Columbia Universitys International Centre for AIDS Care and Treatment (CU-ICAP) - Eastern supports implementation of high quality HIV prevention, care and treatment services in the southern districts of Eastern province. 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. ICAP 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.ICAP is building the capacity of local NGOs as a strategy for transitioning the program. ICAP supports the Provincial and District Health Management Teams and carries out joint planning to promote ownership and sustainability. ICAP has procured 3 vehicles between FY 08-11. ICAP wishes to purchase an additional vehicle for transportation of program officers and supplies to supported facilities since the program has expanded to new regions. This activity supports GHI/LLC

Columbia Universitys International Centre for AIDS Care and Treatment (CU/ICAP) supports adult HIV care in 58 facilities in the southern region of the Eastern Province of Kenya. As of March 2011 SAPR, CU/ICAP had cumulatively enrolled 53,967 patients into care with 30,743 active at end of the period.

CU/ICAP will work with the Ministry of Health (MoH) at the provincial, district and health facilities levels, to jointly plan, coordinate, and implement quality HIV care and support to 36,091 current adult patients in FY12 and 41,680 patients in FY13.

CU/ICAP will offer comprehensive care and support package of services including: HIV testing to partners and family members of index patients and enrolling or referring/linking those that test HIV positive to care and support; provision of Basic Care Kit (safe water vessel, multivitamins, insecticide-treated mosquito nets, condoms, chlorine for water treatment and educational materials); therapeutic nutrition (FBP) to all enrolled HIV positive patients; prevention with positives(PwP), family planning and reproductive health services including cervical cancer screening to all enrolled women.

CU/ICAP in collaboration with MoH will support targeted capacity building (training and mentorship) for health care workers and offer continuous medical education on care and support, e.g. OI diagnosis and treatment. CU/ICAP will identify areas with staff shortages, support recruitment of additional staff, and support good commodities management practices to ensure uninterrupted supply of commodities. CU/ICAP will also support ongoing community interventions for HIV infected individuals including peer education and use of support groups to provide adherence messaging; effective and efficient defaulter tracing and follow up to improve retention in all facilities; referral and linkages to community based psychosocial support groups; water, sanitation, and hygiene programs; economic empowerment and income generating activities (IGAs); home based care services; gender based violence support programs; vocational training; social and legal protection; and food and nutrition and/or food security programs.

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

CU/ICAP will do a cohort analysis and report retention rates as required by NASCOP.CU/ICAP will continue to strengthen data collection and reporting at all levels to improve reporting to National AIDS & STI Control Programme (NASCOP) and PEPFAR. CU/ICAP will adopt the new generation indicators and support the development and use of electronic medical records system in accordance with NASCOP guidelines. CU/ICAP will adapt the quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV care and support services. Indicators will be integrated into routinely collected data and results used to evaluate and improve clinical outcomes. CU/ICAP will support joint Annual Operation Plan (AOP) development, implementation, monitoring and evaluation, and health system strengthening to facilitate sustainability.

Columbia Universitys International Centre for AIDS Care and Treatment (CU/ICAP) will support TB/HIV services in southern region of Eastern Province which reported 12,446 TB patients in 2010. Over 12,000 TB patients received HIV testing and 3,720 TB/HIV co-infected patients were identified. 97% and 47% received cotrimoxazole prophylaxis and ART respectively.

In FY 2012 and 2013, CU/ICAP will intensify efforts to detect TB cases through clinical exams and laboratory investigations and ensure successful TB treatment through provision of appropriate treatment. CU/ICAP will ensure that each facility providing TB/HIV services has adequate and well trained clinical staff supported by well equipped and staffed laboratory, including sputum specimen transport where laboratory services are unavailable. CU/ICAP will ensure that adequate supplies of anti-TB drugs are available and that the national TB treatment guidelines are followed. All TB patients on treatment will be monitored both clinically and through periodic sputum examination.

To reduce the burden of HIV in TB patients, CU/ICAP will ensure that at least 95% of TB patients are screened for HIV and 95% TB-HIV co-infected patients are put on cotrimoxazole and ARVs as early as possible regardless of the CD4 count as per the national guidelines. CU/ICAP will support the one stop model that provides integrated TB and HIV services in all TB clinics. All TB clinics will be stocked with cotrimoxazole and ARVs. 150 HCW in FY12 and 100 in FY13 will be trained.

To reduce the burden of TB in HIV infected patients, CU/ICAP will support intensified TB screening for 32,081 in FY12 and 37,049 in FY13. HIV infected persons identified in their HIV care settings will be screened at each clinical encounter using the national screening tool. 1,604 co-infected patients identified in FY12 and 1,852 co-infected patients identified 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.

