Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4303
Country/Region: Kenya
Year: 2007
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $8,071,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $524,054

1. LIST OF RELATED ACTIVITIES This activity relates to all activities in PMTCT.

2. ACTIVITY DESCRIPTION CDC PMTCT program has continued to support the up scaling of PMTCT services in the country by providing technical support and guidance to the national program. Key areas of program focus include the introduction of Comprehensive PMTCT that encompass a package of care to ensure that the HIV-positive pregnant mother, her infant and family receive the full range of HIV care and treatment services as well as linkage to Family Planning services. The approach also includes a strong emphasis on primary prevention-providing skills to the mother who is HIV- to protect herself and her family from HIV infection.

In FY 2007, CDC PMTCT section will continue supporting these activities under the expanded or comprehensive PMTCT package that includes the following key components: expansion in geographic coverage in all CDC supported sites to ensure universal access to services; Integration of counseling and HIV testing of women in the antenatal clinics and maternity units; Clinical staging of all HIV-positive pregnant women to identify the appropriate PMTCT ARV intervention in line with National guidelines (this includes use of HAART where eligible, or use of combination AZT and sd Nevirapine for early presenters, or use of sd Nevirapine); Administration of the appropriate PMTCT ARV as well as OI prophylaxis for all HIV-positive pregnant women; Early Infant HIV diagnosis for all HIV exposed infants through DNA Polymerase Chain Reaction (PCR) testing; Linkage of eligible infants to pediatric HIV care and treatment services; strengthened post-natal care package; Linkage to family planning services and counseling and testing services for the woman's partner and other family members. This will lead to more women and their partners and infants knowing their HIV status and hence accessing ART, thereby increasing the number of people on ARVs. All these activities will contribute to the Emergency Plan in Kenya goals of HIV prevention and treatment.

During FY 2007 CDC will continue to work with government of Kenya agencies and non-governmental partners to support implementation of these services in the country. CDC Kenya's multi-disciplinary PMTCT team will continue to provide technical guidance that includes the development and review of guidelines, operational procedures and manuals, educational materials and teaching modules for implementing comprehensive PMTCT programs in Kenya. CDC Kenya staff work with local partners to ensure activities are based on the latest relevant science and that scientific knowledge is translated into program guidelines and practices both at national policy and service delivery levels. In collaboration with other partners, CDC staff conducts monitoring and evaluation activities including operational research for the PMTCT program, and ensure that information generated informs national PMTCT policy and practice. CDC Kenya staff also support PMTCT activities at multiple service delivery sites to conform to national guidelines and technical strategies concerning all aspects of PMTCT including models of HIV testing in the antenatal and maternity units, provision of ARVs for prophylaxis and treatment, care and support of the HIV+ woman, her infant and partner and Early Infant diagnosis for HIV exposed infants and linkage to treatment and care for all eligible infants.

The CDC Kenya PMTCT technical team includes six professional staff, one program assistant and three support staff. The technical staff includes one senior technical advisor working 80% of the time; this staff member, an Associate Professor of Pediatrics has extensive national and international experience in clinical and programmatic HIV research including PMTCT, and works directly with the government of Kenya and other partners to ensure the technical soundness of the program. Other technical staff include two medical doctors with experience and expertise in Pediatrics, and Obstetrics and Gynecology respectively, who work directly with programs to ensure technical and up-to-date interventions, in particular the care of the HIV+ woman and pediatric HIV care; Two program managers with nursing and public health experience who work directly with the sites in 34 districts to provide guidance on both technical and effective program management approaches at the service delivery sites, a behavioral scientist and a program assistant. The program assistant is engaged in a variety of tasks to provide logistics support to the team. The team is supported by three drivers, who enable the technical staff to conduct regular field visits and technical supervision. This budget includes costs for contractual services, printing of the curriculum and other post-held account funds.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $300,000

