KEMRI supports the MOH in implementation of HIV services at the NNPGH and service provision in Siaya and Bondo Districts as well as Kibera. KEMRI will ensure high quality, comprehensive HIV prevention, care and treatment services including combination prevention HBCT, abstinence and other preventions programs, PMCT, TB/HIV, adult and pediatric HIV care and treatment and PITC. KEMRI will support provision of the selected and appropriate age specific and evidence/theory-based HIV/AIDS prevention interventions/information and counseling to youth in and out of school. Goals include decentralization and integration of HIV services into existing clinics including maternal and child health and TB clinics. KEMRI supports the national M&E system and will support the scale-up of EMR at facilities. EMR will allow for efficient reporting and support patient outcomes analysis to inform program improvement. KEMRI supports OR and public health evaluation implementation science, will support pilot testing of new evidence-informed interventions including EBIs and Treatment as Prevention, they will establish a GBV recovery center at NNPGH and systematically support the center transitioning to the MOH.

Strategies to reduce cost will include: support for government-led programs to avoid duplication; decentralization of trainings to the districts; and support for an integrated district mentorship program in order to build the capacity of district teams to conduct mentorship and promote ownership and sustainability of the program

KEMRI will support building the capacity of local NGOs as a strategy for transitioning the program and also the PHMTs and DHMTs and carries out joint planning to promote ownership and sustainability.

KEMRI procured 7 vehicles in FY10 and have no plans to buy more

Kenya Medical Research (KEMRI) has been supporting HIV adult care and support at New Nyanza Provincial General Hospital (NNPGH), a referral regional facility for Nyanza Province, since 2004. KEMRI has completed year one of their 5 year co-operative agreement with CDC and in FY12 will continue to support integrated comprehensive clinical services in NNPGH. KEMRI will work with the Ministry of Health (MoH) at all levels to jointly plan, coordinate, implement and ensure provision of quality HIV care and support to 7,183 current adult patients in FY13 and 8,180 current patients in FY13.

KEMRI will provide comprehensive care and support package of services including HIV testing to family members of index patients and refer/ linking those HIV positive to care and support; clinical assessment for ART eligibility and linking eligible PLHIV to treatment; laboratory monitoring including 6 monthly CD4 testing; WHO staging; Basic Care Kit (safe water vessel, multivitamins, insecticide-treated mosquito nets, condoms, chlorine for water treatment and educational materials); adherence assessment counseling and support; nutritional support including supplemental and therapeutic nutrition (FBP) to all eligible HIV positive patients; prevention with positives(PwP); cervical cancer screening to all enrolled women; and ensure referral and linkages to other clinical services including RH/FP.

KEMRI in collaboration with MoH will support targeted training (of 100 health care workers in FY12 and 80 in FY13) and mentorship and additionally provide continuous medical education on care and support and OI management; identify human resources and infrastructure gaps and support in line with guidelines; and support good commodities management practices to ensure uninterrupted availability of commodities.

KEMRI will continue to support ongoing psychosocial and community activities including education by peer educators; referral and linkages to community based psychosocial support groups to strengthen adherence; effective and efficient retention strategies of patients on follow up; water, sanitation and hygiene programs; income generating activities; Home Based Care; vocational training; social and legal protection; and food and nutrition programs. KEMRI will adopt strategies to ensure access to friendly services to youth, elderly and physically or mentally challenged populations.

KEMRI will continue to strengthen data collection to improve reporting to MoH and PEPFAR; adopt the new PEPFAR generation indicators; and support the development and use of electronic medical records system in accordance with MoH guidelines. KEMRI will adapt cohort analysis and 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 program activities. Additionally, KEMRI will evaluate and carry out operation research on implemented programs.

KEMRI will support joint Annual Operation Plan (AOP) planning, implementation, monitoring and evaluation; build the capacity of MOH staff and systems to facilitate sustainability; and collaborate with other partners to leverage and maximize on available USG and non-USG resources.

Kenya Medical Research Institute (KEMRI) has supported the New Nyanza Provincial General Hospital (NNPGH), a regional referral facility, since 2004. Nyanza Province, with a population of 5.4 million, has an estimated adult HIV prevalence of 14.9% compared to the national average of 7.1%. In 2010, out of 19,295 notified TB cases, 64% tested HIV positive. KEMRI will continue to support integrated comprehensive HIV/TB clinical services at NNPGH aligned to the Ministry of Health (MOH) 5-Year National AIDS and TB Strategic Plans in the next phase (FY 12 and 13).

To reduce the HIV burden for TB patients, KEMRI will support HIV screening for all TB patients and ensure 95% of co-infected patients are provided with comprehensive HIV care, including co-trimoxazole prophylaxis, nutritional support and early initiation of ART in line with new MOH policy guidelines. To reduce TB burden for HIV infected patients, 6,385 patients in HIV care in FY12 and 7,271 in FY13 will be screened for TB leading to identification of 319 and 364 TB cases, respectively. These patients will be put on TB treatment while those without active TB will be considered for isoniazid preventive therapy (IPT). Based on the completed TB infection risk assessment report, the partner will support implementation and monitoring of basic administrative and environmental TB infection control measures in this facility.

To improve MDR-TB surveillance, KEMRI will ensure expedited turn-around times (TATs) for TB culture and DST for all TB re-treatment cases whose sputum specimens will be processed within KEMRI TB laboratory located close to NNPGH. To increase access to MDR-TB treatment, KEMRI will continue to support the MOH expand the community treatment model. Further, KEMRI will support establishment of regional TB culture and MDR-TB isolation capacity at NNPGH, and support staff mentorship for MDR-TB diagnosis and treatment, and external quality control. More efficient detection of both regular and MDR-TB will be achieved through introduction of the geneXpert.

KEMRI will also support training of 50 HCWs in FY12 and 30 in FY13, expand access to HIV prevention (PwPs) and support community-based activities to ensure TB and HIV treatment defaulters are traced and retained in to care. They will continue to strengthen the data quality and support preparation of comprehensive quarterly reports for the MOH and PEPFAR using custom and new generation indicators, respectively. KEMRI will undertake cohort analysis and support all efforts to improve the quality and outcomes of integrated TB/HIV services. Current efforts to expand use of electronic medical records will be enhanced.

Additionally, over the 2 years, KEMRI will support implementation of collaborative 5 -7 operation research projects whose outcomes will enable MOH adopt more efficient and effective use of evidence-based TB/HIV interventions, evaluate impact of these interventions and build capacity for more effective MDR TB response in Nyanza Province.

KEMRI has been supporting comprehensive HIV pediatric care and support services at the New Nyanza Provincial General Hospital (NNPGH) since 2004. By March 2011 NNPGH had 1,192 children enrolled in care with 812 currently receiving care.

In the FY 12 KEMRI will provide care and support services to 750 children currently on care. The number of children currently on care will increase to 870 during the FY 13. KEMRI will provide comprehensive, integrated quality services, and scale up to ensure 922 HIV infected infants are put on ARV prophylaxis and all HIV exposed children access pediatric care services.

KEMRI will provide a package of care and support services including HIV testing to family members of index patients, referring and linking those HIV positive to care and support; clinical assessment for ART eligibility and linking eligible PLHIV to treatment; laboratory monitoring including 6 monthly CD4 testing; WHO staging; Basic Care Kit; nutritional assessment counseling and support with vitamin A and zinc supplementation when indicated; de-worming; and ensure referral and linkages to other clinical services.

KEMRI will support integration of HIV services into well child welfare clinic services, including Integrated Management of Childhood Illnesses (IMCI); optimal in-patient care; community outreach efforts; and routine child health care and survival services in the maternal child health department. KEMRI will also support care of the newborn by supporting health facility delivery, prophylactic eye care and comprehensive care services to the newborn.

KEMRI will support targeted training (to 100 health care workers in FY12 and 80 in FY13) and mentorship and continuing medical education on care and support and OI management; identify human resources and infrastructure gaps and support in line with guidelines; and support good commodity management practices to ensure uninterrupted availability of commodities.

KEMRI will strengthen community activities and support groups to strengthen adherence, play therapy, effective and efficient retention and defaulter tracing strategies. Referral and linkages of the care takers to other services like IGAs; Home Based Care; social and legal protection; and food and nutrition programs will also be strengthened to improve the welfare of the pediatrics.

KEMRI will adopt strategies to ensure access to pediatric and adolescent friendly services, strategies to ensure retention and access to pediatric care and support services including scaling up identification of HIV exposed infants, ARVs prophylaxis and follow up, HIV testing (PCR-DNA or antibody) and linking those positive to treatment.

KEMRI will adopt the new PEPFAR generation indicators; and support the development and use of electronic medical records system in accordance with MoH guidelines. KEMRI will adapt cohort analysis and 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 program activities. Additionally, KEMRI will evaluate and carry out operation research to advance program implementation approaches.

KEMRI will support joint Annual Operation Plan (AOP) planning, implementation, monitoring and evaluation, capacity building and health system strengthening to facilitate sustainability and collaborate with other partners to leverage and maximize on available resources.

KEMRI lab has been a PEPFAR funded National Lab program implementer since 2004. KEMRI offered support for equipment and reagents procurement distribution, basic and specialized tests scale up (Rapid tests, CD4, chemistries, hematology, EID, viral load, DRT, MDR TB screening), personnel hiring, related trainings and lab policy formulation.

KEMRI has will support integrated comprehensive lab services in FY12 and 13. This will be at National (with NHRL and TB CRL), regional (Provincial/County) and facility levels (i.e transforming the New Nyanza Provincial General Hospital Lab into a centre of excellence).

KEMRI will work towards universal support in coordination and implementation of quality Lab services in line with PEPFAR and MoH guidelines. Attention will be given to cross cutting activities within PMTCT, Prevention, Care and Treatment, TB HIV program areas as well as S.I to provide data for decision making.

The goals includes:

Increase access to specialized tests including, EID, Viral load, TB culture, DRT and Gene Xpert.

Continue mentoring the NNPGH and Siaya DH towards accreditation.

Validate new tests ,equipments and technologies( rapid tests, point of care tests e.t.c)

Support the KEMRI Production Unit gain ISO/WHO or and GMP certification for the production of RHT Kits as well as EQA and IQA panel production and distribution to attain 90% country coverage.

Support specialized microbiological testing for diagnosis of opportunistic infections in persons living with HIV/AIDS.

KEMRI is a hub for national Lab networking for specialized tests including HIV PCR, TB Culture and HIV viral load. These funds will facilitate related human resource, supervision, transport, training, and 10% Lab buffer supplies.

Transfer skills & technology of specialized testing to MOH-NHRL and support the NHRL in the coordination of multi level EQA activities for HIV testing.

Offer a National/International Biosafety /Biosecurity course annually to reach at least 35 MoH facility-based biosafety officers per annum.

KEMRI lab will conduct other activities including training and mentoring individuals for the WHO Stepwise Accreditation through SLMTA expertise. KEMRI lab will tap into available in-country expertise to provide a hands-on user competency training on use of biosafety cabinets and an annual certification in conjunction with MoH engineers.

KEMRI will harness its research & experience to generate data for operational research for the lab program by working closely with MOH. This will include participation in National Surveillance activities i.e. KAIS 2013 & KDHS. KEMRI will support policy formulation by participation and supporting joint Annual Operation Plan (AOP) planning, implementation, monitoring and evaluation and policy document reviews.

The KEMRI M & E plan for verification of programmatic progress/key Indicator will include reporting on

Number of lab personnel trained Biosafety and Biosecurity

Number of safety cabinets certified ,those up and running

Number of labs offering specialized testing /and those networked to specialized testing labs

Number of labs accredited

Number of in country trained SLMTA mentors through KEMRI support

MDR lab up and running at NNPGH

QA networks formed and running

PT panels produced in the KPU; the coverage in percentage by this service

In total 100 health care workers will be trained.

Over the next two years, KEMRI will be supported to strengthen the capacity of the HISS team to facilitate operational research and program evaluations in Nyanza and at the national level. The strategic information team will support this initiative through the following activities:

Developing and applying innovative ICT tools to improve data collection for HIV and TB programs, HIV and TB surveillance and for operational research. This will include use of cell phones, netbooks, tablet PCs and other mobile devices for data collection. KEMRI/CDC will work with other partners such as ITECH and ICAP to pilot EMR interoperability through the OpenEMRConnect (OEC) that is currently ongoing in Siaya and Bondo counties. Findings of this pilot will inform the MOHs rollout of interoperable EMRs nationally.

Providing data management support for programmatic work undertaken by KEMRI-CDC at the New Nyanza Provincial General Hospital, Siaya and Bondo counties and other parts of Nyanza province. The SI team will also participate in operational research to evaluate technologies that enhance efficient service delivery and improved health outcomes. In order to achieve this, some resources will be invested in building staff capacity on research methodology, data analysis, interpretation, scientific writing and dissemination.

The SI team will continue to generate biannual PEPFAR reports for supported HIV and TB programs. They will support the MOHs initiatives to roll-out the revised M&E tools and conduct training to health workers at supported health facilities in Nyanza and Nairobi.

Supporting data collection, management, analyses and distribution at the Demographic Surveillance Systems (DSS) in Nyanza and Nairobi including Home Based Testing and Counseling to better understand the HIV/AIDS epidemic. These activities will include the development, piloting, and rollout of suitable software and piloting of innovative technologies. KEMRI will also continue to conduct mortality surveillance by cause at the two DSS sites through sample vital registration using Verbal autopsy (SAVVY).

Supporting the Division of Leprosy, TB and Lung Diseases (DLTLD) to maintain PDA based electronic TB register five provinces.

KEMRI will contribute to the prevention of medical transmission of HIV through training of health care workers on IPC/biosafety. This will contribute to the Kenya National AIDS Strategic Plan (KNASP-III) goal of eliminating HIV transmission in healthcare settings. This will be achieved by building the capacity of health workers on biosafety, which will promote safe work practices, infection prevention and control practices among other occupational health programs. This will contribute to health systems strengthening and is in line with the Global Health Initiative principles.

KEMRI will support equipment maintenance and certification activities in the country. This is more cost-efficient as it will be done by local medical engineers compared to bringing in international expatriates as was happening before. Additionally the health workers trained will acquire skills that will enable them use safety equipment in an efficient and more sustainable way.

KEMRI is a local partner who is already integrated into the government system.

This is a national program and will target health workers in MOH. During the training course evaluations will be done (pre- and post-tests). Additionally annual support supervision combined with re-certification activity will be done.

This mechanism shall implement abstinence and being faithful services in Siaya and Bondo Districts within the Health and Demographic Surveillance Systems (HDSS) and Gem Division with interventions targeting the youth aged 9 to 17 years. The objective is to provide the youth with information to help them make informed choices about their sexual and reproductive health. KEMRI will support provision (individually or in small groups) of the selected and appropriate age specific and evidence/theory-based HIV/AIDS prevention interventions/information and counseling to youth in and out of school and will work to identify referral mechanisms to ensure clients receive appropriate services, focusing more on the girl child who are more vulnerable to HIV infection.

Healthy Choices 1(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. Health Choices 2 (HCII) will target youth out of school who will be identified through their social networks, trained peer leaders and youth activities like sports and music extravaganzas. Culturally sensitive and relevant IEC materials specific to sex and age groups will be designed, developed and distributed for promoting HVAB. The mature minors will be linked to HIV testing and counseling services.

Families Matter! Program (FMP) is an evidence-based, parent-focused intervention 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.

To promote quality assurance, KEMRI will provide On Job Trainings (OJTs), mentorships, Continuous Medical Education (CMEs) and refresher courses where knowledge and/or skill gaps are identified. The trainings will target all individuals who are involved in the AB programs including health care workers, peer educators and facilitators. 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 capacity building agency. All data generated by the facilitators and other service providers will be entered into standard data base and periodically analyzed for programming purposes. KEMRI will enhance field site supervision to provide technical support to the service providers and ensure adherence to the guidelines and ethics.

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

KEMRI supports direct implementation of comprehensive prevention, care and treatment activities in 1 district and 1 provincial general hospital in Nyanza Province. It covers several program areas and activities that include HIV Testing and Counseling in health care settings and home based settings. The overall goal of HTC by KEMRI is to increase the proportion of individuals who know their correct HIV status and carry out programmatic evaluations to inform the national program in 2 districts of Nyanza Province, Kenya

In FY 10, KEMRI supported Provider Initiated Testing and Counseling (PITC) services and Home-based Counseling and testing (HBCT) in 2 districts with emphasis in the Home-based setting, Outpatient department, Inpatient and Child welfare Clinics. Between October 2010 and August 2011, a total of 161,938 people were offered comprehensive HTC services through HBCT and over 200,000 were counseled and tested at the health facilities

Guided by gaps identified in KAIS, KDHS 2009 and program data and its core mandate of programmatic evaluations, KEMRI will support HTC implementation at the New Nyanza Provincial General Hospital (NNPGH) with specific area of focus being facility-based PITC approach, in HDSS area in Siaya county through door to door and outreach and Kibera slums in Nairobi through door to door and outreach approaches. KEMRI will work with the Ministry of Health (MOH) at the county, District and health facility levels to jointly plan, coordinate and implement HTC services for both adults and children in support of the KNASP III and the District and Provincial level MOH annual operation plans

KEMRI will target patients, family members and couples at the out-patient, in-patient and child welfare clinics with emphasis on enhancing diagnosis of HIV status among individuals with unknown HIV 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. KEMRI will target a total of 103,000 individuals with HTC of whom 10% will be pediatrics. These will contribute 2.6% of the national targets which aims at increasing knowledge of HIV status to at least 80% of the Kenyan adult population

KEMRI will work to identify areas with training and mentorship needs, staff shortages and support appropriately through a MOH driven mechanism which ensures ownership and program sustainability

All HIV-infected persons will be linked to care, treatment and other HIV prevention services at the facility and community level. Referrals will be strengthened by working together with SI team in implementing an effective referral strategy. HIV-negative individuals will be referred to PEPFAR supported prevention services. KEMRI will strengthen the WHO recommended multistep approach to Quality Assurance in counseling and testing. QA audit teams will be strengthened at the counties. KEMRI will continue to strengthen data collection, analysis, utilization and reporting at all levels to increase and improve reporting to NASCOP and PEPFA

KEMRI will continue to expand access to a high quality comprehensive package of HIV prevention services for general population and MARPS in Nyanza Province specifically within the Health and Demographic Surveillance Systems (HDSS) and Gem Division (HDSS) areas in Siaya County. This program will continue to target male and female youth aged 13 to 17 with HC II, a four session group level evidence informed behavioral intervention (EBI). The sessions are delivered outside of school to a mixed gender group of 12-16. Two facilitators, one male and one female, deliver the intervention which 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.

HIV sero-discordant couples will be targeted by Eban, an EBI that seeks to enhance effective communication between couples and will form a basis for referral to PwP and formation of discordant couple support groups. RESPECT, an individual one session EBI delivered during HIV testing and counseling, will target males and females in the general population at risk of HIV infection.

KEMRI will support implementation of the combination prevention, composed of EBIs, biomedical and structural interventions for all above target populations. Behavioral interventions include peer education and outreach, condom and lubricant demonstration and distribution, risk assessment, risk reduction counseling, and skills building. Biomedical interventions include HTC, VMMC, STI screening and treatment, TB screening and referral to treatment, HIV care and treatment and RH services. Structural interventions include interventions to keep girls in school.

PEPFAR support to KEMRI will establish a comprehensive gender-based recovery center (GBVCR) at the Nyanza Provincial Hospital. The GBVRC will offer comprehensive clinical, psychological and social services and safe houses to victims of GBV. KEMRI will work closely with the USAID supported Center for Rights Education and Awareness program to ensure victims of GBV receive adequate legal services. Upon completion of the center, KEMRI will work closely with the Ministry of Medical Services to transition the administrative, human resource and financial management of the center to the Nyanza PGH.

To promote quality assurance, KEMRI will provide On Job Trainings (OJTs), mentorships, Continuous Medical Education (CMEs) and refresher courses where knowledge and/or skill gaps are identified and addressed through mentorship, trainings and exchange visits for bench marking. All data generated by the facilitators and other service providers will be entered into standard data base and periodically analyzed to inform and improve programming. KEMRI will seek to share experiences, lessons learnt and best practices with other PEPFAR partners and other stakeholders. Quarterly support supervision with NASCOP, ministry of education and DHMTs will ensure quality of services delivered is of the expected standard. The program will continue to strengthen data collection, analysis, utilization and reporting at all levels to increase and improve performance and reporting to NASCOP and PEPFAR.

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 e.g. multiple sexual partners and unprotected sex as well 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 100 PWID with MAT services and 100 with other wrap-around services in Nyanza. This will include capacity strengthening for Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) whose key staff will receive training, support supervision, and mentorship. A 9-intervention package of services per the PEPFAR and UNAIDS/UNODC guidelines will be offered i.e. 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/Nyanza 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 of 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

Kenya Medical Research Institute (KEMRI) has been supporting PMTCT at the New Nyanza Provincial General Hospital (NNPGH), which is a provincial referral facility, since 2010. By end of March 2011 SAPR results, KEMRI supported counseling and testing of 2,002 pregnant women; provided ARVs prophylaxis to 530 HIV positive pregnant women, supported early infant diagnosis and follow up of HIV exposed infants, and trained 36 HCWs on PMTCT.

In FY12, KEMRI will offer HIV counseling and testing to 6,000 pregnant women at the ANC and give ARV prophylaxis to 882 HIV infected pregnant women. The HIV infected women will receive a CD4 test after undergoing a WHO clinical staging. KEMRI will give HAART to all eligible HIV positive pregnant women, in line with the revised PMTCT national guidelines. In FY13, KEMRI will increase the number of pregnant women counseled to 6,300 offer ARV prophylaxis to 1,072 pregnant women and 922 infants, and do EID for 922 infants. KEMRI will focus on the 4 prongs of PMTCT: primary prevention; prevention of unwanted pregnancies, 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 /or treatment, ARV prophylaxis and treatment for both mother and baby, nutritional support, psychosocial support, PWP, follow up & retention , and referral and linkages. KEMRI will incorporate TB screening into routine antenatal care.

KEMRI will reach 1,890 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. KEMRI will support integration of ART in MCH clinics, access to FP/RH services, establish or strengthen infection control and waste management activities.

KEMRI will support hospital delivery through provision of delivery beds and sterile delivery packs, working with CHWs and TBAs to promote community- facility referral mechanism, health education and community services providing skilled birth attendance.

KEMRI will support safe infant feeding practices as per national guidelines; and enrollment and follow up 922 babies born to HIV infected mothers to access CTX, ARV prophylaxis and EID services using the HIV exposed infant register till 18 months. KEMRI will facilitate ART initiation for those who test positive before 2 years.

KEMRI 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 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. KEMRI 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, referral and linkages.

KEMRI will continue to support provincial level activities e.g. EID laboratory testing and conduct operation research on implemented programs.

KEMRI will train 30 health workers in FY12

Kenya Medical Research Institute (KEMRI) has been supporting adult HIV treatment at the New Nyanza Provincial General Hospital (a provincial referral facility), since 2004. As of March 2011 SAPR results, NNGPH had supported a cumulative 9,523 adults on ART and 4,095 were active.

Nyanza province has an estimated population of 5.4 million with an estimated adult HIV prevalence of 14.9% compared to the national 7.1%. In FY12, KEMRI will work with the Ministry of Health (MoH) at all levels to jointly plan and ensure provision of quality adult HIV treatment to 5,762 adults currently receiving ART and 329 new adults resulting to cumulative 6,914 adults ever initiated on ART. In FY 13, this number will increase to 6,009 adults currently receiving ART and new 333 resulting to cumulative 7,247 adults ever initiated on ART.

KEMRI in collaboration with MoH will support in-service training of 50 and 30 health care workers in FY 12 and FY 13 respectively; identify human resources and infrastructure gaps and support in line with MoH guidelines; and support good commodity management practices to ensure uninterrupted availability of commodities. KEMRI will also support provincial level activities, including supporting viral load lab testing for Western region.

KEMRI 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.

KEMRI will continue to support linkages to ongoing community activities and support for HIV infected individuals including education by peer educators; use of support groups to strengthen adherence; effective and efficient retention strategies; referral and linkages to psychosocial support groups; economic empowerment projects; and Home Based Care; and food and nutrition programs. KEMRI will support provision of friendly services to youth and special populations.

KEMRI will adapt the quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV treatment services and integrate them into routinely collected data; and use the results to evaluate and improve clinical outcomes; and additionally support short term activities with great impact and better patient outcomes.

KEMRI will adopt strategies to ensure access and provision of friendly HIV treatment services to all including family focused care and treatment. KEMRI will continue to strengthen data collection and reporting at all levels and improve reporting to NASCOP and PEPFAR. Use of an electronic medical records system will be supported and strengthened. Additionally, KEMRI will evaluate and carry out operation research on implemented

Please see the partner overview narrative for information on the strategy to transition to local ownership.

Kenya Medical Research Institute (KEMRI) has been supporting comprehensive pediatric care and support services at New Nyanza Provincial General Hospital (NNPGH), a provincial referral facility, since 2004. Nyanza province has an estimated population of 5.4 million with an estimated adult HIV prevalence of 14.9% compared to the national 7.1%, and approximately 12,440 paediatrics have ever been initiated on ART as at May 2011. As of March 2011 SAPR results, KEMRI through NNPGH had supported a cumulative 812 paediatric on ART and 710 were active.

In FY12, KEMRI will work with the Ministry of Health (MoH) at provincial, district and hospital management levels to jointly plan, coordinate, implement and ensure provision of quality paediatric HIV treatment to 1,054 pediatrics currently receiving ART and 211 new pediatrics resulting to cumulative 1,265 pediatrics ever initiated on ART. In FY 13, this number will increase to 1,111 pediatrics currently receiving ART and 190 new, resulting to cumulative 1,455 pediatrics ever initiated on ART.

KEMRI 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 of EID as per MoH guidelines; 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.

KEMRI 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.

KEMRI will support in-service training of 50 and 30 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; 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.

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