations, young men in the public transport
sector, jua kali artisans, and truck drivers, as well as areas of very high HIV prevalence. For example,
mobile services will be provided in Suba District, Kenya's highest HIV prevalence district, to complement the
current door-to-door VCT program that PEPFAR is supporting there. In addition, services will be provided
within areas such as the Demographic Surveillance Study area where operational evaluation can be
conducted and in other areas where PEPFAR services exist. A critical component of this activity will be the
provision of AB counseling and interventions for men undergoing both VCT and circumcision. This activity
will help to develop several AB interventions that can be used to help reduce any sexual disinhibition which
may come as a result of programmatic scale-up of MC.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14822
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14822 4246.08 HHS/Centers for Impact Research 6952 692.08 $1,632,500
Disease Control & and Development
Prevention Organization
6896 4246.07 HHS/Centers for Impact Research 4229 692.07 $845,000
4246 4246.06 HHS/Centers for Impact Research 3259 692.06 $100,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
Updated April 2009 Reprogramming. Increased by $105,000. Funds moved from ITM (HVOP).
+ IRDO will expand their Positive Prevention program for adolescents and youth to geographic areas
outside of Kisumu town.
+ Geographic coverage has been revised (or expanded) for the commercial sex worker intervention in
Nyando and in Suba.
+ Clients of CSWs will be targeted with specific interventions that focus on consistent condom use and
knowing HIV status.
+ IRDO through their Tuungane project has begun working with MSMs in Kisumu and this peer education
intervention will be expanded to include more of a comprehensive prevention approach for this population in
Kisumu East as well as through the promotion of CT services and condom distribution networks specific for
the MSM community.
+This activity will incorporate $50,000 to partner with HIV Free Generation activities that focus on youth.
+All VMMC (Voluntary Medical Male Circumcision) activities described the FY08 narrative are now
incorporated in their own narratives in FY09 under VMMC.
The only changes to the program since approval in the 2007 COP are:
•Geographic coverage has been revised (or expanded) to include the Sugar Belt region (Miwani, Chemelil,
Kibos and Muhoroni), characterized by transactional and commercial sex work and vulnerable mobile
populations. Additionally, FY 08 MC funds will allow IRDO's circumcision services to expanded to multiple
areas in Siaya and within the DSS, as well as other health facilities in Suba District.
•The target population has been revised (or expanded) to include sex workers in the Sugar Belt region
adjacent to Kisumu, young men in high risk occupations such as transport sector (bus/matatu touts and
drivers, bicycle taxis, and beach populations especially in Suba district).
•Other changes include: In collaboration with the MOH, the Nyanza Circumcision Consortium, through
IRDO, will work on targeted roll-out of MC services in Nyanza. Service roll-out will initially target areas with
high existing demand for MC services and will be integrated into discordant couples services for discordant
male partners of women in care and treatment programs. Mobile service provision will be provided by
mobile teams consisting of approximately five people (including 2 clinical officer, 2 VCT counselor, 1
surgical nurse, 1 sterilizer/cleaner and 1 driver) targeting high risk groups, such as uniformed services
personnel and truck drivers, and areas of very high HIV prevalence. For example, mobile services will be
provided in Suba district, Kenya's highest HIV prevalence district, to complement the current door-to-door
VCT program that PEPFAR is supporting there. In addition, services will be provided within areas such as
the Demographic Surveillance Study area where operational evaluation can be conducted and in other
areas where PEPFAR services exist. Service delivery capacity building will be rolled out in district hospitals
and some private facilities where providers have been trained and where other USG PEPFAR partners,
including KEMRI, are currently working. In addition to training, support will be provided for non-consumable
commodities (i.e. autoclaves, instrument packs, surgical lamps, etc…) personnel and other infrastructure
that will be necessary for MC service delivery. Additionally, the funds will enable the piloting of provision of
circumcision to infants as well as further expansion of training and service provision based on leveraging
ability of funds from other sources, including the Ministry of Health and the Gates Foundation.
•$50,000 of this activity is programmed with funds from the $7 million FY 2008 plus up for the Healthy Youth
Programs Initiative.
This activity relates to activities in Abstinence and Be Faithful Programs (#6896), Counseling and Testing
(#8751) and HIV/AIDS Treatment/ARV Services (#7090) and Palliative Care: Basic Health Care and
Support (#6870).