1. LIST OF RELATED ACTIVITIES This activity relates to all activities in Abstinence and Be Faithful Programs.

2. ACTIVITY DESCRIPTION During FY 2007 CDC will continue to work with Government of Kenya agencies and non-governmental partners to promote abstinence and faithfulness as an HIV prevention strategy. CDC Kenya now has a wide range of AB activities and partners, including 11 cooperative agreements designed to promote AB activities with young people. CDC continually identifies and continues to provide an intense level of technical assistance and guidance to ensure that partner activities are focused on behavior change. CDC provides technical support through a close program mentorship of staff at the National Youth Service, a uniformed national training service serving up to 10,000 youth each year. In addition, CDC provides technical assistance to number of local FBOs and CBOs through a capacity building project with CHF International. The sub-grantees working in this area include the Africa Inland Church, the Baptist AIDS Response Agency, Kenya Episcopal Secretariat-Catholic Secretariat, and many others. CDC Kenya staff also have a strong partnership with the non-military uniformed services of Kenya, including the Kenya Prisons, Kenya Wildlife Service, and the police. They have had a key role in introducing the Men as Partners (MAP) curriculum into the training offered to young recruits in the National Youth Service and will introduce this curriculum, which emphasizes changes in male behaviors and attitudes, to young recruits into the non-millitary uniformed services. The types of activities CDC technical staff engage in include training in workplan development, assistance with monitoring and evaluation plans, training to bring local CBO and NGO staff up to date in technical areas of HIV and AIDS, reviewing technical proposals for funding, making technical presentations and supervising partners working through the Cooperative Agreements. CDC Atlanta staff come to Kenya on a regular basis to assist the local partners in developing identified technical areas. The CDC Kenya AB technical team includes one Direct Hire (USDH) working 25% in AB. This staff member has extensive international experience in working with FBOs implementing HIV prevention programs, and the incumbent works directly with implementing partners to ensure the technical soundness of the program. CDC has one locally employed technical staff member working on AB and youth programs on full-time basis. She also has extensive experience in this programmatic area, and spends most of her time working directly with local partners. This team will be supported by two locally employed drivers, one in Nairobi and one in Nyanza, whose work is devoted to supporting AB and youth interventions.

Funding for Biomedical Prevention: Blood Safety (HMBL): $260,000

1. LIST OF RELATED ACTIVITIES This activity links to all other activities in blood safety.

2. ACTIVITY DESCRIPTION This activity relates to the prevention of HIV transmission through blood transfusion in health care settings. The National Blood Transfusion Service (NBTS) was established in the year 2000 with the goal of ensuring safe and sufficient blood supplies for the country. Previously blood was obtained solely from family replacement donors at fragmented hospital-based transfusion units that lacked a standardization of procedures. A national survey in 1994 estimated that 2% of transfusions transmitted HIV. At least 130,000 transfusions take place each year. This activity will avail staff to give technical support to the national blood transfusion service for the establishment of goals and objectives and best practices in donor recruitment, blood collection, processing, storage and use. This will be achieved through regular meetings, support supervision, preparation of procedural guidelines and data collection tools and the review and analysis of quarterly reports. Support supervision will involve travel to the six regional blood transfusion centres located in Kisumu, Eldoret, Nairobi, Nakuru, Embu and Mombasa and satellite centres in Voi, Naivasha and Kericho as well as international travel for blood safety related workshops, seminars and conferences. These staff will also liaise with and coordinate the various organizations that support blood donor mobilization for the NBTS so as to avoid conflict and achieve synergy in meeting the blood collection target. These organizations include: Kenya Red Cross, Hope Worldwide and Bloodlink Foundation. Direct support will be given to the Moi Teaching & Referral Hospital blood bank, during its transition from being a direct recipient of funding from CDC to its absorption into the NBTS system. This activity also includes participation in various Ministry of Health committees that impact on blood transfusion policy and practices in the country. These include: Blood Safety Committee, Blood Safety Interagency Committee, Laboratory Interagency Committee, HIV Lab Committee and World Blood Donor's Day Committee. The staff will additionally give in-country support to international groups supporting blood safety activities in Kenya such as the American Association of Blood banks (AABB), Internews and Community Housing Foundation (CHF).

