John Hopkins University supports pre-service training in mid level colleges in Kenya. The objective of the Pre-service HIV education program is to strengthen pre-service education with a focus on HIV/AIDS at all mid-level medical training colleges (MTCs) in Kenya. The ultimate goal of this project is to support the 53 public and private MTCs to ensure the graduating students from six classes of health professionals are competent to provide HIV/AIDS services without needing in-service training.

This program responds to the GHI principle of increasing impact through strategic efficiencies by using pre-service training to reduce in-service training needs. In turn, pre-service training strengthens health systems by supporting cadres of fully trained, new health care providers. The program is working with Academic Boards to make sure the HIV/AIDS teaching materials are integrated into their training programs. An effective and efficient pre-service program will significantly reduce in-service training needs thereby substantially reducing the cost to the programs. Activities under this program will include program evaluation and monitoring of the training programs. These assessments will measure whether students have attained the required competencies before they graduate.

The program is working closely with two local organizations: Kenya Medical Training College which runs 29 public MTCs, and Christian Health Association of Kenya . By building the capacity of these two institutions, the program is well suited to ensure the activities are continued long after the program ends.

The program has one vehicle purchased in 2010 and will require one more vehicle to effectively provide supportive supervision and other program activities.

This activity supports GHI/LLC.

The cervical cancer program uses a geographically targeted approach to reach the greatest number of HIV positive women and women at risk for HIV. There is now extensive evidence that infection with high-risk types of human papillomavirus (HPV) is a necessary precursor to cervical cancer. HPV infection is more common and more likely to persist in HIV-positive women, compared to HIV-negative women. Further, HIV-positive women have a high burden of precancerous lesions and cancer of the cervix, compared to women without HIV. Thus, in the context of HIV infection, cervical cancer can be considered an opportunistic process. The detection and treatment of precancerous lesions can prevent progression to cervical cancer. Given the age profile of cancer cases and considering the prolonged pre-cancerous stage, screening should focus on the highest risk of cohorts, which are women aged 30-49.In low resource settings, cervical cancer screening is optimally achieved in a single visit using visual inspection (VIA) and cryotherapy (treatment for pre-cancerous lesions) and can be carried out by trained physicians and non-physicians, including clinical officers and nurses. This funding will support a targetted cervical cancer program which will (1) ensure that all HIV treatment and PMTCT sites are able to conduct visual screening for cervical cancer (VIA); (2) ensure that cryotherapy for treatment of precancerous lesions is available in all District Hospitals in Nyanza, Nairobi, and Coast provinces (Level 4), the 3 Provincial Hospitals (Level 5) and in the 2 National Referral/Teaching Hospitals (Level 6); and (3) develop and implement a behavioral change communication campaign for cervical cancer targeting HIV-positive women at all entry points to care: including voluntary counseling and testing, comprehensive care centers (CCC), maternal newborn and child health (MNCH), PMTCT, and at the community level through community health workers (CHWs) and community health extension workers (CHEWs). Resources will not be used to procure commodities.

The Ministry of Public Health and Sanitation has recently launched a National Cancer Control Strategy for the period of 2011-16. This strategy outlines the importance of cancer screening and treatment, as well as the control of biological agents that cause cancer including HPV. The strategy also emphasizes the importance of prevention through vaccination, early detection, and treatment of these infections to reduce the risk cervical cancer. Despite this fact, cervical cancer screening coverage in Kenya for all women 18 to 69 years of age is only 3.2%. Additionally, accurate data on cervical cancer prevention and control is minimal even though screening services have been offered in some regions of Kenya for the last ten years.

John Hopkins University (JHPIEGO), which is a lead in a consortium of Danya, Kenya Medical Training College (KMTC), Christian Health Association of Kenya (CHAK), supports training of tutors, strengthening of the Nursing, Clinical Medicine, Oral Health/Dental, Pharmaceutical Technology, Laboratory Technology and Technicians, Public Health, Nutrition, Social Work and other health professions curricula among other Departments. JHPIEGO also supports targeted infrastructure support to improve quality of training and support critically needed supplies/equipment for laboratories and skills laboratories. The goal of this award is to support midlevel medical training colleges (MTCs) to produce graduates who are ready and competent to provide comprehensive HIV/AIDS services without needing in-service training. In addition, the program will support scholarships to support human resource for the MTCs and production of cadre specific HIV/AIDS materials.

JHPIEGO will continue to support strengthening pre-service and in-service training nationally with focus on pre-service HIV Education and Training in public and faith-based MTCs. The students will be trained in all areas of HIV management including HIV diagnosis, prevention, treatment, care and support using integrated curricula and innovative training methods that incorporate TB-HIV materials into the mainstream HIV management training, in line with existing National standards for TB/HIV integration activities. To date, the project has built capacity of 200 tutors from all the 53 MTCs in Kenya on effective teaching skills or student performance assessment or IT skills while 50 tutors who have been identified as master trainers have received training on updated HIV content. Tutors now have the capacity to effectively deliver HIV/AIDS trainings to students in MTCs.

JHPIEGO will support training Adult HIV treatment and all aspects of HIV diagnosis, prevention, treatment, care and support by developing curricula that incorporate materials developed and approved by the National AIDS and STD Control Program (NASCOP), KMTCT, and other MTCs as well as respective professional and regulatory bodies and provide trainings for health care workers in all MTCs including private MTCs and will incorporate components of post training follow up and quality assurance.

The trainings will use integrated, innovative and comprehensive curricula. For example the TB-HIV trainings will adopt and adapt the new NASCOP curriculum and Division of Leprosy, TB, and Lung Disease (DLTLD) guidelines/materials. The training will utilize expert patients to mount skills stations for skills training. The cadre specific materials being revised will ensure all relevant graduates have sufficient knowledge, attitude and skills to support TB-HIV services. Emphasis of the 3Is will be covered in the pre-service training programs. This activity links to other TB/HIV activities (HVTB) provided by comprehensive clinical services. Funds will support refresher training of faculty as well as well as basic laboratory microbiology capacity and link to the laboratory training in order to meet the increased needs of TB testing.

The child health training program will build knowledge and capacity of 6500 health workers in community case management of pneumonia, malaria and diarrheal diseases in the highest HIV prevalence areas of Western, Nyanza and Coast Provinces. The training curricula consist of community case management of uncomplicated pneumonia, diarrheal diseases, and malaria in areas with poor access to healthcare, and the ability to refer complicated cases to the facility level. Activities for the health workers include training targeted at increased diagnosis and management of pneumonia, diarrheal diseases, and malaria. These activities will be achieved through implementation and scale-up of the Integrated Management of Childhood illnesses (IMCI) and use of rapid diagnostic tests for HIV, malaria, and other diarrheal diseases. All of these activities are defined as Government of Kenya (GOK) priorities and are stipulated in the national health services strategic plan. The GOK and other partners will continue to support these activities either through the national or county governments in the event that PEPFAR funding is only provided for the initial implementation period.

The Government of Kenya has also developed a community health strategy that relies on community based health workers to reach mothers and their children within their households. Lifesaving interventions and messages will be scaled up to reach children living with HIV/AIDS and therefore enable prevention of opportunistic infections which will result in improvement of quality of life. Proposed activities include the development and deployment of eLearning materials and messages that can be deployed through a variety of different mobile technologies to include smartphones, SMS, DVD, and internet-based. The focus of these will concentrate mainly on promotion of prevention methods, healthy behaviors at household level including exclusive breastfeeding for children below 6 months, appropriate complementary feeding, dietary diversity targeting -9 to 24 months period, use of long-lasting insecticide-treated bed nets (LLINs), hand washing with soap, safe water storage and treatment and community-led total sanitation.

Since COP 2009, JHPIEGO, an affiliate of the Johns Hopkins University, has worked in partnership with KMTC, CHAK, Danya and NASCOP to strengthen pre-service HIV laboratory training at Kenya Medical Training College and other medical colleges. For the past two years, JHPIEGO has worked with the KMTC faculty to carry out a training needs assessment (TNA) at pre-service level, based on the national guidelines. Based on the TNA, JHPIEGO reviewed existing training curricula and methodologies, while establishing core competencies including HIV diagnosis, quality systems management, commodities management, leadership, biosafety, safe phlebotomy, basic laboratory equipment and step-wise improvement of laboratory quality systems. A product of this effort is a new a modular training curriculum on HIV/AIDS that will be implemented in the 10 diploma training colleges, including national polytechnics.

For the FY 2012, JHPIEGO will build on lessons learnt in 2011 to finalize the implementation of the revised curriculum at the diploma training colleges. This will entail training the faculty/academic members from the Medical Laboratory Sciences (MLS) Departments in Effective Teaching skills (ETS)/Clinical Teaching Skills (CTS) and Student Performance Assessment (SPA) programs. These programs are aimed at improving content delivery in the medical training colleges. In addition, JHPIEGO will partner with Safety Monitoring in International Laboratories (SMILE), a US based QA program specialized web based resources useful for monitoring and supplying lab quality systems such as monitoring results for EQA, preventive actions and web-based access to records and resources, to monitor and provide assistance technical to Kenya labs implementing accreditation. A budget of $300,000 is proposed for JHIEGO to deliver on the following specific activities:

Finalize and implement the revised curriculum at the 10 diploma training colleges as well as national polytechnicsImprove and standardize teaching in all the MLS departments of KMTC collegesTrain 30 faculty/academic members from the MLS Departments in Effective Teaching skills (ETS)/Clinical Teaching Skills (CTS) and Student Performance Assessment (SPA) programsThrough SMILE, assist 30 medical laboratories implementing accreditation with QA tools for monitoring laboratory improvements, EQA/IQA performance and mounting preventive actions

These activities will have strong linkages with the PEPFAR technical area on training and retention of laboratory professionals as it relates to sustaining pre-service training initiative and to ensure training adequately meets Kenyas needs.

The SI activities will strengthen current GOK monitoring, evaluation and surveillance for vital registration systems, routine health management information systems (HMIS) and country health and demographic surveillance systems. With this funding one epidemiologist, one statistician and one HIS advisor will be hired for GOK. This team will train 200 program managers, data managers, health records officers, HIS and M/E officers at the provinicial and county levels, and 90 community interviewers in monitoring, evaluation and use of surveillance tools, use of data, and methodolgies for impact evaluation. The initative will build the capacity of GOK to measure additional process and outcome indicators to evaluate the implementation, uptake and impact of comprehensive health activities in HIV, maternal and child health and non-communicable diseases; and will strengthen and develop additional targets for each of the focus areas using all the current GOK data collection and reporting tools. New tools will be developed for NCD reporting and impact evaluation. These efforts will contribute to the strengthening of the GOK district health information system (DHIS) through improved data quality and more timely reporting. In addition GOK will employ novel and sensitive technologies such as mHealth and train health workers/managers on use of mobile devices for data collection and real-time reporting. Population based health and demographic surveillance systems such as used by KEMRI and Moi University along with the community health information systems (CHIS) will be utilitzed to continuously evaluate morbidity and mortality impact. Finally funding will be for the development of protocols for outcome evaluation, including estimation techniques to measure potential deaths averted or lives saved. The community mortality reporting/death audits will also be used as a data source. Staff hired staff for these activites will be transitioned to GOK within 2 years of program implementation.

Goals and Objectives

John Hopkins University (JHU) will contribute to the prevention of medical transmission of HIV (and other blood borne pathogens) through sharps and other medical waste. It will do this by supporting training in infection prevention and control (IPC) and blood collection/phlebotomy training. Blood drawing has been recognized as a high risk procedure in the country that puts health workers at risk of acquiring HIV and other blood borne pathogens. CDC has worked in partnership with NASCOP and BD Company in a public-private partnership (PPP) to strengthen in-service phlebotomy training throughout the country. The next phase has been to establish a phlebotomy training center of excellence in Nairobi. This funding will scale up this activity to other regions.

Coverage and scope of activities

JHU will support setting up centers of excellence (CoE) for phlebotomy and other sample collection in 5 of its campuses that offer laboratory training in different counties. This will be done by renovating and equipping the current skills demonstration stations and installing the necessary ICT systems for possible e-learning. Dummies and other devices for practical lessons will be provided. All health workers who draw blood and other samples during their work will be expected to rotate in this center including laboratory staff, clinical officers and nurses. JHU will also support 100 in-service trainees to come for a two weeks specialized phlebotomy training in the Nairobi center. In addition JHU will lead the development of a specialized IPC training curriculum that will target those who wish to specialize in this area.

Integration into program

JHU will continue work started in the first year of ensuring integration of injection safety, waste management and infection prevention and control principles into all training curriculum. It will ensure that any HIV pre-service training course at KMTC advocates for IPC and timely access and uptake of post-exposure prophylaxis.

Country ownership and sustainability

By training staff at pre-service level JHU will ensure that they graduate when they are market-ready which will reduce the need for further in-service training. JHU will strengthen the capacity of KMTC which has a national presence spread across the country to offer the required training. Training skills of the tutors will be strengthened and necessary technology as well as infrastructure updated to current international standards. The CoE in phlebotomy will be set up in a flexible way so that other trainings can also be rolled out in the future in the same settings.

Partnerships and collaboration

JHU will work closely with CDC and BD through the existing public private partnerships (PPP) to support this activity. It will also work closely with any other partner that will lead to strengthening of KMTC training capacity.

Quality improvement and M&E

Quality assurance and improvements will be a key component of this program. JHU will ensure this by rolling out a strong monitoring and evaluation system with indicators for tracking along the lifespan of the project.

Commodity security

The training in safe phlebotomy and blood collection will have a component on commodity and logistics management. This will ensure that even as health workers join the working field they have the capacity to ensure appropriate forecasting, procurement and usage of various blood drawing devices.

John Hopkins University (JHPIEGO), is a lead in a consortium of Danya, Kenya Medical Training College (KMTC), Christian Health Association of Kenya (CHAK). The consortium supports training of tutors, strengthening of the Nursing, Clinical Medicine, Oral Health/Dental, Pharmaceutical Technology, Laboratory Technology and Technicians, Public Health, Nutrition, Social Work and other health professions curricula; targeted infrastructure support to improve quality of training.

In line with the PEPFAR goal of capacity building, the goal of the award is to support midlevel medical training colleges (MTCs) to produce graduates who are ready and competent to provide comprehensive HIV/AIDS services without needing in-service training. In addition, the program will support scholarships to support human resource development for the MTCs and production of cadre specific HIV/AIDS materials.

The project had some delay in startup, however to date, the project has built capacity of 200 tutors from all the 53 MTCs in Kenya on effective teaching skills or student performance assessment or IT skills while 50 tutors who have been identified as master trainers have received training on updated HIV content. Tutors now have the capacity to effectively deliver HIV/AIDS trainings to students in MTCs.

JHPIEGO will continue to support strengthening pre-service and in-service training nationally with focus on pre-service HIV Education and Training in public and faith-based MTCs. The students will be trained across the broad range of HIV management including HIV diagnosis, prevention, treatment, care and support using integrated curricula and innovative training methods that incorporate the national HTC curriculum and guidelines. HTC training will cover all the key technical and operational components articulated in the national HTC guidelines (2007) namely testing approaches that is Client Initiated HTC (CITC) and Provider Initiated HTC (PITC); testing in facility and community settings; the key role of HTC in HIV Prevention and how to optimize this for maximum HIV prevention in the population; Couple HTC; Quality Assurance in HTC and issues surrounding testing of children and minors. The training will also focus on innovative approaches to strengthen linkage between HTC services and HIV Care and Treatment services for the HIV infected individuals.

JHPIEGO will continue to work with USG agencies in collaboration with MOH and regulatory and accrediting bodies and professional associations to address pre-service training. Strengthening of pre-service education with directly respond to government approach of reducing in-service training in Kenya thereby reducing service interruptions. JHPIEGO will contribute 3,300( 400 in FY 12 and 13) new healthcare workers graduating competent to provide HIV/AIDS services in the next two years, thus contributing 2.4% of the PEPFAR II goal of 140,000 new pre-service graduates by 2014 and will support KNASP strategies and build the capacity of health care providers to provide quality HIV/AIDS services.

John Hopkins University (JHPIEGO), which is a lead in a consortium of Danya, Kenya Medical Training College (KMTC), Christian Health Association of Kenya (CHAK), supports training of tutors, strengthening of the Nursing, Clinical Medicine, Oral Health/Dental, Pharmaceutical Technology, Laboratory Technology and Technicians, Public Health, Nutrition, Social Work and other health professions curricula; targeted infrastructure support to improve quality of training; and critically needed supplies/equipment for laboratories and skills laboratories.

The goal of this award is to support midlevel medical training colleges (MTCs) to produce graduates who are ready and competent to provide comprehensive HIV/AIDS services without needing in-service training. In addition, the program will support scholarships to support human resource for the MTCs and production of cadre specific HIV/AIDS materials.

To date, the project has built capacity of 200 tutors from all the 53 MTCs in Kenya on effective teaching skills or student performance assessment or IT skills while 50 tutors who have been identified as master trainers have received training on updated HIV content. Tutors now have the capacity to effectively deliver HIV/AIDS trainings to students in MTCs. One key challenge was delay in start up of activities due to funding restrictions on the TNA, which was later lifted after necessary clarifications. Other challenges included unwillingness by institutions to embrace curriculum review especially as some departments had just concluded their curriculum review and staff shortages in the institutions making it difficult to withdraw some staff for capacity building or for important meetings.

JHPIEGO will continue to support strengthening pre-service and in-service training nationally with focus on pre-service HIV Education and Training in public and faith-based MTCs. The students will be trained in all areas of HIV management including HIV diagnosis, prevention, treatment, care and support using integrated curricula and innovative training methods that incorporate the PMTCT curriculum and guidelines. PMTCT training will focus on all the four prongs: primary prevention of HIV; prevention of unwanted pregnancy among HIV positive women; interruption of MTCT among HIV positive pregnant women; and treatment, care and support of HIV positive women and their partners, children and other members of their families. PMTCT training will be comprehensive with emphasis on elimination of MTCT and integration of PMTCT in other services. Infant and young child feeding will also be included. Linkages to pediatric and adult HIV treatment will be emphasized.

JHPIEGO will continue to work with USG agencies in collaboration with MOH and regulatory and accrediting bodies and professional associations to address pre-service training. Strengthening of pre-service education with directly respond to government approach of reducing in-service training in Kenya thereby reducing service interruptions. JHPIEGO will contribute 3,300( 400 in FY 12 and 13) new healthcare workers graduating competent to provide HIV/AIDS services in the next two years, thus contributing 2.4% of the PEPFAR II goal of 140,000 new pre-service graduates by 2014 and will support KNASP strategies and build the capacity of health care providers to provide quality HIV/AIDS services.

John Hopkins University (JHPIEGO) which is a lead in a consortium of Danya, Kenya Medical Training College (KMTC), and Christian Health Association of Kenya (CHAK) supports training of tutors, strengthening of the Nursing, Clinical Medicine, Oral Health/Dental, Pharmaceutical Technology, Laboratory Technology and Technicians, Public Health, Nutrition, Social Work and other health professions curricula among other Departments; targeted infrastructure support to improve quality of training; and support critically needed supplies/equipment for laboratories and skills laboratories. In addition, the program will support scholarships to support human resource for the MTCs and production of cadre specific HIV/AIDS materials.

As of SAPR 2011, JHPIEGO had supported capacity building of 200 tutors from the 53 Medical Training Colleges (MTCs) in Kenya on effective teaching skills or student performance assessment or IT skills while 50 tutors who have been identified as master trainers have received training on updated HIV content. Tutors now have the capacity to effectively deliver HIV/AIDS trainings to students in MTCs.

A total of 500 HCWs will graduate from pre-service training in FY12 and 400 in FY13; 150 HCWs will be provided with in-service training in FY12 and 100 in FY13. JHPIEGO will support training on Adult HIV treatment and all aspects of HIV diagnosis, prevention, treatment, care and support by integrating and design and develop curricula that incorporate materials developed and approved by the National AIDS and STD Control Program (NASCOP) and regulatory bodies. JHPIEGO will provide trainings for health care workers in all MTCs including private MTCs and will incorporate components of quality assurance and post training follow up. The trainings will use integrated, innovative and comprehensive curricula. For example, the adult antiretroviral treatment (ART) trainings will adapt the new NASCOP curriculum on Integrated Management of Adolescent and Adult Illness (IMAI). The program will also use electronic learning platforms to deliver updated adult treatment materials. Specific materials to enhance skills of pharmaceutical students have been included. Linkages to pediatric and adult HIV treatment will be emphasized.

Activities will also include classroom and practical training of health care workers in antiretroviral (ARV) drug management as part of training on comprehensive care of people with HIV/AIDS. In collaboration with other partners, JHPIEGO will incorporate components of post training follow up and quality assurance. Faculty will also receive continuing medical education (CME) as well as accessing updated materials from resource centres the program will be supporting. JHPIEGO will also assist and collaborate with University of Maryland to support in-service and pre-service university HIV training and build their capacity to design, develop, and deliver quality training and mentorship as well as evaluate and monitor the training and its impact.

John Hopkins University (JHPIEGO) which is a lead in a consortium of Danya, Kenya Medical Training College (KMTC), and Christian Health Association of Kenya (CHAK) supports training of tutors, strengthening of the Nursing, Clinical Medicine, Oral Health/Dental, Pharmaceutical Technology, Laboratory Technology and Technicians, Public Health, Nutrition, Social Work and other health professions curricula among other Departments; targeted infrastructure support to improve quality of training; and support critically needed supplies/equipment for laboratories and skills laboratories. In addition, the program will support scholarships to support human resource for the MTCs and production of cadre specific HIV/AIDS materials.

As of SAPR 2011, JHPIEGO had supported capacity building of 200 tutors from the 53 Medical Training Colleges (MTCs) in Kenya on effective teaching skills or student performance assessment or IT skills while 50 tutors who have been identified as master trainers have received training on updated HIV content. Tutors now have the capacity to effectively deliver HIV/AIDS trainings to students in MTCs.

A total of 500 HCWs will graduate from pre-service training in FY12 and 400 in FY13; 150 HCWs will be provided with in-service training in FY12 and 100 in FY13. JHPIEGO will support training in Pediatric HIV treatment and all aspects of HIV diagnosis including early infant diagnosis, prevention, treatment, care and support in infants, young children and older children by integrating and design and develop curricula that incorporate materials developed and approved by the National AIDS and STD Control Program (NASCOP) and respective professional and regulatory bodies and will incorporate components of quality assurance and post training follow up. Pediatric antiretroviral treatment (ART) trainings will adopt and adapt the curriculum on Integrated Management of Childhood Illness (IMCI) and Comprehensive HIV care and treatment in Pediatrics. These activities will include classroom and practical training of health care workers in antiretroviral (ARV) drug management as part of training on comprehensive care of people with HIV/AIDS. Faculty will also receive continuing medical education (CME) as well as accessing updated materials from resource centers the program will be supporting. JHPIEGO will also assist and collaborate with University of Maryland to support training in in-service and pre-service university HIV training and build their capacity to design, develop, and deliver quality training and mentorship and evaluate and monitor the training and its impact.