The goal of University of Nairobi (UoN) is to increase access to quality comprehensive HIV prevention services for Most-At Risk Populations in Central and Eastern Provinces. The objectives are to provide continued support to the implementation and scale-up of a combination of evidence-based package of services to SWs and MSM. UoN goals and objectives are linked to Kenyas Partnership Framework (PF) and are directly aligned to Kenya National AIDS Strategic Plan (KNASPIII).This mechanism leverages from the Government Health ministries and has a broad multi-sectoral stakeholder involvement. Some drop- in- centers are already integrated within Ministry of health (MoH) facilities sustainability and MoH Health Care Providers seconded to these DICES. Implementation of this project has a strong community engagement and uses a peer-led approach in outreach services and delivering behavioral interventions. Transition to country partners: University of Nairobi is a local State University and a Centre of Excellence for many health programs in Kenya.The project collaborates closely with Ministries of Education and Health and has integrated its MARPs services in government facilities for sustainability. It forms an integral part of the national Multi Sectoral Technical working group at MoH,NASCOP. Vehicle information: No project vehicle has been procured so far. In FY10, procurement process was initiated for two vehicles to support field outreach activities and transport staff and peers to the various hotspots in the entire Central and Eastern provinces. They will also support supervision and logistical activities across the 9 drop in centers/clinics for sex workers in these regions and support distribution of supplies. This activity supports GHI/LLC.

The University of Nairobi mechanism is a MARPs project targeting female sex workers and male sex workers including MSMs and IDUs. The mechanism covers Eastern and Central Provinces of Kenya. The exact population of these groups is not known but size estimation exercise is underway. The HIV prevalence from program data across the target sub populations is truckers 4%, MSM 4%, IDUs 5.5%, male sex workers 4.25% and female sex workers 12.6%. In 2012 emphasis will be laid on reaching couples and regular partners with 20 % of those tested being partners or couples in 2012.

The HVCT approach used is Provider initiated testing and counseling (PITC) and all clients are appropriately given HIV education, offered testing and given risk reduction counseling. Those who test HIV positive are enrolled into care and treatment offered within the DICEs. The same clients are screened for STIs and offered appropriate treatment. The clients are tested every three months, and as risky behavior are reported as per the national guidelines. Emphasis will be laid on first time testers. HTC is provided as part of combination prevention with 60% of all tested being first time testers in 2012.

Program activities began in March due to logistic reasons and so for the program has reached 12,501 out of a target of 15,000. A rapid results initiative had to be implemented due to late commencement of activities. In 2012 the program will reach 22,000 clients with testing and counseling services. This number includes the re-testing that happens every three months and when a risky act is reported. Out of this 20% will be couples while 60% will target new testers. Work with IDU will be rolled out in 2012 once the guidelines are finalized.

The program uses the national testing algorithm for testing and counseling.

The clients receive comprehensive package of services including care and treatment in the DICEs but follow up by phone is done for clinic defaulters.

The program follows the national quality management guidelines and participates in the proficiency testing quarterly and collection of DBS for the 20th client tested and counseled per counselor. Support supervision is carried out for the service providers on continuous basis. Quality services is ensured by adherence to national guidelines, use of national certified kits and participation in the external quality assurance through proficiency testing run by the government.

The national M&E framework is used including use of national registers and data collection tools and reporting will be through the DHIS in future. The program will develop work plans and conduct biannual data quality audits and monthly data supervision is carried out and this informs the program implementation improvement.

New indicators like couples tested, discordant couples have been incorporated in the data collection tools.

Promotional activities are conducted by peer mobilization and mass media from the national perspective on the need to know status. (2,991).

UoN will expand access to a high quality comprehensive package of services for MARPS including SWs and MSM. It will target women aged18-55 years, MSM, youth 13-17 years and truckers. It will target high risk sexual behaviors prevalent among sex workers including incorrect and inconsistent condom use and douching practices, excessive alcohol, drug use, and low adherence to treatment. UoN will support Combination Prevention Interventions for SWs as defined in the National Guidelines. These comprise evidence-informed behavioral, biomedical and structural interventions. Biomedical interventions include HTC, STI, TB, care and treatment, RH services, Emergency contraception, Treatment as Prevention and Pre-exposure prophylaxis where feasible, drug and alcohol abuse screening, referral for treatment. Structural interventions focus on enhancing a 100% condom use Program and mitigation of sexual violence. Specific EBIs will include; Healthy Choices 2 (HC2) targets youth 13-17 years, in out-of- school settings and focuses on safer sex, condom use, and negotiation and communication skills. It consists of 8 one hour modules. 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. Respect is a brief individual sessions targeting general population and youth, originally for heterosexual negative persons focusing on reduction of STDs/HIV, risk reduction, condom use and clients understanding of personal risk. UoN will support roll out of video-led EBIs such as Safe in the City to 10800 MARPs. PHDP is an ongoing 5-10min group and individual level intervention that targets PLHIV in clinical and community settings, focusing on partner testing, risk reduction, condom use, disclosure, adherence, STI reduction and family planning. The efficacy of PHDP has been shown to be 68% in preventing transmission of HIV, and 96% in treatment for prevention.. UoN will support placement of Peer Educators to reinforce prevention messages delivered by health providers as a feasible model for task-shifting in the provision of PHDP in clinical and community settings, promotion of MIPA and strengthening ART adherence. UoN works in Central and Eastern provinces. The estimated size of FSWs in these regions is 60,000 with a HIV prevalence of 29.3% .Further size estimation and mapping exercises will be done to provide a validated estimate.9 drop-in-centers will be supported to increase access to services for SWs. In FY 2012/13 UoN will reach 18,000 FSWs, 1200 MSW,1000 MSM and 1600 truckers with comprehensive MARPs services, 2100 PLHIV with PHDP, 5000 youth with HC2,5000 and 8308 with S2S and Respect . Quality assurance for EBIs will be promoted through training and certification of service providers using approved national curricula, standard job-aids, guidelines and regular supervision. Services provided through this mechanism are closely linked to other public services e.g. drug supplies from central drug procurement mechanisms including condoms and to community services. PLHIV will be linked to STI, FP, care and treatment services. Monitoring of EBIs will be done through the review of IMC implementation plan, analysis of KePMS data, quarterly reviews and reports. Evaluation will be conducted through operation research of combination HIV prevention and periodic surveys.

In Kenya, HIV prevalence amongst PWID is 18.3%, which is over two times more than that of the general population. 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 Eastern and Central Provinces. This will include capacity strengthening for several DICES 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/Central & Eastern Provincial Directors 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 implemented under this mechanism.