The Lea Toto Program (LTP) is a project of the Children of God Relief Institute (COGRI), an organization based in Nairobi, offering services to children living with HIV/AIDS. With funding from USAID, Lea Toto program provides services to families with HIV positive children in the main informal settlements in Nairobi Province. The goal of the Lea Toto Project is to mitigate the impact of HIV/AIDS and decrease the risk of HIV transmission by providing and facilitating the implementation of a comprehensive home based care package.This will be achieved through the following five objectives:1. To enhance the provision of high quality medical care, nutritional support and counseling services to 8,500 HIV+ children and their families by 2012.2. To provide a package of social support services to at least 70% of the needy HIV+ children and their families3. To enhance the organizational capacity of all Lea Toto staff to design, monitor and coordinate quality care services for HIV+ children and their families4. To enhance capacity of the target local communities to provide care and support to HIV + children and their families.5. To enhance the capacity of the target communities to carry out preventive measures through negotiation, support and maintenance of safe behavior. This activity supports GHI/LLC and is completely funded by pipeline funds in this budget cycle.

COGRI, through its projects will support a minimum package for home and community based care in line with NASCOP guidelines. The services will include nursing care and palliative care; clinical care with an emphasis on treatment literacy and sustainability; family care and support (including psychosocial support, access to reproductive health services, and initiatives to strengthen food security and proper nutrition); trainings for health care workers, CHWs and peer educators; and establishing proper linkages and referrals to ensure clients access additional services as necessary.

Nyumbani Village will reach 1,000 OVC in the villag. Those to benefit from the project as OVC will constitute children aged 0-17 years while ensuring both girls and boys have equal chances of benefiting from the project. The project will provide educational, food/nutritional and household support, life skills training, career guidance and talent development. The Nyumbani Village sustainability program which aims at increasing food production, nutrition and agro-income security will be expanded to reach an additional 600 households in the neighboring communities through use of low cost integrated sustainable agriculture/organic farming techniques linking market gardens, livestock production, food processing and market enterprises.

Lea Toto program will reach 1,000 OVC in the village and 500 in the community. Those to benefit from the project as OVC will constitute children aged 0-17 years while ensuring both girls and boys have equal chances of benefiting from the project.

In both projects children aged 18 years and above will be considered as beneficiaries on home based care and support. The project will establish a community managed revolving fund/micro credit to offer loans to the grown up OVCs to start small business enterprises and become independent after obtaining the relevant trained skills from the village. The loans will also be offered to the surrounding communities particularly the caregivers to start cottage industries and other income generating activities. CHWs will be trained in accordance to the National guidelines and assigned to OVC/HBC households while project staff will make periodic follow-ups to those within the community to ensure retention on the program. Children within the village will be followed up by counselors/social workers within the Village.M&E: The project will support data collection and reporting using standard tools as per NASCOP/ NACC guidelines. Data will be collect at a household level by CHWs on type of services received by the OVC and HBC clients on the program.

The Village is located in Kitui District in Eastern Province. The primary target groups are OVC and the grandparents who look after them in the village, while the community is secondary target. The Nyumbani Village concept aims to establish a self-sustaining, community-based, residential village that will accommodate approximately 1,000 orphaned children and 100 grandparents infected and affected by HIV/AIDS. Nyumbani Village will provide shelter, food, clothing, medical care, education, legal, spiritual guidance, counseling of both grandparents and children including seminars on life skills, sexuality, behavior change, health care and career counseling. The surrounding community and households will receive technical agricultural expertise, access to medical services at the clinic which include curative, HTC, PMTCT and MCH services.The growing number of adolescent children has created a need for continuous counseling and social activities to minimize incidents of indiscipline. However, the Village has constructed a polytechnic where children more than 18 years who complete schooling can obtain vocational skills.Lea Toto Project will provide care and support services to (4,750) orphans and vulnerable children (OVCs) with high quality home based care and other support services in selected slums in Nairobi namely in Kangemi, Kariobangi, Kibera, Kawangware, Dandora and Mukuru. The activity will also improve the organizational capacity of the Lea Toto program to deliver high quality care and counseling and other support services for HIV+ children and their families. Lea Toto Project will work with trained community workers at the activity sites and will provide or facilitate access to a range of services for families and OVC care givers. It is anticipated that these services will include training around OVC support; anti-retroviral treatment, education, psycho-social support including succession planning, nutritional support, empowering of the caregivers through self-help Groups and eventually referral for micro-business training for family income support and other Micro credit services at the K-REP Development Agency (KDA). A total of 23,750 family members and 4000 children will receive high quality home based care and other support services and 750 caregivers will be trained. This activity will contribute to the Kenya 5-year strategy, will increase the number of OVCs receiving HIV/AIDS care and support, and will reach 23,750 family members of OVC

This activity will involve 100% screening of all the children enrolled in the program for TB. Those found infected will be initiated on treatment in partnership with Government health facilities. All Lea Toto centers are TB treatment centers. In addition households where TB cases are identified will be mobilized to get screened and where necessary seek treatment. The TB treatment in Lea Toto was started in 2006 to provide a one stop shop for HIV positive children who were found to have TB. This was necessary since HIV patients are susceptible to TB hence it was necessary Lea Toto screen all the children under its care periodically. Initially the children were referred to GOK facilities but that posed a challenge of adherence as well as monitoring. Lea Toto sought the help of GOK for the supply of commodities and capacity building for its staff to provide TB treatment. The starting of TB treatment has also helped to reduce time spend seeking services because the children are attended to while coming for the other services provided by the program. Through the home visits, program staff are able to monitor adherence to both TB and ARV treatment as well as Monitoring cases of advance drug reaction if any. 160 health workers will be trained on HIB/TB related issues to ensure that they are effective in their management. This activity will contribute to the Kenya National AIDS strategic plan 2009/10 -2012/2013 outcome 2 increase the proportion of TB patients who are HIV infected and are on ART. This is done through provision of TB testing and counseling and follow up to ensure adherence to treatment as done at Lea Toto centers. Further counseling of TB patients on prevention of transmission is emphasized. Linkages for referral especially other family members is done as well as ensuring that the Health workers in the program are conversant with the reporting requirement especially capturing TB patients on ART as well as ensuring that all PLHIV are screened for TB. TB screening and treatment is among services outlined in the minimum package for health care for facilities in Kenya. This program area will target HIV positive infants and children, care givers, community health workers and program staff. The major emphasis area is training, with a minor emphasis on community mobilization and participation. TB screening and treatment for those infected, adherence to treatment and mobilizing affected households to get screening will be emphasized.

Nyumbani Village will institutionalize the care of pediatric HIV infected infants, children and adolescents, caregivers within and outside the Village. Family testing at community level will be emphasized to identify HIV infected children from the adults on care and treatment. The project is expected to raise the total number of pediatrics on care from 122 to 180 within the next 2 years through engagement at community level.The Lea Toto project will result in (35,000) family members and (8,000) children receiving high quality facility and home based care and other support services. The facility-based activities will include strengthening of facilities that are already serving as network referral centers for pediatric HIV care. Activities will include HIV related laboratory tests, OI prophylaxis and strengthening pharmaceutical management. Lea Toto will also strengthen the ability of targeted local communities to prioritize needs of HIV+ children and their families and carry out activities to meet these needs. Some of the activities include group therapy sessions, life skills training, post disclosure clubs, recreational activities, coping skills, disclosure meetings, support group meetings and follow up counseling sessions.In both projects, following HIV diagnosis, appropriate care and treatment will be provided based on the National pediatric and adolescent care and treatment guidelines. Life skills training sessions will be held with children aged between 7 and 16 years to address issues related to drug adherence basic hygiene and nutrition. Follow-up visits for monitoring and assessments to ensure access to drugs, commodities, primary and basic care packages will be scheduled. All immunization and supplementary feeding will be provided as well as clinical review of response to treatment. Activities will include support for laboratory services for HIV related tests, OI prophylaxis (cotrimoxazole, fluconazole), nutritional assessment/support and strengthening pharmaceutical management. Existing tools for recording and reporting will be deployed and used by all providers and facility-based mentors for pediatric care and support.The activities will contribute to the Kenya 5-year strategy and increase the number of people receiving HIV/AIDS care and support. Specifically, 8000 will be provided with HIV-related palliative care, 1200 trained to provide palliative care and 10 service outlets will provide care.The activities will target people affected by HIV/AIDS including Caregivers, HIV positive infants and children, OVCs and PLWHAs..

Nyumbani Village will expand counseling (CT) and testing activities (as per the HTC guidelines) in the Clinic within the Village and through outreach programs to the Kwa Vonza andKwa Vonza communities. Facility-based HIV CT services in the Clinic will target pregnant women, couples and partners of PLHIV through invitation and mobilization by CHWs, the youth seeking YFS and clients accessing services at the supported health facilities. Provider initiated HIV testing & counseling (PITC) will be the predominant approach for clients seeking services in the outpatient. HIV testing will be offered routinely with the option to opt-out in the context of ANC, maternity, postnatal, MNCH, TB, in-patient and other outpatient services. Other approaches will include outreach/mobile voluntary counseling and testing (VCT). The clinic will be used to identify index HIV clients through whom family-based HIV testing by CHWs and other community counselors will be undertaken to promote early identification of HIV infected family members and access to HIV care and treatment.Under Lea Toto, counseling and testing activities will reach 4,500 children and at least 1,000 adults in 10 existing voluntary counseling and testing centers situated near the project centers selected slums of Nairobi. In addition, 15 VCT counselors will be trained in order to improve the organizational capacity of the Lea Toto program to deliver high quality care and counseling services for HIV+ children and their families. Support groups linked to supported health facilities will be strengthened and community peer volunteers identified to facilitate intra-facility referrals across departments, into the community programs and facilitate tracing of defaulters to follow-up care and treatment. Mobile phone messaging by service providers and the peer volunteers to communicate with individuals after HIV CT will be introduced to enhance linkage for enrolment, follow-up and retention into HIV care and treatment. Existing HTC tools will be used at all entry points to HTC services and summary reports prepared by HTC mentors based in the health facilities and the anchor CU facilities for community outreach services.In both projects targeted population include the General population (men and women), Families affected by HIV and AIDS including HIV positive infants and children, orphaned and vulnerable children due HIV and AIDS, care givers, community health workers and Community Based Counselors.

Nyumbani village will scale-up pediatric care and treatment among the community members seeking support at the village clinic. The project will initiate 40 new children on ART over the next 2 years by optimizing the entry points into care and treatment through increased PITC and community mobilization. Identification of HIV exposed and infected children will be intensified through PITC for the infants and longitudinal follow-up of HEI.The Lea Toto project will expand established programs in targeted slums in Nairobi to include 9 centers; 8 in Nairobi informal settlements. As a result of these activities, 3000 individuals will receive antiretroviral therapy 300 will initiate treatment during the year, with the total of people ever treated reaching 3000, and 160 health care workers will be trained in the provision of antiretroviral therapyIn both projects, early infant diagnosis will be scaled-up to ensure provider competence to collect quality DBS samples and logistical transportation to regional laboratories for HIV DNA PCR diagnosis. OJT for service providers on collection of DBS samples will be conducted at the Nyumbani and Lea Toto clinics to facilitate diagnosis of HIV among the HEI. Service providers will be mentored on the prompt initiation of ART for children less than 2 years with confirmed HIV status while access to CD4 and Viral Load testing will be facilitated through linkage with the Nyumbani diagnostic Laboratory to enhance evaluation and monitoring of patients. Nutritional assessments of pediatric patients and therapeutic and supplemental feeding will be an integral part of their support. Access to all other immunization care, supplementation and growth monitoring services will be undertaken in compliance with National Guidelines. Activities will also include procurement of laboratory services and strengthening rational pharmaceutical managementOrientation to the new MOH tools will be done to ensure that key staff develop the capacity to collect, analyze use data both at local and national level. Adolescent-friendly treatment services will be undertaken through the establishment of adolescent-friendly clinic days and the formation of adolescent support groups. Adolescent clubs to promote healthy and positive living will be linked to appropriate role model mentors from amongst the adult PLHIV in order to allow for smooth transition into adulthood. The program will ensure adherence support to the individuals on follow up including strengthening community facility linkages to curb loss to follow up and improve retention and long term out comes.These activities will contribute to the Kenya 5-year strategy and increase the number of children on antiretroviral therapy, responds to OGAC objectives of increasing the number of children on ART.