1. LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative Care: Basic Health Care and Support (#6960), Counseling and Testing (#6957) and HIV/AIDS Treatment: ARV Services (#6958).

2. ACTIVITY DESCRIPTION The Kenya Department of Defense, (KDOD) medical service provides health care to 100,000 military personnel, their dependants, and the civilian staff employed by KDOD. In FY 2007, KDOD intends to extend Prevention of Mother-To-Child Transmission (PMTCT) services to communities living in the neighborhood of the military barracks with a total population of approximately 500,000. Currently the KDOD offers PMTCT services in 15 of the 40 military camps sites nationwide. In FY 2007, 5 additional PMTCT sites will be added, for a total of 20 service outlets. The PMTCT program will provide Counseling and Testing (CT) in the PMTCT setting to 5,000 pregnant service women, spouses of service personnel, and underserved populations in the neighboring communities surrounding the military barracks. Antiretroviral prophylaxis will be provided to at least 300 of the HIV-infected pregnant women, these will include AZT prophylaxis from 28 weeks gestation to at least 50% of them. 80% of their HIV exposed infants will also be provided with ARV prophylaxis. Cotrimoxazole prophylaxis will be provided to all HIV exposed infants and their mothers. Counseling on infants feeding will also be provided. The PMTCT services will be integrated into all existing military maternity facilities targeting 500 eligible women who will be served with family planning information and services. The KDOD also intends to introduce sexual partner testing targeting 500 men. In order to improve on sustainability, KDOD will train 60 health care workers in PMTCT including family planning and nutrition. Training will be in accordance with the guidelines set by the Ministry of Health (MOH). Quality assurance will be ensured through establishment of a strategic information and monitoring system that will facilities data analysis. Regular consultations and sharing of experiences within the military and with the MOH will be undertaken in an effort to improve PMTCT services and strengthen follow up of infants born to HIV infected women. The KDOD will undertake PMTCT site infrastructure renovations as necessary. Linkages with HIV care and treatment services including antiretroviral treatment (ART) offered by the KDOD will be strengthened to ensure that all those identified as HIV-infected have access to them. Linkages will also be made to family planning services. The KDOD will continue to receive technical assistance from the United States Department of Defense (USDOD).

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute to overall PEPFAR and Kenya government national goal of ensuring that at least 80% of all health facilities are providing PMTCT services by the end of year 2007. KDOD PMTCT activity will also contribute to 0.5% of the overall national target of 1,000,000 pregnant women accessing PMTCT services in FY 2007. The planned activities will also improve equity in access to HIV prevention and care services of the most at risk populations. These activities will contribute to the result of increased access to CT services, and those identified, as HIV-infected will be referred for care, support and treatment.

4. LINKS TO OTHER ACTIVITIES Linkages between PMTCT service and care outlets will be strengthened to improve utilization of care opportunities created through PEPFAR funding. The PMTCT activities will relate to KDOD activities in palliative care (#6960), CT (#6957) and HIV/AIDS treatment/ART services (#6958). PMTCT services include CT which is largely diagnostic, provision of ARV prophylaxis, and appropriate referrals for the management of opportunistic infections and HIV/AIDS treatment.

5. POPULATIONS BEING TARGETED This activity targets adult of reproductive health age, pregnant women, HIV-exposed/ infected infants, and HIV positive pregnant women. Strategies to improve quality of services will target health care workers, doctors, nurses, midwives, clinical officer, and the local communities.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will increase gender equity in programming through PMTCT services targeted towards pregnant women and their male sexual partners. Identifying the women through PMTCT will give them an opportunity to access care for themselves, partners, and their

children-all resulting in improved pregnancy outcomes. Increased availability of PMTCT and PMTCT+ services will increase access to HIV care, treatment and help reduce stigma and discrimination at military community and facility level.

7. EMPHASIS AREAS The major emphasis areas in this activity will be in training more health care workers to meet the demands of the improved PMTCT uptake. Minor emphasis will include infrastructure renovations at targeted health facilities as needed to provide appropriate client privacy and confidentiality. Supportive supervision, quality assurance, and strategic information planning will also be provided to improve PMTCT service delivery quality.

1. LIST OF RELATED ACTIVITIES This activity is related to activities in Counseling and Testing (#6957) and Condoms and Other Prevention (#6962).

2. ACTIVITY DESCRIPTION In FY 2006, Kenya Department of Defense (KDOD) trained 25 personnel as master trainers for the Men as Partners program (MAP): five from each barrack (Lanet Army Barracks, Eldoret Recruits Training College, Embakasi Garrison, Moi Air Base and Mtongwe Naval Base). The MAP program focused on the recruits and young dependents of military personnel living in the camps. Using lessons learned from this experience, the KDOD intends to continue to expand on these activities in FY 2007. This activity aims at identifying young people early at the entry point of their military careers and targeting specific behaviors that are consistent with ensuring the prevention of HIV. This program has proven to be a success in building skills that protect the military personnel against HIV infection. In FY 2007, the program will also focus and address pervasive gender stereotypes and male behaviors that are relevant to uniformed personnel which continue to be risk factors for HIV transmission. Due to the wide distribution of KDOD personnel in remote areas of the country, the program will train 50 additional staff including 20 peer educators with the aim of strengthening the integration of the curriculum into regular KDOD training not only at the basic training stage following recruitment but also into the ongoing cadre course training of the KDOD program. In FY 2007, the KDOD AB activity will also focus on the dependents of the military personnel that are between the ages of 10 and 18 with the development of a peer education program which addresses issues of youth prevention and AB. In FY 2007, KDOD intends to promote greater command-level involvement in all aspects of HIV prevention in the military through seminars and workshops to enhance their ownership and participation in the prevention program. The major emphasis of the AB component of the program will contribute to the outcome of changed social norms to promote HIV prevention behaviors among youth who constitute a part of the population highly vulnerable to HIV infection. This will ensure that larger numbers are reached with HIV prevention efforts and adults become actively involved as supportive mentors for youth. A total 10,000 additional individuals in the KDOD community and its environs is expected to be reached with messages that promote HIV/AIDS prevention through abstinence and/or being faithful.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA AB activities within the KDOD program will contribute to FY 2007 prevention targets for Kenya, especially among young recruits who are entering the military. The activities will also focus on youthful dependents within the military community and young people living in the neighborhood of the military barracks in order to address the prevention needs of the whole military community.

4 LINKS TO OTHER ACTIVITIES This activity is linked to KDOD counseling and testing (CT) activity (#6957) by promoting VCT services as a way of promoting secondary abstinence. This activity also links to the KDOD Condoms and Other Prevention activity(#6962) by offering comprehensive prevention messages for the military community.

5. POPULATIONS BEING TARGETED This activity targets young adults, both men and women of reproductive age. It will have a special focus on the KDOD military personnel who, due to the nature of their duties, are vulnerable to HIV transmission. Particular emphasis will be placed on young military recruits and young dependants of military personnel residing inside the barracks as well as young people living in the neighborhood of the military barracks. Leaders within the KDOD will have their capacity strengthened to provide leadership in this area.

6. KEY LEGISLATIVE ISSUES ADDRESSED Through the skill building and behavior change that occurs as a part of the men as partners program, this activity will address male norms and behavior and reduction of violence and coercion as well as stigma and discrimination. The involvement of both male and female in AB activities will promote increased gender equity in HIV/AIDS Programs to ensure that women are not left out of these important prevention activities.

7. EMPHASIS AREAS

The major emphasis will be on training by the continuation of the MAP program as well as the introduction of peer education for the youth that live within the military community. Minor emphasis areas include work place programs, information, education and communication and community youth mobilization/participation.

1. LIST OF RELATED ACTIVITIES This activity is related to activities in Counseling and Testing (#6957), Abstinence and Being Faithful (#6966), and Prevention of Mother-to-Child Transmission (#6959).

2. ACTIVITY DESCRIPTION The Kenya military recruits 2,500 young men and women in the age group 18 to 24 years old annually. This group is highly vulnerable to HIV infection and other STIs as well. This activity aims to strengthen HIV prevention in the Kenya Ministry of Defense (KDOD) and has three components. The first component will include activities geared to promote prevention of HIV and STIs by focusing on training health care workers in integrating HIV prevention in their STI diagnosis and treatment. In addition, in FY 2007, KDOD will train 30 individuals to promote HIV/AIDS prevention through behavior change messages that will be disseminated through seminars and workshops targeting 5,300 military personnel, their dependants and civilian personnel working in the military. Special forums targeting commercial sex workers (CSWs) with condoms and other prevention (COP) messages will be implemented in three geographic areas within Kenya, specifically Gilgil, Nanyuki and Mombasa, all of which are known to have a high concentration of CSWs due to their position on the major transport corridor through the country. Although STI basic care will be offered in all the military medical facilities, the program will concentrate on four military regions with a high population density which includes Thika, Kahawa, Embakasi and Moi Air Base. Liaisons will be developed between the KDOD and National AIDS and STI Control Program (NASCOP) to ensure high quality care and training in STI and HIV prevention and education for KDOD health personnel assigned at the military health facilities. The second component of the KDOD COP program will involve activities to promote correct and consistent use of condoms among the military personnel. Measures will be put in place to ensure availability of condoms in all the military stations country-wide by maintaining 40 condom outlets throughout the military communities. Regular monitoring of condom uptake by military personnel will be done on a monthly basis. The final component in FY 2007 will focus on the young recruits entering the military. Though this group is being targeted through the youth focused program referred to as "Men as Partners" (MAP) under the AB program area, this funding will support condom education and promotion as a supplement to the AB program activities in order to provide a comprehensive prevention program. This activity also intends to incorporate scaling-up of command involvement and support in promoting behavior change activities by conducting regular trainings and organizing seminars/workshops for the military personnel under their respective commands in order to ensure consistent and correct messages regarding prevention.

3. CONTRIBUTION TO OVERALL PROGRAM AREA KDOD services targeting 5,300 people will contribute to the FY 2007 prevention targets for Kenya among at-risk adult populations. This activity contributes to Kenya's 5-year strategy of reducing the risk of HIV transmission among high risk occupational settings by promoting the knowledge of correct and consistent condom use among this high-risk group as well as STI education/prevention. The KDOD will integrate their OP program with other sexual transmitted infection (STI) clinics and reproductive health clinics at the various military health facilities.

4. LINKS TO OTHER ACTIVITIES This activity is linked to KEMRI-KDOD counseling and testing (CT) (#6957) and prevention of mother-to-child HIV transmission (PMTCT) (#6959). This OP activity is also linked to KEMRI-KDOD AB activity (#6966) by partnering with other prevention activities that promote a comprehensive approach to prevention for the military population.

5. POPULATIONS BEING TARGETED The KDOD OP activity will reach the most at-risk population by targeting the military personnel and their dependants as well as CSWs that live adjacent to four barracks in Kenya. It will also reach the civilian population working in the barracks and the general population living in the neighborhoods of the barracks. The program intends to capture all STI cases and offer comprehensive treatment to those infected as well as provide them prevention messages as part of their STI treatment.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address the issues of male norms and behaviors which promotes HIV risk behavior, especially in this high-risk community of the military. These activities will

challenge traditional male norms that have been identified as contributing to sexual coercion and multiple sexual partners. The KDOD OP program will also address stigma and discrimination that often is a significant obstacle to routine CT services and the use of condoms.

7. EMPHASIS AREAS The major emphasis area for this workplace program will be community mobilization/participation in order to ensure that military personnel receive quality and specific prevention programs. Other emphasis areas will be information, education and communication in order to de-stigmatize treatment for STIs as well as the development of network/linkages/referral systems with other prevention activities. These areas will assist in the systems integration approach that will successfully link information with behavior change. Training will comprise another key emphasis area, and this will all be developed within the military work place program.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in counseling and testing (#6957), Prevention of Mother-to-Child Transmission(#6959), ARV Services (#6958) and Palliative Care: TB/HIV (#6961).

2. ACTIVITY DESCRIPTION The Kenyan Department of Defense (KDOD) will provide basic health care and support to over 2,000 HIV-positive military personnel, their dependents and civilian population residing in near the military barracks at 8 KDOD medical facilities. In FY 2007, KDOD intends to focus upon improving the quality of life of those who are HIV positive by improving on the delivery of care to these individuals. Palliative care activities will include the provision of clinical care to HIV infected individuals who are not yet eligible for antiretroviral therapy or do not have access to antiretroviral therapy. In FY 2007, this activity plans to expand from one primary site this year to 8 additional centers. These centers are well distributed nationally to ensure fair geographical distribution thus ensuring the services are accessible for the population who may require this support. Referral systems and networking among smaller and larger military clinics will be developed to ensure continuity in care. A total of 40 health care workers, 5 for each site, will be trained to offer services in the 8 centers. In partnership with the USDOD Walter Reed Project, the KDOD in the last 4 years has been successful in encouraging KDOD military to come forward for testing so that those who need care can be assisted. Over 26,000 people have been tested and as a result 1350 have been registered in an HIV comprehensive care clinic. As per end of August 2006, 850 people were on antiretroviral therapy, and the remaining 500 were receiving basic health care and support. FY 2007 activities will build upon the success of this program to ensure that HIV positive patients are directly linked to health care and support services. Even though treatment sites are decentralized from the main military hospital in Nairobi (AFMH) to other military regions, the care and treatment of KDOD HIV/AIDS patients will continue to be closely monitored by staff from the main military hospital in liaison with the Ministry of Health to ensure maintenance of standards of care as per national guidelines. The human resource requirements will be reviewed as necessary. Data on the epidemic will be collected systematically and shared openly to facilitate in monitoring of the epidemic and to assess the services provided.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA By providing care and support for over 2000 patients as described, the KDOD basic health care and support program will contribute to the overall number of people under care in Kenya. The trainings and guidelines for this activity will be in accordance with the national guidelines as outlined by the National AIDS/STI Control Program.

4. LINKS TO OTHER ACTIVITIES These activities will link closely with KDOD's counseling and testing (#6957), ARV services (#6958), and TB/HIV services (#6961). Through the KDOD PMTCT program (#6959) family members of mothers testing positive will be identified and offered opportunity for care and treatment. KDOD's BHCS and ART will constitute a continuum of care for HIV positive individuals as part of a comprehensive approach to care and treatment.

5. POPULATIONS BEING TARGETED This activity targets most at risk populations consisting of military personnel and their dependants as well as the civilian population residing close to the barracks where treatment is otherwise unavailable. New treatment sites will increase coverage and access to all these targeted populations. Health care providers will also be targeted by increased ARV training, thus increasing the amount of clients able to be served more efficiently.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address gender equity by ensuring that both males and females are targeted as receiving services if required. This activity will also address stigma and discrimination through community education and mobilization on issues related to living positively with HIV-AIDS.

7. EMPHASIS AREAS This activity includes major emphasis in commodity procurement (drugs for opportunistic infections, nutritional supplements and pain relief) with minor emphasis in the areas of human resources, training and infrastructure. KDOD will renovate the comprehensive care

clinics to create more space in the new sites, purchase diagnostic and medical supplies, hire additional health staff to help manage the increasing workload as more patients are recruited into the comprehensive are clinics.

1. LIST OF RELATED ACTIVITIES This activity is related to activities in Counseling and Testing (#6957), Prevention of Mother-to-Child Transmission (#6959), Palliative Care: Basic Health Care and Support (#6960) and ARV Services (#6958).

2. ACTIVITY DESCRIPTION The Kenya Department of Defense (KDOD) proposes to intensify the care and treatment of military patients with co-infections of tuberculosis and HIV (TB/HIV) by undertaking more health personnel training in management of TB/HIV, improving the laboratory capacity for TB/HIV, and improving the infrastructure as necessary in designated health facilities to cater for 500 patients with TB/HIV co-infections. These combined TB/HIV activities will result in a strengthened capacity for KDOD health professionals to care for HIV infected TB patients, a strengthened capacity of KDOD health institutions to deliver HIV/TB services, improved diagnostics and treatment of TB among HIV+ individuals in the military population, and improved supply of TB drugs in the Kenyan military. KDOD also plans to extend TB/HIV services to the neighboring civil population as well in FY 2007 therefore increasing the capacity of TB/HIV care and treatment. Refresher training for integrated TB/HIV activities for KDOD health professionals will be undertaken. TB/HIV care clinics will be established in the 8 care and treatment centers in Armed Forces Memorial Hospital (AFMH) and Moi Air Base in Nairobi, Mombasa, Nanyuki, Nakuru, Gilgil, Eldoret and Thika. The TB treatment services at the AFMH have been integrated into the Comprehensive Care Clinic to facilitate effective care of TB/HIV co-infected patients.

KDOD also intends to integrate TB/HIV services in all the other seven military clinics. All HIV positive patients will be screened for TB and those found to be infected will be given anti-TB with cotrimoxazole prophylaxis as per the Kenya's National Leprosy and Tuberculosis Program (NLTP) guidelines. TB infected patients will be screened for HIV and STIs and antiretroviral therapy (ART) will be offered appropriately. Liaison with the NLTP will be maintained for both training and maintenance of treatment/care standards. A network system of HIV/TB patient tracing and referral will be maintained in the whole military structure of medical care. KDOD will train 50 health workers to provide clinical prophylaxis and/ treatment for TB/HIV infected individuals (diagnosed or presumed). In partnership with the United States Department of Defense (USDOD) Walter Reed Project (WRP) and the NLTP, the KDOD has in the last four years trained a number of KDOD health personnel in basic TB/HIV management. Intensification of TB/HIV case finding coupled with more training will lead to more patients being identified and appropriate care given. In terms of reporting for TB, the KDOD is recognized as Kenyan Province equivalent. This recognition by the NLTP will be exploited to ensure that the KDOD tuberculosis program is developed further under the President's Emergency Plan.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA Activities in this program area will contribute to the results of expansion of ART for clinically qualified HIV infected patients. This activity will also care for those who have TB/HIV co-infection as well, thus improving the level of care offered to the patients in KDOD. Human capacity to deliver TB/HIV treatment will be strengthened as well as the referral network for provision of ART and TB/HIV care. Effort will be made to ensure that all patients in KDOD and in the neighborhood of military barracks who deserve care in the area of TB/HIV access this care.

4. LINKS TO OTHER ACTIVITIES This activity is part of a comprehensive program and is linked to other KDOD HIV care and treatment activities in the area of Counseling and Testing (#6957), Prevention of Mother-to-Child Transmission (#6959), Palliative Care: Basic Health Care and Support (#6960) and ARV Services (#6958).

HIV-infected patients will be investigated for TB and similarly all TB-infected patients will be tested for HIV. Those found to be infected will be offered opportunity for care and treatment accordingly. Linkages between KDOD CT and Diagnostic Counseling and Testing (DTC) centers and care outlets will be harmonized and strengthened to improve utilization of care opportunities in the nearest KDOD health facility created through PEFAR funding. The KDOD will seek closer collaboration between the various services with a view to sharing the facilities and where possible these services will be extended to the neighboring civil population.

5. POPULATIONS BEING TARGETED This activity targets military personnel, their families and members of the general population in the immediate neighborhoods around the military facilities. The KDOD young men and women often serve away from their homes, thus being vulnerable to risky behaviors thus exposing them to HIV and TB. The stations have significant numbers of young families and continue to be popular heath service delivery points for the surrounding communities benefiting from TB/HIV services. The new sites will include improved laboratory services for handling TB/HIV, thus helping support staff, families and community members.

6. KEY LEGISLATIVE ISSUES KDOD TB/HIV program will increase gender equity in HIV programming by ensuring that equitable numbers of women including children are receiving treatment. The activities will address stigma associated with TB/HIV status through information, education, and communication materials targeted to health care providers, caregivers, and communities while addressing male norms and behaviors.

7. EMPHASIS AREAS This activity includes major emphasis on training and minor emphasis on commodity procurement, human resources, and infrastructure. KDOD will procure medical supplies (e.g. laboratory diagnostics and drugs) as required for the diagnosis and management of HIV/TB co-morbidities. Staff training as well as obtaining additional staff will occur in order to meet the needs of the increased patient load. Finally, minor renovations will be required to prepare clinic space for this program activity in the three new clinics at Eldoret, Thika and Moi Air Base.

1. LIST OF RELATED ACTIVITIES This activity is related to activities in Counseling and Testing (#6957), ARV services (#6958) and Palliative Care: Basic Health Care and Support (#6960).

2. ACTIVITY DESCRIPTION KDOD initiated the orphans and vulnerable children (OVC) activity in FY 2006 following the recent trend of an increased number of deaths among military personnel resulting from HIV/AIDS. It is estimated that 75% of the deaths in the military are HIV related. The result of increased number of deaths in the military has directly increased the number of OVC left without care and support to approximately 5,000 children. Prior to the KDOD OVC program, these children orphaned by HIV/AIDS had no support from the KDOD as a government institution. With funding in FY 2006, the KDOD has been able to establish a program that focuses on care and general support to 800 OVC located through the assistance of Ministry of Home Affairs (MOHA) children's department. The military OVC population has created close links with community organizations and Government of Kenya offices to identify and ensure that each child enrolled in the program receives a comprehensive care package that addresses the essential services required of Emergency Plan OVC activities. The OVC in the KDOD program are collectively monitored and cared for through the establishment of the OVC military coordination offices in 5 existing KDOD sites throughout the country. In FY 2007, the KDOD intends to increase the number of OVC served from 800 to 2,083 through the provision of direct and supplemental support. The program will continue to take the lead in ensuring that the survivors of the servicemen and women are identified and given preference in this unique OVC military activity. The KDOD will ensure increased access to education for their OVC through relevant district Ministry of Education (MOE) offices in the identification and subsequent provision of bursary funds and vocational training opportunities. The KDOD will also continue to implement the care and support of these OVC by strengthening the capacity of the current caregivers in the local community and continue the tradition of communal and familial support of the OVC. 300 additional caregivers will be trained in basic care and support of the OVC as well as on issues regarding the psychosocial health of the child. The KDOD will continue to maintain the regional OVC military coordination offices for better de-centralized service delivery. The KDOD OVC program will work with the existing community services or government children agencies to augment the level of community and family based support already available to the OVC through the wrap-around approach. This approach is supported by the Emergency Plan in which the needs of the OVC are identified at the community level and subsequently cared for by strengthening existing structures already in place to tend to the needs of the OVC in the various regions throughout the country.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA The KDOD will work closely with other government systems and structures as well as local community based and faith based organizations in the wrap-around approach to caring for OVC which is the foundation to the sustainability of all EP OVC activities. The 2,083 children that will be cared for by KDOD will contribute to the national target of identifying and caring for over 288,000 OVC as well as the training of 300 caregivers.

4. LINKS TO OTHER ACTIVITIES This activity is linked to KDOD CT services (#6957) that are established throughout the country. Through the early identification and subsequent care and treatment of those servicemen and women in the KDOD identified as HIV positive, early support and care can also be provided to their dependents. This activity is also linked to KDOD ART program(#6958) by ensuring that all OVC receive subsequent care and treatment from the KDOD medical facilities if previously exposed to HIV by their parents. The palliative care program (#6960) under KDOD will also be linked to the OVC activity by ensuring the provision of care and support for all HIV+ OVC in the military community.

5. POPULATIONS BEING TARGETED This activity targets people affected by HIV/AIDS including millitary personnel and caregivers of OVC by ensuring they are actively supported and linked to services. This activity is also targeting the OVC by ensuring that they are protected, their rights are guarded and basic needs are met. The KDOD in this activity will also directly take a leading role to ensure that the OVC that have been diagnosed as HIV positive receive psychosocial support and medical care required as early interventions for quality care.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will actively address issues surrounding stigma and discrimination by encouraging the formation of psychosocial support groups for the OVC. By focusing on many of the adolescent OVC, the KDOD hopes to establish a youth friendly support network that can work on tackling many of the issues surrounding stigma and discrimination faced by the OVC. The KDOD OVC program will also be an integral part of a wrap around approach to caring and supporting for the OVC through establishing links with other community or religious organizations in ensuring the needs of the OVC are met fully.

7. EMPHASIS AREAS The major emphasis area of this activity is focused in community mobilization and participation. The KDOD will work in mobilizing community based responses to address the comprehensive needs of the OVC. The other emphasis areas will be in maintaining adequate staff in the regional OVC military coordination offices through human resources as well as training needs for the caregivers of the OVC. The other minor emphasis area will be in developing infrastructure, information, education, and communication for the OVC and their caregivers as well as the training of 300 additional OVC caregivers.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Palliative Care: TB/HIV [#6961], Treatment: ARV services [#6958], Abstinence/Being Faithful [#6966] and Condoms and Other Prevention [#6962].

2. ACTIVITY DESCRIPTION Kenya's Department of Defense (KDOD) has received support from the Emergency Plan to implement a comprehensive HIV/AIDS program since FY 2004. One of the key components of this program is HIV counseling and testing (CT), which is useful, both for prevention and for access to care. A large majority of the military personnel and their families are young people. Also, a sizable proportion of the actual military personnel can be classified as high-risk, given that they often travel far away from their families. A comprehensive HIV/AIDS program, including CT is essential in the military. In FY 2007 KDOD will expand its CT activities in both the static sites and through community and military mobile (outreach) activities. Core activities will include training and deployment of 75 additional counselors and establishing three new VCT sites, in addition to the existing 25 sites. By so doing KDOD will have adequate capacity to provide CT to an additional estimated 7,500 people, including military personnel and their dependants, KDOD civilian employees, and the general population living near the barracks. All those who test HIV positive will be referred to the nearest military clinics for care. In terms of training, 50 people (mostly health care workers) will be trained in provider-initiated testing and counseling (PITC), while 25 mostly lay counselors will be trained in VCT. Those who will be trained in PITC will be selected from KDOD health facilities and will upon completion of the training institutionalize routine PITC in the military health facilities. Those who will be trained in VCT will be deployed to either the fixed sites or to the mobile (outreach) program. The mobile (outreach) VCT services will mainly target the high density non military communities around the 4 major military regions (Nairobi, Central, Rift Valley and Coast). It will also take advantage of the military logistics support to provide CT services to the underserved areas in the North Eastern Province. KDOD will also provide refresher training to existing CT providers in emerging issues in VCT as well in the management of post test clubs. In addition, greater involvement of people living with HIV/AIDS will be sought and encouraged as one of the ways of reducing the stigma associated with CT. Quality assurance (QA) for both counseling and testing will be expanded to cope with increased service uptake during the planned scale up in FY 2007. The QA program will be done in keeping with national and international standards. QA for counseling will involve monthly support supervision to practicing counselors.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA KDOD'S CT program will contribute to the overall national CT target by providing CT services to the military, which is a special, high risk population. The mobile VCT services will improve access to HIV prevention and care services in remote areas that do not have fixed VCT sites, thus ensuring better access to CT services. This activity will also contribute substantively to Kenya's 5-year strategy that emphasizes universal knowledge of HIV status amongst Kenyans. Links between CT services and care will be enhanced.

4 LINKS TO OTHER ACTIVITIES This activity is part of a comprehensive HIV care and treatment program within the KDOD linked to other services such as AB (#6966), OP (#6962), TB/HIV (#6961) and ART (#6958). Linkages between CT services and care outlets will be strengthened to improve utilization of care opportunities that have been created in KDOD's health infrastructure through PEPFAR funding.

5. POPULATIONS BEING TARGETED This activity will mainly target the Military personnel, their dependants, KDOD Civilian personnel and adult members of the general population living next to the barracks. Trainings will target health care workers.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will empower and increase awareness through counseling and targeted messages for the military personnel. Vigorous campaigns to educate them on the benefits of VCT services, couple VCT and mutual disclosure of HIV status will be undertaken. Testing and counseling will also be promoted in clinical setting, especially TB, STD, PMTCT Clinics and medical wards to enhance identification and timely referral of those requiring

care. It will also seek to empower and inform the KDOD staff, families and communities through counseling and targeted messages. Analysis of VCT clients data existing from KDOD sites indicates a low service uptake. Activities in this program area will also include promotion, campaigns and mobilization aimed at increasing overall CT uptake. The increased availability of CT services and their popularization among the Military personnel will reduce stigma and discrimination. Ensuring that equitable access to CT services across gender will continue to be a priority as well in FY 2007.

7. EMPHASIS AREAS This activity includes major emphasis on training and minor emphasis in the areas of human resource (health care and PITC providers) and infrastructure improvement. Personnel training in PITC (both initial and refresher) will be undertaken to ensure quality services are rendered in line with national and international guidelines. Training in quality assurance and supervision will also be undertaken to ensure internal capacity for long-term sustainability of the program.

1. LIST OF RELATED ACTIVITIES This activity is related to activities in Counseling and Testing (#6957), Palliative Care: TB/HIV (#6961), Palliative Care: Basic Health Care and Support (#6960) and Prevention of Mother-to-Child Transmission (#6959).

2. ACTIVITY DESCRIPTION Under FY 2007 Emergency Plan funding, the Kenyan Department of Defense (KDOD) will continue to support five military Antiretroviral Therapy (ART) sites in Kenya (Armed Forces Memorial Hospital (AFMH) in Nairobi, The Air Force Medical Centre in Laikipia, Kenyatta barracks - Gilgil, Lanet barracks in Nakuru and Naval Medical center at Mombasa), expand to three new clinics (Thika, Eldoret, and The Air Force Medical Centre in Nairobi at Moi Air Base), bringing the total number of treatment sites in the military to 8. ART will be offered to soldiers, their dependants, KDOD civilian employees and civilians in the neighboring communities. The target is to bring the total ever treated to 2,000 (350 new) including 200 children. In FY 2007, the KDOD HIV program intends to extend treatment and care services to a target population of 600,000 people these will include 100,000 military personel, their dependants, civilian personnel and the neighboring underserved civilian population estimated at 500,000. With the support of US Army Medical Research Unit-Kenya, the KDOD has in the last 4 years developed capacity to manage and run a successful HIV/AIDS comprehensive care clinic at the main military hospital, AFMH, in Nairobi. To date this clinic has 1,350 registered HIV-infected patients. Out of which, over 850 are on ART and over 300 patients continue to receive treatment for tuberculosis (TB). In FY 2007, support activities will include strengthening of the AFMH to serve as a referral center for HIV/AIDS care through improvement of existing laboratory capacity, management of Sexually Transmitted Infections (STIs), and management of complicated medical cases such as ARV drug resistance. AFMH will also continue providing pediatric HIV-AIDS care and treatment. In order to maintain and improve on achievements already attained, the KDOD will need to train additional staff to run the current clinic and 8 peripheral clinics. Over the last six years more than 75 KDOD medical personnel have received basic orientation on Antiretroviral (ARV) administration and treatment of tuberculosis (TB). Due to competing medical and other military duties, only a few remain available to run the clinic on a day to day basis. In FY 2007, staff of various cadres will be trained including 60 health care workers who will be trained on comprehensive adult and pediatric HIV/AIDS care. In addition, manpower requirements will be reviewed and hired as necessary to ensure that KDOD maintains at least 1 registered clinical officer, 1 pharmaceutical technologist and 1 laboratory technologist at each of the 8 treatment centers at any one time. Part of 2007 funds will be used to improve the AFMH and the 7 peripheral clinics in terms of infrastructure, staffing, diagnosis of HIV, STIs and various opportunistic infections, safety monitoring equipment and supplies. These funds will also be used to continue and/or initiate technical assistance from 24 locally employed staff.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA By putting 2,000 people on treatment through the KDOD program, this will contribute to the result of increased number of people on ARVs nationally. Improvement of the infrastructure and of the laboratory services will also lead to better quality of services rendered to the HIV infected patients. Even though treatment sites are decentralized from AFMH to 7 other sites covering the main military regions (namely the Coast, Mount Kenya, 3 sites in central Rift Valley and Central province), the care and treatment of KDOD HIV/AIDS patients will continue to be closely monitored by staff from the AFMH hospital in liaison with the Ministry of Health (MOH) to ensure maintenance of standards of care as per national guidelines. Data on the epidemic will be collected systematically and shared openly to facilitate in monitoring of the epidemic and to assess the services provided.

4. LINKS TO OTHER ACTIVITIES These activities will link closely with KDOD's counseling and testing, basic health care and support, and TB/HIV services. Through the KDOD PMTCT program family members of mothers testing positive will be identified and offered opportunity for care and treatment. ART activities will be linked to KDOD BHCS. Thus KDOD's ART and BHCS will constitute a continuum of care for HIV infected individuals.

5. POPULATIONS BEING TARGETED This activity targets a population of 600,000 people consisting of most at risk populations of military personnel and their dependants as well as the civilian population residing close

to the barracks where treatment is otherwise unavailable. New treatment sites will increase coverage and access to all these targeted populations. Health care providers will also be targeted by increased ART training, thus increasing the amount of clients able to be served more efficiently.

6. KEY LEGISLATIVE ISSUES ADDRESSED Increasing gender equity in HIV/AIDS programs, dealing with male norms and behaviors, and reducing stigma and discrimination are all areas in which this activity will address. ART services that will be provided will be given equitably across genders. Information and education on ART will be done for the public and the medical staff to target stigma.

7. EMPHASIS AREAS This activity includes major emphasis on infrastructure and minor emphasis on commodity procurement, human resources and training. KDOD will renovate the comprehensive care clinics to create more space in the new sites in order to accommodate the integration of pediatric ART services, purchase diagnostic and medical supplies, train staff on ART and hire additional health staff to help manage the increasing workload as more patients are recruited into the comprehensive are clinics.

1. LIST OF RELATED ACTIVITIES This activity is related to activities in Treatment: ARV services (#6958), Palliative Care: TB/HIV (#6961), Prevention of Mother-to-Child Transmission (#6959) and Counseling and Testing (#6957).

2. ACTIVITY DESCRIPTION This activity represents an important component which was funded under the Emergency Plan in FY 2006. In FY 2007, the Kenya Department of Defense (KDOD) intends to complete the development of the necessary laboratory infrastructure initiated in FY 2006 while strengthening laboratory facilities to support HIV/AIDS-related activities. The funding for this activity will go towards infrastructure development for three laboratories intended to support treatment and care at three new sites - Thika, Eldoret and Moi Air Base. Each laboratory facility will have cytometry, hematology and chemistry monitoring equipment necessary for accurate diagnosis, monitoring and follow up of HIV- infected patients at each of the eight KMOD medical treatment facilities including the main military hospital - Armed Forces Military Hospital (AFMH) and the Air Force medical centre at Moi Air Base in Nairobi, as well as eight outlying hospitals in Nanyuki (Laikipia Air Base), Mombasa (Mtongwe Naval Hospital), Gilgil regional Military Hospital (GRMH), Nakuru area (Lanet Army Barracks hospital), Eldoret, and Thika (Center of Excellence). The equipment of these military labs will enable on-site staff to effectively provide laboratory services to 30-40 patients per day. In addition the eight military laboratories will serve as back up for medical facilities in the neighborhood of the military barracks which are often lacking in the basic laboratory facilities critical for ART initiation and monitoring. In FY 2007 KDOD activities will also be used at the AFMH for procurement of specialized microbiology equipment which will include a culture unit, incubators, centrifuges, a fridge and hoods; reagents necessary for the diagnosis of opportunistic infections including TB and STIs; a PCR machine for pediatric diagnosis; development of protocols for quality assurance schemes and strengthening of networks and referral systems between the AFMH and the 8 peripheral laboratories. The AFMH laboratory will be enrolled with external QA/QC program and will be the point of reference for all the 8 peripheral labs.

In addition, this activity will continue to provide links to TB/HIV services by continuing to provide the necessary basic equipment for evaluation of tuberculosis (TB) in all HIV-positive patients with provision of equipment such as microscopes, TB culture media and reagents, incubators, and BSC Class II (laminar) flow hoods. The development of this laboratory infrastructure in FY 2007 will continue to result in the provision of improved quality of medical care and reliable patient monitoring.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA These activities will contribute to the results of expansion of ARV treatment for clinically qualified HIV positive patients by providing the vital laboratory support for the follow up of 2000 HIV positive patients, thus contributing to overall national target of treating 186,000 people by the year 2010. Further, these activities will strengthen human resource capacity to render this laboratory support by training 30 laboratory workers in lab related activities, supporting peripheral laboratories to perform HIV, CD4 and /or lymphocyte tests and strengthen referral network for provision of laboratory services through the proposed Center of Excellence(CoE) in Thika.

4. LINKS TO OTHER ACTIVITIES This activity also relates to activities on HIV/AIDS Treatment/ARV and TB/HIV services and also to activities to be implemented by KEMRI-KDOD in the areas of general health services, HVTB, HVCT and MTCT.

5. POPULATIONS BEING TARGETED As ART is introduced as part of the basic HIV/AIDS care to military personnel, their dependents and civilian personnel, the military laboratories will serve as a contingency and support lab for the health care facilities located in the neighborhood of the 8 KMOD laboratories. KDOD intends to provide local medical personnel with reliable equipment which will allow them to maintain an accurate and up-to-date patient treatment data and laboratory parameter treatment monitoring and lab evaluations such as Elisa, CD4 counts, hematology indices, viral load and chemistry (liver function tests and renal function) which are crucial for ART management and yet often unavailable in most public health facilities in Kenya. Availability of this minimum laboratory equipment is an utmost necessity in order

to be able to provide quality medical care and appropriate medical support to HIV-infected patients in the military population and civil population in the neighborhood of the military barracks.

6. EMPHASIS AREAS This activity includes emphasis on equipment acquisition for 8 laboratories and development of phase 2 of the proposed COE, as well as capacity building of laboratory personnel for all the 8 centers namely Armed Forces Memorial Hospital, Laikipia Air Base Medical Center, Gilgil & Lanet Army Hospital, the Mtongwe Naval Hospital, and the CoE at Thika, Moi Air Base and Eldoret. Minor emphasis in the areas of laboratory infrastructure development and development of protocols for quality assurance schemes and strengthening of networks/linkages and referral systems.

1. LIST OF RELATED ACTIVITIES This activity is related to activities in Prevention of Mother-to-Child Transmission (#6959), Counseling and Testing (#6957), Treatment: ARV Services (#6958), Strategic Information (#7002), Laboratory Infrastructure (#7003), and Strategic Information (#6824).

2. ACTIVITY DESCRIPTION In FY 2005, Kenya Department of Defense (KDOD) initiated the development of a basic data system for documentation of individual patient data collection, analysis and dissemination of HIV/AIDS behavioral and biological surveillance and monitoring information as required by the Kenya Ministry of Health (MOH) as well as the Office of the Global AIDS Coordinator (OGAC). In FY 2007, KDOD will continue supporting the HIV program areas of HTXS, HVCT, MTCT, HKID, HLAB and HVTB at each of 8 KDOD medical treatment facilities, including the Armed Forces Memorial Hospital (AFMH) and Moi Air Base in Nairobi as well the outlying military hospitals in Nanyuki (Laikipia Air Base), Mombasa (Mtongwe Naval Hospital), Gilgil Regional Military Hospital (GRMH), and in Nakuru (Lanet Army Barracks hospital). In addition, 3 new clinics at Thika, Moi Air base and Eldoret will be provided with the necessary data automation computerized system and other communication equipment required for electronic entry of patient-specific encounter data required by the National AIDS/STI Control Program (NASCOP) as well as entry of the targets set by OGAC as Emergency Plan indicators for SI on a monthly basis. Currently, there is a local electronic network between the lab, the Comprehensive Care Centers (CCC) and the pharmacy at the AFMH. In FY 2007, the 7 additional clinics will have a local network between laboratory, clinic and pharmacy installed to facilitate electronic data recording. In FY 2007, this activity intends to have the main military hospital AFMH linked electronically to the data center at Defense Headquarters (DHQ) while the other sites will follow subsequently in the years to come. The data center will continue receiving support as the central monitoring and evaluation system for all the 8 treatment centers in the military. A total of 24 individuals, 3 for each station will be trained in strategic information (includes M&E, surveillance and/or HMIS).

3. CONTRIBUTIONS TO OVERALL PROGRAM The development of the SI system will largely contribute to the expansion of an effective and efficient ART program that will result in the provision of quality care to all HIV-positive patients under the KDOD program. The resulting expansion of care will play a critical role towards achieving the PEPFAR goals for KDOD as well as for the needs of the national HIV/AIDS care and treatment program.

4. LINKS TO OTHER ACTIVITIES This activity links to KDOD-KEMRI activities in the areas of MTCT, HVCT, HVTB, and HTXS by providing linkages between the patient data monitoring system and PEPFAR and national reporting systems through better data generated at each of these clinics within each of the 8 treatment sites. In addition, this activity will link to the HVSI and HLAB activities to be carried out by NASCOP and the SI activity to be carried out by Abt Associates-PHR+ (#6824) in utilizing national software for reporting.

5. POPULATIONS BEING TARGETED As ART is introduced as part of the basic care available to military, dependents and surrounding community civilian personnel, the KDOD will need to provide local medical personnel with a reliable computerized system which will allow them to maintain an accurate and up-to-date patient treatment data and laboratory and pharmacy drug treatment monitoring, to include compliance markers, recording of any side effects, and monitoring of minimum laboratory evaluations such as CD4 counts, hematology indices and chemistry (liver function tests and renal function). Maintenance of this data system at each location will be invaluable in facilitating and adequately providing medical support to HIV-infected patients.

6. EMPHASIS AREAS The major emphasis for this activity will go towards development of the information technology and communications infrastructure by directing resources in acquiring computer equipment and supplies (2 computers and a server at each new site), a local network between laboratory, clinic and pharmacy will be installed in each of the 8 clinics to facilitate electronic data recording. One civilian data manager will be hired to supervise the Health Management Information Systems (HMIS) for the KDOD HIV program, training

of data collection and automation workers (3 per site) and maintenance of the Data Management Unit (DMU) at the central AFMH referral facility and the data center at Defense Headquarters will be undertaken .Thus, the development of this SI initiative will result in the provision of improved quality of care and reliable maintenance and reporting of program specific EP program SI markers on a consistent basis.