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.
Updated April 2009 Reprogramming. Increased by $75,000. 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:
+Splitting of APHIA II Nairobi and Central to APHIA II Nairobi and APHIA II Central. Targets and Budgets
have been split to reflect this change.
+ 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-positive mentor mothers and
+ 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 and other key staffs to fill critical gaps in service delivery.
COP 2008
1. LIST OF RELATED ACTIVITIES
This activity will relate to the ARV services (APHIA II Nairobi), Orphans and Vulnerable Children, Palliative
Care: TB/HIV, Palliative Care: Basic Health Care and Support and Condoms and Other Prevention.
2. ACTIVITY DESCRIPTION
Pathfinder International (PI) supports facilities to provide comprehensive antenatal package for all pregnant
women including screening, prevention and treatment for any infections (such as sexually transmitted
infections and malaria), nutrition support, prophylactic ARVS, counseling on safe infant feeding, counseling
and HIV testing of women and their partners. APHIA II Nairobi will build on this work in Nairobi province.
APHIA II Nairobi will continue to support established support groups that are formed around PMTCT sites
by mothers who have benefited from the project services and scale up the mother to mother support
services to enhance adherence to ART and infant feeding practices. In addition, referral linkages will be
established within facilities where APHIA II Nairobi is providing antiretroviral therapy, through which HIV
positive clients are assessed and put on treatment where necessary. Decentralization of and task shifting in
treatment and care services including TB services will be supported to improve access in lower level health
services. Quality improvement through standards based management and recognition will be introduced
and supported in all supported sites. The number of HIV positive women and children on treatment is
increasing steadily through these networks. Laboratory networks will also be established that will greatly
improve ART uptake as well as early infant diagnosis. In 2009, APHIA II Nairobi will consolidate these
activities and provide HIV counseling and testing to 10,734 (93%) of 11,492 pregnant women and 2147
spouses in the geographic area of coverage. Antiretroviral prophylaxis will be provided to 1179 (93%) of
1262 HIV-positive women identified. Of the positive women, 590 will receive AZT/NVP, 235 HAART and
354 single dose nevirapine only for prophylaxis. 590 exposed infant will receive PCR for early infant
diagnosis. At the community level lay counselors will be trained to strengthen the delivery of PMTCT
services and to provide continued support for the HIV-positive women and their families. The project will
train community health workers to provide community components of PMTCT services. In order to improve
the quality of care, 35 health supervisors will learn management skills, including utilization of data for
decision making. In 2009, this project will use its experience to consolidate progress in existing facilities,
expand to others within the province, up to 35 facilities and continue to strengthen District Health
Management Teams, and referral networks for PMTCT-plus activities. Pathfinder will train 90 health workers
in PMTCT and comprehensive HIV management for HIV-positive mothers and their families. Efforts will be
made to increase early infant diagnosis in order to identify infants that require HIV care and treatment and
offer more appropriate advice on infant feeding choices. More efficacious regimens for PMTCT will be
introduced and scaled up in all the sites offering services. Linkages to FP/RH will be made as well as to
laboratory services in order to offer a more comprehensive package of care. Capacity for service providers
to provide couple HIV Counseling and testing within PMTCT sites will be supported with 2009 funds. Many
women accessing HIV counseling and testing at PMTCT sites do not know their partner's HIV status. The
program will strengthen innovative approaches to increase the number of men accessing HIV testing
services, thereby enabling discordant couples to know their HIV status -an important HIV prevention
strategy among couples. The program will reach at least 2147 couples.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute to 0.8% of the overall 2009 Emergency Plan PMTCT targets for Kenya.
Community participation and male involvement will significantly contribute to PEPFAR goals for primary
prevention, access to care and treatment, and support of those affected and infected. Technical assistance
to the Ministry of health facilities will contribute to improvement of the quality of services including GOK led
regional meetings.
4. LINKS TO OTHER ACTIVITES
Linkages to HIV care and treatment services will be strengthened, to ensure immediate appropriate care for
the woman and exposed infants, and family members as well and thus optimize utilization of
complementary services created through Emergency Plan funding. This activity will relate to the ARV
services, OVC care, TB/HIV services, HBHC and STP services funded under the APHIA II Nairobi.
5. POPULATIONS BEING TARGETED
This activity targets adults, pregnant women, HIV-positive pregnant women, HIV affected families, and HIV-
positive infants. Health care providers including doctors, nurses and other health care workers will be
targeted for training on PMTCT using the national NASCOP PMTCT CDC/WHO based curriculum.
Activity Narrative: 6. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will address gender equity in HIV/AIDS programs through improved PMTCT service delivery at
ante-natal clinics and maternity units and male involvement. Community health workers and mentor
mothers will conduct community mobilization activities that will help increase service uptake as well as
address issues of stigma and discrimination at community level.
