Nyanza Province, with a population of about 5.1 million people, carries the highest HIV burden in Kenya. With an estimated adult HIV prevalence of 14.9% (compared to the national average at 7.1%), ~500,000 people are living with HIV, and ~130,000 require ART in Nyanza. Nairobi Province, on the other hand, has an HIV prevalence of 8.8%. Since 2003, the University of California at San Francisco (UCSF) has been supporting HIV activities in Nyanza and Nairobi Provinces through the Family AIDS Care and Education Services (FACES) program. FACES is a family-focused, comprehensive and coordinated HIV prevention, care, and treatment program that initially started with one HIV site in Nairobi in September 2004 followed by a second site in Kisumu in March 2005. To date FACES supports 62 HIV sites, 60 in Nyanza Province and 2 in Nairobi; 64 Prevention of Parent-to-Child Transmission (PPCT) sites in Nyanza; 55 Provider Initiated Testing and Counseling (PITC) sites in Nyanza and Nairobi, and 17 Voluntary Medical Male Circumcision (VMMC) sites in Migori and Rongo, both in Nyanza. FACES strives to increase local capacity and works in partnership with the Ministry of Health (MOH), District Health Management Teams (DHMTs), City Councils, non-governmental organizations (NGOs), faith-based organizations, and private health facilities for the provision of HIV care and services. The initial 5 year Cooperative Agreement between UCSF and CDC came to an end in April 2010 and, through a competitive process, were given a new award to continue supporting HIV services in 4 Districts (Kisumu East, Rongo, Suba and Migori) in Nyanza and one site in Nairobi.

In FY10 UCSF/FACES is supporting HIV care and treatment, TB/HIV, PMTCT and PITC services in the 4 districts, (except PITC in Kisumu East and Suba Districts being supported by KEMRI and Liverpool, respectively). They are also supporting VMMC/CIRC in District and Sub District hospitals in the 4 Districts.

In FY11 UCSF/FACES will support HIV care and treatment, TB/HIV, PMTCT and PITC services in the 4 Districts, (taking over PITC in Kisumu East and Suba Districts), and continue to support VMMC in the District and sub-District hospitals. This will ensure that they support comprehensive HIV services at facility level, to optimize resource leverage and strengthen linkages and provision of comprehensive services across the program areas. UCSF will ensure provision of HIV treatment services to 34,743 adult patients receiving ART. UCSF will work with the Ministry of Health at the Provincial, District and health facilities levels to jointly plan, coordinate and implement adult HIV treatment services, in accordance with the Kenya National Strategic Plan III, the GOK and USG Partnership Framework and the District andProvincial level annual operation plans. UCSF will continue to support and build the capacity of the Ministry of Health to offer the HIV services. UCSF will also support Suba, Migori, Rongo and Kisumu East Districts to offer quality HIV treatment. HIV trainings will continue to be supported through both classroom training and mentorship. UCSF working with the provincial Ministry of Health team will offer continuous medical education for HIV treatment in the four districts. UCSF will work with the MOH to identify areas with staff shortages, and support recruitment of additional staff. UCSF will offer a comprehensive package of services to all HIV patients at health facility level, including clinical assessment for ART eligibility; provision of ART for those eligible; laboratory monitoring with biannual CD4 testing; cotrimoxazole prophylaxis; psychosocial counseling, including, positive living and referral to support groups; adherence counseling; nutritional assessment and supplementation; secondary prevention (prevention with positives [PwP], including support for family testing for spouses/partners and children; supportive disclosure, adherence counseling, risk reduction counseling including condom provision, alcohol risk counseling, family planning counseling and provision or referral of services; STI diagnosis and treatment, etc.); provision of a BCK (safe water system, multivitamins, insecticide-treated mosquito nets, condoms, and educational materials); improved OI diagnosis and treatment, including TB screening, diagnosis and treatment; and pain management with non-steroidal anti-inflammatory drugs.

Ongoing community interventions for HIV+ individuals, including education by peer educators and use of support groups to provide adherence messaging, and defaulter tracing and follow up will continue to be supported. UCSF will collaborate with other partners supporting community activities to ensure linkage and provision of community components of HIV services.

