1. LIST OF RELATED ACTIVITIES This activity links to ARV services (#8826), palliative care (#8931), TB/HIV (#9068), (counseling and testing services (#8777), Abstinence and Be Faithful (#8994) and Condoms and other prevention activities (#8927).

2. ACTIVITY DESCRIPTION This activity will continue the expansion of PMTCT services in public sector and faith-based health facilities in Western Provinces building on the support previously provided through USAID's AMKENI EngenderHealth, Family Health International IMPACT, the Catholic Medical Mission Board and Elizabeth Glaser Pediatric AIDS Foundation Call to Action Projects in the region. In most of the facilities, across the 10 districts counseling and testing will be provided to 116,944 pregnant women and antiretroviral prophylaxis to 9362 HIV-positive women. Of the positive women, 4680 will receive AZT, 930 HAART and 3752 single dose nevirapine for prophylaxis. 4680 infant will be targeted with PCR for early infant diagnosis. Service delivery will continue to incorporate best practices including the opt-out approach for testing, rapid testing and appropriate referrals for care, treatment and support. Priority will be given to the provision of integrated services, including family planning, reproductive health, maternal and child health and the management of opportunistic infections. Effective referral linkages will be established to support postnatal follow up of HIV+ mothers and exposed infants including early infant diagnosis and ART.

Significant changes from 2006 will include emphasis on universal counseling and testing of antenatal clients; the use of more efficacious regimens for ARV prophylaxis and the establishment of referral linkages for the provision of HIV treatment, care and support for HIV infected mothers and immediate members of the child's family. As mentioned above emphasis will also be put on early infant diagnosis, ART for infected mothers, babies and their families, male involvement and greater involvement of people living with HIV/AIDS as care givers and lay counselors. These program refinements will improve the geographic coverage for services within the districts and strengthen the service delivery networks.

The new APHIA II Western in 2007 will use Emergency Plan funding to increase the sites to at least 80, train 150 service providers in PMTCT and in HIV stigma reduction. This activity will use the Ministry of Health's WHO/CDC-based curriculum, comply with Ministry's clinical and reporting guidelines, and participate in the MOH's Technical Working Group to ensure coordination of activities between the public and private sectors. Support to infrastructure development, procurement of medical equipment and improved data collation will enhance service provision. Facilitative supervision by the District Health Management Teams (DHMT) and innovative deployment of health workers will improve service quality. Behavior change communication (BCC) activities amongst rural community members will focus on stigma reduction, psychosocial support, promotion of antenatal care services, facility based deliveries and PMTCT services. Operations research to determine and test appropriate interventions for HIV stigma reduction among community members will be conducted.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA PMTCT in this geographical area will significantly support PEPFAR goals for primary prevention and care by contributing 11.7% of 2007 overall Emergency Plan PMTCT targets for Kenya. Increase in number of sites contributes to the program's efforts to achieve district wide coverage for services. Support to high volume health centers and district hospitals will significantly strengthen networks for PMTCT and PMTCT plus services. Access to services and linkages to sites where medical treatment and care are provided will encourage rural women in underserved communities to attend ante natal care services. Subsequently health workers will be able to plan for post natal follow up of HIV positive women, infants and their family members.

This APHIA II Western activity also contributes substantively to Kenya's 5-year strategy of encouraging pregnant women to know their status, availing services which can reduce mother-to-child infections and providing critical links to HIV/AIDS treatment as a step towards preserving the family unit. It also contributes to the strategy to integrate testing with other health services and improving the referral links among all of these services.

4. LINKS TO OTHER ACTIVITIES These activities will link to APHIA II Western CT activities, other prevention, BHCS

activities and ARV services. PMTCT services include counseling and testing which is largely diagnostic, provision of ARV prophylaxis, and appropriate referrals for the management of opportunistic infections and HIV/AIDS treatment. This activity will also conduct operations research on stigma reduction.

5. POPULATIONS BEING TARGETED This APHIA II Western activity targets adults of reproductive health age, pregnant women, family planning clients, infants, and HIV positive pregnant women. BCC activities will involve community leaders and community based organizations to increase demand for services amongst community members. Strategies to improve quality of services will target private and public health doctors, nurses, mid wives and other health care workers such as clinical officers and public health officers in both public and faith based facilities.

6. KEY LEGISLATIVE ISSUES ADDRESSED This APHIA II Western activity will increase gender equity in programming through partnering with women's groups in the design of community mobilization approaches. The behavior change communication (BCC) activities will promote a family approach to PMTC, to address male norms, encourage male participation and help reduce stigma and discrimination. Increased availability of services with appropriate referrals for PMTCT plus will also reduce stigma.

7. EMPHASIS AREAS This APHIA II Western activity includes major emphasis on training, quality assurance and supportive supervision to build capacity within MOH and private facilities to manage and supervise programs. There is minor emphasis on development of network/linkages/referral systems, and community mobilization, as detailed in the activity description in Section 1 above.

1. LIST OF RELATED ACTIVITIES This activity relates to activities in Condoms and Other Prevention (#8927), HIV/AIDS Treatment: ARV Services (#8826), and Counseling and Testing (#8777).

