Nyumbani Village, is a program of the Children of God Relief Institute (COGRI) caring for both HIV infected and affected children that aims at establishing a self-sustaining, community based residential village serving children orphaned as a result of HIV/AIDS in Kitui District Eastern Province.Objectives1. Provide holistic social services to 100 Nyumbani village families and 1000 children and 100 grandparents.2. To expand the activities of Nyumbani village state of the art healthcare centre in order to provide services to residents of Nyumbani village while integrating the Kwa- Vonza and Kwa-Mutonga communities to reach an additional 1,200 adults and 750 children within a period of four years.3. To expand the capacity of the vocational training centre with adequate equipment and staff in order to facilitate the older orphans and care givers acquire vocational training skills in woodwork, tailoring, building and construction, agro-business and food processing4. To expand the sustainability program in order to increase food production, nutrition and agro-income security by 50% within a period of 12 months, to support 814 OVCs and the grandparents living in Nyumbani village and additional 600 households in the neighbouring communities5. Establish a community managed revolving fund/micro credit to offer loans to the grown up OVCs to start small business enterprises and become independent after obtaining the relevant trained skills from the village.6.. To continue to work with local leaders, government and religious leaders to seek ways to influence and support the surrounding communities to upgrade their standards of living. This activity supports GHI/LLC and is completely funded with pipeline funds in this budget cycle.

The project will support a minimum package for home and community based care in line with NASCOP guidelines. The services will include nursing care and palliative care; clinical care with an emphasis on treatment literacy and sustainability; family care and support (including psychosocial support, access to reproductive health services, and initiatives to strengthen food security and proper nutrition); trainings for health care workers, CHWs and peer educators; and establishing proper linkages and referrals to ensure clients access additional services as necessary. Nyumbani Village will reach 1,000 OVC in the village and 500 in the community. Those to benefit from the project as OVC will constitute children aged 0-17 years while ensuring both girls and boys have equal chances of benefiting from the project. The project will provide food/nutritional and household support, life skills training, career guidance and talent development.Those aged 18 years and above will be considered as beneficiaries on home based care and support. The project will establish a community managed revolving fund/micro credit to offer loans to the grown up OVCs to start small business enterprises and become independent after obtaining the relevant trained skills from the village. The loans will also be offered to the surrounding communities particularly the caregivers to start cottage industries and other income generating activities. CHWs will be trained in accordance to the National guidelines and assigned to OVC/HBC households while project staff will make periodic follow-ups to those within the community to ensure retention on the program. Children within the village will be followed up by counselors/social workers within the Village. The mature OVC will receive ASRH information and services.

Sustainability: To expand the sustainability program in order to increase food production, nutrition and agro-income security by 50% within a period of 12 months, to support 814 OVCs and the grandparents living in Nyumbani village and additional 600 households in the neighbouring communities through use of low cost integrated sustainable agriculture/organic farming techniques linking market gardens, livestock production, food processing and market enterprises.

M&E: The project will support data collection and reporting using standard tools as per NASCOP/ NACC guidelines. Data will be collect at a household level by CHWs on type of services received by the OVC and HBC clients on the program. At the village data will be collected by the Counselors located within the Village

The Nyumbani Village concept aims to establish a self-sustaining, community-based, residential village that will accommodate both those infected and affected by HIV/AIDS. The project is being implemented over a six year period with a goal of housing approximately 1,000 orphaned children and 100 grandparents who have lost their security in society due to the premature deaths of their own children. Nyumbani Village is providing a family-like structure for the orphaned children under the stewardship of elderly caregivers.

Nyumbani Village will provide shelter, food, clothing, medical care, education, spiritual guidance and leisure opportunities for the children residing in the village. Counseling of both grandparents and children is provided including seminars on life skills, sexuality, behavior change, health care and career possibilities. Through Legal protection the children are able to retain their ancestral land and will return to their homes once they complete their education. The surrounding community and households receive technical agricultural expertise and in return, the community members are asked to tend a perimeter tree system which acts as protection for the Village. The surrounding community is also gradually being involved in identifying the needs of the orphans, infected children and in mobilizing resources to meet their needs.Apart from providing OVC services, Nyumbani Village seeks to become a resource centre, a focus for social and medical care, together with educational and cultural activities for the surrounding community and an agent of innovation, training, inspiration and technical support for others. It will expand vocational training opportunities for the OVC in Nyumbani village and in the surrounding Kwa-Vonza and Kwa-Mutonga communities.

