Catholic Relief Services (CRS) AIDS Relief project through Track 1 funding supports implementation of comprehensive HIV prevention, care and treatment activities for Faith-based facilities (FBO) in Kenya. CRS facilitates FBO facility linkages to Government of Kenya health systems and strengthens business development and advocacy for the facilities. They offer comprehensive training for all local partner treatment facilities (LPTFs) including clinical HIV care, laboratory, adherence, community mobilization, strategic information, finance, compliance, and supply chain management. The projects goals are aligned with those of the GHI principles including decentralization of HIV services into existing clinics, maternal and child health, and TB clinics.

To increase cost efficiencies, CRS will support task shifting to ensure effective use of clinical staff, prioritized home visits, and a strengthened community-based treatment support initiative.

CRS will build local partner capacity of Kenya Episcopal Conference and Christian Health Association of Kenya by preparing incremental transfer of its functions, responsibilities, and resources for grant management, supply chain, and strategic information the end of February 2013. The project will provide mentorship on reporting the comprehensive set of required donor indicators, ensuring a high level of quality, timeliness, validity, and reliability with linkage to the national M&E framework. Quarterly dash board reviews for project progress, performance, and updates will be conducted.

This activity supports GHI/LLC.

CRS has purchased 45 vehicles between FY04-11 since the beginning of the award in 2004. CRS does not request for purchase of any new vehicle.

Catholic Relief Services (CRS) has been supporting care services in Nyanza, Western, Rift, Central, Eastern, Coast and Nairobi Provinces through Track 1 funding since 2004. CRS is in the process of transitioning these activities to local partners: Kenya Episcopal Conference and Christian Health Associations of Kenya. The first regions to be transitioned are Nairobi, Nyanza, Eastern, and Central. CRS will provide direct support in Western and Coast while continuing to provide support to the local partners in the other regions. By March 2011, CRS had cumulatively enrolled 124,842 of whom 71,737 are active and receiving cotrimoxazole prophylaxis.

CRS will work with the MOH at all levels to jointly plan, coordinate, implement and ensure provision of quality HIV care and support to 42,992 current adult patients in FY12. In FY 13, CRS will transition all the activities to the local partner, but will remain as a sub partner for capacity building.

CRS will offer a package of services including HIV testing to partners and family members of index patients and enroll 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) except condom and family planning promotion.

CRS in collaboration with MOH will support targeted capacity building for HCWs and offer continuous medical education on care and support, e.g. OI diagnosis and treatment. CRS will identify areas with staff shortages, support recruitment of additional staff, and support good commodities management practices to ensure uninterrupted supply of commodities. Community interventions for HIV infected individuals will be supported including peer education and use of support groups to provide adherence messaging; effective defaulter tracing and follow up to improve retention in all facilities; referral and linkages to community based psychosocial support groups; water, sanitation and hygiene programs; economic empowerment/income generating activities projects; home based care; gender based violence support programs; vocational training; social and legal protection; and food and nutrition security programs. Strategies will be adopted 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.

CRS will continue to strengthen data collection and reporting at all levels to improve reporting to NASCOP and PEPFAR. CRS will adopt the new generation indicators and support the development and use of electronic medical records system in accordance with NASCOP guidelines. Quality of care indicators (CQI) will be used for monitoring the quality of HIV care and support services and integrated into routinely collected data. Results will be used to evaluate and improve clinical outcomes. CRS will do a cohort analysis and report retention rates. CRS will support joint Annual Operation Plan (AOP) development, implementation, monitoring and evaluation, and health system strengthening to facilitate sustainability.

Catholic Relief Services (CRS) has been supporting TB/HIV services in Nyanza, Western, Rift, Central, Eastern, Coast and Nairobi Provinces through Track 1 funding since 2004. CRS is in the process of transitioning these activities to local partners: Kenya Episcopal Conference and Christian Health Associations of Kenya. The first provinces to be transitioned are Nairobi, Nyanza, Eastern and Central. CRS will continue to provide support in Western and Coast while continuing to support to the local partners in the other provinces. CRS provides TB/HIV services in line with the MOH Division of Leprosy, Tuberculosis and Lung Disease (DLTLD) and the National AIDS and STI Control Program (NASCOP).

Kenyas 5-Year National AIDS and TB Strategic Plans shared objectives are to ensure co-infected TB patients and suspects receive quality and comprehensive care and that the threat of drug resistant TB is contained. CRS supported training and hiring of additional staff, procurement of simple laboratory TB diagnostics, and minor renovations of TB Clinics to ensure better infection control practices. CRS used the existing national TB and HIV M&E framework and tools to report on TB/HIV Indicators.

For FY 12 and 13, CRS will continue to intensify efforts to detect TB cases through clinical exams and laboratory investigations and ensure successful TB treatment through provision of appropriate treatment. To ensure timely and accurate TB diagnosis, CRS will ensure that facility staff are well trained and supported by well equipped and staffed laboratory. CRS will ensure that adequate supplies of anti-TB drugs are available and that TB treatment guidelines are followed. All TB patients on treatment will be monitored both clinically and through periodic sputum examination.

CRS will ensure that all TB patients are screened for HIV and 95% of 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. CRS 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.

CRS will support intensified TB screening using the national screening tool for 38,215 in FY12 and 48,400 in FY13 HIV infected persons identified in their HIV care settings. 1,911 co-infected patients identified in FY12 and 2,420 co-infected patients identified 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.

CRS will ensure that the national IC guidelines are available at all sites and that staff are trained on IC. CRS 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. CRS 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 results are returned to those facilities. CRS will expand prevention with positive (PwP) services except condom and family planning promotion, strengthen linkages between facility and community-based services, improve patient referral and tracking systems, and increase support for TB-HIV operations research. CRS will report selected custom indicators to assist with program management and evaluation and monitoring of new activities.

Catholic Relief Services (CRS) has been supporting pediatric care services in Nyanza, Western, Rift Valley, Central, Eastern, Coast, and Nairobi Provinces through Track 1 funding. CRS is in the process of transitioning these activities to local partners namely Kenya Episcopal Conference and Christian Health Associations of Kenya. The first provinces to be transitioned are Nairobi, Nyanza, Eastern, and Central.

By March 2011, CRS had 23,929 children enrolled in care with 8,491 receiving HIV care and 5,133 on cotrimoxazole prophylaxis. There were also 715 children on ARV prophylaxis. In FY 12 CRS will provide care and support services to 4,602 children currently on care. These activities will be transitioned to the local implementing partner in FY 13

CRS will provide comprehensive and integrated services to ensure HIV exposed children access pediatric care services. CRS will improve access to cryptococcal antigen testing, TB screening and management, pain and symptom relief, psychosocial support (including disclosure counseling and support) provided through education, counseling, and linkages to facility or community based support groups.

CRS will strengthen the provision of therapeutic or supplementary feeding support to children with growth faltering and provision of vitamin A, zinc, and de-worming; provision of safe water, sanitation and hygiene interventions (WASH) in the community and health facilities to prevent diarrhea and other illnesses among the HIV infected, exposed and other children in the community; and malaria screening, treatment, and provision of long lasting insecticide treated nets in malaria endemic areas. Emphasis will be on enhanced follow up and retention of all identified HIV infected and exposed children.

CRS will support the integration of HIV services into routine child health care and survival services in the MCH 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.

Hospital and community activities will be supported to meet the needs of HIV infected adolescents such as support groups to enhance disclosure, adherence messaging, PwP, except condom and family planning promotion, substance abuse counseling, support for transitioning into adult services, and teaching life skills.

CRS will ensure optimized linkages of children to various programs including TB/HIV, PMTCT and OVC services, and other community based programs such as education, protection, legal, and social services. CRS will also support relevant class-based and on-job trainings, including continuous medical education. CRS will strengthen pediatric data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. With guidance from the national PEPFAR office, the new generation indicators will be adopted. To improve the quality of care and strengthen pediatric services, CRS will support supervision and mentorship activities and use the quality of care indicators (CQI and HIVQuaL) for monitoring the quality of pediatric HIV services and integrate them into routinely collected data.

Target population: AIDSRelief 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 are offered within all out patient departments, TB clinics, ANCs, special clinics, HIV clinics (targeting family members) and in patient departments. The counseling and testing is either 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, AIDSRelief will target to provide HTC services to 87,000 persons of which 20% will be tested as couples and 10% will be children below the age of 15.

Testing algorithm: National algorithm is being used.

Referrals and linkages: In order to strengthen referrals, AIDSRelief 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, AIDsRelief 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; proper handling (storage and transportation) 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: AIDSRelief 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.

CRS implements comprehensive prevention, care and treatment programs nationally. In FY 2012/13, CRS will expand HIV prevention services to include an evidence based behavioral intervention (EBI) 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 EBI implemented will be Positive Health and Dignity Prevention (PHDP) targeting adult male and female and adolescents living with HIV (PLHIV).

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; sexual risk reduction counseling on reduction of sexual partners, alcohol counseling, promoting of; 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.

CRS 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 centers 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. The national HIV prevalence is (7.1%). CRS will reach 24273 (60%) PLHIV in FY2012 and 35845 (70%) in FY 2013 with a minimum package of PHDP except condom and family planning promotion.

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.

CRS will work with appropriate national Technical Working Groups (TWG) 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 services, as necessary, through patient escorts.

Monitoring of PHDP will be done through the review/input of CRS 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 Demographic and health survey, Kenya Indicator AIDS Survey, Kenya Service Provision Assessment) .

Catholic Relief Services (CRS) will implement comprehensive PMTCT services to pregnant mothers in Western and Coast regions. CRS through the Track 1 mechanism has been implementing PMTCT in Faith Based Organizations facilities nationally since 2004. Activities are being transitioned to two local partners: Kenya Episcopal Conference and Christian Health Association of Kenya. By March 2011, 11,549 women were counseled and tested and 579 were given ARV prophylaxis. CRS will strengthen PMTCT services in the 16 main facilities and over 80 satellites by integrating ART into the MCH clinics.

In FY12, CRS will offer HIV counseling and testing to 13,733 pregnant women at ANC and give ARV prophylaxis to 880 HIV infected pregnant women. The HIV infected women will receive a CD4 test after undergoing WHO clinical staging. CRS will give HAART to all eligible HIV positive pregnant women in line with the revised PMTCT national guidelines. In FY13, CRS will transition these activities to the local partners since the mechanism will end in Feb 2013.

CRS will focus on 3 prongs of PMTCT: primary prevention; ARV prophylaxis to all HIV positive pregnant mothers and exposed infants; and care and treatment to eligible HIV positive mothers, partners, and children. The Minimum care package will include health and HIV education, individual/ family HIVCT, clinical/laboratory monitoring and assessment, OI screening and/or treatment, ARV prophylaxis and treatment for both mother and baby, nutritional support, psychosocial support, PWP except condom and family planning promotion, follow up, retention, and referral and linkages. CRS will incorporate TB screening into routine antenatal care.

CRS will reach 4,120 of 1st visit ANC attendees with couple CT to identify discordant and concordant couples to improve primary prevention and facilitate linkages to HIV care and treatment for the eligible.

CRS will support integration of ART in MCH clinics, and establish or strengthen infection control and waste management activities.

CRS will support hospital delivery through provision of delivery beds and sterile delivery packs, training, working with CHWs and TBAs to promote community-facility referral mechanism, health education, and community services providing skilled birth attendance.

CRS will support safe infant feeding practices as per national guidelines and support enrollment and follow up of 660 of babies born to HIV infected mothers to access CTX, ARV prophylaxis, and EID services using the HIV exposed infant register till 18 months. CRS will facilitate ART initiation for those who test positive before 2 years.

CRS will adopt efficient retention strategies for mothers and babies by supporting use of diaries and registers for tracking defaulters, having a structured mentorship and supervision plan (train 30 CHWs in FY12), enhancing data quality and streamlining M&E gaps including orientation of new MOH ANC/maternity registers and utilizing data at facility level for program improvement and quarterly progress reports to CDC.

Program quality and proficiency testing will be emphasized to validate PMTCT results.

CRS will train HCWs on PMTCT and provide orientation to the revised PMTCT and infant feeding guidelines and engage in community activities for demand creation for health services such as male involvement with couple CT services.

Catholic Relief Services (CRS) AIDS Relief has been supporting treatment services in Nyanza, Western, Rift Valley, Central, Eastern, Coast, and Nairobi Provinces through Track 1 funding since 2004. CRS is transitioning these activities to local partners: Kenya Episcopal Conference and Christian Health Associations of Kenya. The first regions to be transitioned are Nairobi, Nyanza, Eastern and Central. CRS will continue to provide direct support in Western and Coast region while supporting the local partners in the other regions.

As of June 2011, CRS had supported 75,240 patients ever initiated on ART including 8,562 children; 53,680 patients were actively on ART of which 6,217 were children; 21,560 patients were newly initiated on ARVs, 2,708 stopped ART, 9,316 transferred out, 5,013 died (mortality rate 7%) and 4,423 were lost to follow up. The overall patient retention was 84%.

In FY12, CRS will jointly work with the Ministry of Health (MoH) to continue supporting expansion and provision of quality adult HIV treatment services as per MoH guidelines to 5,019 patients currently receiving ART and 397 new adults resulting to cumulative 6,023 adults who have ever been initiated on ART. In FY13, this number will increase to 5,317 currently receiving ART and 401 new resulting to 6,424 adults who have ever been initiated on ART.

CRS will support in-service training of 80 and 70 HCWs and continuous mentorship of trained HCWs on specialized treatment, including management of ARV treatment failure and complicated drug adverse reactions. CRS will identify human resources and infrastructure gaps and support in line with MoH guidelines as well as support good commodities management practices to ensure uninterrupted availability of commodities.

CRS will support provision of a comprehensive package of services to all PLHIV including ART initiation; laboratory monitoring including biannual CD4 testing and viral load testing for suspected treatment failure (through strengthened laboratory network); cotrimoxazole prophylaxis; psychosocial and adherence counseling; referral to support groups; nutritional assessment and supplementation; prevention with positives (PwP) except condom and family planning promotion; and improved OI diagnosis and treatment including TB screening, diagnosis and treatment. Ongoing community interventions for PLHIV including peer education and support groups to provide adherence messaging, defaulter tracing, and follow up will continue to be supported to improve retention in all sites. CRS will also support strategies to ensure access and provision of friendly HIV treatment services to all, including supporting peer educators, support groups, and supporting patients to disclose and bring their partners for testing and care and treatment.

CRS will do cohort analysis and report retention as required by MoH. CRS will adapt the quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV treatment services, integrate them into routinely collected data, and use the results to evaluate and improve clinical outcomes.

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

Catholic Relief Services (CRS) has been supporting pediatric treatment services in Nyanza, Western, Rift Valley, Central, Eastern, Coast and Nairobi Provinces through Track 1 funding since 2004. CRS is in the process of transitioning these activities to local partners: Kenya Episcopal Conference and Christian Health Associations of Kenya. The first regions to be transitioned are Nairobi, Nyanza, Eastern and Central. CRS will continue to provide direct support in Western and Coast Provinces while supporting the local partners in other regions. As of March 2011, CRS had enrolled 1,337 children on ART with 945 active on treatment.

In FY12, CRS will 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 580 children currently receiving ART and 116 new pediatrics resulting to cumulative 696 pediatrics ever initiated on ART. In FY 13, these activities will be fully transitioned to the local partners.

CRS will work with MoH in line with the Kenya National Strategic Plan III and the annual national, provincial and district operational plans to plan and coordinate decentralization of pediatric ART services including recruitment of additional staff.

CRS will continue to build the capacity of health facilities to offer comprehensive pediatric ART services including supporting renovations to ensure access to child friendly services. They will build the capacity of the health care workers in pediatric HIV treatment including management of treatment failure and treatment complications.

To optimize identification of HIV positive children, CRS will strengthen the use of the mother-baby booklet to facilitate early infant diagnostic testing, strengthen provider initiated testing and counseling, family testing, and ensure linkage of the HIV infected children to care and ART services. Integrated pediatric services will be offered at the MCH clinic to incorporate child survival strategies including growth and development monitoring, immunization, and case management of common childhood illnesses. HIV treatment services provided will be comprehensive including clinical history, physical examination, WHO staging, assessment for ART eligibility, access to CD4 counts/percentage, hematology and chemistry (through lab capacity building and strengthening of lab networks), pre-ART adherence and psychosocial counseling, initiation of ART for those eligible, ART response monitoring, clinical assessment, and targeted viral load testing for those with clinical or immunologic failure.

Routine pediatric data collection and reporting will be strengthened at all levels including use of electronic medical records system and integrating quality of care indicators to improve reporting to NASCOP and PEPFAR.

CRS will strengthen hospital and community activities to support the needs of adolescents to enhance disclosure and adherence messaging, PwP activities except condom and family planning promotion, substance abuse counseling, teaching life skills, and supporting their transition into adult services.

CRS will collaborate with other partners supporting community activities to ensure optimal linkages in order to reduce loss to follow-up and ensure continuity of pediatric HIV services for better treatment outcomes.