2. ACTIVITY DESCRIPTION Although the HIV prevalence level (4.9%) in Western Province is lower than the national average (6.7%), it is still considered high, and prevention interventions will be continued to address rising levels of incidence in the province. This APHIA II Western activity will continue the expansion of abstinence-based programs for youth (through child-to-child programs) in Western Province building on the support previously provided through USAID'S APHIA II TBD activity approved in the 06 COP. The 06 COP APHIA II TBD activity included follow-on activities of the previous AMKENI project. APHIA II TBD also builds on mass media programs carried out by FHI/IMPACT targeting in- and out-of-school youth in Western province. The previous work of Population Council through the Kenya Adolescent Reproductive Health Program (KARHP) working on dissemination of HIV/AIDS information and behavior change among in-school youth in collaboration with the Ministries of Education, Health and Gender, Culture and Social Services will also be monitored as throughout 2006 every district in the province had been covered.

The detailed activity will be articulated through discussions among USAID, other USG partners and the consortia that will be awarded in the Cooperative Agreement. However it is expected that, at the current level of funding, 15,000 youths will be reached with AB messages and 200 people will be trained to provide AB messages.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA AB in this geographical area will contribute substantively to the Kenya Five-Year Strategy for primary prevention which puts youth first to protect them from infection. The child-to-child program provides significant support for appropriate messages to pre-adolescents and their families.

4. LINKS TO OTHER ACTIVITIES This activity carries forward previously approved activities in the 2006 COP by Amkeni and IMPACT projects in Western province, including counseling and testing (#8777), OP (#8927) and ART (#8826). Community media messages will encourage safer behavior and promote CT.

5. POPULATIONS BEING TARGETED This activity targets girls, boys, primary school students, adults, out-of-school youth, community leaders, rural communities, religious leaders, teachers, other public health care workers including public health officers, community-based organizations and faith-based organizations. The nature of population-specific messages will be discussed and agreed upon by the successful partner and USAID.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address male norms and behaviors, reducing violence and coercion through peer family programs aimed at changing social norms.

7. EMPHASIS AREAS This activity primarily emphasizes community mobilization/participation through peer education by youth advocates with a minor emphasis on training of youth, parents and community leaders as detailed in the activity description in Section 1 above. Local civil society organizations will be strengthened to carry out these activities, and information, education and communication materials will be disseminated as appropriate and needed.

1. LIST OF RELATED ACTIVITIES This activity relates to all other program area activities for APHIA II Western-TBD: Abstinence and Be Faithful Programs (#8994), Counseling and Testing (#8777), HIV/AIDS Treatment: ARV Services (#8826), Orphans and Vulnerable Children (#9073), Palliative Care: TB/HIV (#9068), and especially in the areas of Palliative Care: Basic Health Care and Support (#8931) and Prevention of Mother-to-Child Transmission (#8738).

2. ACTIVITY DESCRIPTION This APHIA II Western activity will continue the expansion of STI prevention and treatment services in Western Province, building on the support previously provided through USAID's AMKENI Project. It will also build on HIV/AIDS prevention activities that were approved in 2006 in the area of "other prevention" implemented through FHI/IMPACT. The detailed activity will be articulated through discussions with the consortium that will be awarded the cooperative agreement, but it is expected that 400,000 individuals will be reached through community outreach programs; 2,000 individuals will be trained to provide Other Prevention messages and 60 outlets targeted for condom distribution.

Emphasis will be placed on reaching out to the informal sector, targeting high-risk populations including women and men in worksites, low-income community women, sex workers, truck drivers, single mothers, matatu touts (mini-bus conductors) and women in churches and mosques in Western Province.

Significant changes in 2007 for this activity include the emphasis on HIV and FP integration and supervision to improve quality of services and facilitate referrals across programs.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This APHIA Western TBD activity will contribute substantially to the 2007 Emergency Plan risk reduction strategy. This activity also provides significant support to Kenya's 5-year strategy which focuses on primary prevention and calls for attention to the increased vulnerability of women. Through increased access to integrated services with linkages to HIV services, women and other community members will be encouraged to utilize these services.

4. LINKS TO OTHER ACTIVITIES This activity carries forward previously approved 2006 COP activities of Engender Health/AMKENI and FHI/IMPACT. The OP activities link to other all other program area activities for APHIA II Western TBD, including AB (#8994), CT (#8777), ARV Services (#8826), OVC (#9073), TB/HIV (#9068), and especially in the areas of HBHC (#8931) and PMTCT (#8738). STI prevention and treatment services form an integral part of PMTCT and palliative care.

5. POPULATIONS BEING TARGETED This activity targets adults, family planning clients, pregnant women, people living with HIV/AIDS, community leaders, doctors and nurses in both public and private sector, other health care providers namely clinical officers and community-based organizations. It also targets men and women in the work place, male and female sex workers and their partners and clients, and other high-risk populations including truck drivers and out-of-school youth.

6. KEY LEGISLATIVE ISSUES ADDRESSED The behavior change communication activities for STI and HIV prevention will promote gender equity through partnering with women's organizations in the design and implementation of community activities. The activity will address male norms and behavior including multiple sexual partners through community interventions. It will also address issues of stigma and discrimination.

7. EMPHASIS AREAS The actual emphasis of this APHIA II Western activity will be elaborated during the CA award but will include community mobilization/participation, training, development of networks and referral systems, and local organization capacity development.

Unallocated funds in the amount of $100,000 will enable APHIA II Western to expand support in HIV prevention and supportive services among high-risk adults including commercial sex workers and their clients and transport workers. Programs will target 20,000 adults with alternatives to sex work as well as protective barriers to HIV transmission, both with commerical partners and steady boyfriends and husbands. They will train 50 peer educators to work with this target population.

Plus-up funds in the amount of $100,000 will enable APHIA II Western to expand support in HIV prevention and supportive services where the incidence of victims of gender-based violence is reportedly high. Through awareness creation, targeted support services integrated with care and support programs, anti-rape campaigns and education and training for the police in Western province, they will train 50 police, community leaders and womens groups to reach 120,000 people including youth. Further activities targetting high-risk youth will be carried out with $100,000. Building on the KAHRP project which targetted in-school youth, they will utilize a cross-sectoral approach, collaborating with the Ministries of Youth Affairs, of Home Affairs and of Gender, Sports and Culture. They will target sexually active out-of-school youth in particular, utilizing community theatre and other interventions. They will train another 100 peer educators and community leaders to reach 120,000 high-risk youth.

This APHIA II program will roll out the Ministry of Eduaction Sector Policy for HIV and AIDS.

1. LIST OF RELATED ACTIVITIES The APHIA II Western HBHC activities relate to HIV/AIDS Treatment/ARV Services (#9073), TB/HIV care activities (#9068), AB (#8994), PMTCT (#8738) and Strategic Information (#8855).

2. ACTIVITY DESCRIPTION In the FY 2006 COP USAID transitioned a number of existing partners in palliative care into the APHIA II Western TBD. During FY 2006 these activities continued in transition due to the re-advertisement of the Western APHIA II RFA. These activities included 1) providing PLWHAs and their families with a comprehensive package of home-based and community support 2) increase the capacity of public and private health facilities to provide quality services for the management of opportunistic infections 3) upgrade laboratories in several districts to improve treatment for opportunistic infections and referrals to comprehensive care centres and 4) provide financial services to HIV/AIDS infected and affected persons in three districts (Kakamega, Butere-Mumias, and Busia).

In FY 2007 these activities will continue and expand as the new prime partner for APHIA II Western begins implementing activities in the last quarter of FY 2006. Details of the partners and strategies will be dependent on the discussions with the District Health Management Teams and provincial MOH in the districts and province. However, the partner will ensure that at the facility level, cotrimoxazole and (where indicated- fluconazole) prophylaxis becomes part of basic standard of care for HIV infected patients. The TBD partner will also ensure that the procurement of OI drugs is done at the central level as is the case with ARVs. The partner will also ensure that the basic care includes activities that enhance prevention with positives, as well as active TB screening in all HIV infected patients. Efforts to link more clients to ARV and to ensure ARV and DOTS adherence will be stepped up in FY 2007. It is expected that 9000 HIV positive individuals will be provided with standard basic care as well as training a number of caregivers.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute to the FY 2007 Emergency Plan result by increasing the availability of skilled health workers to provide care and treatment. It will enable service providers to identify and provide treatment to the large numbers of HIV infected patients who are potential candidates for ART. Through increased access to integrated services with linkages to HIV services, women and other community members will be encouraged to utilize services. It will also contribute to Kenya's 5-year strategy emphases of developing effective linkages between prevention, care and treatment services within an integrated network. With respect to mitigation of socio-economic impact, the activity will contribute to the program area through behavioral change, improve living standards, provide better planning and organizational abilities for income generating activities (IGAs) productivity through the training provided to them by the project. There will be reduced stigmatization against HIV/AIDS infected and affected persons reduced where non-infected recognize the infected persons doing better economically and socially.

4. LINKS TO OTHER ACTIVITIES This activity is linked to the Basic Care Package TBD (#8849), HIV/AIDS Treatment/ARV Services (#9073), TB/HIV care activities (#9068), AB (#8994), PMTCT (#8738) and Strategic Information (#8855).

5. POPULATIONS BEING TARGETED Two populations are being targeted. 1) People affected by HIV/AIDS (including Caregivers, HIV positive children and infants, HIV/AIDS-affected families and People living with HIV/AIDS) and 2) Groups/Organizations (including community-based organizations, country coordinating mechanisms and faith-based organizations. The clients are members of financial services associations (FSA) or other organized groups such as post test clubs or Home based care groups in each district.

6. KEY LEGISLATIVE ISSUES ADDRESSED The main legislative issue is the reduction of Stigma and Discrimination of PLWHAs by improving their health and increasing the possibility of returning to work to contribute to their families' welfare. This activity will increase gender equity ensuring better coverage of women and children who are more disproportionately affected by HIV/AIDS. There is a wrap around for food and microfinance/micro credit.

