Christian Health Association of Kenya (CHAK) will implement high quality, comprehensive HIV prevention, care and treatment activities in Faith based (FBO) facilities previously supported through CRS Track 1 mechanism. The program goal and objectives are linked to Kenyas Partnership Framework (PF) and Global Health Strategy (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.

Cost efficiency is being addressed through integration of services, reduction of the technical teams with increased capacity building of the FBO staff, use of existing evidence-based efficient strategies, task shifting, implementing more facility-based training and mentorship as opposed to offsite training, evaluating cost effective strategies for defaulter management, laboratory networking, and mobilization

CHAK is a registered FBO in Kenya. The program model promotes local ownership and sustainability at all levels; enhances district-level linkages and non-clinical capacity building to empower local leadership to manage HIV services in a cost effective, comprehensive and collaborative approach.

CHAK has already procured one vehicle with FY2011 funds and will procure another one with FY2012 funds to support program implementation activities, e.g. TA site visits, supervision and monitoring. The vehicle will enhance efficiency and effectiveness in the execution of program activities. This activity supports GHI/LLC.

Christian Health Association of Kenya (CHAK) has just received a CDC award to start implementing HIV care services from Oct 2011. CHAK will support comprehensive HIV care and support previously supported by CRS-HRSA in Eastern, Central and Nairobi region.

CHAK will work with the Ministry of Health (MoH) at the provincial, district and health facilities levels to jointly plan, coordinate, implement and ensure provision of quality HIV care and support to 19,542 current adult patients in FY12 and 24,750 current patients in FY13 in public, faith-based and high volume private health facilities, within agreed limits of rationalization and towards universal access to care and support services.

CHAK will offer a 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, chlorine for water treatment and educational materials); supplemental and therapeutic nutrition (FBP) to all eligible HIV positive patients; prevention with positives (PwP), and family planning and reproductive health services including cervical cancer screening to all enrolled women.

CHAK in collaboration with MoH will support targeted capacity building (training and mentorship) for health care workers and offer continuous medical education on care and support, such as OI diagnosis and treatment. CHAK will identify areas with staff shortages, support recruitment of additional staff, and support good commodities management practices to ensure uninterrupted supply of commodities. CHAK will also support ongoing community interventions for HIV infected individuals, including education by peer educators and use of support groups to provide adherence messaging. Effective and efficient defaulter tracing and follow up will continue to be supported and strengthened to improve retention in all facilities. CHAK will support referral and linkages to community based psychosocial support groups; water, sanitation and hygiene programs; economic empowerment and income generating activities; home-based care services; gender-based violence support programs; vocational training; social and legal protection; and food and nutrition and food security programs. CHAK 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. CHAK will continue to strengthen data collection and reporting at all levels to improve reporting to NASCOP and PEPFAR.

CHAK will adopt the new generation indicators and support the development and use of electronic medical records system in accordance with NASCOP guidelines. CHAK will continue using the quality of care indicators (CQI) for monitoring the quality of HIV care and support services, integrate them into routinely collected data and use the results to evaluate and improve clinical outcomes. CHAK will do cohort analysis and report retention rates as required by the NASCOP. CHAK will support joint Annual Operation Plan (AOP) planning, implementation, monitoring and evaluation and health system strengthening to facilitate sustainability.

Christian Health Association of Kenya (CHAK) is a new grant that will support TB/HIV activities in six facilities that were previously supported by the CRS-HRSA grant in the Nairobi, Central and Eastern regions. CHAK will provide TB/HIV services in line with the Ministry of Health Division of Leprosy, Tuberculosis and Lung Disease (DLTLD) and the National AIDS and STI Control Program (NASCOP). CHAK will align and adhere to Kenyas 5-Year National AIDS and TB Strategic Plans objectives to ensure co-infected TB patients and suspects receive quality and comprehensive care to contain the threat of drug resistant TB.

In FY 2012 and 2013, CHAK will continue to intensify efforts to detect TB cases through clinical exams and laboratory investigations and ensure provision of appropriate TB treatment. CHAK will ensure that facility staffs are adequate and well trained. Laboratories will be equipped to support various TB diagnostic tests including sputum specimen transport where laboratory services are unavailable. CHAK 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. CHAK will ensure that at all TB patients are screened for HIV and 80% TB-HIV co-infected patients are put on cotrimoxazole and ARVs as early as possible regardless of the CD4 count as per the national guidelines. CHAK 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.

To reduce the burden of TB in HIV infected patients, CHAK will support intensified TB screening in HIV care for 17,371 in FY12 and 22,000 in FY13 at each clinical encounter using the national screening tool. 869 co-infected patients identified in FY12 and 1,100 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

CHAK will ensure that the national IC guidelines are available at all sites and staff are trained on IC. CHAK 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. CHAK 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. CHAK will expand prevention with positive (PwP) services in TB clinics, strengthen linkages between facility and community-based services, improved patient referrals and tracking systems, and increase support for TB-HIV operation research. CHAK will report selected custom indicators to assist with program management and evaluation and monitoring of new activities.

Christian Health Association of Kenya (CHAK) will implement comprehensive integrated pediatric care services to children in Eastern, Central and Nairobi region in six facilities that were previously supported by CRS-HRSA Track 1 activities.

In FY 12 period, CHAK will ensure provision of pediatric care and support services to 2,092 children. The number of children on care will increase to 2,633 during FY 13.

CHAK will provide comprehensive, integrated quality services and scale up to ensure 307 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.

CHAK 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.

CHAK 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 service.

CHAK 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, 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. CHAK will strengthen pediatric data collection and reporting at all levels to increase and improve reporting to NASCOP/PEPFAR and conduct a cohort analysis to inform programming.

Target population: CHAK will support HIV testing and counseling services in several mission/faith-based health facilities in following counties: Migori, Homabay, Kisumu, Siaya, Bungoma, Kakamega, Kiambu, Kirinyaga, Nyeri, Nyandarua, Kitui, Embu, Tharaka-Nithi, Meru, and Taita-taveta. Target population will include all patients, their family members and caretakers who access out and in patient services in all the supported facilities.

HTC Approaches: The program will utilize provider initiated opt out approach and the services will be 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 will either be 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: In COP 2012, CHAK will target to provide HTC services to a total of 37,000 persons of which 20% will be tested as couples and 10% will be children below the age of 15.

Testing algorithm: National algorithm will be used.

Referrals and linkages: In order to strengthen referrals, CHAK will put in place several important strategies. They include: use of peer educators as patient escorts from one hospital department to the CCC; 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, CHAK 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: CHAK 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.

CHAK implements comprehensive prevention, care and treatment programs in Central and Eastern provinces. In FY 2012/13, CHAK 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.

CHAK 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 Central is (3.6%) and (4.6%) in Eastern province. CHAK will reach 11033 (60%) PLHIV in FY2012 and 16293 (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.

CHAK will work with appropriate national Technical Working Groups 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 CHAK 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 DHS, Kenya Indicator AIDS Survey, Kenya Service Provision Assessment).

Christian Health Association of Kenya (CHAK) will implement comprehensive PMTCT services to pregnant mothers in six facilities located in Eastern, Central and Nairobi region that were previously supported by CRS-HRSA track 1 activities. CHAK will strengthen PMTCT services in the 6 main facilities and their satellites by integrating ART into the MCH clinics.

In FY12 CHAK will offer HIV counseling and testing to 6,524 pregnant women at the ANC and give ARV prophylaxis to 297 HIV infected pregnant women. The HIV infected women will receive a CD4 test after undergoing a WHO clinical staging. CHAK will give HAART to all eligible HIV positive pregnant women in line with the revised PMTCT national guidelines. In FY13 CHAK will increase the number of pregnant women counseled to 6,850 and offer ARV prophylaxis to 361 pregnant women and 310 infants. 310 infants will receive an early infant diagnosis test using PCR.

CHAK will work to improve ANC attendance and hospital deliveries by working with existing community programs to increase demand for skilled delivery and promote community- facility referral. Maternity services will be strengthened by supporting provision of basic equipment at the hospitals.

Scale up of uptake of RH services including FP referral and linkages in MCH will be supported. PITC will be promoted including counseling and testing of mothers at the well baby and post natal clinics, which will identify HIV exposed infants. CHAK will work with the MoH at all levels to jointly plan, coordinate and implement PMTCT services, in line with the Kenya National Strategic Plan III, the GOK and USG Partnership Framework, and the district and provincial annual operation plans.

Areas of staff shortages will be identified and recruitment of additional staff will be supported. CHAK will build the capacity of health care workers by trainings on revised PMTCT guidelines, early infant Diagnosis, safe infant and young child feeding and a structured mentorship and supervision plan to support facilities. 30 health care providers will be trained in FY12 and equal number in FY13.

Data collection and reporting will be strengthened by orientation of health care workers on the revised data tools and facilities will be encouraged to use their data for program improvement.

CHAK will support the 4 prongs of PMTCT: primary prevention; referral and linkages for family planning; provide ARV prophylaxis to all HIV positive pregnant mothers and exposed infants; and care and treatment to eligible HIV positive mothers, partners, and children. A minimum care package that includes health and HIV education, individual and family HIV counseling and testing, clinical and laboratory monitoring and assessment, OI screening and /or treatment, clinical (WHO criteria) and immunological (CD4 cell count) staging, ARV prophylaxis and treatment for both mother and baby, nutritional support, TB screening, psychosocial support, PWP, follow up, and retention/referral linkages will be provided. Enrollment, follow up, early Infant Diagnosis, and ART initiation of those who test positive before 2 years of HIV exposed infants will be supported. Effective retention strategies for mothers and babies through care will be supported through use of appointment diaries and registers for tracking defaulters.

Christian Health Association of Kenya (CHAK) will support treatment in 6 sites located within Eastern, Central and Nairobi provinces. Eastern, Central and Nairobi provinces have an estimated population of 5.6, 4.4 and 3.1 million people respectively with an estimated adult HIV prevalence of 4.6%, 3.6% and 8.8% respectively compared to the national 7.1%. These services are currently being supported by CRS through the Track 1 mechanism but will be handed over to CHAK from Oct 2011. As per 2011 SAPR results, a cumulative 8,887 adults had ever been started on ART and 6,407 were active.

In FY12, CHAK will work with the Ministry of Health (MoH) to continue supporting expansion and provision of quality adult HIV treatment services as per MoH guidelines to 15,450 adults currently receiving ART and 2,169 new adults resulting to cumulative 18,540 adults who have ever been initiated on ART. In FY13, this number will increase to 17,078 currently receiving ART and 2,193 new adults resulting to 19,271 adults who have ever been initiated on ART.

CHAK will support in-service training of 150 and 100 HCWs in FY 12 and 13 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.

CHAK will support provision of comprehensive package of services to all PLHIV including ART initiation for those eligible; laboratory monitoring including CD4 and viral load testing for suspected treatment failure; cotrimoxazole prophylaxis; psychosocial counseling; referral to support groups; adherence counseling; nutritional assessment and supplementation; prevention with positives (PwP); FP/RH; and improved OI diagnosis and treatment including TB screening, diagnosis, and treatment. Ongoing community interventions for PLHIV will include peer education and use of support groups to provide adherence messaging and defaulter tracing and follow to improve retention in all sites. CHAK will also support provision of friendly services to youth and special populations. CHAK will adopt strategies to ensure access and provision of friendly HIV treatment services to all including peer education, support groups, disclosure, partner testing and family focused care and treatment.

CHAK will provide support for community activities to HIV infected individuals including peer education, 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.

CHAK 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 additionally support short term activities with increase impact and improve patient outcomes.

CHAK 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. Cohort analysis will be performed and retention rates reported as required by the national program and discuss the analysis results with facility staff in order to improve program performance.

Christian Health Association of Kenya (CHAK) will support pediatric treatment services in 6 Faith based facilities in Eastern, Central and Nairobi provinces previously supported by CRS-HRSA Track 1 mechanism. As per 2011 SAPR results, a cumulative 1,019 paediatrics had ever been started on ART and 679 were active.

In FY12, CHAK 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 2,256 pediatrics currently receiving ART and resulting to cumulative 2,707 pediatrics ever initiated on ART. In FY 13, this number will increase to 2,256 pediatrics currently receiving ART and new 406 resulting to cumulative 3,113 pediatrics ever initiated on ART.

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

CHAK 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.

CHAK will support in-service training of 150 and 100 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; 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.

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