The goal of the KDOD HIV Program is to conserve the fighting strength of the Kenya Defense Force by preventing and alleviating HIV-related illnesses and death among 135,000 soldiers and their dependants. This is done through a comprehensive HIV prevention and treatment program supported by the WRP since 2004.During FY12 and FY13, the program emphasis will include HTC expansion in all the treatment sites including PITC, couple and family testing at the facility level. This will contribute towards the PF goal to support implementation of the GOK HIV response as articulated in the KNASP III that seeks to strengthen the capacity of facilities and providers in increasing HCT such that 80% of Kenyan adults know their status. Other emphases will be on strengthening linkages of identified HIV positives to care, PMTCT services, EID, TB management, patient retention and overall HIVQUAL activities.In order to build on sustainability, KDOD will support the integration of HIV plans into the annual military performance contracts. The program will support and strengthen the capacity of KDOD HIV structures from the Unit HIV committees to the Armed Forces AIDS Committee at the highest level. High command sensitization will be maintained in order to promote ownership and leadership.

This partner used part of FY 07 funds for the purchase of 2 vehicles (1Toyota Land Cruiser, 1 Toyota Hiace) to support supervision, coordination and evaluation of the expansive KDOD field activities. In FY 12, the program will procure 2 new vehicles to support M&E activities.Target populations, geographic coverage, and monitoring and evaluation plans are addressed in budget code narratives.This activity supports the GHI/LLC and is funded primarily with FY12 funds in this budget cycle.

KDOD HIV program is a national wide program serving a total population of 135,000 people including soldiers, their dependants, civilian DOD personnel and one community outreach program at Mtongwe. These are served by 9 HIV comprehensive care centers and 1 Community Outreach Clinic. The facilities are adequately staffed by both military and non military personnel even though there is high turnover of military staff due to core military activities necessitating continuous HIV training, mentorship and supervision as well as sustained civilian staffing. Each of the 10 facilities will continue to provide a comprehensive package of services aimed at extending and optimizing quality of life throughout the continuum of illness. These include provision of clinical, psychological, spiritual, social, and prevention services. Clinical care services include prevention and treatment of OIs and other HIV/AIDS-related complications including malaria and diarrhea; nutrition assessment, counseling and support; and pain and symptom relief. Psychological and spiritual support will include group and individual counseling. Prevention services will include partner/couples HIV testing and counseling, risk reduction counseling, adherence counseling and support, STI diagnosis and treatment, family planning counseling, and condom provision. The purchase of OI drugs to supplement the military procurement will continue.

In order to improve retention of patients initiated on ART, the program supports a telephone defaulter tracking system. 9 peer educators are engaged in the provision of adherence counseling and defaulter tracing. The program supports adherence promoting activities such as adherence measurement using self report, pill count, CD4 and Viral load monitoring. Activities of post test clubs and youth friendly clinics are supported and will be enhanced.

Cervical cancer screening, STI assessment and treatment, family planning services for HIV positive individuals will be integrated into routine care as much as possible and where this is not possible, strong linkages and referral systems will be enhanced. HIV positive individuals with other infections such as malaria or TB will be linked to appropriate treatment services. HIV positive pregnant women will be linked to PMTCT services. Individuals with mental health problems will be referred to on-going counseling services and support services. In addition, HIV positive individuals with alcohol or substance abuse problems will be linked with substance abuse treatment programs and needle/syringe exchange programs.

Support supervision, mentorship, monitoring and evaluation visits and data quality assessment will be supported. Review and roll out of data collection, recording and reporting tools for implementation of next generation indicators has been initiated and will continue to be strengthened. Development of quality of care indicators for monitoring the quality of HIV clinical services (HIVQUAL) was initiated in FY09 and will be re-launched and strengthened. Roll out plan for patient level EMR system will be supported at 3 treatment sites to ensure improved reporting to PEPFAR.

