Goals and objectives: The projects goal is to expand access of high quality HIV prevention, care, and treatment services through building technical and institutional capacity of 31 local non-governmental organizations (NGOs). The project also supports Ministry of Public Health and Sanitation (MoPHS) to formulate policies and develop guidelines to implement HIV Prevention evidence-informed behavioral interventions (EBI). Capacity building of local NGOs is aligned to the Kenya Partnership Framework and PEPFAR guidance so as to ensure sustainability.

2. Cost-efficiency strategy: This mechanism funds 31 local NGOs directly, with increasing levels over 5 yrs. In COP 2012, 88% of funding will be allocated to sub-grantees. Technical capacity for EBI service delivery fidelity will be done, and delivered through combination prevention for efficiency and effectiveness. At prime partner level, staffing will be streamlined and technical assistance will be targeted.

3. Transition to country partners:

The project is supporting the MoPHS to adapt more effective interventions, formulate policies and guideline on HIV Prevention and as such ensures country ownership. In addition, it supports 32 local NGOs to build their technical and institutional capacity for continued HIV prevention, care and treatment service delivery. Sub-grantees are thus expected to compete and secure funding on their own in future.

4. Vehicle information: 2 vehicles were procured in FY10 and 1 vehicle in FY11 for a total of 3 project vehicles. These vehicles are used by project staff to support sub-grantees in technical assistance and mentoring to the projects sub-grantees and local MOH partners. No vehicle will be procured with FY12 funds.

This activity supports GHI/LLC.

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) TUNAWEZA project builds capacity for indigenous organizations to ensure sustainability of HIV/AIDS interventions. They will work with sub-grantees namely; Catholic Diocese of Lodwar, African Inland Church, Lodwar District Hospital, Beacon of Hope, Tumaini Medical center, Share our Sorrows childrens home, and Our Lady of Perpetual Support to provide technical assistance through mentorship, supportive supervision and direct implementation of adult care and support activities in Rift Valley, Nyanza, Nairobi and Eastern regions.TUNAWEZA will work with the MOH at all levels to jointly plan, coordinate, implement and ensure provision of quality HIV care and support to 3816 current adult patients in FY12 and 4045 in FY13. TUNAWEZA will offer comprehensive care and support package of services including HIV testing to partner and family members of index patient 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.TUNAWEZA will support targeted capacity building (training and mentorship) for health care workers and additionally offer continuous medical education on care and support e.g. OI diagnosis and treatment. TUNAWEZA will identify areas with staff shortages, and support recruitment of additional staff; support good commodities management practices to ensure uninterrupted supply of commodities. TUNAWEZA will support ongoing community interventions for HIV infected individuals, including education by peer educators and use of support groups to provide adherence messaging, effective and efficient defaulter tracing and follow up will continue to be supported and strengthened 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; food and nutrition or/and food security programs. They 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. TUNAWEZA will continue to strengthen data collection and reporting at all levels to improve reporting to NASCOP and PEPFAR. Cohort analysis will be done and report retention rates as required by the NASCOP. TUNAWEZA will adopt the new generation indicators support the development and use of electronic medical records system in accordance with NASCOPs guidelines. TUNAWEZA will adapt the quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV care and support services and integrate them into routinely collected data and use the results to evaluate and improve clinical outcomes. TUNAWEZA will support joint Annual Operation Plan (AOP) development, implementation, monitoring and evaluation and health system strengthening to facilitate sustainability.