UCSF will adapt the quality of care indicators for monitoring the quality of HIV treatment services that will be developed by the National AIDS and STI Control Program (NASCOP), and integrate them into routinely collected data. UCSF will adopt strategies to ensure access and provision of friendly HIV treatment services to youth, elderly and disabled populations. Strategies to increase access to ART by men will be employed, including supporting male peer educators, mentors and support groups, and supporting women to disclose and bring their male partners for testing and care and treatment. UCSF will prioritize and support renovation of health facilities to improve space for provision of HIV services. UCSF will continue to strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. With guidance from the national PEPFAR office, the new generation indicators will be adopted. Use of an electronic medical records system will be supported and strengthened. Specific activities and targets in each program area are as follows; The package of HIV clinical care services will include cotrimoxazole prophylaxis, treatment of opportunistic infections, nutritional supplementation, TB screening, and sexually transmitted infection (STI) diagnosis and treatment, PMTCT, PITC, improved access to malaria prevention interventions, and safe water for pediatric households. UCSF will also support and expand adult and infants' male circumcision in District and Sub District hospitals. Other activities will include providing family-centered care for HIV rather than individuals with HIV. This innovative approach has ensured equity and greater disclosure within families

PMTCT: UCSF will provide HIV counseling and testing to 53,093 pregnant women, and provide ARV prophylaxis to a total of 7,399 HIV positive women and their infants as per the Kenyan guidelines. HIV positive pregnant women eligible for ART will be started on Highly Active Anti Retroviral therapy (HAART) as per the Kenyan guidelines. All identified HIV exposed infants will have early infant diagnosis (EID) done using PCR at six weeks. PCR negative exposed infants will be followed up at the MCH clinic and will receive cotrimoxazole and Nevirapine prophylaxis until their HIV status is determined, while the positive ones will be started on HAART.

HBHC and PDCS: UCSF will support HIV care services for 69,486 adults and 6,684 children below 15 years. Activities will include evaluation for ART using CD4 and WHO staging, management of opportunistic infections, provision of basic HIV care package including but not limited to cotrimoxazole prophylaxis, multivitamins, safe water system, and condom to all patients in care. Prevention with positive (partner and family member testing, condom provision, referral for FP, etc) activities will be provided to all HIV positive clients. Discordant couples identified will be prioritized for evaluation and initiation of ART. 100 health workers will be trained to provide adult and pediatric HIV related palliative care

HTXS and PDTX: UCSF will support ARV treatment for 34,743 adults and 3,342 children below I5 years. Specific activities will include ART initiation, monitoring of patients for toxicity and treatment failure, support for adherence, and prevention with positives activities as described above. 100 Health workers will be trained to deliver ART services according to national standards

HVTB: UCSF will support HIV testing for 2,500 TB patients identified through the TB clinic and TB screening for 55,776 HIV infected patients in the HIV clinics. It is expected that these activities will result in identification and treatment of 2,000 TB /HIV co-infected patients.50 individuals will be trained to provide TB treatment to HIV infected patients.To ensure access and provision of HIV care (including cotrimoxazole prophylaxis) and ART to all TB/HIV co-infected patients, referrals and linkage of TB/HIV patients to the HIV clinic will be strengthened. TB screening for PLWHA will be strengthened, by adopting the standardized TB screening tool that NASCOP has finalized and is rolling out in FY10. Support will be provided to improve the laboratory capacity for quality sputum microscopy services through training of laboratory technologists on AFB microscopy using the national AFB microscopy manual, and collection of sputum slides and re-reading of the slides by the District medical laboratory technologists, as part of the sputum quality assurance system. Support for TB infection control and use of Isoniazid Preventive Therapy in children will continue in line with the national guidelines.

