Kisumu West (KW) program aims to increase access to HIV services, including PMTCT, HTC, PWP, care and treatment. KW will endeavor to support 100% coverage of PMTCT interventions in ANC settings and 80% knowledge of HIV status among adults by 2012; which is in keeping with Kenyas PFIP. This will be achieved through integration of HIV services within the wider MOH services; and social mobilization to increase demand for HIV services. KW will expand HTC activities through multiple mutually-reinforcing and non-redundant methodologies.Stable patients will be cared for at lower-level health facilities. In addition, a one-stop shop for clients will be offered by linking together HIV, non-communicable and communicable disease services (including TB) among infected and affected individuals. These will reduce duplication and improve cost-efficiency of health workforce and management resources.To aid transition to country partners, KW will strengthen local institutions, including the District Health Management Team, through trainings, joint planning and support supervision. A strategic country-driven improvement of the health system to address a multiplicity of health issues, including HIV, will create an efficient, sustainable and cost-effective program.KW will work with MOH to build the capacity of community health workers to deliver services. This will strengthen referral systems, with a focus on reaching the most marginalized groups.KW procured 2 vehicles using FY09 and FY10 funds. These were needed to support logistics, transport laboratory/pharmaceutical commodities, and make site supervisory visits.Target populations, geographic coverage, and monitoring and evaluation plans are addressed in budget code narratives. This activity supports the GHI/LLC.

Kisumu West (KW) supports HIV care and prevention activities in Kisumu West district, Nyanza province of Kenya. The HIV rates range from 18-29% in KW compared to the national average of 7.1%. USG technical, capacity building and financial support to KW HIV services are factored into District and Provincial Annual Operation Plans (AOP) prepared and coordinated by the Ministry of Health (MOH). KW will continue to support HIV care services for 6000 adults and 1000 children below 15 years. This is aimed at reducing mortality, morbidity and new infections by 50% by 2014. This program will endeavor to enhance activities that foster early identification and management of opportunistic infections, quality provision of the basic care package, individual and facility-based nutritional support, access to cotrimoxazole prophylaxis, as well as enhancing community PwP through condom provision, referral for family planning services, identification and support of discordant couples, provision or /referral to other PWP services, and supporting implementation of the MOH community health strategy. HIV-positive adults and children identified through HTC services including PMTCT, TB/HIV, VCT, PITC, and home-based CT will be linked to care and treatment services. In addition, the program will continue to support other clinical services (pain relief, safe water, multivitamins, prevention and treatment of other complications such as diarrhea, cervical cancer screening and Kaposis sarcoma); psychological and spiritual services (group and individual counseling, end-of-life care, bereavement services)for all HIV positive clients. In addition, HIV prevention services (partner/couples testing, risk reduction counseling, adherence counseling, and STI diagnosis and treatment) will be part of our package. Patients in care will be linked, in an integrated manner, to other HIV treatment, care and prevention services including TB screening, treatment and prevention.

KW will strengthen the scope and quality of program activities in 23 health facilities over the next 2 years. Cumulatively, some 7,000 patients, 1,190 of these in the first half of FY 2011, were placed on different spectrum of the basic care package to extend and improve quality of life throughout the HIV illness. This basic care included prevention and treatment of opportunistic infections (OIs).

KW will also support good supply chain practices to ensure uninterrupted supply of commodities. KW will continue to strengthen data collection and reporting at all level; in addition to doing cohort analysis and reporting retention rates as required by the HIV program (NASCOP) and PEPFAR. KW will adopt the new generation care indicators and support on-going development and use of NASCOPs electronic medical records system. The partner will adapt the quality of care indicators (CQI) to monitor HIV care and support services and integrate these into routinely collected data and use the results to evaluate and improve clinical outcomes.

Kisumu West (KW) supports HIV care and prevention activities in Kisumu West district, Nyanza province of Kenya. The HIV rates range from 18-29% in KW compared to the national average of 7.1%. USG technical, capacity building and financial support are factored into District and Provincial Annual Operation Plans (AOP) prepared and coordinated by the Ministry of Health (MOH). KW currently supports pediatric care services, including Early Infant Diagnosis, in 23 sites. KW plans to expand these services to additional 4 sites in the next phase. KW will continue to provide HIV care services for over 1500 children below 15 years. This is aimed at reducing mortality, morbidity and new infections by 50% by 2014. The program will endeavor to enhance activities that foster early identification and management of opportunistic infections; and provision of clinical, psychological, spiritual, social, and prevention services. In addition, insecticide treated nets, laboratory services, pain and symptom relief, individual and facility-based nutritional support will be offered throughout the continuum of illness.

KW will further decentralize services to attain 80% coverage over the next 2 years. This will lead to a cumulative total of 2000 children on care. KW will work with MOH to improve the quality of services through in-service staff training; mentorship; expanded access to regular CD4 monitoring and better patient retention strategies; including active defaulter tracing practices. Additional 60 health providers will be trained to support expansion of pediatric care services. The partner will strengthen provision of comprehensive HIV services including viral load testing for patients failing treatment, cotrimoxazole prophylaxis, disclosure in a sensitive and culturally appropriate manner, psychosocial counseling, participation in children support clubs, adherence and disclosure counseling, PWP and nutritional assessment and supplementation. KW will strengthen integration of early infant diagnosis in MCH and inpatient settings. To further strengthen adherence and transition to adult services, childrens clubs will be stratified based on age, with the older adolescents being separated from younger children. Patients will be screened for TB at each clinic encounter to ensure that those with active disease are promptly put on TB treatment and ARVs based on recently updated MOH guidelines. The diagnosis, prevention and treatment of other OIs and tumors such as candidiasis, and Karposis sarcoma will be enhanced through staff training and support for commodities and infrastructure. KW will support conduct of cohort analysis and report retention rates as per national guidelines. KW will adapt the quality of care indicators for monitoring the quality of pediatric care services and integrate these into routinely collected data used to evaluate and improve clinical outcomes. The partner will continue to strengthen data collection and reporting at all levels to increase and improve the quality and timeliness of data reported to MOH and to PEPFAR. Use of an electronic medical records system will be supported in addition to performing data quality audits. To promote transition to local ownership and sustainability of ART services, the Kenya Government is expanding her budgetary contribution to ART procurement.

Kisumu West (KW) program supports HIV /TB treatment and prevention activities in Kisumu West district, Nyanza province of Kenya. The HIV rates range from 18-29% in KW compared to the national average of 7.1%. HIV TB co-infection rates are higher at 80% in KW compared to the national rate of 50%. USG technical, capacity building and financial support to KW HIV/TB services are factored into District and Provincial Annual Operation Plans (AOP) prepared and coordinated by the Ministry of Health (MOH).

In FY 11, 157 newly diagnosed TB patients received their HIV results in KW supported sites. Over the same period, 6781 clients in HIV care were screened for TB leading to a yield of 16 active disease.11 TB re-treatment cases were registered with no drug resistant TB detected over this period. In the next 2 years, KW will intensify TB control efforts through timely clinical and laboratory evaluations. KW will screen up to 80% of patients in HIV Clinics for TB; 500 TB patients in TB settings will be counseled and tested for HIV while 200 TB/HIV co-infected patients will be put on treatment. The program will scale up the 3Is Intensified Case Finding, Isoniazid Preventive Therapy, Infection Control, promotion of Integrated TB/HIV services in the TB Clinic, and immediate initiation of ART in those co-infected patients irrespective of their CD4 count. This is in line with MOH guidelines. Other services provided will include clinical monitoring, related laboratory services, treatment and prevention of tuberculosis, as well as screening and referral of TB clinic clients for HIV testing.

Each site will receive adequately trained and supported clinical and laboratory staff. TB patients on treatment will be monitored clinically and through periodic sputum examination. KW will support the one stop shop model to provide integrated services and ensure continuum of care for individuals with both TB/HIV co-infection. TB and HIV clinical staff will undergo refresher trainings to gain proficiency in management of both diseases. Through the MOH community strategy, the program will train 64 community health workers as cough monitors. They will identify chronic coughers in the community and refer them for screening at health facilities. In addition, cough monitors will track TB patients who miss their drugs or default on their clinic appointments. To reduce TB burden for PLWHA, KW will support intensified TB screening for all patients newly diagnosed with HIV. Those with active TB will be put on treatment. To strengthen TB infection control (IC), KW will support distribution and use of national IC guidelines. Coughers will be triaged by cough monitors and fast tracked at the HIV clinics. To improve surveillance and management of drug-resistant TB, KW will support timely DSTs for TB re-treatments and ensure all MDR-TB cases are followed up using the Demographic and Health Surveillance System (DHSS) and treated to cure.

KW will support good supply chain practices to ensure uninterrupted supply of commodities. KW will continue to strengthen data collection and reporting and do cohort analysis and report retention rates as required by the HIV program (NASCOP) and PEPFAR. KW will adopt the new generation TB/HIV indicators and support timely processing and uploading. Data will be used to evaluate progress and improve clinical outcomes through Continuous Quality Improvement (CQI) initiatives.

Kisumu West (KW) supports HIV care and prevention activities in Kisumu West district, Nyanza province of Kenya. The HIV rates range from 18-29% in KW compared to the national average of 7.1%. USG technical, capacity building and financial support are factored into District and Provincial Annual Operation Plans (AOP) prepared and coordinated by the Ministry of Health (MOH). KW currently supports pediatric care services, including Early Infant Diagnosis, in 23 sites. KW plans to expand these services to additional 4 sites in the next phase. KW will continue to provide HIV care services for over 1500 children below 15 years. This is aimed at reducing mortality, morbidity and new infections by 50% by 2014. The program will endeavor to enhance activities that foster early identification and management of opportunistic infections; and provision of clinical, psychological, spiritual, social, and prevention services. In addition, insecticide treated nets, laboratory services, pain and symptom relief, individual and facility-based nutritional support will be offered throughout the continuum of illness.

KW will further decentralize services to attain 80% coverage over the next 2 years. This will lead to a cumulative total of 2000 children on care. KW will work with MOH to improve the quality of services through in-service staff training; mentorship; expanded access to regular CD4 monitoring and better patient retention strategies; including active defaulter tracing practices. Additional 60 health providers will be trained to support expansion of pediatric care services. The partner will strengthen provision of comprehensive HIV services including viral load testing for patients failing treatment, cotrimoxazole prophylaxis, disclosure in a sensitive and culturally appropriate manner, psychosocial counseling, participation in children support clubs, adherence and disclosure counseling, PWP and nutritional assessment and supplementation. KW will strengthen integration of early infant diagnosis in MCH and inpatient settings. To further strengthen adherence and transition to adult services, childrens clubs will be stratified based on age, with the older adolescents being separated from younger children. Patients will be screened for TB at each clinic encounter to ensure that those with active disease are promptly put on TB treatment and ARVs based on recently updated MOH guidelines. The diagnosis, prevention and treatment of other OIs and tumors such as candidiasis, and Karposis sarcoma will be enhanced through staff training and support for commodities and infrastructure. KW will support conduct of cohort analysis and report retention rates as per national guidelines. KW will adapt the quality of care indicators for monitoring the quality of pediatric care services and integrate these into routinely collected data used to evaluate and improve clinical outcomes. The partner will continue to strengthen data collection and reporting at all levels to increase and improve the quality and timeliness of data reported to MOH and to PEPFAR. Use of an electronic medical records system will be supported in addition to performing data quality audits. To promote transition to local ownership and sustainability of ART services, the Kenya Government is expanding her budgetary contribution to ART procurement.

Kisumu West (KW) program supports HIV care and prevention activities in Kisumu West district, Nyanza province of Kenya. The HIV rates range from 18-29% in KW compared to the national average of 7.1%. USG technical, capacity building and financial support are factored into District and Provincial Annual Operation Plans prepared and coordinated by the Ministry of Health (MOH). In FY 2010, KW initiated development of a basic data system for documentation of individual patients and will continue to phase-in a data collection, recording, monitoring, reporting, and dissemination system to all treatment and prevention sites. These will be further strengthened to include provision of computerized data automation systems and other communication equipment required for electronic entry of patient-specific encounter data; and enhancement of email and internet system for information sharing and submission of reports in real time. The partner will continue to strengthen data collection and reporting at all levels to increase and improve the quality and timeliness of data reported to MOH and to PEPFAR.

KW will support MOH to establish a functional Electronic Medical Records (EMR) system in 4 health facilities to improve clinical management and program reporting; with initial emphasis in ART program. Paper based system will be strengthened to collect, manage, analyze, and generate routine reports; and carry out cohort analysis. The partner will adapt DHIS, the national reporting system, and its customization for use in reporting all the health data and information needs. The partner will support implementation of a generic m-health solution to include SMS notification for EID, patient follow-up, commodity and supplies management.

KW will strengthen supportive supervision; mentorship; leadership; management and coordination; ICT technical support; systems capacity development, and knowledge management (including data use) through MOH leadership (HIS) covering all program areas. Data Quality Audits and data reconstruction will be strengthened. In addition, the partner will support stakeholder meetings/data review forums to discuss results, disseminate evaluation reports and set up quality improvement teams. These will aim at building capacity of the data teams to continually use information for routine programming and for better patient management. Capacity building and system strengthening are a strategic component in engaging with the MOH from the highest government level to the medical reception stations where direct patient care is executed. 30 data management personnel will be trained to review community data, develop action plans in data management, data use, demand creation and analysis. Local MOH capacity to carry out M&E activities and rollout national indicator tools will be improved through training of District Health Management Teams (DHMTs).

KW will support the linking of EMR to DOD health and demographic surveillance system. This will enable the partner to generate risk maps and HIV/AIDS density clusters. The information will be used to improve efficiency and effectiveness in service delivery, resistance tracking, second line ART regimen usage, access to care, demand creation and evaluating prevention effectiveness. The information gained will further assist in augmenting the development of health care policies which lends itself to country sustainability.

Kisumu West (KW) program supports HIV care and prevention activities in Kisumu West district, Nyanza province of Kenya. The population is composed of 47.7% males and 52.3% females with 52.6% of the total population being <18years (WRP Kisumu Health and Demographic Surveillance System). The HIV prevalence in rural Nyanza Province is at 14.9% (KAIS 2007). It is estimated that the greater Kisumu District has an HIV prevalence of 18.3% (based on PMTCT national program data). Approximately 21% of pregnant women tested in Kisumu-West District in 2008 were found to be HIV-infected (WRP unpublished data). Further, 14% (76/534) of HIV-exposed infants tested in 2008 were found to be HIV-infected. In FY 11, KW initiated Home-Based Testing and Counseling (HBTC) that has tested 6711 clients with 543 tested positive. HBTC activities will continue and will target testing 70,000 clients. All HIV positives identified will be linked to care and treatment activities and other services including PWP, VMMC, STI screening, family planning, TB and PMTCT. Referrals and linkage will be strengthened through use of community health workers to track HIV-positive individuals not enrolling in care or treatment services. This is in line with the MOH community strategy.

KW will provide counseling and testing to an extra 10,000 individuals through Provider initiated testing and counseling (PITC). It will focus on increasing HTC access to first time testers and couples (couple counseling should account for over 10% of the target population). Efforts will be geared towards scaling up PITC in all health facilities and reaching the most at risk populations among the fisher-folks with mobile services as well as integration of PWP services in HTC settings and continued promotion of quality assurance. The program will place emphasis on strengthening the health systems capacity to scale up access to quality HTC services and referrals.

Each site will receive adequately trained and supported HTC service providers; who will undergo refresher trainings to gain proficiency. Task-shifting to lay counsellors will be emphasized to ease the burden on other healthcare staff. Quality assurance for HCT will be achieved by following MOH national guidelines and standard operating procedures (SOPs); ensuring all HTC providers have been trained; and through the use of standardized pre-printed registers for recording HIV test results. 5-10% of samples will be sent to the national reference laboratory for re-testing. In addition, QA measures will include counseling support supervision to prevent burn out of HTC service providers. Demand for HTC will be created through community mobilization and use of local administrative barazas in order to reach 80% population coverage. Sign boards will be installed in all HTC sites so that these service delivery points can be clearly identified by clients and patients.

KW will support good supply chain management practices to ensure uninterrupted supply of commodities. KW will continue to strengthen data collection and reporting and report the number of newly diagnosed HIV positive clients successfully linked to care; as required by the HIV program (NASCOP) and PEPFAR. KW will adopt the new generation HIV indicators and support their timely processing and uploading. Data will be used to evaluate progress and improve clinical outcomes through Continuous Quality Improvement (CQI).

Kisumu West (KW) program supports HIV prevention, care and activities in Kisumu West district, Nyanza province. The HIV rates range from 18-29% in KW compared to the national average of 7.1%. USG technical, capacity building and financial support are factored into District and Provincial Annual Operation Plans (AOP) prepared and coordinated by the Ministry of Health (MOH). KW currently supports PMTCT services in 23 clinics in KW district. In the first half of FY 11, 1660 pregnant women received HIV counseling and testing and received their test results. 124 (7.5%) of these women tested HIV positive out of whom 81 (65 %) received ART prophylaxis to protect their unborn babies. KW will continue to support the provision of HIV counseling and testing to 6,586 pregnant women, and provide ARV prophylaxis to 1,099 HIV positive women and their infants as per the Kenyan MOH guidelines. HIV positive pregnant women eligible for ART will be started on Highly Active Anti Retroviral therapy (HAART). The partner will facilitate the provision of DNA PCR tests to HIV exposed infants at six weeks. PCR negative exposed infants will be followed up at the MCH clinic and will receive cotrimoxazole and ARV prophylaxis as MOH guidelines. Once their final status is determined, the HIV positive ones will be initiated on ART.

Over the next 2 years, additional services will focus on the four PMTCT prongs: primary HIV prevention; FP to stem unwanted pregnancies; ARV prophylaxis for all HIV positive pregnant mothers and their exposed infants; and care and treatment for eligible mothers, partners and children. The minimum care package will include health education, individual and family HIV counseling and testing, clinical and laboratory monitoring, OI screening, prevention and/or treatment, ART prophylaxis and treatment for both mother and baby, nutritional and psychosocial support. Additional interventions will include TB screening and TB treatment for mothers with active TB. KW will expand couple counseling and testing targeting at least 30% of 1st ANC attendees. This will improve male involvement in PMTCT. HIV prevention interventions will be provided to discordant couples to prevent new HIV transmissions and facilitate linkage to HIV care and treatment services. The partner will promote skilled deliveries and support improvement of infrastructure and adequate supply of commodities such as sterile delivery packs. KW will promote safe infant feeding and postnatal ART prophylaxis practices in line with MOH guidelines. HEI will be monitored for HIV infection by PCR-based early infant diagnostic (EID) tool and children who test PCR positive before 18 months will be initiated on ART. Mothers and their babies will be retained in care through strategic use of community health workers, appointment diaries, and registers to track defaulters.

In collaboration with the District Health Management Team (DHMT), KW will support a structured staff mentorship and support supervision program to ensure that district-wide PMTCT services produce high quality data essential for program planning and evaluation. KW will spend less than $20 per woman and use the same amount to cover other wraparounds such as safe water, FP, safe motherhood and malaria prevention. KW will work closely with the MOH, through the community strategy, to support community mobilization activities, improve quality of ANC services, and create demand for ANC services and safe skilled deliveries.

Kisumu West (KW) supports HIV care and prevention activities in Kisumu West district, Nyanza province of Kenya. The HIV rates range from 18-29% in KW compared to the national average of 7.1%. USG technical, capacity building and financial support are factored into District and Provincial Annual Operation Plans (AOP) prepared and coordinated by the Ministry of Health (MOH). KW currently supports ART services in 9 sites and plans to expand services to additional 4 sites; with the aim of attaining 80% coverage over the next 2 years. In the first half of FY 11, 466 patients were initiated on ART making a cumulative total of 3,074 patients.

KW will work with MOH to improve the quality of ART services through in-service staff training; mentorship; expanded access to regular CD4 monitoring and better patient retention strategies; including active defaulter tracing practices. The partner will continue to build the capacity of local MOH sites to offer specialized treatment, including management of ARV treatment failure and complicated drug adverse reactions. Additional 45 health providers will be trained to support expansion of ART sites and increased demand for HIV treatment; in addition to adequately managing treatment failures and increased transition to second line drug regimens. KW will identify areas with staff shortages and support recruitment of additional staff. The partner will support provision of comprehensive HIV treatment services including clinical assessment for ART eligibility, toxicity monitoring, laboratory monitoring with biannual CD4 testing, viral load testing for patients failing treatment, cotrimoxazole prophylaxis, psychosocial counseling, participation in patient support groups, adherence counseling and nutritional assessment and supplementation. Additional services will include delivery of HIV prevention (PWP) package including disclosure, partner testing, family planning, and provision or referral to STI diagnosis and treatment. Patients will be screened for TB at each clinic encounter to ensure that those with active disease are promptly put on TB treatment and ARVs while based on recently updated MOH guidelines. The diagnosis, prevention and treatment of other OIs and tumors such as candidiasis, and Karposis sarcoma will be enhanced through staff training and support for commodities and infrastructure. Ongoing community interventions including peer education and use of support groups to provide adherence messaging and defaulter tracing will be supported to improve treatment retention. KW will support conduct of cohort analysis and report retention rates as per national guidelines. KW will adapt the quality of care indicators (CQI) for monitoring the quality of HIV treatment services and integrate these into routinely collected data used to evaluate and improve clinical outcomes. The partner will continue to strengthen data collection and reporting at all levels to increase and improve the quality and timeliness of data reported to MOH and to PEPFAR. Use of an electronic medical records system will be supported in addition to performing data quality audits. To promote transition to local ownership and sustainability of ART services, the Kenya Government is expanding her budgetary contribution to ART procurement. Please see the partner overview narrative for information on the strategy to transition to local ownership.

Kisumu West (KW) supports HIV care and prevention activities in Kisumu West district, Nyanza province of Kenya. The HIV rates range from 18-29% in KW compared to the national average of 7.1%. USG technical, capacity building and financial support are factored into District and Provincial Annual Operation Plans (AOP) prepared and coordinated by the Ministry of Health (MOH). KW currently supports ART services in 9 sites and plans to expand services to additional 4 sites in the next phase. In the first half of FY 11, 58 children were initiated on ART making a cumulative total of 325 children on ART. KW will expand ART uptake in the current 9 sites and also decentralize further to attain 80% coverage over the next 2 years. This will lead to a cumulative total of 565 children ever on ART. KW will work with MOH to improve the quality of ART services through in-service staff training; mentorship; expanded access to regular CD4 monitoring and better patient retention strategies; including active defaulter tracing practices. The partner will continue to build the capacity of local MOH sites to offer specialized treatment, including management of ARV treatment failure and complicated drug adverse reactions in children. Additional 60 health providers will be trained to support expansion of ART sites and increased demand for pediatric HIV treatment. The partner will support provision of comprehensive HIV treatment services including toxicity monitoring, laboratory monitoring with biannual CD4 testing, viral load testing for patients failing treatment, Cotrimoxazole prophylaxis, disclosure in a sensitive and culturally appropriate manner, psychosocial counseling, participation in children support clubs, adherence and disclosure counseling; and nutritional assessment and supplementation. KW will continue to strengthen Early Infant Diagnosis in all health facilities in KW. To further support adherence and disclosure, childrens clubs will be stratified based on age, with the older adolescents being separated from younger children. Patients will be screened for TB at each clinic encounter to ensure that those with active disease are promptly put on TB treatment and ARVs while based on recently updated MOH guidelines. The diagnosis, prevention and treatment of other OIs and tumors such as candidiasis, and Karposis sarcoma will be enhanced through staff training and support for commodities and infrastructure. Ongoing community interventions including use of support groups to provide defaulter tracing will be supported to improve treatment retention. KW will support conduct of cohort analysis and report retention rates as per national guidelines. KW will adapt the quality of care indicators (CQI) for monitoring the quality of HIV treatment services and integrate these into routinely collected data used to evaluate and improve clinical outcomes. The partner will continue to strengthen data collection and reporting at all levels to increase and improve the quality and timeliness of data reported to MOH and to PEPFAR. Use of an electronic medical records system will be supported in addition to performing data quality audits. To promote transition to local ownership and sustainability of ART services, the Kenya Government is expanding her budgetary contribution to ART procurement.