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) through its local partners will support 2,000 OVC in FY12 and 5,000 OVC in FY13 with access to essential services. EGPAF will train 200 caregivers, and build the capacity of local, community and faith-based organizations, to meet the needs of OVC in their communities. EGPAF will continue to work in Nyanza, Rift Valley and Nairobi Provinces and will support the partners to provide critical services to OVC which include providing a comprehensive package that includes education, shelter, nutritional support, psychosocial support, support to OVC caretakers; which provides education and clothing, while linking OVC to other critical services and economic strengthening activities. EGPAF will target all OVC aged between 0 and 18 years and will provide 6 plus 1 services and report on at least 3 services which they provide to the OVC based on individual need. By March 2011, EGPAF had achieved the following: 1914 OVC served; 916 of OVC received primary direct support (PDS); 998 of OVC were provided with Supplemental Direct Support (SDS) and 84 providers/caretakers trained in caring for OVC. EGPAF continues to experience challenges in capacity building, partner linkages and networking to the local partners. In the next two years EGPAF will focus on strengthening HIV prevention education among OVC to equip them with life skills that would reduce their vulnerability to the risk of HIV infection. EGPAF will start to implement OVC interventions that are evidence-based in order to achieve their two year goals. They will also train local organizations to strengthen the family support system and help to establish strong linkages between PLWHAs, HIV-infected children and health care services, including ensuring those children and their caregivers and other family members affected access appropriate care and treatment. EGPAF will work closely and link OVC with care and treatment partners to ensure that HIV-infected children receive appropriate psychosocial support and that they have a consistent caregiver to assure adherence to treatment. EGPAF will continue to work closely with District Children's Department and follow guidelines provided by the Ministry of Gender, Children and Social Development, as well as PEPFAR guidelines. EGPAF will support the local partners to establish partnerships and networks among other NGOs to strengthen their collective voice, build a unified approach, improve coordination, and share knowledge. EGPAF will embrace community and family centered approaches (such as the cash transfer program) that are preferred to institutional approaches and that they should explore OVC programming opportunities from a livelihoods approaches to OVC. There is limited information regarding current OVC programming in the EGPAF supported partners. EGPAF will undertake an OVC situation and gap analysis for its CBOs to document best practices and lessons learned for OVC and help the CBOs to explore new program approaches. EGPAF will also develop an OVC advocacy curriculum and provide training to CBOs and other OVC stakeholders. EGPAF will work with the local organizations to engage and advocate for OVC issues with key stakeholders in the Kenyan HIV/AIDS response, including donors. EGPAF will improve M&E systems based on rapid capacity and gaps analysis of the OVC activities they support. The program will also capture age specific services that are offered to OVC aged between 0 and 18 years.

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) TUNAWEZA builds capacity for indigenous organizations to ensure sustainability of HIV/AIDS interventions. They will work with sub-grantees; Catholic Diocese of Lodwar, African Inland Church, Lodwar District Hospital, Beacon of Hope, Tumaini Medical center, Share our Sorrows childrens home, Our Lady of Perpetual Support and the Kenya Association for Prevention of Tuberculosis and Lung Diseases (KAPTLD), to support TB/HIV activities in Rift Valley, Nyanza, Nairobi, and Eastern Provinces by providing technical assistance through mentorship and supportive supervision, and by direct implementation of TB/HIV activities. By March 2011, 118 TB/HIV co-infected patients were on ART and 633 TB patients had received HIV testing. In FY 12 and FY 13, TUNAWEZA will intensify efforts to detect TB cases through clinical exams, laboratory investigations and ensure successful TB treatment through provision of appropriate treatment. Facilities providing TB/HIV services will have adequate and well trained clinical staff supported by well equipped and staffed laboratory, including sputum specimen transport where laboratory services are unavailable. All TB patients on treatment will be monitored both clinically and through periodic sputum examination. To reduce the burden of HIV in TB patients, TUNAWEZA will ensure that at least 95% of TB patients are screened for HIV and 95%TB-HIV co-infected patients are put on cotrimoxazole and ARVs regardless of the CD4 count as per the national guidelines. TUNAWEZA 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 HCWs in FY12 and 60 in FY13 will be trained.

To reduce the burden of TB in HIV infected patients, TUNAWEZA will support intensified TB screening for 3392 in FY12 and 3596 in FY13 in their HIV care settings. 170 co-infected patients identified in FY12 and 180 co-infected patients identified 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, TUNAWEZA will ensure that adherence to the national IC guidelines at all sites and training of staff on IC is done. TUNAWEZA 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, TUNAWEZA 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. They will also support scaling up of drug-resistant treatment sites thus expanding access to MDRTB treatment. TUNAWEZA will support expansion of prevention with positive (PwP) services in TB clinics, strengthen linkages of facility and community-based services, and improve patient referrals and tracking systems. TUNAWEZA will continue supporting Kenya Association for prevention of Tuberculosis and Lung Diseases (KAPTLD) to finalize an ongoing survey to assess current TB diagnostic practices, current TB and TB/HIV management practices, service provision practices, and policy application/implementation among private health providers.