In FY 2006 KDOD initiated the orphans and vulnerable children (OVC) activity following an increased number of deaths among military personnel resulting from HIV/AIDS. HIV remains a significant cause of death in the Kenya military. There are an estimated 5,000 OVC linked to KDOD members. Prior to the KDOD OVC program, these children orphaned by HIV/AIDS had no support from the KDOD as a government institution. With funding from COP FY 2006, KDOD was able to establish a program that focused on care and general support to 800 OVC located throughout the country with the assistance of the military unit commanders and local administration. In FY 2008 COP the military OVC program shifted from service provision to identification, tracking and linking the OVC to the local agencies offering services in the community. In FY 2010 the program identified a total of 1055 out of which 471 were linked to local agencies, 55 very needy OVC were supported with school fees and 4 families supported with cash transfer. Stigma surrounding HIV status disclosure among some caregivers, a bench mark for linkage to PEPFAR funded programs and absence of local agencies offering OVC services are some of the challenges affecting linkage. To overcome stigma, a total of 90 caregivers have been trained in basic care and support, stigma and discrimination reduction, basic counseling skills on psychosocial health of the child and empowered on HIV Positive status disclosure. In FY 2012/2013 additional 25 caregivers will be trained and supported to form groups geared to income generating activities for sustainability. In FY 2012/13, the KDOD will continue to identify, locate and link additional 500 OVC to PEPFAR funded partners and local agencies in the community. The KDOD OVC target will contribute to the national target of 752,700. The program will continue to take the lead in ensuring that the survivors of the servicemen and women are identified, tracked, linked and given preference in this unique OVC military activity. Timely identification and subsequent linkage of sick children to care and treatment will also be provided. The program social workers will continue to network with PEPFAR funded partners and local agencies providing services to KDOD OVC in the community. Liaison with military commanders to ensure timely OVC names submission will be enhanced. The KDOD will also continue to implement the care and support of these OVC by strengthening the capacity of caregivers and continue the tradition of communal and family support of the OVC. KDOD in line with COP 2012 guidelines will prioritize on capacity building, identification, location and linkage, paying school fees for the needy OVC and family strengthening approaches that reinforce long term caring capacities as the basis of a sustainable response to children affected by HIV/AIDS. KDOD OVC program will continue to work closely with military unit commanders responsible for the troops, existing community services and government children agencies to augment the level of community and family based support already available to the OVC through the holistic approach to care. This approach is supported by the Emergency Plan in which the needs of the OVC are identified at the community level and subsequently cared for by strengthening existing structures already in place to tend to the needs of the OVC in the various regions throughout the country.

The Kenya Department of Defense (KDOD) will continue to intensify the diagnosis, care and treatment of military patients with co-infections of TB and HIV (TB/HIV) by promoting screening activities of all HIV infected patients for TB as well as ensuring all TB infected patients are offered HIV testing, STI screening, HIV prevention messages including condom distribution. Those found to be co-infected will be given antiTB, cotrimoxazole prophylaxis treatment (CPT) and ART as per the Kenyas TB guidelines. Through this concerted effort, in FY2012 and 2013, the program will provide HIV testing to all TB patients; and offer TB and HIV services to at least 100 TB/HIV co-infected patients. The program will intensify efforts of contact tracing by conducting door to door sputum testing of TB contacts. This will lead to more cases being identified and appropriate care being given in a timely manner. In order to achieve this, KDOD intends to continue improving the laboratory capacity for TB/HIV and improving capacity of the health personnel through training in management of TB/HIV. Refresher training for integrated TB/HIV activities for KDOD health professionals will be undertaken by training an additional 50 health workers on TB/MDR, TB and DTC using MOH curriculum to support the expected increased workload. TB/HIV services will continue to be supported in the 10 care and treatment centers in Deense Forces Memorial Hospital (DFMH), Moi Air Base in Nairobi, Mombasa, Mtongwe civil outreach, Nanyuki 4th BDE, Laikipia Air Base, 3KR Lanet,Gilgil Regional Hospital, 9KR Eldoret and 12 Engineers Thika. In FY2012/2013, funds will be used to enhance TB/HIV integration across the 10 ART sites so as to facilitate effective care of TB/HIV co-infected patients. KDOD will also continue extending TB/HIV services to the neighboring civil population. DFMH remains the referral hospital for all patients requiring specialized diagnosis, treatment and in-patient care including patients suspected to have failed treatment. In FY 2012 and 2013, efforts to improve the capacity in the laboratory at DFMH to perform QA in smear microscopy will be continued. In line with the national guidelines, the DFMH lab will continue to send samples to the National reference laboratory for TB cultures, drug sensitivity and resistance testing. In addition, the program will continue to ensure efficient and timely supply of TB drugs to all treatment sites while maintaining regular supervision of all TB/HIV treatment activities. Strengthening of community based adherence/follow up of patients in this program will be promoted through telephone tracking of defaulters and the use of social workers. In terms of reporting for TB, the KDOD is recognized as Kenyan Province equivalent. This recognition by the NLTP will be exploited to ensure that the KDOD tuberculosis program is developed further under the Presidents Emergency Plan. The KDOD program will continue to be regularly reviewed by staff from Walter Reed Project and the Division of Leprosy, TB and Lung Disease to report high-quality data using the national TB and HIV M&E framework and tools to track progress toward stated objectives/targets. In preparation towards readiness to report on the revised TB/HIV indicators, WRP has trained HCW and rolled out the newly revised tools.

The KDOD Program serves a population of approximately 135,000 people, with a HIV prevalence ranging from 3% to 5%. So far EP funds have been used to support pediatric care and support at 10 treatment sites. By the end of August 2011, the program had enrolled 256 children. In FY 12 and 13, KDF seeks to use PEPFAR funds to address the needs of HIV+ children by supporting 180 on treatment and 200 children on care.

Since 2009, KDF has used EP funds to support pediatric care activities including; strengthening of the DFMH to serve as a referral center for HIV/AIDS treatment and management of complicated pediatric cases. Infrastructural expansion at 4 of the CCCs is underway to create a pediatric/adolescent friendly environment, training of 25 health care workers on pediatric ART and care management based on the revised MOH pediatric guidelines, sensitization of 15 other HCW on the new pediatric guidelines, laboratory support on the monitoring of children on treatment, adherence support, pediatric nutritional assessment and counseling procurement of equipment required to carry out effective nutritional assessment, micronutrient supplementation according to WHO guidance have been provided.

In FY 12 and 13 KDOD will continue to prioritize activities geared towards improving access to quality pediatric care services across all the military treatment sites. The scope of care services to be provided will include; EID, linkage to care & treatment, clinical monitoring, prevention and treatment of OIs & other HIV related ailments, malaria, pneumonia, diarrhea, and pain symptom management. The program will also provide other components of the minimum package of pediatric basic health care and support including provision of cotrimoxazole prophylaxis, nutritional assessment and support including supplementation & treatment for nutrient deficiencies, deworming, and psychosocial counseling & support. Scaling up of pediatric HIV care and treatment services through health system strengthening will be achieved through improving pediatric diagnostic services as well as follow up and referral systems. Efforts towards networking all the 12 PMTCT sites to an EID laboratory close to their locations will be made. Expansion on the use of HIV rapid antibody testing in children will be supported. To ensure appropriate disease staging and treatment monitoring capacity, the program will support availability of CD4 cell counts and percentages as well as hematology and biochemistries. To ensure quality pediatric care provision, KDOD program will support in-service training for 30 HCWs on Basic Health Care and Support, EID, nutrition and psychosocial counseling and support. The program will support ongoing mentorship for HCWs to initiate and maintain children on care and ART with quarterly supervision by regional pediatricians and other qualified physicians. The program will put efforts on the special challenges for pediatric and adolescents psychosocial and social support needs by working with families and caregivers, supporting activities of adolescents post test clubs, holding forums to address caregivers concerns and needs as well as supporting disclosure and informing about HIV, treatment and care adherence. The program will support the development of an Electronic Medical Record System to aid systematic data collection and timely reporting on pediatric ART in line with the Kenya MOH and PEPFAR guidelines.

The Kenya Department of Defense (KDOD) HIV program offers comprehensive health services needed to reduce HIV related morbidity and mortality within the Kenyan Military population. The Kenya Military has an estimated population of 135,000 service personnel and their families. The military population is spread out through the country and has a battalion deployed internationally for peacekeeping duties.

The KDOD program has been a key player since 2004 in the origin of PEPFAR in Kenya. In FY 2005, KDOD initiated the development of a basic data system for documentation of individual patient and will continue to phase in a data collection, recording, monitoring, reporting, dissemination system to all other treatment and prevention sites in line with the national protocols. Support in provision of the necessary data automation computerized systems and other communication equipment required for electronic entry of patient-encounter data, internet system for information sharing and real time submission of reports will be strengthened. A functional Electronic Medical Records system to all the 10 comprehensive care centers to support clinical management and program reporting with initial emphasis in ART program and a long term goal of expanding to other areas will be rolled out. In addition, strengthening of the paper based system in other medical reception stations and base medical centers within Army, Air Force and Navy to be able to collect, manage, analyze, generate routine reports and carry out cohort analysis will be enhanced. The military reporting system will be strengthened to be able to report all the health data and information needs within KDODS and link it to the national system. Supervisory support, Data Quality Assessments and mentorship visits including reporting tools for implementation and operationalization of next generation indicators will be supported. Regular stakeholder meetings to discuss disseminate/evaluate reports and Quality Improvement teams in 9 regions will be supported to enable continuous use of information for routine programming and better patient management. Capacity building to KDF for HIV behavioral and biological surveillance, surveys, monitoring program results and support to health information systems will be enhanced. Monitoring and Evaluation site visits, baseline and end term program routine assessments to identify risk factors and provide evidence based prevention services to reduce risk of transmission or acquisition of HIV infection will be conducted and a functional Surveillance system will be rolled out to all PMTCT and HTC sites to monitor HIV incidence.Activities to strengthen KDF capacity to monitor clinical HIV programs including HIV program inputs, costs, activities, outputs and outcomes collected through routine monitoring and with special attention to data quality and data use for strategic planning and decision making including roll out of the new M and E curriculum and SOPs will be conducted. More emphasis will be geared towards capacity building, sustainability and collaborative activities in engaging with the Ministry of Public Health, Ministry of Medical services and Ministry of Defense from the highest government level to the military hospitals and medical reception stations in which direct patient care is executed. The program will continue to support implementation and monitoring of the 5 year strategic plan in line with the national strategic plan.

With PEPFAR support through implementing partners, VMMC services delivery in Kenya began in 2008, ensuring that the defined minimum package(opt-out HTC for VMMC client and their partners, age appropriate sexual risk reduction, counseling on abstinence during the six weeks of healing period and promotion of correct and consistent condom use) is implemented according to the national guideline. The Kenya military recruits approximately 3,500 young men in the age group 18 26 years old annually. This group is highly vulnerable to HIV infection and other STIs. In FY2010 KDOD received support from PEPFAR to implement male circumcision in the military in response to the KNASP Priority 1- prevention of new infections including a targeted focus. In FY2010 a total of 113 individuals were reached with VMMC services. In FY2012/13 KDOD intends to provide a comprehensive male circumcision package to 1000 male troops. This target will contribute to the national target of 671,797. The activity will focus on the troops as well as support the maintenance of healthy partner relationships that will significantly reduce risks related to acquisition of HIV. Kenya rolled out the male circumcision program in 2008 targeting uncircumcised males to reduce risk of getting HIV. KDOD will continue to align the male circumcision intervention to GOK policy and guidelines. KDOD recruits from both circumcising and non-circumcising populace. It is estimated 3 -5 % of Kenya military male soldiers are uncircumcised. In FY2012/13 KDOD VMMC services will be concentrated within the military medical establishments and detachments distributed nationally. In FY2010 a total of 28 health care workers were trained to provide male circumcision services in the military. In FY2012/13 KDOD intends to train 24 additional health care workers to ensure adequate capacity to provide services to troops deployed in static units and detachments. Core activities include training on VMMC in line with national guidelines, awareness creation, quality assurance, equipment and commodities procurement, CT provided on site, pre and post operative sexual risk reduction counseling, active exclusion of symptomatic STIs and syndromic treatment when indicated, provision and promotion of correct and consistent use of condoms, circumcision surgery and link to care and treatment. The program will leverage on the well established MAP program to disseminate correct information on VMMC. In addition Commanding Officers barazas, Padre Hour and mobilization activities will be used to create demand for VMMC among the troops.This activity is part of a comprehensive HIV prevention strategy within KDOD linked to other services such as CT, AB, OP, PwP and ART. This activity will target the military troops, their dependents and KDOD civilian employees. Training will target health care workers. This activity will increase the level of HIV prevention interventions among the target group in the military. Intensified campaigns to educate the troops on the benefits of VMMC will be undertaken. Monitoring and Evaluation will be undertaken to ensure the program meets its target and quality assurance procedure are adhered to. Continuous monitoring of the activity will be undertaken in line with the national operationalised tools and practices.

Every year KDOD appx recruits 3500 young men and women age group of 18-25 yrs. The aim of focusing on this group is to catch them early in their lives and careers and instill life skills, values and norms consistent with AB thus helping to protect them against HIV infection at an early stage in their military career which by its very nature exposes them to the high risk of acquiring HIV. In FY10 KDOD through MAPP scaled up prevention interventions that focus on the recruits and in and out of school dependents of military personnel living in the camps. This activity aims at identifying young people early at the entry point of their military careers and targeting specific behaviors that are consistent with ensuring the prevention of HIV. This program has had a positive impact in building skills that protect the military personnel against HIV infection. In FY12, the program through Evidence based intervention will focus on healthy choices, family matters and PwP to address pervasive gender stereotypes and male behaviors that are relevant and which continue to be risk factors for HIV transmission. Due to the wide distribution of KDOD military personnel in remote areas of the country, 25 peer educators will be trained on Evidence based intervention with the aim of strengthening awareness and rolling out behavior change intervention through small groups, integration of the curriculum into regular KDOD training both at the basic training stage following recruitment and into the ongoing cadre course training will also be considered. The per educators will be empowered to conduct small groups sessions of not more than 15 participants of which each group will be followed for at least 3 times. The small groups will be targeted with behavior change information messages. The evidence based intervention curriculum will be merged with other HIV prevention curriculum into standardized training material to ensure the Prevention messages remain relevant. In FY12, KDOD AB activity will also focus on the in and out of school dependents of the military personnel between 13 and 24 years with the development of a peer education program which addresses issues of youth HIV prevention. KDOD intends to promote greater command-level involvement and ownership in all aspects of HIV prevention in the military through seminars and workshops to ensure program sustainability. The major emphasis of the AB component of the program will contribute to the outcome of changed social norms that promote HIV prevention behaviors among this age group who are classified as highly vulnerable to HIV infection. In FY12 KDOD targets to reach a total of 19500 additional individuals with messages that promote HIV prevention through AB. AB activities within the KDOD program will contribute to FY12 prevention targets for Kenya, especially among young newly recruited. The involvement of both male and female in AB activities will promote increased gender equity in HIV Programs to ensure women are not left out in prevention activities. AB activity is linked to KDOD CT activity by promoting VCT/PITC services as a way of promoting secondary abstinence. It is also linked to the KDOD Condoms and OP activity by offering comprehensive prevention messages for the military community Those who are HIV -VE will be encouraged to maintain a negative status while the positives youths will benefit from early entry to care. KDOD will conduct quarterly M&E to ensure targets are achieved & objectives met.

Kenyas Department of Defense (KDOD) has received support from the Emergency Plan to implement a comprehensive HIV/AIDS program since FY 2004. One of the key components of this program is HIV counseling and testing (CT), which is useful, both for prevention and access to care. A large majority of the military personnel and their families are young. Military personnel can be classified as high-risk, often deployed away from their families, hence the need for comprehensive HIV/AIDS program, including CT in the military. In FY 2010 KDOD has seen scale up in CT activities through different CT approaches including VCT 13,120, Moonlight/outreach 2,062 and PITC 3,185. In FY 2012/2013 KDOD will scale up CT through an integrated approach (PITC, VCT, mobile outreach and moonlight,). In FY2010, 156 health workers were trained in PITC.KDOD intends to train additional 100 health care workers and 20 counselor supervisor who will ensure adequate capacity to provide CT services to an additional 20,000 troops, their dependants and KDOD civilian employees. In FY 2012/13, the KDOD program will intensify mobile/moonlight HCT services to the Military in Hard to reach high prevalence areas and detachment camps and will increase integration of CT services in the military health care system. This will improve access to HIV prevention and better care services in remote areas. To contribute to the national target of reaching 80% of population with CT services, the KDOD strategy will target Formations/units, workplace and detachment camps. Couple counseling to identify discordant couples, promote disclosure, positive living and reduce stigma at family level will be enhanced. Discordant couples will be targeted with prevention strategy and referred appropriately. Military logistics support to provide CT services to the underserved areas in the North Eastern Province with heavy military presence will be utilized. MIPA will be strengthened as one of the ways of reducing stigma associated with CT. This activity is part of a comprehensive HIV care and treatment program within the KDOD linked to other services such as AB, OP, MC, TB/HIV and ART. Referrals and linkages between CT services and care outlets will be strengthened to improve care and support opportunities within KDOD health facilities through PEPFAR funding. Intensified campaigns to educate the military personnel, their dependents and KDOD civilian employees on the benefits of HTC services, couple HTC and mutual disclosure of HIV status will be undertaken. Quality assurance (QA) for both counseling and testing will be expanded to cope with increased service uptake in keeping with national standards through 1) counselor Support supervision. 2) Sample DBSs to National reference labs and results monitored. 3) Monitoring & Evaluation for quality service delivery. Rapid assessments and surveys will be conducted to assess risky behaviors and evidence based interventions implemented, monitored and evaluated to show outcomes.

The Kenya military population is estimated at 135,000 people (troops, dependents and KDOD civilian employees). Every year approximately 3,500 young men and women in the age group 18 to 24 years old are recruited. This group comprises of sexually active population and therefore highly vulnerable to HIV infection and other STIs. This activity aims to strengthen HIV prevention in the Kenya Department of Defense (KDOD) focusing on activities geared to promote prevention of HIV and STIs by training 30 additional health care workers aimed at integrating HIV prevention in their STI diagnosis and treatment. In addition, in FY 2012, KDOD will intensify HIV/AIDS prevention through behavior change messages that will be disseminated through seminars and workshops targeting 22,000 military personnel, their dependants and civilians working in the military. Special forums that promote knowledge, correct and consistent condom use will be strengthened. This activity will target this most at-risk population of the military personnel, their dependants, KDOD civilian employees and female sex workers (FSWs) living adjacent to military barracks within four geographical areas in Kenya specifically Gilgil, Nanyuki, Isiolo and Mombasa, all of which are known to have a high concentration of FSWs. Although STI basic care will be offered in all the military medical facilities, the program will concentrate on four military regions with a high population density which includes Thika, Kahawa, Embakasi and Moi Air Base. Liaison will be enhanced between the KDOD, National AIDS and STI Control Program (NASCOP) and the Division of Family Health to ensure high quality of care and training of health care workers in STI. In addition, KDOD will strengthen activities that focus in reducing the risk of HIV transmission among high risk occupational settings by promoting the knowledge on correct and consistent use of condoms among this high risk group. Special focus will be on the young recruits entering the military who on entry are HIV negative. Though this group is being targeted through the youth focused program referred to as Men as Partners (MAP) under the ABY program area, this funding will support condom education and promotion as a supplement to the ABY program activities in order to provide a comprehensive prevention program. This activity will address the issues of male norms and behaviors which promote engaging in HIV risk behavior, especially in this high-risk community of the military. KDOD also intends to continue scaling-up command involvement and support in promoting behavior change activities by conducting regular trainings, organizing seminars and workshops for the military. The KDOD OP program will also address stigma and discrimination that often is a significant obstacle to routine CT services and the use of condoms. Measures will be put in place to ensure availability of condoms in all the military formations country-wide by maintaining 40 condom outlets throughout the military bases. Regular monitoring of condom uptake by military personnel will be done on a monthly basis by the personnel under their respective commands. This activity linked to counseling and testing (CT), prevention of mother-to-child HIV transmission (PMTCT). This OP activity is also linked to ABY activity by partnering with other prevention activities that promote a comprehensive approach to prevention for the military population.

The Kenya Department of Defense, (KDOD) program provides health care to approximately 135,000 military personnel, dependants, and civilian employees. In FY 2012/13, KDOD will continue to strengthen and expand Prevention of Mother-To-Child Transmission (PMTCT) services in 14 of the 40 military units sites nationwide. Of the total military population, approximately 30,000 are women, 16% of who are within the reproductive age group (estimated 4,800 births per year). Of these, only about 50% (2,000) births are conducted within the camps, since most families reside outside the barracks. An estimated 93% of all pregnant women will receive HIV counseling and testing (2095 in FY12 and 2200 in FY13). The PMTCT prevalence in KDOD has been estimated to be about 3.5%. This is based on surveillance data collected over a period of 3 years. 85% of all the HIV positive pregnant women will receive maternal prophylaxis. Kenya has adopted WHO option A for PMTCT, and currently 30% of HIV+ women will have a CD4 of < 350 and therefore they will be eligible for HAART. An estimated 40 % of the women will be on prophylaxis using maternal AZT. An estimated 20% of women will arrive in labor at first contact and these will receive single dose Nevirapine.Non-breastfeeding infants and all infants of mothers on HAART will receive Nevirapine syrup daily up to 6 weeks of age. AZT syrup will be used as an alternative for infants of mothers on HAART. Breastfeeding infants will receive Nevirapine syrup daily for the duration of breastfeeding up to 1 week after cessation of breastfeeding. Lamivudine syrup will be used for infants hypersensitive to Nevirapine .Cotrimoxazole prophylaxis will be provided to all HIV exposed infants and their mothers. Counseling on infants feeding will also be provided. For capacity building and sustainability, KDOD will train 30 health care providers in PMTCT. A further 130 health care providers will receive refresher training on PMTCT using Ministry of Health guidelines. Quality assurance will be ensured through establishment of a strategic information and monitoring system that will facilitate data analysis. Regular consultations and sharing of experiences within the military and with the MOH will be undertaken in an effort to improve PMTCT services and strengthen follow up of infants born to HIV infected women. KDOD will undertake minor site PMTCT repairs as necessary. This activity will contribute to overall PEPFAR and Kenya government national goal of universal access to PMTCT services by contributing 0.1% of the overall national target. All facilities providing MCH services will be strengthened to deliver integrated PMTCT interventions around the 4 prongs. Capacity to provide essential commodities and equipment for PMTCT and strong management systems and laboratory logistics will be prioritized. Linkages between PMTCT service and care outlets will be strengthened to improve utilization of care opportunities created through PEPFAR funding. Emphasis will be placed on primary prevention for the majority of women identified as HIV negative through PMTCT programs. KDOD plans to enhance greater involvement of people living with HIV and AIDS (GIPA) through the facility and community based psychosocial support groups, Mentor Mothers, Prevention with Positive (PwP).The KDOD also will continue to offer sexual partner testing targeting 500 men through PwP initiative.

Tremendous progress in the provision of adult ART to the KDOD program has been made in the last 6 years, ensuring provision of ART to over 1800 and HIV care services to 3500 soldiers and their dependants including populations living in the neighborhood of the military barracks. The KDOD program will continue to support 10 military ART sites.

A comprehensive package of services offered to all HIV + patients at each of the ART clinics includes assessment for ART eligibility; ART for those eligible; lab monitoring with CD4 testing; psychosocial counseling; adherence counseling; nutritional assessment supplementation; prevention with positives (PwP), OI diagnosis and treatment, including TB services and defaulter tracing. The target population is 135,000 people including military personnel and their dependants and civilians living in the neighborhood of the military barracks. Over the past 7 years, the program has employed several strategies to improve programmatic efficiencies and allow for continued expansion. These strategies include decentralization of ART services to lower level facilities, integration of ART in MCH and TB clinics, leveraging MOH and MOSD funds to support ART activities including training of HCWs, constructions, procurement of laboratory equipment and drugs for OI. Joint review and planning meetings with KDF will be continued to ensure joint commitment towards achieving the set goals.

So far more than 100 KDOD medical personnel have received in-service ART training including orientation on the newly revised MOH guidelines. However due to competing medical and other military duties, only a few remain available to run the clinic on a day to day basis. In FY 2012, 60 HCW will be trained on comprehensive adult and pediatric HIV/AIDS treatment and care. Trainings will be decentralized to 4 regions of the military. Close onsite supervision is provided on a daily basis by locally deployed HJF staff. Quarterly Monitoring and Evaluation and mentorship exercise is done jointly between HJF and KDF technical staff.

Facility Quality improvement teams have been formed to focus on quality improvement of HIV services provided at each of the treatment sites. Development of quality of care indicators for monitoring the quality of HIV clinical services was initiated in 2009. The program routinely collects data on treatment outcomes as well as program level data using both paper and electronic based database. In order to improve retention of patients initiated on ART, the program supports a telephone defaulter tracking system. 9 peer educators are engaged in the provision of adherence counseling and defaulter tracing. The program supports adherence promoting activities such as adherence measurement using self report, pill count, CD4 and Viral load monitoring. Activities of post test clubs and youth friendly clinics are supported. In order to promote transition to local ownership and build sustainability of ART service delivery, the program has continued to encourage the integration of HIV care and ART plans into the annual Military performance. The program has also continued to support and strengthen the capacity of the Kenya Defense Forces HIV structures from the Unit HIV committees at the lowest military establishment to the Armed Forces AIDS Committee at the highest level. High level command sensitization is maintained in order to promote ownership of the program.

By the end of August 2011, the KDOD program had enrolled 256 children. Of these 198 have ever been on ART and 139 were actively receiving ART. The average newly enrolled on ART is 25 children per annum. In FY 12 and 13, EP funds will be used to support 24 and 28 newly enrolled on ART respectfully, 140 and 154 current on ART respectively. This activity will contribute to Kenyas goal of providing scaling up PDTX for HIV infected children 0-15 years of age.

EP funds have been used to support pediatric treatment activities including; strengthening of the DFMH to serve as a referral center for HIV/AIDS treatment and management of complicated pediatric cases, infrastructural expansion at 4 of the CCCs has been undertaken in order to create a pediatric friendly environment. Training of 25 HCWs on pediatric ART management based on the revised MOH pediatric guidelines, sensitization of 15 other HCW on the new pediatric guidelines, laboratory support on the monitoring of children on treatment, adherence support, pediatric nutritional assessment and counseling before and during ART will be conducted. Procurement of pediatric weighing scales, stadiometers, MUAC tapes and other equipment required to carry out effective nutritional assessment will be obtained. Micronutrient supplementation according to WHO guidance will be provided. In line with the national dialogue regarding an increased role of nurses in AIDS treatment, KDOD is focusing on mentoring and training nurses on all areas of HIV in order to facilitate task shifting. ARV drugs are supplied to the sites through the distribution system of Kenya Pharma while the KDF funds the procurement of 80% of the required medications for the treatment of opportunistic infections.

In FY 12 & 13 KDOD will continue to prioritize activities geared towards improving access to quality pediatric ART services across all the military treatment sites. Several distinct efforts will be supported to accomplish this. They include support of the process of implementing the updated treatment recommendations for infants and children by holding sensitization seminars for 20 HCWs drawn from all the military treatment sites, providing in-service pediatric ART training to 20 HCWs mainly nurses, clinical officers and doctors. Printing guidelines and developing job aids and training materials for implementation at clinical sites will be conducted. The program will support ongoing mentorship for HCWs to initiate and maintain children on ART with quarterly supervision by regional pediatricians and other qualified physicians. Scaling up of pediatric HIV care and treatment services through health system strengthening will be achieved through improving pediatric diagnostic services as well as follow up and referral systems. Expansion on the use of HIV rapid antibody testing in children will be supported. Through the Lab Infrastructure, the program will support the development for EID networking between the PMTCT sites and the national EID Labs. Networks between all pediatric treatment sites with the referral lab at DFMH will be strengthened to ensure access to Viral load monitoring for all enrolled children. To ensure appropriate disease staging and treatment monitoring capacity, the program will support availability of CD4 cell counts and percentages as well as hematology and biochemistries. The program will support systematic data collection and reporting on pediatric ART in line with the newly revised M and E tools.