Kenya Episcopal Conference (KEC) has a new award to implement HIV prevention, care and treatment activities in Faith based organization (FBO) facilities previously supported by the CRS Track 1 mechanism. KECs goal is to reduce HIV related morbidity and mortality through provision of high quality, sustainable HIV prevention, care and treatment services. KECs goal and objectives are linked to Kenyas Partnership Framework (PF) and Global Health Initiative (GHI) strategies and are aligned to PF pillars 1-3: prevention, care and mitigation, treatment, and systems strengthening. Strategies to reduce maternal and child mortality and eliminate MTCT include supporting integration of MTCT within MCH. M&E plans will align with PEPFAR and country PF. Training on and use of MOH HMIS systems will be supported to eliminate parallel M&E. Cost efficiency will be addressed through integration of services, reduction of the technical teams by increased capacity building of the FBO staff, use of existing evidence-based strategies, task shifting, relying on facility-based training and mentorship rather than offsite training, evaluating cost effective strategies for defaulter management, laboratory networking, and mobilization.KEC will work with FBO facilities and MOH to build a country owned program. Emphasis will be placed on data demand and use to inform decision making thereby increasing site ownership of data. Quarterly dashboard reviews will be conducted to monitor the programs quality and related resource expenditure. KEC will support health facilities to integrate the HIV/AIDS program into health systems of the facility for ownership and sustainability purposes. KEC will purchase 2 vehicles with COP 12 funds to support supervision. This activity supports GHI/LLC.

Kenya Episcopal Conference (KEC) was awarded a new CDC grant in Oct 2011 to support comprehensive HIV care and support in previously CRS-HRSA supported sites in Nyanza Province.KEC will work with the Ministry of Health (MoH) at the provincial, district and health facility level, to jointly plan, coordinate, implement and ensure provision of quality HIV care and support to 15,634 current adult patients in FY12 and 19,800 current patients in FY13 in public, faith based and high volume private health facilities within agreed limits of rationalization and towards universal access to care and support services.KEC will offer a package of services including HIV testing to partners and the 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, chlorine for water treatment and educational materials); supplemental and therapeutic nutrition (FBP) to all eligible HIV positive patients; prevention with positives(PwP); and cervical cancer screening to all enrolled women.KEC, in collaboration with MoH, will support targeted capacity building (training of 150 health care workers in FY12 and 100 in FY13, and mentorship) and additionally offer continuous medical education on care and support, e.g. OI diagnosis and treatment. KEC will identify areas with staff shortages and support recruitment of additional staff as well as support good commodities management practices to ensure uninterrupted supply of commodities.KEC will continue to support ongoing psychosocial and community activities including peer education; referral and linkages to community based psychosocial support groups to strengthen adherence; effective and efficient retention strategies of patients on follow up; water, sanitation and hygiene programs; income generating activities; Home Based Care; vocational training; social and legal protection; and food and nutrition programs.KEC 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.KEC will continue to strengthen data collection and reporting at all levels to improve reporting to NASCOP and PEPFAR. KEC will adopt the new generation indicators and support the development and use of electronic medical records system in accordance with NASCOP guidelines. KEC will continue using the quality of care indicators (CQI) for monitoring the quality of HIV care and support services, integrate them into routinely collected data, and use the results to evaluate and improve clinical outcomes. KEC will do cohort analysis and report retention rates as required by the NASCOP.KEC will support joint Annual Operation Plan (AOP) development, implementation, monitoring and evaluation and health system strengthening to facilitate sustainability.

Kenya Episcopal Conference (KEC) was awarded a new grant to support TB/HIV activities in seven facilities previously supported by the CRS-HRSA grant in Nyanza Province. KEC will provide TB/HIV services in line with the Ministry of Healths Division of Leprosy, Tuberculosis and Lung Disease (DLTLD) and the National AIDS and STI Control Program (NASCOP). KEC will align and adhere to the Kenyas 5-Year National AIDS and TB Strategic Plans shared objectives to ensure co-infected TB patients and suspects receive quality and comprehensive care and that the threat of drug resistant TB is contained. KEC will support training and hiring of additional staff, procurement of simple laboratory TB diagnostics, and minor renovations of TB Clinics to ensure better infection control practices. KEC will use the existing national TB and HIV M&E framework and tools to report on TB/HIV Indicators.In FY12 and FY13, KEC will continue to intensify efforts to detect TB cases through clinical exams, laboratory investigations and ensure successful TB treatment through provision of appropriate treatment. KEC will ensure that facility staffs are adequate and well trained and that laboratories well equipped to support optimal TB diagnosis. Laboratory support will include sputum specimen transport where laboratory services are unavailable. KEC 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. KEC will ensure that all TB patients are screened for HIV and 95% of 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. KEC 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, and TB staff trained as needed.

To reduce the burden of TB in HIV infected patients, 13,896 and 17,600 HIV infected patients will be screened for TB in HIV care settings in FY12 and in FY13 respectively; 694 co-infected patients identified in FY12 and 880 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.KEC will ensure that the national IC guidelines are available and staff are trained (100 staff trained in FY12 and 80 in FY13) at all sites. KEC will support scaling up of at least 2 components of the national TB infection control strategy in HIV care settings, one of which should be fast tracking of patients with cough for expedited diagnostic work up and treatment. KEC 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 the results to those facilities. KEC will expand prevention with positive (PwP) services in TB clinics, strengthen linkages between facility and community-based services, improve patient referrals and tracking systems and increasing support for TB-HIV operations research. KEC will support reporting of custom indicators to assist with program management and evaluation and monitoring of new activities.

Kenya Episcopal Conference (KEC) has just received a new CDC award starting Oct 2011. KEC will implement comprehensive, integrated pediatric care services to children in Nyanza Province in seven facilities that were previously supported by CRS-HRSA Track 1 activities.In FY 12, KEC will provide care and support services to 1,674 children currently on care. The number of children currently on care will increase to 2,106 during FY 13. KEC will provide comprehensive, integrated quality services, and scale up to ensure 335 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 ensuring those identified HIV infected are linked to care and ART services.KEC 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 and treatment; 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, 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.KEC 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.KEC will support hospital and community activities to meet the needs of HIV infected adolescents: 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 as well as relevant trainings will continue to be supported (training of 150 health care workers in FY12 and 100 in FY13). KEC will strengthen pediatric data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR and cohort analysis to inform programming.

Target population: KEC will support HIV testing and counseling services in several mission/faith-based health facilities in following counties: Migori, Homabay, Kisumu, Siaya, Bungoma, Kakamega, Kiambu, Kirinyaga, Nyeri, Nyandarua, Kitui, Embu, Tharaka-Nithi, Meru, and Taita-taveta. Target population will include all patients, their family members and caretakers who access out and in patient services in all the supported facilities.HTC Approaches: The program will utilize provider initiated opt out approach and the services are offered within all out patient departments, TB clinics, FP, ANCs, special clinics, HIV clinics (targeting family members) and in patient departments. The counseling and testing is either done within the consultation rooms by trained clinicians or in counseling rooms by lay counselors within the outpatient departments if space is available or at the laboratories.Targets and achievements: In COP 2012, CHAK will target to provide HTC services to a total of 30,000 persons of which 20% will be tested as couples and 10% will be children below the age of 15.Testing algorithm: National algorithm is being used.Referrals and linkages: In order to strengthen referrals, KEC will put in place several important strategies. They include: use of peer educators as patient escorts from one hospital department to the CC; same day enrollment of clients to CCC; use of an integrated defaulter tracing system for tracing patients who default on care or ART upon enrollment; introduction of documented referral system by use of the NASCOP referral booklet; use of mobile phones to follow up whether the client was actually enrolled.Quality management: In order to improve and monitor quality of HTC services, KEC will put in place the following strategies: Training and continuing education of HTC providers; strict adherence to the standard operating procedures outlined in the national HTC guidelines; management of HIV rapid kits as per the guidelines; putting in place a functional QA systems as provided for in the national HTC guidelines; participation in EQA- proficiency testing and finally conducting support supervisory visits.

Monitoring and evaluation: KEC will use all ministry of health tools to capture HTC data, both for couples and individual patients. These include HTC lab Register and Monthly summary tool (MOH 711). MOH approved HTC lab registers will be introduced at all HIV testing points except PMTCT.

Promotional activities for HTC: All patients attending the supported facilities will be given health talks including the need for HIV counseling and testing and the importance of couple testing. Couples are given priority services. Sexual partners of HIV positive clients will be given individualized invitations though the index clients and available avenues for testing including individualized home testing.

KEC implements comprehensive prevention, care and treatment programs in Nyanza province. In FY 2012/13, KEC 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.KEC 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. Nyanza province has the hisghest HIV Prevalence (14.9%). KEC will reach 8827 (60%) PLHIV in FY2012 and 13034 (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.KEC 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 KEC 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)

KEC will implement comprehensive PMTCT services to pregnant mothers in Nyanza region is seven facilities that were previously supported by CRS-HRSA. KEC will strengthen PMTCT services in the 7 main facilities and satellites by integrating ART into the MCH clinics. In FY12, KEC will offer HIV counseling and testing to 2,095 pregnant women at the ANC and give ARV prophylaxis to 320 HIV infected pregnant women.KEC will support the 4 prongs of PMTCT: primary prevention, referral and linkages for family planning, provide ARV prophylaxis to all HIV positive pregnant mothers and exposed infants, and care and treatment to eligible HIV positive mothers, partners and children. The HIV infected women will receive clinical evaluation including WHO staging and CD4 testing. KEC will give HAART to all eligible HIV positive pregnant women in line with the revised PMTCT national guidelines. In FY13, KEC will increase the number of pregnant women counseled to 2,200 offer ARV prophylaxis to 389 pregnant women and 335 infants, and do EID for 335 infants. Effective retention strategies for mothers and babies through care will be supported through use of appointment diaries, and use of registers for tracking defaulters. Efforts will be made to reduce the cost of service provision to < $18 dollar per woman by leveraging on other activities like malaria prevention in line with GHI principles.KEC will work to improve ANC attendance and hospital deliveries by working with existing community programs to increase demand for skilled delivery and promote community- facility referral. Maternity services will be strengthened by supporting provision of basic equipment at the hospitals. To optimize PMTCT uptake, male involvement and couple counseling and testing will be prioritized to strengthen Prevention with Positives. Scale up of uptake of RH services including FP referral and linkages in MCH will be supported. PITC will be promoted including counseling and testing of mothers at the well baby and post natal clinics which will identify HIV exposed infants.KEC will work with the Ministry of Health at all levels to jointly plan, coordinate and implement comprehensive PMTCT services, in line with the Kenya National Strategic Plan III, the GOK and USG Partnership Framework, and the district and provincial annual operation plans.

Areas of staff shortages will be identified and recruitment of additional staff will be supported. KEC will build the capacity of 30 health care workers in FY12 and equal number in FY 13 by supporting trainings on the revised PMTCT guidelines, early infant diagnosis and safe infant and young child feeding; a structured mentorship and supervision plan to support facilities.Data collection and reporting will be strengthened by orientation of health care workers on the revised data tools and facilities will be encouraged to use their own data for program improvement.

Kenya Episcopal Council (KEC) will support treatment services in 7 faith based facilities in Nyanza which are currently supported by CRS Track 1 mechanism. As of 2011 SAPR, a cumulative 9,118 adults were ever initiated on ART and 6,158 were active.In FY12, KEC will jointly work with the Ministry of Health (MoH) to continue supporting expansion and provision of quality adult HIV treatment services in line with MoH guidelines to 12,360 adults currently receiving ART and 1,734 new adults, resulting to cumulative 14,832 adults who have ever been initiated on ART. In FY13, this number will increase to 13,663 currently receiving ART and 1,784 new adults, resulting to 16,616 adults who have ever been initiated on ART.KEC, in collaboration with MoH, will support in-service training of 100 and 80 health care workers in FY12 and FY13 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.KEC will support provision of comprehensive package of services to all PLHIV including ART initiation for those eligible; laboratory monitoring including biannual CD4 testing, 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.KEC will continue to support ongoing psychosocial and community activities including peer education; referral and linkages to community based psychosocial support groups to strengthen adherence; effective and efficient retention strategies of patients on follow up; water, sanitation and hygiene programs; income generating activities; Home Based Care; vocational training; social and legal protection; and food and nutrition programs. KEMRI will adopt strategies such as family focused care and treatment to ensure access to friendly services to youth, elderly and physically or mentally challenged populations.KEC will adapt the quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV treatment services and integrate them into routinely collected data; use the results to evaluate and improve clinical outcomes; and additionally support short term activities with great impact and better patient outcomes. Additionally, KEC will do cohort analysis and report retention rates as required by the national program and discuss the analysis results with facility staff in order to improve program performance. KEC 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.

Kenya Episcopal Council (KEC) will support HIV pediatric treatment services in seven sites previously supported by CRS-HRSA in Nyanza province. As of March 2011 SAPR results, these sites had a cumulative 1,170 pediatrics on ART of whom 737 were active.In FY12, KEC 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 1,805 pediatrics currently receiving ART and 361 new pediatrics resulting to cumulative 2,166 pediatrics ever initiated on ART. In FY 13, this number will increase to 1,952 pediatrics currently receiving ART and new 324 resulting to cumulative 2,490 pediatrics ever initiated on ART.KEC 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 of EID as per MoH guidelines; provision of 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. Linkage of ART services to pediatric care services, PMTCT, TB/HIV, community programs, and other related pediatric services will additionally be optimized.KEC will support hospital and community activities to meet 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.KEC will support in-service training of 100 and 80 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.KEC will continue to strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. Additionally, KEC will review data and evaluate programs to inform programming and decision making. Use of an electronic medical records system will be supported and strengthened. KEC will strengthen local capacity as part of the transition plan to MOH for sustainable long-term HIV patient management in Kenya.