Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)-PAMOJA project works in 11 districts of Nyanza Province to support implementation of high quality, comprehensive HIV prevention, care and treatment services. Aligned with the Kenya GHI principles, POMOJA supports decentralization of HIV services by integrating these services into existing clinics including maternal and child health and TB clinics. PAMOJA will strengthen the health systems by building the capacity of healthcare workers (HCW) through training, hiring additional staff in facilities with shortages and supporting facility renovations. Integrated quality management and mentorship teams will be supported to ensure that skills are transferred to MOH staff for continuity and sustainability.

PAMOJA will support strategies to address cost efficiencies including: assessments to inform targeted assistance based on prioritized needs, co-location of project staff within the district teams, joint planning with the districts to ensure work plans are harmonized, and use of cost effective training methodologies such as on job trainings and mentorship.

PAMOJA will build the capacity of Provincial and District Health Management Teams in planning, mentorship, and supervision by supporting their training in general management, human resource management, and monitoring and evaluation. Improved leadership and management skills by these teams will encourage ownership and allow project efforts to transition over time to the government.

To optimize the projects geographic coverage a third project vehicle will be procured with FY2012 funds. Two vehicles were purchased in FY11 and are being used to transport staff for supervision and mentorship to the sites. This activity supports GHI/LLC.

Elizabeth Glasier Pediatric Foundation (EGPAF) PAMOJA project has been supporting TB/HIV activities in Homab Bay, Rachuonyo North and South, Ndhiwa, Manga, Masaba North and South, Gucha, and Borabu districts. By March 2011 SAPR, 6,870 patients had ever been enrolled in HIV care and 4,205 were active.

In FY12, PAMOJA will continue to support the same region, and will jointly work with the Ministry of Health (MoH) to continue supporting expansion and provision of quality adult HIV Care and support as per MoH guidelines to 3,346 adults and 3,524 in FY 13.

PAMOJA will provide comprehensive care and support package of services including HIV testing to family members of index patient and referring and linking HIV positive ones to care and support; clinical assessment for ART eligibility and linking eligible PLHIV to treatment; laboratory monitoring including 6 monthly CD4 testing; WHO staging; Basic Care Kit (safe water vessel, multivitamins, insecticide-treated mosquito nets, condoms, chlorine for water treatment and educational materials); Adherence assessment counseling and support including FBP; prevention with positives(PwP), cervical cancer screening to all enrolled women and ensure referral and linkages to other clinical services including RH/FP.

PAMOJA in collaboration with MoH will support targeted training for 100 HCWs in FY 12 and 80 in FY 13 and continuous medical education and mentorship for health care workers on care and support e.g. OI management. PAMOJA will also identify human resources and infrastructure gaps and support in line with guidelines and support good commodities management practices to ensure uninterrupted availability of commodities.

PAMOJA 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. PAMOJA will adopt strategies to ensure access to friendly services to youth, elderly and physically or mentally challenged populations.

PAMOJA will continue to strengthen data collection to improve reporting to MoH and PEPFAR; adopt the new PEPFAR generation indicators; support the development and use of electronic medical records system in accordance with MoH guidelines. PAMOJA will adapt cohort analysis and quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV care and support services and integrate them into routinely collected data and use the results to evaluate and improve program activities. Additionally, PAMOJA will evaluate and carry out operation research on implemented programs.

PAMOJA will support joint Annual Operation Plan (AOP) development, implementation, monitoring and evaluation, capacity building and health system strengthening to facilitate sustainability and collaborate with other partners to leverage and maximize on available USG and non-USG resources.

Elizabeth Glaser Pediatric Foundation (EGPAF) PAMOJA project has been supporting TB/HIV activities in Homa Bay, Rachuonyo North and South, Ndhiwa, Manga, Masaba North and South, Gucha, and Borabu districts. By the end of June 2011, 3,186 TB patients were tested for HIV and 53% of the 2,141 TB/HIV co-infected patients were treated for both HIV and TB. EGPAF additionally supported training and hiring of HCWs.

PAMOJA will continue to support scaling up of TB/HIV services to reduce TB among HIV patients and HIV among TB patients through TB/HIV collaborative activities. All TB patients will be screened for HIV and 95% of TB/HIV co-infected patients will be put on cotrimoxazole and ART as per national guidelines. To reduce the burden of TB in HIV infected patients, PAMOJA will support intensified TB screening of 2,974 and 3,133 HIV infected patients in HIV care settings in FY 12 and 13 respectively using the national screening tool. Active TB patients (149 in FY12 and 157 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. PAMOJA will strengthen TB infection control and support roll out of guidelines and implementation in all sites including baseline infection control assessments. This includes fast tracking patients with a cough and expediting diagnostic work up and treatment.

To improve drug-resistant TB surveillance and management, PAMOJA will strengthen screening of all retreatment cases, sputum sample shipment and return of results from central reference laboratory and facilitate linkages of MDR-TB cases to treatment. PAMOJA will support a standard care package that includes health education, clinical and lab assessments including networking for AFB and CD4,OI screening and management, CTX prophylaxis, nutritional support, BCK, adherence and psychosocial support, ART initiation and monitoring for co-infected patients, toxicity and drug interaction assessments, prevention with positive (PwP) services, strengthening linkages between facility and community-based services through improved referrals and tracking systems.

PAMOJA will support MOH annual operation plan development, implementation and review process while offering technical and non technical support. A structured mentorship and supervision plan will be strengthened to improve service delivery, quality data collection, utilization and reporting at all levels. Program quality will be emphasized and periodically monitored through standards of care/ clinical quality improvements assessments. EGPAF will support cohort analysis to evaluate outcomes of service delivery and also report selected custom indicators to assist with program management monitoring and evaluation of new activities at NASCOP (DLTLD) and PEPFAR.

PAMOJA will support operations research and also health management teams to strengthen their health systems in governance, lab capacity, and sample networking to increase access in remote facilities, commodity supply chains, targeted infrastructure renovations, hiring of different cadres of HRH and support regular supervision, mentorship and defaulter tracing mechanisms. PAMOJA will train 100 health workers in FY12 and 80 in FY13 on TB/HIV, 5Is and data management trainings.

Elizabeth Glaser Pediatric Foundation (EGPAF) PAMOJA project has been supporting pediatric ART services as part of integrated comprehensive HIV clinical services in 154 sites in Homa Bay, Rachuonyo North and South, Ndhiwa, Manga, Masaba North and South, Gucha, and Borabu districts. By March 2011 SAPR, 2,665 patients were enrolled into HIV care.

In FY12, PAMOJA will work with the Ministry of Health (MoH) at Provincial and District levels to jointly plan, expand and ensure provision of quality pediatric HIV care and support in all public and faith based health facilities to 350 new pediatrics in FY 12 and 375 in FY 13.

PAMOJA will provide comprehensive care and support package of services including family testing; clinical assessment for ART eligibility and linking eligible ones to treatment; laboratory monitoring including 6 monthly CD4 testing (through strengthened laboratory networking); WHO staging; Basic Care Kit; Nutritional assessment counseling and support; vitamin A, zinc; de-worming and ensure referral and linkages to other clinical services; integration of HIV services into well child welfare clinic services, integrated Management of Childhood Illnesses (IMCI), in-patient, community outreach efforts and routine child health care and survival services in the maternal child health department. PAMOJA will also support care of the newborn by supporting hospital delivery, prophylactic eye care and comprehensive care services to the newborn.

PAMOJA will support in-service training of 100 and 80 HCWs in FY 12 and 13 respectively; continuous mentorship on care and support e.g. diagnosis and management of opportunistic infection; 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 care and support services to ART, PMTCT, TB/HIV, community programs, and other related pediatric services will additionally be optimized.PAMOJA will support hospital and community strategies to ensure access to pediatric and adolescent care and support including 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; scaling up identification of HEIs, ARVs prophylaxis and follow up, HIV testing (PCR-DNA or antibody) and linking those positive to treatment.PAMOJA will continue to strengthen data collection to improve reporting to MoH and PEPFAR; adopt the new PEPFAR generation indicators; support the development and use of electronic medical records system in accordance with MoH guidelines. PAMOJA will adapt cohort analysis and quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV care and support services, integrate them into routinely collected data and use the results to evaluate and improve program activities.

The goal of the country as reflected in Kenya National Aids strategic plan (KNASP III) is to reach 80% knowledge of HIV status in the country by 2013. Nyanza Province, which has a population of about 5.1 million people, carries the highest HIV burden in Kenya. With an estimated adult HIV prevalence of 14.9% compared to the national 7.1%, ~500,000 people are living with HIV.EGPAF - Pamoja Project supports direct implementation of comprehensive prevention, care and treatment activities in nine districts in Nyanza Province that include: Homabay, Rachuonyo North, Rachuonyo South, Ndhiwa, Manga, Masaba North, Masaba South, Gucha, and Borabu Districts. It covers several program areas and activities that include HTC in health care settings. The overall goal of the Pamoja Project is to increase use of high quality, comprehensive HIV services in nine districts of Nyanza Province, Kenya.In FY10, Pamoja Project supported Provider Initiated Testing and Counseling (PITC) services in the nine districts with emphasis in the Outpatient department, Inpatient and Child welfare Clinics. Between October 2010 and June 2011, a total of 52,965 people were offered comprehensive HTC services amongst them 32,840 females and 20,125 males. A total of 7,431 (14%) individuals were identified as HIV infected and were linked to care and treatment services.Guided by gaps identified in KAIS, KDHS 2009 and program data, PAMOJA project will continue to support HTC service implementation in the nine districts with specific area of focus being facility-based PITC approach. PAMOJA will work with the Ministry of Health (MOH) at the county, District and health facility levels to jointly plan, coordinate and implement HTC services for both adults and children in support of the KNASP III and the District and Provincial level MOH annual operation plans.PAMOJA will target clients at the out-patient, in-patient and child welfare clinics with emphasis on enhancing diagnosis of HIV status among individuals with unknown HIV infection status, enhanced knowledge of HIV status with emphasis of identifying HIV infected individuals and HIV sero-discordant couples and strengthened linkage to appropriate HIV prevention, care and treatment services. Pamoja will target a total of 139,000 individuals with HTC of whom 10% will be pediatrics. These will contribute 2.2% of the national targets which aims at increasing knowledge of HIV status to at least 80% of the Kenyan adult population. These targets have been sub-divided to county and district level targets to guide implementation and program monitoring.Pamoja will work to identify areas with training and mentorship needs, staff shortages and support appropriately through a MOH driven mechanism which ensures ownership and program sustainability.All HIV-infected persons will be linked to care, treatment and other HIV prevention services at the facility and community level. Referrals will be strengthened by working together with SI team in implementing an effective referral strategy. HIV-negative individuals will be referred to PEPFAR supported prevention services. Pamoja will strengthen the WHO recommended multistep approach to Quality Assurance in counseling and testing. QA audit teams will be strengthened at the counties. Pamoja will continue to strengthen data collection, analysis, utilization and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR.

EGPAF implements comprehensive prevention, care and treatment programs in Nyanza province. In FY 2012/13, EGPAF 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.

EGPAF 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 has the highest HIV Prevalence (14.9%). EGPAF will reach 1885 (60%) PLHIV in FY2012 and 2320 (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.

EGPAF 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 EGPAF 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) .

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)-PAMOJA project will support implementation of PMTCT in several districts in Nyanza. Nyanza province has an estimated population of 5.4 million people with an estimated adult HIV prevalence of 14.9% compared to the national 7.1% and ANC prevalence of 17%. EGPAF PAMOJA will continue to support PMTCT activities in Homa Bay, Rachuonyo, Ndhiwa, Manga, Masaba, Gucha, and Borabu districts. By March 2011, 17,259 pregnant women were counseled and tested and 1,508 were given ARV prophylaxis.

In FY 12, PAMOJA will work with the Ministry of Health (MoH) to scale up counseling and testing to 47,754 first visit ANC attendees with unknown or known HIV- status through an opt-out approach, assess clinically (WHO stage) and immunologically (CD4) and provide a more efficacious ARV prophylaxis to 4,813 pregnant women who test HIV+ and HAART to 1,925 per current national PMTCT guidelines. In FY 13, PAMOJA will scale up ANC HIV CT to 50,142 mothers and provide ARV prophylaxis to 5,846 in line with MOH guideline. PAMOJA will also support training and mentorship of 90 HCWs in FY 12 and 90 in FY 13 on comprehensive PMTCT/EID services.

PAMOJA will support all PMTCT prongs: primary prevention (HTC, STI and FP), ARV prophylaxis to all HIV+ pregnant mothers and their exposed infants, enrollment, follow up and retention of mother baby pair and other infected family members. Male involvement in RH and FP services will be strengthened through effective and efficient mechanisms to reach 15,043 couples with couple HTC, primary prevention, PwP and linkages into care.

PAMOJA will support safe infant feeding practices as per national guidelines, support enrollment and follow up of 5,028 HIV-exposed infants to access CTX, ARV prophylaxis and EID services using the HIV-exposed infant register till exit at 18 months. PAMOJA will expedite ART initiation for 250 HIV confirmed pediatrics under 2 years.

PAMOJA will support hospital delivery through needs assessments, equipment support, capacity trainings and develop effective and efficient antenatal and post natal retention strategies for mothers and babies through recruitment of peer educators and use of appointment diaries and registers. The team will engage in community education to promote demand creation for health services, support referral and linkages, and also reach out to non clinic attendants.

PAMOJA will support MoH annual operational planning, implementation and program review while offering technical and non technical support. Approximately $18 dollar per woman will support all PMTCT prongs and other wrap around activities like malaria prevention and other tropical diseases in line with GHI principles. A structured mentorship and supervision plan will be strengthened to improve service delivery, quality data collection, utilization and reporting at all levels. Program quality will be emphasized and periodically monitored through standards of care/clinical quality improvements assessments.

PAMOJA will support cohort analysis to evaluate outcomes of service delivery and also improve reporting to NASCOP and PEPFAR. PAMOJA will strengthen the health systems through improving lab capacity and sample networking to increase access in remote facilities, commodity supply chains, targeted infrastructure renovations, hiring of HCWs and support regular supervision, mentorship and defaulter tracing mechanisms including phone tracing.

Elizabeth Glaser Pediatric Foundation (EGPAF) PAMOJA has been supporting HIV activities in Homa Bay, Rachuonyo North and South, Ndhiwa, Manga, Masaba North and South, Gucha, and Borabu districts. By June 2011, 1700 patients were on ART. Since most of the facilities where they work are supported by a different partner, these enrolments have been achieved by integrating ART in MCH and TB clinics.

In FY12, PAMOJA will continue to work in the same region and will work with the Ministry of Health (MoH) to continue supporting expansion and provision of quality adult HIV treatment services as per MoH guidelines to 2,881 patients currently receiving ART and 1,006 new adults resulting to cumulative 3,457 adults who have ever been initiated on ART. In FY13, this number will increase to 3,636 currently receiving ART and 1,018 new adults resulting to 4,475 adults who have ever been initiated on ART.

PAMOJA will support in-service training of 100 and 80 HCWs, continuous mentorship of trained health care workers on specialized treatment, including management of patients with 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.PAMOJA 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; improved OI diagnosis and treatment including TB screening, diagnosis and treatment. Ongoing community interventions for PLHIV including peer education and use of support groups to provide adherence messaging, defaulter tracing and follow up will continue to be supported to improve retention in all sites.PAMOJA will adapt the quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV treatment services integrate them into routinely collected data and use the results to evaluate and improve clinical outcomes. PAMOJA will also support strategies to ensure access and provision of friendly HIV treatment services to all, including supporting peer educators, mentors, support groups, and supporting patients to disclose and bring their partners for testing and care and treatment.PAMOJA will continue to strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. PAMOJA will do cohort analysis and report retention as required by MoH. Additionally, PAMOJA will review data and evaluate programs to inform programming and decision making. Use of an electronic medical records system will be supported and strengthened. PAMOJA will strengthen local capacity as part of the transition plan to MOH for sustainable long-term HIV patient management in Kenya.

Elizabeth Glaser Pediatric Foundation (EGPAF) PAMOJA project has been supporting pediatric ART services as part of integrated comprehensive HIV clinical services in 154 sites in Homa Bay, Rachuonyo North and South, Ndhiwa, Manga, Masaba North and South, Gucha, and Borabu Districts of Nyanza province.

In FY12, PAMOJA will continue to 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 142 pediatrics currently receiving ART and 100 new pediatrics resulting to cumulative 171 pediatrics ever initiated on ART. In FY 13, this number will increase to 193 pediatrics currently receiving ART and new 90 resulting to cumulative 261 pediatrics ever initiated on ART.

PAMOJA 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; and community outreach efforts and integration of HIV services in other MNCH services.

PAMOJA 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.

PAMOJA 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; 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.

PAMOJA will continue to strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. Additionally, PAMOJA will review data and evaluate programs to inform programming and decision making. Use of an electronic medical records system will be supported and strengthened. PAMOJA will strengthen local capacity as part of the transition plan to MOH for sustainable long-term HIV patient management in Kenya.