Elizabeth Glaser Pediatric AIDS Foundation-TUNAWEZA project will work with sub-grantees; Catholic Diocese of Lodwar, African Inland Church, Lodwar District Hospital, Beacon of Hope, Tumaini Medical center, Share our Sorrows childrens home and Our Lady of Perpetual Support to implement pediatric HIV care and support services in Rift Valley, Nyanza, Nairobi, and Eastern Provinces and also they will directly implement pediatric care and support services. Since 2009,

TUNAWEZA has been supporting PDCS activities in these regions and by March 2011 TUNAWEZA had 668 children enrolled in care of whom 487 are on cotrimoxazole prophylaxis. They will provide care and support services to 399 and 430 children currently on care in FY 12 and 13 respectively and also provide comprehensive, integrated quality services, and scale up to ensure 325 HIV infected infants are put on ARV prophylaxis and all HIV exposed children access pediatric care services. The focus of pediatric care services will be provision of comprehensive, integrated quality services including strengthening the use of the Mother-baby booklet, early infant diagnosis, provider initiated testing and counseling, and ensure those identified HIV infected are linked to care .

TUNAWEZA 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, malaria screening, treatment and provision of long lasting insecticide treated nets in malaria endemic areas.

TUNAWEZA will support integration of HIV services into routine child health care and survival services in the MCH 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.

TUNAWEZA will support hospital and community activities to meet the needs of the HIV infected adolescents: support groups to enhance disclosure and adherence messaging, PwP, substance abuse counseling, support for transitioning into adult services and teaching life skills.

Commodity access and infrastructure development will continue to be supported as will relevant trainings. TUNAWEZA will strengthen pediatric data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR.

EGPAFs activities focus on strengthening institutional capacity building for 31 indigenous organizations to improve HIV treatment, care and support services in Kenya. Overall, the mechanism seeks to build the capacity of Sub-grantees financial and human resource management structure. Specific system barriers to be addressed will include conducting a final review of their human resource regulations, code of ethics and finance policies. These barriers will be addressed through Providing training updates for all 31 sub-grantee Boards, reviewing human resource and finance policies as appropriate, Infrastructure improvement policies and developing sub-partners HIS system.

The mechanism envisage developing linkages with the MoH community strategy, Global fund and TOWAs reporting system as most of the organizations are community based. They will also be supported make applications for the current Global fund to Kenya Principal recipient, the Kenya Red Cross Society. Other linkages will be to identify and collaborate with on-going sustainable social programs to ensure the programs are more effective.

The target populations for service provision include Youth, MCH clients, PLHIV, fisher folk, sex workers and truckers. Those targeted for training include service providers, supervisors from implementing partners including members of the Turkana county District Health Management Team, members of the EBI TWG and Ministry of Health key staff at headquarters level.

Monitoring and evaluation are conducted through regular site visits for each sub-grantee. Overall monitoring will be through reports to CDC Kenya and the KePMS. In addition, EGPAF will be required to make progress presentations to CDC Kenya, Prevention branch. CDC Kenya staff will also conduct at least two visits per sub-grantee in a 12 month period.

EGPAF supports HVAB activities by providing technical support to the Government of Kenya in the development, packaging, and roll-out of a portfolio of evidence-informed behavioral interventions (EBIs) for HIV prevention, including interventions designed to delay sexual debut, reduce the number of sexual partners, and promote monogamy in relationships; by strengthening the organizational capacity of local agencies implementing HVAB programs; and by providing grants to local partners for implementation of evidence-based HVAB programming. For 2012/13, EGPAF and its partners will provide HVAB services in the following provinces and counties: Rift Valley (Baringo, Nakuru, Laikipia, and Narok counties), Nyanza (Migori, Kisumu, and Homa Bay counties), Western (Kakamega county), and Northeastern (Marsabit county). Within these jurisdictions, EGPAF will reach 81,098 (of 246,555) 10-14-year-olds, 22,189 (of 290,155) and 15-19-year-olds.

EGPAF and its partners will serve youth aged 10-14 with two EBIsHealthy Choices I (HC1) and Families Matter! Program (FMP). Older adolescents aged 15-19 will receive Healthy Choices 2 (HC2).

FMP is an EBI for parents of preadolescents and promotes positive parenting practices, positive reinforcement, parental monitoring, and effective parent-child communication on sexual topics and sexual risk reduction. FMP seeks to delay onset of sexual debut by training parents to deliver primary prevention messages to their children. HC1 targets in-school youth and aims to delay sexual debut by providing knowledge and skills to negotiate abstinence, avoid negative peer pressure, avoid or handle risky situations, and to improve communication with a trusted adult. HC2 provides older adolescents with the knowledge, confidence, and skills necessary to reduce their risk of STDs, HIV, and pregnancy by abstaining from sex or using other risk reduction strategies.

Monitoring, evaluation, and quality assurance of these EBIs is promoted through rigorous training and certification of facilitators, ongoing process monitoring with standardized tools, and quality assurance site visits by a CDC activity manager or other technical experts. EGPAF has put in place for all sites the following: use of approved national curricula; emphasis of importance of fidelity to the curricula; use of trained and certified facilitators; observation of practice implementation; use of standardized, national data tools at every stage of EBI implementation; and regular field visits by trained program staff to check on delivery of EBIs and offer support supervision.

Target population: The EGPAF mechanism provides technical assistance to 23 FBOs and CBOs to provide HTC services as part of the HIV combination prevention package targeting the general population with emphasis on couples in Nyanza, Rift Valley, Eastern and Nairobi Provinces. The respective regional HIV prevalence and HTC coverage rates vary. Eastern province has the lowest prevalence of 4.6% with testing coverage of 53% among women and 31% in men. Nyanza province with the highest HIV prevalence of 14.9% has testing coverage of 63.5% among women and 34.3 % among men. EGPAF will increase the number of CBOs/FBOs supporting HTC to a total of 32 and in target populations namely youth out of school, fisher folk, couples and the general population. The program will focus on increasing knowledge of HIV status among individuals who have never received HIV test and those with increased HIV acquisition risk.

Approaches: Services are primarily delivered through client initiated approaches at the community level. Settings include stand alone VCT, outreach/mobile HTC and door-to door HTC services.

Targets and achievements: During the first 9 months of 2010 COP, the program provided HTC services to 62,427 individuals surpassing the annual target of 50,000 and supported refresher training of 53 counselors on re-testing recommendation, QA and use of registers. In 2012 COP EGPAF will provide HTC services to 132,107 individuals with a target of 60% new testers and 30 % couples. Testing algorithm: The national testing algorithm is used.

Referrals and linkages: To ensure successful referral and linkage to ongoing care, the program has mapped out the respective Government and faith based HIV care and treatment sites and the community psychosocial support groups. The national (NASCOP) referral tool is used to refer clients from the HTC to care sites. Using structures within the national community health strategy, the program has trained the community health workers (CHWs) in working with HIV positive clients to facilitate linkage to care and treatment services. In collaboration with the HTC service providers and HIV care and treatment sites, the CHWs actively track the linkage of HIV positive client and follow up those who have not accessed. The CBOs also participate in respective district level forums that analyze and review the status of referral and linkage networks within the HIV prevention, care and treatment sites to ensure continuum of care.

Quality management: HTC service providers are trained and certified in line with the national guidelines. Service delivery including testing procedures, job aids and room set up to ensure confidentiality in counseling is in line with national standards. The sites participate in the national quality assurance strategy in proficiency testing and supervision.

Monitoring and evaluation: The program uses national tools for data recording and reporting. Data collected includes national and PEPFAR indicators such as individuals receiving HIV testing services disaggregated by age, sex, and couple.

Promotional activities: Since these are community groups, mobilization and demand creation for HTC services is undertaken through their existing peer led networks and structures in addition to mass media through a different mechanism. The groups use IEC material with key messages on the importance of accessing HIV prevention, care and treatment services, with the emphasis that HIV testing is the entry point.

EGPAF HVOP activities include: 1) providing technical support to the Government of Kenya (GOK) in the packaging and roll-out of HIV prevention evidence-informed behavioral interventions (EBIs), 2) strengthening the technical capacity of local organizations that are implementing HIV prevention programs, and 3) providing grants to local partners for implementation of evidence-based HIV prevention programming. The first of these efforts is a national initiative whereas the latter two support capacity development and prevention activities among 32 local partners. EGPAFs target populations are Youth aged 15-24, MCH clients, PLHIV, fisher folk, sex workers and truckers. EGPAF and its partners will provide HVOP services in the following provinces and counties: Rift Valley (Baringo, Nakuru, Laikipia, and Narok counties), Nyanza (Migori, Kisumu, and Homa Bay), Western (Kakamega), and Eastern (Marsabit). EGPAF will expand HIV prevention services to include EBIs in clinical settings at comprehensive care centers (CCC), TB and Maternal Child Health (MCH) clinics as part of combination prevention.

