This TBD represents a follow-on for HIV clinical services (MTCT, HBHC, HTXS, PDCS, PDTX, HVTB, ) currently provided by the following partners whose awards are expiring on March 31, 2010: AMREF (295.09), CARE International (368.09), EDARP (282.09), IMC (662.09), IRC (305.09) NARESA (296.09), NYU (286.09), Pathfinder International, UCSF (292.09), University of Manitoba (287.09), University of Nairobi (217.09 and 303.09), University of Washington (483.09). The existing services will transition to several TBD partners (PS09-991, PS09-962 and PS10-1004). The current activities under the listed partners are located in Central, Nairobi, Eastern and Nyanza regions. We anticipate making ~9 awards to follow on these activities. This TBD will cover Comprehensive Prevention care and treatment activities including PMTC, Provider Initiated Counseling and Testing, Basic care, Antiretroviral treatment and Prevention of HIV in clinical settings.

These activities will contribute to the expansion of access to quality comprehensive care and treatment services for people with HIV and pregnant mothers, strengthened human resource capacity to deliver comprehensive, prevention and treatment services, and a strengthened referral network for the provision of these services.

Activities will cover Nairobi, Eastern, Central and Nyanza regions in Kenya. These activities target pregnant mothers and people living with HIV/AIDS, including HIV positive infants (0 - 5 years), children (6 - 14 years), adult men and women and pregnant women. Public health care providers, including doctors, nurses, pharmacists, and laboratory workers are targeted for increased comprehensive prevention, care and treatment knowledge and skills

The To be Determined (TBD) partners will expand a collaborative relationship with National AIDS and STD control Program at national, provincial and district level . TBD will also support establishment/strengthening of other regional activities, including developing a system for quality control at supported facilities and the development of a regional system for transfer of blood samples/results to optimize the utilization of CD4 cell count machines. TBD partners will also assist with development of a quality improvement program for the region and will assist the National AIDS and STD Control Program (NASCOP) with implementation of a similar system nationally.

Due to the expansion of HIV clinical care services and the shortage of health workers, funds will be used to hire additional health workers who will be placed at the facilities providing HIV services. Funds will also be used for training of these health workers in comprehensive prevention care and treatment.

TBD partners will support integration of prevention care and treatment services at facility level. TBD partners will implement in coordination with other USG partners and Ministry of health at provincial and district level.

The To be Determined (TBD) partners will expand a collaborative relationship with Kenya Ministries of health through the National AIDS and STI Control Program(NASCOP) at national , provincial and district level in Central, Nyanza, Eastern and Nairobi regions, providing care for over 135,700 adults with HIV. This TBD represents a follow-on for Pediatric HIV basic care activities (PDCS ) currently provided by the following partners whose awards are expiring on March 31, 2010: AMREF ( 9039), EDARP (9062), IRC , NYU (8989), UCSF (8946), University of Manitoba (8947), University of Nairobi (8939 and 8940), University of Washington (8935). The existing services will transition to several TBD partners under the CDC clinical services Funding Opportunity Announcements (PS09-991, PS09-962 and PS10-1004). TBD will support staff salaries, training, laboratory evaluation, adherence counseling, and monitoring. The activity will also support the training of 200 individuals in the provision of HIV-related palliative care services. The package of services provided to children will include cotrimoxazole prophylaxis, treatment of opportunistic infections, management of malnutrition, improved access to safe drinking water, and interventions to reduce the risk of malaria. TBD will work closely with, and support the activities of, the Provincial AIDS and STI Coordinating Officer for the region, e.g., supporting regular meetings of area providers. TBD will also support establishment/strengthening of other regional activities, including developing a system for quality control at district level and the development of a regional system for transfer of blood samples/results to optimize the utilization of CD4 cell count machines and Early Infant Diagnosis. TBD partners will also assist with development of a quality improvement program for the assigned region and will assist NASCOP with implementation of a similar system nationally.

