Columbia University Mailman School of Public Health (CU-ICAP) in Nyanza supports implementation of high quality HIV prevention, care and treatment services in 3 districts (Siaya, Bondo and Nyando) in Nyanza Province. CU- ICAP ensures availability of high quality, comprehensive HIV prevention, care and treatment services including PMTCT, TB/HIV, adult and pediatric HIV care and treatment, and PITC. The projects goals are aligned with the GHI principles and include decentralization and integration of HIV services into existing clinics including maternal and child health and TB clinics. The program supports the national M&E system and will continue to build the capacity of Health Records Information Officers and also scale-up electronic medical records at facilities, to allow for efficient reporting both to PEPFAR and NASCOP and support patient outcomes analysis to inform program improvement. Strategies to reduce cost will include: support for government-led programs to avoid duplication; decentralization of trainings to the districts; and support for an integrated district mentorship program in order to capacity build district teams to conduct mentorship and promote ownership and sustainability of the program. CU-ICAP is building the capacity of local NGOs as a strategy for transitioning the program. The partner also supports the Provincial and District Health Management Teams and carries out joint planning to promote ownership and sustainability.CU-ICAP had procured 5 vehicles between FY 10-11and does not plan to acquire additional vehicles. This activity supports GHI/LLC.

Columbia University Mailman School of Public Health (CU/ICAP) has been implementing HIV care services in Nyando since 2008 and extended to Siaya, Bondo and Rarieda districts in October 2010.

In FY12, CU-ICAP will jointly work with the Ministry of Health (MoH) to continue supporting expansion and provision of quality adult HIV Care and Support in Nyanza as per MoH guidelines to 88,989 adults in FY 12 and 104,002 in FY 13.

CU-ICAP will support provision of comprehensive care and support package of services including HIV testing to family members of index patient and referring and linking HIV positive ones to care and support; clinical assessment for ART eligibility and linking eligible PLHIV to treatment; laboratory monitoring including 6 monthly CD4 testing; WHO staging; Basic Care Kit (safe water vessel, multivitamins, insecticide-treated mosquito nets, condoms, chlorine for water treatment and educational materials); Adherence assessment; counseling and support including FBP; prevention with positives (PwP); cervical cancer screening to all enrolled women; and ensure referral and linkages to other clinical services including RH/FP.

CU-ICAP in collaboration with MoH will support targeted training for 200 HCWs in FY 12 and 150 in FY 13 as well as continuous medical education and mentorship for health care workers on care and support e.g. OI management. CU-ICAP will identify human resources and infrastructure gaps and support in line with MoH guidelines and support good commodities management practices to ensure uninterrupted availability of commodities.

CU-ICAP will continue to support ongoing psychosocial and community activities including peer education; referral and linkages to community based psychosocial support groups to strengthen adherence; effective and efficient retention strategies of patients on follow up; water, sanitation and hygiene programs; income generating activities; Home Based Care; vocational training; social and legal protection; and food and nutrition programs. CU-ICAP will adopt strategies to ensure access to friendly services to youth, elderly and physically or mentally challenged populations.

CU-ICAP will continue to strengthen data collection to improve reporting to MoH and PEPFAR; adopt the new PEPFAR generation indicators; and support the development and use of electronic medical records system in accordance with MoH guidelines. CU-ICAP will adopt cohort analysis and quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV care and support services and integrate them into routinely collected data and use the results to evaluate and improve program activities. Additionally, CU-ICAP will carry out operation research on implemented programs.

CU-ICAP will support joint Annual Operation Plan (AOP) planning, implementation, monitoring and evaluation, capacity building and health system strengthening to facilitate sustainability and collaborate with other partners to leverage and maximize on available USG and non-USG resources.

Columbia University Mailman School of Public Health (CU-ICAP) will support implementation of TB/ HIV Services in 3 districts in Nyanza. CU-ICAP has been implementing comprehensive HIV services including TB in Nyando since 2008 but extended coverage in October 2010 to Siaya, Bondo and Rarieda districts of Nyanza province. By the end of June 2011, CU-ICAP had increased coverage of TB treatment and HIV services to >90% and 89% respectively.

CU-ICAP will continue to support scaling up of TB/HIV services to reduce TB among HIV patients and HIV among TB patients through TB/HIV collaborative mechanisms. All TB patients will be screened for HIV and 95% of TB/HIV co-infected patients will be put on cotrimoxazole and ART as per national guidelines.