The village is located in Kitui District in Eastern Province. The target groups are OVC and the grandparents who look after them. The surrounding community also benefits from the program by accessing medical services at the clinic which include HTC, PMTCT and MCH services.

There has been a rapid increase in the number of OVC enrolled; younger children less than five years pose as a challenge in terms of care by the elderly grandparents. The growing number of adolescent children has created a need for continuous counseling and social activities to minimize incidents of indiscipline. Several children are fast approaching 18 years and will therefore not be eligible for OVC care. However, the Village has constructed a polytechnic where children who complete schooling can obtain vocational skills. The challenge is funding for those who are eligible to join institutions of higher learning.

This activity will reach 1000 OVC with comprehensive quality services under 100 care givers/providers.

Nyumbani Village will institutionalize the care of pediatric HIV infected infants, children and adolescents through a clinic managed by staff whose competencies to address the evolving needs of infected children has been adequately built and supported. The target population shall be all children 0-15years identified through facility and community testing who will be followed-up till they are transitioned to the adult care and treatment clinics. Family testing at community level will be emphasized to identify HIV infected children from the adults on care and treatment. We hope to raise the total number of pediatrics on care from 122 to 180 within the next 2 years through engagement at community level. Following HIV diagnosis , appropriate care and treatment will be provided based on the National pediatric and adolescent care and treatment guidelines. Follow-up visits for monitoring and assessments will be scheduled to ensure access to drugs, commodities, primary and basic care packages as well as supplies appropriate for the conditions that are identified. All immunization and supplementary feeding will be provided as well as clinical review of response to treatment. Parents/guardians counseling will be undertaken to promote access to and treatment adherence. Activities will include support for laboratory services for HIV related tests, OI prophylaxis (cotrimoxazole, fluconazole), nutritional assessment/support and strengthening pharmaceutical management. The program will also strengthen the ability of targeted local communities to prioritize needs of HIV+ children and their families and carry out activities to meet these needs. Some of the activities include group therapy sessions, life skills training, post disclosure clubs, recreational activities, coping skills, disclosure meetings, support group meetings and follow up counseling sessions. Life skills training sessions which are held with adults and children aged between 7 and 16 years address issues related to drug adherence basic hygiene and nutrition; especially to ensure smooth transition into adulthood. The activity will also improve the organizational capacity of the dedicated pediatric mentors who will support the establishment and strengthening of the pediatric care and support services embedded into the regional multidisciplinary mentorship teams.Existing tools for recording and reporting will be deployed and used by all providers and facility-based mentors for pediatric care and support.

Nyumbani Village will expand counseling and testing activities within its cathment population- that is Kwa Vonza andKwa Vonza communities. This will be both facility based at the Clinic within the Village and through outreach programs. I CT activities will also target market days that congregate traders and business persons.

Facility-based HIV CT services in the Clinic will target pregnant women, couples and partners of PLHIV through invitation and mobilization by CHWs, the youth seeking YFS and clients accessing services at the supported health facilities. Provider initiated HIV testing & counseling (PITC) will be the predominant approach for clients seeking services in the outpatient. HIV testing will be offered to patients, their family members and visitors routinely with the option to opt-out in the context of ANC, maternity, postnatal, MNCH, TB, in-patient and other outpatient services. Other approaches will include outreach/mobile voluntary counseling and testing (VCT). The clinic be used to identify index HIV clients through whom family-based HIV testing by CHWs and other community counselors will be undertaken to promote early identification of HIV infected family members and access to HIV care and treatment.

The nationally recommended HIV testing algorithm will be in used . The clinic will liaiase closely with the District Health Medical Team to ensure that the provider/s receive orientation on the national HTC quality assurance strategy. Further provider orientation on the re-testing recommendations contained in the HTC Guidelines will be done to facilitate a structured approach in implementation. Partner testing will be promoted in care settings through active invitation for partners of identified cases for HIV CT services. Support groups linked to supported health facilities will be strengthened and community peer volunteers identified to facilitate intra-facility referrals across departments, into the community programs and facilitate tracing of defaulters to follow-up care and treatment. Mobile phone messaging by service providers and the peer volunteers to communicate with individuals after HIV CT will be introduced to enhance linkage for enrolment, follow-up and retention into HIV care and treatment. Existing HTC tools will be used at all entry points to HTC services and summary reports prepared by HTC mentors based in the health facilities and the anchor CU facilities for community outreach services.

The project is supporting comprehensive adult HIV care and treatment in within the Nyumbani Village and the surrounding communities of Kwa Vonza and Kwa Mutonga Adults within the Village will include grandparents and project staff. The project is expected to reach 150 HIV positive clients

The package of care and treatment services provided through the project include cotrimoxazole prophylaxis provision, TB screening during all client visits, CD4 testing for initiation and monitoring, lab tests for ART initiation and monitoring (such as HB, urinalysis and creatinine testing) according to national guidelines, food by prescription (FBP) and supply of ARV commodities at ART sites.To enhance adherence, we also support the establishment of patients psycho-social support groups that meet on a monthly basis. During their meetings we support the facilities to provide them with tea and snacks. Supported defaulter tracing and prevention strategies include provision of HIV treatment literacy, adherence monitoring, and use of phone tracing and home visits by peer educators. In addition to this daily appointment diaries at the clinic will be used to track daily clinic appointments. At the end of the clinic day, the missed appointments are immediately notified to the peer educators who initiate defaulter tracing by making telephone calls to the clients, carrying out home visits and notifying patient support group leaders.

Training and mentorship will be offered to the Health care providers and QI standards developed. Monthly ART cohort reports will be compiled and used to review the clinical outcomes. ADR and adverse event monitoring will be instituted and for those patients who develop treatment failure, access to rationalized regimens will be facilitated through the Level 5 Hospital Treatment Review Team review of treatment and access to non-standard regimens.

Nyumbani village will scale-up pediatric care and treatment among the community members seeking support at the village clinic. We hope to identify and initiate 40 new children on ART over the next 2 years. At present about 58% of HIV positive individuals are on ART; this proportion will be increased to about 70% in the next 2 years through improvement of quality and adoption of the new WHO guidelines. The program aims to ensure optimization of entry points into care and treatment through increased PITC and community mobilization. Identification of HIV exposed and infected children will be intensified through longitudinal follow-up of HEI and PITC for the infants, children with unknown status and linkage with ANC units. Early infant diagnosis will be scaled-up to ensure provider competence to collect quality DBS samples and logistical transportation to regional laboratories for HIV DNA PCR diagnosis. Mentorship teams will ensure providers minimize missed opportunities for HIV diagnosis amongst exposed children. OJT for service providers on collection of DBS samples will be conducted at the Nyumbani clinic to facilitate diagnosis of HIV among the HEI. Turnaround times for receipt of results will be analyzed and optimized through measures to reduce time waiting for and relaying the results. Service providers will be mentored on the prompt initiation of ART for children less than 2 years with confirmed HIV status while access to CD4 and Viral Load testing will be facilitated through linkage with the Nyumbani diagnostic Laboratory to enhance evaluation and monitoring of patients. Nutritional assessments of pediatric patients and therapeutic and supplemental feeding will be an integral part of their support. Access to all other immunization care, supplementation and growth monitoring services will be undertaken in compliance with National Guidelines. The program will build the capacity of health service providers in pediatric HIV management through targeted orientations and intensified clinical mentorship to ensure that regimen dosing is appropriate for the ages of the children. Orientation to the new MOH tools will be done to ensure that key staff develop the capacity to collect, analyze use data both at local and national level. Adolescent-friendly treatment services will be undertaken through the establishment of adolescent-friendly clinic days and the formation of adolescent support groups. Adolescent clubs to promote healthy and positive living will be linked to appropriate role model mentors from amongst the adult PLHIV in order to allow for smooth transition into adulthood. The program will ensure adherence support to the individuals on follow up including strengthening community facility linkages to curb loss to follow up hence improve retention and long term out comes.