PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED
REFERENCES TO GEOGRAPHIC COVERAGE, TARGETS AND BUDGETS.
Geographic coverage has been expanded to include Kisumu West district in Nyanza province. DNA
Polymerase Chain Reaction for HIV testing for early infant diagnosis will be supported for all facilities
implementing PMTCT services in the Rift Valley through the Walter Reed Project research laboratory.
1. LIST OF RELATED ACTIVITIES
This activity relates to activities in Counseling and Testing (#6968), HIV/AIDS Treatment: ARV services
(#6973), Palliative Care: TB/HIV (#6975), Palliative Care: Basic Health Care and Support (#6922) and
APHIA II Rift Valley
2. ACTIVITY DESCRIPTION
Since August 2001, the Kenya Medical Research Institute /Department of Defense (KEMRI/DOD) had been
implementing a Prevention of Mother-to-Child Transmission of HIV infection (PMTCT) program in the
Kericho District of the South Rift Valley Province. With Emergency Plan (EP) support, KEMRI/DOD has
scaled-up PMTCT services in 5 other districts of south Rift Valley Province (SRV) and expects to scale up
to Kisumu West District in Nyanza province. The number of PMTCT sites has increased from three to over
170 and as a result 130,520 pregnant women have received PMTCT Counseling and Testing (CT). In the
period Between October 2006 and March 2007, 25,200 pregnant women presented for their first antenatal
visit, of which 99% received their HIV test results. Among them, 1,137 women were diagnosed as HIV-
infected of which 80% and 67% of them and their HIV exposed infants received ARV prophylaxis
respectively. Male involvement has been encouraged through the development of Saturday male clinics in
some health facilities in the region. Though the program has been successful, due to inadequate numbers
of trained health workers, limited working space, poor infrastructure, weak logistics supply chain
management, inadequate management, as well as fear of stigma and discrimination in the communities
continues to limit the full utilization of PMTCT services and further access to care and treatment by the HIV-
infected women and family members. Low levels of male involvement, lack of appropriate infant feeding
options, and limited access to family planning information and services are further barriers. The SRV
Province has 250 health facilities and fewer than 175 are currently providing PMTCT services. In 2008,
KEMRI-SRV will continue to work with Provincial and District Ministry of Health (MOH) Health Management
Teams (HMT) to address these barriers in an effort to scale up PMTCT services from the expected 180
health facilities at the end of FY 2007 to 200 in the six districts of south Rift Valley Province and 1 district in
Nyanza Province in FY 2008. The coordination with Government of Kenya in the implementation of this
activity will ensure sustainability and quality of the services. CT services will be provided to 96,038 (about
94% of all pregnant women) women during the antenatal, intra-partum, and immediate postpartum period.
4760 HIV-infected mothers and 4,115 of their babies will receive ARV prophylaxis. The prophylaxis will
include AZT to 50% of the HIV infected women in WHO stage 1, 2 and 3 (if CD4 is greater than 350 in the
later) from 28 weeks gestation and their exposed infants after birth. Women in WHO stage 3 (if CD4 is less
than 350) and 4 will be initiated on HAART. A total of 300 health workers will be trained to address the
shortage of skilled human resources. In addition, technical assistance will be provided by 4 additional locally
employed staff. CT within the PMTCT program area will be extended to male sexual partners of the
pregnant women, their young children, the Child Welfare Clinic, and Family Planning (FP) clients.
Presumptive Malaria Treatment, provision of mosquito nets and cotrimoxazole prophylaxis to both mother
and infants will be supported. Dry Blood Spots (DBS) will be used for rapid HIV antibody testing quality
assurance and control and for Polymerase Chain Reaction (PCR) testing of the HIV exposed or infected
children. HIV-infected women will be screened for comprehensive HIV care and treatment eligibility. Follow-
up and referral as appropriate of the HIV-infected women, their HIV exposed children, and their sexual
partners will be supported. Counseling regarding infant feeding practices will be provided. Family planning
services will be supported through appropriate training and supervision. The KEMRI/WRP Clinical Research
Center laboratory in Kericho will provide HIV PCR diagnostic testing services to the whole of Rift Valley
province.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This KEMRI/WRP activity will contribute to approximately 8.4 % of the total, direct PMTCT Emergency Plan
targets of 1,200,000 pregnant women offered CT in FY 2008. This will also support government efforts of
ensuring that at least 80% of pregnant women have access to PMTCT services by the end of 2008 with a
50% reduction in pediatric HIV infections. Planned activities will improve equity in access to HIV prevention
and care and treatment services since the currently underserved rural communities will have better access.
KEMRI will work to ensure the availability of networks and linkages among medical sites where AIDS care
and treatment are provided for both adults and children.
4. LINKS TO OTHER ACTIVITIES
The PMTCT activities will relate to the following KEMRI-SRV comprehensive approach to HIV/AIDS care
and treatment: Palliative Care: Basic Health Care and Support (#6922), CT (#6968), Treatment: ARV
services (#6973), and TB/HIV (#6975). This activity will be linked directly to Treatment: ARV for those
women who screen HIV positive during the PMTCT process and CT will be conducted on male partners and
children of women in the PMTCT clinics. The women will also be screened for TB as a direct link with
TB/HIV services. Linkages between PMTCT service and care outlets will be strengthened to improve
utilization of care opportunities created through PEPFAR funding.
5. POPULATIONS BEING TARGETED.
This activity targets adults of reproductive age, pregnant women, family planning clients, infants, and
People Living With HIV/AIDS (PLWHA) including HIV-positive pregnant women. Strategies to improve
quality of services will target MOH staff, doctors, nurses, midwives, and other health care workers such as
clinical officers and public health officers in both public and faith based facilities as well as the local
communities through training, Support Supervision, and Health Education.
