This Implementing Mechanism provides technical assistance to enhance the national capabilities in the conduct of public health field surveillance and epidemiology; development of national high-quality laboratory systems and diagnostic capacity; and implementation of evidence-based public health programs on important human infectious diseases, with an emphasis on HIV/AIDS and related interventions including but not limited to blood safety, injection safety, infection control, and medical waste management, Malaria, Emerging and Re-emerging infectious Diseases, Neglected Tropical Diseases, Tuberculosis, Influenza and other diseases with pandemic potential as well as Environmental Health issues, Chronic Diseases, Maternal and Child Health, Reproductive Health, Public Health Preparedness, Bio-safety, and Injury Control and Prevention.

The activities carried out by this IM will target all populations on a national level and address all four core pillars of the KNASP III:

Pillar 1: Health Sector HIV Service Delivery

Pillar 2: Sectoral Mainstreaming of HIV and AIDS

Pillar 3: Community/Area-based HIV Programmes

Pillar 4: Governance and Strategic Information

Contributions to Health Systems Strengthening:

Enhance the human resources for health (HRH) technical, scientific and managerial capacities through the provision of training opportunities for university and graduate level students; public health professionals; and GOK staff and other program implementers. Focus areas include but are not limited to training in basic and applied public health research, public health program planning, program implementation, program evaluation, data collection and analysis, and financial and administrative management.

Cross-cutting programs and key issues: describe: Strengthen the Ministry of Public Health and Sanitation's institutional capability to plan, implement and evaluate evidence-based public health programs, conduct public health surveillance and develop public health interventions that support national and regional disease identification as well as disease prevention and control efforts. other entities concerned about public health issues in the region. incorporate the results of research and program evaluations into operational disease prevention and control programs, ensure the sharing of expertise and research findings nationally, regionally and internationally, and use the results to inform national public health policies and guidelines.

IM strategy to become more cost-efficient over time: leveraging funds received from other organizations to reduce reliance upon USG funds or implementation and evaluation of HIV/AIDS related activities.

This TBD is a follow on to the activities currently supported by The National AIDS and STD Control Program (NASCOP) which ends in September 2011. The procurement of the new partner is in process and it is anticipated to be a sole source to the Ministry of public Health and Sanitation (MOPHS) in collaboration with Ministry of Medical Services (MOMS).

The partner will oversee the implementation of all HIV care programs to all people living with HIV/AIDS including health care workers and others providing services to people living with HIV in Kenya. These activities will also result in the training of 200 health care workers. Emphasis will be placed on developing regional trainers who will provide classroom training and mentorship of health care workers at the facility level. Specific TBD supported activities will include the coordination of all partners in the provision of care for people with HIV (through national level meetings such as the National ART task force), and supervision of treatment in Government of Kenya (GOK) and other facilities. Specific guidelines for prevention and treatment of opportunistic infections, including sexually transmitted illness, HIV prevention in care settings, and management of nutrition interventions will be updated, printed, and distributed as needed. The national system for tracking the numbers of people enrolled in patient support centers (i.e. HIV clinics) will continue to be improved. Funds will also be used to provide administrative support and transport for the Provincial/Regional ART coordinators so that they can coordinate, track, and provide supportive supervision to sites in their areas as well as supporting regular regional meetings of care providers.

The national supervisory structure includes a core staff at a national level that consists of a small technical and administrative staff and an expanding staff responsible for M&E. A system of regional supervision of HIV/AIDS treatment activities has been established using Provincial AIDS and STI Coordinating Officers (PASCOS) who are responsible for assisting with the establishment of care and treatment services at additional sites, conducting site evaluations and accreditation, and supervision of care programs. The partner will distribute HIV prevention materials for health care providers that incorporate consistent messages regarding HIV status disclosure, partner testing, and condom use to prevent sexual transmission. Other activities will include the development of referral systems and care linkages for HIV positive mothers identified through the PMTCT programs, decentralization of care and treatment services to lower level health facilities to increase access and reduce the waiting list at the provincial and district hospitals, and improved coordination with other sources of support such as the Global Fund for AIDS Tuberculosis, and Malaria.

There are strong linkages between these activities and virtually all HIV prevention and treatment activities in Kenya. All Emergency Plan partners have been encouraged to extend efforts to further strengthen these linkages by coordinating with and supporting the activities of the PASCOS and by participating in national efforts such as policy/guideline revision and national stakeholders meetings. Activities are closely linked to the Management Systems of Health (MSH) supported logistics/systems strengthening particularly for the Kenya Medical Supplies Agency. Other linkages include Counseling and Testing, PMTCT, ARV Services, Strategic Information and TB/HIV.

This TBD is a follow on to the activities currently supported by The National AIDS and STD Control Program (NASCOP) which ends in September 2011. The procurement of the new partner is in process and it is anticipated to be a sole source to the Ministry of public Health and Sanitation (MOPHS) in collaboration with Ministry of Medical Services (MOMS).

The partner will oversee the implementation of all HIV care and antiretroviral treatment (ART) programs for people living with HIV/AIDS, health care workers and others providing services to people with HIV in Kenya. These activities will also result in the training of 200 health care workers not included in other targets. Specific activities supported by NASCOP will include the coordination of all partners in the area of ART provision (through national level meetings such as the National ART task force), and supervision of treatment in Government of Kenya (GoK) supported and other facilities. It will also continue to coordinate with other sources of support such as Global fund for AIDS, Tuberculosis and Malaria, and Clinton Foundation.

The partner will improve the national system for tracking the number of people receiving ART, and provide financial and administrative support to the Provincial AIDS and STI coordinating Officer (PASCO) so that they can coordinate, track and provide supportive supervision to area sites. Funds will also be used to support regular regional meetings of care providers. The National supervisory structure includes a core staff at a national level that consists of a small technical and administrative staff, and an expanding staff responsible for monitoring and evaluation activities. The PASCOs are responsible for assisting with the establishment of services at additional sites, conducting site evaluations and accreditations, and the supervision for ART programs. All activities are closely linked to other GOK and PEPFAR supported HIV treatment and prevention activities, the networks of care in the Private and Mission sectors, and Kenya Pharma/ Chemonics supported logistics/systems strengthening (particularly for the Kenya Medical Supplies Association). Emphasis will be placed on developing regional trainers who will provide classroom training and mentorship of health care workers at the facility level.

The partner will continue to support implementation of HIV prevention activities in clinical care settings, the development of referral systems and care linkages for HIV positive mothers and infants identified through the PMTCT programs, decentralization of care and treatment services to lower level health facilities to increase access and reduce the waiting list at the provincial and district hospitals, and improved coordination with other sources of support such as the Global Fund for AIDS, Tuberculosis, and Malaria.. These activities are essential to the overall implementation and coordination of HIV treatment programs in Kenya. NASCOP supported activities are essential to the formation/strengthening of the linkages needed in the network model and to the development of a sustainable system to provide HIV treatment in Kenya.

All Emergency Plan partners have been encouraged to extend efforts to further strengthen these linkages by coordinating with and supporting the activities of the Provincial ART coordinators and by participating in national efforts such as policy/guideline revision and national stakeholders meetings. This activity includes minor emphases in development of networks, human resources, policy and guidance development, quality assurance and supportive supervision, training, and strategic information.

This Implementing Mechanism (IM) will coordinate National activities pertaining to HIV testing and counseling. The mechanism will continue to give overall guidance and coordination of all service provision activities by determining the policies and guidelines to be followed by service providers. This IM will ensure that standardized practices are carried out in the country and that clients get quality services. The IM will be instrumental in influencing policy at national level especially the HIV bill to adopt practices that make it easy for clients to access and get to know their HIV status. The IM will coordinate and work with all partners and stakeholders to develop guideline documents and tools for data collection for the innovative approaches like Home based testing and counseling, work place and outreach services. The IM will roll out disseminate and supervise the implementation of the National quality assurance strategy to ensure all stakeholders adhere to quality standards for HIV testing and counseling. This will be done by developing sound supervisory tools and using such tools in the visits.