7. EMPHASIS AREAS
This activity includes emphasis on human capacity development through training, supportive supervision
and task shifting, support to strategic information, linkage to family planning, safe motherhood, TB and
nutrition programs as well as Quality Assurance, Community Mobilization/Participation and Development of
Network/Linkages/Referral Systems.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
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 $55,875
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
+ 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
This activity relates to activities in Counseling and Testing (#8976), Palliative Care: TB/HIV (#9072), and
Prevention of Mother-to-Child Transmission (#8729).
$200,000 of this activity supports the HIV Free Generation activities. In FY 2009, Pathfinder and its
prevention partners, including PSI, will target 239,308 youth and adults with community outreach HIV/AIDS
prevention programs that promote abstinence and/or being faithful. Peer education, informal and formal
worksite interventions, community outreach by PLWA, mobile VCT and life skills education for youth will all
serve as a means through which messages will be conveyed. An in-school program for 10 to15 year olds
will emphasize creation of support systems for students to focus on long-term goals, self-esteem and life
skills. Emphasis will be on delayed sexual debut, and secondary abstinence will be encouraged for those
youth who are already sexually active. APHIA II community-level partner capacity for undertaking
prevention and behavior change activities will also be strengthened, so that messages can be conveyed
widely through implementing partners undertaking home and community support activities as well. It is
expected that 1,662 persons will be trained to provide HIV/AIDS prevention programs that promote
abstinence and/or being faithful. Additional project partners to be trained in Other Behavior Change will also
contribute to AB message dissemination. There will be a component of Prevention with Positives whereby
the Project will work through PLWHA Support Groups linked to the Comprehensive Care Centres in Nairobi.
This activity will provide support to patient support groups and post-test clubs in VCT Centres to ensure
abstinence by HIV-infected persons. This will empower 5 people in each of the 15 patient support groups to
become peer and advocacy leaders in prevention at the community level and will reach 30,000 PLWAs.
APHIA II Nairobi will expand their work with the Kenya Girl Guides Association. $150,000 will expand
support in HIV prevention and supportive services to victims of gender-based violence in Nairobi through
the Nairobi Womens Hospital and other facilities. This activity will reach 20,000 youth. $150,000 will be
used to reach high risk out-of-school youth including street children with AB messages. This activity will
reach 70,000 youth.
This activity will contribute significantly to the overall Emergency Plan AB Prevention targets for Kenya.
Integrating prevention into all community outreach for treatment and care, with special emphasis on men
and youth, will significantly contribute to PEPFAR goals for primary prevention and the Kenya Five-Year
strategy for HIV/AIDS.
4. LINKS TO OTHER ACTIVITIES
Support to AB Prevention will be one component of a package of integrated support at health facility and
community levels in the region, holistically addressing HIV prevention, treatment and care. This activity
relates to activities in Counseling and Testing (#8976), Palliative Care: TB/HIV (#9072), and PMTCT
(#8729) through referrals and networking.
The activity targets youth with messages about abstinence and both adults and youth with messages
advocating faithfulness to one partner. Special emphasis will be placed on reaching men through outreach
by PLWAs and involvement of community leaders, by couples counseling in PMTCT and through worksite
interventions. Implementing partner counterparts from NGOs, CBOs, FBOs and schools will be targeted for
training to implement prevention programs.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will be consistent with national strategies for HIV prevention promoting abstinence, delay of
sexual debut including secondary abstinence, fidelity, partner reduction and related community and social
norms.
There will be a major emphasis on capacity building of implementing partners, community-owned resource
persons and other community level implementing partners. Community involvement in the design and
implementation of activities will play an integral part in ensuring the success of these interventions.
New/Continuing Activity: Continuing Activity
Continuing Activity: 21278
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
21278 21278.08 U.S. Agency for Pathfinder 9253 9253.08 APHIA II - $1,150,000
International International Nairobi
Development
Workplace Programs
Table 3.3.02:
+ 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 $150,000 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.
This activity is linked to Palliative Care: Basic Health Care and Support (#8936), Counseling and Testing
(#8976), and Palliative Care: TB/HIV (#9072).
In 2009, APHIA II Nairobi will reach 500,000 individuals, train 1049 people and distribute condoms through
314 outlets. This activity will strengthen HIV prevention programs through other behavior change
approaches (i.e. all behavior change approaches that do not focus on abstinence and being faithful) under
the APHIA II Nairobi Project. In FY 2009, Pathfinder and its prevention partners, including PSI, will target
youth and adults with behavior change messages that are appropriately adapted to different target groups.
Peer education, informal and formal worksite interventions, community outreach by PLWA, mobile VCT, life
skills education for youth, high-risk outreach and transport corridor activities will all serve as means through
which messages will be conveyed. In particular, the project will capitalize on PSI's experience in targeting
informal worksites, market places, and "hot zones" where high-risk behavior is common. Street theater,
interactive games, PLWA testimonials, outreach sessions and community mobilization will be used to
convey messages that include consistent and correct use of condoms, knowing one's status and knowing
your partner's status. APHIA II community level partner capacity for undertaking prevention and behavior
change activities will also be strengthened, such that messages can be conveyed widely through
implementing partners and undertaking home and community support activities.
