Goals and objectives: The UNHCR co-operative agreement aims to increase access and utilization of comprehensive HIV prevention, care and treatment and strengthen the public health systems serving refugees in Daadab and Kakuma refugee camps. Specific objectives in FY12 include:

Scale up evidence-based HIV prevention interventions for youth, general population and most at risk groups.1.Enhance knowledge of HIV status and foster effective linkages to care and treatment services.

Scale up comprehensive adult and pediatric HIV care and treatment services including prevention of mother to child transmission (PMTCT), TB/HIV diagnosis and treatment, care and support for persons living with HIV and orphans and vulnerable children. 2. Cost-efficiency strategy: UNHCR will invest more resources in the promotion and scale up of provider initiated HIV testing and counseling (PITC) due to the low HIV prevalence among

refugees (< 1%). This approach is cost effective and fosters better linkages of PLHIV to care, treatment and support services. UNHCR will also enhance engagement and training of incentive staff (refugees and host community) to provide services. This is cost effective and will address language barriers due to the varied nationalities in the camps, high turn-over of staff and build local capacity to implement the program. 3. Transition to country partners: UNHCR will build the capacity of local non-governmental and other organizations among them the National Council of Churches in Kenya, to offer comprehensive HIV care and treatment services to refugees. 4. Vehicle information: UNHCR has not used PEPFAR funds for vehicle purchase in the past and is not requesting funds in FY12.This activity supports GHI/LLC.

United Nations High Commission for Refugees (UNHCR) has two sub grantees offering adult care and support, IRC and ADEO, who will continue to support comprehensive HIV care and support in health facilities in Dadaab and Kakuma refugee camps. By March 2011, UNHCR had cumulatively enrolled 1,233 patients in HIV care of whom 1,118 were active and on cotrimoxazole prophylaxis.

UNHCR will work with the Ministry of Health (MoH) at the provincial, district and health facility level to jointly plan, coordinate, implement and ensure provision of quality HIV care and support to 466 current adult patients in FY12 and current patients in FY13.

UNHCR will offer a package of services including HIV testing to partner and the 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, chlorine for water treatment and educational materials); supplemental and therapeutic nutrition (FBP) to all eligible HIV positive patients; prevention with positives(PwP); and cervical cancer screening to all enrolled women.

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

UNHCR will also support ongoing community interventions for HIV infected individuals, including peer education and 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; Home Based Care services; Gender based violence support programs; vocational training; social and legal protection; and food and nutrition programs.

UNHCR will adopt strategies to ensure access and provision of friendly services to youth, elderly and disabled populations. Strategies to increase access of care services by men will be employed, including supporting male peer educators, mentors and support groups, and supporting women to disclose and bring their male partners for testing and care and treatment.

UNHCR will continue to strengthen data collection and reporting at all levels to improve reporting to NASCOP and PEPFAR. UNHCR will adopt the new generation indicators and support the development and use of electronic medical records system in accordance with NASCOP guidelines. UNHCR will continue using quality of care indicators (CQI) 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. UNHCR will do cohort analysis and report retention rates as required by NASCOP. UNHCR will support joint Annual Operation Plan (AOP) development, implementation, monitoring and evaluation, and health system strengthening to facilitate sustainability.

United Nations High Commission for Refugees (UNHCR) currently has 4 partners providing OVC services: Save the Children, SCUK in Dadaab and LWF/FAI in Kakuma. By March 2011, UNHCR had achieved the following: 150 OVC served, 120 of OVC received primary direct support (PDS), 30 of OVC were provided with Supplemental Direct Support (SDS), and none of the providers/caretakers trained in caring for OVC.

In FY12 and FY13, UNHCR will reach 200 and 250 OVCs respectively with OVC care, 80% of which will be PDS and 20% SDS. UNHCR will provide critical services to OVC including providing a comprehensive package of education, shelter, nutritional support, psychosocial care and support, and support to OVC caretakers while linking OVC to other critical services and economic strengthening activities.

UNHCR will target all OVC aged between 0 and 18 years and will provide 6 plus 1 services and report on at least 3 services that they provide to the OVC based on individual need. UNHCR continues to experience challenges in areas of capacity building, partner linkages, and networking to the local partners. In the next two years, UNHCR will focus on strengthening HIV prevention education among OVC to equip them with life skills that will reduce their vulnerability to the risk of HIV infection.