This mechanism supports efforts to adapt, package, and roll-out the following EBIs: Positive Health, Dignity, and Prevention (PHDP), Healthy Choices 2 (HC2), Sister to Sister (S2S), Respect, Eban and START. EGPAF will also support its partners to implement EBIs. PHDP is a 5-10 minute, group and individual level EBI for HIV infected persons in clinical and community settings, focusing on partner testing, risk reduction, condom use, disclosure, adherence, STI reduction, and family planning. HC2 has 8 one-hour modules and targets out of school youth aged 13-17 and focuses on safer sex, condom use, negotiation, and communication skills. S2S is a 20-minute individual level EBI that targets women of reproductive age and focuses on self efficacy, safer sex negotiation skills, and condom use. START is an individual level EBI targeting incarcerated men and men leaving correctional facilities. Eban is a couple and group level EBI targeting sero-discordant couples. It has 8 weekly 2-hour sessions that focus on risk assessment, enhancing couple communication, and shared health responsibility. RESPECT has 2 brief individual sessions and focuses on risk reduction, condom use, and clients understanding of personal risk. With guidance from the GOK, EGPAF will also support roll out of other EBIs including those targeting MSM and safe in the city

EGPAF will recruit and support peer educators (PE) to reinforce prevention messages delivered by health providers as a task shifting model in clinical PHDP. It will support placement of 5 PE at MCH, TB and CCC Clinics in hospitals and 2 PE at health centers and provide appropriate counseling space procuring 316 tents for hospitals and renovating 60 health centres. One PE within the hospital setting and another within the health centre will do regular client home follow up to strengthen ART adherence.

Monitoring of EBIs is promoted through rigorous training and certification of facilitators, routine KePMS, use of standardized MoH tools and quarterly reports. Quality assurance will be conducted through site visits, standardized MoH tools and support supervision.

Elizabeth Glazier Pediatric Foundation (EGPAF) - TUNAWEZA project builds capacity for indigenous organizations to ensure sustainability of HIV/AIDS interventions. In FY 12 and 13, they will work with sub-grantees; Diocese of Lodwar, Share our Sorrows, Beacon of Hope, Feed the Hungry, AIC Lodwar and Our Lady of Perpetual Support supporting PMTCT activities in Rift Valley, Nyanza, Nairobi and Eastern Provinces by providing tailor-made technical assistance through mentorship and supportive supervision as well as direct implementation of PMTCT activities. In FY12, EGPAF TUNAWEZA will offer HIV counseling and testing to 7,749 pregnant women at ANC and give ARV prophylaxis to 311 HIV infected pregnant women. The HIV infected women will receive a CD4 test after undergoing a WHO clinical staging. EGPAF TUNAWEZA will give HAART to all eligible HIV positive pregnant women in line with the revised PMTCT national guidelines. In FY13, EGPAF TUNAWEZA will increase the number of pregnant women counseled to 8,136, offer ARV prophylaxis to 378 pregnant women and 325 infants, and do EID for 325 infants. EGPAF TUNAWEZA will focus on 4 prongs of PMTCT: primary prevention; prevention of unwanted pregnancies, ARV prophylaxis to all HIV positive pregnant mothers and exposed infants, 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 /or treatment, ARV prophylaxis and treatment for both mother and baby, nutritional support, psychosocial support, PWP, follow up, retention, referral and linkages. TB screening will be incorporated into routine antenatal care. Efforts will be made to reach 2,441 of 1st 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. Integration of ART in MCH clinics and access to FP/RH services will be supported. Partner will establish or strengthen infection control and waste management activities. EGPAF TUNAWEZA 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. EGPAF TUNAWEZA will support safe infant feeding practices as per national guidelines and support enrollment and follow up of 325 of babies born to HIV infected mothers to access CTX, ARV prophylaxis and EID services using the HIV exposed infant register till 18 months. EGPAF TUNAWEZA will facilitate ART initiation for those who test positive before 2 years. They will adapt 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, streamlining M&E gaps (new MOH ANC/maternity registers) and utility 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. 60 Health Care Workers will be trained in FY12 and equal number in FY13 on PMTCT and orientation on the revised PMTCT, infant feeding guidelines, and community activities to increase demand creation for health services such as male involvement with couple CT services.

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) TUNAWEZA project builds capacity for indigenous organizations to ensure sustainability of HIV/AIDS interventions. They will work with sub-grantees namely; Catholic Diocese of Lodwar, African Inland Church, Lodwar District Hospital, Beacon of Hope, Tumaini Medical center, Share our Sorrows childrens home, and Our Lady of Perpetual Support to provide technical assistance through mentorship, supportive supervision and direct implementation of adult care and support activities in Rift Valley, Nyanza, Nairobi and Eastern regions. By March 2011 SAPR, they had enrolled 3,689 adult patients on ART, and 2,908 were active on ARTand 605 newly initiated on ART.