Impact Research & Development Organization (IRDO) will reach 338,032 at-risk and vulnerable youth and
other persons engaged in risky sexual behavior under the Tuungane behavior change project with condoms
and other prevention activities. It will continue to work through the seven youth-friendly centers in six major
slum neighborhoods of Kisumu City, in Nyanza Province and a central referral and coordination center at
Tuungane central. Tuungane will continue to encourage the involvement of adolescent girls and young
mothers through targeted activities for girls. This project will also target various high-risk groups including
bodaboda and matatu operators, street youth, out of school youth, partners and clients of sex workers, bar
workers and discordant couples identified through their CT services. Most importantly, Tuungane will
develop interventions for positive prevention among individuals with HIV. These will include behavioral
interventions targeting PLWAs. Given Tuungane's focus on girls and young women, another intervention
will entail prevention of unintended pregnancies among girls and young women. In addition to the existing
STI prevention services offered by this project, Tuungane will intensify STI screening and treatment for
individuals with HIV and their partners. Through its linkage with USCF's FACES project, Tuungane will
ensure access to care and treatment, including ART for positive people identified through the project.
Overall, this project will promote leadership by individuals with HIV in the positive prevention efforts. An
important need identified by the project in the previous year is addressing sexual violence through
integrating it into the education for behavior change activities and providing Post Exposure prophylaxis.
Education and sensitization on alcohol and substance abuse will be integrated into the condoms and other
prevention activities whenever appropriate. Tuungane has demonstrated a remarkable strength in
implementing intensive and quality interventions in the community and has useful lessons which will be
scaled up to the underserved and highly vulnerable population of Suba district in Nyanza. Tuungane will
work with youth in Suba as well as with identified high-risk groups, including the beach community to
provide comprehensive OP education. Given IRDO's technical capacity, specific interventions will be
evaluated for effectiveness by the Kenyan researchers who are part of the staff of Impact Research and
Development Organization. Significant changes from 2006 to 2009 for this activity include the scale up to
Suba. Another important addition in FY 2009 is the focus on positive prevention. This project will actively
involve existing youth community groups to enable it to rapidly expand behavior change activities for youth
in the slums. Service delivery will be improved through mobile integrated services including provision of free
Activity Narrative: counseling services for youth, including street youth and referrals for free STI treatment.
Abstinence and faithfulness activities and information on correct and consistent use of condoms targeting
youth in the slum areas of Kisumu will significantly contribute to the PEPFAR goals of averting HIV
infections. Specifically, this project will train 1005 youth leaders to reach 338,032 individuals with condoms
and other prevention services. 304 condom outlets will be established.
Tuungane's OP activities in Kisumu slums relate to activities in CT (#8751), ART (#7090), AB (#6896) and
STI treatment. Linkages between existing youth service providers include the Family Health Options of
Kenya, the Network for Adolescents and Youth in Africa, local youth groups, and the Municipal Council of
Kisumu. A strong referral linkage will be strengthened for individuals with HIV. Currently, referrals for young
general hospital as well as the FACES project. PLWHAs who are aged 21 years and above are referred for
psychosocial support to FACES and most of those aged 21 years or below enroll in Tuungane's support
group.
5. POPULATIONS BEING TARGETED
This activity targets the general population including men and women of reproductive age as well as youth.
It also targets special populations, mainly most at risk populations such as discordant couples, street youth
(many of whom are men who have sex with men) and out-of-school youth. At community level, this program
will target community and religious leaders, most of whom will work in a volunteer capacity in their
respective areas of work. Through its alcohol intervention, brothel owners and bar workers will be targeted.
Existing community structures will be utilized including youth and community organizations as well as faith-
based organizations. It will also work with private and public health care providers to strengthen STI
screening and treatment and referrals for HIV/AIDS care and treatment.
gender equity in its programming, particularly enhancing the participation of young women in the Other
Prevention activities. Participatory approaches will be employed to address male norms and behaviors as
well as the reduction of violence and coercion through participatory education and training. Stigma and
This program will have a major emphasis in Community mobilization/participation. Minor emphasis will be in
development of network/linkages/referral systems, Information Education and Communication, training and
needs assessment. This is an expansion to the existing COP 2007 activity. Impact Research and
Development Organization's Tuungane project will expand its support to at-risk youth in the Kisumu slums
and youth/young people involved in alcohol and substance abuse. This expansion will also allow for a
minimal start up in a selected location in Suba district, where the Tuungane project has recently set up new
project activities focusing on the fisherfolk community of Suba District, Nyanza province. The expansion in
Kisumu will allow for an increase in scope to allow coverage of new locations adjacent to the five major
Kisumu slums. These will include Mamboleo, Kibos, Nyamasaria and Kisian areas. Additionally, the
Tuungane project will intensify its campaigns against sexual violence, which is a rampart practice
significantly affecting adolescent girls. These activities will be integrated into the existing broader prevention
program, including increasing linkages and referrals to counseling and testing.
