The Lea Toto Program (LTP) is a project of the Children of God Relief Institute (COGRI), an organization based in Nairobi, offering services to children living with HIV/AIDS. With funding from USAID, Lea Toto program provides services to families with HIV positive children in the main informal settlements in Nairobi Province. The goal of the Lea Toto Project is to mitigate the impact of HIV/AIDS and decrease the risk of HIV transmission by providing and facilitating the implementation of a comprehensive home based care package.

This will be achieved through the following five objectives:

1. To enhance the provision of high quality medical care, nutritional support and counseling services to 8,500 HIV+ children and their families by 2012.

2. To provide a package of social support services to at least 70% of the needy HIV+ children and their families

3. To enhance the organizational capacity of all Lea Toto staff to design, monitor and coordinate quality care services for HIV+ children and their families

4. To enhance capacity of the target local communities to provide care and support to HIV + children and their families.

5. To enhance the capacity of the target communities to carry out preventive measures through negotiation, support and maintenance of safe behavior. This activity supports GHI/LLC and is completely funded by pipeline funds in this budget cycle.

The project is currently supporting implementation of quality, chronic care model for care of PLWHIV in Kwa-Vonza and Kwa-Mutonga communities of Kitui District and the adolescents over 15 year on follow up at the LeaToto clinics in Nairobi. COGRI offers these services at the Nyumbani Village Clinic and the 8 LeaToto clinics in Nairobi slums by providing comprehensive intevention packages. This projects contributes to the decentralization of treatment services through both facility based and community outreach HIV treatment and monitoring services. Technical support to establish and maintain laboratory network for CD4, VL and other laboratory tests is a key area of support to ensure patients managed by the project access laboratory investigations. COGRI will continue to support the intergration of HIV services with other clinical services. Defaulter prevention and tracing mechanisims will be strengthened to ensure patient retention to treatment and care while establishing intra-facility and community linkages. To further improve retention to care and treatment mobile phone massaging for patients on treatment, patient support groups, and linkages to CHW home based follow-up will be strengthened. Adolescent friendly clinic days will be established to cater for this unique cohort. Monthly ART cohort reports will be compiled and used to review clinical outcomes. Support to strengthen phamaceutical and laboratory commodity management will be emphasised by the project to minimize risk of acute stock outs as well as mitigating expiry of commodities at the facility. The project will continue to empower patients through psychosocial support groups, health education, supporting prevention by implementation of PWP package and also the peer educator program.The project will also continue its emphasis on TB/HIV collaborative activities including strengthening of TB case finding, diagnosis and management.

Nyumbani village will scale-up pediatric care and treatment among the community members seeking support at the village clinic. The project will initiate 40 new children on ART over the next 2 years by optimizing the entry points into care and treatment through increased PITC and community mobilization. Identification of HIV exposed and infected children will be intensified through PITC for the infants and longitudinal follow-up of HEI.

The Lea Toto project will expand established programs in targeted slums in Nairobi to include 9 centers; 8 in Nairobi informal settlements. As a result of these activities, 3000 individuals will receive antiretroviral therapy 300 will initiate treatment during the year, with the total of people ever treated reaching 3000, and 160 health care workers will be trained in the provision of antiretroviral therapy

In both projects, early infant diagnosis will be scaled-up to ensure provider competence to collect quality DBS samples and logistical transportation to regional laboratories for HIV DNA PCR diagnosis. OJT for service providers on collection of DBS samples will be conducted at the Nyumbani and Lea Toto clinics to facilitate diagnosis of HIV among the HEI. Service providers will be mentored on the prompt initiation of ART for children less than 2 years with confirmed HIV status while access to CD4 and Viral Load testing will be facilitated through linkage with the Nyumbani diagnostic Laboratory to enhance evaluation and monitoring of patients. Nutritional assessments of pediatric patients and therapeutic and supplemental feeding will be an integral part of their support. Access to all other immunization care, supplementation and growth monitoring services will be undertaken in compliance with National Guidelines. Activities will also include procurement of laboratory services and strengthening rational pharmaceutical management

Orientation to the new MOH tools will be done to ensure that key staff develop the capacity to collect, analyze use data both at local and national level. Adolescent-friendly treatment services will be undertaken through the establishment of adolescent-friendly clinic days and the formation of adolescent support groups. Adolescent clubs to promote healthy and positive living will be linked to appropriate role model mentors from amongst the adult PLHIV in order to allow for smooth transition into adulthood. The program will ensure adherence support to the individuals on follow up including strengthening community facility linkages to curb loss to follow up and improve retention and long term out comes.

These activities will contribute to the Kenya 5-year strategy and increase the number of children on antiretroviral therapy, responds to OGAC objectives of increasing the number of children on ART.