6. KEY LEGISLATIVE ISSUES ADDRESSED.
This activity will increase gender equity in programming through PMTCT services targeted towards
pregnant women and their spouses. Women bear a high HIV burden through not only primary infection but
also as caregivers and impact of stigma and discrimination. Identifying these women through PMTCT will
provide an opportunity to access care for themselves, their spouses, and their infants - all targeting
improved pregnancy outcomes. Increased availability of PMTCT and PMTCT+ services will increase access
Activity Narrative: and help reduce stigma at community and facility levels. Men will be encouraged to come for CT services
and male PMTCT clinics will be expanded. Psychosocial Support Groups, Mothers to Mothers To Be and
Peer Counseling will be encouraged to improve on PMTCT uptake and to also reduce fear of stigma and
discrimination.
7. EMPHASIS AREAS
The major emphasis area in this activity is training health care workers and facilitating early infant diagnosis.
Minor emphasis will be placed on infrastructure, development of networks/linkages and referral systems,
quality assurance, quality improvement and supportive supervision.
1. ACTIVITY DESCRIPTION
KEMRI-South Rift Valley (SRV) has provided HIV comprehensive care and support to six districts in the
south Rift Valley since 2005. Although HIV testing, care and support have been very successful programs
prevention efforts focusing on Abstinence/Being Faithful in the larger area have been minimal. HIV
prevention interventions for very vulnerable populations in this region has been traditionally neglected
therefore having minimal affects on the learning and subsequently adapting new behaviors that will
systematically and successfully limit the number of new infections that occur in this region on an annual
basis. In FY08, KEMRI-SRV will develop a comprehensive HIV prevention program that will focus on
minimizing the risks for young people as well as support the development of healthy relationships that will
significantly reduce the risks related to the acquisition of HIV. The KEMRI-SRV AB program will focus its
efforts in the activity in the development and implementation of Family Matters! and Men as Partners in
Prevention (MAPP). Both of the interventions are evidence based curriculums that will be scaled-up
through out the seven districts in the south Rift Valley through local faith based organizations and churches
as well as in conjunction with the Ministry of Education. Family Matters! focuses on augmenting the family
unit as the major support in reducing the risks of HIV that young people face as well as provides families
with the skills and knowledge to discuss issues of HIV and human sexuality in a positive and productive
manner with their children. KEMRI-SRV will also continue working with the university student population at
East Africa Baraton University through the on-going support of the I Choose Life program by training 50
people in the program and reaching over 50,000 individuals. The KEMRI-SRV AB program will train a total
of 200 people: 50 people in Families Matter!, 75 people in MAPP and 75 people in I Choose Life. Together
these three programs will reach over 50,000 individuals with HIV/AIDS prevention. KEMRI-SRV will also be
active participants in the development and the implementation of the Healthy Youth Initiative (HYPE) as it is
expanded nationally past the urban areas of Kenya. KEMRI-SRV will actively identify community based and
faith based organizations that work with the youth of south Rift Valley and engage them in the development
of interventions that HYPE could support and be effective with rural youth. The KEMRI-SRV AB program
will also partner with other organizations in the implementation of the comprehensive HIV prevention
interventions such as Kericho Youth Center, AIC Litein and Tenwek Hospital.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute to the national Emergency Plan AB program by ensuring that all interventions
follow evidence-based approach to prevention that is informed by rigorous analysis of Kenya's epidemic.
The major focus of this activity will focus on the youth especially those at heightened risk of HIV by
strengthening the larger systems that these youth operate in through focusing on family and community
structures that will be supportive in evading HIV infection. A major focus will be on young girls that are at a
heightened risk of HIV by also focusing on the protection of the girl child from gender based violence or
coercion. The KEMRI-SRV AB program will target a total of 50,000 individuals reached through community
outreach that promotes HIV/AIDS prevention through abstinence and/or being faithful and train an additional
200 individuals in the promotion of HIV/AIDS prevention.
3. LINKS TO OTHER ACTIVITIES
This activity is linked to other prevention activities in the DOD Emergency Plan prevention portfolio such as
the KEMRI-SRV OP activity and the Live with Hope Center's AB and OP activity. They are also linked to
counseling and testing activities in the south Rift Valley with partners such as Tenwek Mission Hospital, Live
with Hope Center and KEMRI-SRV. The links to these activities provide a comprehensive approach to
prevention from abstinence to the correct and consistent use of condoms as outlined in the PEPFAR
Guidance for ABC programs. The KEMRI-SRV AB activity will also be linked with local Orphans and
Vulnerable Children (OVC) partners to ensure that all OVC receive age-appropriate HIV prevention
interventions, addressing the heightened risk this population is in to be abused or taken advantage of.
4. POPULATIONS TARGETED
This activity targets the general population from children to adults recognizing that prevention activities are
comprehensive and the development process of human sexual development is also an on-going transitional
process. Other populations that are targeted for this activity will be teachers and religious leaders through
the work that KEMRI-SRV AB will do with faith based organizations as well as the local Ministry of
Education schools. This activity will also focus on street youth and orphans and vulnerable children,
recognizing the heightened risk that this population is exposed to due to their vulnerable situation.
5. EMPHASIS AREAS/KEY LEGISLATIVE ISSUES ADDRESSED
KEMRI-SRV AB activity will address issues in gender especially in the areas of addressing male norms and
behaviors through the MAPP program as well as increasing gender equity in HIV/AIDS programs by
focusing interventions at the family level through Family Matters!. Efforts will also be made in protecting
OVC and the girl child against violence and coercion. In-service trainings will also be an emphasis area to
ensure that the services and interventions are de-centralized and reach the most people.
REFERENCES TO TARGETS AND BUDGETS.
The only changes to the program since approval in the 2007 COP are:
+ Geographic coverage has been expanded to include Bomet District, Bureti District, Nandi North and Nandi
South;
+ The target population has been expanded include discordant couples, personnel of public service
vehicles, university students at East Africa Baraton University and people living with HIV;
+ $7,000 of this activity is programmed with funds from the $7 million FY 2008 plus up for the Healthy Youth
Programs Initiative;
+ $137,500 of this activity is programmed with funds for the promotion, education and awareness of male
circumcision as a prevention intervention;
+ Other changes include the following new interventions in the OP activity:
>Men as Partners in HIV Prevention
>Positive Prevention in Community Settings
>I Choose Life program for University Students
This activity relates to activities in Abstinence and Being Faithful (#6891) and Counseling and Testing
(#6968).
Kenya Medical Research Institute (KEMRI) will embark on a new piloted initiative in south Rift Valley in the
area of Condoms and Other Prevention in 2007 in order to bring prevention to high-risk populations in two
stop-over locations along the Nariobi-Kisumu transport highway corridor within Kericho District. Both sites
have been extremely underserved in the area of prevention which has fueled the prevalence rate to
increase among core transmitters as well as the surrounding general communities. KEMRI south Rift Valley
program has had a comprehensive HIV care program for the residents of south Rift Valley since the 2005
Emergency Plan which includes counseling and testing as well as HIV/AIDS treatment. A significant aspect
of the existing KEMRI-south Rift Valley HIV comprehensive care program which has been missing is in the
area of prevention, especially among high-risk populations. The reliance on conventional voluntary
counseling and testing (VCT) sites to address this need has not been a sufficient prevention intervention. In
FY 2008, KEMRI south Rift, will address this existing gap in HIV-AIDS prevention by targeting 10,000
individuals in Kapsoit and Chepseon in creating a sustainable prevention program which addresses the
specific risk factors of commercial sex workers (CSW) as well as other high-risk adults in both locations.
Kapsoit and Chepseon have an estimated HIV prevalence rate of 4-6% among the general population, but
the targeted group for this activity is estimated to be higher than that. Even after personal knowledge of HIV
status, there is a significant gap in prevention activities due to the lack of personal knowledge and skills that
assist an individual to change behavior. KEMRI-south Rift will address this issue in these two localities with
condom promotion and STI identification and management. They will also target 50 people to be trained in
promoting HIV/AIDS prevention among high-risk adults.
KEMRI-south Rift Valley's new activity in Condoms and Other Prevention will contribute to the overall
objective of reducing high-risk behaviors among high-risk adults. This activity will also empower and train 50
individuals in both locations in the promotion of routine testing of STIs as well as the promotion of consistent
and correct condom use. This activity will target 10,000 individuals with HIV prevention messages as well as
behavior change skills that significantly minimize their risk behaviors. 50 condom dispensers will also be set
up throughout the two locations.
4. LINKS TO OTHER ACTIVIITES
This activity is linked to Live with Hope's Abstinence/Being Faithful program (#6891) as another prevention
activity occurring in Kericho District. Through coordination the two programs will work closely together in
identifying populations to reach with prevention. Counseling and testing services through KEMRI-south Rift
Valley (#6968) will also be linked to this activity in the promotion of gaining personal knowledge of HIV
status as a key to prevention and access to care.
5. POPULATIONS BEING TARGETED
This activity will target adults in the general population with prevention messages as well as the most at-risk
populations of commercial sex workers and mobile populations; specifically truck drivers. Brothel owners
and bar maids will also be a targeted population for this activity.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will address adult men in educating them about the identification of male norms and behaviors
which may be risk factors in HIV-AIDS transmission. The project activities with CSWs will increase gender
equity in HIV-AIDS programs as well as increasing women's access to income and productive resources.
Stigma reduction will also be addressed through information, education and community mobilization.
The primary focus of KEMRI-south Rift Valley in this activity will be to mobilize the community in the
participation of these prevention activities as well as reduce stigma in specific high-risk populations. This
activity will also dedicate part of its time to information, education and communication in the development of
material that serves as mass media prevention campaigns as well as in training of individuals to sustain the
prevention activities. Unallocated funds for this activity will expand existing activities in the 2007 COP.
Activity Narrative: FY 2008, KEMRI south Rift, will address this existing gap in HIV-AIDS prevention by targeting 10,000
promoting HIV/AIDS prevention among high-risk adults. The additional funds will also be used to identify
and implement 50 condom distribution sites in non-traditional locations where access to free condoms is
limited.
The only change to the program since approval in the 2007 COP is:
+geographic coverage has been expanded to include Kisumu West District in Nyanza Province and
Kipkelion District in Rift Valley, therefore increasing the geographic coverage from 6 to 8 districts.
This activity relates to HIV/AIDS Treatment/ARV services (#6973.08), Palliative Care: TB/HIV (#6975.08),
Counseling and Testing (#6968, #7038), Prevention (#8808.08), OVC (#12478.08) and PMTCT (#4804.08).
The South Rift Valley (SRV) Program is a broad initiative by the Walter Reed/KEMRI-HIV project in
collaboration with the Ministry of Health and Faith-based (including a local community based organization)
health care programs within 8 districts (2 new districts added to the previous 6 districts) in the South Rift
Valley and Nyanza Provinces of Kenya.
The South Rift Valley Program serves a population of approximately 2.7 million people, with a HIV
prevalence ranging from 5% to as high as 19% in some congregate settings. In 2006, about 100,000 adults
were estimated to be living with HIV, and about 15,000 being children under 15 years. As of March 31,
2007, the South Rift Valley program was providing basic health care and support services to 16,065 HIV
infected patients, of whom 6021 were on ARVs. In FY08 the program will increase the number of HIV
infected patients receiving facility based basic care services to 33,000.
To ensure sustainability the program will work hand in hand with the Ministry of Health and NASCOP in
offering basic health care and support services. In FY08, concerted efforts will continue to support quality
clinical care for HIV infected patients including routine patient follow up, laboratory monitoring, prevention
(including Co-trimoxazole Preventive Therapy) and treatment of opportunistic infections (OIs), and
treatment literacy and drug adherence. Nutritional (including multi-vitamin supplementation) support;
psychosocial care, including support groups to encourage positive living, disclosure counseling, and mental
health services; prevention with positives; family planning and STI services will additionally continue to be
supported. Regular support supervision and technical assistance; and timely, efficient and accurate data
collection, analysis and dissemination will be further consolidated.
In order to decongest the overcrowded district level facilities and enhance accessibility of basic care
services by the rural underserved population, decentralization of basic health care services and follow up of
stable patients at lower level facilities (health centers and dispensaries) will continue to be supported in
accordance with the network model. In FY08, this model will be expanded to support 12 additional lower
level facilities throughout the 8 districts, bringing the number of facilities offering basic health care in the
region to 86. By doing so, over 40% of the current patients seeking basic care services will be able to
access the services in nearby rural facilities. To support the scale up, 120 additional health workers will be
trained on basic health care and support.
As of March 31, 2007, the South Rift Valley program was providing basic health care and support services
to 1,668 children, of whom 580 were on ART. In FY08 the program will continue to strengthen pediatric
diagnosis (including early infant diagnosis), provision of quality pediatric care and treatment, and improve
referrals and linkages; with an aim of providing basic care to 3,300 children.
In FY 2008, the South Rift Valley basic health care and support program will also support Live with Hope
Center (LWHC) in their community home based care program which has been receiving Emergency Plan
funds since FY 2004. In FY 2008, the program will continue to serve and care for over 1,000 individuals in
their homes in the provision of basic health care as well as psychological support and counseling through
community clinical health workers as well as PLWHA community volunteers.
This activity will contribute substantively to Kenya's FY08 goal of providing facility based basic care and
support to 460,200 clients, by providing services to 33,000 individuals (7% of the overall FY 2008
Emergency Plan national target). The collaboration with MOH, other GOK offices and major stakeholders
will ensure these services are sustainable.
This activity is linked directly to the other KEMRI-SRV HIV/AIDS program initiatives in 8 districts in the SRV
and Nyanza provinces of Kenya. It is directly related to KEMRI-South Rift ARV services (#6973.08) in the
identification and provision of palliative care to all HIV+ patients (including those not on ARVs). It is also
linked to the orphans and vulnerable children (OVC) program (#12478.08) to ensure those HIV+ children in
palliative care that require additional services are adequately linked to receive the support.
4. POPULATION BEING TARGETED
The KEMRI-SRV basic health care and support program serves the civilian population in the SRV region.
The program will target primarily those people affected by HIV/AIDS including discordant couples,
caregivers as well as children since the main objective is to provide supplemental care to existing ART
services. Health care providers (both in public and private institutions) will also be targeted by increased
palliative care training to enhance their capacity to provide basic health care services. The work
accomplished by LWHC will be a demonstration of palliative care work with a community/faith based group
in Kericho district.
5. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will address increasing gender equity in HIV/AIDS programs by ensuring that both men and
women access basic health care and support services. Traditionally, women are more receptive to the
service but efforts will be made through a strong peer support network and counseling services to
encourage men to access services as well. Counselors will continue to be used to address psychosocial
issues that may contribute to the spread of HIV, including issues of disclosure and discordance among
partners. The effort of decentralization of services to lower level facilities through the network model will
continue to be strengthened and will help in reducing stigma and discrimination by the delivery of services
Activity Narrative: at the community level.
6. 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;
collaboration with the MOH and NLTP to support family planning, malaria prophylaxis and treatment and
commodities for TB diagnosis and treatment; 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.
Kipkelion District in Rift Valley
+a target population has been expanded to include the general population through TB case finding by
piloting House to House TB screening in Kericho, in conjunction with door to door HIV counseling and
testing services.
+the TB diagnostic capacity will be expanded to include a TB culture laboratory that will be set up in the
region.
This activity relates to HIV/AIDS Treatment/ARV services (#), Basic Health Care and Support (#),
Counseling and Testing (#6968, #7038), Prevention (#), OVC (#) and PMTCT (#).
The South Rift Valley Program is a broad initiative by the Walter Reed/KEMRI-HIV project in collaboration
with the Ministry of Health and Faith-based health care programs within 8 districts (2 new districts added to
the previous 6 districts) in the South Rift Valley (SRV) and Nyanza Provinces of Kenya.
prevalence ranging from 5% to as high as 19%, and a TB prevalence of about 300 per 100,000 population.
On average about 30-50% of TB patients are co-infected with HIV.
In FY08 the SRV Program will continue to strengthen and scale up the ongoing FY07 TB/HIV activities in
the 8 districts, in the following key areas: 1) Reduce burden of HIV among TB patients/suspects and their
partners and families through expanded HIV testing, delivery of Cotrimoxazole (CTX), ARVs and positive
HIV prevention in TB settings; 2) Reduce burden of TB among PLWA through intensified TB screening and
TB infection control in HIV Care settings; 3) Strengthen collaboration of TB and HIV services including joint
planning, coordination and support supervision, monitoring and evaluation, and patient referral and tracking
systems; 4) Contribute to the overall national program agenda to strengthen local and international
partnerships in delivery of TB/HIV services, and strengthen capacity for quality diagnostic and treatment TB
services for PLWA and containment of emerging threat of MDR-TB. Through this concerted effort, in FY08,
the SRV program will strive to achieve 95% HIV testing for TB patients, 100% provision of CTX to co-
infected patients, and 50% provision of ART to those eligible. In doing so, in FY08, the program will train an
additional 40 health workers to provide TB/HIV services in 32 health facilities in the region; provide HIV
testing to 4500 TB patients; and offer TB and HIV services to 2250 TB/HIV co-infected patients.
Additionally, 16,500 patients accessing HIV services in the region will be screened for TB, and those found
positive provided with TB treatment.
In FY08, based on successes in implementing a model of an Integrated TB/HIV Clinic in 3 district hospitals
in the region, the model will be scaled up and strengthened in all the 8 district hospitals in the region. The
model is unique in that TB/HIV co-infected patients are managed by one care provider. In this model, all TB
patients are offered HIV testing, recognition and management of STIs and HIV prevention messages. Those
with TB/HIV co-infection receive CTX and comprehensive HIV care, support and treatment.
The program will continue to support lower level facilities to provide or link patients to TB/HIV services. The
district hospital will continue to be strengthened as the referral unit for TB/HIV patients requiring specialized
diagnostic, treatment or in-patient services from the lower level facilities.
To increase TB case finding, House to House TB screening will be piloted in Kericho, in conjunction with
HIV testing that will be implemented by the CT program. In an effort to further reduce the prevalence of
active TB, support will continue for the contact tracing program that will be initiated in FY07 at Kericho
District Hospital.
