ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:

The prime partner will not only implement the Mentor Mothers project in Kenya through Catholic Medical

Mission Board in 50 sites but will also work closely with NASCOP, MOH in Kenya and the National PMTCT

TWG to adopt the curriculum being used in the project for national use. The Prime partner will then help

train training of trainers at National and Provincial level to help roll out the project nationally for greater

involvement of women living with HIV. The prime partner is expected to lay down a clear devolution strategy

to the in-country implementing partner and NASCOP for sustainability.

In light of this new development to continue to refine and adapt the m2m program model and begin to

respond to the challenge to support rapid national scale-up of integrated services to ~4000 sites or more,

m2m proposes undertaking a two-pronged approach including a) initiation of technical assistance to support

scale-up and b) a service delivery component with program sites that would serve as "centers of excellence"

and provide a reference for technical assistance activities against which implementing partners could

benchmark efforts to replicate and scale-up Mothers2Mothers' model of care.

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

This activity supports key attributions in human capacity development through the training of health care

service providers and mentor mothers on PMTCT and other HIV prevention and care topics in order to

equip them with knowledge and skills to provide quality PMTCT services.

COP 2008

1. ACTIVITY DESCRIPTION

With PEPFAR New Partners Initiative's (PEPFAR-NPI) and in-country support, Mothers2Mothers (m2m) will

increase the effectiveness of PMTCT services through a comprehensive program of facility-based, peer

education and psychosocial support for pregnant women, new mothers and caregivers living with HIV/AIDS

in Kenya. There are four components to the activity that contribute to support of PMTCT: curriculum-based

training and education programs; psychosocial support and empowerment services; counseling and testing;

and bridging services linking PMTCT treatment and care to anti-retroviral treatment (ARV) and other health

services. The first component is training. FY 2009 PEPFAR funding will be used to deliver a comprehensive

curriculum-based training for approximately 108 m2m paid site staff, Site Coordinators (SC) and Mentor

Mothers (MM), (all of whom are PLWHA) who will provide education programs designed to improve PMTCT

outcomes of pregnant women and new mothers with HIV and AIDS. The training curriculum given to m2m

staff provides guidance about PMTCT and ARV treatment, as well as disclosure, safer feeding options,

family planning, nutrition, couples counseling, and prevention guidance for these PLWHA and their partners.

Annual trainings are given to all staff, inclusive of new staff and retraining for existing staff (two weeks for

MM and three weeks for SC). m2m does not provide formal training on direct PMTCT service provision for

healthcare providers, including doctors and nurses. The second component is providing psychosocial

support and empowerment programs to HIV-positive pregnant women and new mothers to improve

pediatric and maternal outcomes. PEPFAR funding will be used to provide individual and group

psychosocial support and empowerment programs for pregnant women and new mothers with HIV/AIDS to

help issues including stigma and discrimination, disclosure, reducing risky behavior and pediatric support.

The outcome of both group and individual support is knowledge transfer around issues that women living

with HIV and AIDS face in navigating the PMTCT process. Another outcome is empowering the women to

focus on and take responsibility for the health of their babies, and their own health. Nutritional education

and support is also part of the program; and there is a provision for specific support programs for the m2m

staff. The third component is increasing PMTCT services through encouragement of HIV testing and uptake

of prophylaxis for PMTCT. PEPFAR funds will help m2m staff work as part of the antenatal care team at

facilities in Kenya. In this role, the m2m staff focuses on increasing counseling and testing uptake by

working with women like themselves and drawing on their training and their own personal experience. The

program also encourages pediatric counseling and testing efforts by counseling women to return to clinics

post-delivery to test their infants, supporting the women in the post-delivery period, and providing

information about pediatric treatment programs. The fourth component is assisting HIV-positive women to

access linkages and referral systems to bridge PMTCT and other health services. In active collaboration

with local and provincial health officials, PEPFAR funding will be used to link women and infants with AIDS

defining conditions to ARV therapy programs, and to refer all ante/post natal women to clinics providing

wellness care for themselves and their infants. While m2m does not provide formal referrals for healthcare,

the staff is well informed about where services are available and can inform women about how to access

both medical and social services. Finally, PEPFAR funds will be used to help adopt the training curriculum

and roll out of the m2m services country-wide. The prime partner will be expected to have a very clear

devolution strategy to the in-country implementing partner.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA

All activities, which began in 2007, have been and will continue to be coordinated with local PMTCT service

providers and their partners and will also be carried out in conjunction with provincial, district and municipal

health authorities. The program implementing partner is Catholic Medical Mission Board (CMMB), an

international NGO. Implementation will be facilitated through CMMB's relationships with its partner

organizations, the Christian Health Alliance for Kenya (CHAK) and the Kenya Episcopal Conference (KEC)

for in-country program implementation. The above results contribute to the PEPFAR 2-7-10 goals by

increasing the number of women cared for by PMTCT programs, by improving prevention (PMTCT)

outcomes, thus reducing the number of infected children, and by increasing the number of pregnant women,

new mothers, and infants receiving treatment by providing a referral system from PMTCT to ARV services.

As providers of indirect services to established PEPFAR supported PMTCT programs; with PEPFAR-NPI

funds m2m and CMMB will strengthen and enhance PMTCT services at 6 sites in Central Province (Kiambu

District) and Nairobi Province (district to be determined) and initiate service in 50 additional sites in:

Southern Rift Province, Nyanza Province, Western Province, and Coastal Province. As an indirect service

provider, m2m will report indicators and set targets that demonstrate the outcomes of the program.

PEPFAR PMTCT indicators will be collected; however these numbers will duplicate those reported by the

direct PEPFAR service provider at the site. Additional targets that measure the work and impact of the m2m

program specifically will be reported in addition, including the number of new women who received m2m

health talks in clinic waiting rooms, the number of HIV-positive women who received services from m2m,

Activity Narrative: the number of return visits to m2m, as well as additional indicators that m2m is working to formulate in

coordination with the NPI secretariat in Washington DC.

3. LINKS TO OTHER ACTIVITIES

In support of PMTCT services, m2m provides linkages to other critical components of HIV care and

prevention efforts. The program works directly with Counseling and Testing (VCT) programs by encouraging

women to learn their HIV status during pregnancy. M2m also provides women with information about

programs that provide treatment with ARVs (ART) for pregnant women who are eligible during pregnancy.

The program also helps increase uptake of infant testing by educating and encouraging women to bring

their babies back after delivery for HIV tests and OI prophylaxis. By encouraging behaviors that can help

mothers sustain their well-being, the program aims to reduce the potential that children could become

Orphans and/or Vulnerable Children (OVC).

4. POPULATIONS TARGETED

The specific target populations that benefit from the m2m package of care at PMTCT services sites include

the pregnant women, primarily HIV-positive pregnant women who receive m2m educational and

psychosocial support, people living with HIV/AIDS (PLWHA) which includes both the women who receive

the services and the HIV-positive women who are employed by the program. The HIV-exposed infants who

are born to the women who receive m2m services are also beneficiaries of the m2m program activities.

5. EMPHASIS AREAS/KEY LEGISLATIVE ISSUES

The primary emphasis areas for these activities are Human Capacity Development; and Local Organization

Capacity Development and Sustainability. Key legislative issues addressed include prevention with

positives, reducing stigma and discrimination, care for caregivers and support of PLWHA.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17560

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17560 17560.08 U.S. Agency for Mothers 2 Mothers 7793 7793.08 New Partners $0

International Initiative

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $50,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01: