Goals and objectives: 1)To contribute to Kenyas goal of 80% knowledge of HIV status by 2013 through innovative quality assured HTC service delivery using multiple approaches targeting couples, first time testers, MARPS and vulnerable populations including people with disabilities. 2)To increase uptake and delivery of combination prevention interventions for general and special needs populations and strengthen referrals and linkages to other services. 3) Support Ministries of Gender and Health and other stakeholders to define and roll out a comprehensive gender-based violence package to train providers and law enforcement personnel. Cost-efficiency strategy: The mechanism targets areas of high burden and greatest risk of HIV transmission by mapping, mobilizing and taking services to the target populations. Couples, rural populations and MARPs are reached. The National testing guidelines and algorithm are strictly followed. The HTC approaches are carefully chosen based on the population. To enhance cost effectiveness combination prevention services are offered. Transition to country partners: LVCT is an indigenous organization. The program works closely with the Ministry of Health at national, provincial and district level health facilities and community levels, utilizing the countrys community health strategy. Innovative ideas generated are shared at the National technical working group at NASCOP for replication and scale up. The program uses the national M&E framework and tools for reporting. Vehicle Information: In FY 2010 LVCT purchased a Land cruiser for program monitoring and support and HTC campaigns.This activity supports GHI/LLC.

In 2012, the HTC mechanism will implement a wide range of EBIs which will have been adopted by the country and integrated into combination prevention. This budget code will target general population with special emphasis on enhancing parent child communication, delaying sexual debut among the youth and adolescents. The populations that will be targeted in this mechanism are the youth in school and parents with adolescents age 9-12 years of both sexes.People with disability will be a special category targeted as programs have tended to ignore them. The populations will be mapped and appropriate EBI implemented for specific groups. Both Families Matter Program- (FMP) and HC1 - have been adopted in the country and will be expanded to cover the whole of lower Eastern region covering the counties of Machakos, Kitui and Makueni. The program will work with churches, schools and the local county health departments and local administration to identify the specific groups for interventions.Families Matter Program (FMP) is a 5 weekly session intervention targeting parents with children age 9-12 years.The goal of FMP is to reduce sexual risk behavior among adolescents, including delaying onset of sexual debut, by training parents to deliver primary prevention messages to their children. More effective parental communication can help to delay their childrens sexual behavior and increase protective behaviors as their children get older. The intervention also links parents to other critical evidence-based interventions including HTC and VMMC. A target of 3500 youths will be reached in 2012.Quality assurance of FMP is promoted through rigorous training and certification of facilitators, ongoing process monitoring with standardized tools, and quality assurance site visits by a capacity building agency.

Healthy Choices I (HCI) targets in-school youth aged 10-14 years and aims to delay sexual debut by providing knowledge and skills to negotiate abstinence, avoid negative peer pressure, avoid or handle risky situations and to improve communication with a trusted adult. HC I consists of 8 modules of approximately one hour each. It can be delivered in 4 sessions of 2 hours each or in 8 sessions of 1 hour each. A target of 3634 youths will be reached in 2012.Quality assurance of HC is promoted through rigorous training and certification of facilitators, ongoing process monitoring with standardized tools, and quality assurance site visits by a capacity building agency.Monitoring and evaluation is built up in the program implementation. Process evaluation will be done as determined and developed by the technical working group and the national program and the impact evaluation will be done in larger surveys like the Demographic health survey incorporating HIV markers.