Counseling and testing has a national target of achieving 80% universal knowledge of HIV status by 2011 will review and coordinate the strategies for accellerati9ng activities to achieve this. To this end the IM will convene regular and special Technical working groups to deliberate and design strategies to be implemented for example the National testing campaigns. The IM has the mandate of strengthening the regions to identify and respond to their epidemic patterns by using the most suitable innovative and evidence based testing and counseling approaches. Data collection is an important aspect of a national program and the IM will ensure that all data collection tools are available and service providers know how to use them and provide timely reports to the national office. In ordered to promote learning and experience sharing, the IM will organize and hold national implementers meeting on Testing and counseling for purposes of disseminating any new guidance, sharing of best practices across programs and to evaluate the progress towards the achievement of the national target coordinate and the IM will conduct supervisory visits and support to the regions to ensure quality of service provision.

This TBD is a follow on to the activities currently supported by The National AIDS and STD Control Program (NASCOP) which ends in September 2011. The procurement of the new partner is in process and it is anticipated to be a sole source to the Ministry of public Health and Sanitation (MOPHS) in collaboration with Ministry of Medical Services (MOMS). The partner will oversee the implementation of all pediatric HIV care and antiretroviral treatment programs for the under 15 year olds in Kenya. These activities will result in the training of 200 health care workers not included in other targets.

Specific activities supported by the TBD will include the coordination of all partners in the area of pediatric antiretroviral treatment (ART) provision (through national level meetings such as the National ART task force), and supervision of pediatric treatment in Government of Kenya (GOK)-supported and other facilities. TBD will also continue to coordinate with other sources of support such as Global fund for AIDS, Tuberculosis and Malaria. TBD will continue to improve the national system for tracking the number of children receiving ART, and provide financial and administrative support to the Provincial AIDS and STI coordinating officers (PASCO) so that they can coordinate, track and provide supportive supervision to area sites. Funds will also be used to support regular regional meetings of care providers. The national supervisory structure includes a core staff at a national level that consists of a small technical and administrative staff, and an expanding staff responsible for monitoring and evaluation activities. The PASCO's are responsible to assist with establishment of services at additional sites, conducting site evaluations and accreditations, and supervising for ART programs. All activities are closely linked to other GOK and PEPFAR supported HIV treatment and prevention activities, the networks of care in the Private and Mission sectors, and Kenya Pharma/Chemonics supported logistics/systems strengthening (particularly for KEMSA, the Kenya Medical Supplies Association). Emphasis will be placed on developing regional trainers who will provide classroom training and mentorship of health care workers at the facility level. TBD will support development and implementation of HIV prevention activities in clinical care settings, the development of referral systems and care linkages for HIV positive mothers and infants identified through the PMTCT programs, decentralization of care and treatment services to lower level health facilities to increase access and reduce the waiting list at the provincial and district hospitals, an intensified focus on pediatric provision of care, and improved coordination with other sources of support such as the Global Fund for AIDS, Tuberculosis, and Malaria.

These activities are essential to the overall implementation and coordination of HIV treatment programs in Kenya. All Emergency Plan partners have been encouraged to extend efforts to further strengthen these linkages by coordinating with and supporting the activities of the PASCO's and by participating in national efforts such as policy/guideline revision and national stakeholders meetings.

This TBD is a follow on to the activities currently supported by The National AIDS and STD Control Program (NASCOP) which ends in September 2011. The procurement of the new partner is in process and it is anticipated to be a sole source to the Ministry of public Health and Sanitation (MOPHS) in collaboration with Ministry of Medical Services (MOMS). TBD will oversee the implementation of all pediatric HIV care and antiretroviral treatment programs for the under 15 year olds in Kenya. These activities will result in the training of 200 health care workers not included in other targets.

Specific activities supported by the partner will include the coordination of all partners in the area of pediatric antiretroviral treatment (ART) provision (through national level meetings such as the National ART task force), and supervision of pediatric treatment in Government of Kenya (GOK)-supported and other facilities. This partner will also continue to coordinate with other sources of support such as Global fund for AIDS, Tuberculosis and Malaria. TBD will continue to improve the national system for tracking the number of children receiving ART, and provide financial and administrative support to the Provincial AIDS and STI coordinating officers (PASCO) so that they can coordinate, track and provide supportive supervision to area sites. Funds will also be used to support regular regional meetings of care providers. The supervisory structure at NASCOP includes a core staff at a national level that consists of a small technical and administrative staff, and an expanding staff responsible for monitoring and evaluation activities. the PASCOs are responsible to assist with establishment of services at additional sites, conducting site evaluations and accreditations, and supervising for ART programs. All activities are closely linked to other GOK and PEPFAR supported HIV treatment and prevention activities, the networks of care in the Private and Mission sectors, and Kenya Pharma/Chemonics supported logistics/systems strengthening (particularly for KEMSA, the Kenya Medical Supplies Association). Emphasis will be placed on developing regional trainers who will provide classroom training and mentorship of health care workers at the facility level. TBD will continue to support development and implementation of HIV prevention activities in clinical care settings, the development of referral systems and care linkages for HIV positive mothers and infants identified through the PMTCT programs, decentralization of care and treatment services to lower level health facilities to increase access and reduce the waiting list at the provincial and district hospitals, an intensified focus on pediatric provision of care, and improved coordination with other sources of support such as the Global Fund for AIDS, Tuberculosis, and Malaria. These activities are essential to the overall implementation and coordination of HIV treatment programs in Kenya. These national activities are essential to the formation/strengthening of the linkages needed in the network model and to the development of a sustainable system to provide HIV treatment in Kenya. All Emergency Plan partners have been encouraged to extend efforts to further strengthen these linkages by coordinating with and supporting the activities of the provincial teams and by participating in national efforts such as policy/guideline revision and national stakeholders meetings.

Reprogramming $250,000 in HVSI to MOPHS/MOPHS. The goals and objectives of this award are to strengthen the national monitoring and evaluation systems through strong data management and surveillance systems.

Specific activities to achieve the above goals and objectives are:

To support the implementation of Kenya National AIDS Strategic Plan through development of M&E tools and collecting routine data.

Data Quality Assessment (DQA) of program data at selected sites

Direct support to the provincial and district health management teams through PASCO's and DASCO's to enhance their data use skills.

MOPHS will also work with other partners to strengthen the collection, analysis and use of surveillance information through:

ANC sentinel surveillance and moving towards the use of PMTCT program data to measure national HIV prevalence

MARPs and STI surveillance

HIV drug resistance surveillance

MOPHS will coordinate and supervise the implementation of standards based Electronic Medical Records (EMR) system with linkages to lab and pharmacy systems for patient monitoring. MOPHS will coordinate the Phones for Health activities to improve data flow from health facilities.

The MOPHS will provide technical staff and other resources to generate and promote the use of strategic information for evidence based policy formulation and decision making. The use of SI should encourage the host country government to commit more resources to support M&E, surveillance and informatics and reduce dependency on partner support. Use of SI in the annual operation plan (AOP) will ensure allocation of GoK budget lines for priority activities.

The ongoing capacity building for the GoK staff will ensure sustainability of the systems put in place through partnership with PEPFAR. It is also anticipated that as part of the partnership framework, MOPHS will ensure commitment of additional GoK resources (human, financial and other) towards the sustainability of these projects.

None

National AIDS & STD Control Program (NASCOP) will coordinate and monitor the implementation of all national policies, standards, guidelines and strategic plans for injection safety and health care waste management in the country. NASCOP guide the scale up and integration of medical Injection Safety, phlebotomy and Infection Prevention and Control as well as bio-safety into existing health programs by various partners country-wide. Sharps injuries surveillance will be strengthened to identify practices and procedures that pose risk to HIV exposure to health workers and patients. Uptake of post exposure prophylaxis by health care workers will be assessed and linkages to Care and Treatment services established. In FY 10 particular emphasis will be given to enhancing safe medical waste management systems and phlebotomy practices.