To reduce the burden of TB in HIV infected patients, CU-ICAP will support intensified TB screening of 79,102 and 92,446 HIV infected patients in HIV care settings in FY 12 and 13 respectively using the national screening tool. Active TB patients (3,955 in FY12 and 4,622 in FY13) will be put on TB treatment and those without active TB will be provided with Isoniazid Preventive Therapy (IPT) as per national IPT protocol. CU-ICAP will strengthen TB infection control and support roll out of guidelines and implementation in all sites including baseline infection control assessments. This includes fast tracking patients with a cough and expediting diagnostic work up and treatment.

To improve drug-resistant TB surveillance and management, CU-ICAP will strengthen screening of all retreatment cases, sputum sample shipment and return of results from central reference laboratory, and facilitate linkages of DR-TB cases to treatment. CU-ICAP will support a standard care package that includes health education, clinical and lab assessments including networking for AFB and CD4, OI screening and management, CTX prophylaxis , nutritional support, BCK, adherence and psychosocial support, ART initiation and monitoring for co-infected patients, toxicity and drug interaction assessments, prevention with positive (PwP) services, and strengthening linkages between facility and community-based services through improved referrals and tracking systems.

CU-ICAP will support an MOH annual operation plan, implementation and review process while offering technical and non technical support. A structured mentorship and supervision plan will be strengthened to improve service delivery, quality data collection, utilization and reporting at all levels. Program quality will be emphasized and periodically monitored through standards of care/clinical quality improvements assessments. ICAP will support cohort analysis to evaluate outcomes of service delivery and also report selected custom indicators to assist with program management monitoring and evaluation of new activities at NASCOP (DLTLD) and PEPFAR.

CU-ICAP will support operational research and also health management teams to strengthen their health systems in governance, lab capacity and sample networking to increase access in remote facilities, commodity supply chains, targeted infrastructure renovations, hiring of different cadres of HRH, and support regular supervision, mentorship and defaulter tracing mechanisms. CU-ICAP will train 200 health workers in FY12 and 150 in FY13 on TB/HIV, 5 Is and data management trainings.

Columbia University Mailman School of Public Health (CU-ICAP) will support implementation of pediatric care in Nyanza. CU-ICAP has been implementing comprehensive HIV services including pediatric care and support in Nyando since 2008 but extended to Siaya, Bondo and Rarieda districts in October 2010. As of March 2011 SAPR, CU-ICAP had enrolled 6172 children in care and 4,893 were active in 122 sites.

In FY12, CU-ICAP will work with the Ministry of Health (MoH) at provincial, county and district levels to jointly plan, expand and ensure provision of quality pediatric HIV care and support in all public and faith based health facilities to 9,299 pediatrics in FY 12 and 11,064 in FY 13.

CU-ICAP will provide a comprehensive care and support package of services including family testing; clinical assessment for ART eligibility and linking eligible ones to treatment; laboratory monitoring including 6 monthly CD4 testing (through strengthened laboratory networking); WHO staging; Basic Care Kit; Nutritional assessment counseling and support (vitamin A and zinc provision, de-worming, and ensure referral and linkages to other clinical services); integration of HIV services into child welfare clinic services; integrated Management of Childhood Illnesses (IMCI); in-patient; community outreach efforts; and routine child health care and survival services in the maternal child health department. CU-ICAP will also support care of the newborn by supporting hospital delivery, prophylactic eye care and comprehensive care services to the newborn.

CU-ICAP will support in-service training of 200 and 150 HCWs in FY 12 and 13 respectively; continuous mentorship on care and support (e.g. diagnosis and management of opportunistic infections); identify human resources and infrastructure gaps and support in line with MoH guidelines; and support good commodities management practices to ensure uninterrupted availability of commodities. Linkage of care and support services to ART, PMTCT, TB/HIV, community programs, and other related pediatric services will additionally be optimized.

CU-ICAP will support hospital and community strategies to ensure access to pediatric and adolescent care including support groups to enhance disclosure and adherence messaging; PwP; substance abuse counseling; teaching life skills, providing sexual and reproductive health services and support their transition into adult services; and scaling up identification of HEIs to provide ARVs prophylaxis, HIV testing (PCR-DNA or antibody), and linking those positive to treatment.

CU-ICAP will continue to strengthen data collection to improve reporting to MoH and PEPFAR, adopt the new PEPFAR generation indicators, and support the development and use of electronic medical records system in accordance with MoH guidelines. CU-ICAP will adapt cohort analysis and quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV care and support services, integrate them into routinely collected data and use the results to evaluate and improve program activities.

Target population: ICAP Nyanza supports HIV testing and counseling services in all health facilities in Siaya, Bondo, Rarieda and Nyando districts in Nyanza Province. Target population includes all patients, their families and caretakers who access out and in patient services at all the health facilities in the 4 districts.

HTC Approaches: The program utilizes provider initiated opt out approach and the services are offered within all out patient departments, TB clinics, VMMC clinics, FP, ANCs, special clinics, HIV clinics (targeting family members) and in patient departments. The counseling and /or testing is either done within the consultation rooms by trained clinicians, or in counseling rooms by lay counselors within the outpatient departments if space is available or the in laboratories.

Targets and achievements: HTC targets for ICAP Nyanza from July 2010 to June 2011 were 40,000 and achieved 68,345 (170%). HIV positive clients were 15%. In COP 2012, ICAP Nyanza will target 133,000 persons of which 20% will be tested as couples and 10% will be children below the age of 15.

Testing algorithm: National algorithmReferrals and linkages: In order to strengthen referrals, ICAP Nyanza has put in place several important strategies. They include: use of peer educators as patient escorts from one hospital department to the PSC; same day enrollment of clients to PSCs; use of an integrated defaulter tracing system for tracing patients who default on care or ART upon enrollment; use of the NASCOP referral booklets; use of mobile phones to follow up whether the client was actually enrolled.

Quality management: In order to improve and monitor quality of HTC services, ICAP Nyanza will put in place the following strategies: Training and continuing education of HTC providers; strict adherence to the standard operating procedures outlined in the national HTC guidelines; proper handling (storage and transportation) of HIV rapid kits as per the guidelines; putting in place a functional QA systems as provided for in the national HTC guidelines; participation in EQA- proficiency testing and finally conducting support supervisory visits.

Monitoring and evaluation: ICAP will use all ministry of health tools to capture HTC data, both for couples and individual patients. These include HTC lab Register and Monthly summary tool (MOH 711 and MOH 731). MOH approved HTC lab registers have been introduced at all HIV testing points except PMTCT.

Promotional activities for HTC: All patients attending the supported facilities will be given health talks including the need for HIV counseling and testing and the importance of couple testing. Couples are given priority services. Sexual partners of HIV positive clients will be given individualized invitations though the index clients and available avenues for testing including individualized home testing.

ICAP implements comprehensive prevention, care and treatment programs in Nyanza province. In FY 2012/13, ICAP will expand HIV prevention services to include evidence based behavioral interventions (EBIs) for specific target populations in clinical settings at comprehensive care center (CCC), TB and Maternal Child Health (MCH) clinics as part of HIV combination prevention programs. The EBIs will include Positive Health and Dignity Prevention (PHDP) targeting adult male and female and adolescents living with HIV (PLHIV); and Sister to Sister EBI (S2S) targeting sexually active HIV negative women attending the MCH clinics.

PHDP is an ongoing 5-10min group and individual level intervention that targets PLHIV in clinical and community settings. This mechanism will support this intervention which constitutes of ART adherence counseling and support; partner and family testing; provision of PEP to the discordant spouse; treatment for prevention once approved; safer pregnancy counseling and provision of modern contraception; sexual risk reduction counseling including reduction of sexual partners, alcohol counseling, promoting of consistent and correct condom use; Sexually Transmitted Infections (STI) screening and treatment and using meaningful involvement of people living with HIV/AIDS ( MIPA ). The efficacy of PHDP has been shown to be 68% in preventing transmission of HIV, and 96% in treatment for prevention.

S2S is a 20 minute individual level intervention that targets women of reproductive age that focuses on self efficacy, safer sex negotiation skills and condom use. Condoms are 80% effective in heterosexual relationships when used correctly and consistently.

ICAP will use HVOP funding to recruit and support appropriate peer educators/counselors to reinforce prevention messages delivered by health providers as a feasible model for task-shifting in the provision of PHDP in clinical settings, and specifically promote MIPA. It will support placement of 5 Peer Educators at the MCH, TB and CCC Clinics in hospitals, and 2 Peer educators at health centres and provide appropriate counseling space. One of the peer educators will do regular client home follow up to strengthen ART adherence.

Approximately 1.6 million Kenyans are PLHIV. The Kenya AIDS Indicator Survey 2007 showed 6% of couples to be in discordant relationships. Nyanza province has the highest HIV Prevalence (14.9%). ICAP will reach 50127 (60%) PLHIV in FY2012 and 68464 (70%) in FY 2013 with a minimum package of PHDP. It will implement S2S EBI on a pilot basis.

Quality assurance for EBIs will be promoted through appropriate training and certification of peer educators using approved national curricula, standard job-aids and guidelines and regular supervision.

ICAP will work with appropriate national Technical Working Groups (TWG) to support integration of HIV prevention into care and treatment programs in clinical settings. These programs will also be linked to other HIV community programs. PLHIV will be specifically linked to STI and FP services, as necessary, through patient escorts.

Monitoring of PHDP and S2S will be done through the review/input of ICAP implementation plan, analysis of KePMS data, quarterly reviews, semiannual and annual reports. Evaluation will be conducted through operation research of combination HIV prevention and periodic surveys (Kenya Demographic and health survey, Kenya Indicator AIDS Survey, Kenya Service Provision Assessment)

Columbia University Mailman School of Public Health (CU-ICAP) will support implementation of PMTCT activities in 3 districts in Nyanza. Nyanza province has a population of about 5.4 million people with an estimated adult HIV prevalence of 14.9% compared to the national 7.1% and ANC prevalence of 17%. CU-ICAP has been implementing HIV services in Nyando since 2008 and extended to Siaya, Bondo and Rarieda districts in October 2010. As of March 2011 SAPR, CU-ICAP had counseled and tested 20,291 pregnant women and provided ARV prophylaxis to 4,736 pregnant women.

CU-ICAP will work with MoH to scale up counseling and testing to 45,046 in FY12 and 47,298 in FY13, first ANC attendees with unknown or known HIV negative status through an opt out approach, assess clinically (WHO stage) and immunologically (CD4) and provide a more efficacious ARV prophylaxis to 7,713 in FY12 and 9,368 in FY13 pregnant women who test HIV positive, as per current national PMTCT guidelines. They will support training and mentorship of 90 HCWs in FY 12 and 90 in FY 13 on comprehensive PMTCT/EID services.

Support all PMTCT prongs: primary prevention (HTC, STI and FP); ARV prophylaxis to all HIV positive pregnant mothers and their exposed infants; and enrollment, follow up and retention of mother baby pair and other infected family members. Male involvement in RH and FP services will be strengthened through effective and efficient mechanisms to reach 14,189 couples with couple HTC, primary prevention, PwP, and linkages into care.

Support safe infant feeding practices as per national guidelines and support enrollment and follow up of 5,786 in FY12 and 8,058 in FY13, HIV exposed infants to access CTX, ARV prophylaxis, and EID services using the HIV exposed infant cohort register till exit at 18 months. They will expedite ART initiation for children under 2 years confirmed HIV positive.

Support hospital delivery through needs assessments, equipment support, capacity trainings for HCW, and developing effective and efficient antenatal and post natal retention strategies for mothers and babies through recruitment of peer educators and use of appointment diaries and registers. The team will engage in community education to promote demand creation for health services, support referral and linkages, and also reach out to non clinic attendants.

Support MoH annual operational planning, implementation, and program review through offering technical and non technical support. Approximately $18 dollar per woman will support all PMTCT prongs and other wrap around activities like malaria prevention and other tropical diseases in line with GHI principles. A structured mentorship and supervision plan will be strengthened to improve service delivery, quality data collection, data utilization, and reporting at all levels. Program quality will be emphasized and periodically monitored through standards of care/clinical quality improvements assessments.

Support cohort analysis to evaluate outcomes of service delivery and also report selected custom indicators to assist with program management, M&E of new activities at NASCOP and PEPFAR. Strengthen the health system through improving lab capacity and sample networking to increase access in remote facilities, improving commodity supply chains, targeted infrastructure renovations, hiring of HCWs, supporting regular supervision and mentorship, and supporting defaulter tracing mechanisms including phone tracing.

Columbia University Mailman School of Public Health (CU-ICAP) will support implementation of adult treatment in Nyanza. They have been implementing HIV services in Nyando since 2008 and extended to Siaya, Bondo and Rarieda districts in October 2010. As of March 2011 SAPR, CU-ICAP had supported a cumulative 49,402 adults on ART and 38,737 were active in 122 sites.

In FY12, CU-ICAP will work with the MoH to continue supporting expansion and provision of quality adult HIV treatment services in Nyanza Province as per MoH guidelines to 51,356 patients currently receiving ART and 7,704 new adults resulting to cumulative 61,627 adults who have ever been initiated on ART. In FY13, this number will increase to 57,142 currently receiving ART and 7,794 new adults resulting to 69,421 adults who have ever been initiated on ART.

CU-ICAP in collaboration with MoH will support in-service training of 150 and 100 health care workers in FY 12 and 13 respectively, identify human resources and infrastructure gaps and support in line with MoH guidelines, and support good commodities management practices to ensure uninterrupted availability of commodities.

CU-ICAP will support provision of comprehensive package of services to all PLHIV including ART initiation for those eligible; laboratory monitoring including biannual CD4 testing and viral load testing for suspected treatment failure (through strengthened laboratory network); cotrimoxazole prophylaxis; psychosocial counseling; referral to support groups; adherence counseling; nutritional assessment and supplementation; prevention with positives (PwP); FP/RH; and improved OI diagnosis and treatment including TB screening, diagnosis, and treatment. Ongoing community interventions for PLHIV 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 to improve retention in all sites.

CU-ICAP will continue to support ongoing psychosocial and community activities including education by peer educators; referral and linkages to community based psychosocial support groups to strengthen adherence; effective and efficient retention strategies of patients on follow up; water, sanitation and hygiene programs; income generating activities; Home Based Care; vocational training; social and legal protection; and food and nutrition programs. CU-ICAP will adopt strategies to ensure access to friendly services to youth, elderly and physically or mentally challenged populations.

CU-ICAP will adapt the quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV treatment services integrate them into routinely collected data; use the results to evaluate and improve clinical outcomes and additionally support short term activities to increase impact and improve patient outcomes. Additionally, CU-ICAP will do cohort analysis and report retention rates as required by the MoH and discuss the analysis results with facility staff in order to improve program performance.CU-ICAP will adopt strategies to ensure access and provision of friendly HIV treatment services to all including supporting peer educators, support groups, disclosure, partner testing and family focused care and treatment. CU-ICAP will continue to strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. Use of an electronic medical records system will be supported and strengthened.

Columbia University Mailman School of Public Health (CU-ICAP) has been implementing HIV services in Nyando since 2008 and extended to Siaya, Bondo and Rarieda districts in October 2010. As of March 2011 SAPR, CU-ICAP had supported a cumulative 5,598 children on ART and 4,893 were active in 122 sites.

In FY12, CU-ICAP will work with the Ministry of Health (MoH) at Provincial, county and District levels to jointly plan, coordinate, expand and ensure provision of quality pediatric HIV treatment in all public and faith based health facilities to 5,586 paediatrics currently receiving ART and 1,117 new pediatrics resulting to cumulative 6,703 paediatrics ever initiated on ART. In FY 13, this number will increase to 6,765 pediatrics currently receiving ART and new 1,006 resulting to cumulative 7,710 pediatrics ever initiated on ART.

CU-ICAP will support comprehensive pediatric ART services including growth and development monitoring; immunization as per the Kenya Expanded Program on Immunization(KEPI); management of childhood illnesses OI screening and diagnosis; WHO staging; ART eligibility assessment; laboratory monitoring including 6 monthly CD4, hematology and chemistry (through strengthening of lab networks); Pre-ART adherence and psychosocial counseling; initiation of ART as per MoH guidelines; Toxicity monitoring; treatment failure assessment through targeted viral load testing; Adherence strengthening; enhanced follow up and retention; support EID as per MoH guidelines and PITC to all children and their care givers attending child welfare clinics; support family focused approach; community outreach efforts; and integration of HIV services in other MNCH services.

CU-ICAP will support health facility and community activities to support the needs of the HIV infected adolescents: support groups to enhance disclosure and adherence messaging, PwP, substance abuse counseling, teaching life skills, providing sexual and reproductive health services, and support their transition into adult services

CU-ICAP will support in-service training of 200 and 150 HCWs in FY 12 and 13 respectively and support continuous mentorship and capacity building of trained health care workers on specialized pediatric treatment including management of ARV treatment failure and complicated drug adverse reactions. CU-ICAP will identify human resources and infrastructure gaps and support in line with MoH guidelines and support good commodities management practices to ensure uninterrupted availability of commodities. Linkage of ART services to pediatric care services, PMTCT, TB/HIV, community programs, and other related pediatric services will additionally be optimized.

CU-ICAP will continue to strengthen data collection, cohort analysis, and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. Additionally, CU-ICAP will review data and evaluate programs to inform programming and decision making. Use of an electronic medical records system will be supported and strengthened. CU-ICAP will strengthen local capacity as part of the transition plan to MOH for sustainable long-term HIV patient management in Kenya.