THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

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 2008, KDOD will continue 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 20 of the 40 military camps sites nationwide. 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 while 50% of them will be given

the more comprehensive regime consisting of AZT and NVP. 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 continue to 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 will continue to offer sexual partner testing

targeting 500 men. In order to improve on sustainability, KDOD will train 30 additional health care workers in

PMTCT including family planning and nutrition. A further 30 health care workers will receive refresher

training on PMTCT. 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 facilitate 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 2008. KDOD PMTCT activity

will also contribute to 0.4% of the overall national target of 1,200,000 pregnant women accessing PMTCT

services in FY 2008. 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.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

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 2007, Kenya Department of Defense (KDOD) trained 25 personnel as master trainers for the Men as

Partners in Prevention program (MAPP): five from each barrack (Lanet Army Barracks, Eldoret Recruits

Training College, Embakasi Garrison, Moi Air Base and Mtongwe Naval Base). The MAPP 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 2008. 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 2008, 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 250 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

2008, 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 2008, 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 12,000 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 2008 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 MAPP 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.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

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 2008, KDOD will train

30 individuals to promote HIV/AIDS prevention through behavior change messages that will be

disseminated through seminars and workshops targeting 5,000 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 50 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 2008 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 in Prevention" (MAPP) 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 5,000 people will contribute to the FY 2008 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.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS

The only changes to the program since approval in the 2007 COP are:

+a prevention component has been integrated that is budgeted in this activity and includes the following

elements:

>Positive Prevention in Clinical Settings

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 3,500 HIV-

positive military personnel, their dependents and civilian population residing near the military barracks at 8

KDOD medical facilities. In FY 2008, 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. The package of palliative care

services will include cotrimoxazole prophylaxis, treatment of opportunistic infections, nutritional

supplementation, de-worming of children, TB screening, sexually transmitted infection (STI) management

and improved access to malaria prevention interventions. Other activities will include support of HIV positive

OVCs of the military to ensure they are provided with palliative care and linked to ART services, providing

support to post test clubs, strengthening of logistics capacity (particularly pharmacy management), and

procurement of commodities such OI medications and laboratory reagents. In FY 2008, this activity plans to

intensify palliative care in 8 existing military palliative care centers to reach a total of 3,500 patients with

palliative care services and screen at least 1,750 of them for TB. The treatment 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. Adherence to care will be supported through extensive

involvement of PLWHA who will be trained as peer counselors to provide psychosocial support, ART and

TB adherence support for both clinic patients and at the community/barrack level. Part of the FY 2008 funds

will be used to role out the Prevention with positives (PWPs) initiative through procurement of

supplies/materials e.g. flow charts, hand outs, posters, counselor support and evaluation. 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 1660 have been registered in an HIV comprehensive care clinic.

As per August 2007, 1025 people were on antiretroviral therapy, and the remaining 635 were receiving

basic health care and support. FY 2008 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 to over 3500 patients as described, the KDOD basic health care and support

program will contribute to the overall number of people under care in Kenya. Capacity building of PLWHA to

act as peer educators will contribute to mobilization and strengthening of the KDOD program capacity to

plan integrate and evaluate facility and community care support programs. 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 (that is the

population in the Kenyan administrative location within which the military treatment and care centers are

located). 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 emphasis on minor construction/renovation of health facilities to ensure adequate

space to offer basic care services; human capacity development including training and empowering the

health workers to provide basic health care and support services by supporting necessary commodities;

data collection, analysis and dissemination, which will further support program monitoring and evaluation;

and increasing gender equity in HIV/AIDS programs, by ensuring that equitable number of women and

children are receiving treatment, and targeting increased access of services by men.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS

The only changes to the program since approval in the 2007 COP are:

+other (NON-SUBSTANTIVE CHANGE): implementation of TB contact tracing through door to door sputum

testing

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) will continue to intensify the diagnosis, care and treatment of

military patients with co-infections of TB and HIV (TB/HIV) by promoting screening activities of all HIV

infected patients for TB as well as ensuring all TB infected patients are offered HIV testing, STI screening,

HIV prevention messages including condom distribution. Those found to be co-infected will be given anti-

TB, Cotrimoxazole prophylaxis treatment (CPT) and ART as per the Kenya's National Leprosy and

Tuberculosis Program (NLTP) guidelines. Through this concerted effort, in FY08, the program will provide

HIV testing to 300 TB patients; and offer TB and HIV services to 150 TB/HIV co-infected patients.

Additionally, 1,750 patients accessing HIV services in the region will be screened for TB, and those found

positive provided with TB treatment. The program will intensify efforts of contact tracing by conducting door

to door sputum testing of TB contacts. This will lead to more cases being identified and appropriate care

being given in a timely manner. In order to achieve this, KDOD intends to continue improving the laboratory

capacity for TB/HIV and improving capacity of the health personnel through training in management of

TB/HIV. Refresher training for integrated TB/HIV activities for KDOD health professionals will be undertaken

by training of additional 36 health workers on TB and DTC using NASCOP/NLTP curriculum to support the

expected increased workload. TB/HIV services will continue to be supported in the 8 care and treatment

centers in Armed Forces Memorial Hospital (AFMH), Moi Air Base in Nairobi, Mombasa, Nanyuki, Nakuru,

Gilgil, Eldoret and Thika. In FY2007, funds were used to develop an integrated TB/HIV clinic within the

AFMH with marked success. In FY 2008, funds will be used to replicate the integrated clinic in the other 7

treatment centers so as to facilitate effective care of TB/HIV co-infected patients. KDOD will also continue

extending TB/HIV services to the neighboring civil population. AFMH remains the referral for all patients

requiring specialized diagnosis, treatment and in-patient care including patients suspected to have failed

treatment. In FY 2008, efforts to improve the capacity in the laboratory at AFMH to perform QA in smear

microscopy (florescent microscopy) will be continued. In line with the national guidelines, the AFMH lab will

continue to send samples to the National reference laboratory for TB cultures, drug sensitivity and

resistance testing. In line with National guidelines, the program will continue to ensure efficient and timely

supply of TB drugs to all treatment sites while maintaining regular supervision of all TB/HIV treatment

activities. Strengthening of community based adherence/follow up of patients in this program will be

promoted through telephone tracking of defaulters and the use of social workers. TB laboratories in the

military will continue to serve civilian patients and will be contingency for the district and provincial hospitals

in the regions in which they are located (that is the population in the Kenyan administrative location within

which the military treatment and care centres are located). 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). 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.

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 8 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 emphasis on human capacity development including training and empowering the

health workers to provide basic health care and support services by supporting necessary commodities;

data collection, analysis and dissemination, which will further support program monitoring and evaluation;

and increasing gender equity in HIV/AIDS programs, by ensuring that equitable number of women and

children are receiving treatment, and targeting increased access of services by men.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

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 2008, the KDOD will continue to provide the 1,000 OVC of the military with components of

Primary 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. 100 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 hire continue to support the services of 6

social workers to maintain the regional OVC military coordination offices for better de-centralized service

delivery. The KDOD OVC program will continue to 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 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 1,000 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 100 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. 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 military 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 on providing the Primary and Supplementary needs of

the OVC. Minor 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 emphasis area will be on developing appropriate information, education, and communication for the

OVC and their caregivers.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

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 2008 KDOD will expand

its CT activities in both the static sites and through community and military mobile (outreach) activities. 2

new VCT sites will be created to make a total of 30 VCT sites. Core activities will include training and

continued support to the existing 28 VCT sites. By so doing KDOD will have adequate capacity to provide

CT to an additional estimated 10,000 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, 100 people (mostly health care

workers) will be trained and retrained in Provider-Initiated Testing and Counseling (PITC), lay counselors

including PLWHA will be trained in VCT and 20 counselors will be trained as supervisors. In FY 2008, the

KDOD program will intensify mobile VCT services targeting the Military Hot spots and 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. In addition, greater involvement of people living with HIV/AIDS (GIPA) 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 2008. 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. Trainings will target health care workers, lay people and PLWHA

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. The increased availability of CT services and their

popularization among the Military personnel will reduce stigma and ensure equitable access to CT services

across gender.

7. EMPHASIS AREAS

This activity includes major emphasis on commodity procurement and training with minor emphasis in

infrastructure improvement.

N/A (exempt)

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

The only changes to the program since approval in the 2007 COP are

+ other (NON-SUBSTANTIVE) change:

>One doctor will be trained at MSc level on molecular diagnostics and one laboratory technologist will be

trained on Immunology at a National Higher Diploma level

>The significant portion of constructions/renovations mentioned in FY07 will have been completed, no

further funding will be used at these sites for further renovations.

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. 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 6500 HIV positive patients, thus

contributing to overall national target of treating 250,000 people by the year 2008. Further, these activities

will strengthen human resource capacity to render this laboratory support by training 25 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.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

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) and Laboratory Infrastructure (#7003).

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). For the purpose of ART patient monitoring and

assessment of treatment success and drug resistance the KDOD will continue to develop a unified HMIS at

all its sites. In FY 2008, KDOD will continue supporting all the HIV program areas of HTXS, HVCT, MTCT,

HKID, HLAB and HVTB at each of 8 KDOD Comprehensive Care Clinics, including the Armed Forces

Memorial Hospital (AFMH) in Nairobi, the Airforce Base Medical centre in Laikipia, Gilgil Regional Military

Hospital (GRMH), Lanet Army Barracks hospital, Naval Sick Bay at Mombasa, the Airforce Base Medical

centre in Nairobi(Moi Air Base), as well the outlying military hospitals in Eldoret and Thika and. In addition,

all the stations will continue to 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. The data center will continue receiving support as the

central monitoring and evaluation point for all the 8 treatment stations in the military and the neighboring

satellite clinics. As data systems scale up there is need to train more staff in Data management, Monitoring

and Evaluation, Surveillance and HMIS. To improve the local human resource capacity to carry out SI

activities a total of 27 individuals will be trained in strategic information and data management (includes

M&E, surveillance, health systems research, epidemiology and/or HMIS). In FY 2008 an effective and

efficient planning, monitoring and evaluation system including a functioning MIS will continue to be

developed and ICT capacity at DHQ and all the stations will be enhanced. The KDOD will continue to

develop a unified health management information system for all its stations. The KDOD will also develop

and expand its capacity to carry out public health evaluations. 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 and result to improved patient management. 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. It will also result to improved data gathering, reporting, data quality

and accessibility.

4. LINKS TO OTHER ACTIVITIES

This activity links to KDOD-KEMRI activities in the areas of MTCT, HVCT, HVTB, HTXS and HKID by

providing linkages between the patient data monitoring system and PEPFAR national reporting systems

through better data generated at each of these clinics within each of the 8 treatment sites and its satellite

clinics. It will link to other activities by providing a broad range of technology that allows sharing of

information and development of strategies for promotion of better health. 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 hardware and software

development as well as networking equipment and supplies. The KDOD will continue to support the 8 data

clerks (one for each station), who will administer, supervise the Health Management Information systems

(HMIS) and manage the ICT resources. Training of data automation workers and maintenance of the Data

Management Unit (DMU) at the central AFMH referral facility as well as capacity enhancing of 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. It will also result to improved level of reporting that is timely,

consistent, and accurate.