To strengthen TB infection control in HIV settings, CU/ICAP will ensure that the national IC guidelines are available at all sites and IC training of staff is done. CU/ICAP will support scaling up of at least 2 components of the national TB infection control strategy in HIV care settings, one of which will be fast tracking of patients with cough for expedited diagnostic work up and treatment.

To improve surveillance and management of drug-resistant TB, CU/ICAP will support timely transport of sputum specimens of TB retreatment cases from health facilities to the central reference laboratory for drug susceptibility testing and ensure return of results to the facilities. CU/ICAP will also support scaling up of drug-resistant treatment sites thus expanding access to MDRTB treatment.

CU/ICAP will also support expansion of prevention with positive (PwP) services in TB clinics, TB/HIV control activities in the prisons, strengthening linkages between facility and community-based services, and improving patient referrals and tracking systems. To strengthen HVTB program monitoring, CU/ICAP will support reporting of selected custom indicators to assist with program management and monitoring and evaluation of new activities.

Columbia Universitys International Centre for AIDS Care and Treatment (CU/ICAP) supports pediatric HIV care in 58 facilities in southern Eastern Province of Kenya. By March 2011, CU/ICAP had 6,634 children enrolled in care with 5,113 receiving HIV care.

In FY 12 period, CU/ICAP will provide care and support services to 3,771 children currently on care. The number of children on care will increase to 4,434 in FY 13. CU/ICAP will provide comprehensive, integrated quality services and scale up to ensure 3,764 HIV infected infants are put on ARV prophylaxis and all HIV exposed children access pediatric care services.

The focus of pediatric care services will continue to be provision of comprehensive, integrated quality services including strengthening the use of the Mother-baby booklet, early infant diagnosis, universal provider initiated testing and counseling, and ensure those identified HIV infected are linked to care and ART services.

CU/ICAP will ensure children enrolled in care receive quality clinical care services, including clinical history and physical examination; WHO staging, CD4 tests, and other basic tests; opportunistic infection diagnosis, prophylaxis and management; TB screening; pain and symptom relief and management; and psychosocial support. Additional key care services will include nutritional assessment, counseling and support based on the WHO and IYCF guidelines (including provision of therapeutic or supplementary feeding; support to children with growth faltering; and provision of vitamin A, zinc, and de-worming); provision of safe water, sanitation and hygiene interventions (WASH) in the community and in health facilities; and malaria screening, treatment and provision of long lasting insecticide treated nets in malaria endemic areas.

CU/ICAP will support integration of HIV services into routine child health care and survival services in the maternal child health department including growth and development monitoring; immunization as per the Kenya Expanded Program on Immunization guidelines; case management of diarrhea, pneumonia, and other childhood illnesses; and community outreach efforts. They will also support the care of the newborn by supporting hospital delivery and ensuring that there is provision for newborn resuscitation and care (thermal care, hygiene cord care) and prophylactic eye care. Exposed children management and follow up will continue to be supported and will include enrollment, HIV testing (PCR-DNA and antibody testing) as per the national guidelines, provision of Nevirapine throughout the breastfeeding period, follow up and retention, and linkages of those positive to care and ART services.

CU/ICAP will support hospital and community activities to support the needs of the HIV infected adolescents including support groups to enhance disclosure and adherence messaging, PwP, substance abuse counseling, support for transitioning into adult services, and teaching life skills. Commodity access and infrastructure development will continue to be supported, including relevant trainings.

CU/ICAP will strengthen pediatric data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR.

ICAP implements comprehensive prevention, care and treatment programs in Eastern 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. HIV prevalence in Eastern province is (4.6%).ICAP will reach 20330 (60%) PLHIV in FY2012 and 27437 (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 (CU/ICAP) will support implementation of PMTCT services in Eastern Province. Since January 2011, CU/ICAP has been implementing PMTCT services in 246 sites in southern Eastern Province with about 141,080 expected pregnancies annually and HIV prevalence of 4.1%. Between January and March 2011, CU/ICAP had tested 18,792and given ARV prophylaxis to 555 HIV positive pregnant women.

In FY12, CU/ICAP will offer HIV counseling and testing to 105,980 pregnant women at the ANC and give ARV prophylaxis to 3,604 HIV infected pregnant women. The HIV infected women will receive a CD4 test after undergoing a WHO clinical staging. CU/ICAP will give HAART to all eligible HIV positive pregnant women per the revised PMTCT national guidelines. In FY13, CU/ICAP will increase the number of pregnant women counseled to 111,279, offer ARV prophylaxis to 4,377 pregnant women and 3,765 infants, and do EID for 3,765 infants.

CU/ICAP will focus on 4 prongs of PMTCT: primary prevention; family planning; ARV prophylaxis to all HIV positive pregnant mothers and exposed infants; and care and treatment to eligible HIV positive mothers, partners, and children. The Minimum care package will include health and HIV education, individual/ family HIVCT, clinical/laboratory monitoring and assessment, OI screening and treatment, ARV prophylaxis and treatment for both mother and baby, nutritional support, psychosocial support, PWP, follow up, retention, and referral and linkages. CU/ICAP will also incorporate TB screening into routine antenatal care.

Efforts will be made to reach 33,384 of 1st visit ANC attendees with couple CT to identify discordant and concordant couples to improve primary prevention and facilitate linkage to HIV care and treatment for the eligible.

CU/ICAP will support integration of ART in MCH clinics, access to FP/RH services, and establish or strengthen infection control and waste management activities.

CU/ICAP will support hospital delivery through provision of delivery beds and sterile delivery packs, training, working with CHWs and TBAs to promote community- facility referral mechanism, health education, and community services providing skilled birth attendance.

CU/ICAP will support safe infant feeding practices as per national guidelines and support enrollment and follow up of 3,765 of babies born to HIV infected mothers to access CTX, ARV prophylaxis, and EID services using the HIV exposed infant register till 18 months. CU/ICAP will facilitate ART initiation for those who test positive before 2 years.

CU/ICAP will adopt efficient retention strategies for mothers and babies by supporting use of diaries and registers for tracking defaulters, having a structured mentorship and supervision plan, and enhancing data quality and streamlining M&E gaps. HCWs will be orientated on the new MOH ANC/maternity registers and data will be utilized at facility level for program improvement and quarterly progress reports to CDC.

Program quality and proficiency testing will be emphasized to validate PMTCT results.CU/ICAP will train 120 HCWs in FY12 and equal number in FY13 on PMTCT and provide orientation to the revised PMTCT and infant feeding guidelines. CU/ICAP will engage in community activities for demand creation for health services such as male involvement with couple CT services, referral and linkages.

Columbia Universitys International Centre for AIDS Care and Treatment Program (ICAP) will support treatment in Eastern Province. Eastern Province has an estimated population of 3 million people with an estimated adult HIV prevalence of 4.2% compared to the national 7.1%. Since 2007, ICAP has supported HIV treatment in 58 facilities and as of March 2011 SAPR, a cumulative 29,737 patients were started ART with 16,990 active.

In FY12, ICAP will jointly work with MoH to continue supporting expansion and provision of quality adult HIV treatment services in the southern region of Eastern Province as per MoH guidelines to 18,749 patients currently receiving ART and 1,417 new adults resulting to cumulative 22,499 adults who have ever been initiated on ART. In FY13, this number will increase to 19,813 currently receiving ART and 1,433 new adults resulting to 23,932 adults who have ever been initiated on ART.

ICAP in collaboration with MoH will support in-service training of 200 and 150 health care workers in FY 12 and FY 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.

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 peer education and support groups to provide adherence messaging and defaulter tracing and follow up will continue to be supported to improve retention in all sites.ICAP will adopt strategies to ensure access and provision of friendly HIV treatment services including supporting peer educators, support groups, disclosure, partner testing and family focused care and treatment.

ICAP will continue to support ongoing community activities and support for HIV infected individuals including peer education and use of support groups to strengthen adherence, effective and efficient retention strategies; referral and linkages to psychosocial support groups, economic empowerment projects, Home Based Care, and food and nutrition programs. ICAP will support provision of friendly services to youth and special populations.

ICAP will do cohort analysis and report retention as required by MoH and discuss the analysis results with facility staff in order to improve program performance. ICAP will adopt 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 support short term activities to increase impact and improve patient outcomes.

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 Universitys International Centre for AIDS Care and Treatment (CU/ICAP) will support Pediatric treatment in Eastern Province. Eastern Province has an estimated population of 4.3 million people with an estimated adult HIV prevalence of 3.6% compared to the national 7.1%. CU/ICAP will support pediatric treatment services in 58 facilities in southern Eastern Province in the next two years. As of March 2011 SAPR, CU/ICAP had enrolled 6,634 patients on ART with 3,975 active on treatment.

In FY12, CU/ICAP will jointly work with the Ministry of Health (MoH) at all levels to continue supporting, expanding and ensuring provision of quality pediatric HIV treatment services as per MoH guidelines to 2,139 pediatrics currently receiving ART and 428 new pediatrics for a cumulative 2,567 pediatrics ever initiated on ART. In FY 13, an additional 385 pediatrics will be initiated on ART, for a total 2,223 pediatrics currently receiving ART, and a cumulative 2,952 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; 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 hospital 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 150 and 100 HCWs in FY 12 and 13 respectively, 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, 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 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.