This activity will contribute significantly to the overall 2009 PEPFAR OP targets for Kenya. By specifically
focusing on men and youth, this activity will significantly contribute to PEPFAR goals for primary prevention
through the integration of prevention into all community outreach for treatment and care.
Support to Prevention/Other Behavior Change will be one component of a package of integrated support at
health facility and community levels in the region, holistically addressing HIV prevention, treatment and
care. It is specifically linked to palliative care, basic health care (#8936), counseling and testing (#8976),
and palliative care, TB/HIV (#9072).
This activity targets both adults and youth, with additional emphasis on worksites to reach men as well as
high-risk groups and persons frequenting/working in "hot spots". It will target special populations such as
bar maids to improve their HIV risk awareness, their rights as bar maids and how they can protect
themselves from acquiring HIV infection. Implementing-Partner counterparts from NGOs, CBOs, FBOs and
schools will be targeted for training to implement prevention programs.
This activity will be consistent with national policies regarding other prevention and will specifically address
gender to improve gender equity in HIV programming as well as address male norms and behavior that
often hinder uptake of prevention activities.
This activity includes major emphasis on worksites and minor emphases implementing-partner capacity
building, linkages with other sectors and initiatives and training. APHIA II Nairobi will expand their activities
to target high-risk youth by training peer educators. The activity will focus on HIV prevention with male and
female sex workers to promote alternatives to commercial sex work as well as protective barriers to prevent
HIV transmission, both with commercial partners and steady boyfriends/girlfriends and husbands/wives. In
addition they will use $100,000 to expand support in HIV prevention and supportive services to 20,000
victims of gender-based violence in Nairobi through the Nairobi Womens Hospital and outreach centers and
train 20 health workers and community participants.
Continuing Activity: 21267
21267 21267.08 U.S. Agency for Pathfinder 9253 9253.08 APHIA II - $600,000
Table 3.3.03:
ACTIVITY UNCHANGED FROM COP 2008
This activity supports key cross-cutting attributions in human capacity development through its training
program for health workers ($30,000).
1. ACTIVITY DESCRIPTION
This activity relates to the strengthening and expansion of adult HIV care services, as well as care and
support, for PLHIV and families affected by HIV & AIDS under the APHIA II Nairobi Project. In FY09, APHIA
II Nairobi will target 95 sites in Nairobi Province to support adult care and support services. Support at
ongoing and new sites will include Ministry of Health supervision and progress review meetings as well as
strengthening of quality assurance, especially with regard to integrating HIV services, integrating HIV with
RH/FP and TB services and HMIS. At new and ongoing sites, service providers will receive training in adult
HIV care management including prevention and treatment of OI, HIV adherence counseling, HIV nutritional
assessment and counseling, couple counseling and prevention with positives (PWP) will be given more
attention in order to curb the tide of new infections. Treatment at the CCCs will be expanded to link and
network with other entry points, such as the out patient departments, inpatient departments, PMTCT, VCT
centers. APHIA II Nairobi will continue to strengthen linkages with community services which include patient
empowerment on adherence through treatment literacy, strengthened support mechanisms (PTC/support
groups, counseling, IGA and legal aid), community based defaulter tracing, home nursing care, prevention
and strengthened referral linkages to the health facilities. APHIA II Nairobi will also provide more
empowering support to people living with HIV providing more opportunities for Greater Involvement of
PLHIV (GIPA) and making the participation of PLHIV more meaningful and sustainable. Efforts will be made
to decentralize services so that patients get treatment where they are presenting for care. It is expected that
23,000 adult clients will be receiving OI prophylaxis at the end of this reporting period in the 95 sites. The
project will continue to support clinical staff, continuous medical education, mentorship, on site technical
assistance, furniture and equipment at health facilities and grantees (Catholic Medical Mission Board,
Nairobi Women's Hospital and Gold Star Network) to strengthen provision of HIV services. Regarding
training 80 service providers will be trained in adult HIV management (care and treatment), 60 in HIV
adherence counseling and 60 in nutritional management in PLHIV. These service providers will also be
targeted for periodic orientation on home and community services to strengthen linkages and between the
facilities and community sites, and to ensure support for HCS at facility level. Caregivers of PLHIV will be
given special attention and will be empowered through formation of support groups, IGAs and PSS sessions
to bolster their coping mechanisms. Approximately 690 caregivers, CHWs and service providers will be
trained on adult care and support. APHIA II will continue to work with existing and new Implementing
partners (IPs) with cutting edge approaches to palliative care (basic). Continuous capacity building will be
rendered to select IPs to strengthen their technical and institutional capacity to own and implement the
planned activities.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute significantly to the overall 2009 Emergency Plan HIV Care and Support targets
for Kenya.
3. LINKS TO OTHER ACTIVITIES
Community based BCC teams such as drama groups and PLHIV advocates, as well as CHWs will play a
pivotal role in mobilization, sensitization, literacy training and advocacy for enhanced adherence. These
community BCC teams will also provide much needed information on both community and health facility
services while being contact points for various types of referrals such as PMTCT, ART, CT, OVC, TB
testing and other basic health services. Clinical supervisors and other health care providers will reinforce
clinic to community referrals by being kept up-to-date on local resources for psychosocial, economic, legal
and food security support. APHIA II Nairobi will continue to link with local partners such as K-REP, to
address economic insecurity through microfinance and business skills training. Implementing partners will
collaborate with local programs and agencies to address food insecurity and nutrition needs.