Continuing Activity: 14823
14823 6583.08 HHS/Centers for Impact Research 6952 692.08 $3,072,500
6897 6583.07 HHS/Centers for Impact Research 4229 692.07 $930,000
6583 6583.06 HHS/Centers for Impact Research 3259 692.06 $260,000
Table 3.3.03:
Updated April 2009 Reprogramming. Increased by $500,000. Partnership Framework: IRDO currently
covers most districts in Nyanza, but 3 districts (Bondo, Rarienda and Ugenya) are yet to be covered. With
additional funds, they could cover most rural areas and expand to these districts.
+ the activity description has been expanded to include more information on activities.
+ In addition to existing 4 youth facilities in Mbita, Mfangano, Central and TYTC, the two youth centers in
Nyando and Kisumu West district will be expanded to offer over 500 MCs monthly totaling to 36,000 VMMC
in FY 09.
+Youth sites will be modified to create space for circumcisions i.e. VCT, clinical exam, a surgical minor
theatre, recovery and sterilization rooms.
+Improved rooms will be provided with MC support equipment (Lamps, autoclaves, Couches, Trolleys, trays
etc), instruments and consumables.
+Each facility will be manned by two experienced and trained clinical officers, two scrub/theatre nurses, one
cleaner/infection control staff and one nurse assistant/counselor to provide consenting, risk reduction
counseling and appropriate health education for MC.
+Community education and mobilization in the areas covered with FY2008 funds will continue, namely Suba
and Kisumu East. Altogether, IRDO will work with 223 youth groups in four districts: Suba, Kisumu East,
Kisumu West and Nyando Districts.
+Training consistent with WHO/UNAIDS guidelines and the WHO Manual for Male Circumcision under
Local Anesthesia will be provided to additional staff besides those trained with FY08 funding in Bondo,
Suba and Siaya districts. Cadres include Medical officers, Clinical officers, Nurses, Counselors and hygiene
staff.
This activity relates to activities in AB (#6896) and OP (#6897), Counseling and Testing and adult care and
treatment.
2. ACTIVITY DESCRPTION
In collaboration with the MOH, the Nyanza Circumcision Consortium, through IRDO, will work on targeted
roll-out of MC services in Nyanza. Service delivery capacity-building will be rolled out in district hospitals
that will be necessary for MC service delivery. Service roll-out will initially target areas with high existing
demand for MC services and will be integrated into discordant couples's services for discordant male
partners of women in care and treatment programs. Mobile service provision will be provided by mobile
teams consisting of approximately five people (including 1 clinical officer, 1 VCT counselor, 1 surgical nurse,
1 sterilizer/cleaner and 1 driver) targeting high risk groups, such as uniformed services personnel and truck
drivers, and areas of very high HIV prevalence. For example, mobile services will be provided in Suba
District, Kenya's highest HIV prevalence district, to complement the current door-to-door VCT program that
PEPFAR is supporting there. In addition, services will be provided within areas such as the Demographic
Surveillance Study area where operational evaluation can be conducted and in other areas where PEPFAR
services exist. A critical component of this activity will be the provision of VCT services.
3. CONTRIBUTION TO OVERALL PROGRAM AREA
This IRDO project will contribute to the Male Circumcision policy that envisages adoption of MC as one of
the HIV prevention strategies. It will provide this service to 100,000 individuals in Nyanza province
prioritizing adolescents and young adults.
4. LINKS TO OTHER ACTIVITIES.
These will be linked to the Abstinence/be faithful, Condoms and Other prevention to promote health
behaviors and CT. HIV-infected persons identified through this program will be linked to Care and
Treatment activities.
5. POPULATION BEING TARGETED.
This activity targets adolescents and adults living in rural and urban settings. It targets those who are HIV
negative, as identified in home based CT programs or as referred from PMTCT, discordant couple services
or in care and treatment settings. Training activities target public and private based health care workers and
other health workers, but with emphasis on public HCWs. Community activities will target community based
organizations, faith based organizations, community leaders and religious leaders.
6. KEY LEGISLATIVE ISSUES ADDRESSED.
The activity will mainly address gender equity concerns as well as stigma and discrimination issues. By
focusing on young people in community outreaches, the program will strengthen gender equity and facilitate
women's access to HIV/AIDS services.
7. EMPHASIS AREA
This IRDO activity has a major emphasis on training, quality assurance, and supportive supervision. It also
has a major emphasis on community sensitization.
Table 3.3.07:
+ Prevention messages and programs will be integrated with the home based HIV counseling and testing
program to ensure that discordant couples and adult men and women above the age of 50 are targeted.
+ The HBCT program geographic coverage will be expanded to include the larger Kisumu East District
+ Voluntary Medical Male Circumcision key messages will also be discussed in all CT activities as part of
their integrated approach to prevention.
+ All MC activities described in the FY08 narrative are now incorporated in their own narratives in the FY09
under MC.
The only other changes to the program since approval in the 2007 COP are:
+ In FY 2008 IRDO will implement home-based HIV counseling and testing (HBCT) for urban slum dwellers
in Kisumu city. This is an expansion of the CT activities from FY 07, which were mainly site-based. In FY
08, IRDO will establish a fully fledged HBCT program including a communication strategy. This will lead to a
large increase in the number of people counseled and tested and accessing care and treatment with the
support of IRDO.
+ They have also successfully implemented youth prevention programs that included counseling and
testing. They will therefore use their experience and community structures to promote CT as a primary
activity. IRDO will receive support in training of CT providers including supervisors. Since home based CT in
urban slums is a new concept, this activity will be evaluated from time to time.
This activity relates to activities in AB and OP.
In FY 2009, Impact Research & Development Organization's (Impact Research) Tuungane project will
provide HIV counseling and testing (CT) services to 50,000 individuals in Kisumu's slums and other
underserved areas. This activity will respond to the high demand for counseling and testing created through
Tuungane's behavior change activities targeting youth and at-risk populations. Tuungane will work through
the 20 youth-friendly satellite centers in 5 major slums of Kisumu, in Nyanza Province and a central referral
and coordination center. They will train at least 200 counselors to support their fixed, mobile and Home
Based CT services. Tuungane has made remarkable strides in targeting hard to reach and underserved
populations such as adolescent girls and young mothers through targeted activities. Other high risk
subpopulations to be targeted include bodaboda and matatu operators, street youth, out of school youth,
partners and clients of sex workers, bar workers and discordant couples. Most importantly, Tuungane will
implement a prevention-with-positives program, working with PLWHAs. Additionally, Tuungane will support
couples counseling and disclosure. Communities will be educated on couple discordance and the
importance of couples knowing their HIV status together. Tuungane will also incorporate CT into their
community outreach activities. Tuungane will also introduce diagnostic HIV testing and counseling (DTC) at
its clinic at the Tuungane central youth facility where STI treatment is provided. Nurses and clinical officers
currently working in the clinic will be trained and supported to provide DTC. Tuungane will continue
providing youth-friendly services and addressing barriers that hinder access to counseling and testing. A
coupon referral system and free boda boda transportation will ensure that transportation costs do not hinder
people from seeking services. Through its linkage with USCF's FACES project, Tuungane will ensure
access to care and treatment, including ART for positive people identified through the project. This far,
Tuungane has demonstrated a remarkable strength in implementing intensive and quality interventions in
the community and has useful lessons which will be scaled up to the underserved and highly vulnerable
population of Suba district in Nyanza. Tuungane will work with high-risk groups in a site in Suba including
the beach community to provide counseling and testing services, alongside its behavioral interventions of
condoms and other prevention services. This project will actively involve existing youth community groups
to enable it make rapid scale up of services. Service delivery will be improved through mobile integrated
services including provision of free counseling services for youth and high-risk groups and referrals for free
STI treatment.
The Tuungane's CT program will contribute not only to the overall CT portfolio in Kenya, but will also target
a special and vulnerable population. They will target the youth, especially young girls in a slum area in
Kisumu town. Kisumu town is in Nyanza region, which has the highest HIV prevalence in Kenya. They will
also work in the beaches of Suba district, which is also a high risk population. Through this work Tuungane
will help implement operational models which can be replicated elsewhere in Kenya with vulnerable
populations. Thus Tuungane's contribution is very strategic and should help with future PEPFAR
programming.
In the past Tuungane has implemented several prevention activities. These will be linked to the CT activity.
Some of these programs include; AB, OP and STI treatment. HIV-infected persons identified through this
program will be linked to Care and Treatment activities.
5. POPULATION BEING TARGETED
The activity will mainly target both the street and out-of-school youth, both male and female. It will also
target discordant couples in stable relationships, who will benefit from couple counseling support. It will also
target commercial sex workers and some migrant workers among the beach population in Suba.
focusing on young people, especially girls, Tuungane will strengthen gender equity and facilitate women's
access to HIV/AIDS services.
Tuungane's CT program will focus mainly on community mobilization and participation. To a lesser extent
Activity Narrative: they will focus on human resource and training to support the continuity of the program. Service Delivery in
Facilities and through Mobile approaches: In collaboration with the MOH, the Nyanza Circumcision
Consortium, through IRDO, will work on targeted roll-out of MC services in Nyanza. Service delivery
capacity-building will be rolled out in district hospitals and some private facilities where providers have been
surgical lamps, etc…) personnel and other infrastructure that will be necessary for MC service provision.
into discordant couples' services for discordant male partners of women in care and treatment programs.
Mobile service provision will be provided by mobile teams consisting of approximately five people (including
1 clinical officer, 1 VCT counselor, 1 surgical nurse, 1 sterilizer/cleaner and 1 driver) targeting high risk
groups, such as uniformed services personnel and truck drivers, and areas of very high HIV prevalence. For
example, mobile services will be provided in Suba District, Kenya's highest HIV prevalence district, to
complement the current door-to-door VCT program that PEPFAR is supporting there. In addition, services
will be provided within areas such as the Demographic Surveillance Study area where operational
evaluation can be conducted and in other areas where PEPFAR services exist. A critical component of this
activity will be the provision of VCT services.
Continuing Activity: 14824
14824 8751.08 HHS/Centers for Impact Research 6952 692.08 $500,000
8751 8751.07 HHS/Centers for Impact Research 4229 692.07 $260,000
Table 3.3.14:
ACTIVITY UNCHANGED FROM COP 2008
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
Although this is mainly a prevention initiative, it will be closely linked to the delivery of other services. Those
visitng the health facilities for MC services and test HIV positive will be referred for Care and Treatment
services. Follow-up data on the selected individuals will be used to inform other prevention messages to be
delivered to targeted populations.
1. LIST OF RELATED ACTIVITIES:
This activity is related to the prevention (####) activities.
2. ACTIVITY DESCRIPTION:
This activity will be implemented through a MC Consortium comprising of Impact Research Development
Organization as prime partner, with the following sub-partners: UNIM (Universities of Nairobi, Illinois and
Manitoba), Tuungane Project, Nyanza Reproductive Health Society (NRHS), and Partners in Reproductive
Health (PIRH). Both Tuungane, administered by IRDO and PIRH, administered by NRHS, will be involved in
community education and mobilization. UNIM will be a training Center, IRDO will administer the funds from
PEPFAR/CDC and sub-contract NRHS (a registered Kenyan NGO) to oversee performance of UNIM and
PIRH. For this specific activity, UNIM will work closely with NASCOP, the National MC Task Force and other
key stakeholders to develop appropriate routine monitoring tools for MC programmatic efforts in Kenya. As
a core component of UNIM's MC service delivery, all clinicians (public and private) trained by UNIM will
record key monitoring data on NASCOP-approved data collection forms that will be adapted from UNIM's
clinical trial protocol. Key data elements will include: adverse events, surgical outcomes, client satisfaction,
age of client, consent of client or guardian, and outcomes at post-surgical visits. During year one, closer
monitoring of programmatic outcomes will be important. A random sample of approximately 10% of clients,
stratified by age group and rural versus urban/periurban residence will be selected for follow-up 30-40 days
post-surgery by 2 trained nurses to observe the surgical outcomes and to administer a questionnaire to
assess level of satisfaction, history of adverse events, history of clinical visits, and sexual history since
surgery. Data will be entered at selected health facilities and transmitted to the UNIM Training Centre. Data
will be aggregated and provided to the District Medical Office, the Provincial Medical Office, NASCOP and
the National Male Circumcision Task Force.
This activity will provide vital data needed to monitor the progress and outcome of this key prevention
intervention. The data generated will inform further scale up and provide outcome indicators needed to
evaluate the intervention.
The activity is closely linked to prevention (###) initiatives
The targeted population is the health workers who will be trained on recording the relevant data on the MC
Task Force approved form. However, the long term beneficiary of this intervention will be the eligible male.
Continuing Activity: 14825
14825 12497.08 HHS/Centers for Impact Research 6952 692.08 $100,000
12497 12497.07 HHS/Centers for Impact Research 4229 692.07 $100,000
Table 3.3.17:
