HWWK is implementing HIV Prevention activities in peri-urban and informal settlement areas in the Eastern part of Nairobi County with the goal of contributing to reduction in incidence of HIV infections in this county with a prevalence of 8.8%.The objectives are to contribute to HIV prevention through implementation of combination evidence informed behavioral, structural and biomedical interventions, increase access to quality comprehensive HIV prevention services for the youth and general population, increase access to confidential HIV testing and counseling services in line with the KNASP III. HWWK also contributes to prevention of HIV transmission through provision of safe blood in Kenya.This is achieved through mobilization and recruitment of safer blood donors while incorporating HIV prevention and healthy life styles contributing to GHI goals of reducing maternal, infant and malaria related mortality.HWWK works in collaboration with the government in the planning of services to ensure these are harmonized with country plans. Involvement and capacity building of local community based organizations and community members key strategies used to ensure activities are supported by recipients. Services are provided within the comprehensive HIV framework for greater HIV prevention impact. In the Blood Safety program, the project will give a comprehensive package of services and will leverage HIV prevention programs to develop a pool of safe regular blood donors.This is a Kenyan partner with country ownership * leadership. This activity will support GHI/LLC.Partner procured 3 vehicles in FY05, FY06 and FY08 to coordinate mobile HTC services - no vehicles for FY12.Target pop, geographic coverage, & M&E info are included in the budget code narritives.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? No

HWWK will contribute to the prevention of HIV transmission by providing AB HIV prevention and other evidence based interventions to potential blood donors while mobilizing for safe blood supply in the country. It will work within the Kenya National Blood Transfusion Service (KNBTS) policy and the blood donor mobilization strategy and in line with approaches that will be guided by the National Blood Donor Services sub-committee of the KNBTS Advisory Committee. HWWK will work closely with the Nairobi Regional Blood Transfusion center and the Machakos center to ensure they achieve the set blood donation targets in the region.

This partner will work comprehensively within the target population to ensure maximum reach of potential blood donors. It will train a pool of mobilizes that will reach all market segments of blood donors including the youth in schools and out-of-school; colleges and universities; the working and those in faith based or community based groups. Those reached will be given HIV prevention messaging; healthy lifestyles including nutrition and donor education on all aspects of blood donation. Additionally HWWK will support establishment of blood donor clubs among the youth such as Pledge-25 as well as among the adult population. It will also support donor counseling and in collaboration with NBTS help in donor results notification and referral of those needing care and treatment. It will create a culture of regular blood donation among those found to be safe and free of transfusion transmissible infections.Integration with other activities

HIV AB and other prevention messaging will be integrated in the blood donor mobilization activities. Those seeking only to know their status will be referred to the HCT program; conversely those people found to be HIV negative and are eligible to donate will be informed of blood donation activities and encouraged to become regular blood donors. Those found to be HIV positive from the blood donation program will be referred for care and treatment. They will be encouraged to disclose and engage in partner referral or Prevention-with-the-positives interventions.

Coverage and scope:The activities will cover all potential blood donors from 16 years to 65 years in line with KNBTS policy guidelines. The partner will cross-cut all blood donor market segment but will primarily target safer donors (avoiding populations perceived to be most-at-risk). The geographical coverage for this activity will be the Nairobi region by KNBTS definitions which includes the following counties: Nairobi City, Kimbu, Kajiado, Machakos, Makueni and Kitui. Through this grant HWWK will mobilize 40,000 units of blood in collaboration with Nairobi and Machakos RBTC while reaching at least 100,000 people with HIV prevention and healthy lifestyles messages.

Country ownership and Sustainability:The program is mainly led by local staff and will be working to enhance the work of KNBTS which is a local MOH organization led by Kenyans. The partner will train community people to work as mobilizes even beyond the time of the project. Secondly it will promote formation of blood donor clubs that will out-live the life of the project. Lastly once the culture of regular blood donation is inculcated people will continue to donate even in the absence of the partner.

Hope World Wide supports implementation of comprehensive HIV prevention services targeting the youth and general population in the Eastern region of Nairobi County. In FY 2012, the mechanism will continue to expand access to high quality combination evidence informed behavioral interventions (EBIs) for the following priority populations: youth 10-14 (7,459) and youth 15-19 years ( 9,005) who are at risk of early sexual debut and increased risk of HIV acquisition, males 30-44 (3,042) who engage in concurrent and unprotected sexual partnerships and finally the Discordant couples(1,847) and People living with HIV/AIDS ( 3,189) where there is increased risk of HIV transmission. The EBIs will be implemented in Embakasi, Makadara , Njiru and Districts. All EBIs are linked to other HIV services such as HIV testing and counseling, provision of condoms, care and treatment and community care and support services.

Healthy Choices I and II (HCII) targets both in and out of school youth 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 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.

FMP is an EBI delivered to parents in 5 weekly sessions and promotes positive parenting practices that contribute to effective parent-child communication on sexual related topics. The goal is to reduce sexual risk behavior among adolescents by training parents to deliver primary prevention messages to their children.Prevention with Positives is an ongoing 5-10min group and individual level intervention that targets HIV infected persons in clinical and community settings, focusing on partner testing, risk reduction, condom use, disclosure, adherence, STI reduction and family planning.

RESPECT will be implemented along with HTC and provision of condoms for males and females ages 20 24, males ages 30 -44, and persons with STIs. Respect 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.