The To be Determined (TBD) partners will expand a collaborative relationship with Kenya Ministries of health through the National AIDS and STI Control Program(NASCOP) at national , provincial and district level in Central, Nyanza, Eastern and Nairobi regions, to enhance and expand the antiretroviral treatment program in Eastern , Central, Nairobi and Nyanza regions in Kenya, providing treatment to 71, 600 people with HIV (including 9660 new , bringing the total ever treated to 85,920 in over 150 sites. 900 health care providers will receive ART training. This TBD represents a follow-on for treatment activities (HTXS) currently provided by the following partners whose awards are expiring on March 31, 2010: The existing services will transition to several TBD partners under the CDC clinical Services AMREF ( 9039), EDARP (9062), IRC , NYU (8989), UCSF (8946), University of Manitoba (8947), University of Nairobi (8939 and 8940), University of Washington (8935). Funding Opportunity Announcements (PS09-991, PS09-962 and PS10-1004).TBD partners will support, staff salaries, training, laboratory evaluation, adherence counseling, and monitoring. ARVs will be supplied to the sites through the distribution system of the recently awarded Kenya Pharma project and the Kenya Medical Supplies Agency (KEMSA).

The partners will work closely with and support the activities of the Provincial AIDS and STI Coordinator for the assigned region. These activities will include support for regular meetings of providers from sites in each region. TBD will also support establishment/strengthening of other regional activities, including developing a system for quality control, a regional system for transfer of blood samples/results to optimize the utilization of the CD4 cell count machines, and a regional quality improvement program.

To be determined (TBD) partners will continue to work with the Kenyan ministries of health and the National AIDS and STI control program at the national, provincial and district levels to support the provision of HIV testing and counseling services in all health facilities in four provinces of Nyanza, Central, Eastern and Nairobi. The partners will specifically support provider initiated HIV testing and counseling (PITC) provided by all health workers as part of routine minimum package of care for all patients, family members and relatives regardless of their presenting signs and symptoms. This shall be in line with the Kenya National AIDS Strategic Plan for HIV AIDS (KNASP III) that aims to attain universal access to HIV testing and counseling by 2013. This TBD will support HIV testing and counseling for 357,000 patients, family members and relatives in 2010-2011 program year. It will also support training of health 2,325 healthcare workers on PITC, support staff salaries, continuous medical education, promotional meetings, national and regional coordination meetings, quality assurance activities, printing of recording and reporting tools, supplies and other relevant logistics.

The TBD partners will continue to ensure that at least 30% of all out patients and 80% of all patients admitted in the medium to high level public facilities are provided HIV testing and counseling and received their results as per national guidelines. The TBD partners will work closely with NASCOP and the ministry of medical services, medical superintendants and other relevant leadership to ensure that a positive attitude and support is given towards routine HIV testing and counseling. It will also work towards ensuring high level of quality through supporting of regular supervisions, mentorships, and external test validation and proficiency testing as per the Kenya national quality assurance strategy. Finally, the TBD will work to ensure effective referral and linkages to prevention, care and treatment depending on the outcome of the HIV testing and counseling.

The To be Determined (TBD) partners will expand a collaborative relationship with Kenya Ministries of health through the National AIDS and STI Control Program(NASCOP) at national , provincial and district level in Central, Nyanza, Eastern and Nairobi regions, providing care for 16,750 children below 15 years with HIV. This TBD represents a follow-on for Pediatric HIV basic care activities (PDCS ) currently provided by the following partners whose awards are expiring on March 31, 2010: AMREF ( 9039), EDARP (9062), IRC , NYU (8989), UCSF (8946), University of Manitoba (8947), University of Nairobi (8939 and 8940), University of Washington (8935). The existing services will transition to several TBD partners under the CDC clinical services Funding Opportunity Announcements (PS09-991, PS09-962 and PS10-1004). TBD will support staff salaries, training, laboratory evaluation, adherence counseling, and monitoring. The activity will also support the training of 200 individuals in the provision of HIV-related palliative care services. The package of services provided to children will include cotrimoxazole prophylaxis, treatment of opportunistic infections, management of malnutrition, improved access to safe drinking water, and interventions to reduce the risk of malaria. TBD will work closely with, and support the activities of, the Provincial AIDS and STI Coordinating Officer for the region, e.g., supporting regular meetings of area providers. TBD will also support establishment/strengthening of other regional activities, including developing a system for quality control at district level and the development of a regional system for transfer of blood samples/results to optimize the utilization of CD4 cell count machines and Early Infant Diagnosis. TBD partners will also assist with development of a quality improvement program for the assigned region and will assist NASCOP with implementation of a similar system nationally.