7. EMPHASIS AREAS The area of major emphasis is the Development of Network/Linkages/Referral Systems by building providers' capacity to offer high quality clinical palliative care and support services, and by reinforcing quality assurance linkages with the Ministry of Health. Minor emphasis includes Quality Assurance and Supportive Supervision, Training and Linkages with Other Sectors and Initiatives by strengthening systems to link clients to other HIV/AIDS resources, including home based and psychosocial care.

1. LIST OF RELATED ACTIVITIES This activity links with other HVTB activities by Indiana University (#6900) as well as other USG partners. These activities are linked with activities in HTXS (#8826), HBHC (#8931), PMTCT (#8738), and OVC (#9073).

2. ACTIVITY DESCRIPTION The only major USAID partner that has been working in Western Province in this program area is Indiana University. The APHIA II Western TBD partner will develop a program that links with all other relevant program areas and partners in order to ensure integrated quality services in the province. In FY 2007, the TBD partner will strengthen the Kakamega Provincial General Hospital as a referral to a number of TB diagnostic and treatment centres, development of effective referrals, dissemination of provider job-aides, educational campaigns, strengthening of management of drug resistance, and surveillance and institutionalization of TB/HIV collaboration.

Although the detailed activity will be discussed and agreed up on with the TBD partner, the FY 2007 activity will ensure active TB screening for HIV infected patients, that HIV testing for TB patients is intensified, emphasis on Cotrimoxazole prophylaxis for all HIV infected TB clients, piloting of ART in TB clinics, and an increase in the number of sites that can appropriately do IPT. As a result of the 2007 activity, it is expected that 3000 new clients will be provided with TB/HIV services and a 100 of service providers trained to provide these services. Diagnostic HIV testing for all TB patients will be on an "opt out" principle. Guidelines on HIV testing and universal precautions - consent, confidentiality and counseling - will be observed as part of standard universal practice

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This APHIA II TBD activity will provide clinical prophylaxis and treatment for TB to 3,000 people, thus contributing to the national TB/HIV targets, and train 100 health workers in TB/HIV related activities in 10 health care facilities in Western Province. These set of activities will contribute to the results of strengthened delivery of integrated HIV and TB services, including strengthened referral systems, improved diagnostics and treatment of TB among HIV-positive patients and of HIV in TB patients, and strengthened capacity of health workers to provide integrated HIV and TB services.

4. LINKS TO OTHER ACTIVITIES This activity carries forward previously approved activities in the FY 2005 COP by FHI/IMPACT and links with other HVTB activities by Indiana University (#6900) as well as other USG partners. These activities are linked to all other APHIA II Western program areas such as HTXS (#8826), HBHC (#8931), PMTCT (#8738), and OVC (#9073) in Western Province.

5. POPULATIONS BEING TARGETED General population, Health workers, PLWHA with dual TB/HIV infections.

6. KEY LEGISLATIVE ISSUES ADDRESSED Increased availability of CT in clinical settings and increased access to HIV-related care for TB patients will help reduce stigma and discrimination.

7. EMPHASIS AREAS Major emphasis is training, with minor emphases in Community mobilization/participation, development referral systems, local organizations capacity development, and IEC.

APHIA II Western with these additional Plus Up funds will intensify provider-driven DCT in health care settings seeking to enhance testing in TB diagnostic centres that currently do not provide ART services. These facilities are largely health centres and dispensaries that offer TB diagnostic services but are not providing ART. HIV positive patients identified via these activities will be referred to nearby treatment sites. This will complement the current DCT program that has intensified testing in facilities where both TB and ART services are provided ($100,000).

1. LIST OF RELATED ACTIVITIES This activity relates to activities in counseling and testing (#8777), TB/HIV (#9068), PMTCT (#8738) and Palliative Care: home based care (#8931).

2. ACTIVITY DESCRIPTION The majority of Kenya's 1.7 million orphans, having lost one or more parents to AIDS, live in precarious conditions. OVC are frequently left behind in terms of education, life skills, access to health services and nutrition, and they are at greater risk of HIV infection and domestic violence. The FY 2006 COP activity addressed OVC needs within the context of the six essential elements of OVC support. These essential services were agreed upon by all stakeholders and include: Nutrition, Education, Health, Protection, Psychosocial support, Basic Material needs and Livelihood Capacity Building. In order to ensure an agreed upon level of quality for each of these services, all seven are being defined by the OVC ITT and OVC PEPFAR stakeholders.

The FY 2006 focus of AED/Speak for the Child Program was to train household mentors through community based organizations to support OVC. AED has implemented global health programs for more than 30 years and planned to work with existing local implementing partners in the new districts to enroll new OVC and extend services to older OVC. In its scale up AED/Speak for the Child program selected experienced community based organizations (CBOs) with extensive outreach to OVC. CBOs were to recruit and train household mentors in the SFC program, establish school, health clinic, and pharmacy agreements and procure commodities. Trained mentors visit households weekly to facilitate household problem-solving with caregivers on issues of health, nutrition, and psychosocial care.