Eban is a couple and group level intervention targeting sero-discordant couples. Its 8 weekly 2 hour sessions for 3-5 couples focusing on talker-listener technique, risk assessment, enhancing couple communication and shared health responsibility.

To ensure quality, the program adheres to national standards and guidance from the National Technical Working Group on EBIs. These include use of approved national curricula; maintaining fidelity to the respective curricula and use of trained and certified facilitators. Further, trainings on EBIs are conducted by certified national trainers and there is observed practice of implementation done soon after training. The program uses standardized, national data tools at every stage of EBI implementation and regular field visits by trained program staff are conducted to check on delivery of EBIs and offer support supervision.

Monitoring and evaluation will be conducted with EBI approved data capture / monitoring tools. Mechanism has a data monitoring plan for tracking program performance.

Target population: HWWK works in the eastern region of Nairobi county in the urban and peri-urban areas supporting implementation of combination HIV prevention services targeting the youth in school and out of school, as well as the general population. Nairobi has an HIV prevalence of 8.8% with a testing coverage of 75.6% among women and 59.9% for men. HWWK will continue to provide HTC services with a focus on reaching individuals who have never ever been tested and those at increased risk of HIV acquisition particularly the HIV discordant couples. The program will target: youth out of school as part of the combination HIV prevention services and the general population with a focus on couples.HTC approaches: Services will be provided through the client initiated as well as provider initiated approaches to reach the specific target groups within the community. These will be provided in various settings such as mobile or outreach HTC, stand alone VCT and Home-based HTC via index client or door to door HTC.

Targets and achievements: During 2010 COP, HWWK provided HTC services to 41,110 individuals out of a target of 40,000. During this period, the program reached 21% first time testers and 9% couples. In FY 2012, HWWK will provide HTC services to 40,000 individuals with a target of 60% new testers and 55% men. The program will also target to reach 30% couples.

Testing algorithm: National HIV testing algorithm used.

Referrals and linkages: The referral mechanism in place ensures newly diagnosed HIV positive clients are linked to the GoK and other PEPFAR supported HIV care and treatment sites for the continuum of HIV prevention, care and treatment services. The program uses the NASCOP referral tool, and in collaboration with HIV care and treatment sites reviews data periodically to determine the success rate in the referral and linkage strategies. HIV infected clients are enrolled into the Positive Health Dignity and Prevention program which enhances follow up through the community structures. Using this strategy, the program is able to track individuals who have not accessed services referred to, and is also tracks success of linkage to other care and treatment programs.

Quality management: To ensure quality in testing and counseling, national standards in training, certification and supervision of HTC providers is enforced. Program uses nationally approved and recommended HIV rapid test kits and algorithm. HTC providers receive regular updates and participate in proficiency testing in line with the national QA strategy.

Monitoring and evaluation: All HTC service delivery points use the national HTC lab register to capture data that includes individuals and couples tested. Data is further disaggregated in line with the PEPFAR indicators and analyzed by the program on a regular basis to determine progress and achievement. Rapid data quality assessment is undertaken periodically to ensure data quality.

Promotional activities: Mass media campaigns and targeted community mobilization strategies are used for demand creation. The community mobilization strategy utilizes peer educators who interact with community members and educate them on the importance of accessing HIV testing as an entry point to HIV prevention, care and treatment programs. Education on the importance of knowing ones and sexual partners HIV status is emphasized in order to reach couples and individuals who have never been tested.

Hope World Wide supports implementation of comprehensive HIV prevention services targeting the youth and general population in the Eastern region of Nairobi County. In FY 2012, the mechanism will continue to expand access to high quality combination evidence informed behavioral interventions (EBIs) for the following priority populations: youth 15-19 years ( 9,005) who are at risk of early sexual debut or may be involved in unprotected sex and so are at increased risk of HIV acquisition, males 20-24 ( 6,390) and females 20-24 (21,436) who are at increased risk of HIV acquisition related to a number of factors such as low self perception of HIV risk, low condom use and lack of negotiation skills for condom use especially among the females. Males 30-44 (3,042) who engage in concurrent and unprotected sexual partnerships and finally the Discordant couples(1,847) and People living with HIV/AIDS ( 3,189) where there is increased risk of HIV transmission will also be targeted. The EBIs will be implemented in Embakasi, Makadara , Njiru and Districts. All EBIs are linked to other HIV services such as HIV testing and counseling, provision of condoms, care and treatment and community care and support services.

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.

Prevention with Positives is an ongoing 5-10min group and individual level intervention that targets HIV infected persons in clinical and community settings, focusing on partner testing, risk reduction, condom use, disclosure, adherence, STI reduction and family planning.

RESPECT will be implemented along with HTC and provision of condoms for males and females ages 20 24, males ages 30 -44, and persons with STIs. Respect 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.

Eban is a couple and group level intervention targeting sero-discordant couples. Its 8 weekly 2 hour sessions for 3-5 couples focusing on talker-listener technique, risk assessment, enhancing couple communication and shared health responsibility.

To ensure quality, the program adheres to national standards and guidance from the National Technical Working Group on EBIs. These include use of approved national curricula; maintaining fidelity to the respective curricula and use of trained and certified facilitators. Further, trainings on EBIs are conducted by certified national trainers and there is observed practice of implementation done soon after training. The program uses of standardized, national data tools at every stage of EBI implementation and regular field visits by trained program staff is conducted to check on delivery of EBIs and offer support supervision.

Monitoring and evaluation will be conducted with EBI approved data capture / monitoring tools. Mechanism has a data monitoring plan for tracking program performance.