The Central Province Response Integration, Strengthening and Sustainability Project (CRISSP) of the UON has just been awarded a follow on to the Columbia Track 1 activities in Central Province. CRISSP aims to build the capacity of two districts in Central Province to ensure sustainable, universal access to high quality HIV prevention, care and treatment services, with focus on integration within the broader health and developmental context through an evidence-based, cost-effective and sustainable model of care. In line with the Kenya GHI Strategy, they will strengthen MCH services, support laboratory capacity to for diagnosis of endemic conditions, and promote good governance by supporting training in governance and leadershipCost efficiency will be addressed through integration of services, reduction of the technical teams by increasing capacity of the Ministry of Health (MoH) staff, use of existing evidence-based strategies, task shifting, implementing facility-based training and mentorship as opposed to offsite training, evaluating cost effective strategies for defaulter management, laboratory networking, and mobilization.Through the active involvement of MoH and the broader community and by development of standard operating procedures (SOP) and a solid referral network, CRISSP hopes to showcase a model of excellence that will blend into community adoption and ownership, thus ensuring a smooth process of transition to local providers at the end of the project period. To strengthen a common M&E system and to ensure data quality, analysis, reporting, and use for evidence-based programming, electronic medical records systems will be supported.3 vehicles will be required for technical teams to conduct supervision and mentorship.this activity supports GHI/LLC.

The Central Province Response Integration, Strengthening and Sustainability Project (CRISSP) of the University of Nairobi (UON) will support two districts in Central province, which has a combined population of approximately 1.5 million people and an estimated adult HIV prevalence of 3.6% (compared to the national 7.1%).CRISSP will work with the Ministry of Health (MoH) at provincial, district and health facility levels to jointly plan, coordinate, implement and ensure provision of quality HIV care and support to 7,439 current adult patients in FY12 and 8,838 current patients in FY13.CRISSP will offer a comprehensive care and support service package including HIV testing to partners and family members of index patients and enrolling or referring/linking those that test HIV positive to care and support; provision of Basic Care Kit (safe water vessel, multivitamins, insecticide-treated mosquito nets, condoms, chlorine for water treatment and educational materials); therapeutic nutrition (FBP) to all enrolled HIV positive patients; prevention with positives (PwP); and cervical cancer screening to all enrolled women.CRISSP in collaboration with MoH will support targeted capacity building (training and mentorship) for health care workers and additionally offer continuous medical education on care and support, such as OI diagnosis and treatment. CRISSP will identify areas with staff shortages, support recruitment of additional staff, and support good commodities management practices to ensure uninterrupted supply of commodities.CRISSP will also support ongoing community interventions for HIV infected individuals including peer education and support groups to provide adherence messaging and defaulter tracing and follow up to improve retention in all facilities. CRISSP will continue supporting referral and linkages to community based psychosocial support groups; Water, sanitation and hygiene programs; Economic empowerment - Income generating activities (IGAs); Home Based Care services; Gender based violence support programs; vocational training; social and legal protection; and food and nutrition programs.CRISSP 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.CRISSP will continue to strengthen data collection and reporting at all levels to improve reporting to NASCOP and PEPFAR, including a cohort analysis and report retention rates as required by NASCOP. CRISSP will adopt the new generation indicators and support the development and use of electronic medical records system in accordance with NASCOP guidelines. CRISSP will adapt the 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 clinical outcomes. CRISSP will support joint Annual Operation Plan (AOP) development, implementation, monitoring and evaluation, and health system strengthening to facilitate sustainability.

The Central Province Response Integration, Strengthening and Sustainability Project (CRISSP) of the University of Nairobi (UON) won an award in 2011 to support HIV activities including TB/HIV. CRISSP will support TB/HIV services in two districts in Central Province, which has a combined population of about 1.5 million people and reported 10,623 TB patients in 2010. Over 10,000 TB patients received HIV testing and 3,531 TB/HIV co-infected patients were identified. 97% and 47% received cotrimoxazole prophylaxis and ART respectively.In FY12 and FY13, CRISSP will intensify efforts to detect TB cases through clinical exams and laboratory investigations and ensure successful TB treatment through provision of appropriate treatment. CRISSP will ensure that each facility providing TB/HIV services has adequate and well trained clinical staff supported by well equipped and staffed laboratory, including sputum specimen transport where laboratory services are unavailable. CRISSP will ensure that adequate supplies of anti-TB drugs are available and that the national TB treatment guidelines are followed. All TB patients on treatment will be monitored both clinically and through periodic sputum examination.To reduce the burden of HIV in TB patients, CRISSP will ensure that at least 95% of TB patients are screened for HIV and all 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. CRISSP 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. 80 HCW will be trained in FY12 and 60 HCW will be trained in FY13.To reduce the burden of TB in HIV infected patients, CRISSP will support intensified TB screening for 6,613 in FY12 and 7,856 in FY13 at each clinical encounter using the national screening tool. 330 co-infected patients identified in FY12 and 393 in FY13 will be put on TB treatment and those without active TB will be provided with Isoniazid Preventive Therapy (IPT) as per national IPT protocol. To strengthen TB infection control in HIV settings, CRISSP will ensure that the national IC guidelines are available at all sites and training of staff on IC is done. CRISSP 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.To improve surveillance and management of drug-resistant TB, CRISSP 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. CRISSP will also support scaling up of drug-resistant treatment sites thus expanding access to MDRTB treatment.CRISSP will also support expansion of prevention with positive (PwP) services in TB clinics, TB/HIV control activities in the prisons, strengthening linkages between facility and community-based services, and improving patient referrals and tracking systems. To strengthen HVTB program monitoring, CRISSP will support reporting of selected custom indicators to assist with program management and evaluation and monitoring of new activities.

The Central Province Response Integration, Strengthening and Sustainability Project (CRISSP) of the University of Nairobi (UON) has just been awarded as a follow on to the Columbia Track 1 activities in Central Province. CRISSP will support pediatric care and treatment services in 8 sites located in two districts in Central Province, with a combined population of about 1.5 million people and an estimated adult HIV prevalence of 3.6% (compared to the national 7.1%).In FY12, CRISSP will provide care and support services to 777 children currently on care. The number of children currently on care will increase to 940 in FY13. CRISSP will provide comprehensive, integrated quality services and scale up to ensure 949 HIV infected infants are put on ARV prophylaxis and all HIV exposed children access pediatric care services.CRISSP will focus on strengthening the use of the Mother-baby booklet, early infant diagnosis, universal provider initiated testing and counseling, and ensure those identified as HIV infected are linked to care and ART services.CRISSP will ensure children enrolled in care receive quality clinical care services including clinical history and physical examination; WHO staging, CD4 tests, and other basic tests; opportunistic infection diagnosis, prophylaxis and management; TB screening; pain and symptom relief and management; and psychosocial support. Additional key care services will include nutritional assessment, counseling and support based on the WHO and IYCF guidelines (including provision of therapeutic or supplementary feeding, support to children with growth faltering, 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.CRISSP 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.CRISSP will support hospital and community activities to meet the needs of HIV infected adolescents such as support groups to enhance disclosure and adherence messaging, PwP, substance abuse counseling, support for transitioning into adult services, and teaching life skills. Commodity access and infrastructure development will continue to be supported as will relevant trainings.CRISSP will strengthen pediatric data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR.

Target population: CRISP will support HIV testing and counseling services in al a number of health facilities in Kiambu and Kirinyaga counties of central province. Target population will include all patients, their family members and caretakers who access out and in patient services a number of health facilities in the 4 counties.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: CRISP is a new mechanism. In COP 2012, CHS will target to provide HTC services to a total of 85,000 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, CHS will put in place several important strategies. They include: use of peer educators as patient escorts from one hospital department to the PSC; same day enrollment of clients to PSCs; 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 (each facility has a phone supported by ICAP) to follow up whether the client was actually enrolled.Quality management: In order to improve and monitor quality of HTC services, CRISP 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: CRISP 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.

UON CRISSP implements comprehensive prevention, care and treatment programs in Central province. In FY 2012/13, UON CRISSP will expand HIV prevention services to include evidence based behavioral interventions (EBI) 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 EBI 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.UON CRISSP 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 centers and provide appropriate counseling space. One of the peer educators will do regular client home follow up to strengthen ART adherence.Approximately 1.6 million Kenyans are PLHIV. The Kenya AIDS Indicator Survey 2007 showed 6% of couples to be in discordant relationships. HIV Prevalence in Central province is (3.6%). UON CRISSP will reach 4190 (60%) PLHIV in FY2012 and 5818 (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.UON CRISSP 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 UON CRISSP 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

The Central Province Response Integration, Strengthening and Sustainability Project (CRISSP) of the University of Nairobi (UON) has just won a PEPFAR award to support the implementation and expansion of PMTCT activities in sites in Kiambu and Kirinyaga Districts in Central Province, which previously were supported by Columbia Universitys International Center for AIDS Care and Treatment Programs-Kenya (ICAP) Track 1 mechanism.In FY12, CRISSP will offer HIV counseling and testing to 28,379 pregnant women at ANC and give ARV prophylaxis to 908 HIV infected pregnant women. HIV infected women will receive a CD4 test after undergoing WHO clinical staging. CRISSP will give HAART to all eligible HIV positive pregnant women in line with the revised PMTCT national guidelines. In FY13, CHS will increase the number of pregnant women counseled to 29,798, offer ARV prophylaxis to 1,103 pregnant women and 949 infants, and do EID for 949 infants.CRISSP will focus on 4 prongs of PMTCT: primary prevention; family planning; ARV prophylaxis to all HIV positive pregnant mothers and exposed infants; and care and treatment to eligible HIV positive mothers, partners and children. The minimum care package will include health and HIV education, individual/ family HIVCT, clinical/laboratory monitoring and assessment, OI screening and treatment, ARV prophylaxis and treatment for both mother and baby, nutritional support, psychosocial support, PWP, follow up, retention, and referral and linkages. CRISSP will incorporate TB screening into routine antenatal care.CRISSP will reach 8,939 of 1st visit ANC attendees with couple CT to identify discordant and concordant couples to improve primary prevention and facilitate linkage to HIV care and treatment for the eligible. CRISSP will support integration of ART in MCH clinics, access to FP/RH services, and establish or strengthen infection control and waste management activities.CRISSP will support hospital delivery through provision of delivery beds and sterile delivery packs, training, working with CHWs and TBAs to promote community-facility referral mechanism, health education, and community services providing skilled birth attendance.CRISSP will support safe infant feeding practices as per national guidelines and support enrollment and follow up of 949 of babies born to HIV infected mothers to access CTX, ARV prophylaxis, and EID services using the HIV exposed infant register till 18 months. CRISSP will facilitate ART initiation for those who test positive before 2 years.CRISSP will adopt efficient retention strategies for mothers and babies by supporting use of diaries and registers for tracking defaulters, having a structured mentorship and supervision plan, enhancing data quality and streamlining M&E gaps including orientation of new MOH ANC/maternity registers, and utilization of data at facility level for program improvement and quarterly progress reports to CDC.Program quality and proficiency testing will be emphasized to validate PMTCT results.CRISSP will train 60 HCWs in FY12 and equal number in FY 13 on PMTCT and provide orientation to the revised PMTCT and infant feeding guidelines and engage in community activities for demand creation for health services such as male involvement with couple CT services, referral and linkages.

The Central Province Response Integration, Strengthening and Sustainability Project (CRISSP) of the University of Nairobi (UON) will support treatment in 2 districts (Kiambu and Kirinyaga) in Central Province. Central Province has an estimated population of 4.4 million people with an estimated adult HIV prevalence of 3.6% compared to the national 7.1%. These 2 districts were previously supported by Columbia University Track 1 mechanism.In FY12, CRISSP will jointly work with the Ministry of Health (MoH) to support expansion and provision of quality adult HIV treatment services in line with MoH guidelines to 5,528 patients currently receiving ART and 1,330 new adults resulting to cumulative 6,634 adults who have ever been initiated on ART. In FY13, this number will increase to 6,527 currently receiving ART and 1,346 new adults resulting to 7,980 adults who have ever been initiated on ART.CRISSP, in collaboration with MoH, will support in-service training of 80 and 60 HCWs 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.CRISSP 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.CRISSP will continue to support ongoing community activities and support for HIV infected individuals including peer education and use of support groups to strengthen adherence; effective and efficient retention strategies; referral and linkages to psychosocial support groups; economic empowerment projects; Home Based Care; and food and nutrition programs. CRISSP will support provision of friendly services to youth and special populations. CRISSP will adopt strategies to ensure access and provision of friendly HIV treatment services by supporting peer educators, support groups, disclosure, partner testing and family focused care and treatment.CRISSP will continue to strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. CRISSP 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. Use of an electronic medical records system will be supported and strengthened. Quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV treatment will be adopted, integrated into routinely collected data, and results used to evaluate and improve clinical outcomes. CRISSP will also support short term activities to improve impact and patient outcomes.

The Central Province Response Integration, Strengthening and Sustainability Project (CRISSP) of the University of Nairobi (UON) will support pediatric treatment services in 8 treatment sites located in Kiambu District in Central Province which previously were supported by Columbia Universitys International Center for AIDS Care and Treatment Programs-Kenya (ICAP). Central Province has an estimated population of 4.4 million people with an estimated adult HIV prevalence of 3.6% compared to the national 7.1%.In FY12, CRISSP 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 580 pediatrics currently receiving ART and 116 new pediatrics resulting to a cumulative 696 pediatrics ever initiated on ART. In FY13, this number will increase to 725 pediatrics currently receiving ART and 104 new resulting to cumulative 800 pediatrics ever initiated on ART.CRISSP 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; and adherence strengthening. CRISSP will also support enhanced follow up and retention, EID as per MoH guidelines, PITC to all children and their care givers attending child welfare clinics, family focused approaches, community outreach efforts, and integration of HIV services in other MNCH services.CRISSP will support hospital and community activities to meet the needs of the HIV infected adolescents such as 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.CRISSP will support in-service training of 80 and 60 HCWs in FY 12 and 13 respectively as well as 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. CRISSP will identify human resources and infrastructure gaps, support in line with MoH guidelines, and support good commodities management practices to ensure uninterrupted availability of commodities. Linkage of ART services to pediatric care services, PMTCT, TB/HIV, community programs, and other related pediatric services will additionally be optimized.CRISSP will continue to strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. Additionally, CRISSP will review data and evaluate programs to inform programming and decision making. Use of an electronic medical records system will be supported and strengthened. CRISSP will strengthen local capacity as part of the transition plan to MOH for sustainable long-term HIV patient management in Kenya.