1.Goals and objectives:

Project Goal: To reduce the number of new HIV infections through a combination HIV/AIDS prevention services for general populations and youth using evidence-based, cost-effective approaches in Turkana County of the Republic of Kenya. Project Objectives: i)Implement targeted interventions aimed at decreasing HIV risk behaviors and increasing protective behaviors among young people and the general population. ii)Increase access to confidential HIV testing and counseling services.2.Cost-efficiency strategy: In order to reduce costs, IRC will work with local partners, using local resources and structures and ensure that community participation remains a valued element in the project. In addition, IRC will use its existing operational structures with already established field offices and other existing long term health interventions in Turkana for integrated programming.3.Transition to country partners: IRC is working with two indigenous partners with an aim of building their capacity to be able to in future carry on with the activities. IRC is also working closely with the Government of Kenya to build its capacity at the regional level to be able to implement HIV prevention activities.4.Vehicle information: A total of three vehicles have bought in the previous and current mechanism. Two vehicles were bought under Cooperative Agreement number U62PS224875 in Year 1 (2005/06) and Year 3 (2007/08) and one vehicle under Co-Ag number U2GPS002866 in Year 1 (2010/11). All vehicles bought were field-oriented four wheel drives bought to facilitate mobile outreach program activities in the hard terrain and are all based in Turkana. This activity supports GHI/LLC.

IRC works exclusively in Turkana County targeting youth in and out of school with two HIV-prevention, abstinence and being faithful evidence-informed behavioral interventions (EBIs), Healthy Choices I (HC1) and Families! Program (FMP).

The two interventions are implemented in 7 administrative divisions of the Turkana County; Turkana Central, Loima, Kakuma, Lokichar, Kalokol, Lokichoggio. The population of adolescents in the county between the ages of 10 17 as per 2009 Census is estimated at 219,191. The targets to be reached will be 5000 throgh HCI and 5000 through FMP.

FMP is an evidence-based, parent-focused EBI for parents, guardians, and other primary caregivers (hereafter referred to as parents) of preadolescents ages 912 years. Delivered in 5 weekly sessions to give parents time to internalize new information and practice skills, the program promotes positive parenting practices such as positive reinforcement and parental monitoring and effective parent-child communication on sexual topics and sexual risk reduction. The goal of FMP is to reduce sexual risk behavior among adolescents, including delaying onset of sexual debut, by training parents to deliver primary prevention messages to their children. More effective parental communication can help to delay their childrens sexual behavior and increase protective behaviors as their children get older. The intervention also links parents to other critical evidence-based interventions including HTC and VMMC. Quality assurance of FMP is promoted through rigorous training and certification of facilitators, ongoing process monitoring with standardized tools, and quality assurance site visits by a CDC activity managers and technical experts.

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. HC I consists of 8 modules of approximately one hour each. It can be delivered in 4 sessions of 2 hours each or in 8 sessions of 1 hour each. Quality assurance of HC is promoted through rigorous training and certification of facilitators, ongoing process monitoring with standardized tools, and quality assurance site visits by a capacity building agency.

For further quality assurance, IRC has put in place for all sites the following: use of approved national curricula; emphasis of importance of fidelity to the respective curricula; use of trained and certified pair of gender balanced facilitators; trainings on EBIs are conducted by certified national trainers; observed practice of implementation is done soon after training; 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.

The proposed activities and EBIs are guided by the goal and objectives of the project. Targets for each of the interventions are laid out at the start of the project year which is tracked on a monthly basis through respective field reports. Results are analyzed on a quarterly basis. The targets are in line with the PEPFAR NGIs. Monitoring and evaluation will be conducted with EBI approved data capture / monitoring tools. Field staff will send reports on a monthly basis; these reports will be compiled into an overall report quarterly which will be submitted to CDC.

Target population: IRC targets to provide HIV testing and counseling services to youth and general population residing in Turkana County. Currently, IRC is working in four (4) Districts in Turkana County. These are: Turkana Central District (Lodwar and Kalokol), Loima District (Turkwel and Loima), Turkana West District (Kakuma, Lokichoggio and Oropoi) and Turkana South (Lokichar). HIV prevalence in Turkana county is estimated to be 6.7% in rural areas and 8 -14% in Urban areas. HTC

Approaches: Main approaches are home based HTC and Static HTC.

Targets and achievements: In the past one year, IRC had a target to test a total 20,000 but they managed to test 21,095 (105%). There were no HTC trainings. For COP 2012, IRC will target to provide HTC services to 64,000 persons of which 20% will be tested as couples, and 10% will be children below the age of 15.

Testing algorithm: National testing algorithm is used.

Referrals and linkages: At point of testing, detailed contact details of client are obtained to enable easy follow up. Use of new MOH 362 HTC register also captures name of client enabling easy follow up. In addition, clients are counseled on their positive result extensively and made to understand the need to seek early treatment, care and support. Referral is then given to local preferred facility for care and treatment and recorded using MOH Community Referral form. Beginning July 2011, monthly reports are prepared on tracking of referral of HIV positive persons by the counselors using the referral tracking form developed by IRC. Strong linkages exist between HTC counselors with the health facilities in catchment areas. PWP facilitators and the health center are notified by HTC counselors on a new HIV Positive person identified and advised to follow-up the cases through visitation to the client. For proper monitoring of the referrals, field visitation of client by counselors, monthly reporting on status of referral, cross checking data from health centers. Beginning July 2011, monthly reports are prepared on tracking of referral of HIV positive persons by the counselors using the referral tracking form developed by IRC. Data obtained from the form is used for continuous follow-up on clients not linked to care & treatment.

Quality management: Activities for quality assurance in both testing and counseling include: use of qualified counselors applying core principles of HTC; obtaining kits from approved and nationally recognized health centers; ensuring the proper and hygienic storage of kits and other cold chain commodities; application of nationally approved algorithm; proper data capture and management using approved and standardized MOH tools; conduction of client exit interviews as well as administration of provider self assessment; field supervision by MOH officials and POA project team; implementation of monthly counselor support supervision; Proficiency testing & Dry Blood sample (DBS) collection for EQA.

Monitoring and evaluation: IRC 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: Community awareness and demand creation facilitated by community health workers/promoters ; Mass media campaigns (HTC video screening, IEC materials) targeting the general population.

IRC works exclusively in Turkana County implementing evidence-informed behavioral interventions (EBIs; see below) with the following priority populations: youth 15-19 (119,187), people living with HIV/AIDS (Positive Health and Dignity Prevention; PHDP) (~5,307); sero-discordant couples (~6,000), males 20-24 (43,110), females 20-24 (37,149), males 30-44 (53,459), persons with STIs (~4,804), and female sex workers (get number from Mercy). EBIs will be implemented in 7 administrative divisions of the Turkana County; Turkana Central, Loima, Kakuma, Lokichar, Kalokol, Lokichoggio. All EBIs are linked to other HIV services such as HIV testing and counseling, provision of condoms, care and treatment.

HCII targets both in and out of school youth aged 13 17 years and aims to delay sexual debut, promote secondary abstinence or have protected sexual intercourse, by providing knowledge and skills on correct and consistent condom use, handling peer pressure, and learning ones HIV status. HC II consists of 8 modules of approximately one hour each. It can be delivered in 4 sessions of 2 hours each or in 8 sessions of 1 hour each. Quality assurance of HC II is promoted through rigorous training and certification of facilitators, ongoing process monitoring with standardized tools, and quality assurance site visits by a capacity building agency.

Prevention with Positives is an ongoing 5-10min group and individual level intervention that targets HIV infected persons in clinical and community settings, focusing on partner testing, risk reduction, condom use, disclosure, adherence, STI reduction and family planning.

RESPECT will be implemented along with HTC and provision of condoms for males and females ages 20 24, males ages 30 -44, and persons with STIs. Respect has 2 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.

Comprehensive HIV prevention interventions will be implemented for female sex workers. These interventions will include Sister to Sister, a 20 minute individual level intervention that targets women of reproductive age that focuses on self efficacy, safer sex negotiation skills and condom use.

For further quality assurance, IRC has put in place for all sites the following: use of approved national curricula; emphasis of importance of fidelity to the respective curricula; use of trained and certified pair of gender balanced facilitators; trainings on EBIs are conducted by certified national trainers; observed practice of implementation is done soon after training; 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.

The proposed activities and EBIs are guided by the goal and objectives of the project. Targets for each of the interventions are laid out at the start of the project year which is tracked on a monthly basis through respective field reports. Results are analyzed on a quarterly basis. The targets are in line with the PEPFAR Next Generation Indicators (NGIs). Monitoring and evaluation will be conducted with EBI approved data capture / monitoring tools. Field staff will send reports on a monthly basis; these reports will be compiled into an overall report quarterly which will be submitted to CDC.