In FY 2006 COP, the COPHIA activity applied approaches and activities to include: a Community Health Worker role in monitoring health; training service providers in pediatric HIV/AIDS; strengthening linkages to specialized pediatric services; 2-way clinic-community referrals; vocational training; provision of uniforms, books and shoes; linking secondary students to bursaries; nutrition education; food production; income generating activities; training teachers in child counseling; support to community based counselors, paralegals and support groups; obtaining clothing and housing improvements; and involving the community for improved linkages with relevant services.

The FY 2006 COP focus for World Vision Kenya activity included training of church leaders, traditional birth attendants, youth peer educators, community psychosocial counselors, PMTCT service providers and community based organizations/faith based organizations (CBO/FBO) staff in providing HBC, supporting voluntary counseling and testing (VCT) services, providing food aid and treatment of infections for needy HIV-positive orphans and vulnerable children (OVC), life skills training for older OVC, micro-enterprise development for foster families and assisting with the payment of OVC school fees.

This FY 2007 COP APHIA Western activity will continue the expansion of support for orphans and vulnerable children in Western Province, building on the support previously provided through USAID's World Vision, COPHIA, and AED projects. The detailed activity will be enunciated through discussions with the consortia that will be awarded the cooperative agreement.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA The FY 2007 activities will reach 16,667 OVC and train 4,100 caregivers. The APHIA II Western TBD will respond to the National OVC Action Plan by mobilizing communities, building family and community capacity to protect and care for OVC, and improving access to health, education, food and shelter. The TBD will ensure that GOK policies and guidelines are utilized and communicated, and staff participates in national level HIV Technical Working Groups.

4. LINKS TO OTHER ACTIVITIES OVC activities are an element of home and community support. Prevention is a cross-cutting theme. CHWs link clients with PMTCT, ART and non-ART services and provide follow-up. This activity is linked to the APHIA II for Palliative Care: home and community support (#8931), counseling and testing (#8777), TB/HIV (#9068), and PMTCT (#8738).

5. POPULATIONS BEING TARGETED Individuals infected and affected by HIV/AIDS, OVC - especially the girl child and caregivers. By focusing on building the local capacity of caring for the OVC efforts will also target community and religious local leaders as well as partnering with community and faith based organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED Increased gender equity in HIV/AIDS will be addressed by ensuring the girl child receives equitable OVC services. Wrap around services in the area of food and education will also be addressed by building the local capacity along other existing community institutions in serving the needs of the OVC.

7. EMPHASIS AREAS Major emphasis area is in development of network/linkages/referral and minor emphasis is training and community mobilization as well as in local organization capacity and development.

1. LIST OF RELATED ACTIVITIES This activity is related to activities in HIV/AIDS treatment services (#8826), Abstinence and Be Faithful Program (#8994), OVC (#9073), HBHC (#8931), HVTB care activities (#9068), OP (#8927), PMCT (#8738), and strategic information (#8855).

2. ACTIVITY DESCRIPTION: USG has previously supported HVCT activities in Western Kenya through USAID projects. In 2006 COP, USAID's APHIA II TBD activity was funded to build on activities approved in 2005 and implemented through World Vision. The activity aimed at increasing access to VCT services, particularly among underserved and hard-to-reach populations in a few districts in Western Kenya by forging partnership with community-based organizations (CBOs) and faith-based organizations (FBOs) to mobilize communities for VCT and make appropriate referrals to MOH-supported Specialist Centers (clinics). The facilities also offered diagnostic counseling and testing services, and treatment including ARVs.

The second assistance was through the FY 2006 USAID'S ACCESS project implemented by JHPIEGO. The main aim of the activity was to continue to promote the availability and delivery of high quality counseling and testing services in public Ministry of Health (MOH) facilities. The MOH's National Guidelines for Counseling and Testing in clinical and medical settings were to be disseminated in selected districts of Western Province and orientation provided to about 100 health workers. Subsequently these health workers would give service orientation to 500 health workers using a cascade on-the-job (OTJ) approach. The activity would promote the availability of diagnostic counseling and testing (DCT) in Ministry of Health facilities and strengthen referrals and linkages to care, treatment, and prevention.

The third previous support was through the 2006 APHIA II TBD activity that consisted of activities approved in 2005 and implemented through FHI/IMPACT. The 2006 APHIA II TBD activities was to provide counseling and testing services through existing static sites, expanded testing in clinical settings, and increased outreach services. Increasing access to antiretroviral therapy dictates that CT efforts quickly transform to accommodate active case finding through provider initiated testing (PIT) in clinical settings, in addition to the more passive client initiated testing (CIT). The activity was to ensure that existing integrated VCT sites are used to support these efforts in the interim but strengthened to support DTC efforts (e.g. supporting start up activities, providing testing for partners and other family members of index patients, providing ongoing counseling, providing bedside counseling, consolidating CT returns, and managing HIV test kit supplies etc) in the future.

The detailed 2007 activity will be determined through discussions with the consortia that will be awarded the cooperative agreement. However, it is imperative that the 2007 COP activity will consolidate these past assistance, taking them forward in terms of improved programming through innovation, expansion and integration with other program areas. It is expected that 40,000 individuals will receive CT services in about 40 sites and about 100 providers trained.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute to the 2007 Emergency Plan result for increased availability of diagnostic counseling and testing through training of health workers. It will enable service providers to identify the large numbers of HIV infected patients who are potential candidates for ART. It therefore contributes to Kenya's 5-year strategy emphases of encouraging Kenyans to learn their status and developing strong links between counseling and testing and HIV services for those who are HIV positive and in need of health care.