A study carried out in Kenya in 1998 found that 4% of blood transfusions transmitted HIV attributed to inadequate testing, lack of standards and clerical errors. The Ministry of Health (MOH) intends to abolish hospital based blood banks, but Kenya is still in a transitory phase with both a national transfusion service and hospital based blood banks. National blood requirements are not known. This activity involves a national evaluation of all blood transfusion services in the country to inform on the number of transfusing facilities, total units of blood transfused, occurrence of post-transfusion adverse events, integrity of the blood cold chain, extent and methodology of pre-transfusion blood testing. This mid-term review of the PEPFAR blood safety program in Kenya will determine the levels of blood safety and sufficiency. Cost-analysis will determine expenditure at various stages of blood collection and processing so as to guide the MOH in developing a sustainability plan for blood safety. ($300,000) Only 5-10% of 100,000 blood donors of get to know their results annually due to lack of a formalized system for notification of donor test results. This translates to a missed opportunity to inform 95,000 persons of their HIV status and reinforce prevention (AB) messages given in pre-donation talks. Several people continue to donate repeatedly due to lack of knowledge of their HIV status, endangering both their health and that of recipients and is also wasteful of NBTS resources. In this activity at least two schemes for donor notification will be piloted. Two NGOs (Hope Worldwide and Kenya Red Cross) currently supporting the NBTS in donor mobilization and also engaged in HIV counseling and testing activities could easily collaborate with NBTS in this activity. Lessons learnt will guide the NBTS donor notification policy. Up to 95,000 adults will receive HIV test results, AB messages and other TTI test results. ($200,000)

Funding for Biomedical Prevention: Injection Safety (HMIN): $252,000

1. LIST OF RELATED ACTIVITIES This activity relates to all other activities in injection safety.

2. ACTIVITY DESCRIPTION ACTIVITY DESCRIPTION This activity relates to the prevention of HIV transmission among health care workers, medical waste handlers and the community. These funding will enable HHS/CDC staff to give technical support to six implementers of injection safety initiatives in Kenya. This will involve joint planning meetings, review of guidelines, standards and training material and support supervision at intervention sites and at training workshops. These staff will participate in the MOH injection safety steering committee and the injection safety stakeholders meetings to influence policy decisions in this arena. Activities are currently being scaled up to achieve national coverage by 2008. Staff will be involved in frequent travel across the country and will attend international conferences for dissemination of latest findings. One staff will dedicate 100% of their time to this activity while another will commit 40% time.

The world Health Organization (WHO) estimates of global burden of disease suggest that unsafe injections around the world account for 5% of HIV infections, 32% of hepatitis B virus infections and 40% of hepatitis C virus infections. A 2004 survey by JSI-MMIS in Kenya revealed that over 70% of respondents received an average of 1.5 injections per year. Needle stick injuries within the previous six months were reported by 58% of health care workers. These findings supported those of an earlier study by the University of Nairobi among 214 nurses in Nairobi, which reported 61% needle stick injuries in health care workers over a three-month period. Needle recapping accounted for 46% of the injuries while 12% occurred in the process of sharps disposal. A majority of health facilities surveyed reported having experienced a shortage of disposable injection supplies in the 12 months prior to the survey, particularly in the curative sector. This reflected a less than optimal logistics system for forecasting, procurement, distribution and stock monitoring that may contribute to re-use of injections. Analysis of the status of injection logistics in the country revealed that there was no data to support rational forecasting of injection requirements. Procurement was based on previous consumptions. Appropriate product selection was poor due to lack of national standards for injection devices, registered suppliers of injection equipment and an appropriate board to handle non-pharmaceutical equipment. Track 1 funds were awarded to JSI-MMIS in 2004 to implement injection safety activities in Kenya and other PEPFAR focus countries.

The activity aims to:1) improve training of health workers and managers on safe injection practices, infection control and disposal procedures; 2) institute an advocacy strategy to decrease demand for injections by the population; 3) establish reliable estimates of re-use prevention injection device equipment requirements, minimum stock levels and effective supply and distribution systems for re-use prevention injection device equipment; 4) institute monitoring and supervision procedures to ensure adequate supplies at all levels and correct practices by health workers; 5) ensure safe disposal of used injection equipment through the progressive introduction of appropriate incinerators; 6) secure the required budget for injection safety and infection control including safe disposal of used equipment. To date safe injection practices have been implemented in three districts, five of eight provincial hospitals and one of three university teaching hospitals. In FY 2006 the Ministry of Health, through the National AIDS and STD Control Program, received country funds to facilitate development of policy documents and coordinate injection safety initiatives countrywide. In the current COP, additional partners will include the University of Nairobi, Danya International and USAID APHIA II implementing partners.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $250,000

1. LIST OF RELATED ACTIVITIES This activity relates to all activities in Condoms and Other Prevention.

2. ACTIVITY DESCRIPTION In FY 2007 CDC will continue to work with Government of Kenya agencies and non-governmental partners to assist in the implementation of a wide range of HIV prevention services covered under Condoms and Other Prevention. CDC Kenya staff will provide technical assistance and guidance to local partners to ensure the technical soundness of these programs, adherence to Emergency Plan guidelines, and to ensure that these programs receive appropriate monitoring and evaluation. CDC Kenya has a close partnership with the International Rescue Committee to implement OP activities in the Kakuma refugee camp and will provide technical support to the State Department-funded UNHCR for activities in Dadaab refugee camp. The provision of technical guidance is a key element of this partnership. CDC staff will work closely with the Institute of Tropical Medicine (ITM) to ensure the technical and programmatic soundness of the young vulnerable women project in Kisumu. In addition, CDC provides intensive day to day support to over fifteen local FBOs and CBOs through a capacity building project with CHF International. The sub-grantees working in this area serve a broad range of at-risk groups including sugar plantation workers, sex workers, matatu and transport workers and those in the ‘jua kali' informal sector. CDC will provide technical guidance in FY 2007 to help partners in this program area focus on Positive Prevention. This important behavioral approach has already been incorporated in the activity narratives for a majority of HVOP CDC partners. A new project to be supported by this mechanism will be one providing behavioral interventions for young men enrolling in the Kisumu male circumcision project (non-PEPFAR funded). The types of activities CDC technical staff engage in include training in workplan development, assistance with monitoring and evaluation plans, training to bring local CBO and NGO staff up to date in technical areas of HIV and AIDS, and other technical services. CDC Kenya staff also provide technical assistance to the non-military uniformed services of Kenya, including the National Youth Service, Kenya Prisons, Kenya Wildlife Service, and the police. The CDC Kenya OP technical team includes one Direct Hire (USDH) who has extensive international experience in implementation of behavioral HIV prevention programs and will provide 5% of time to OP. One locally employed staff works 50% of her time on this program and proposes to add one locally employed technical staff member to share the increasing workload. In addition, CDC Kenya will draw on technical expertise from other CDC prevention experts in Africa and in Atlanta. CDC also supports two local staff through the KEMRI COAG to coordinate the uniformed services project. This team OP team will be supported by two locally employed drivers whose work is devoted to supporting HIV prevention interventions.

Funding for Care: TB/HIV (HVTB): $520,000

1. LIST OF RELATED ACTIVITIES This activity relates to all other activities in the Palliative Care: TB/HIV program area.

2. ACTIVITY DESCRIPTION CDC Kenya staff provide an intensive level of technical assistance and programmatic guidance on the integration of TB and HIV activities in partnership with the National Leprosy and TB Program (NLTP), the National AIDS and STI Control Program (NASCOP), WHO, non-governmental organizations, faith-based organizations, private practitioners and other USG partners involved in TB/HIV activities. CDC staff are active leaders in the National TB/HIV coordinating committee and are assisting the Ministry of Health to coordinate the roll-out of routine HIV testing for TB patients/suspects, TB screening for HIV+ individuals and provision of additional HIV-related care (prevention of opportunistic infections, ARV therapy) for HIV+ TB patients. TB/HIV section staff, who include four Kenyan physicians, one laboratory technologist (funded separately under the Laboratory Program), and three support staff, are instrumental in developing project protocols and conducting operational research designed to improve care and prevention of HIV-related TB in collaboration with the above partners. The same staff will continue to provide technical support to evolving TB/HIV programs in Southern Sudan. CDC Kenya staff also provide best practice training and guidance to medical staff, including assistance to the Ministry of Health in developing TB/HIV training curricula and guiding the agenda for the national, regional and more localized TB/HIV coordinating bodies. Other technical assistance to the NLTP includes collection, analysis, and dissemination of national TB/HIV data. The same staff are involved in the piloting of electronic TB/HIV registers, the development and evaluation of data collection instruments and monitoring and evaluation of TB/HIV collaborative activities across the country. CDC Kenya professionals assist with the formulation of national policies and guidelines on HIV/TB matters. This budget includes support for 7 CDC Kenya staff, 6 weeks of technical assistance from CDC Atlanta in the coming financial year, and a considerable amount of in-country travel for supervision of project activities and supply of essential commodities such as HIV test kits and cotrimoxazole. CDC Kenya staff supervise and monitor the use of USG funds in all CDC supported projects dealing with TB/HIV activities.

Funding for Testing: HIV Testing and Counseling (HVCT): $400,000

1. LIST OF RELATED ACTIVITIES This activity relates to all activities in the Counseling and Testing program area.

2. ACTIVITY DESCRIPTION HIV Counseling and Testing (CT) has a central role in both prevention and treatment of HIV infection. With support from CDC and other partners, Kenya has achieved great success in implementing Voluntary Counseling and Testing since 2000. Recent scale up of ART services in the country, made possible largely through Presidential Emergency Fund, now means that CT clients found to be HIV+ can be readily referred for care and treatment services. But these emerging care opportunities are not fully utilized because majority of Kenyans (86%) don't know their HIV status and yet knowledge of status is the entry point to comprehensive HIV/AIDS care. Personal knowledge of HIV status is a priority intervention in the Kenya 5 Year Strategy, and increasing access to CT services continues to be a high priority for the Emergency Plan in Kenya. During FY 2007 CDC will continue to work with government of Kenya and non-governmental partners to promote CT in both clinical and non clinical settings including STI clinics, TB clinics, medical and pediatric wards, antenatal clinics as well as integrated, stand alone and mobile VCT sites. In FY 2007 there will be an effort to encourage the government and other partners to implement home based VCT, especially in high prevalence regions, as this will lead to the identification of many patients who would benefit from care and treatment. The CDC Kenya's multidisciplinary CT team will continue to provide technical guidance for these activities. This technical support involves consolidating and disseminating the most up-to-date technical information relating to CT, working with the government of Kenya to ensure that policies relating to CT are appropriate and technically sound and monitoring CT activities of local partners to ensure adherence to national and international standards. Technical activities of the CT team also involves collecting and analyzing performance information to track progress toward planned results; using performance information to inform program decision-making and resource allocation; and communicating results achieved. The CDC CT team has three technical staff and one program assistant working in CT on full-time basis in CDC's Nairobi office. The technical staff includes a medical officer with expertise in both VCT and CT in medical settings, a counselor who works directly with the counseling staff of implementing partners and a mobile VCT coordinator who works with local partners to deliver mobile VCT services. In addition to these, there is a new technical advisor position to provide technical guidance to VCT and CT partners in Nyanza province, the part of Kenya with the highest HIV prevalence and the principal geographic focus area for CDC Kenya. The program assistant is engaged in a variety of tasks to support the technical team, such as reviewing and assembling training curricula and other technical materials, organizing training programs, and other duties to support the technical work of the CT staff. This team will be supported by seven locally employed regular drivers whose work is devoted to supporting CT activities. Four drivers will drive mobile VCT trucks operated by CDC to address CT needs of remote Kenyan communities; these vehicles have been purchased with Emergency Plan funds in previous fiscal years. The other drivers will enable the technical staff to conduct regular field visits and technical supervision. The total proposed CT management budget for FY 2007 is US$ 400,000.