NASCOP will monitor injection practices country-wide and give supportive supervision that will strengthen performance at all levels of health delivery. Infection Prevention Committees (IPC) at hospitals will be reactivated to oversee infection control, safe injection and waste management practices. The lessons learned from these initial hospitals will be used to enhance the functions of IPC at all hospitals in the country. These committees will serve to ensure sustainability of safe injection practices in years to come. NASCOP will coordinate quarterly meetings to plan and monitor the outcomes of activities for safe injection practice, phlebotomy, infection control and sharps waste management. NASCOP will support a community communication campaign to reduce injection demand and promote safe injection practices and medical waste disposal practices. Training in phlebotomy practice commenced in FY09 through a public-private partnership with Becton-Dickinson will be expanded to more health facilities across the country. This activity will also support medical training colleges and universities to integrate safe injection practices into pre-service and in-service training curricula.

Target Explication

Formulate policy, coordinate and monitor implementation of policies for injection safety, phlebotomy and medical waste management practices leading to prevention of medical transmission of HIV.

This TBD is a follow on to the activities currently supported by The National AIDS and STD Control Program (NASCOP) which ends in September 2011. The procurement of the new partner is in process and it is anticipated to be a sole source to the Ministry of public Health and Sanitation (MOPHS) in collaboration with Ministry of Medical Services (MOMS).

This new mechanism will support, supervise and monitor abstinence and faithfulness programs targeting youth in Kenya. It will also take the lead in developing policies and guidelines as needed. As a follow-up mechanism to NASCOP, it will continue to strengthen a coordination mechanism for youth HIV prevention in Kenya. It will continue to explore feasible avenues of strengthening HIV prevention programs such as the integration of alcohol prevention efforts with HIV prevention work. It will coordinate the development and distribution of print materials as needed in support of abstinence and faithfulness programs for youth as well as youth-friendly services. It will also partner with the Kenya Medical Training College (KMTC) and other higher levels of tertiary education to help develop in-service training guidelines for trainees on broad behavioral prevention issues for youth and the provision of youth-friendly services. This element will be in response to the need identified in 2005 by the Kenya Service Provision Assessment (KESPA) which pointed to huge gaps in the provision of youth friendly services. This training will help sensitize health workers on the need to offer appropriate information and counseling to young people to help them adopt healthy behavior and safer sexual practices. These will contribute to improved HIV preventive behaviors among young people, changed social and community norms to promote HIV preventive behaviors among youth and young adults as well as reduced HIV/AIDS stigma and discrimination. It will play a key role in ensuring that epidemiological data is captured, analyzed and presented for use in implementation of prevention programs.

This TBD is a follow on to the activities currently supported by The National AIDS and STD Control Program (NASCOP) which ends in September 2011. The procurement of the new partner is in process and it is anticipated to be a sole source to the Ministry of public Health and Sanitation (MOPHS) in collaboration with Ministry of Medical Services (MOMS).

This new mechanism will support policy formulation, guidelines development, and roll-out documents focusing on at-risk youth, most-at-risk-populations, prevention with positives and other vulnerable populations in Kenya. In addition, STI management will be strengthened through revision of STI surveillance and management protocols geared towards Positive prevention and Most-at-risk populations. Further, health workers will be continually updated and educated on new information concerning STI screening and treatment for individuals with HIV. The new mechanism will continue supporting NASCOP with its coordination role in the promotion, information and education of condoms to vulnerable populations in Kenya. It will continue to explore feasible avenues of strengthening HIV prevention programs such as the integration of alcohol prevention efforts with HIV prevention work. The new mechanism will coordinate the development and distribution of print materials as needed in support of condoms and other prevention programs for young people and most-at-risk populations. It will support increased condom access through increasing the number of condom outlets country wide. These will contribute to improved HIV preventive behaviors among young people, changed social and community norms to promote HIV preventive behaviors among youth and young adults as well as reduced HIV/AIDS stigma and discrimination.

