IRDO is a Kenyan NGO based in Kisumu, Nyanza Province. Its principal mandate is to design, implement and evaluate public health programs and research. In October 2004, IRDO was funded by PEPFAR, through a CoAg with CDC, to design and implement a HIV prevention program that promotes abstinence and being faithful among the youth living in the informal (slum) settlements of Kisumu City. The program has expanded both in geographical coverage (from 5 small slums to the entire Kisumu East, Suba, Kisumu West, Nyando, Siaya, Bondo and Rarieda districts) and in programmatic areas to cover more comprehensive preventions programs including male circumcision, evidence based behavioral interventions and biomedical interventions.

In COP 2012, the goals of this mechanism are to reach out to 11,972 members of the general population with individual or small group HIV prevention interventions that are evidence-based (Community PwP and RESPECT); circumcise 94,556 males as part of the minimum package of MC for HIV Prevention services per national standards and in accordance with the WHO/UNAIDS/Jhpiego Manual for Male Circumcision under Local anesthesia; provide 43,000 individuals with HIV testing and counseling services and to ensure effective linkage to care for those infected; and provide services to 600 injecting drug users as per PEPFAR guidelines.

IRDO is supporting MOH and building the capacity of local staff and organizations. To ensure good quality of services, IRDO will conduct regular supervisory visits using national or WHO/UNAIDS standard supervisory tools. Monitoring will done using SAPR and APR reports, KePMS, quarterly presentations to CDC staff, and regular documented site visits.

IRDO is not purchasing vehicles under this mechanism. this activity supports GHI/LLC.

The Kenya Government/MOH recognized MC as an additional HIV prevention intervention in 2007 and with PEPFAR support developed a MC policy guidance, MC strategy and communication strategy, and adapted/adopted relevant documents (VMMC clinical Manual, M&E indicators/tools) to guide service delivery and demand creation and tracking. The programs objective is to circumcise men aged 15 49 years by 2013 and reach 80% coverage. Four provinces (Nyanza, Western, Rift Valley and Nairobi) have been identified for priority scale up. Nyanza Province has MC rates of 48% and HIV prevalence of 14.9%. HIV prevalence among the uncircumcised Luo is 17%, and MC rates is estimated to be 22% (KDHS 2008/9). Nairobi Province has MC rates of 83% and HIV prevalence of 8.8%. Since 2008, VMMC services have been provided through PEPFAR implementing partners working at Ministry of Health (MoH) facilities, to over 300,000 males. However, gaps still exist, and while coverage is nearly 50% in some Nyanza districts, it is very low in Nairobi among members of non-circumcising communities, and in other urban centers. In 2012, IRDO will contribute to addressing the VMMC gaps existing in Nyanza, Nairobi and other pockets with significant populations of uncircumcised men in Kenya as advised by National Taskforce on VMMC

IRDO will provide VMMC services to 94,556 boys and men aged 15 years and above in these areas (18,717 men in Kisumu county,25,604 men in Homabay County, 28,075 men in Migori County,9,358 men in Nairobi and 12,802 in other identified areas

Current coverage of VMMC services in counties ranges between 5% in some, and reaching 50% in others, and IRDO will contribute to covering these gaps

IRDO (clinical & M&E) staff, the district and provincial M&E subcommittees will conduct quarterly support supervision visits to VMMC sites to ensure quality assurance, using the adapted VMMC QA tools and ensure reporting is done through the MOH M&E reporting system

IRDO will ensure requisite demand for services in generated by males and females in and around the catchment area of each facility where VMMC services are available, and explore other efficiency approaches, including conducting outreaches/mobiles, electrocultery, and moonlight services where applicable

As part of comprehensive package, clients will be provided with the minimum package of services at site according to national guidelines, which include opt out HTC for VMMC clients and their partners, age appropriate sexual risk reduction counseling, counseling on abstinence during 6 week healing period, and promotion of correct and consistent condom use

Where necessary, HCW teams to provide services will be trained to build their capacity, using the MOH VMMC training guidelines

Linkage with other services within facilities and within districts/counties will ensure VMMC is part of comprehensive package of prevention package. Identified men infected with HIV will be effectively linked to Care and treatment sites. Active linkages with other programs has been established, with cross referrals to care and treatment for HIV positive men, as well as referral of uncircumcised men from routine HTC sites and discordant couples to VMMC services

Regular EQA from WHO and PEPFAR teams has ensured VMMC activities adhere to international standards. Service provision will be monitored using the standardized VMMC reports and evaluated regularly through the MOH M&E reporting system

The goal of the country as reflected in Kenya National Aids strategic plan KNASP III is to reach 80% knowledge of HIV status in the country by 2013. Nyanza Province, which has a population of about 5.1 million people, carries the highest HIV burden in Kenya. With an estimated adult HIV prevalence of 14.9% compared to the national 7.1%, ~500,000 people are living with HIV.

IRDO The Pembe Tatu Project supports the Provision of Integrated HIV Prevention Interventions. This mechanism covers several program areas and activities that include HIV testing and Counseling in outreaches/mobiles and national Rapid Response Initiative (RRI) campaigns. Many of these activities build synergies between HIV testing and counseling, HIV Prevention, care and treatment services. The overall goal of HTC is to increase the proportion of individuals who know their correct HIV status in Migori and Homabay counties.

In FY10, this mechanism supported HTC in the two counties using various approaches including national RRI campaigns, mobile/outreach and moonlight HTC. Between October 2010 and August 2011, a total of 115,482 people were offered comprehensive HTC services. A total of 16,203 (14%) individuals were identified as HIV infected and were linked to care and treatment services.

Guided by gaps identified in KAIS 2007, KDHS 2009 and program data, this mechanism will continue to support HTC service implementation in the two counties with specific area of focus being outreach/mobile and targeted HTC approaches to most-at-risk populations. This mechanism will work with the Ministry of Health (MOH) at the county, District and community levels to jointly plan, coordinate and implement HTC services for both adults and children in support of the Kenya National Strategic Plan III, the Partnership framework and the District and Provincial level MOH annual operation plans.

This mechanism will target couples, sexually active youth, youth out of school and general population amongst others with intent to enhancing diagnosis of HIV status among individuals with unknown HIV infection status, enhanced knowledge of HIV status with emphasis of identifying HIV infected individuals and HIV sero-discordant couples and strengthened linkage to appropriate HIV prevention, care and treatment services and ensuring disclosure as a key strategy of strengthening HIV prevention among sero-discordant couples. The program will target a total of 43,000 individuals with HTC of whom 10% will be pediatrics.

A significant effort will be directed towards building capacity of MOH staff to provide safe and quality services, as well as minor renovations in MOH facilities to ensure ownership for sustainability.

Working with other relevant stakeholders, the program will work to strengthen appropriate referral and linkages between Community HTC and other HIV/AIDS prevention, care and treatment services in the selected districts. The program will also work with the GoK system and in particular NASCOP to support the following activities at district level: Commodity management, Training of HIV service providers, Implementation of the WHO recommended multistep approach to Quality Assurance and National Quality Assurance Strategy on HIV Testing, Supervision and Implementation of the community PwP strategy. The program will continue to strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR.

The drug use epidemic in Kenya has a HIV prevalence that is 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 therefore target the PWUD/PWID population in general, and provide appropriate targeted responses to each of the sub-groups within this population to address their varied risk profiles. Among social networks drug-users, high risk sexual and injecting practices include multiple sexual partners, unprotected sex among injecting peers, needle-sharing and flash-blood sharing. 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 IDUs.

This mechanism will support the set up and scale up of a comprehensive package of services targeting 600 PWID/PWUD who will receive a 8-intervention package of services per the PEPFAR and UNAIDS/UNODC guidelines. These services 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. Some program interventions will be implemented for the first time in Kenya, and will involve careful planning with a broad range of stakeholders, including involvement of local administration with a view to enlisting the crucial buy-in and support for an enabling environment. This activity will be carefully rolled out to assure efficiency in rolling out drug dependency treatment. Service providers in this program will receive training in addiction counseling and managing drug dependence treatment, in collaboration with the national Treatment II program. Close linkages will be established with the regional drug-dependence treatment. Out-patient treatment will be the desirable model of offering MAT, backed by a close follow-on addiction counseling therapy.

IRDO will participate in the IDU sub-Technical working group led by NASCOP, with participation from the Health Ministrys Mental Health Services to adapt and disseminate national PWID program guidelines, MAT treatment protocols and reporting tools to guide implementation. Training, supportive supervision and mentorship will be provided to this program. Other key players with who this program will work with include the UNODC, NACADAA and the HIV treatment and care programs. PWID/PWUD will be linked to collaborating HIV care and treatment centers to ensure a close follow-on to their treatment and adherence.