Funding for Treatment: Adult Treatment (HTXS): $900,000

1. LIST OF RELATED ACTIVITIES This activity relates to all activities in the HTXS program area.

2. ACTIVITY DESCRIPTION Access to treatment with antiretroviral drugs in Kenya has expanded dramatically during the past few years. Established HIV treatment services have improved the quality of life and prolonged the lives of many HIV-infected individuals. During this phase of rapid scale up, there is substantial need for supportive supervision of both partners and local Kenyan health care workers. Although the latter is the mandate of the ministry of health, the responsibility for this important function has been shared with partners and donors, including the technical staff of the US government agencies. CDC staff has contributed by assisting with the development of policies and guidelines, assisting implementing partners to improve the technical quality of their care and treatment programs, and by providing direct technical assistance to sites and geographic areas not yet fully supported by other partners.

During FY 07 CDC will continue to work with government of Kenya agencies and non-governmental partners to initiate, maintain, and decentralize antiretroviral treatment programs. These services will include a broad range of activities including capacity building for health care workers, laboratory and pharmacy management, support for adherence, and for management of advanced HIV disease and toxicities. These services are very closely linked to palliative care services provided at the same sites. Technical activities of the CDC team include assisting with the development of appropriate monitoring tools, analyzing performance information to track progress toward planned results; using performance information to inform program decision-making and resource allocation; and communicating results achieved. The CDC Kenya care and treatment technical team includes one Direct Hire (USDH), five locally employed technical staff and one program assistant. The team is supported by locally employed drivers whose work is devoted to supporting care and treatment activities. In addition to enabling the technical staff to conduct regular field visits and technical supervision, the drivers participate in activities such as demonstration of point of use chlorination systems used to improve access to safe water, and assist with delivery of equipment and supplies required by the supported programs. The total proposed HTXS management budget for FY 2007 is US $ 900,000 and will be distributed across expenditure categories.

Funding for Laboratory Infrastructure (HLAB): $1,246,000

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Counseling and Testing (#7009) and TB/HIV (#7001) and all other Lab Infrastructure activities.

2. ACTIVITY DESCRIPTION Through this management and staffing activity the Centers for Disease Control and Prevention (CDC) provides laboratory technical support to the National Public Health Laboratory Services (NPHLS) of the Ministry of Health and other laboratory service providers in Kenya. The CDC laboratory technical team works in collaboration with NASCOP, NPHLS, and other laboratory service providers in Kenya to develop, strengthen and implement the delivery of effective and quality laboratory services to support all the HIV and TB programs supported by PEPFAR. Key achievements in FY 2005 through FY 2006 included contribution to development of National Laboratory Policy Guidelines, the National Strategic Plan for the laboratory, Standard Operating Procedures [SOPs], National training curricula for testing and Quality Assurance Schemes, upon which lab practices that support expansion of ART services are based. The team also trains laboratory supervisors to offer support supervisory visits to peripheral HIV/TB testing sites. Four provincial based quality assurance laboratories have been established, another four are planned.

The CDC laboratory technical team currently consists of: a PhD immunologist and 2 Technical Advisors with specialist experience in the areas of training in HIV, TB, CD4, viral load testing, early infant diagnosis and quality assurance (QA) measures. Funds are requested from GHAI for a contractor laboratory expert to operate from Nairobi and assist the team on issues related to quality assurance and laboratory accreditation, 3 additional technical advisors to focus on expansion of laboratory services in specific regions and program areas, a program assistant to offer technical organizational support to the laboratory team and drivers based in Nairobi will facilitate field travels of the team for training sessions, Quality Assurance activities, support of laboratory networks with common standards and support supervisory visits to testing sites throughout the country. Due to expanded care and treatment activities in Kenya, and Nyanza in particular, the GAP lab team is expected to provide technical support for high quality lab service delivery including QA, training, mentorship and logistic support. Funds are included in this activity to support an expatriate position of lab advisor in Nairobi to help in articulating national issues and those of partners across the laboratory infrastructure program area. The lab advisor will work under the Nairobi team and also supervise the Kisumu-based GAP lab activities and personnel.

This activity also includes support to CDC-GAP lab in Nairobi for the procurement of minor equipment, back up lab reagents and/or supplies and contractual services for maintenance of CDC lab equipment which is used by the lab team for training and providing clinical lab services to CDC supported HIV/TB sites. This funding will also be used to purchase reagents for specific assays not included in the planned SCMS procurements, such as long ELISAs and other reagents and supplies for use in External Quality Assurance of the NPHLS laboratories, evaluation of new technologies, and printing of national SOPs, manuals and other guidelines for quality assurance schemes. Some funds are also included to support technical assistance visits from CDC Atlanta laboratory staff; these staff are involved in providing technical support for activities and partner's across the laboratory infrastructure program area.

Funding for Strategic Information (HVSI): $690,000

1. LIST OF RELATED ACTIVITIES This activity relates to all activities in SI.

2. ACTIVITY DESCRIPTION CDC professional staff dedicated to strategic information includes a team of medical epidemiologists, behavioral scientists, senior data managers, and statisticians, a Monitoring and Evaluation (M&E) specialist and additional support staff. The senior data manager, who serves as the SI in-country liaison, works with the Ministry of Health, National AIDS/STI Control Programme (NASCOP), National AIDS Control Council (NACC), Kenya Medical Research Institute (KEMRI), NGO partners and other USG agencies to coordinate SI activities, lead Emergency Plan reporting, and guide dissemination of strategic information. He is also responsible for the CDC and KEMRI data management team, assists in design of Health Management Information Systems, develops model systems for reporting for the Emergency Plan, and guides training in SI. The behavioral scientist also assists these organizations in the design, training of personnel, and conduct of surveys and targeted evaluations and serves as a training coordinator with expertise in adult learning and curriculum design. The epidemiologist works with NASCOP to conduct surveillance, support HMIS for program data, and build the capacity of the Ministry of Health to analyze and utilize surveillance, survey and other strategic information. An M&E officer will work closely with program managers and funded partners to help set targets in line with PEPFAR's country level targets, prepare workplans, make field visits to assess implementation progress and evaluate the rate of activity scale up. Three drivers and one administrative assistant support this team in fieldwork and links to other program areas. Included in this budget is support for printing forms and reports for dissemination of strategic information.

Funding for Management and Operations (HVMS): $2,728,946

The management and staffing budget for CDC is used to ensure that there is adequate staffing and administrative support for CDC's PEPFAR-related activities detailed in the COP and not already accounted for in the individual program areas. In this activity area, the Ministry of Health receives technical support with development and distribution of policies, guidelines and plans for implementation of HIV prevention and treatment programs. More than one hundred local and international Non Governmental Organizations, Faith Based Organizations and Community Based Organizations implementing HIV prevention and treatment programs have received technical and administrative support. A team of 29 personnel engaged full time at CDC-Kenya carries out this support. The 29 positions include 3 direct-hire United States government staff and 26 locally hired staff. One of the direct hires is in Technical leadership/management position. The other two are in Technical Advisors/Program manager's positions. Of the locally hired staff, five are Financial/Budget staff and 21 are administrative/Support staff. Two of the five finance and budget staff are engaged in day-to-day monitoring and training of the cooperative agreement partners that are funded through PEPFAR. Among the two is the Finance Director who is responsible for budgeting and resource planning including budgeting for CDC's COP entries. Collectively, this team provides high level technical, managerial and administrative support for our partner activities and helps to ensure high quality PEPFAR programs.