In FY12, TUNAWEZA will jointly work with the Ministry of Health (MoH) to continue supporting expansion and provision of quality adult HIV treatment services as per MoH guidelines to 3,780 patients currently receiving ART and 973 new adults resulting to cumulative 4,536 adults who have ever been initiated on ART. In FY13, this number will increase to 4,511 currently receiving ART and 984 new adults resulting to 5,520 adults who have ever been initiated on ART.

TUNAWEZA will support in-service training of 80 and 60 HCWs; continuous mentorship of trained health care workers on specialized treatment, including management of patients with ARV treatment failure and complicated drug adverse reactions; identify human resources and infrastructure gaps and support in line with MoH guidelines; and support good commodities management practices to ensure uninterrupted availability of commodities.

TUNAWEZA will support provision of a comprehensive package of services to all PLHIV including ART initiation for those eligible; laboratory monitoring including biannual CD4 testing, viral load testing for suspected treatment failure (through strengthened laboratory network); cotrimoxazole prophylaxis; psychosocial counseling; referral to support groups; adherence counseling; nutritional assessment and supplementation; prevention with positives (PwP); FP/RH; improved OI diagnosis and treatment including TB screening, diagnosis and treatment. Ongoing community interventions for PLHIV including peer education and use of support groups to provide adherence messaging, defaulter tracing and follow up will continue to be supported to improve retention in all sites. TUNAWEZA will also support strategies to ensure access and provision of friendly HIV treatment services to all, including supporting peer educators, mentors, support groups, and supporting patients to disclose and bring their partners for testing and care and treatment.

TUNAWEZA will continue to strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. TUNAWEZA will adapt the quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV treatment services integrate them into routinely collected data and use the results to evaluate and improve clinical outcomes. TUNAWEZA will do cohort analysis and report retention as required by MoH. Additionally, TUNAWEZA will review data and evaluate programs to inform programming and decision making. Use of an electronic medical records system will be supported and strengthened. TUNAWEZA will strengthen local capacity as part of the transition plan to MOH for sustainable long-term HIV patient management in Kenya.

Elizabeth Glaser Pediatric Foundation TUNAWEZA project builds capacity for indigenous organizations implementing HIV services to ensure sustainability of these services. They will work with sub-grantees namely; Catholic Diocese of Lodwar, African Inland Church, Our Lady of Perpetual Support, Lodwar District Hospital, Beacon of Hope, Tumaini Medical center and Share our Sorrows childrens home to support pediatric ART services as part of integrated comprehensive HIV clinical services in Rift Valley, Nyanza, Nairobi and Eastern provinces and they will directly implement pediatric ART activities. By March 2011 SAPR, they had enrolled 569 children patients on ART and 276 were currently on ARTand 90 newly initiated on ART.

In FY12, TUNAWEZA will jointly work with the MoH at all levels to continue supporting, expanding and ensuring provision of quality pediatric HIV treatment services as per MoH guidelines to 264 pediatrics currently receiving ART and 200 new pediatrics resulting to cumulative 240 pediatrics ever initiated on ART. In FY 13, this number will increase to 338 pediatrics currently receiving ART and new 180 resulting to cumulative 420 pediatrics ever initiated on ART.

TUNAWEZA will support comprehensive pediatric ART services including growth and development monitoring, immunization as per the Kenya Expanded Program on Immunization, management of childhood illnesses OI screening and diagnosis; WHO staging; ART eligibility assessment; laboratory monitoring including 6 monthly CD4, hematology and chemistry (through strengthening of lab networks); Pre-ART adherence and psychosocial counseling; initiation of ART as per MoH guidelines; Toxicity monitoring, treatment failure assessment through targeted viral load testing; Adherence strengthening; enhanced follow up and retention; support EID as per MoH guidelines and PITC to all children and their care givers attending Child welfare clinics; support family focused approach; community outreach efforts and integration of HIV services in other MNCH services.

TUNAWEZA will support hospital and community activities to support the needs of the HIV infected adolescents: support groups to enhance disclosure and adherence messaging, PwP, substance abuse counseling, teaching life skills, providing sexual and reproductive health services and support their transition into adult services.

TUNAWEZA will support in-service training of 80 and 60 HCWs in FY 12 and 13 respectively, continuous mentorship and capacity building of trained health care workers on specialized pediatric treatment including management of ARV treatment failure and complicated drug adverse reactions; identify human resources and infrastructure gaps and support in line with MoH guidelines; support good commodities management practices to ensure uninterrupted availability of commodities. Linkage of ART services to pediatric care services, PMTCT, TB/HIV, community programs, and other related pediatric services will additionally be optimized.

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