This TBD represents follow-on for national PMTCT (NASCOP) activities currently provided by the National STD and STI Control Program (NASCOP) whose award expires in September 2010. The TBD partner will provide leadership and coordination to the national PMTCT program towards the goal of universal access to comprehensive integrated PMTCT services. In partnership with all USG agencies and other PMTCT implementing partners and stakeholders this partner will promote strategies towards the achievement of KNASP, PEPFAR and UNGASS PMTCT goals In collaboration with the MOH's Division of Reproductive Health and Medical Training College (MTC), and will strengthen its stewardship, regulatory and supervisory functions and quality assurance to ensure delivery of high quality comprehensive integrated PMTCT services that reflect current scientifically proven interventions and in accordance to the National Comprehensive PMTCT guidelines.

The TBD partner will guide establishment of systems and mechanisms for stronger linkages and coordination between PMTCT and other HIV treatment and care programs to ensure comprehensive care and support to the HIV-positive woman, infant and family members within maternal and child health care settings. It will improve coordination across ministries of health (Ministry of Public Health Services (MOPHS) and Ministry of Medical Services MOMS) programs supporting MCH services at the national provincial and district levels with decentralization to the district level. Through the national Technical Working Groups (TWGs), the partner will provide the framework and guidance for the national roll out of comprehensive integrated PMTCT services in addressing all the four PMTCT prongs including provision of FP services within PMTCT programs and couple counseling and testing. It will facilitate the functioning of the Provincial PMTCT TWGs that will work at district level to enhance active community participation, coordinate various partner activities, review district micro plans and use program data for improving specific regional performance. Other significant activities include developing models to ensure improved access to HAART for eligible mothers either within the MCH setting or through linkage with existing ART programs.

Additionally, the program will continue working at strengthening the referral systems for the continuum of care for successful referral of mothers to antiretroviral therapy centers and early infant diagnosis and referral to appropriate care to enhance maternal and child survival. This program will also adopt a training package for the training of community groups to provide HIV prevention, treatment, care and support services at the community level.

Ministries of health in Kenya encourage improvement of integrated laboratory services to support both clinical care and public health demands. Key among the drivers of laboratory strengthening laboratory in Kenya will include development and/or implementation of sound policies, strategic planning, and coordination of services provided by various stakeholders and monitoring and evaluation of laboratory capacity to support program goals.

Objective 1. Expansion of QA capacity for rapid HIV, CD4, clinical chemistry and hematology testing for ART monitoring to regions.

Objective 2. Strengthen decentralization and regional on-site support supervision for quality and timely service delivery. Coordinate provincial level lab activities by allocating resources to regions for these activities.

Objective 3. Strengthen of PCR testing capacity at public laboratories; establish PCR testing capacity at 2 provincial hospital laboratories.

Objective 4. Strengthen central data unit to streamline timely submission and analysis of monthly lab reports from facilities to ensure data generated is used for decision making.

Objective 5. Coordinate laboratory policy formulation efforts through provision of national and regional leadership and stakeholder's involvement (Lab Quality policy, equipment technology policy, and Infrastructure development plan, Referral networks plan, and supervision plan, strategic and operational plans).

Objective 6. Oversee dissemination/implementation of laboratory policy guidelines development/review.

Objective 7. Strengthen monitoring system of HIV test kits (kit lot validation and post market surveillance) and laboratory equipments (procurement and maintenance) to conform to nationally established standards.

Objective 8. Strengthen diagnostic microbiology capacity at district level.

This TBD is a follow on to the activities currently supported by The National AIDS and STD Control Program (NASCOP) which ends in September 2011. The procurement of the new partner is in process and it is anticipated to be a sole source to the Ministry of public Health and Sanitation (MOPHS) in collaboration with Ministry of Medical Services (MOMS).

The partner will be responsible for establishing TB policy and provide overall coordination, implementation and evaluation oversight for all TB/HIV activities in Kenya. TB/HIV is a priority program area for DLTLD and the National AIDS and STI Control Program (NASCOP) with which collaborative activities will be strengthened and expanded in FY 10. As part of their national mandates, DLTLD and NASCOP coordinate implementation of collaborative activities through national, regional and district coordinating bodies. Since 2004, TB/HIV activities have advanced on the national agenda and are well articulated in the National TB Strategic Plan.