Working with the National Leprosy and TB Program (NLTP) to ensure sustainability, the program will
continue to support improvement of the capacities of the laboratories in TB diagnosis. In close collaboration
with the KEMRI/WRP regional laboratory, the Kericho District Hospital lab will continue to offer quality
assurance in smear microscopy in the region. The development of a TB culture laboratory, as recognized in
national planning (including MOH/NLTP, CDC/O-GAC) on the grounds of the MOH/Kericho District Hospital
and in close collaboration with and support from the KEMRI/WRP CRC laboratory will proceed. This facility
will be part of the national TB culture laboratory network, and will support TB culture services in the
Southern Region of the Rift Valley.
Additionally, the program will continue to support efficient and timely supply of TB drugs to all the TB
treatment sites; regular support supervision and technical assistance to all the health facilities offering TB
and HIV services; use of standardized national registers and reporting tools; and timely, efficient and
accurate data collection, analysis and dissemination.
KEMRI- SRV will contribute towards the provision of integrated TB/HIV care by reducing TB morbidity and
mortality in HIV-infected individuals and reducing HIV-related morbidity and mortality in TB patients.
Planned activities will further contribute to the overall national program agenda to strengthen local and
international partnerships in delivery of TB/HIV services and containment of emerging threat of MDR-TB.
This activity is linked to KEMRI-SRV ARV services (#6973) throughout the 8 districts; KEMRI-SRV
Counseling and Testing (#6968), with a primary focus on provider initiated testing and counseling; Tenwek
Mission Hospital's CT activity (#7038); and the SRV PMTCT program (#6967), as part of comprehensive
care services offered to HIV infected pregnant women.
5. POPULATION BEING TARGETED
The SRV program supports civilian population in 8 districts in Rift Valley and Nyanza provinces. This activity
will target the general population of both adults and children, but primarily those infected with TB or HIV,
Activity Narrative: including discordant couples. Trainings under this activity will focus on health care workers both in the
public and private sectors. All TB/HIV activities will be implemented in accordance and in collaboration with
host government programs, namely the National AIDS/STI Control Program (NASCOP) and the National
Leprosy and TB Program (NLTP).
KEMRI-SRV TB/HIV activity will address increasing gender equity in HIV/AIDS programs, by ensuring that
equitable number of women and children are receiving treatment. The activities will address stigma
associated with TB/HIV status through information, education and communication materials targeted at
health care providers, caregivers, patients and communities.
space to offer TB/HIV services; human capacity development including TB/HIV training and empowering the
health workers to provide TB/HIV services by supporting necessary commodities; data collection, analysis
and dissemination, which will further support program monitoring and evaluation; collaboration with the
NLTP program who support commodities for TB diagnosis and treatment; 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 HAS BEEN UPDATED TO REFLECT CHANGES.
This activity was begun with 2007 plus-up funds and is part of a five-site effort to strengthen the link
between clinical and household settings for HIV+ children. All sites meet regularly with a sixth entity,
AED/Capable Partners, for real-time sharing of lessons learned and review the effectiveness of different
approaches in preparation for scale-up.
The Mwangalizi model is being tested in response to concern expressed by clinicians that assuring optimal
care for HIV+ OVC was difficult in many instance because they were accompanied to different clinic visits
by different relatives or community members, necessitating constant re-education of adults managing care
of children.
Central to the approach is recruitment of adult patients who are successfully managing their own care to
accompany pediatric patients to all clinic visits when a consistent caregiver from the household is not
available. These "accompagnateurs" will be trained to be on watch for development of side effects or
complications, remunerated for their time, and expected to perform home visits to monitor medication
consumption. They will also be expected to develop an ongoing and supportive relationship with the OVC
household, assess the social environment and refer for needed services, and seek wherever possible to
identify a household or community contact who can be prepared to assume the long-term responsibility of
being a treatment advocate for the child.
Sites were carefully selected to represent a cross section of Nairobi and coastal urban slum (Eastern
Deanery, Coptic, and Bomu), peri-urban (AMPATH/Eldoret, Bomu) and rural (Kericho District Hospital)
communities. Standard measures of household and clinician satisfaction with the value-added by the
accompagnateur, accompagnatuer satisfaction with the experience, and clinical progress of OVC
participating in the program will be tracked. Numbers of OVC served are captured under care and
treatment activities.
The KEMRI-South Rift Valley program will also leverage additional funding available through the Muangalizi
project to reach an additional 500 OVC with comprehensive care packages through existing faith based
organizations such as Tenwek Mission Community Health and AIC Litein's community health program. An
additional 50 caregivers will also be trained as well.
+ geographic coverage has been expanded to include Kisumu West district in Nyanza Province and
Kipkelion district in Rift Valley Province
+ the target population has been expanded to include the general population in home based counseling and
testing
1. LIST OF RELATED ACTIVITIES This activity relates to activities in HIV/AIDS treatment/ARV services
[#6973], TB/HIV [#6975], Abstinence/Being Faithful [#6981], and Condoms and Other Prevention [#8808].
In FY 2008, Kenya Medical Research Institute (KEMRI) will continue to provide HIV counseling and testing
(CT) services in partnership with the Ministry of Health (MOH) in six districts in the south Rift Valley
Province and one district in Nyanza province. Together the six districts represent a collection of 60 district
hospitals, sub-district hospitals, and health facilities that will be equipped and supported to serve as
nationally registered CT sites. In FY 2008, the six districts will provide CT services to over 110,000 people
in the traditional voluntary counseling and testing (VCT) sites as well as through the new provider initiated
testing and counseling (PITC) strategy. Twenty individuals will be trained in voluntary counseling and
testing, while 40 clinicians will be trained in PITC, to enable them provide PITC in health facilities. An
additional twenty will be trained in couple counseling and an additional 20 will be trained in home based
counseling and testing. In implementing this, KEMRI will work closely with the district AIDS/STI coordinator
(DASCO) in order to strengthen coordination and referral, especially between CT and care services.