3. LINKS TO OTHER ACTIVITIES THIS ACTIVITY CARRIES FORWARD PREVIOUSLY APPROVED ACTIVITIES, MAINLY APHIA II TBD IN 2006 COP.

This activity links with the APHIA II Western Counseling and Testing activities will relate to HIV/AIDS treatment services (#8826), Abstinence and Be Faithful Program (#8994), HKID (#9073), HBHC (#8931), HVTB care activities (#9068), OP(#8927), PMCT (#8738), and strategic information (#8855)

4. POPULATIONS BEING TARGETED

This APHIA II Western TBD activity will target the general population: adult men and women of reproductive age, and HIV/AIDS-affected families, underserved and hard-to-reach populations, particularly in rural communities. It will also target MOH staff including program managers in the NASCOP, public health care doctors and nurses, other health care workers including community health workers and non-governmental organization.

5. KEY LEGISLATIVE ISSUES ADDRESSED This activity will help to reduce stigma associated with HIV status by increasing the availability of routine testing for diagnosis in medical settings. Gender is a key legislative issue addressed in this activity. This includes activities supporting counseling that challenges norms about masculinity, delayed sexual activity and reduced multiple sex partners for boys and men and transactional sex. The activity also include support for testing and support services for victims of sexual abuse and violence, training on couple counseling, risk assessment, stigma reduction, and supporting women to mitigate potential violence.

6. EMPHASIS AREAS The major emphasis is on community mobilization and participation with minor emphases on development of network/linkages/referral systems, local organization capacity development, and quality assurance and supportive supervision. The minor emphasis is the development and implementation of referral systems, quality assurance and supportive supervision for CT counselors. Another minor emphasis is in the area of training.

1. LIST OF RELATED ACTIVITIES All services will be tightly linked across the spectrum of care with other services supported by APHIA II Western TBD in home-based care and systems strengthening. Specifically, these activities are linked to PMTCT (#8738), OP (#8927), HBHC (#8931), and TB/HIV (#9068) activities implemented in APHIA II.

2. ACTIVITY DESCRIPTION One of the past treatment activities in Western province supported by USAID COP 06 funding was APHIA II TBD which aimed at continuing with FHI/IMPACT activities that included the strengthening of Kakamega PGH which was already serving as network referral centre. Other supported ART sites included St Mary's Mumias and Bungoma District Hospital. Additional activities included procurement of commodities such as laboratory equipment, reagents, renovation of clinic facilities, strengthening pharmacy management, and supporting outpatient provision of ARVs. In the communities, the activity was to support treatment awareness, literacy and advocacy through appropriate behaviour change promotion facilitated actively by motivators.

The second previous assistance was the World Vision's AIDS Treatment and Support for OVCs (KATSO) project, which transitioned into APHIA II TBD in the 2006 COP. The aim was scale up this response to the prevailing need for holistic—emotional, material, and physical—care for those affected by the HIV/AIDS crisis. Using the existing large network of churches/faith-based organizations and community-based organizations, the APHIA II program planned to initiate innovative HIV/AIDS care, support, and prevention interventions, while scaling up programming in 10 districts in Kenya. The activity was also expanding services currently being offered through USAID's comprehensive programs for orphans and vulnerable children to include the establishment of treatment with antiretroviral drugs for adults and children with advanced HIV in Teso District.

This 07 activity will build on the USAID's 2006 COP activities and other past support in order to ARV services scale up, improve programming, and ensure uninterrupted service to on-going clients in the imperative sites. The detailed focus for FY 2007 will be discussed with the consortia (yet TBD) that will be awarded the agreement. However, the partner will ensure that paediatric ART is scaling up so that all ART sites also enroll and follow pediatric patients and ensure early infant diagnosis of HIV. In addition, the APHIA II partner will be expected to propose prevention-with positives approaches. The partner will consider and follow-up on results of technical evaluations such as the Pop Council work on PWP, CRTU's RH needs of PLWHA on HAART, alcohol and ARV adherence, etc. As a result of the 2007 activities, it is expected that a total of 6000 clients will be enrolled on ART of which 3,000 will be new and 600 will be children. 100 service providers will be trained to provide quality ART services. Because the issue of stigma and discrimination is still high amongst health workers in Kenya this activity whilst conducting clinical training will also train workers on stigma and discrimination using a curriculum specifically produced for this purpose.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This APHIA II Western TBD activity will expand established ART programs to include new areas Western Province. As a result of these activities, 3,000 new clients will receive antiretroviral contribute to the results of expansion of ARV treatment for clinically qualified HIV-positive patients, strengthened human resource capacity to deliver ARV treatment, and a strengthened referral network for provision of ART.

4. LINKS TO OTHER ACTIVITIES This activity carries forward previously approved activities in 2006 COP by FHI/Impact, World Vision Kenya as part of APHIA II TBD activities in Western Kenya. All services will be tightly linked across the spectrum of care with other services supported by APHIA II Western TBD in home-based care and systems strengthening. Specifically, these activities are linked to PMTCT (#8738), OP (#8927), HBHC (#8931), and TB/HIV (#9068) for APHIA II - Western. Prevention services in care settings will be strengthened through improvement of institutional infection prevention practices, reinforcement of behavior change, sustenance of low risk behavior, condom use, appropriate nutrition for People Living with HIV/AIDS (PLWHA), and reduction of risk of infection among discordant couples.

5. POPULATIONS BEING TARGETED This APHIA II Western TBD activity targets people affected by HIV/AIDS, orphans and vulnerable children, people living with HIV/AIDS, HIV/AIDS affected families, HIV positive infants and children and caregivers of OVC and PLWHA. It also targets the community in order to improve community support and health care providers in public, private and faith based health facilities.

6. KEY LEGISLATIVE ISSUES ADDRESSED The main legislative issues addressed by this activity are gender, and stigma and discrimination. The activity will also focus on activities to support vulnerable groups such as women. Activities will include support to the reduction in violence and coercion as well as stigma and discrimination. It will also address wrap around activities such as food insecurity, microfinance, micro credit and education.

7. EMPHASIS AREAS The major emphasis area is training of health workers, with minor emphasis areas being Development of Networks/ Linkages/ Referral systems, Information, Education and Communication, and workplace programs.

APHIA II Western will with these Unallocated Funds renovate and expand physical infrastructure at current or potential treatment sites particularly hospitals (district and sub-district hospitals) where an estimated 6,600 HIV positive individuals will receive care. This will complement the current renovation work undertaken by PATHFINDER that concentrates on renovating lower down facilities - health centres and dispensaries. The activitiy is expected to renovate approximately 5 district or sub-district hospitals improving their ability to provide essential ART services ($100,000).

1. LIST OF RELATED ACTIVITIES This activity is related to the strategic information activity to be carried out by University of North Carolina/MEASURE Evaluation (#7098), strategic information activity to be carried out by NASCOP (#7002) and strategic information TE/TBD (#9220).

2. ACTIVITY DESCRIPTION This activity will strengthen the provincial and district level Health Management Information Systems (HMIS) currently in use by MOH at health facilities and Community Based Program Activity Reporting (COBPAR) currently being rolled out at Constituency AIDS Control Committees (CACCS) levels by NACC through 3 key components. Component 1: Support APHIA II WESTERN /TBD and MOH program data collection processes for performance reporting needs (quarterly, semi-annual, annual). This component will support a participatory, coordinated and efficient data collection, analysis, use and provision of information to track achievement of APHIA II WESTERN /TBD and MOH's district level Annual Operation Plan II objectives, and inform decisions at the local, district and provincial levels, using standardized M&E/HMIS tools approved by the MOH. Component 2: Strengthen community and facility based reporting systems being rolled out by NACC and NASCOP. The component will support APHIA II WESTERN /TBD and MOH to measure progress towards its contribution to the overall country's Emergency plan, National Health Sector Strategic Plan II and Kenya National HIV/AIDS Strategic Plan goals and results frameworks. Specific activities will include building capacity of 25 local organisations and facilities to collect, report, analyse, and use both routine facility and non-facility data for planning and program improvement. Component 3: Take lead role in coordinating M&E activities in the province to meet the information needs of USAID/Kenya, the Emergency Plan, MOH, NACC and other stakeholders, in line with the "three ones" principle. APHIA II WESTERN /TBD will organize district-level consensus building forums on M&E issues, distribute standardized data collection and reporting tools, conduct regular data quality assurance processes at all data generation points, train 75 facility based data point staff on the new data collection/reporting tools and data use for improving program performance, and hold provincial level quarterly and annual stakeholders' information dissemination meetings. APHIA II Western/TBD will be held accountable for tangible results, especially in increased use of harmonized data collection and reporting tools at health facilities developed by MOH, increased data use in planning and at dissemination workshops to various stakeholders, increased supportive-supervisory visits and routine data quality assessments at all data collection points by M&E/HMIS officers, and improved coordination of M&E activities in Western province. These efforts should result into demonstrated evidence in increased national level reporting by up to 60% from health facilities to NASCOP national database.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA The activity builds on the FY 2006 activities that support the national M&E systems as well as contributing to the Emergency Plan's training outputs. In overall, the activity will provide technical assistance to twenty five local organizations/health facilities in strategic information in addition to supporting the training of 75 SI and program managers in M&E/HMIS, reporting and data use for program management.

4. LINKS TO OTHER ACTIVITIES This activity is related to the strategic information activity to be carried out by University of North Carolina/MEASURE Evaluation (#7098), where MEASURE Evaluation will be supporting NACC in rolling out COBPAR system for community level reporting. It is also related to the strategic information to be carried out by NASCOP (#7002), where NASCOP will be rolling out Form 726, Form 727 and program specific client registers for data collection and reporting at health facilities. It is also related to SI TE/TBD (#9220) that will attempt to investigate the causes for low reporting rate by health facilities and recommend strategies for achieving 100% reporting level by health facilities.