UNHCR will start to implement OVC interventions that are evidence based in order to achieve their two year goals. They will also train the local organizations to strengthen the family support system and help them to establish strong linkages between PLWHAs, HIV-infected children, and health care services. UNHCR will ensure that children and their parents or caregivers and other family members affected access appropriate care and treatment. UNHCR 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.

UNHCR will continue to work closely with District Children's Department and will follow guidelines provided by the Ministry of Gender, Children and Social Development, alongside PEPFAR guidelines. UNHCR will support the local partners to establish partnerships and networks among other NGOs in order to strengthen their collective voice, build a unified approach, improve coordination, and share knowledge.

UNHCR will embrace community and family centered approaches (such as the cash transfer program) that are preferred to institutional approaches as well as explore livelihoods approaches to OVC programming.

There is limited information regarding current OVC programming in the UNHCR supported partners.

UNHCR 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. UNHCR will also develop an OVC advocacy curriculum and provide training to CBOs and other OVC stakeholders. UNHCR will work with the local organizations to engage and advocate for OVC issues with key stakeholders in the Kenyan HIV/AIDS response, including donors.

UNHCR will work with the local partners to 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.

United Nations Higher Commission for Refugees (UNHCR) will support TB/HIV services for refugee populations. UNHCR has two sub-partners providing HVTB services: IRC and ADEO. UNHCR will support the sub-grantees in capacity building to provide quality HIV/TB services in three health facilities in Dadaab and Kakuma. UNHCR has been supporting TB/HIV services in these sites since October 2010 in line with the MOH Division of Leprosy, Tuberculosis and Lung Disease (DLTLD) and the National AIDS and STI Control Program (NASCOP).

Between October 2010 and March 2011, 49 TB patients received HIV testing, 13 TB/HIV coinfected patients were identified, and 126 HIV positive patients were screened for TB. In FY 2012 and 2013, UNHCR will intensify efforts to detect TB cases through clinical exams and laboratory investigations and ensure successful TB treatment through provision of appropriate treatment. UNHCR will ensure that each facility providing TB/HIV services has adequate and well trained clinical staff supported by well equipped and staffed laboratory, including sputum specimen transport where laboratory services are unavailable. UNHCR will ensure that adequate supplies of anti-TB drugs are available and that the national TB treatment guidelines are followed. All TB patients on treatment will be monitored both clinically and through periodic sputum examination.

To reduce the burden of HIV in TB patients, UNHCR will ensure that at least 95% of TB patients are screened for HIV and 80%TB-HIV co-infected patients are put on cotrimoxazole and ARVs as early as possible regardless of the CD4 count as per the national guidelines. UNHCR 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 and staffed with 60 trained HCW as needed.

To reduce the burden of TB in HIV infected patients, UNHCR will support intensified TB screening for 291 in FY12 and 419 in FY13 at each clinical encounter using the national screening tool. 15 co-infected patients identified in FY12 and 21 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, UNHCR will ensure that the national IC guidelines are available at all sites and training of staff on IC is done. UNHCR 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, UNHCR 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. UNHCR will also support scaling up of drug-resistant treatment sites thus expanding access to MDRTB treatment.

UNHCR will also support expansion of prevention with positive (PwP) services in TB clinics, TB/HIV control activities in the prisons, strengthening linkages between facility and community-based services, and improving patient referrals and tracking systems. To strengthen HVTB program monitoring, UNHCR will support reporting of selected custom indicators to assist with program management and evaluation and monitoring of new activities.

United Nations High Commission of Refugees (UNHCR) has two sub-grantees (IRC and ADEO) who have been supporting ART provision as part of integrated comprehensive HIV clinical services in 3 health facilities in Dadaab and Kakuma refugee camps. As of September 2010 (APR), UNHCR had trained 63 HCWs in providing ART, 41 adults were newly initiated on ART, 335 adults were ever initiated on ART, and 294 adults and 27 children were currently on ART. The overall patient retention was 91%.

In FY12, UNHCR 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 340 patients currently receiving ART and 217 new adults resulting to cumulative 408 adults who have ever been initiated on ART. In FY13, this number will increase to 502 currently receiving ART and 219 new adults resulting to 627 adults who have ever been initiated on ART.

UNHCR will support in-service training of 30 and 20 HCWs and continuous mentorship of trained health care workers on specialized treatment, including management of patients with ARV treatment failure and complicated drug adverse reactions. UNHCR will identify human resources and infrastructure gaps and support in line with MoH guidelines as well as support good commodities management practices to ensure uninterrupted availability of commodities.

