The comprehensive goals and objectives under this TBD are to continue to support the implementation and scale up of combination evidence-based, cost-effective HIV prevention interventions for Most At Risk Populations (MARPs) in Kenya. The TBD funded partners will implement programs based on a national minimum package of services including peer education and outreach, condom and lubricant promotion, STI screening and treatment, HIV counseling and testing and HIV care and treatment. Referrals and linkages to reproductive health services, psychosocial support and livelihood skills training and opportunities will also be included. Implementing partners will work in close collaboration with the NASCOP, service providers and other partners and use national standard operational procedures currently under development. The primary MARPs populations to be targeted will include male and female commercial sex workers (CSWs), Men who have sex with men (MSM), and injecting and non-injecting drug users, including alcohol and substance abusers and partners of these sub-groups. Additionally, populations that have an increased vulnerability to HIV will also be targeted including fisher folk and truckers.

The goals and objectives of this TBD are similar to those of the partnership framework in that they promote intensive prevention interventions that are consistent with the national strategic plan. The program encompasses broad program areas including behavioral prevention, counseling and testing, clinical services addressing STI and HIV prevention and treatment and linkages with psychosocial and structural interventions.

This program announcement covers MARPS including male and female commercial sex workers, MSM, IDU/non-IDUs, fisher folk, mobile populations, and partners of these persons. The following provinces are targeted: Nyanza, Nairobi, Central, Eastern, Rift Valley region, and Nairobi.

The TBD partner will work in close collaboration with health service providers in their provinces through facilitating training partnerships, efficient referral linkages and regional technical working groups and technical consultative forums as guided by NASCOP and other relevant Government of Kenya departments.

TBD partner(s) will support increasing access to combination HIV prevention services that incorporates behavioral, structural, and biomedical HIV-prevention interventions. Prevention efforts in Kenya must be multifaceted in order to magnify their impact; the TBD partners will be encouraged to be cross-cutting in their prevention efforts in all areas: behavioral, bio-medical and structural.

The TBD supports using cost effective strategies, mainly integrated service delivery models. Implementing partners will be required to develop plan to assess cost-effectiveness of program activities that would lead to adoption of models with the optimal efficiency. These programs will be expected to have a significant impact on incidence reduction among both the MARPs population as well as with the general population with whom the MARPS sexual networks interact.

The comprehensive goals and objectives under this TBD are to continue to support the strengthening, implementation and scale up of a comprehensive package of evidence-based quality services for injecting and non-injecting drug use prevention and treatment, including interventions for prevention and risk reduction of alcohol-related sexual risk behavior. This initiative will be integrated within programs targeting Most At Risk Populations in Kenya including male and female commercial sex workers (CSWs), Men who have sex with men (MSM), and injecting and non-injecting drug users, including alcohol and substance abusers and very importantly, partners of these sub-groups. HIV Testing and Counseling (HTC) services will be provided to the MARPs using a variety of approaches including Provider Initiated HTC within facilities, as well as both client initiated and provider initiated HTC within community settings such as Outreach or mobile HTC, moonlight HTC, workplace HTC and door-to-door HTC where appropriate. Services will be integrated within the Prevention program, and will be provided in line with the Kenya National HTC guidelines. The program targets to provide HTC to 70,000 MARPs and support the training of 90 health care workers on HTC services using the national HTC training curriculum. The program will also work to provide HTC services to the sexual partners of these MARPs focusing on the importance of knowing self and sexual partner's HIV status as a key strategy in HIV prevention. All HIV infected individuals will be referred to identified health care facilities for linkage to HIV Care and Treatment Services, while all HIV uninfected individuals will be linked to the ongoing HIV Prevention services. TBD will work the Ministry of Health at implementation level to strengthen the commodity management system to ensure constant supply particularly of Rapid Test Kits and will also support the implementation of the National Quality Assurance Strategy to improve counseling quality and ensure accuracy and validity of HIV test results. Standard operating procedures will be used for implementation as well as national M&E and reporting system. The program will be implemented in five provinces: Nyanza, Nairobi, Central, Eastern and Rift Valley.

The comprehensive goals and objectives under this TBD are to continue to support the strengthening, implementation and scale up of a comprehensive package of evidence-based quality services for Most At Risk Populations in Kenya. The package will include peer education and outreach, condom and lubricant promotion, STI screening and treatment, HIV counseling and testing and HIV care and treatment. Referrals and linkages to reproductive health services, psychosocial support and livelihood skills training and opportunities will also be included as well as a referral directory. The TBD partner(s) will design and implement targeted HIV-prevention behavioral interventions. Adaptations of evidence-based behavioral interventions (e.g., interventions from the Diffusion of Behavioral Interventions project or Replicating Effective Programs project [www.effectiveinterventions.org and www.cdc.gov/hiv/topics/prev_prog/rep/index.htm]) are also encouraged. Behavioral interventions will focus on reduction of sexual partners, provision of condoms, promotion of correct and consistent condom and lubricant use, reducing concurrent partnerships, HIV testing and counseling (including partner/couple testing and disclosure) and decreasing cross-generational and transactional sex among sexually active adults. Interventions may include use of peer educators through utilization of evidence based models. Standard operating procedures will be used for implementation and a strengthened M&E system linked to the national framework will be used. Populations to be targeted will include male and female commercial sex workers (CSWs), Men who have sex with men (MSM) and, very importantly, partners of these sub-groups. Additionally, populations that have an increased vulnerability to HIV will also be targeted including fisher folk and truckers. The program will be implemented in five provinces: Nyanza, Nairobi, Central, Eastern and Rift Valley.

This TBD mechanism will reach 39,618 CSW, 8,775 MSM, 25,067 fisher folk, and 6,771 truckers with a minimum package of services including behavioral interventions.

The comprehensive goals and objectives under this TBD are to continue to support the strengthening, implementation and scale up of a comprehensive package of evidence-based quality services for injecting and non-injecting drug use prevention and treatment, including interventions for prevention and risk reduction of alcohol-related sexual risk behavior. This initiative will be integrated within programs targeting Most At Risk Populations in Kenya including male and female commercial sex workers (CSWs), Men who have sex with men (MSM), and injecting and non-injecting drug users, including alcohol and substance abusers and very importantly, partners of these sub-groups. Standards and tolls for prevention and risk reduction will be adopted from the WHO and other existing ones such as the CAGE and the brief intervention model for risk assessments and addiction therapy. Service providers will be trained to integrate these services within the public and private health care systems and a collaborative referral network with IDU/NIDU Services established. The program will also offer a technical collaborative partnership with youth and general population programs for synergy and referrals. Standard operating procedures will be used for implementation and a strengthened M&E system linked to the national framework will be used. Quality assurance informed by central policy guidelines and standards will guide the implementation of programs. The program will be implemented in five provinces: Nyanza, Nairobi, Central, Eastern and Rift Valley.

This TBD mechanism will reach 3,650 IDUs with a minimum package of services including behavioral interventions.