1. Goals and objectives:

With funding from PEPFAR IMC is currently supporting implementation of HIV Prevention and Care services in the districts of Suba and Migori in Nyanza Province, the overall goal of the project being to reduce the number of new HIV infections in Suba and Migori district in Nyanza province through Evidence Informed Behavioral Interventions (EBIs) biomedical and structural interventions.

Objectives

Provide 97,204 individuals with HIV testing and counseling with all receiving their test results

Advocate for positive gender norms in relation to HIV/AIDS prevention and utilization of services among the targeted communities

Reach 19,500 MARPs (Fisher folk 15,500, 4,000 FSWs) and 15,321 to be provided with cPwP through individual or small groups, using the Fisher Folk Peer Model strategy

Provide Family matters! Program, Health Choices 1 and Health Choices 2 to 8,582 youth aged 9 24 years.

2. Cost-efficiency strategy:

IMC will adopt integrated programming and leverage on MoH and other partner activities for cost efficiency. Purchase of a program car will significantly reduce cost of maintaining and hiring a car.

3. Transition to country partners [or Expected timeline for award/Calculation of funding]:

IMC is identifying local partners (in consultation with the MoH and other stakeholders) to which the program will be transited to the expiry of its implementing agreement period.

4. Vehicle information:

IMC purchased a motor boat and Toyota Land cruiser with FY 2010 funds. The vehicle was for official use for transportation of program staff to meeting and program activities and program supplies sites in Suba & Migori. This was a strategy to reduce program cost on car hiring and maintenance. This activity supports GHI/LLC.

IMC will support the provision of HIV prevention in Suba, Nyatike and Migoi Districts with interventions targeting 4,842 youth aged 9 to 17 years. The objective is to provide them with information to help them make informed choices about their sexual and reproductive health.

Healthy Choices (HC) I

Healthy Choices I (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. Quality assurance of HC 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. A portion of HVAB funding will also be used to infuse abstinence / be faithful messages in EBIs that are implemented among the following priority populations: 15-19-year-olds, serodiscordant couples, men aged 30-44, and persons living with HIV.

The Families Matter! Program

FMP is an evidence-based, parent-focused EBI 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. 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 CDC activity managers and technical experts.

Quality Assurance

To promote quality assurance, IMC has put in place for all sites the following: use of approved national curricula; emphasis of importance of fidelity to the respective curricula; use of trained and certified pair of gender balanced facilitators; trainings on EBIs are conducted by certified national trainers; observed practice of implementation is done soon after training; use of standardized, national data tools at every stage of EBI implementation; and regular field visits by trained program staff to check on delivery of EBIs and offer support supervision. Targets for each of the interventions are laid out at the start of the project year which is tracked on a monthly basis through respective field reports. Results are analyzed on a quarterly basis. The targets are in line with the PEPFAR Next Generation Indicators (NGIs). Monitoring and evaluation will be conducted with EBI approved data capture / monitoring tools. Field staff will send reports on a monthly basis; these reports will be compiled into an overall report quarterly which will be submitted to CDC.

Target population: IMC is implementing comprehensive HIV prevention services in Migori and Homabay counties in Nyanza region targeting the youth and general population as well as MARPs (female sex workers and fisher folk). HIV prevalence among the general population (14.9%) and MARPs (22%) is higher than the national average of 7.1%. Testing coverage varies with 63.5% among women and 39.8% in men. HTC services are provided as part of the combination HIV prevention services targeting these population groups.

HTC approaches: HTC approaches used are both Client and Provider Initiated that are provided primarily through targeted mobile/outreach services, door-to-door HTC and targeted HTC campaigns.

Targets and achievements: In the first 9 months of 2010 COP, IMC has provided HTC services to 119,250 individuals out of a target of 120,000 with an HIV prevalence of 4.6%. 66% of this target was achieved through door-to-door approach. The program also supported capacity building of service providers in Early Infant HIV Diagnosis, Proficiency testing, national re-testing recommendations and data collection tools. In FY 2012, the program will provide HTC services to 97,204 individuals of these 40% new testers, 30% couples and 18% MARPs.

Proportion allocation of funding: 40% of the budget supports HTC among the MARPS and is provided as part of the combination HIV prevention package.

Testing algorithm: The national testing algorithm is used.

Referrals and linkages: A directory of existing GoK and other HIV care and treatment facilities is maintained and all HIV positive clients are referred to these for further care using the NASCOP referral tool. A regular analysis is of the status of referral between the HTC program and the care and treatment facilities undertaken to monitor linkages and take corrective action as needed. A system is in place to provide follow up visits for clients tested at home providing opportunity for follow up of clients who have not accessed care and or treatment services.

Quality management: To maintain quality service providers are trained and certified by NASCOP. Quality Assurance systems are in place including proficiency testing and counselor support supervision system. DBS for QA is also taken for every 20th client. Use of job aids and timers ensure standardization of services. The program collaborates with the respective District Health Management Team to conduct monthly counselor supervision that includes observed practice.

Monitoring and evaluation: The program uses the national tools for both data recording and reporting. Indicators collected include individuals receiving HIV testing disaggregated by age, sex, couples, MARPs.

Promotional activities: Peer led networks are used to encourage and create demand among the MARPs to access the range of HIV prevention services. Use of mass media campaigns with targeted messages to the general population is used to promote knowledge of HIV status as a key step in protecting oneself and family. The program also works trains and works with some community members who provide information to other community members regarding accessing available HIV prevention services.

IMC will continue to expand access to a high quality comprehensive package of HIV prevention, care and treatment services for general population and MARPS in Nyanza Province specifically in Suba, Migori and Nyatike districts. The target populations will be FSWs (4000), fisher folk (stepping stones 10000, sister to sister 5500), cPwP (15321) in Migori and Homa Bay counties with total populations of 322,002 and 352,973 respectively. This program will continue to target high risk sexual behavior prevalent among these populations including incorrect and inconsistent condom use particularly with regular sex partners.

IMC will work with the beach management units to select, recruit and train fisher folk peer leaders on peer education and facilitation skills of peer sessions of the Fisher Folk Peer Model. Small groups of 20 individuals are identified by the peer educators based on age and gender to enhance discussion. During the peer sessions, demand creation and referrals for other services like HTC VMMC, STI treatment, HIV care and treatment services will be offered. Each group undergoes 5 sessions on various SRH topical issues to for a person to qualify. Follow up sessions will be conducted after 6 months for each group. Other behavioral risk factors that will be addressed include excessive alcohol and substance abuse, gender based violence and low adherence to treatment among fisher folk.

This mechanism will support implementation of the Combination Prevention Interventions for FSWs as defined in the National Guidelines for the package of services for SWs. These comprise evidence-informed behavioral, biomedical and structural interventions. Behavioral interventions include peer education and outreach, condom and lubricant demonstration and distribution and risk assessment, risk reduction counseling and skills building. Specific EBIs for this group will be RESPECT, Sister-to-Sister and Safe in the City. Biomedical interventions include HTC, STI screening and treatment, TB screening and referral to treatment, HIV care and treatment, RH services, Emergency contraception and Pre-exposure prophylaxis.

IMC is considering initiating Treatment as Prevention for MARPS and initiating Pre-exposure prophylaxis where feasible, malaria treatment all within its drop in and service centres. Among the discordant couples IMC will implement an EBI EBAN with the objective of lowering the rate of risky behavior among HIV-discordant couples and promoting safe sex through increased condom uptake in this sub population. This shall be offered in an integrated setup with other services also available

3700 Youth aged 1519 years and 20-24 years both in and out of school will be reached with Healthy Choices II (HCII) that 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.

To promote quality assurance, IMC will provide On Job Trainings, mentorships, Continuous Medical Education, exchange visits for bench marking and refresher courses where knowledge and/or skill gaps are identified and addressed. Data generated by the facilitators and other service providers will be entered into database and periodically analyzed for programming purposes. Quarterly support supervision with NASCOP, ministry of fisheries and DHMTs will ensure quality of services delivered is of the expected standard.