UNHCR will support provision of comprehensive package of services to all PLHIV including ART initiation for those eligible; laboratory monitoring including biannual CD4 testing, viral load testing for suspected treatment failure (through strengthened laboratory network); cotrimoxazole prophylaxis; psychosocial counseling; referral to support groups; adherence counseling; nutritional assessment and supplementation; prevention with positives (PwP); FP/RH; and improved OI diagnosis and treatment including TB screening, diagnosis and treatment. Ongoing community interventions for PLHIV including peer education and support groups to provide adherence messaging, defaulter tracing, and follow up will continue to be supported to improve retention in all sites. UNHCR will do cohort analysis and report retention as required by MoH.

UNHCR 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. UNHCR 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.

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

The UNHCR co-operative agreement aims to increase access and utilization of comprehensive HIV prevention, care and treatment for refugees and strengthening the public health systems serving refugees in the Daadab and Kakuma refugee camps. PEPFAR support to the United Nations High Commission for Refugee (UNHCR) will support provision and scale up of comprehensive and evidence-based HIV prevention interventions targeting youth aged 10-24years and adults living in the Daadab and Kakuma refugee camps in Kenya.

An estimated 12,190 youth (10-14 years) in school will be reached with Healthy Choices I (HCI). HCI targets in-school youth aged 10-14 years 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. HCI has 8 modules of approximately one hour each. It is delivered in 4 two hour sessions or in 8 one-hour sessions. To address gender-based violence, low levels of knowledge about HIV/AIDS and HIV-related stigma levels in the camps, the HCI intervention will be complimented by targeted HIV stigma reduction messages targeting youth in school as well as the broader community. HIV prevention messages and stigma reduction messages will be translated in local languages to address the needs of various nationalities living in the two camps.

Quality assurance of HCI will be promoted through rigorous training and certification of facilitators, ongoing process monitoring with standardized tools, and quality assurance site visits by a capacity building agency. The routine behavioral surveillance survey conducted by UNHCR will provide impact data on median age at sexual debut among youth over time and proportion of youth who have had sex by age 15.

Target population: The primary target population for UNHCR is all the Refugees residing in Kenyas two main Refugee camps namely, Kakuma and Daadab. The total population served is 505,481 (UNHCR September 2011). This number continues to rise as more Somali refugees flee in to Kenya to escape war and famine in the Horn of Africa. HIV prevalence in the refugee population ranges from 1.4-1.91%. Currently, coverage of HTC is approximately 30-36% in both camps. For HTC, UNHCR will specifically target pregnant women, Most at Risk Populations (FSW, MSM/ MSW, Clients of sex workers), Couples, Youth in and out of School, OVCs, inpatient and outpatient clients including TB/STI clients in all health facilities.

HTC Approaches: HTC approaches are primarily PITC and CITC. For PITC, all sections in the health facilities including TB clinics, STI clinics, and outpatient and inpatient departments are utilized to provide CT services. At the community level, mobile and outreach VCT is used especially targeting groups and settings with potential high HIV risk.

Targets and achievements: In the past one year, UNHCR had a target to test a total 20,000 but they managed to test 33,700 (167%). 37 HCW/Counselors were trained on PITC, 36 on Couple Counseling. For COP 2012, UNHCR will target to provide HTC services to 80,000 refugees of which 20% will be tested as couples, and 10% will be children below the age of 15.

Testing algorithm: National algorithm is being used

Referrals and linkages: A referral system is in place to ensure newly diagnosed HIV positive clients are linked to appropriate care and treatment services. Community health promoters follow up all the HIV positive clients to ensure access to services. At the community level, HIV positive clients are linked to post test clubs and are provided with prevention with positive (PWP) interventions. Systems to measure proportion of effective referrals against the number of all referrals from HTC to other services and vice versa are being strengthened. Use and record keeping of referral forms allows for comparison of total number of clients referred for services against the total number who accessed the referred services. Frequent monitoring of effectiveness is conducted.

Quality management: In order to improve and monitor quality of HTC services, UNHCR will put in place the following strategies: Training and continuing education of HTC providers; strict adherence to the standard operating procedures outlined in the national HTC guidelines; proper handling of HIV rapid kits as per the guidelines; putting in place a functional QA systems as provided for in the national HTC guidelines; participation in EQA- proficiency testing and finally conducting support supervisory visits.

Monitoring and evaluation: UNHCR uses all ministry of health tools to capture HTC data, both for couples and individual patients. These include HTC lab Register and Monthly summary tool (MOH 711). MOH approved HTC lab registers have been introduced at all HIV testing points except PMTCT.

Promotional activities for HTC: Health talks at the facility level targeting inpatient and outpatient clients; Community awareness and demand creation facilitated by Community Health Workers/Promoters ; Mass Media campaigns (HTC video screening, IEC materials) targeting the general population; Peer leaders supported to reach out to MARPS to encourage access to comprehensive services.

The UNHCR Refugee Health Program provides comprehensive HIV prevention services in Daadab and Kakuma refugee camps, home to over 500,000 refugees. With PEPFAR support, , UNHCR will scale up evidence-based behavioral (EBI) interventions for youth, adults, female sex workers (FSW) and persons living with HIV/AIDS (PLHIV). An estimated 4090 out of school youth in Daadab and Kakuma will be reached with Healthy Choices II (HCII). HCII targets youth 1317 years and aims to delay sexual debut, promote secondary abstinence and condom use, skills for handling peer pressure, and learning ones HIV status. HCII has 8 one-hour modules delivered either in 4 two-hour or 8 one-hour sessions. HCII will be complimented by provision of HIV testing and counseling services, referral for voluntary medical male circumcision, and condom promotion and provision.

UNHCR will target 3030 adults with RESPECT, a 2-session individual level EBI that focuses on reduction of sexually transmitted diseases (STD), fostering client understanding of personal HIV/STD risk and risk reduction steps. UNHCR will train 30 RESPECT facilitators to integrate RESPECT in HIV testing and counseling services targeting the general population and FSW. UNHCR will recruit 5 Positive Health and Dignity Prevention (PHDP) peer educators to work in comprehensive care centers, maternal child health and TB clinics, 2 peer educators for health centers and provide counseling space. One peer educator will strengthen ART adherence through home follow ups. 300 PLHA will receive PHDP intervention in clinical and community settings. PHDP is a 5-10min group or individual level EBI that targets PLHIV in clinical and community settings and focuses on knowledge of HIV status, partner testing, risk reduction counseling including condom use and partner reduction, supportive disclosure, adherence counseling, STI assessment and treatment and family planning counseling.

An estimated 250 female sex workers (FSW) will receive HIV/STI screening, STI treatment and referral, economic empowerment interventions, information and referrals to reproductive health, drug and alcohol reduction services and gender based violence services.

To address gender-based-violence (GBV), low levels of HIV/AIDS knowledge and HIV stigma, targeted behavior change communication will be disseminated in community meetings, strategic locations and media. In FY12, PEPFAR will support access to a comprehensive GBV package of services including post-exposure prophylaxis and linking young GBV victims to services targeting vulnerable children.

Quality assurance of EBIs and related interventions will be achieved through rigorous selection, training and certification of facilitators, process monitoring with standardized tools for each EBI and routine site visits. Routine behavioral surveys by UNHCR will provide outcome data on sexual behaviors over time and inform effective targeting of the interventions.

United Nations High Commission for Refugees (UNHCR) will support PMTCT activities targeting refugee populations in Dadaab and Kakuma camps through two sub-grantees (IRC and ADEO) working in 3 health facilities with approximately 14,000 expected pregnancies. The HIV prevalence is low at 2%. As of APR 2010, UNHCR had counseled and tested 8,953 pregnant women and given ARV prophylaxis to 16 out of 18 (89%) HIV positive pregnant women and 16 infants (88%). UNHCR trained 78 HCW in PMTCT, gave food supplements to 18 HIV positive pregnant women, and tested 7 HIV exposed infant for HIV of whom all tested negative.

In FY12, UNHCR will offer HIV counseling and testing to 12,784 pregnant women at ANC and give ARV prophylaxis to 227 HIV infected pregnant women. The HIV infected women will receive a CD4 test after undergoing WHO clinical staging. UNHCR will give HAART to all eligible HIV positive pregnant women in line with the revised PMTCT national guidelines. In FY13, UNHCR will increase the number of pregnant women counseled to 13,423, offer ARV prophylaxis to 276 pregnant women and 237 infants, and do EID for 237 infants.

UNHCR will focus on the 4 prongs of PMTCT: primary prevention; family planning; ARV prophylaxis to all HIV positive pregnant mothers and exposed infants; and care and treatment to eligible HIV positive mothers, partners, and children. The minimum care package will include health and HIV education, individual/family HIVCT, clinical/laboratory monitoring and assessment, OI screening and treatment, ARV prophylaxis and treatment for both mother and baby, nutritional support, psychosocial support, PWP, follow up, retention, and referral and linkages. UNHCR will incorporate TB screening into routine antenatal care.

UNHCR will support integration of ART in MCH clinics, access to FP/RH services, and establish or strengthen infection control and waste management activities. UNHCR 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.

UNHCR will support safe infant feeding practices as per national guidelines and support enrollment and follow up of 237 HIV exposed infants to access CTX, ARV prophylaxis, and EID services using the HIV exposed infant register till 18 months. UNHCR will facilitate ART initiation for those who test positive before 2 years.

UNHCR will adopt efficient retention strategies for mothers and babies by supporting use of diaries and registers for tracking defaulters, having a structured mentorship and supervision plan, enhancing data quality and streamlining M&E gaps including orientation of new MOH ANC/maternity registers, and utilization of data at facility level for program improvement and quarterly progress reports to CDC. UNHCR spends $18 per woman for PMTCT which will now stretch to cover all PMTCT prongs and wrap around like malaria prevention in line with GHI principles. Program quality and proficiency testing will be emphasized to validate PMTCT results

UNHCR will train 30 HCWs in FY 12 and equal number in FY13 on PMTCT and provide orientation to the revised PMTCT and infant feeding guidelines. They will also engage in community activities for demand creation for health services such as male involvement with couple CT services, referral and linkages, and reach non clinic attendants.

United Nations High Commission of Refugees (UNHCR) has two sub-grantees (IRC and ADEO) who have been supporting ART provision as part of integrated comprehensive HIV clinical services in 3 health facilities in Dadaab and Kakuma refugee camps. As of September 2010 (APR), UNHCR had trained 63 HCWs in providing ART, 41 adults were newly initiated on ART, 335 adults were ever initiated on ART, and 294 adults and 27 children were currently on ART. The overall patient retention was 91%.

In FY12, UNHCR 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 340 patients currently receiving ART and 217 new adults resulting to cumulative 408 adults who have ever been initiated on ART. In FY13, this number will increase to 502 currently receiving ART and 219 new adults resulting to 627 adults who have ever been initiated on ART.

UNHCR will support in-service training of 30 and 20 HCWs and continuous mentorship of trained health care workers on specialized treatment, including management of patients with ARV treatment failure and complicated drug adverse reactions. UNHCR will identify human resources and infrastructure gaps and support in line with MoH guidelines as well as support good commodities management practices to ensure uninterrupted availability of commodities.

UNHCR will support provision of comprehensive package of services to all PLHIV including ART initiation for those eligible; laboratory monitoring including biannual CD4 testing, viral load testing for suspected treatment failure (through strengthened laboratory network); cotrimoxazole prophylaxis; psychosocial counseling; referral to support groups; adherence counseling; nutritional assessment and supplementation; prevention with positives (PwP); FP/RH; and improved OI diagnosis and treatment including TB screening, diagnosis and treatment. Ongoing community interventions for PLHIV including peer education and support groups to provide adherence messaging, defaulter tracing, and follow up will continue to be supported to improve retention in all sites. UNHCR will do cohort analysis and report retention as required by MoH.

UNHCR 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. UNHCR 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.

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

United Nations High Commission for Refugees (UNHCR) has two sub-grantees (IRC and ADEO) who have been supporting pediatric ART services as part of integrated, comprehensive HIV clinical services in 3 health facilities in Dadaab and Kakuma refugee camps.

In FY12, UNHCR will jointly work with the Ministry of Health (MoH) at all levels to continue supporting, expanding and ensuring provision of quality pediatric HIV treatment services as per MoH guidelines to 53 pediatrics currently receiving ART and 11 new pediatrics resulting to cumulative 64 pediatrics ever initiated on ART. In FY13, this number will increase to 68 pediatrics currently receiving ART and 9 new resulting to a cumulative 73 pediatrics ever initiated on ART.

UNHCR 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; and enhanced follow up and retention. UNHCR will 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.

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

UNHCR will support in-service training of 30 and 20 HCWs in FY 12 and 13 respectively as well as continuous mentorship and capacity building of trained HCWs on specialized pediatric treatment including management of ARV treatment failure and complicated drug adverse reactions. UNHCR will 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. Linkage of ART services to pediatric care services, PMTCT, TB/HIV, community programs, and other related pediatric services will additionally be optimized.

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