The Community HTC mechanism targets general population with special emphasis on identifying discordant couples, key populations, rural men and people with disability. The area of coverage includes the counties in Eastern province with a prevalence of 3.5% and Nairobi County with a prevalence of 7.0%. Coverage for couples has remained poor at paltry 16% and yet data show that the driver of the epidemic in Kenya is infection in marriages and unions. The disability program has a national coverage (the prevalence among this group is not known) and will aim at developing and dissemination of national standardized training curriculum and development of operational guidelines. The mechanism will work with young people especially in Universities and colleges and provide comprehensive HIV prevention services targeting first time testers whose coverage now stand at 40%. Other services integrated include TB screening, FP screening and alcohol consumption screening followed by appropriate referrals. Innovative strategies like self testing and point of care CD4 will be integrated in HTC to assess its impact on referral uptake.The mechanism uses the national guideless for HTC service provision and employs both provider- initiated and client initiated HTC both in facilities and in the community settings. Approaches which have been successfully used are workplace, moonlight and celebrity testing and accelerated testing campaigns, the later being organized by the national program. Celebrity testing is key in creating demand for workplace testing and counseling. Home based approach is used in areas of high population density. The total number of targets achieved in the past year is 83,000 clients offered HTC services. A total of 146 providers were offered refresher training in HTC following the of new guidelines and also in including quality management and integration of services. Training and technical updates will be key in provision of quality services. In 2012, 210,929 clients will receive HTC provided through multiple approaches; HBTC- 63,299; VCT- 63,300; mobile -78,000 and workplace services -6,350.The national testing algorithm is used in all the program work. Referral uptake among clients remain a challenge and the strategies used to improve this are updated comprehensive referral directories available in all sites, PLHIV CHWs are used to make follow up, they make visits where possible, use phone calls and send short messages (sms) to clients to ensure referral uptake. The clients are followed up and tracked for 3 months and a register is maintained to ensure service uptake. These services will be integrated in the governments community strategy for sustainability.The program follows in the national quality management guidelines and participates in the national quarterly proficiency testing, and observed practice for new providersThe program develops work plans and conducts biannual data quality audits and monthly data supervision is carried out and this informs the program implementation.The national M&E framework is used including use of national registers and data collection tools. New indicators like couples tested, discordant couples, MARPs and people with disability have been incorporated in the national tools.Promotional activities for demand creation include the print and electronic media, social media is used and materials are posted in face book for the youth. A hot line is operated that has a national reach.

The Community HTC mechanism targets general population with special emphasis on identifying the high risk group. These will include women especially in the reproductive age, older men especially the rural folk and young people in and out of school. Those especially in marriages or unions will be targeted with prevention messages especially the discordant couples. People with disability will be a special category targeted as programs have tended to ignore them. The populations will be mapped and appropriate EBI implemented for specific groups.

RESPECT targets ages 20-24 females and 30-44 males with STI. It has 2 brief individual sessions targeting general population and youth, originally for heterosexual negative persons. It focuses on reduction of STDs/HIV, risk reduction, condom use and clients understanding of personal risk.Healthy Choices II (HCII) targets both in and out of school youth aged 13 17 years and aims to delay sexual debut, promote secondary abstinence or have protected sexual intercourse, by providing knowledge and skills on correct and consistent condom use, handling peer pressure, and learning ones HIV status. HC II consists of 8 modules of approximately one hour each. It can be delivered in 4 sessions of 2 hours each or in 8 sessions of 1 hour each.Eban/Connect is a six session, relationship-based intervention that teaches couples including those discordant, techniques and skills to enhance the quality of their relationship, communication, and shared commitment to safer sexual behaviors and will allow couples to work together to solve shared problems.Sister to Sister is a brief (20-minute), one-on-one, skill-based HIV/sexually transmitted disease (STD) risk-reduction behavioral intervention for sexually active women 18 to 45 years old. The purpose of Sister to Sister is to: provide intensive, culturally sensitive health information to empower and educate and help women understand the various behaviors that put them at risk for HIV and other STDs; and enhance womens knowledge, beliefs, motivation, confidence, and skills to help them make behavioral changes that will reduce their risk for STIs, especially HIV.PwP is an individual intervention promoting positive living and strategies to reduce HIV transmission and re-infection, promotes enrolment to care and treatment, drug adherence, family planning, continued counseling and promotes partner testing and disclosure of status as well as proper and consistent condom use.

All the interventions will have integrated condom demonstration and distribution. Comprehensive gender based sexual violence service package will be integrated in the prevention interventions targeting adolescents and adults.

These populations are most at risk of HIV infection and have the prevalence higher than the national average. Sex is not discussed in family relationships, couples do not know each others HIV status and HIV discordance is high in the country about 45% of HIVinfected persons and partner testing is low.Quality assurance of all these interventions is promoted through rigorous training and certification of facilitators, ongoing process monitoring with standardized tools, and quality assurance site visits by a capacity building agency. Appropriate evaluation modalities will be developed by the Technical working group to assess the impact.