5. POPULATIONS BEING TARGETED This activity targets host government and other health care workers like M&E and HMIS officers responsible for data collection, analysis, reporting and use at both health facilities and community level. Program managers are as well targeted for orientation on the role M&E program management.

6. EMPHASIS AREAS

The major emphasis area is Health Management Information Systems (HMIS) and minor areas include Monitoring, evaluation, or reporting (or program level data collection) and Other SI Activities.

This APHIA II program will roll out the Ministry of Eduaction Sector Policy for HIV and AIDS.

Table 3.3.15: Program Planning Overview Program Area: Management and Staffing Budget Code: HVMS Program Area Code: 15 Total Planned Funding for Program Area: $ 12,425,703.00

Program Area Context:

Key Result 1: Adding critical staff competencies in laboratory logistics at CDC and other health commodities and logistics at USAID Key Result 2: Enhancing capacity for raising public awareness and improving public diplomacy under the Office of the Country Coordinator Key Result 3: Promoting technical leadership among locally employed staff Key Result 4: Enhancing understanding of individual agency programmatic, management and contracting, and technical capacities and limitations

STATE OF THE USG TEAM IN COUNTRY Kenya has a well integrated and highly functional interagency team fulfilling critical planning, management, and monitoring and evaluation functions related to the Emergency Plan. 2006 has been a year of significant staff transitions in leadership positions, especially at CDC, and new personnel have been smoothly transitioned into effective team participation. Across all agencies only 3.6% of total resources have been required to achieve this level of excellence, which is well below the recommended 7% ceiling for this function.

Capacity to fulfill the important coordination function has been enhanced by adding a full time deputy country coordinator (in part to relieve the country coordinator for work outside Kenya at the request of the Global AIDS Coordinator), an experienced FSN executive assistant, and a public information officer.

During the course of preparing the 2007 COP it became evident that a laboratory logistician (as opposed to the existing technical strengths in improving laboratory technical capacity and consistency) was needed. Funding is included in CDC's budget to add such a position. It was also determined that direct USG management of the increasingly complex and financially significant realm of drugs and other health commodities required additional staffing and a full time position for that function has been included in USAID's management and staffing budget. Determination of which agency would "house" each of these important new positions evolved through interagency consensus, and they are both being perceived as resources to the larger USG team.

INDIVIDUAL AND AGENCY PRIMARY FUNCTIONS USAID has a lead role in all programming related to OVC and is staffed for this function. It manages very large procurements of ARVs and other commodities that benefit all USG agencies and are dispensed to their partners working in care and treatment. USAID manages significant home-based care, treatment, and prevention work and a number of prime partners who fund over 100 subrecipients, including many indigenous faith- and community-based organizations. USAID also has responsibility for in-country oversight of Track 1 AB and OVC partners. Many USAID programs are national in scope, although its management of treatment programs is focused on Western, Rift Valley, Nairobi/Central, Coast, Eastern and North Eastern provinces where other USG agencies are not dominant players.

CDC manages significant work in treatment, counseling and testing, laboratory infrastructure, and TB/HIV. Through its cooperative agreements with both the National AIDS and STD Control Programme (NASCOP) and the Kenya Medical Research Institute (KEMRI), it is a primary vehicle for both direct funding to the host government as well as government-to-government technical cooperation and capacity building. CDC provides in-country direction to Track 1 partners in the areas of blood safety, anti-retroviral treatment, and injection safety. Its geographic focus is predominantly Nyanza Province, with additional substantial work in Nairobi/Central and Coast provinces.

The Walter Reed Army Medical Research Unit (WRAMRU) of the Department of Defense manages a comprehensive prevention, care and treatment portfolio centered in the South Rift Valley around Kericho District. Beginning with a program that grafted PEPFAR-funded treatment onto its existing HIV vaccine

research platform, WRAMRU has expanded far beyond its base in the commercial tea plantations and extended treatment to thousands through an expanding network of district and lower-level public health facilities. It has modest programs in counseling and testing, youth prevention, and OVC that will be supplemented and carefully coordinate in the year ahead with the new USAID APHIA II partner that will work in the South Rift.

The Peace Corps currently has 53 volunteers committing more than 50 percent of their time to PEPFAR, and that number will decrease modestly in 2007 although the proportion paid for with GHAI funding will increase from 11 to 20. They are active in very specialized deaf education that includes significant HIV/AIDS content as well as more general HIV and health interventions at the grassroots level.

USAID, CDC and WRAMRU have technical staff providing strategic information leadership across the interagency team and it is a special point of pride that the leaders of five of eight interagency technical teams are Kenyan nationals.

ENHANCING INTERAGENCY COLLABORATION During 2007 we will improve our already high levels of interagency collaboration by: (1) conducting more interagency site visits, (2) fully operationalizing structures to ensure coordination of APHIA II partners in provinces where other USG agencies have significant programs, (3) moving toward a goal of 100% interagency benefit from technical TDYs emanating from a single agency headquarters, and (4) conducting quarterly interagency team meetings in different locations across Kenya.

Table 3.3.15: