Goals and Objectives

The APHIA II Follow On is an integrated national activity covering all eight provinces of Kenya and will result in multiple awards. There will be a prime partner with multiple sub-partners to support increasing access to ART; providing care to people affected by HIV, including orphans and vulnerable children; and preventing new infections. The mechanism will seek to increase HIV testing and counseling through community involvement, PMTCT, TB clinical and other provider-initiated approaches. HIV positive mothers and infants will be given ARVs per national ART/PMTCT guidelines. The mechanism will contribute towards national OVC goals and seek to cover approximately 35% of the total OVC population at the provincial level, based on disease burden and OVC population. Comprehensive combination prevention strategies, consisting of evidence-based behavioral, bio-medical and structural interventions will be implemented. The TBD partner will support national guidelines development for IDU/NIDUs and implementation. Support will also be extended to GoK to implement VMMC in accordance with national recommendations. All of these activities will be developed jointly with the GOK and are aligned with national priorities set forth in the PF and KNASP III.

How IM Links to PF Goals

The PF strengthens coordination and collaboration between GoK, USG and other partners to set programmatic priorities; the APHIA II follow-on will work closely with GoK to ensure full coordination and ownership. Furthermore, the PF supports development and implementation of policies that address and mitigate societal norms or cultural practices that impede HIV programming To enhance coordination and fill existing gaps, the TBD partners will seek to increase HIV testing and counseling through community, PMTCT, TB clinical and other provider-initiated approaches; support proven behavioral interventions targeting sources of new infections and MARPs ;strengthen community support and mitigation programs to reach households with PLWHA and OVC with effective prevention, health maintenance and economic support services; enhance M&E capacity at community level and health facilities to collect and report routine data and continuously inform programming, operational and strategic planning.

Geographic coverage and Target population

This will be a national activity covering all eight provinces. The target populations are (i) Community level - OVC, youth (in and out of school), MARPs, pregnant women, adults and the general population; (ii) Health Facilities and health workers; and (iii) GoK Health Systems and Human Resources..

Contributions to Health systems Strengthening

The TBD partners will offer a comprehensive package of integrated support to health facilities and communities holistically addressing HIV prevention, care and treatment. Support to health commodity supply chain management and human resource capacity will impact positively on the country's health system. Collection and reporting of routine data will continually inform strategic planning.

Cross-cutting programs and key issues

TBD partners will support gender issues, including male involvement to address male norms to indirectly strengthen women's ability to access health services; focus on achieving gender equity in HIV/AIDS activities and services and increasing women's access to income and productive resources through IGA activities. The TBD partners will link FP with PMTCT services, interlink the blood program with malaria and obstetric programs and strengthen the hospital end of the transfusion service. Build the capacity of local partners to address gender-based vulnerabilities and risk factors for OVC, support stronger linkages to reproductive health/family planning services, PwP messaging and interventions for those HIV-positive. Support robust mechanisms for TB/HIV collaboration at all levels; and build sustainable clinical and laboratory structures to support HIV, TB and MDR-TB surveillance, diagnosis and treatment. Collaborate with and provide technical assistance to private companies to establish or enhance workplace programs.

Cost Efficiency

TBD partners will implement integrated programs that include HIV/AIDS, reproductive health, child survival and malaria activities. In doing so, efficiencies will be realized in investments in equipment, infrastructure and training as services are co-located and the same staff and facilities are utilized in service delivery. They will also work towards providing technical assistance on task shifting to increase health worker efficiencies. Additionally, they will collaborate with the National work groups exploring options of sustainable financing, such as health insurance schemes and promoting integration of the private sector in service delivery. The TBD partners will provide technical assistance to the GOK programs at the provincial, district and service delivery levels to ensure ownership of the programs by the Government of Kenya. Furthermore, they will support strengthening systems, including working with DHMTs and PHMTs, as well as enhancing partnership with host governments to strengthen country ownership and build capacity for a sustainable, long-term GoK response to the HIV pandemic.

Budget Allocation: Redacted

APHIA II follow on will be a national activity covering all the eight provinces of Kenya targeting the HIV infected adult population. This activity will build on the progress of APHIA II activities providing adult care and support working through health facilities and communities. The TBD partner will implement all facility-based and community-based activities for HIV infected adults and their families aimed at extending and optimizing quality of life for the HIV-infected clients and their families throughout the continuum of illness through provision of clinical, psychological, spiritual, social, and prevention of OIs and other HIV and AIDS-related complications including malaria and diarrhea.

The TBD partner will continue to strengthen linkages of HIV-infected patients identified through HTC services including, PMTCT, TB/HIV, VCT, PITC, and home-based counseling and testing to care and treatment services. HIV + pregnant women will be enrolled in care at MCH or HIV care clinics where they will start CTX and be evaluated for ART. HIV+ men identified through HTC during male circumcision activities will be linked to care; HIV-negative men in discordant relationships will be referred for male circumcision. Involvement of the community and organizations of persons living with HIV (PLWHA) will continue through psychosocial support groups, PLWHA employment as peer educators, HIV treatment awareness activities, wrap-around food programs, and income-generating activities.

The TBD partner will offer an integrated comprehensive package of care services to all HIV+ patients at health facility level, including clinical assessment for ART eligibility; laboratory monitoring with 6 monthly CD4 testing; psychosocial counseling, including support for HIV status disclosure, positive living and referral to support groups; adherence counseling and support ; nutritional assessment , counseling and supplementation; prevention with positives; family planning; support for family testing for spouses/partners and children; opportunistic infection diagnosis and treatment, including TB screening, diagnosis and treatment, and increasing access to crypotococcal antigen test for diagnosis of cryptococcal meningitis; pain management including use of non-steroidal inti-inflammatory drugs, and increased access to opioids for registered palliative care centers. The TBD partner will work closely with the regional nutrition and HIV program (NHP) including participation in scale up and implementation support - trainings, equipment, inventory management, and early identification of malnutrition using MUACs for early referrals. The partner will also increase linkages to and implementation of food security and livelihoods interventions as they graduate patients out of therapeutic nutritional care.

The TBD partner will build on the APHIA II systems for data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. The PEPFAR indicators will be realigned to incorporate the new generation indicators. The partner will use an electronic medical records system to monitor indicators to capture the number of people receiving community and/or facility care will be developed to avoid double counting. In 2010 persons reported as receiving basic care and support will receive at least one clinical service, plus at least one service in another domain of palliative care (psychosocial, spiritual, social or preventive).

This activity supports the Kenya Partnership Framework by focusing on strengthening community support and mitigation programs and expanding services to reach 80% of households with PLWHA with effective prevention, health maintenance including treatment adherence and disease monitoring and social support services.

Support to HBHC will be one component of a package of integrated support at health facilities and communities, holistically addressing HIV prevention, treatment and care.

The budget allocation is Redacted. This Activity will result in multiple awards.

APHIA II follow on will be a national activity covering all the eight provinces of Kenya targeting HIV infected and affected Orphans and Vulnerable Children and their families and will build on the progress of APHIA II activities in providing care and support for HIV infected and affected Orphans and Vulnerable Children and their families. The TBD partner will continue to work with local CBOs, FBO, NGOs and local communities to serve OVC and their families and implement community based activities aimed at reducing their vulnerability to HIV and AIDS and to help them grow into healthy and productive members of society.

The TBD partner will continue to strengthen the capacity of families and provide the range of essential services in line with the Kenya's National Plan of Action for OVC and the USG Guidance for OVC programming. The partner will provide an increased number of services to individual children and their families based on needs and will continue to support and strengthen local committees in the identification, targeting and support to vulnerable children.

The TBD partner will offer a Family-Centered Care for OVC and will ensure that families are empowered to care for their own OVC. The partner will specifically focus on keeping parents alive, increasing their capacity to care for their own children and enhancing access to education. The TBD partner will focus on bolstering family capacity to provide OVC with comprehensive care, a greater focus will be on identifying strategies for enhancing Household Economic Strengthening (HES) and in ensuring that economic strengthening activities and vocational training for older OVC and caregivers are adequately linked with market conditions.

The TBD partner will offer support to the community based mechanisms with the aim of changing gender roles between men and women. The partner will collaborate with the Ministry of Education at the regional level to support and sensitize schools on their role in making schools a safer place for children. The partner will also focus on identifying highly vulnerable children that have hitherto not been reached. TBD partners working in urban areas will provide services to street children especially addressing HIV prevention and providing linkages to care and treatment.

The TBD partner will continue to support capacity building of local partners. Specific areas of capacity building will include building their capacity to integrate best practices and lessons learnt in caring for HIV positive OVC and linking them non-facility service providers based on lessons learnt from the Muangalizi pilot project, enhancing capacity of local partners to provide quality OVC services and initiating quality improvement processes at the point of service delivery, identification and implementation of appropriate exit strategies for adolescent OVC, integrating HIV prevention interventions, promoting stronger linkages to Reproductive Health/Family Planning services as well as appropriate PWP messaging and interventions for HIV positive adolescents as well as building the capacity of local partners in collecting, storing, retrieving and reporting on, and analyzing data for effective program implementation.

The activity supports the partnership framework by addressing community support and mitigation for OVCs, including capacity building for households with OVC to expand care to reach at least 80 % of children orphaned by AIDS and 80% of household with OVC.

Support to HKID will be one component of a package of integrated support at health facilities and communities, holistically addressing HIV prevention, treatment and care

The Budget allocation is Redacted. This activity will result in multiple awards.

APHIA II follow on will be a national activity covering all the eight provinces of Kenya targeting the HIV infected children, youth and adult population. This activity will build on the progress of APHIA II in all the provinces of Kenya. The TBD partner on will continue to strengthen the ability of the ART facilities to provide quality HIV services. The activities will include infrastructure, training clinicians and other providers, clinical monitoring, related laboratory services, community-adherence activities and management of opportunistic infections.

The TBD partner will build the capacity of health workers through training and introduction of innovative methods of service delivery. The training activities will include in-service trainings, mentorships and preceptor program. During the training, best practices and lessons learnt will be shared across the various provinces of Kenya. The TBD partner will support clinical staff continuing medical education, mentorship, onsite technical assistance to strengthen the provision of HIV services. The TBD partner will also support training in commodity management to ensure proper use and reporting of the commodities. Due to the high staff turnover and changing disease patterns the TBD partner will regularly evaluate training needs and subsequently organize for the necessary training.

The TBD partner will support the ministries of health's supportive supervision and progress review meetings as well as strengthen quality assurance. The partner will support the introduction and institutionalization of continuous quality improvement (CQI) teams at the facility level. The CQI teams will champion the continuous quality improvement will the small test of change concept. The partner will enhance quality of care through improved case management and introduction/strengthening of Electronic Medical Records (EMR). The EMR will improve patient tracking and will also be a major resource for the CQI teams. The EMR will improve the facility reports in terms of accuracy, completeness and timeliness. The partner will also encourage data use at the facility level in order to improve the service delivery. Most of the service improvement can be addressed at the facility if the management and staff learn to use the data they collect. The laboratory networks will be strengthened and networked to provide the required HIV monitoring tests like CD4 tests, hematology and liver function test. This will ensure that patients are evaluated for eligibility of starting ART or regimen switch. The partner will support viral load testing for suspected treatment failure cases through the network. Referral mechanism will be strengthened to ensure proper handling of suspected treatment failure cases. The partner will strengthen the case management of second line patients to minimize failure in this category as the third regimen is expensive and not readily available.

The TBD partner will enhance the facility capacity in treatment preparation for patients before starting ART. Adequate treatment preparation is necessary for good adherence to treatment by patients. The TBD partner will also enhance the capacity and create systems to strengthen facility-community linkages by sharing and implementing best practices across the program. The partner will support community activities carried out by the facilities. Patient follow up in the community will be a crucial activity to enhance adherence. The program will provide support in adherence training to ensure that the facilities have adequate capacity to provide the adherence services. The TBD partner will also support communities to improve referral and linkage to the health facilities. The TBD partner will follow up to ensure that loss to follow up is kept to a minimum and adherence rates are above the recommended levels. Because of the cultural diversity among the various communities in Kenya, tailor made behavior change communication programs will be established to address stigma reduction; encourage utilization of treatment services; treatment compliance as part of psychosocial support; and prevention of HIV among HIV positive individuals. Because the issue of stigma and discrimination is still high even amongst health workers in Kenya, this activity whilst conducting clinical training will also train health workers on stigma and discrimination reduction using a curriculum specifically produced for this purpose.

The TBD partner will carry out activities to support the strengthening and expansion of ART services in all the provinces of Kenya. The TBD partner will support both public and private sector facilities to strengthen their capacity in providing comprehensive HIV services. The partner will support and strengthen Public Private Partnership initiatives. Through this initiative the capacity of faith based and private service providers to provide HIV treatment services will be strengthened. This will involve offering ART technical assistance, provision of laboratory, pharmaceutical and other commodities. The TBD partner will support the integration of HIV services with Reproductive Health/Family Planning (RH/FP) and TB services. Prevention services will be emphasized and treatment at the comprehensive care clinics will be expanded to link to other entry points such as outpatient departments, inpatients, PMTCT, VCT centers and community services. The partner will support decentralization of services so that patients can get treatment closer to where they live to improve access. The TBD partner will support the introduction and strengthening of Gender based violence services at the facility.

This activity supports the Partnership Framework by focusing on strengthening community support and mitigation programs and expanding to reach 80% of households with PLWHA with effective prevention, health maintenance including treatment adherence and disease monitoring and social support services.

Support to HTXS will be one component of a package of integrated support at health facilities and communities, holistically addressing HIV prevention, treatment and care

Budget Allocation Redacted. This activity will result in multiple awards.

The APHIA II follow on will be a national activity covering all the eight provinces of Kenya. This activity will support implementation of innovative HTC activities, implement social mobilization activities to increase uptake of CT services to increase the number of individuals who know their accurate HIV status, work to strengthen referral systems between HTC and other prevention, care and treatment services; and build the capacity of local organizations to implement HTC services. Accurate knowledge of one's HIV status is the entry point to HIV prevention, care and treatment services and coupled with appropriate behavior change can contribute to reducing HIV transmission in the population. This activity will build on the progress of APHIA II activities providing community and facility based CT services.

The overall objective of the APHIA II Follow on HTC activities will be to support HTC service implementation with specific areas of focus including supporting facility and community-based HTC approaches to permit expansion of HTC services to increase knowledge of HIV status to at least 80% of the Kenyan adult population. Using HTC combination approaches, APHIA II will support the national HTC through targeted approaches which include PITC, HBCT, VCT, and mobile/outreach. Targets will be subdivided into provincial and district level targets to guide implementation and program monitoring. This activity will target the general population across all ages in the community and household setting with an emphasis on couples. Other population groups targeted include children and adolescents; Most-at-risk Populations (MARPS) such as sex workers and their clients, men who have sex with other men (MSM), Injection Drug users (IDU), long distance truck drivers and migrant workers. Public health care providers, and non clinical service providers such as lay counselors, peer educators and community members are targeted for increased prevention (including HTC), care and treatment knowledge skills on HTC.APHIA II Follow-on will work to support structures for linkage between HTC and HIV Care and Treatment programs for HIV-infected individuals through improved documentation and reporting.

The TBD Partner will work in collaboration with other programs to facilitate referral and linkages for individuals and their families reached through HTC services. All HIV infected individuals will be referred to health facilities for comprehensive HIV Care and Treatment services and HIV Community Care and support services. All individuals, including the HIV un-infected, will be referred and linked to existing comprehensive HIV prevention services. TBD partners will also build capacity of local organizations implementing community HTC activities to ensure establishment of community structures for the sustainability of services. The TBD partners will support to develop and strengthen organizational structure, management and capacity of these local organizations through training and other approaches to implement quality community HTC services.

APHIA II Follow-on will support implementation, coordination and monitoring of KNASP III in achieving universal access to HTC and increased knowledge of status through supporting implementation of identified national standardized package of HTC services. To support service delivery, TBD Partners will support training of HTC providers using revised national HTC training curriculum package. This activity supports the partnership framework by increasing access to HIV testing and counseling through community as well as PMTCT, TB clinical and other provider-initiated approaches to achieve the goal of at least 80% of Kenyan adults know their status.

Support to HVCT is one component of a package of integrated support at health facilities and communities, holistically addressing HIV prevention, treatment and care.

The budget allocation is Redacted.This activity will result in multiple awards.

APHIA II follow on will be a national activity covering all the eight provinces of Kenya targeting the HIV exposed/infected and affected children. The aim will be to optimize the continuum of care for HIV exposed and infected infants from birth through provision of clinical, psychosocial, spiritual, and social and prevention services to enroll HIV infected children in care.

The TBD partner will build upon the APHIA II program and continue to prioritize the identification of exposed, and infected children through EID for those <18 months of age, conduct PITC in clinical settings, family-testing through clinical and community HTC strategies, and the launch and use of the combined mother-child card. The activities will involve the intensified identification of HIV-exposed and infected children both at the facility and community level, collection of samples for DBS and strengthening of DBS networks to all facilities offering PMTCT services. DBS collection will be closely linked to Cotrimoxazole prophylaxis, immunization schedule and regular growth & nutritional monitoring. Exposed children will be followed until their status is confirmed, and they are proactively linked to pediatric care services and ART if HIV-infected. Efforts will be made to decentralize services so that patients get treatment where they are presenting for care.

The laboratory networks for CD4 count tests will be strengthened and improved to ensure that all infected children are screened to assess eligibility for ART.

The partner will provide a care and support package that will 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. Life skills training sessions will be held with adults and children aged between 7 and 16 years address issues related to drug adherence basic hygiene and nutrition.

The partner will work in collaboration with other partners to ensure that malnourished children receive nutrition therapeutic or supplementary feeding for better health outcomes. Health care workers will be trained on infant and young child feeding (IYCF) in order to strengthen the care components.

In addition, these families will be linked to a supply of insecticides treated bed nets targeting especially those with pregnant women and children less than five years.

The partner will also support and strengthen prevention and treatment of opportunistic infections (OIs) including malaria and diarrheal diseases by training and sensitizing the health care workers on the management of OIs, distributing free cotrimoxazole to eligible children and scaling up prevention in young people. Distribution of job aids to enhance correct protocol use in management of OIs, and support the sites with emergency stocks of drugs for both prevention and treatment of OIs including Septrin, fluconazole, antibiotics, anti-diarrheal and anti-protozoa's will also be done.

The partner will work towards establishing or strengthening linkages with HIV community care services through Community Health Extension Workers (CHEW) or Community Health Workers (CHW). CHEW or CHW activities will include pediatric and family HTC, referral, tracking, and enrollment into clinical care of all identified HIV-infected children; monitoring usage of BCK and assisting with refills; pediatric and family medication adherence counseling and monitoring; and patient education on general health issues. The project will link with and support efforts in community awareness to educate and support caregivers, to inform them about available services and to reduce stigma.

These activities support the Partnership Framework which seeks to increase support for OI prophylactic and curative medicines to mitigate HIV related morbidity and mortality among adults and children with HIV. Support to PDCS will be one component of a package of integrated support at health facility and communities, holistically addressing HIV prevention, treatment and care

Budget allocation: Redacted. The activity will result in multiple awards

APHIA II follow on will be a national activity covering all the eight provinces of Kenya targeting the HIV infected children.

The TBD partner will build upon the APHIA II program and continue to prioritize the identification of exposed, and infected children through EID for those <18 months of age, conduct PITC in clinical settings, family-testing through clinical and community HTC strategies, and the launch and use of the combined mother-child card. In 2010, the partner will prioritize identification of exposed/infected children <5 years of age. Key emphasis will be placed on identifying the 100,000 children estimated to be HIV-infected and initiating ART for all HIV-positive children <18 months of age, regardless of CD4

Increased access to pediatric care and treatment began in 2006 and will continue through decentralization to lower-level health facilities and integration of care and treatment into MCH. In addition to this, a using family-centered model will be utilized to provide services to all family members. The partner will institutionalize task shifting / task sharing approaches to address the human capacity began in 2006 and will continue. EP support will strengthen service delivery systems including referral mechanisms. The partner will endeavor have children representing 15% of the adults on treatment.

The TBD partner will provide a package of basic care services to exposed/infected/affected children through supported facility, community, and/or home-based basic care services. Services include nutrition assessment, growth monitoring, safe water interventions, malaria prevention, OI management, psycho-social support, TB screening, and CTX at the service delivery points. Infected children will be provided with a BCK including a safe water system, CTX for OI prophylaxis, an insecticide-treated bed net, and multivitamins.

The TBD partner will strengthen pediatric TB case finding, diagnosis and treatment, and will increase availability of the cryptococcal antigen test.

In 2010, the partner will work in collaboration with the Kenya Pediatric Association (KPA) and regional mentors to offer regular pediatric HIV care mentorship in all the satellite pediatric HIV sites and to include mentorship in clinical monitoring and management of HIV-related complications and treatment.

Child psychosocial support will be directed towards providers involved both in child counseling and testing as well as treatment. The partner will establish kids clubs and adolescents psychosocial support groups that will be supported at facility level to improve community linkages, adherence to ART and stigma reduction among the infected children.

Other forms of partner support include infrastructure improvement, logistics strengthening, procurement of supplies and dissemination of materials such as standard treatment protocols, guidelines and pamphlets to address adherence, networking and establishment of laboratory services to new health centers and facilitate provision of laboratory equipments and reagents including CD4 percent and CD4 count.

The partner will build on the APHIA II systems for data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. The PEPFAR indicators will be realigned to incorporate the new generation indicators. The partner will also support both paper based and electronic versions of record keeping at the CCC in line with the NASCOP guidelines.

This supports the Partnership Framework by strengthening community support and mitigation programs and expanding to reach 80% of households with PLWHA with effective prevention, health maintenance including treatment adherence and disease monitoring and social support services.

Support to PDTX will be one component of a package of integrated support at health facilities and communities, holistically addressing HIV prevention, treatment and care.

Total budget allocation: Redacted. This activity will result in multiple awards

APHIA II Follow On will be a national activity covering all the eight provinces of Kenya focusing on strengthening activities at provincial, district and facility level. The TBD Partner will continue with the work currently going at all these levels. The TBD Partner will continue to support strengthening of host country's national HMIS system at the decentralized structures; support will mainly focus on training health providers on the use of the revised tools in the collection, collation, reporting and use of health data to improve the quality of service delivery. The program will continue to assess and improve the quality of data being collected, reported and used by health managers in managing service delivery. Use of Routine Data Quality Assessment tools at the facility level will be strengthened through planning and implementation of RDQA jointly with MoH staff. Capabilities of health managers to collect, analyze, report and use data on service delivery will be assessed routinely to inform the revision of capacity building plans on an annual basis. Health managers will also be supported to develop data dissemination plans at the district level as a strategy for enhancing data use in planning and targeting. Strong APHIA II follow on and MoH partnerships will be built around M & E supportive supervision, data quality audits, capacity building, better analysis and use of program monitoring data to advance better targeting of HIV prevention, care and treatment programs at the provincial and district level.

Generation and utilization of quality information to support effective prevention, care and treatment program management and implementation is key to improving quality of life of PLWHAs at the community level. APHIA programs have played a critical role in supporting the decentralized structures for collection, collation and reporting of results for community based programs. National AIDS Control Council's Community Based Program Activity Report (COBPAR System) despite having received technical support from the current APHIA II programs, still has very low reporting rates for the community-based programs. APHIA II follow on will increase their capacity building activities targeting Constituency AIDS Control Committees on all aspect of data collection, collation, reporting and use. Capacity building of community-based organizations in basic M&E and M&E-related institutional strengthening functions will remain as the main strategy for ensuring improved delivery at community level. Focus will also shift to strengthening the district level structures for them to support the flow and management of community based data for planning and decision-making. Building of stronger linkages between community and facility-based monitoring systems will remain critical area of focus for the APHIA II follow on program.

Overall, APHIA II follow-on will play a major role in the implementation of PEPFAR II's Next Generation Indicators for community and facility-based programs. The TBD partner will especially focus on building the capacity of health providers to effectively use the revised HMIS and COBPAR tools to collect and report quality and reliable data. TBD partner will ensure that existing facility and community-based monitoring systems are fully harmonized with national systems through supporting the use of national data collection and reporting systems in meeting USG's reporting requirements. The TBD partner will also support the host country in rolling out the Electronic Medical Records Systems at provincial and at least three high volume district hospitals.

These activities support the Partnership framework by enhancing the capacity of Kenyan facilities to collect and report routine data which will continuously inform strategic planning and program implementation as well as strengthen national systems.

Support to SI will be one component of a package of integrated support at health facility and communities, holistically addressing HIV prevention, treatment and care

Budget allocation: Redacted. This activity will result in multiple awards.

APHIA II follow on will be a national activity covering all the eight provinces of Kenya. This activity will focus on enhancing policy dissemination, commodity management systems and quality assurance from national level to the provincial and district regions in Kenya. Overall goal is to establish a policy framework that will optimally support HIV/AIDs programming and the overall health sector, strengthen GOK commodities management systems, improve quality assurance and inform GOK budget allocation process of recurrent expenditures specific to HIV/AIDS as well as overall health sector.

In addition, this activity will assist the Ministry of Health increase efficiency in utilization of resources by strengthening the monitoring of activities carried out under the Health Sector Services Fund (HSSF), Hospitals Management Services Fund (HMSF) as well as in assisting in the rollout of the Output Based Approach (OBA) program. The HSSF program seeks to provide direct funding to dispensaries and health centers thus increasing the amount of resources available at lower level facilities and enhancing the care provided by these facilities whereas the HMSF is expected to improve efficiency and effectiveness of services in districts and provincial hospitals through the formation of management teams that will run them. The OBA program provides vouchers to previously identified low-income families for specific services identified by the program this in Kenya ranges from Long-acting family planning methods to paying for deliveries.

This is part of supply-side reforms with the HSSF fund increasing resources to low level facilities thus improving the care provided at these facilities and helping to decongest the public sector district and provincial hospitals. The OBA program is a demand-side reform program providing clients with vouchers for specific services and allowing them to choose where to go to receive these services. This has been shown to create useful competition amongst providers both public and private and helps in increasing access to key services.

The TBD Partner will also work with the ministries of health, specifically KEMSA, to enhance coordination of commodity supply and information reporting to and from national level and health facilities. The activity will also support commodity re-distribution among health facilities in the districts and provinces. The TBD Partner will support coordination of all logistics functions at the district and provincial levels. This will include technical assistance to build facility capacity in forecasting and quantification, local procurement and warehousing/distribution as well as setting up a logistics management information system for health commodities. This will ensure timely replenishment of supplies from the national level.

The TBD Partner will support Human Resources for Health (HRH) initiatives. This will be done in relation to the national HRH strategy and in recognition of the leadership, management and sustainability of health sector. The initiatives will include, strengthening institutions, structures and policies for Human resources management; improvement of health workers competencies at all levels of service delivery and improving workforce through hiring, support, productivity and improved HRM systems. These activities are support the partnership framework which seeks to increase GOK recurrent budget expenditure for health, establish policies that will address and mitigate societal norms or cultural practices that impede HIV programming and improve GOK health commodity supply chain management and human resource for health capacity building.

The TBD Partners will be expected to work with the regional, district and health facility management teams to promote health sector reform process activities such as logistics management and trainings as well as inform the formulation of policies and strategies e.g. National health framework, National Health Finance Strategy, National Medical Supplies Agency (KEMSA) and others.

Support to OHSS will be one component of a package of integrated support at health facilities and communities, holistically addressing HIV prevention, treatment and care.

Budget allocation: Redacted. This allocation will result in multiple awards.

The USAID APHIA II Follow on project will continue to expand the geographical coverage to increase access to Voluntary Medical Male Circumcision (VMMC) services. This will be a national activity focusing on areas that have the highest numbers of uncircumcised men, including Nairobi, Nyanza, Western, and Rift Valley Provinces. The TBD partner will build on the progress of APHIA II activities, which were initiated in Nyanza Province in FY 2008, in providing a high quality minimum package of male circumcision services to eligible boys and men.

Activities will include training in VMMC clinical skills to health care workers, including nurses, doctors, and clinical officers, based on curriculum developed and approved by the Government of Kenya. HIV testing and counseling, STI screening and treatment, sexual risk reduction counseling, and condom provision, promotion, and demonstration are all part of the integrated VMMC program. Provision of integrated services at both facility and outreach levels will ensure effective linkages to treatment, care and support, as well as to family planning and reproductive health services. The TBD partner will support purchase of equipment, furniture, consumables, and reusable supplies. VMMC in clinical settings will require support for logistics, creation and renovation of space, supportive supervision, ongoing clinical mentoring and monitoring and mainstreaming VMMC reporting.

This activity is part of a comprehensive prevention package delivered by the APHIA II Follow on. Activities will incorporate preventive messaging at health facilities targeting VMMC clients, their partners, and their families. It will involve the concept of AB and will promote the use of condoms in high-risk encounters and support STI prevention and management. Behavior change communication (BCC) strategies will focus on stigma reduction to increase utilization of services, psychosocial support and promotion of VMMC services. Outreach workers, peer educators, and community health workers will be trained to reach out to communities, men's and women's groups, workplace employees, and community leaders to increase knowledge of health benefits of VMMC.

The TBD partner will create awareness and demand as appropriate through activities such as community radio. Radio spots with appropriate BCC messages will be aired and interactive programs that bring in experts to debate the importance of VMMC while creating awareness and provoking communities to action will be facilitated to reach a large percentage of youth, men and women. Similarly, FBO-based youth leaders in supported churches/mosques will be facilitated to promote ABY and VMMC messages to adolescents and young adults. There will be continued advocacy with community structures such as the Luo Council of Elders in Nyanza Province and other leaders to increase acceptability of VMMC as part of an integrated prevention strategy.

The TBD partner will develop an intensive monitoring and evaluation plan in order to ensure the highest quality services are delivered. Activities for monitoring and evaluation will include routine site visits, reporting checks, and training of workers in data collection. Adverse events will be closely monitored and steps taken to improve the rate of such events. The TBD partner will ensure standardization of data collection forms and consent forms across all sites and according to national and World Health Organization guidance.

This activity supports the Kenya Partnership Framework by using evidence-based, data driven approaches, efficiency of activities, and sustainability of all interventions. The goals and objectives of the partnership framework include providing facilities, personnel, and technical leadership for VMMC facilities, and to support community mobilization and outreach approaches.

Support to VMMC will be one component of a package of integrated support at health facilities and communities, holistically addressing HIV prevention, treatment and care

Budget allocation is Redacted. This activity will result in multiple awards.

The APHIA II Follow On will be a national activity covering all eight provinces of Kenya targeting general populations, adults, youth both in and out of school, teachers, most-at-risk populations, and more with community outreach HIV/AIDS prevention programs that promote abstinence and/or being faithful. Specific attention will be paid to AB messaging that targets young men and women aged,15-35,with the aim of reducing multiple concurrent partnerships. Gender-specific programming and messaging will be taken into account in all activities. Peer education, informal and formal worksite interventions, community outreach by PLWA, mobile VCT and life skills education for youth will all serve as means through which messages will be conveyed. In-school programs for 10 to18 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. 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. The TBD partner will ensure that persons will be trained to provide HIV/AIDS prevention programs that promote abstinence and/or being faithful. The TBD partner will implement prevention with positives by working with PLWHA support groups, linking them to comprehensive care centers and other services, and delivering key messages about living positively. This activity will provide assistance to patient support groups and post-test clubs in VCT centers to ensure abstinence by HIV-infected persons. This will empower support group participants to become peer and advocacy leaders in prevention at the community level. Technical assistance will continue to be provided to implementing partners working in behavior change communication programs in HIV and develop new print materials addressing alcohol abuse, stigma and discrimination. The TBD partner will develop an intensive monitoring and evaluation plan in order to ensure the highest quality services are delivered. Activities for monitoring and evaluation will include routine site visits, reporting checks, and training of workers in data collection. This activity supports the Kenya Partnership Framework by using evidence-based approaches that promote character formation and abstinence among youth as well as fidelity and partner reduction by sexually active persons. Support to AB will be one component of a package of integrated support at health facility and community levels, holistically addressing HIV prevention, treatment and care. Budget allocation: Redacted.This activity will result in multiple awards.

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The APHIA II Follow On will be a national activity covering all eight provinces of Kenya and targeting general populations, adults, youth both in and out of school, teachers, high-risk populations including low-income community women, sex workers (both male and female), men having sex with men, truck drivers, cattle traders, uniformed services, fisher folk, mobile populations, and discordant couples with community outreach HIV/AIDS prevention programs that promote condoms and other prevention strategies.

The TBD partner will ensure that persons will be trained to provide HIV/AIDS prevention programs that promote prevention other than abstinence and being faithful. The TBD partner will implement prevention with positives by working with PLWHA support groups, linking them to comprehensive care centers and other services, and delivering key messages about living positively. This activity will provide assistance to patient support groups and post-test clubs in HCT centers, empowering participants to become peer and advocacy leaders in prevention at the community level.

The TBD Partner will link with and provide referrals to existing networks of HIV/AIDS counseling and testing, home-based care and ART programs in the program areas. Activities will also include targeted promotion of correct, consistent condom use and distribution to high-risk populations through countrywide condom outlets and improved quality of STI services working through the Ministry of Health and other partners. Prevention activities might include the following: targeting out-of-school and most at risk youth with prevention information and referral to youth friendly services; supporting peer education interventions with sex workers and linking them to HCT, PMTCT, care and support services; support prevention efforts among the uniformed services to expand police peer education programs; support peer education programs targeting MARPS; support prevention programs targeting hard-to-reach MARPS such as the MSM and injection drug users; provide counseling, information and prevention to HIV-positive individuals through peer and provider education, outreach services and regional mass media. Implementing partners will integrate prevention messages into models of care and support for OVC and PLWHAs. Technical assistance will continue to be provided to implementing partners working on behavior change communication programs in HIV and substance abuse and develop new print materials addressing alcohol abuse, stigma and discrimination.

The TBD Partner will expand support in HIV prevention and supportive services to victims of gender-based violence in all provinces with projects based on the successes of the Gender Based Violence Center at Nairobi Women's Hospital. The GBV activities will target police, uniformed services, women, leaders, employees of the Kenyan judicial system, medical personnel, spouses and others on issues of gender-based violence.

The TBD partner will develop an intensive monitoring and evaluation plan in order to ensure the highest quality services are delivered. Activities for monitoring and evaluation will include routine site visits, reporting checks, and training of workers in data collection.

This activity supports the Kenya Partnership Framework by using evidence-based, data driven approaches, efficiency of activities, focusing on human rights, meaningful involvement of PLWHA, and sustainability of all interventions. The goals and objectives of the partnership framework include using evidence-based a behavioral interventions to promote character formation, abstinence among youth, fidelity, partner reduction, and correct and consistent condom use by sexually active persons targeting populations at risk for transmission or acquisition of HIV.

Support to OP will be one component of a package of integrated support at health facilities and communities, holistically addressing HIV prevention, treatment and care.

Budget allocation is Redacted. This activity will result in multiple awards.

The APHIA II follow on will be a national program covering all the eight provinces of Kenya. This activity will support implementation of IDU activities in select provinces. Injection drug users (IDUs), though relatively small in number in Kenya, are at disproportionately high risk for HIV infection. Many share needles and syringes and engage in unprotected, often transactional, sex often with multiple partners to support their drug dependency. IDUs are universally recognized as a "bridging" population, hastening the spread of HIV to the general population. The Modes of Transmission Study (MOT) conducted in 2008 indicates that most-at-risk populations (MARPS) contribute to more than one-third of new HIV infections in Kenya. According to KAIS 2007 IDUs contribute 3.83% of HIV prevalence in Kenya.

This activity will build on the progress of APHIA II activities providing IDU and NIDU. Work at the community level has occurred primarily through the APHIA program. Outreach programs have been established in several geographical regions of Kenya to provide education and VCT testing for IDUs and NIDUs. Training and technical assistance has been provided to develop the capacity of each of the respective implementing NGOs at the community level. Some scale up has occurred in expanding coverage areas by each of the NGOs. Most of the activities are implemented in the Coast Province and in Nairobi.

The overall objective of the APHIA II Follow on IDUs and NIDUs is to reduce the spread of HIV among the high-risk populations of drug and alcohol users. The program will utilize both recovering drug users as well as non-drug-users to make contact with addicts to establish behavior plans to reduce their risk of HIV. Other activities will include a comprehensive mapping exercise of IDU/NIDUs in the different regions of Kenya. Some regions already providing IDU/NIDU interventions will be able to strengthen their programs based the mapping results. In addition, current programs need to strengthen the technical programming in terms of mediation assisted treatment, addiction recovery treatment services, and improving skills in the area of HIV outreach behavior change interventions. Prevention with positives is also a targeted need for the IDU/NIDU population which will include an intensive case management program to follow HIV positive IDU/NIDU in their HIV treatment services. Such programs will track IDU/NIDUs through each level of their HIV treatment process and ARV adherence. The goal is to facilitate comprehensive wraparound services. Working with HIV treatment centers in identifying HIV positive substance abusers (IDU/NIDU & Alcohol) to provide HIV risk reduction services, dealing with ARV adherence issues, and offering addictions recovery treatment services.

The APHIA II Follow-on program will continue supporting in- school drug abuse awareness and will continue supporting the development of community based alcohol education, treatment and support services. The APHIA II follow-on supported programs will continue to ensure effective referrals for relevant services, including HIV counseling and testing, HIV care and treatment services and male circumcision services.

This activity supports the Kenya Partnership Framework by implementation of proven behavioral interventions optimally targeted to the sources of new infections and those most at risk groups, specifically IDU/NIDUs.

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Budget allocation: Redacted. This activity will result in multiple awards

APHIA II follow on will be a national activity covering all eight provinces of Kenya with the goal of reaching more than 80% of expected pregnant women with PMTCT interventions, utilizing both facility and community based approaches. The TBD partner will support facilities to provide a comprehensive antenatal package for all pregnant women including screening, prevention and treatment for any infections, nutritional support, prophylactic ARVs, counseling on safe infant feeding, counseling and HIV testing of women and their partners.

The TBD will utilize multiple approaches to reach women currently not accessing ANC due to challenges related to culture, stigma and inaccessibility due to vast distances to health facilities.

Counseling and testing will be offered primarily to pregnant women in both ANC and labor and delivery, (including repeat testing in high prevalence areas). The CT services will be extended to other family members including children using the pregnant woman as the entry point. This will foster a family centered approach to care and treatment and help improve post natal follow up of the mother-infant pair.

All HIV- infected pregnant women who will be enrolled into HIV care, and those eligible will initiate ART. In an effort to improve access to HIV care and treatment services including ART, the TBD partner will support the integration of HIV care and treatment into MCH for the mother and family by strengthening referral laboratory networks for CD4, decentralization and task-shifting. The use of this family-centered approach will improve retention in care and treatment. The partner will use national referral tools to link mothers and their families to palliative care, including TB services and home-based care; ART; malaria prevention activities; FP services; and income-generating activities. Mothers will be offered the most efficacious regimen according to the national guidelines.

The TBD partner will use a combination of strategies, including working with other partners carrying out activities to promote male involvement in PMTCT. Such strategies, though not limited, will include reduction in concurrent partners, condom use, circumcision and couple counseling.

The TBD partner, in collaboration with other partners, will support logistics to improve Early Infant Diagnosis (EID) as well the follow up of exposed infants by integrating the follow up with well child and immunization services. The partner will build upon existing Infant and Young Child Feeding (IYCF) strategies such as involvement of men, grandmothers, PLHIV peer educators, mother-to-mother support groups, and other community leaders at community level and explore the use of ARVs at facility level to make breastfeeding safer.

The partner will conduct both in service training according to the national guidelines as well as ensure that a comprehensive supervision and mentorship program is set up to enhance on job skills.

The partner will work meaningfully with people living with HIV/AIDS to promote the uptake of PMTCT interventions. Such groups will include Mentor Mothers whose roles and activities will be standardized using mothers to mothers (m2m) program tools.

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.

The partner will provide updates/training to the PHMT and DHMT members to build their capacity to manage the PMTCT program. Under this strategy periodic meetings will be held at different levels as a part of a performance feedback process. The partner will be encouraged to use program level quality indicators to increase effectiveness.

This activity supports the Partnership Framework, by supporting 100% coverage of PMTCT; a key priority will be to expand FP within PMTCT settings in support of the RH/HIV Integration strategy. Increased linkages to sexual and reproductive health/FP services will include skilled deliveries, cervical cancer screening and referral and screening and HIV testing for gender-based violence victims. Gender mainstreaming will ensure that the sexual and reproductive health needs of women focus on preventing unwanted pregnancies.

Support to PMTCT will be one component of a package of integrated support at health facilities and communities, holistically addressing HIV prevention, treatment and care

Budget allocation: Redacted. This activity will result in multiple awards.

APHIA II follow on will be a national activity covering all the eight provinces of Kenya targeting the HIV and TB co-infected adult and children population. In Kenya, tuberculosis (TB) is the leading cause of death of PLWH and HIV is the greatest factor behind the nearly 3-fold rise in the TB burden in the last 10 years. This activity will build on the progress of APHIA II activities providing HIV/TB services working through health facilities and communities. The overall objective of the APHIA II Follow on HIV/TB care project is to decrease the prevalence of TB in all areas served and integrate care of co-infected patients into a comprehensive program that meets the objectives of the Division of Leprosy, Tuberculosis and Lung Diseases (DLTLD) and NASCOP. This activity will support and strengthen what Kenya has adopted, the Global Stop TB Strategy emphasizing effective DOTS delivery with focus on HIV-associated and drug-resistant TB, health system strengthening (particularly primary care and laboratories) and closer engagement with patients and communities.

The TBD partner will assist the provinces adapt the Management and Organizational Sustainability Tool HVTB (MOST HVTB) strategy to achieve FY10 national and EP goals. The mandates of the present national, provincial and district HVTB steering committees will be strengthened to make them more responsive to stakeholder needs. New steering committees will be established to cover new districts. The TBD partner will support coordination meetings, supervision, training, and strategic information. In Kenya, HIV testing for newly diagnosed TB patients is and will remain the standard of care; > 80% of patients are tested, and >90% of co-infected patients initiated cotrimoxazole (CTX). The TBD partner will target 100% of all co-infected patients for CTX and provide access to ART to 50% of those eligible. To reduce the TB burden in PLWH, 80% of HIV patients in each province will receive intensified TB case finding (ICF). ICF will start in select care and treatment sites before expansion to PMTCT and HIV testing sites. Select care and treatment clinics in at least 3 provinces will pilot the new adult TB screening tool and the pediatric TB screening tool. Patients diagnosed with active TB will receive rapid treatment and reduce further transmission. Patients without active TB will be considered for IPT in sites able to conduct/sustain patient adherence and document outcomes.

The TBD partner will support CHW engagement for ICF, assist with family TB/HIV screening, and provide adherence support and patient education. Facility and community groups will provide a two-way referral and communication systems to coordinate outreach activities to identify/support co-infected patients and families. Community-based care will expand and link to PwP, community HIV testing, and ICF strategies. TB clinics will initiate PwP interventions such as supported disclosure, adherence counseling, condom use, and risk reduction counseling with linkages to family planning, STI, and medical male circumcision services.

The TBD partner will support strengthening HVTB program monitoring and evaluation through development of electronic TB and HIV recording/reporting systems to improve patient referrals and programs linkages and evaluation. National and regional TB/HIV data review and coordination meetings will ensure that collected data collected are comparable and accurate. Efforts will support data use for planning, resource allocation and program improvement.

This activity supports the Partnership Framework by increasing TB screening, detection and treatment in HIV care settings, and referral from TB settings so that at least 80% of co-infected eligible individuals are on ART.

Support to HVTB will be one component of a package of integrated support at health facilities and communities, holistically addressing HIV prevention, treatment and care

Budget allocation is Redacted. This activity will result multiple awards.