4. POPULATIONS BEING TARGETED
This activity targets PLHIV and families affected by HIV/AIDS. Local implementing partners will be targeted
for training and capacity building. Health care providers will be targeted for sensitization and training related
to home-based care. Community Health Workers and caregivers will be trained and receive periodic and
relevant refresher training. Health care providers including Doctors, Nurses and Other Health care workers
will be targeted for training using national curricula.
5. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will address issues gender equity and greater involvement of people living with HIV.
6. EMPHASIS AREAS
This activity includes major emphasis on expansion of HIV care, adherence, expansion of quality HCS,
quality assurance, training, linkages between community and formal health care sector, development and
strengthening of networks and referral systems.
Estimated amount of funding that is planned for Human Capacity Development $30,000
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 ($250,000).
This activity will specifically be linked to other APHIA II Nairobi supported activities in PMTCT (APHIA II
Nairobi), OVC (APHIA II Nairobi) and TB/HIV (APHIA II Nairobi), home based care and other prevention
activities (APHIA II Nairobi) ensuring successful referral of individuals that require ART care and support.
This activity relates to support to be provided to strengthen and expand ART services in Nairobi Province
under the APHIA II Nairobi Province Project. In FY09, Pathfinder International (PI), which is the lead
partner, in collaboration with other partners will target 60 sites in Nairobi Province for support in adult
treatment services. Support at ongoing and new sites will include Ministry of Health supervision and
progress review meetings as well as strengthen quality assurance, especially with regard to integrating HIV
services, integrating HIV with RH/FP and TB services and HMIS. At new sites, service providers will receive
training in adult HIV treatment. Prevention with positives will be given more attention in order to curb the tide
of new infections. Treatment at the CCCs will be expanded to link and network other entry points such as
the out patient departments, inpatient departments, PMTCT, VCT centers and community services. Efforts
will be made to decentralize services so that patients get treatment where they are presenting for care.
Laboratory costs are often a hindrance to uptake of services and efforts will be made to facilitate laboratory
networks, support laboratory reagents and equipment that improve uptake of ARV services. It is expected
that 3,000 adult clients will be newly initiated on ART, with 8,400 as the cumulative number of ART adults
clients and 7,000 adult clients will be receiving antiretroviral therapy at the end of this reporting period at
these sites. The project will continue to support clinical staff, continuous medical education, mentorship, on
site technical assistance, furniture and equipment at health facilities and grantees (Catholic Medical Mission
Board, Nairobi Women's Hospital and Gold Star Network) to strengthen provision of HIV services. 80
service providers will be trained in adult HIV management (care and treatment), 60 in ART commodity
management and 15 in ART laboratory monitoring.
This activity will contribute significantly to the overall 2009 Emergency Plan ART targets for Kenya. It will
also ensure that more adults are identified through the various treatment entry points and linkages in order
to increase the number of adults on treatment.
Coordination will take place with other USG partners and non USG partners supporting HIV treatment
services in Nairobi. Support to ART services will be one component of a package of integrated support at
care. This activity will specifically be linked to other APHIA II Nairobi supported activities in PMTCT, OVC
and TB/HIV, home based care and other prevention activities ensuring successful referral of individuals that
require ART care and support.
This activity targets HIV+ adults. Health care providers including Doctors, Nurses and Other Health care
workers will be targeted for training using national curricula.
The main Emphasis Areas for these activities will be workplace HIV prevention; care and treatment
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: 21434
21434 21434.08 U.S. Agency for Pathfinder 9253 9253.08 APHIA II - $2,050,000
Estimated amount of funding that is planned for Human Capacity Development $250,000
Table 3.3.09:
+ APHIA II Nairobi/Central has been separated into two mechanisms; APHIA II Nairobi and APHIA II
Central. Provincial targets have also been updated appropriately.
This activity supports key cross-cutting attributions in Economic Strengthening by linking care-givers of HIV
positive children to microfinance opportunities with K-REP Development Agency.
This activity will be linked to PMTCT, VCT (APHIA II Nairobi), ARV services (APHIA II Nairobi), OVC Care
(APHIA II Nairobi), TB/HIV services (APHIA II Nairobi)
1. ACTIVITY DESCRIPTION: This activity relates to strengthening and expansion of pediatric care and
support services as well as care and support for families with children affected by HIV & AIDS under the
APHIA II Nairobi Project. In FY09, APHIA II Nairobi will target 95 sites for support in pediatric care &
support. Support will include support of MOH supervision and progress review meetings as well as
strengthening of quality assurance, especially with regard to integrating HIV services with TB services,
psychosocial support and HMIS. Service providers will be trained in pediatric HIV care management
including prevention and treatment of OI, HIV adherence counseling, HIV nutritional assessment and
counseling, pediatric psychosocial support including play therapy. Treatment at the CCCs will be expanded
to link and network with other entry points such as the out-patient departments, in-patient departments,
pediatric psychosocial services, and PMTCT. APHIA II Nairobi will continue to strengthen linkages with
community services in order to empower families with children living with HIV (CLHIV) and make their
participation in the program more meaningful and sustainable. Efforts will be made to strengthen and scale
up early infant diagnosis through training of service providers and support for transportation of dry blood
spot (DBS) samples for DNA Polymerase Chain Reaction (PCR). The care and support package will also
include aggressive patient empowerment on adherence for older children and caregiver/parent
empowerment on adherence for younger children, strengthened support mechanisms (support groups, IGA
for families, advocacy and legal aid), home nursing care, community based defaulter tracing, nutritional
support, specialized counseling and strengthened continuum of care from health facility to the community
level, including strong linkages with PMTCT services for prevention. Other community BCC activities will
include formation of Kids clubs, adolescent support groups and working with adolescent post-test club
members will be enhanced, fun days for children, peer education, dialogue forums, sporting activities and
edutainment for youth. Caregivers/parents of CLHIV will be given special attention and will be empowered
through formation of support groups, treatment literacy, and support for IGA and PSS sessions to bolster
their coping mechanisms. Efforts will be made to decentralize services so that patients get treatment where
they are presenting for care. It is expected that 1,100 pediatric clients will be receiving OI prophylaxis at the
end of this reporting period in the 95 health facilities, while 2,050 children will be targeted for home and
community support. The project will continue to support clinical staff, continuous medical education,
mentorship, on site technical assistance, furniture and equipment at health facilities and grantees to
strengthen provision of HIV services. A total of 150 service providers will be trained in pediatric care and
support including pediatric psychosocial support and play therapy. These service providers will also be
facilities and community sites, and to ensure support for HCS at facility level. Palliative care for pediatrics
will include a comprehensive package of community home-based care consisting of home nursing, clinical
care, nutrition, education, OVC care, paralegal support and protection, psychosocial and spiritual support.
This will be implemented through 50 IPs and 20 service delivery sites and will reach 2,050 pediatric
patients. A total number of 100 care givers with children living with HIV will be trained in nutritional support,
formation of support groups, counseling and PSS. PI will continue with treatment literacy training via
support groups to enhance adherence, establish paralegal clinics, facilitate VHC quarterly meetings and
enhance links to income generating activities notably training and facilitating caregivers on IGA. PI will scale
up IGA, VSL and food security through working with the MOA and K_REP Development Agency.
Cotrimoxazole prophylaxis and where indicated, fluconazole prophylaxis will be the basic standard of care
for HIV infected children within the community and at facilities. APHIA II Nairobi will work with local
implementing partners including established NGOs, CBOs, and FBOs. APHIA II Nairobi will strengthen the
technical and institutional capacity of partners and build collaborative working relationships with a variety of
stakeholders to encourage effective, efficient programming. Elaborate plans will be put in place to improve
on data collection and record keeping. CHWs will be updated on child counseling and testing, and ensure
referral linkages are established with health facilities providing CT. Other care and support services for the
pediatric are mostly provided in the community and are included within services for OVC. Linkages will be
strengthened between the community and the facility where the facility will be supported by APHIA II Nairobi
to provide a basic care package inclusive of; Nutritional counseling of caregivers, safe water provision, and
pain management. OI treatment, insecticide treated mosquitoes and clinical support.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute significantly to the
overall 2009 Emergency Plan Palliative Care targets for Kenya.
3. LINKS TO OTHER ACTIVITIES Linkages to clinical services will be established through a two-way
referral system and will include PMTCT, ART, OVC, TB testing and other basic health services. Clinical
supervisors and other health care providers will reinforce clinic to community referrals by being kept up-to-
date on local resources for psychosocial, economic, legal and food security support. APHIA II Nairobi will
link with local partners such as K-Rep, to address economic insecurity through microfinance and business
skills training. Implementing partners will collaborate with local programs and agencies to address food
insecurity and nutrition needs. APHIA II Nairobi will continue to expand its close working relationship with
FBOs because of their comprehensive community support programs addressing a wide range of needs for
those households made vulnerable by HIV and AIDS. Children living with HIV will be linked to pediatric CCs
and other facilities that provide care, legal aid and specialized services as need arises.
4. POPULATIONS BEING TARGETED This activity targets people and families affected by HIV & AIDS.
Local implementing partners will be targeted for training and capacity building. Health care providers,
Activity Narrative: religious leaders and the administration officials will be targeted for sensitization and training related to
home-based care. Community Health Workers and caregivers will be trained and receive periodic refresher
training. They will also continue to receive HBC supplies, uniforms gumboots, bicycles and bags. IEC
materials on child CT will be developed, produced and distributed.
5. KEY LEGISLATIVE ISSUES ADDRESSED: This activity will address issues of expanding access to and
training in home-based care following the GOK guidelines and curriculum. The activity will also address
decentralization of services to widen the catchment areas for patients requiring the services. It will address
gender equity, gender based violence and greater involvement of people living with HIV/AIDS.
6. EMPHASIS AREAS:
Estimated amount of funding that is planned for Economic Strengthening $10,000
Table 3.3.10:
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS:
program for health workers ($20,000).
Nairobi), OVC (APHIA II Nairobi) and TB/HIV (APHIA II Nairobi), Adult and Pediatric care and Treatment
services, and other prevention activities (APHIA II Nairobi) ensuring successful referral of individuals that
require ART care and support
This activity relates to support to be provided to strengthen and expand pediatric treatment services in
Nairobi Province under the APHIA II Nairobi Province Project. In FY09, Pathfinder International (PI), the
lead partner and its partners will target 20 sites in Nairobi Province for support in pediatric antiretroviral
treatment (ART) treatment services. Support at ongoing and new sites will include MOH supervision and
services with TB services, psychosocial support and HMIS. At new sites, service providers will receive
training in pediatric HIV care and treatment and strengthening of the same at ongoing sites. Efforts will be
made to strengthen and scale up early infant diagnosis through training of service providers and support for
transportation of dry blood spot (DBS) samples for DNA Polymerase Chain Reaction (PCR). Treatment at
the CCCs will be expanded to link and network other entry points such as the out-patient departments, in-
patient departments, pediatric psychosocial services, PMTCT and community services. Efforts will be made
to decentralize services so that patients get treatment where they are presenting for care. Laboratory costs
are often a hindrance to uptake of services and efforts will be made to facilitate laboratory networks, support
laboratory reagents and equipment that improve uptake of treatment services. It is expected that 250
pediatric clients will newly initiated on ART, with 1,020 as cumulative ART pediatric clients and 850 pediatric
clients will be receiving antiretroviral therapy at the end of this reporting period at these sites. The project
will continue to support clinical staff, continuous medical education, mentorship, on site technical
Nairobi Women's Hospital, Gertrude's Children's' Hospital, Gold Star Network) to strengthen provision of
HIV services. 30 service providers will be trained in pediatric HIV management.
also ensure that more children are identified through early infant diagnosis and through other means in
order to increase the number of children on care and treatment.
Coordination will take place with other USG and non USG partners supporting pediatric ART services in
Nairobi. Support to ART services will be one component of a package of integrated support at health facility
and community levels in the region, holistically addressing HIV prevention, treatment and care. This activity
will specifically be linked to other APHIA II Nairobi supported activities in PMTCT, OVC and TB/HIV, home
based care and other prevention activities ensuring successful referral of individuals that require ART care
and support.
This activity targets HIV+ children. Health care providers including Doctors, Nurses and Other Health care
Estimated amount of funding that is planned for Human Capacity Development $20,000
Table 3.3.11:
+ Splitting of APHIA II Nairobi/Central to APHIA II Nairobi and APHIA II Central. Targets and budgets have
been split to reflect this change.
This activity supports key cross-cutting attributions in human capacity development through its on-site
training program that targets health workers ($30,000).
This activity will be linked to treatment services (APHIA II Nairobi), Care and support services (APHIA II
Nairobi) CT Services (APHIA II Nairobi), home based care and other prevention activities (APHIA II Nairobi)
and (DLTLD) services.
This activity relates to support for strengthening and expanding palliative care in both clinical and
community settings addressing TB and HIV. Pathfinder International (PI), the lead partner in APHIA II
Nairobi, will continue to support TB service delivery through provision of food supplements, X-ray services,
essential TB laboratory supplies, continuous medical education to health workers, and TB awareness rising
in the community through focus group discussions. In 2009, 30 sites in Nairobi will be supported in
provision of TB/HIV services. Through all supported sites, 750 HIV-infected clients attending HIV care and
treatment services will receive treatment for TB while 1500 registered TB patients will receive HIV
counseling, testing and receive their test results. A total of 2,500 HIV-infected clients will undergo intensified
TB screening. Continued emphasis will be on filling gaps in service delivery and linking to community based
services. TB prevention, treatment and care programs will be strengthened and effective linkages made
between TB and HIV services. Through external quality assurance for TB laboratory diagnosis, joint clinical
supervisors by project staff, district, provincial and national TB teams service quality and supervision at all
levels of facility care and referral will be improved. Drug supply management, case management, records
systems, supervision and TB defaulter tracing will be strengthened. All health facilities targeted by the
project will provide OI treatment, including TB, cotrimoxazole prophylaxis, and nutritional support. APHIA II
Nairobi will work to expand diagnostic and DOTS case management capacity. According to GOK policy, all
HIV+ patients will be screened for TB, and all TB patients tested for HIV. Malteser, the lead APHIA II
Nairobi Partner for TB, will provide guidance for training of clinical and laboratory staff as well as CHWs;
annual refresher training on TB/HIV/AIDS diagnosis, treatment and care; and basic training on clinical
observation and case management. TB treatment and care programs will be strengthened and effective
linkages made between TB and HIV services. Contact tracing of family and household members, as well as
defaulter tracing, will take place through facility and community based CHWs. The training of CHWs in
TB/ART defaulter tracing will be supported. APHIA II will continue to support TB service delivery through
provision of X-ray services, essential TB laboratory supplies, rehabilitation of TB diagnostic laboratories,
and continuous medical education to health workers, and TB awareness-raising in the community through
focus group discussions. Through external quality assurance for TB laboratory diagnosis, joint clinical
supervision by project staff, district, provincial and national TB teams, service quality and supervision at all
levels of facility care and referral will be improved. External Quality Assurance (EQA) will be conducted
quarterly through random testing of sputum smears from TB diagnostic laboratories. In 2009, 60 health
workers will be trained to provide treatment for TB to HIV infected individuals while 15 laboratory staff will be
trained on TB AAFB microscopy.
This activity will contribute to the expansion of the overall 2009 Emergency Plan Palliative Care - TB/HIV
targets for Kenya, and the control of urban TB.
Clinic-based palliative care is one component in a comprehensive treatment and care approach under
APHIA II, such that clients will benefit from long term ART as appropriate and linkages to community
services. Linkages will also be made with the DLTLD and VCT sites.
This activity targets clients at ante-natal clinics, VCT sites, in-patients and clients of DTC, TB-ward patients
and clients of home and community support services who are referred for clinical care by community health
workers. Health care providers including doctors, nurses and other health care workers will be targeted for
training using national curricula.
This activity will address issues of expanding access and decentralization of services.
Continuing Activity: 21268
21268 21268.08 U.S. Agency for Pathfinder 9253 9253.08 APHIA II - $250,000
Table 3.3.12:
+ A prime partner will be 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 12,600 with testing and
counseling. Of those tested, approximately 1,000 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 $30,000 towards
Economic Strengthening through the support of income generating activities to support increased
household food security. The activity will also attribute a portion of its budget to supporting educational
activities targeting OVC enrolled in the program in the amount of $50,000. A further $10,000 will be
attributed to provision of safe water guards for households looking after OVC.
This activity relates to counseling and testing (#8976), ARV Services (#8765) and palliative care: Basic
Health Care and Support (#8936).
This activity relates to expanded support to be provided to OVC. Pathfinder International (PI), the lead
partner in APHIA II Nairobi/Central, will partner with Christian Children's Fund (CCF) to provide integrated,
age-appropriate services to build resilience of children infected with and affected by HIV/AIDS. Emphasis
will be placed on development of healthy and supportive home and community environments where OVC
and guardians/families have access to psychosocial support, education, health and nutrition services,
economic livelihood support, shelter and protection from exploitation and abuse. Institutional capacity and
technical expertise of implementing partners will be strengthened. OVC support will be integrated with and
linked to the project's home and community support. Village Health Committees and implementing partners
will identify OVC, who are often in the same households as those individuals receiving home-based care
It is anticipated that in FY 2008 a total of 14,000 OVC in Nairobi will be reached. Training of individuals in
caring for OVC will cover 1,260 people in Nairobi. This will contribute to the overall 2008 emergency Plan
OVC targets for Kenya.
This activity will be linked with other Pathfinder International APHIA II activities in the areas of counseling
and testing (#8976), ARV Services (#8765) and Palliative Care: Basic Health Care and Support (#8936) in
both Central and Nairobi Provinces.
This activity targets orphans and vulnerable children, caregivers, Community Health Workers, guardians
and educators involved with OVC. Capacity building efforts with the local communities will focus on the
community and religious leaders as well as partnering with other community and faith based groups that
exist in the area.
Issues addressed are stigma and discrimination and the wrap around services in food and education.
This activity includes major emphasis in the development of the local organization and minor emphasis in
the areas of community mobilization and participation.
* Increasing women's access to income and productive resources
* Increasing women's legal rights
* Reducing violence and coercion
Estimated amount of funding that is planned for Economic Strengthening $30,000
Estimated amount of funding that is planned for Education $50,000
Estimated amount of funding that is planned for Water $10,000
Table 3.3.13:
+ APHIA II Nairobi/Central hasbeen split into two activities: APHIA II Nairobi and APHIA II Central.
+ APHIA II Nairobi will expand counseling services within the province and include outreach services
provided through existing and new CT sites that are integrated within health facilities. The CT services will
include, PITC, home testing, and door to door testing of family members of the infected individuals receiving
care and treatment within the facility.
+ APHIA II Nairobi will also support the annual national HIV testing campaigns with a focus on Nairobi
Province
+ HBCT will be initiated in the Mukuru slum in Nairobi
This activity relates to activities in HIV/AIDS treatment services, abstinence and be faithful, OVC, and
HBHC, TB/HIV care activities, other prevention, PMCT and strategic information.
This activity relates to support to be provided to increase VCT coverage while taking account of the need to
emphasize provider initiated/diagnostic testing and counseling (PITC/DTC) as well. New VCT sites may be
needed, for example, in large companies where employees lack easy access. Mobile VCT will complement
fixed sites. Youth friendly services will be emphasized. Where possible, VCT will be integrated with facility
and community level treatment and social support services for individuals testing positive and with
prevention activities for discordant couples and individuals testing negative. PITC/ DTC will be scaled up in
support of the National AIDS and STI Control Program. APHIA II Nairobi will continue strengthening of C &
T in existing site facilities, PMTCT and blood transfusion sites and in district hospitals, sub-district hospitals
and health centers with laboratory capacity. A subcontractor will train counselors from target facilities and
work with GOK and NGO counterparts to ensure supervision. Individuals who test positive will be
systematically referred to CCC and higher levels for comprehensive care and treatment and linkages to
community services. APHIA II Nairobi will liaise with NASCOP to ensure HIV test kits supply is not
interrupted. It is anticipated that in FY09, 100,000 people in Nairobi will be tested in 50 sites. In FY09, 100
people in Nairobi will be trained in counseling and testing, including couple counselling and adherence
counselling. In addition counsellor supervisor trainings will be supported. Continued emphasis will be placed
on paediatric psychosocial support through training of health workers and play therapists. The project will
continue with its partnership with KNH VCT in support of C & T at the country's largest referral hospital.
This activity will contribute significantly to the overall 2009 Emergency Plan Counseling & Testing targets for
Kenya. Integrating promotion of VCT into all community outreach for treatment and care will significantly
contribute to PEPFAR goals for primary prevention.
Support to counseling and testing will be a linchpin activity in APHIA II Nairobi resulting in increased
numbers of individuals accessing care, treatment and support and in strengthening prevention efforts. This
activity will specifically be linked to treatment services (APHIA II Nairobi), TB/HIV (APHIA II Nairobi) and
care and support services (APHIA II Nairobi).
This activity targets a wide range of population groups, including, for DTC, those receiving other clinical
services, and for VCT, the general population, with emphasis on sexually active individuals, youth, OVCs
and high risk groups such as bar workers, matatu and boda-boda, and other transport workers and
discordant couples. Health service providers will be targeted for training.
This activity will address the GOK VCT policy and guidelines and legislation related to protection of human
rights and confidentiality. It will address gender issues to ensure that women who are disproportionately
affected by HIV are identified and linked with care and treatment programs. Couples in discordant
relationships will also benefit from knowing their status so that they can make informed decisions in their
sexual relationships.
6. EMPHASIS AREAS This activity includes major emphasis on training to build capacity of Counseling
&Testing providers and CHWs. The activity emphasizes VCT as a major prevention strategy. Implementing
Partners, Community Own Resource Persons and other community level implementing partners are key to
its success.
Continuing Activity: 21433
21433 21433.08 U.S. Agency for Pathfinder 9253 9253.08 APHIA II - $750,000
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.
+ Support all health facilities and community partners in the province to have adequate record-keeping
systems for monitoring HIV/AIDS care and support.
+ 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. One operations research will be designed, implemented and analyzed
with a view to improving project activities
SECONDARY CROSS CUTTING BUDGET ATTRIBUTIONS
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.
COP2008
This activity is related to the strategic information activities to be carried out by University of North
Carolina/MEASURE Evaluation (#7098), NASCOP (#7002), and TE/TBD (#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 Committees (CACCS) levels by NACC through 3
key components. Component 1: Support APHIA II NAIROBI-CENTRAL/PATHFINDER INTERNATIONAL
and MOH program data collection processes for performance reporting needs (quarterly, semi-annual,
annual). This component will support a participatory, coordinated and efficient data collection, analysis, use
and provision of information to track achievement of APHIA II NAIROBI-CENTRAL/PATHFINDER
INTERNATIONAL and MOH's district level Annual Operation Plan II objectives, and 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 NAIROBI-CENTRAL/PATHFINDER INTERNATIONAL and MOH to
measure progress towards its contribution to the overall country's Emergency plan, National Health Sector
Strategic Plan II and Kenya National HIV/AIDS Strategic Plan goals and results frameworks. Specific
activities will include building capacity of the 83 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 lead role in coordinating M&E activities in the province to meet the information needs of
USAID/Kenya, the Emergency Plan, MOH, NACC and other stakeholders, in line with the "three ones"
principle. APHIA II NAIROBI-CENTRAL/PATHFINDER INTERNATIONAL 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 100 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 Nairobi-Central/Pathfinder International 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 Nairobi/Central
provinces. 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 forty
local organizations/health facilities in strategic information in addition to supporting the training of 110 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 University of North
Carolina/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
responsible 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
Monitoring, evaluation, or reporting (or program level data collection) and Other SI Activities.
Estimated amount of funding that is planned for Human Capacity Development $90,000
Table 3.3.17:
In 2009 APHIA II Nairobi 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 Nairobi will
continue to support provincial and district health systems strengthening by convening consultative meetings
and various stakeholders' forums.
In addition, APHIA II Nairobi 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.
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 Nairobi activities, particularly in AB and OP.
This activity will target all population of Nairobi 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.
Table 3.3.18:
