Mkomani Clinic Society (MCS) supports the implementation and expansion of high quality HIV Prevention, Care and Treatment Activities at the facility and community level at the Bomu Clinic and affiliated sites. The program goal and objectives are linked to Kenyas Partnership Framework (PF) and Global Health Initiative (GHI) strategies and are directly aligned to PF pillars 1-3: prevention, care and mitigation, treatment, and systems strengthening. Strategies to reduce maternal and child mortality and eliminate MTCT include supporting family planning integration into HIV clinics. Monitoring and evaluation (M&E) plans will align with PEPFAR and country PF. Training on and use of MOH HMIS systems will be supported to eliminate parallel M&E.

MCS has developed a strategy of partnering with corporate organizations to provide capital investment. In this manner, they reduce capital expenditure and the program becomes cost effective. MCS also runs other clinical departments that generate income and provide a point of entry to the HIV program.

MCS is already partnering with the MOH in various aspects of the HIV program to provide training for MOH and affiliated facilities. Capacity-building strategies are aimed at strengthening sustainable local systems for effective transition of technical support from MCS to MOH and the community. MCS will continue to build its capacity in monitoring and evaluation of the program by sending its key staff for training and courses in grants management and administration.

Since 2010, MCS has procured 1 vehicle. MCS intends to purchase a vehicle for the implementation of the program and extension of services beyond the normal working hours.This activity supports GHI/LLC.

Mkomani Clinic Society (MCS) will support 4 facilities in Coast Province, which they have been supporting HBHC activities since 2010. By March 2011, MCS had cumulatively enrolled 21,642 patients in HIV care and of these 14,329 were active and on Cotrimoxazole prophylaxis.

MCS will work with the Ministry of Health (MoH) at provincial, district and health facility level, to jointly plan, coordinate, implement and ensure provision of quality HIV care and support to 14,484 current adult patients in FY12 and 18,022 current patients in FY13.

MCS 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 positive patients; prevention with positives(PwP), and cervical cancer screening to all enrolled women.

MCS 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, e.g. OI diagnosis and treatment. MCS will identify areas with staff shortages, support recruitment of additional staff, and support good commodities management practices to ensure uninterrupted supply of commodities.

MCS 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) projects; home based care services; gender based violence support programs; vocational training; social and legal protection; and food and nutrition programs. MCS 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.

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

Mkomani clinic Society (MCS) is a local, not-for-profit, non-governmental partner that will provide 1500 OVC in FY12 and 2000 OVC in FY13 with access to essential services in the Coast region. MCS will train 100 caregivers, to meet the needs of OVC in their communities. MCS will provide critical services to OVC which include providing a comprehensive package that includes education, shelter, nutritional support, psychosocial care and support, support to OVC caretakers; while linking OVC to other critical services and economic strengthening activities.

MCS 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, MCS had achieved the following: 1500 OVC served; 850 of OVC received primary direct support (PDS); 650 of OVC were provided with Supplemental Direct Support (SDS) and 70 providers/caretakers trained in caring for OVC.

In the next two years MCS 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. MCS 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 and HIV-infected children and health care services, including ensuring that children and their parents or caregivers and other family members affected access appropriate care and treatment. MCS will work closely and link 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. MCS will continue to work closely with the District Children's Department and will follow guidelines provided by the Ministry of Gender, Children and Social Development, as well as PEPFAR guidelines. MCS 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.

MCS 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 approach to OVC. There is scanty information regarding current OVC programming in the MCS supported partners. MCS 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. MCS will also develop an OVC advocacy curriculum and provide training to CBOs and other OVC stakeholders. MCS will work with the local organizations to engage and advocate for OVC issues with key stakeholders in the Kenyan HIV/AIDS response, including donors.

MCS 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.

Mkomani Clinic Society (MCS) will support 4 sites in Coast region, which has a population of about 4.4 million people and reported 10,623 TB patients in 2010. Over 10,000 TB patients received HIV testing and 3,531 TB/HIV co-infected patients were identified. 97% and 47% received cotrimoxazole prophylaxis and ART respectively. Since 2010, MCS has been supporting TB/HIV activities as a local transition partner from New York University in the Coast region.

In FY12 and FY13, MCS will intensify efforts to detect TB cases through clinical exams and laboratory investigations as well as ensure successful TB treatment through provision of appropriate treatment. MCS 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.

MCS 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, MCS will ensure that at least 95% of TB patients are screened for HIV and all 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. MCS 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 50 HCW will be trained in FY12 and 30 HCW trained in FY13.

To reduce the burden of TB in HIV infected patients, MCS will support intensified TB screening using the national screening tool for 12,874 in FY12 and 16,020 in FY13 at each clinical encounter. 644 co-infected patients identified in FY12 and 801 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, MCS will ensure that the national IC guidelines are available at all sites and training of staff on IC is done. MCS 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, MCS 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. MCS will also support scaling up of drug-resistant treatment sites thus expanding access to MDRTB treatment.

MCS 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, MCS will support reporting of selected custom indicators to assist with program management and evaluation and monitoring of new activities.

Mkomani Clinic Society (MCS) will support pediatrics activities in Coast Province, which has an estimated population of 3.3 million people with an estimated HIV prevalence of 8.1% compared to the national 7.1%. MCS has been supporting HIV activities as a local transition partner from New York University in 4 treatment sites in Coast Province. By March 2011, MCS had enrolled 4,370 children in care, of whom 2645 were active and on cotrimoxazole.

In FY 12, MCS will provide care and support services to 1,513 children currently on care. The number of children currently on care will increase to 1,917 in FY13. MCS will provide comprehensive, integrated quality services and scale up to ensure 42 HIV infected infants are put on ARV prophylaxis and all HIV exposed children access pediatric care services.

The focus of pediatric care services will continue to be provision of comprehensive, integrated quality services including strengthening the use of the Mother-baby booklet, early infant diagnosis, universal provider initiated testing and counseling, and ensure those identified HIV infected are linked to care and ART services. MCS 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; and malaria screening, treatment, and provision of long lasting insecticide treated nets in malaria endemic areas.

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

MCS 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. Relevant trainings will continue to be supported. MCS will strengthen pediatric data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR.

Target population: Mkomani Medical society will support HIV testing and counseling services in 4 health facilities in Mombasa county of Coast province. Target population will include all patients, their family members and caretakers who access out and in patient services a number of health facilities in the 4 counties.

HTC Approaches: The program will utilize provider initiated opt out approach and the services are offered within all out patient departments, TB clinics, FP, ANCs, special clinics, HIV clinics (targeting family members) and in patient departments. The counseling and testing is either done within the consultation rooms by trained clinicians or in counseling rooms by lay counselors within the outpatient departments if space is available or at the laboratories.

Targets and achievements: MMS in the past 12 months had a target to provide HTC services to a total of 10,000 persons but managed to serve 23,489 (234%) out of which 4185 (17.8%) tested positive. In COP 2012, MMS will target to provide HTC services to a total of 27,000 persons 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: In order to strengthen referrals, MMS will put in place several important strategies. They include: use of peer educators as patient escorts from one hospital department to the CC; same day enrollment of clients to CCC; use of an integrated defaulter tracing system for tracing patients who default on care or ART upon enrollment; introduction of documented referral system by use of the NASCOP referral booklet; use of mobile phones to follow up whether the client was actually enrolled.

Quality management: In order to improve and monitor quality of HTC services, MMS 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; management 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: MMS will use 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 will be introduced at all HIV testing points except PMTCT.

Promotional activities for HTC: All patients attending the supported facilities will be given health talks including the need for HIV counseling and testing and the importance of couple testing. Couples are given priority services. Sexual partners of HIV positive clients will be given individualized invitations though the index clients and available avenues for testing including individualized home testing.

BOMU implements comprehensive prevention, care and treatment programs in Coast province. In FY 2012/13, BOMU will expand HIV prevention services to include evidence based behavioral interventions (EBIs) for specific target populations in clinical settings at comprehensive care center (CCC), TB and Maternal Child Health (MCH) clinics as part of HIV combination prevention programs. The EBIs will include Positive Health and Dignity Prevention (PHDP) targeting adult male and female and adolescents living with HIV (PLHIV); and Sister to Sister EBI (S2S) targeting sexually active HIV negative women attending the MCH clinics.

PHDP is an ongoing 5-10min group and individual level intervention that targets PLHIV in clinical and community settings. This mechanism will support this intervention which constitutes of ART adherence counseling and support; partner and family testing; provision of PEP to the discordant spouse; treatment for prevention once approved; safer pregnancy counseling and provision of modern contraception; sexual risk reduction counseling including reduction of sexual partners, alcohol counseling, promoting of consistent and correct condom use; Sexually Transmitted Infections (STI) screening and treatment and using meaningful involvement of people living with HIV/AIDS ( MIPA ). The efficacy of PHDP has been shown to be 68% in preventing transmission of HIV, and 96% in treatment for prevention.

S2S 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. Condoms are 80% effective in heterosexual relationships when used correctly and consistently.

BOMU will use HVOP funding to recruit and support appropriate peer educators/counselors to reinforce prevention messages delivered by health providers as a feasible model for task-shifting in the provision of PHDP in clinical settings, and specifically promote MIPA. It will support placement of 5 Peer Educators at the MCH, TB and CCC Clinics in hospitals, and 2 Peer educators at health centres and provide appropriate counseling space. One of the peer educators will do regular client home follow up to strengthen ART adherence.

Approximately 1.6 million Kenyans are PLHIV. The Kenya AIDS Indicator Survey 2007 showed 6% of couples to be in discordant relationships. HIV Prevalence in Coast province is (8.1%). BOMU will reach 8159 (60%) PLHIV in FY2012 and 11864 (70%) in FY 2013 with a minimum package of PHDP. It will implement S2S EBI on a pilot basis.

Quality assurance for EBIs will be promoted through appropriate training and certification of peer educators using approved national curricula, standard job-aids and guidelines and regular supervision.

BOMU will work with appropriate national Technical Working Groups (TWG) to support integration of HIV prevention into care and treatment programs in clinical settings. These programs will also be linked to other HIV community programs. PLHIV will be specifically linked to STI and FP services, as necessary, through patient escorts.

Monitoring of PHDP and S2S will be done through the review/input of BOMU implementation plan, analysis of KePMS data, quarterly reviews, semiannual and annual reports. Evaluation will be conducted through operation research of combination HIV prevention and periodic surveys (Kenya Demographic and health survey, Kenya Indicator AIDS Survey, Kenya Service Provision Assessment)

The Kenya drug use epidemics prevalence is 18.3%, over two times more than that of the general population. HIV prevalence amongst PWID is 18.3% amongst needle-sharing sharing IDUs, prevalence is 30% while for non-needle sharing PWID, it is 5%. This mechanism will target the PWUD/PWID population with appropriate targeted responses to each of the sub-groups within the PWUD/PWID population to address their varied risk profiles. These will include social networks of drug-users, addressing high risk sexual practices such as multiple sexual partners and unprotected sex and drug injecting practices such as needle-sharing and flash-blood practices among users and their peers. Women who use or inject drugs face additional risks due to their engagement in sex work and in transacting sex for drugs. They also face additional stigma, which becomes exacerbated in the event of a pregnancy. These behaviors are reinforced by multiple determinants such as criminalization of injecting drug use, and poverty among majority of the self-identified PWUD/PWID. Children of female PWID will also be linked to appropriate wrap around services that address gender and the needs of continually abused children. This mechanism will support the set up and scale up of a comprehensive package of services targeting 1,000 PWID/PWUD in the Coast region where BOMU works. A 9-intervention package of services per the PEPFAR and UNAIDS/UNODC guidelines will be offered to include Medication-Assisted Treatment (MAT) for drug-dependence treatment, ART, HTC, STI prevention and treatment, Condom demonstration and distribution for PWID and their partners, targeted behavioral interventions and IEC materials, TB diagnosis and treatment and vaccination, diagnosis and treatment of viral hepatitis. Methadone and other MAT drugs and supplies will be centrally procured through a designated supply chain and therefore funds under this mechanism may not be used for drug procurement, unless under special circumstances. Per PEPFAR guidance, funds in this mechanism may not be used to procure Needle and Syringe Program (NSP) supplies but the program may work with other partners to support NSP. This program will work collaboratively with the public health sector/Coast Provincial Director of Medical Services, participate in national MARPS and PWUD/PWID forums careful planning with a broad range of community and local administration stakeholders with a view to enlisting the crucial buy-in and support for an enabling environment. Training will be conducted in collaboration with the national training program for use of national PWID guidelines and MAT treatment protocols. Out-patient treatment will be the desirable model of offering MAT, backed by a close follow-on addiction counseling therapy. PWID/PWUD and MAT treatment services will be integrated with the HIV comprehensive, care and treatment program that is currently implemented under this mechanism

Mkomani Clinic Society (MCS) will support implementation of PMTCT services in Coast Province, where they have been supporting 4 sites since 2010. Coast Province has an HIV prevalence of 3.4%. By March 2011 SAPR, MCS had counseled and tested 15,850 pregnant women and given ARV prophylaxis to 1,325 HIV positive pregnant women and 399 infants.

In FY12, MCS will offer HIV counseling and testing to 2,857 pregnant women at ANC and give ARV prophylaxis to 204 HIV infected pregnant women. HIV infected women will receive a CD4 test after undergoing WHO clinical staging. MCS will give HAART to all eligible HIV positive pregnant women in line with the revised PMTCT national guidelines. In FY13, MCS will increase the number of pregnant women counseled to 3,000, offer ARV prophylaxis to 247 pregnant women and infants, and offer EID for 213 infants.

MCS will focus on 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, referral, and linkages. MCS will incorporate TB screening into routine antenatal care.

Efforts will be made to reach 900 of 1st visit 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 increased access to FP/RH services will be supported. MCS will establish or strengthen infection control and waste management activities.

MCS 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.

MCS will support safe infant feeding practices as per national guidelines and support enrollment and follow up of 213 of babies born to HIV infected mothers to access CTX, ARV prophylaxis and EID services using the HIV exposed infant register till 18 months. MCS will facilitate ART initiation for those who test positive before 2 years.

MCS 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 (train 30 health workers in FY12 and equal number in FY13), enhancing data quality and streamlining M&E gaps including orientation of new MOH ANC/maternity registers, and utilizing 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.

MCS will train HCWs on PMTCT and provide orientation to the revised PMTCT and infant feeding guidelines and engage in community activities for demand creation for health services such as male involvement with couple CT services.

Mkomani Clinic Society (MCS) will support treatment in 4 sites in Coast Province. Coast Province has an estimated population of 3.3 million people with an estimated adult HIV prevalence of 8.1% compared to the national 7.1%. Since 2010, MCS has been supporting treatment in 4 sites as a local transition partner from New York University in Coast Province. As of SAPR 2011, 11,099 adults had ever been initiated on ART and 8,793 were active.

In FY12, MCS will jointly work with the Ministry of Health (MoH) to continue supporting expansion and provision of quality adult HIV treatment services in line with MoH guidelines to 12,614 patients currently receiving ART and 2,995 new adults resulting to cumulative 15,137 adults who have ever been initiated on ART. In FY13, this number will increase to 14,864 currently receiving ART and 3,030 new adults resulting to 18,167 adults who have ever been initiated on ART.

MCS in collaboration with MoH will support in-service training of 50 and 30 health care workers (HCW) 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.

MCS will support provision of a comprehensive service package 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.

MCS will continue to support ongoing community activities and support 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. MCS will support provision of friendly services to youth and special populations. MCS 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.

MCS 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 support short term activities that improve impact and patient outcomes. Additionally, MCS will do cohort analysis, report retention rates as required by the national program, and discuss the analysis results with facility staff in order to improve program performance

MCS 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.

Mkomani Clinic Society (MCS) will support pediatrics activities in Coast Province, which has an estimated population of 3.3 million people with an estimated HIV prevalence of 8.1% compared to the national 7.1%. MCS has been supporting HIV treatment activities as a local transition partner from New York University in 4 treatment sites in Coast Province. As of SAPR 2011, 1,425 pediatrics were ever initiated on ART and 946 were active.

In FY12, MCS 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 1,531 pediatrics currently receiving ART and 306 new pediatrics resulting to cumulative 1,837 pediatrics ever initiated on ART. In FY13, this number will increase to 1,731 pediatrics currently receiving ART and 276 new resulting to a cumulative 2,113 pediatrics ever initiated on ART.

MCS 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. MCS will also support EID as per MoH guidelines and PITC to all children and their care givers attending Child welfare clinics; support family focused approach; and support community outreach efforts and integration of HIV services in other MNCH services.

MCS 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, teaching life skills, providing sexual and reproductive health services, and support their transition into adult services.

MCS will support in-service training of 50 and 40 HCWs in FY12 and 13 respectively and provide 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. MCS 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. Linkage of ART services to pediatric care services, PMTCT, TB/HIV, community programs, and other related pediatric services will additionally be optimized.

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