DLTLD has expanded TB treatment points from 1909 to 2280 and TB diagnostic points from 930 to 1183. In FY 10, the Emergency Plan will continue to provide essential support towards the achievement of targets set in the National TB Strategic Plan. National roll-out of collaborative TB/HIV activities is coordinated by the National TB/HIV Steering Committee (NTHSC) established jointly by the DLTLD and NASCOP, both of which previously operated as separate delivery systems. TB services in Kenya have been decentralized to the health center level; drug supplies are consistent, and are provided free to all TB patients attending public and mission health facilities.

Concurrently, in partnership with Kenya USG agencies and the Tuberculosis Control Assistance Program (TB CAP), the National AIDS and STD Control Program (NASCOP) and DLTLD held a joint workshop to strengthen collaboration and adapted the Management and Organizational Sustainability Tool (MOST TB/HIV) in order to assess their level of collaboration and develop action plans for improvement. The MOST TB/HIV instrument was introduced by TBCAP and adapted to the Kenya TB and HIV contexts.

In 2008 DLTLD registered 110,345 TB cases. Out of these, 33.4%, 27.5% and 15.3% constituted smear positive, smear negative and extra-pulmonary disease, respectively. Of the 41,950 registered HIV+ TB patients in 2008, 6,712 (16%) invited their partners out of whom 4,732 (71%) were tested for HIV leading to identification of 2,404 positive and 2,328 negative partners. Directly observed therapy (DOTS) coverage is universal and treatment is observed either by a health provider, a community health worker or a treatment partner for 87% of cases. After achieving WHO TB control targets in FY07, TB case detection rates increased from 70% to 80% in FY09 and treatment success rates improved from 85% to 85.2% over the same period. HIV testing among TB patients is the standard of care with HIV status documented for 83% of patients. The average national HIV prevalence among TB patients remains around 45-48% but is as high as 70% in some settings. In FY 09, 93% of co-infected patients received cotrim. The percentage of MDR-TB patients is estimated at <1% and drug susceptibility testing (DST) for TB re-treatment cases improved from 40% in FY07 to 60% in FY09. Since 2003, 401 MDR-TB cases and 1 XDR-TB have been identified. Through the support of the Green Light Committee (GLC) and other sources, 100 MDR-TB cases are receiving treatment at 4 facilities (Kenyatta National Hospital [KNH], Blue House, Moi Teaching and Referral Hospital [MTRH] and Homa Bay District Hospital) and increased coverage is planned in the next phase

In FY 10, the DLTLD will build on gains already made to consolidate and further increase access to integrated TB/HIV services nationwide.

In FY 10, the DLTLD will concentrate on getting more eligible TB patients onto ART and intensify, in collaboration with NASCOP and other partners, TB screening for HIV-infected persons identified in HIV care settings, TB infection control in HIV care settings and expand access to TB preventive treatment (IPT) in selected sites. The DLTLD is coordinating efforts to optimize MDR-TB surveillance and expand access to treatment. USG is supporting revision of the national TB/HIV training curriculum to equip providers with essential technical and managerial skills through an expanded pre and in-service training plan. In FY10, USG will assist Kenya conduct a national anti-TB drug resistance survey, strengthen TB diagnostic services, support construction of a new central reference laboratory and decentralize TB culture capacity. Other priorities include: expanding prevention with positive (PwP) services in TB clinics, sustaining TB/HIV control activities in the prisons, strengthening linkages between facility and community-based services, improving patient referrals and tracking systems and increasing support for operation research (OR). To strengthen HVTB program monitoring, USG will expand support for establishment of electronic TB and HIV recording and reporting systems to improve patient referrals, tracking, linkages and program evaluation. In addition to required PEPFAR TB/HIV indicators, the DLTLD will support reporting of selected custom indicators to assist with program management and evaluation and monitoring of new activities.