HVCT: UCSF will expand its geographical coverage to include all health facilities in Kisumu East District, Migori, Rongo and Suba Districts. UCSF will aim at ensuring that PITC coverage in in-patient facilities is maintained at over 80% and that for out-patient departments goes beyond 50%. PITC implementation shall be in accordance with the Kenya National PITC Implementation manual (2010). Ways to improve efficiency and coverage in OPD shall include task shifting to lay counselors, better use of the lab and better engagement and ownership of the project by MOH staffs. UCSF will target to test 120,000 persons of whom 12,000 of them will be tested as couples. UCSF will also train 90 health workers on PITC as per the Kenya national PITC training curriculum. UCSF will refocus its strategies to minimize unnecessary re-testing in accordance with the WHO guidance on re-testing (2010) and will continue to improve quality of HTC services by adhering to the national quality management guidelines.

CIRC: UCSF will promote sustainability, in collaboration with the Kenyan Ministry of Health (MOH), the PEPFAR team, and the HHS/CDC office in Kenya, to strengthen and expand high quality, VMMC services in large and busy MOH health facilities in selected four Districts in Nyanza Province along where they provide HIV care and treatment services. UCSF will continue to 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. 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, UCSF will train health care workers and provide over 5,000 Male Circumcisions. Pre-operative assessment may follow individual or 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

Nyanza province, which has a population of about 5.1 million people, carries the highest HIV burden in Kenya, with an estimated adult HIV prevalence of 14.9% (compared to the national 7.1%), and ~500,000 people are living with HIV, and ~130,000 requiring ART. Nairobi province has a HIV prevalence of 8.8%. Since 2003, the University of California at San Francisco (UCSF) has been supporting HIV activities in Nyanza and Nairobi provinces.

Their initial 5 year cooperative agreement with CDC came to an end in April 2010, and through a competitive process were given a new award to continue supporting HIV services in Suba, Migori, Rongo and Kisumu East Districts. In these four districts they will support comprehensive HIV services including HIV care and treatment, TB/HIV, PMTCT and PITC, except in Kisumu East and Suba Districts where another partner will support PITC services.

In FY10 UCSF will ensure provision of HIV care services to 38,000 adult patients receiving ART. UCSF will work with the Ministry of Health at the provincial, district and health facilities levels, to jointly plan, coordinate and implement adult HIV treatment services, in accordance with the Kenya National Strategic Plan III, the GOK and USG Partnership Framework, and the district and provincial level annual operation plans. UCSF will continue to support and build the capacity of the Ministry of Health to offer the HIV services.

In FY10 UCSF will support Suba, Migori, Rongo and Kisumu East Districts to offer quality HIV care services. HIV trainings will continue to be supported, through both classroom training and mentorship. UCSF working with the provincial Ministry of Health team, will offer continuous medical education for HIV treatment to health care workers in the four districts. UCSF will work with the MOH to identify areas with staff shortages, and support recruitment of additional staff.

UCSF will offer a comprehensive package of services to all HIV+ patients at health facility level, including clinical assessment for ART eligibility; provision of ART for those eligible; laboratory monitoring with biannual CD4 testing; cotrimoxazole prophylaxis; psychosocial counseling, including, positive living and referral to support groups; adherence counseling; nutritional assessment and supplementation; secondary prevention (prevention with positives [PwP], including support for family testing for spouses/partners and children; supportive disclosure, adherence counseling ,risk reduction counseling including condom provision, alcohol counseling, family planning counseling and provision or referral of services; STI diagnosis and treatment, etc.); provision of a BCK (safe water system, multivitamins, insecticide-treated mosquito nets, condoms, and educational materials); improved OI diagnosis and treatment, including TB screening, diagnosis and treatment; and pain management with non-steroidal inti-inflammatory drugs.

Ongoing community interventions for HIV+ individuals, including education by peer educators and use of support groups to provide adherence messaging, and defaulter tracing and follow up will continue to be supported. UCSF will collaborate with other partners supporting community activities to ensure linkage and provision of community components of HIV services.

UCSF will adapt the quality of care indicators for monitoring the quality of HIV care services that will be developed by NASCOP, and integrate them into routinely collected data.

UCSF will adopt strategies to ensure access and provision of friendly HIV care services to youth, elderly and disabled populations. Strategies to increase access of HIV care by men will be employed, including supporting male peer educators, mentors and support groups, and supporting women to disclose and bring their male partners for testing and care and treatment.

UCSF will prioritize and support renovation of health facilities to improve space for provision of HIV services.

UCSF will continue to strengthened data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. With guidance from the national PEPFAR office, the new generation indicators will be adopted. Use of an electronic medical records system will be supported and strengthened.

Nyanza province, which has a population of about 5.1 million people, carries the highest HIV burden in Kenya, with an estimated adult HIV prevalence of 14.9% (compared to the national 7.1%), and ~500,000 people are living with HIV, and ~130,000 requiring ART. Nairobi province has a HIV prevalence of 8.8%. Since 2003, the University of California at San Francisco (UCSF) has been supporting HIV activities in Nyanza and Nairobi provinces.

Their initial 5 year cooperative agreement with CDC came to an end in April 2010, and through a competitive process were given a new award to continue supporting HIV services in Suba, Migori, Rongo and Kisumu East Districts. In these four districts they will support comprehensive HIV services including HIV care and treatment, TB/HIV, PMTCT and PITC, except in Kisumu East and Suba Districts where another partner will support PITC services.

In FY10 UCSF will ensure provision of HIV treatment services to 20,000 adult patients receiving ART. UCSF will work with the Ministry of Health at the provincial, district and health facilities levels, to jointly plan, coordinate and implement adult HIV treatment services, in accordance with the Kenya National Strategic Plan III, the GOK and USG Partnership Framework, and the district and provincial level annual operation plans. UCSF will continue to support and build the capacity of the Ministry of Health to offer the HIV services.

In FY10 UCSF will support Suba, Migori, Rongo and Kisumu East Districts to offer quality HIV treatment. HIV trainings will continue to be supported, through both classroom training and mentorship. UCSF working with the provincial Ministry of Health team, will offer continuous medical education for HIV treatment in the four districts. UCSF will work with the MOH to identify areas with staff shortages, and support recruitment of additional staff.

UCSF will offer a comprehensive package of services to all HIV+ patients at health facility level, including clinical assessment for ART eligibility; provision of ART for those eligible; laboratory monitoring with biannual CD4 testing; cotrimoxazole prophylaxis; psychosocial counseling, including, positive living and referral to support groups; adherence counseling; nutritional assessment and supplementation; secondary prevention (prevention with positives [PwP], including support for family testing for spouses/partners and children; supportive disclosure, adherence counseling ,risk reduction counseling including condom provision, alcohol counseling, family planning counseling and provision or referral of services; STI diagnosis and treatment, etc.); provision of a BCK (safe water system, multivitamins, insecticide-treated mosquito nets, condoms, and educational materials); improved OI diagnosis and treatment, including TB screening, diagnosis and treatment; and pain management with non-steroidal inti-inflammatory drugs.

Ongoing community interventions for HIV+ individuals, including education by peer educators and use of support groups to provide adherence messaging, and defaulter tracing and follow up will continue to be supported. UCSF will collaborate with other partners supporting community activities to ensure linkage and provision of community components of HIV services.

UCSF will adapt the quality of care indicators for monitoring the quality of HIV treatment services that will be developed by NASCOP, and integrate them into routinely collected data.

UCSF will adopt strategies to ensure access and provision of friendly HIV treatment services to youth, elderly and disabled populations. Strategies to increase access of ART by men will be employed, including supporting male peer educators, mentors and support groups, and supporting women to disclose and bring their male partners for testing and care and treatment.

UCSF will prioritize and support renovation of health facilities to improve space for provision of HIV services.

UCSF will continue to strengthened data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. With guidance from the national PEPFAR office, the new generation indicators will be adopted. Use of an electronic medical records system will be supported and strengthened.

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Nyanza province, which has a population of about 5.1 million people, carries the highest HIV burden in Kenya, with an estimated adult HIV prevalence of 14.9% (compared to the national 7.1%), and ~500,000 people are living with HIV, and ~130,000 requiring ART. Nairobi province has a HIV prevalence of 8.8%. Since 2003, the University of California at San Francisco (UCSF) has been supporting HIV activities in Nyanza and Nairobi provinces.