The To be Determined (TBD) partners will expand a collaborative relationship with Kenya Ministries of health through the National AIDS and STI Control Program(NASCOP) at national , provincial and district level in Central, Nyanza, Eastern and Nairobi regions, to enhance and expand the antiretroviral treatment program in Eastern , Central, Nairobi and Nyanza regions in Kenya, providing treatment to xxx children below 15 years with HIV (including 2,850 new , bringing the total ever treated to 10,644 in 150 sites. 900 health care providers will receive ART training. This TBD represents a follow-on for pediatric treatment activities (PDTX) currently provided by the following partners whose awards are expiring on March 31, 2010: AMREF (295.09), EDARP (282.09), IRC, (305.09) NYU (286.09), UCSF (292.09), University of Manitoba (287.09), University of Nairobi (217.09 and 303.09), University of Washington (483.09). The existing services will transition to several TBD partners under the CDC clinical Services Funding Opportunity Announcements (PS09-991, PS09-962 and PS10-1004).TBD partners will support, staff salaries, training, laboratory evaluation, adherence counseling, and monitoring. ARVs will be supplied to the sites through the distribution system of the recently awarded Kenya Pharma project and the Kenya Medical Supplies Agency (KEMSA).

The partners will work closely with and support the activities of the Provincial AIDS and STI Coordinator for the assigned region. These activities will include support for regular meetings of providers from sites in each region. TBD will also support establishment/strengthening of other regional activities, including developing a system for quality control, a regional system for transfer of blood samples/results to optimize the utilization of the CD4 cell count machines, and a regional quality improvement program.

The TBD partner will promote sustainability, in collaboration with the Kenyan Ministry of Health (MOH), the PEPFAR team, and the HHS/CDC office in Kenya, to strengthen, expand and initiate high quality, VMMC services in selected geographical areas in Nairobi province. To avoid duplication, the partner will work in collaboration with other stakeholders and implementing partners in Nairobi province.

Nairobi province has second highest HIV prevalence in Kenya. According to the 2007 Kenya AIDS Indicator Survey, the province had an HIV prevalence rate of 9%, whereas Kenya's average rate was 7.4%. About 20% of males are not circumcised and based on population; this is estimated to about 170,000 uncircumcised men aged 15-64 years. Specific areas within the Nairobi province where these uncircumcised males reside require targeted demand creation as well as provision of safe and quality MC services.

It is envisaged that the TBD will deliver the minimum package for MC services, using innovative approaches as recommended by the Kenya MC Taskforce, to ensure rapid coverage of 'catch up' population with quality and safe MC services through training of health care providers on MC skills. These may include use of facilities, as well as mobile and outreach MC services to smaller dispensaries, health centers, schools, churches and market places/community centers. The capacity of facilities serving residents will be increased to provide MC in response to increased demand for services likely to result from near-universal awareness of HIV status among many clients who will be referred from Home based CT services (HBVCT). Through this activity, the partner will train Health Care workers and provide over 10,000 Male Circumcisions. Outreach and/or mobile MC services will involve high quality high-volume standardized approach through trained mobile teams and will follow MOH guidance. Mobile teams will work at temporary sites including existing buildings and tents that will be equipped for minor surgical procedures and pre- and post-operative services. Mobile MC Teams may geographically follow HBVCT teams as they move through the target geographical area to ensure coverage and no missed opportunities.

Pre-operative assessment will follow group education about MC and HIV risk reduction, including the information that MC is not 100% protective against HIV acquisition. Standard HIV prevention messages in group educational sessions will include age-appropriate information about delaying sexual debut, abstinence where appropriate, partner risk reduction and use of condoms correctly and consistently. This activity includes major emphasis in training of health care providers on VMMC skills, development and distribution of Information, Education and Communication, minor renovation of health facilities out-patient theatres to provide VMMC services and linkages to appropriate health care services.

This TBD represents a follow-on for Prevention of Mother to child Transmission (MTCT)) currently provided by the following partners whose awards are expiring on March 31, 2010: AMREF (295.09), CARE International (368.09), EDARP (282.09), IMC (662.09), IRC (305.09) NARESA (296.09), NYU (286.09), Pathfinder International, UCSF (292.09), University of Nairobi (217.09 and 303.09), The existing services will transition to several TBD partners (PS09-991, PS09-962 and PS10-1004). The To be Determined (TBD) partners will expand a collaborative relationship with Kenya Ministries of health through the National AIDS and STI Control Program(NASCOP) at national , provincial and district level in Nyanza, Eastern and Nairobi regions, to enhance and expand Prevention of Mother to child Transmission in Eastern , Nairobi and Nyanza regions in Kenya, providing HIV testing ad counseling for 240,104 pregnant mothers. All HIV positive pregnant women shall have immunological and HIV clinical staging to identify appropriate ARV prophylaxis regimen as per the national guidelines. The partners will target to provide a complete course of ARV prophylaxis to 26,266 of the 28,550 HIV positive pregnant mothers as per the Ministry of Health guidelines.

All HIV exposed infant will be given ARV prophylaxis in line with the National PMTCT guidelines. The program will strengthen comprehensive PMTCT including couple counseling and will target to reach at least 14,000 male partners with HIV counseling and testing services. To improve the quality of life for HIV infected women, the program will wrap around other programs namely Safe motherhood and Family planning as well as TB screening and linkage to treatment. In strengthening the linkage between PMTCT and Pediatric HIV care services, the program shall support early infant HIV infection diagnosis by use of Polymerase Chain Reaction (PCR) for all HIV exposed infants and link all eligible infants to the pediatric ART program. The program shall strengthen the post natal HIV care clinic and shall support all the facilities in all the regions to initiate this strategy. The program shall also work and strengthen linkage with Child Survival activities to ensure that all infants and especially the HIV exposed and infected access immunization, growth monitoring, safe water and Infant and Young Child feeding services and support which will contribute to improved infant and child health outcomes. The mentor mothers' initiative is another national effort aimed at improving Infant and Young Child Feeding especially for the HIV exposed or infected child. The program will support the roll out of this strategy in at in all assigned regions. Improved access to laboratory services for HIV+ women and their exposed infants is an important step in ensuring accurate assessment for HIV care and treatment. The program will work with the other PEPFAR funded partners, Ministry of Health and other implementing partners in establishing and maintaining a functional laboratory network in the geographical area of focus. Intra-partum and immediate post partum counseling and testing shall also be strengthened with a target of reaching 100% of all women attending delivery services at the maternity units within the program area. Currently over 50% pregnant women admitted in the labor and delivery units do not know their HIV status. The program will also promote couple counseling and testing to identify discordant and concordant couples to improve primary prevention and facilitate linkage to HIV care and treatment program for the eligible, in addition to strengthening Prevention with Positives strategy. The program will support the training of 100 service providers on PMTCT, Rationale use of ARVs, and Data collection and reporting in all facilities

The To Be Determined Partners (TBD) will support TB/HIV services BY screening ~ 78,000 HIV patients, identify and treat ~7,900 TB patients including children sites in Eastern, Nairobi, Central and Nyanza regions in Kenya. This TBD represents follow-on for TB/HIV activities (HVTB) currently provided by the following partners whose awards are expiring on March 31, 2010: AMREF ( 9039), EDARP (9062), IRC , NYU (8989), UCSF (8946), University of Manitoba (8947), University of Nairobi (8939 and 8940), University of Washington (8935) and IMC (9097). The existing services will transition to several TBD partners under the CDC Funding opportunity Announcements (PS09-991, PS09-962 and PS10-1004). TB screening will be offered to all HIV patients as a standard of care at the facilities; approximately 80,000 patients will be diagnosed as co-infected with TB and HIV. Funds will support refresher training of laboratory staff and improvement of basic laboratory microbiology capacity in order to meet the increased needs of TB testing. 150 health care workers will be trained to provide clinical prophylaxis and/or treatment for TB to HIV-infected individuals. The TBD partners will maintain data concerning the numbers of people served and will report both nationally and through the Emergency Plan.