The goal of this mechanism is to provide technical, financial and logistical support to improve program management and implementation capacity of the non-military uniformed services in Kenya. The project has 3 main objectives: a) Improve the capacity of the AIDS control units of the uniformed services departments b) Improve and expand activities to increase healthy behaviors among uniformed services personnel, families and surrounding communities c) improve and expand uniformed services facility-based TB and AIDS Prevention, care and treatment services.Implementation of this project is by officers of the Uniformed Services agencies and Ministry of Medical Services clinical personnel. This ensures efficiency in service delivery and builds upon existing structures. The HIV services are complemented by other wrap-around services provided in these institutions.ARIFU is a capacity-strengthening mechanism with a goal of transitioning these GoK partners to full ownership of the program at the end of the five-year project period. It has developed a strong training and mentorship program for the officers and service providers and is working at ensuring that ACUs in all regions can efficiently manage the programs.Two vehicles were purchased in FY08 and four in FY10. All are four-wheel vehicles which are used for field work and supportive supervision to over 55 districts. Many project sites are hard-to-reach. One vehicle is assigned to each agency ie PATH, EGPAF, Police, KWS, NYS, AP for logistical support given the vehicle shortfalls within GoK.

Please note that target populations, geographic coverage, and M&E plans are addressed in budget code narratives.

This activity supports GHI/LLC.

Program for Appropriate Technology in Health (PATH) Uniformed Services Program will support non-military uniformed services personnel families and surrounding communities. PATH has been supporting HBHC activities and increased the capacity of the AIDS Coordinating Units (ACUs) and sub-ACUs in each of the four uniformed services to facilitate the delivery of high quality HIV care services for personnel, their families, and surrounding communities. By March 2011 PATH had cumulatively enrolled 321 patients in HIV care and of these 286 were active and placed on cotrimoxazole prophylaxis.

PATH 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 466 current adult patients in FY12 and 708 current patients in FY13.

PATH will offer comprehensive care and support package of services 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+ patients; prevention with positives (PwP); and cervical cancer screening to all enrolled women.

PATH, in collaboration with MoH, will support targeted capacity building (training and mentorship) for health care workers and offer continuous medical education on care and support, e.g. OI diagnosis and treatment. PATH will identify areas with staff shortages, support recruitment of additional staff, and support good commodities management practices to ensure uninterrupted supply of commodities.

PATH will also support ongoing community interventions for HIV infected individuals, including peer education and use of support groups to provide adherence messaging; effective and efficient defaulter tracing and follow up to improve retention in all facilities; 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. PATH will also 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 such as supporting male peer educators, mentors, and support groups.

PATH will continue to strengthen data collection and reporting at all levels to improve reporting to National AIDS & STI Control Programme (NASCOP) and PEPFAR. PATH will do cohort analysis and report retention rates as required by NASCOP. New generation indicators will be adopted and PATH will support the development and use of electronic medical records system in accordance with NASCOP guidelines. PATH will adapt 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. PATH will support joint Annual Operation Plan (AOP) development, implementation, monitoring and evaluation, and health system strengthening to facilitate sustainability.

The Uniformed services program targets all the non military personnel and their families including the communities around their bases with HIV prevention activities throughout the country. The uniformed services officers include the Police, the National Youth service, the Kenya wildlife service and the Administration police. The approaches used for provision of HTC include PITC in the supported facilities and home based testing for index clients on care and treatment. Client initiated testing and counseling in stand - alone and integrated VCT sites. A major approach that yields many clients reached is outreach services during special events like their national sports days national holidays celebration, recruits and platoons visits.In the last year they had a target of 20,000 clients to be reached with testing and counseling services and they surpassed that target and reached 25,000 clients with the services. Out of these 45% came from stand alone VCT, 36% from HTC outreaches and 19% from facility based PITC.The program trained staff on new HTC guidelines 45 participants, couple HTC and quality assurance.HIV positive clients are referred to care and treatment services in the facilities within the camps. Psychosocial groups have been established making the platform for offering PwP services.