Their initial 5 year cooperative agreement with CDC came to an end in April 2010, and through a competitive process were given a new award to continue supporting HIV services in Suba, Migori, Rongo and Kisumu East Districts. In these four districts they will support comprehensive HIV services including HIV care and treatment, TB/HIV, PMTCT and PITC, except in Kisumu East and Suba Districts where another partner will support PITC services.

UCSF will ensure provision of PMTCT counseling and testing to 58,309 pregnant mothers, and provision of ARVs for PMTCT to 9,214 HIV positive mothers. Decentralization of PMTCT services to lower level facilities will be supported to ensure coverage of all the health facilities in the districts.

UCSF will work with the Ministry of Health at the provincial, district and health facility levels, to jointly plan, coordinate and implement PMTCT services, in accordance with the Kenya National Strategic Plan III, the GOK and USG Partnership Framework, and the district and provincial annual operation plans.

HIV trainings will be supported, through both classroom training and mentorship. UCSF will work with the district and provincial Ministry of Health (MOH) teams, to offer continuous medical education for PMTCT. UCSF will work with the MOH to identify areas with staff shortages, and support recruitment of additional staff.

Of the expected annual pregnancies in the districts UCSF will work in, efforts will be made to offer HIV CT services to 90% pregnant women attending antenatal, intra-partum, postpartum services. Additionally UCSF will strive to provide ARV prophylaxis to all HIV-infected pregnant women and their babies. All HIV-positive pregnant women will be staged clinically and immunologically by WHO criteria and CD4 cell count testing respectively. Women in WHO stage 3 & 4 and all those with CD4 cell count less than 350 will be initiated on ART. UCSF will strive to initiate AZT from 28 weeks gestation for those in WHO stage 1 & 2 with CD4 cell count greater than 350, and offer a minimum of Single dose nevirapine (SdNVP) to those who present late. All the HIV-positive pregnant women who receive SdNVP will be given AZT and 3TC combination for one week post natally to cover the Nevirapine "tail" to reduce the development of NVP resistance. All exposed babies will receive SdNVP, 3TC for one week and AZT for six weeks. Nevirapine tablets will be dispensed to all HIV-positive pregnant women at first contact to minimize missed opportunities.

All HIV-positive pregnant women will receive a comprehensive package of HIV care and ART services, either at the MCH or HIV clinic. Linkage to the HIV clinic will be strengthened by use of peer counselors or mentor mothers. The comprehensive package of services will include clinical assessment for ART eligibility based on the national guideline; provision of ART for those eligible; laboratory monitoring with biannual CD4 testing; cotrimoxazole prophylaxis; psychosocial counseling; adherence counseling; nutritional assessment and supplementation; secondary prevention (prevention with positives [PwP], including support for family testing for spouses/partners and children; supportive disclosure, adherence counseling ,risk reduction counseling including condom provision, alcohol counseling, family planning counseling and provision or referral of services; STI diagnosis and treatment, etc.); provision of a BCK (safe water system, multivitamins, insecticide-treated mosquito nets, condoms, and educational materials); improved OI diagnosis and treatment, including TB screening, diagnosis and treatment.

Cotrimoxazole prophylaxis will be provided to all HIV exposed infants and their mothers. Counseling on infants feeding will also be provided. The PMTCT services will continue to be integrated into all existing maternity facilities. Emphasis will be placed on primary prevention for the majority of women identified as HIV -ve through PMTCT programs.

Greater involvement of people living with HIV and AIDS through the facility and community based psychosocial support groups, Mentor Mothers and Prevention with Positive (PwP) strategies will be enhanced. Strategies will be adopted to encourage spouses of women to be tested and receive HIV services.

Efforts will be made to improve ANC attendance and hospital deliveries by working with existing community programs and organizations.

UCSF will adapt the quality of care indicators for monitoring the quality of PMTCT services that will be developed by NASCOP, and integrate them into routinely collected data.

UCSF will prioritize and support renovation of health facilities to improve space for provision of MCH and PMTCT services.

UCSF will strengthened data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. With guidance from the national PEPFAR office, the new generation indicators will be adopted.

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