Technical assistance will be provided by 2 locally employed staff. The combination of client-initiated (VCT)
and provider-initiated CT services will significantly contribute to an increased proportion of Kenyans learning
their HIV status in the south Rift Valley Province, which has a population of greater than 2.2 million and a
HIV prevalence rate of approximately 5-7%. KEMRI-MOH will also continue to maintain the l youth friendly
stand alone site in Kericho which combines recreational services as well as CT services in this very
dynamic approach to behavior change and HIV prevention among the youth. The center was established in
partnership with Kericho District Hospital with support from PEPFAR in FY 2004, and has successfully
assisted over 400 youth between the ages of 15-24 per month to learn their HIV status. The center also
offers youth-friendly mobile VCT services in collaboration with mobile reproductive health clinics in the
larger district. KEMRI will also continue to work in developing mobile VCT activities in conjunction with MOH
to reach populations of the districts who have poor or no access CT services. This will be the primary
method used in Transmara District, because part of the population in the district has a nomadic lifestyle and
also there are parts of the district that are hard-to-reach. The prevalence rate in this district which borders
Tanzania is estimated to be around 8-9% but accessibility of HIV services is extremely limited. KEMRI south
Rift Valley Mobile VCT activities will reach at least 30,000 individuals in FY 2008 in the six districts served
by KEMRI. This number will part of the annual CT target for KEMRI south Rift, referred to above.
3. CONTRIBUTION TO OVERALL PROGRAM AREA
The South Rift Valley Province is one of the areas in Kenya that have large rural populations. These rural
areas will be the main target of the CT initiative in FY 2008. Together with the MOH, KEMRI will provide
high quality CT services both to the Tea farming community and to the general community through mobile
CT services. Currently, mobile CT services are conducted weekly and reach between 100 and 250 clients
per week. In order to meet the needs of rural Kenya, KEMRI will assist the MOH to scale up mobile CT
services in these areas. These coordinated CT activities will successfully provide VCT as well as PITC to
over 110,000 Kenyans in the south Rift Valley Province. This combined effort to extend quality CT services
to this geographical area will successfully contribute to 4% of 2007 Emergency Plan CT targets for Kenya.
KEMRI will be instrumental in contributing to the national objectives of extending CT to hospital patients and
TB patients in both the inpatient and outpatient clinical settings. The youth recreational center and VCT site
in Kericho will continue to consistently target out of school and in-school youth, a special population that has
become a national focus in the provision of VCT services.
This activity is linked to KEMRI-south Rift Valley ARV services (#6973) by ensuring that every individual
who has tested positive for HIV in the CT service is linked to care and treatment. This activity is also linked
to KEMRI-south Rift Valley TB/HIV (#6975) to ensure that every person who tests positive for TB is given
the opportunity to test for HIV in the PITC setting. This activity is also linked to prevention activities by Live
with Hope AB (#6973) and KEMRI-south Rift Condoms and Other Prevention program (#6981).
5. POPULATIONS BEING TARGETED KEMRI's CT services will target the general population, including
children and youth. Mobile VCT services will target migratory populations in Transmara. KEMRI is working
in partnership with the MOH offices in six districts and therefore will be in a position to train public health
care workers in PITC in the clinical settings as well as private health care workers in AIC Litein. KEMRI, in
FY 2008, will train and equip 40 public health care workers in PITC in order to support the national scale-up
of CT in clinical settings within Kenya. The youth center in Kericho will also target its CT services to out-of-
school youth as well as other most at risk youth like street youth. In general, VCT activities provide CT
services to the most at-risk populations. CT activities are done collaboratively with National AIDS control
program staff at the local level.
KEMRI, in partnership with the MOH, will improve gender equity in accessibility of CT services within the six
districts in south Rift Valley. CT will be an important intervention strategy in challenging current sexual
norms that have contributed to the risks of contracting HIV in many of the rural communities. Through
information and education material stigma surrounding issues of knowing HIV status will also be addressed.
KEMRI's efforts in CT will be divided between community mobilization/participation, human resources,
information and communication, infrastructure, and training. They will improve the awareness of their CT
services by focusing a part of their efforts in community mobilization and participation. Other efforts will also
go towards the training of 40 health care workers in the provision of CT services in the clinical setting. Many
Activity Narrative: of the health care settings do not have the existing space to provide CT services and therefore some of the
efforts in FY 2008 will be to make minor renovations in the already existing infrastructure of the medical
health facilities.
N/A (exempt)
PHE CONTINUING STUDY:
Project Title: Utility of Viral Load Monitoring In Addition to Routine CD4 + WHO Clinical Staging In Patients
Receiving Antiretroviral Therapy in the South Rift Valley of Kenya
Name of Local Co- Investigator:
1. Eunice Obiero, MBChB, MMED (Ministry of Health, Provincial ART Officer)
2. Hellen Muttai, MBChB, MPH (Kenya Medical Research Institute, South Rift Valley HIV Clinical Care
Manager)
3. Douglas Shaffer, MD, MHS (US DOD/United States Military HIV Research Program, HIV Program
Director)
Project Description:
Patients receiving ART are routinely monitored based upon Kenya MOH guidelines using WHO staging and
CD4. Research equipoise exists if additional viral load (VL) testing would identify treatment failures earlier
or missed all together, which ultimately has impact upon potential resistance. This 12-month randomized
controlled trial compares clinic-based routine care (CD4+WHO Stage) versus viral load supplemented care
(new MOH: VL+CD4+WHO Stage) with viral failure powered (n=600) as the primary outcome. Secondary
outcomes include death, hospitalization, OI, WHO Stage, loss-to-follow-up, viral resistance, adverse events,
proportion second line, and agreement between CD4+WHO Stage vs. "blinded" VL in the routine care arm.
Timeline:
FY 2008 = Year 2 of activity
Year started: FY20O7
Expected year of completion: FYO8 (depending upon enrollment rate & final follow-up/analyses: into FY09)
Funding:
Funds received to date: None (FY07 budget = $ 166,760)
Funds expended to date: $ 106,275 (obligated based upon approval to proceed/funds pending)
Funds requested to complete the study:
FY 08: $400,000
Beyond FY08: None
Describe funds leveraged/contributed from other sources:
1. Professional contribution/participation at no charge: Dr. Muttai (KEMRI; PI), Dr. Shaffer (US DOD
Kenya; PI), Dr. Sawe (KEMRI; Associate Investigator [AI]), Dr. Kiptemas (KEMRI, AI), Dr. Shikuku (KEMRI,
Lab), Mr. Langat (KEMRI/Lab), Ms. Tarus (KEMRI/Pharmacy), Dr. Marovich (US DOD/USA-ID Expert
consultant/AI), Dr. Oster (US DOD/USA-ID Expert consultant/AI), and Dr. Nelson Michael (US DOD/USA-
Lab Expert consultant/AI).
2. Laboratory services (CD4, viral load, resistance) at cost only: Kenya Medical Research Institute/Walter
Reed Project (Kericho) and United States Military HIV Research Program (Rockville, MD; USA).
Status of Study:
The study protocol is under development and preparation for reviews (O-GAC, KEMRI IRB, WRAIR IRB)
based upon the fact it was learned in late May that the PHE may proceed and the proposal/protocol has
been modified based upon earlier O-GAC feedback (i.e. more stringent prospective methods; additional
clinical descriptors (outcomes).
Lessons Learned:
N/A
Information Dissemination Plan:
Results will be presented initially internally within the study key stakeholders (Kenya MOH [NASCOP
including ART ITT], KEMRI, & United States Military HIV Research Program) as well as O-GAC.
Subsequently, results will be submitted for national and international meeting presentations as well as
scientific journal peer review.
Planned FY08 Activities:
In FY08, we plan to undertake the following activities:
1. Continue enrollment and follow of patients.
2. Cost-outcome analysis of using viral load versus CD4 + WHO monitoring based upon primary and
secondary outcomes.
Budget Justification for FY2008 Budget (USD):
Salaries/ fringe benefits: $138,000
Equipment $0
Supplies: $38,000
Travel (ID Expert to Kenya) and vehicle cost $12,500
Participant Incentives, defaulter tracing and home visits $31,000
Training $14,500
Laboratory Testing: $14,800
Other: TA (Health Economist Expert) $20,000
Communication $8,000
Overheads (22%; 12 WRAIR, 10% KEMRI) $83,200
Contingency (10%) $40,000
Total: $400,000
1.ACTIVITY DESCRIPTION
Under the US DOD, the Kenya Medical Research Institute (KEMRI)/South Rift Valley (SRV) program has
been providing laboratory support services for HIV care to approximately 20,000 patients, of which ~ 9000
have started ART. This laboratory support has been provided in two forms: through the regional laboratory
and direct district level/facility support.
Since the beginning of PEPFAR, the KEMRI/Walter Reed Project (WRP) Clinical Research Center (CRC)
Laboratory in Kericho has served as the regional reference lab for conducting CD4 viral load, and early
infant diagnoses tests, as indicated for HIV evaluations and treatment. Leveraging upon existing research
infrastructure, the SRV lab has developed lab capacity at 9 of the 11 treatment sites, especially in areas of
lab safety. The KEMRI/WRP lab is part of the national network of laboratories that perform early infant
diagnosis using PCR on dried blood spots (DBS).
Still, the KEMRI/SRV program continues to provide direct supportive supervision, technical assistance, and
QA/QC for necessary laboratory infrastructure and testing at each of the 11 treatment sites, including rural
health centers. Consistent with consistent with MOH guidelines for monitoring ART, laboratory capacity to
perform chemistries and hematology has been developed at 9 of 11 sites. In FY08, the KEMRI/SRV
program will extend support to a total of 73 labs providing HIV diagnostics (including rapid testing) and 8
labs for CD4 evaluations.
This new activity represents a critical aspect of laboratory funding not previously addressed and will serve to
strengthen MOH and FBO laboratories. The activity will further develop the capacity of the regional
reference lab to manage a lab network throughout the southern Rift Valley. It is expected that such a
network will address issues of QA/QC, especially split sample QA testing for clinical chemistry and
hematology. The new activity will also support labs to enroll in external QA programs. In addition, this
activity will facilitate the development of the regional laboratory to do additional infant HIV diagnoses,
tuberculosis diagnoses and culture for even a larger network in the Rift Valley Province that will extend to
other implementing partners (e.g. FHI/USAID) as has been agreed upon in USG PEPFAR planning, MOH
(including National Leprosy and Tuberculosis Program), and CDC/OGAC country visits and strategic
planning. Finally, this activity will offer laboratory capacity development similar to the model applied in the
SRV to the Kisumu West District based upon new country planning and support for Nyanza Province.
Diagnostic evaluations for HIV co-infections including PCP, toxoplasmosis, cryptococcus, and
cytomegalovirus that are being set up at the SRV lab will be rolled out to selected sites.
This activity will continue to provide links to TB/HIV services through the provision of necessary basic
equipment for accurate and timely diagnosis of TB in about 15,000 HIV-positive patients being seen in
southern Rift Valley. Equipment to support this will include appropriate microscopes, TB culture media and
reagents, incubators, and air flow hoods that will be installed in 6 high volume diagnostic sites, districts in
the southern Rift Valley Province and Kisumu West District of Nyanza Province. Development of a TB
culture laboratory at the MOH/Kericho District Hospital will markedly improve TB diagnosis and
management in this region (see Tb/HIV narrative).
An automated DNA extractor for DNA-PCR machine for pediatric diagnosis will be purchased to
accommodate the ever increasing need of this service in the larger Rift Valley Province. In addition to
laboratory equipment, this activity will aid in improving the existing regional laboratory reference network as
logistical challenges and coverage of a large geographical area in rural Kenya are addressed. Ultimately,
such attention will help ensure timely delivery of quality samples and results.
Finally, the development of protocols for quality assurance schemes and off-loading such activities as
individual sites develop capacity will continue. Given the close collaboration and working relationship with
the Kericho District Hospital, this site will continue to be developed to offer back-up for safety labs and
QA/QC support to other treatment centers.
2.CONTRIBUTIONS TO OVERALL PROGRAM AREA
In FY08, this activity will contribute to training 100 laboratory technicians in hematology, chemistry, CD4,
and QA/QC with emphasis on interpretation of results generated in the laboratories. This will be achieved
through pre-service/in-service training, workshops, and seminars facilitated by internal and external experts.
This will improve access and use of quality diagnostic laboratory services at the treatment facilities. This
activity will support one laboratory technologist for higher national diploma training in hematology and one in
microbiology at the Kenya Medical Training College. Laboratories in 12 treatment sites will be refurbished
and strengthened on requisite quality assurance procedures, laboratory policies and management, use of
SOP's, and implementation of QA/QC systems for the follow up of 33,000 HIV patients thus contributing to
the overall national target of treating 550,000 people by the year 2010.
3.LINKS TO OTHER ACTIVITIES
This activity relates to KEMRI-South Rift Valley activities in HIV/AIDS Treatment: ARV Services, Palliative
Care: TB/HIV, Palliative Care: Basic Health Care and Support, Counseling and Testing, and Prevention of
Mother-To-Child Transmission.
4.POPULATIONS BEING TARGETED
The target population for this activity is primarily people living with HIV/AIDS that are identified through the
care and treatment centers in the KEMRI-South Rift Valley portfolio.
5.EMPHASIS AREA/KEY LEGISLATIVE ISSUES ADDRESSED
The activity includes emphasis on construction/renovation in the renovation of Ministry Health lab facilities
as well as minor work at the CRC laboratory. Other emphasis areas will also include human capacity
development both in pre-service training and in-service training. This activity will also be part of wrap
around programs in health in the area of safe motherhood and TB.
Project Title: Using Traditional Circumcision as Opportunities for Sharing HIV Prevention Messages and
Active Adverse Event and Behavioral Risk Surveillance
Name of Local Co- Investigator: Ministry of Health-Kenya, Kenya Medical Research Institute
KEMRI/WRP will work with traditional circumcisers in targeted divisions among 6 districts in the rural,
southern Rift Valley Province, where approximately 80% of men are circumcised, nearly ¾ by traditional
circumcisers. Two activities will occur in FY07: First, HIV prevention messages based upon WHO and
Kenya MOH guidance will be shared with young men undergoing circumcision. It is estimated that
approximately 1000 young men in 6 districts will be reached. Second, protocol development will proceed in
close collaboration with the MOH for active surveillance of adverse events associated with traditional
circumcision as well as evaluation of prevention messages provided.
Year started: 2007
Expected year of completion: 2009
Funds received to date: Planned: $300,000 (COP 07)
Funds expended to date: N/A
FY 08: $300,000
Beyond FY08: TBD
N/A.
The study is currently in the design stage and the protocol is currently being developed by KEMRI/Walter
Reed Project. Internal review procedures at KEMRI/Walter Reed will continue after a protocol has been
designed.
The funding for this study has not yet been received and therefore there has been a delay in the initial
phase of the evaluation. There has been considerable discussion within the Kenya team and with O-GAC
given this PHE. Such close discussion will be critical given the sensitivities around traditional circumcision
and how quickly policy, guidance, and opinions of primary stakeholders (e.g. MOH) are developing. It is
anticipated that using year-1 to focus upon sharing of prevention messages and developing a working
relationship in the rural areas will permit subsequent adverse event and behavioral survey to proceed more
effeciently.
Description and sharing of actual prevention messages given to young men undergoing traditional
circumcision will occur within the Kenya MC team, the Kenya MOH, Kenya Medical Research Institute, and
O-GAC. Demographic coverage of prevention message recipients as well as traditional circumcisers will be
provided to these same stakeholders as well. Once the adverse event active surveillance behavioral
assessment protocol is developed, it will be sent to O-GAC prior to or in conjunction with IRB submissions.
Ultimately after appropriate internal dissemination and review, results will be shared publicly, and also with
the participating communities.
1. Extend our year-1 activity prevention messages based upon state-of-the-art prevention messages
endorsed by Kenya MOH and WHO (staying focused on the fact that traditional circumcision is an excellent
venue for prevention messages) to other areas in Kenya where traditional circumcision is prevalent. One
potential area would be Bungoma District where previous USAID-funded qualitative work (Bailey and
Egesah; April 2006) work with traditional circumcision and Luhyas.
2. Implement adverse event data collection in to any extended area of prevention messages (consistent
with the protocol we will develop for active surveillance) and include a more robust behavioral assessment
reflecting the prevention messages given.
3. Consider where WHO and Kenya MOH (and O-GAC) are with regard to traditional circumcisers for other
potential interventions.
Salaries/ fringe benefits: $87,600
Equipment: $25,000
Supplies/office costs: $25,000
Travel: (Local) $25,000
Participant Incentives: $ -
Laboratory Testing: $ -
Other: Development of Prevention Interventions$75,000
Indirect (22%: 12% WRAIR, 10% KEMRI)$62,400
Total: $300,000
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 by NACC through Constituency AIDS Control
Committees (CACC), through three key components.
Component 1:
Support South Rift Valley 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 South Rift Valley and MOH's
district level 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 South Rift Valley 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 the 6 districts
and their heath facilities to collect, report, analyze, 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 the
Emergency Plan, MOH, NACC and other stakeholders, in line with the "three ones" principle. South Rift
Valley 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 200 facility based data point staff on the new data collection/reporting tools and data use for
improving program performance, and hold quarterly and annual stakeholders' information dissemination
meetings.
South Rift Valley 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 South rift Valley. These efforts should result into demonstrated evidence in
increased national level reporting by up to 60% from health facilities to NASCOP national database.
The activity builds on 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 the six districts
and their health facilities in strategic information in addition to supporting the training of 200 facility based
data point staff, SI, program managers in M&E/HMIS, reporting and data use for program management.
This activity links to South Rift Valley activities in the areas of MTCT, HVCT, HVTB, HKID, HBHC and HTXS
by providing linkages between the patient data monitoring system and PEPFAR and national reporting
systems through better data generated at each of the treatment sites. In addition, this activity will link to the
HVSI activities to be carried out by NASCOP.
This activity targets host government workers and other health care workers like M&E and HMIS officers 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 of M&E program management.
5.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), Information Technology (IT) and
Communications Infrastructure and Other SI Activities.