In 2012 the program will continue to provide quality HTC services reaching a target of 40,000 out of which 20% will be couple testing and counseling and 60% will be new testers. The emphasis will be laid more on covering the uniformed servicemen as opposed to general population around them. The clients testing HIV positive will be linked to care and treatment immediately their facilities. The program uses the national guidelines and algorithm for testing and counseling. The program will expand to cover the whole country, train and empower Soldiers of Hope who are living with HIV to encourage testing and adherence to treatment among the peers. These activities will be incorporated in combination prevention. Capacity building for service providers will be expanded using innovative strategies of mentorship, CMEs and structured training.The program follows the national quality management guidelines and participates in the proficiency testing quarterly and collection of DBS for the 20th client tested and counseled per counselor. Support supervision is carried out for the service providers on continuous basis. Quality services are also ensured by adherence to national guidelines, use of national certified kits.The national M&E framework is used including use of national registers and data collection tools and reporting will be through the DHIS in future. The program will develop work plans and conduct biannual data quality audits and monthly data supervision is carried out and this informs the program implementation improvement.New indicators like couples tested, discordant couples have been incorporated in the data collection tools.Promotional activities are conducted by peer mobilization, supply of IEC materials and mass media from the national perspective on the need to know status.

PATH will continue to provide technical assistance and capacity strengthening to 79,000 members of the Kenya uniformed services which comprise the Kenya Police service, Administration Police Service, Kenya Wildlife Service and the National Youth service through the ARIFU Project. The ARIFU mechanism targets three broad categories of Uniformed Services population: the officers at their workplace, their families living within the camps and the surrounding community members who access services in the camps.In FY2012/2013, ARIFU will expand HIV prevention services to include evidence-based behavioral interventions targeting the sub-groups within their camps. This will comprise the following:Prevention among adolescents and adult PLHIV will receive Positive Health and Dignity Prevention (PHDP). This is a 5-10min group and individual level intervention that targets HIV infected persons in clinical and community settings, focusing on knowledge of status, partner testing, risk reduction counseling including condom use and partner reduction, supportive disclosure, adherence counseling, STI assessment and treatment and family planning counseling. This mechanism will recruit and support peer educators and counselor to reinforce prevention messages delivered by health providers, conduct client home follow-ups for adherence as a feasible model for task shifting.Sexually active youth will receive the Healthy Choices II intervention. It targets youth 13-17 years, in out-of- school settings and focuses on safer sex, condom use, negotiation and communication skills. HC2 consists of 8 one-hour modules.Uniformed services women, including young women recruits, servicewomen and officers will receive the Sister to Sister intervention. This 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.Uniformed officers at the workplace will receive the RESPECT intervention. This is a brief individual sessions targeting general population and youth, originally for heterosexual negative persons. It focuses on reduction of STDs/HIV, risk reduction, condom use and clients understanding of personal risk. Safe in the City, a video-based intervention will also be used at clinic waiting bays and youth centers.Quality assurance of all EBIs is promoted through rigorous training and certification of facilitators, ongoing process monitoring with standardized tools, and quality assurance site visits. MOPHS will further provide technical support across regions including joint stakeholder meetings and regular supervision visits to assure quality implementation of prevention activities.

Program for Appropriate Technology in Health (PATH) has been supporting adult HIV treatment activities and increased the capacity of the AIDS Coordinating Units (ACUs) and sub-ACUs in each of the four uniformed services to facilitate provision of high quality HIV treatment services for personnel, their families, and surrounding communities. As per 2011 SAPR results, PATH had supported 100 adults ever initiated on ART, of which 46 were current. PATH will continue to support HIV adult treatment, ACUs and sub ACUs.

In FY12, PATH will jointly work with the Ministry of Health (MoH) and the uniformed services to continue supporting expansion and provision of quality adult HIV treatment services in line with MoH guidelines to 175 patients currently receiving ART and 123 new adults resulting to cumulative 210 adults who have ever been initiated on ART. In FY13, this number will increase to 267 currently receiving ART and 125 new adults resulting to 335 adults who have ever been initiated on ART.

PATH, in collaboration with MoH, will support in-service training of 30 and 20 health care workers in FY12 and FY13 respectively, identify human resources and infrastructure gaps and support in line with MoH guidelines, and support good commodities management practices to ensure uninterrupted availability of commodities.

PATH will support provision of a comprehensive service package to all PLHIV including ART initiation for those eligible; laboratory monitoring including biannual CD4 testing and viral load testing for suspected treatment failure; 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.

PATH will continue to support activities 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. PATH will support provision of friendly services to youth and special populations. PATH will adopt strategies to ensure access and provision of friendly HIV treatment services to all including supporting peer educators, support groups, disclosure, partner testing, and family focused care and treatment.PATH will adapt the quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV treatment services integrate them into routinely collected data; use the results to evaluate and improve clinical outcomes and additionally support short term activities with great impact and better patient outcomes. Additionally, PATH 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. PATH will continue to strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. Use of an electronic medical records system will be supported and strengthened.