Detailed Mechanism Funding and Narrative

Years of mechanism: 2007 2008 2009

Details for Mechanism ID: 4917
Country/Region: Kenya
Year: 2008
Main Partner: Pathfinder International
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $7,535,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $425,000

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

REFERENCES TO TARGETS, EMPHASIS AREAS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

This activity will relate to the ARV services (#8765), Orphans and Vulnerable Children (#9056), Palliative

Care: TB/HIV (#9072), Palliative Care: Basic Health Care and Support (#8936) and Condoms and Other

Prevention (#8874).

2. ACTIVITY DESCRIPTION

Pathfinder International (PI) supports facilities to provide comprehensive antenatal package for all pregnant

women including screening, prevention and treatment for any infections (such as sexually transmitted

infections and malaria), nutrition support, prophylactic ARVS, counseling on safe infant feeding, counseling

and HIV testing of women and their partners. APHIA II Nairobi/Central will build on this work in both Nairobi

and Central provinces. APHIA II Nairobi/Central will continue to support established support groups that are

formed around PMTCT sites by mothers who have benefited from the project services. In addition, referral

linkages will be established within facilities where APHIA II Nairobi/Central is providing antiretroviral

therapy, through which HIV positive clients are assessed and put on treatment where necessary. The

number of HIV positive women and children on treatment is increasing steadily through these networks.

Laboratory networks will also be established that will greatly improve ART uptake as well as early infant

diagnosis. In 2008, APHIA II Nairobi/Central will consolidate these activities and provide HIV counseling and

testing to 47,193 pregnant women and provide antiretroviral prophylaxis to 3772 HIV-positive women. Of

the positive women, 1886 will receive AZT, 754 HAART and 1132 single dose nevirapine for prophylaxis.

1886 exposed infant will receive PCR for early infant diagnosis. At the community level lay counselors will

be trained to strengthen the delivery of PMTCT services and to provide continued support for the HIV-

positive women and their families. The project will train community health workers to provide community

components of PMTCT services. In order to improve the quality of care, 500 health supervisors will learn

management skills, including utilization of data for decision making. In 2008, this project will use its

experience to consolidate progress in existing facilities, expand to others within the two provinces, up to 72

facilities and continue to strengthen District Health Management Teams, and referral networks for PMTCT-

plus activities. Pathfinder will train 180 health workers in PMTCT and comprehensive HIV management for

HIV-positive mothers and their families. Efforts will be made to increase early infant diagnosis in order to

identify infants that require HIV care and treatment and offer more appropriate advice on infant feeding

choices. More efficacious regimens for PMTCT will be introduced and scaled up in all the sites offering

services. Linkages to FP/RH will be made as well as to laboratory services in order to offer a more

comprehensive package of care. Capacity for service providers to provide couple HIV Counseling and

testing within PMTCT sites will be supported with 2008 funds. Many women accessing HIV counseling and

testing at PMTCT sites do not know their partner's HIV status. The program will strengthen innovative

approaches to increase the number of men accessing HIV testing services, thereby enabling discordant

couples to know their HIV status -an important HIV prevention strategy among couples. The program will

reach at least 10,000 couples and will be implemented in Nairobi and Central Province.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to 4% of the overall 2008 Emergency Plan PMTCT targets for Kenya. Community

participation and male involvement will significantly contribute to PEPFAR goals for primary prevention,

access to care and treatment, and support of those affected and infected. Technical assistance to the

Ministry of health facilities will contribute to improvement of the quality of services.

4. LINKS TO OTHER ACTIVITES

Linkages to HIV care and treatment services will be strengthened, to ensure immediate appropriate care for

the woman and exposed infants, and family members as well and thus optimize utilization of

complementary services created through Emergency Plan funding. This activity will relate to the ARV

services (#8765), OVC care (#9056), TB/HIV services (#9072), HBHC (#8936) and STP services (#8874)

funded under the APHIA II Nairobi/Central.

5. POPULATIONS BEING TARGETED

This activity targets adults, pregnant women, HIV-positive pregnant women, HIV affected families, and HIV-

positive infants. Health care providers including Doctors, Nurses and Other Health care workers will be

targeted for training on PMTCT using the national NASCOP PMTCT CDC/WHO based curriculum.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address gender equity in HIV/AIDS programs through improved PMTCT service delivery at

ante-natal clinics and maternity units. Community health workers will conduct community mobilization

activities that will help increase service uptake as well as address issues of stigma and discrimination at

community level.

7. EMPHASIS AREAS

This activity includes emphasis on human capacity development through training, supportive supervision

and task shifting, support to strategic information, linkage to family planning, safe motherhood, TB and

nutrition programs as well as Quality Assurance, Community Mobilization/Participation and Development of

Network/Linkages/Referral Systems.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $1,150,000

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:

• $200,000 of this activity supports the Youth Prevention Initiative programmed with funds from the $7

million FY 08 plus up;

• Peer education activities will be rolled out with the Kenya Girl Guides Association;

• The target population has been expanded to include teachers at the worksite: $45,000 in AB funds will go

toward this activity complemented by allocations in OP and OHPS totaling $300,000 to reach 1,200

teachers and train 40 more;

• In response to the Ministry of Education's request the KARHP methodology will be continued at the level

of approximately $225,000 targeting teachers and in-school youth; and

• $150,000 will expand support in HIV prevention and supportive services to victims of gender-based

violence in Nairobi and Central province through the Nairobi Womens Hospital and other facilities.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in Counseling and Testing (#8976), Palliative Care: TB/HIV (#9072), and

Prevention of Mother-to-Child Transmission (#8729).

2. ACTIVITY DESCRIPTION

$200,000 of this activity supports the Youth Prevention Initiative programmed with funds from the $7 million

FY 08 plus up. In FY 2008, Pathfinder and its prevention partners, including PSI, will target 600,000 youth

and adults with community outreach HIV/AIDS prevention programs that promote abstinence and/or being

faithful. Peer education, informal and formal worksite interventions, community outreach by PLWA, mobile

VCT and life skills education for youth will all serve as a means through which messages will be conveyed.

An in-school program for 10 to15 year olds will emphasize creation of support systems for students to focus

on long-term goals, self-esteem and life skills. Emphasis will be on delayed sexual debut, and secondary

abstinence will be encouraged for those youth who are already sexually active. APHIA II community-level

partner capacity for undertaking prevention and behavior change activities will also be strengthened, so that

messages can be conveyed widely through implementing partners undertaking home and community

support activities as well. It is expected that 130,000 individuals will be reached with community outreach

HIV/AIDS prevention programs that promote abstinence and/or being faithful, while 500 persons will be

trained to provide HIV/AIDS prevention programs that promote abstinence and/or being faithful. Additional

project partners to be trained in Other Behavior Change will also contribute to AB message dissemination.

There will be a component of Prevention with Positives whereby the Project will work through PLWHA

Support Groups linked to the Comprehensive Care Centres in Nairobi and Central Provinces. $100,000 of

plus-up will provide support to patient support groups and post-test clubs in VCT Centres to ensure

abstinence by HIV-infected persons. This will empower 5 people in each of the 15 patient support groups to

become peer and advocacy leaders in prevention at the community level and will reach 30,000 PLWAs.

The PwP activity is additional to the narrative in the 2007 COP narrative for this prime partner. $200,000 of

plus-up funds will enable APHIA II Nairobi Central to expand their work with the Kenya Girl Guides

Association by training 2,500 Girl Guides to reach 350,000 in-school youth with abstinence and being

faithful messages. $150,000 will expand support in HIV prevention and supportive services to victims of

gender-based violence in Nairobi and Central province through the Nairobi Womens Hospital and other

facilities. This activity will reach 20,000 youth. $150,000 will be used to reach high risk out-of-school youth

including street children with AB messages. This activity will reach 70,000 youth.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute significantly to the overall 2007 Emergency Plan AB Prevention targets for

Kenya. Integrating prevention into all community outreach for treatment and care, with special emphasis on

men and youth, will significantly contribute to PEPFAR goals for primary prevention and the Kenya Five-

Year strategy for HIV/AIDS.

4. LINKS TO OTHER ACTIVITIES

Support to AB Prevention will be one component of a package of integrated support at health facility and

community levels in the region, holistically addressing HIV prevention, treatment and care. This activity

relates to activities in Counseling and Testing (#8976), Palliative Care: TB/HIV (#9072), and PMTCT

(#8729) through referrals and networking.

5. POPULATIONS BEING TARGETED

The activity targets youth with messages about abstinence and both adults and youth with messages

advocating faithfulness to one partner. Special emphasis will be placed on reaching men through outreach

by PLWAs and involvement of community leaders, by couples counseling in PMTCT and through worksite

interventions. Implementing partner counterparts from NGOs, CBOs, FBOs and schools will be targeted for

training to implement prevention programs.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will be consistent with national strategies for HIV prevention promoting abstinence, delay of

sexual debut including secondary abstinence, fidelity, partner reduction and related community and social

norms.

7. EMPHASIS AREAS

There will be a major emphasis on capacity building of implementing partners, community-owned resource

persons and other community level implementing partners. Community involvement in the design and

implementation of activities will play an integral part in ensuring the success of these interventions.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $600,000

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:

+ $100,000 of this OP activity is programmed with funds from the $7million FY08 plus-up for the Youth

Prevention Initiative

+ OP funds totaling $58,500 will contribute to the sensitization of teachers as a worksite population linking

with AB and OPHS funds for a $150,000 activity to reach 1,500 teachers and train 40 more.

+APHIA II Nairobi/Central will work with select health facilities, police, uniformed services, opinion leaders

and others on issues of gender-based violence.

+ The OP activity will include Prevention with Positives (PwP) activities working through PLWA support

groups linked to the Comprehensive care Centers

+ APHIA II Nairobi/Central will also expand their activities with CSWs and MSMs.

+ APHIA II Nairobi/Central will continue work with select health facilities, police, uniformed services, opinion

leaders and others on issues of gender-based violence.

1. LIST OF RELATED ACTIVITIES

This activity is linked to Palliative Care: Basic Health Care and Support (#8936), Counseling and Testing

(#8976), and Palliative Care: TB/HIV (#9072).

2. ACTIVITY DESCRIPTION

In FY 08, APHIA II Nairobi/Central will reach 350,000 individuals, train 1,000 people and distribute condoms

through 25 outlets. This activity will strengthen HIV prevention programs through other behavior change

approaches (i.e. all behavior change approaches that do not focus on abstinence and being faithful) under

the APHIA II Nairobi/Central Province Project. In FY 2007, Pathfinder and its prevention partners, including

PSI, will target youth and adults with behavior change messages that are appropriately adapted to different

target groups. Peer education, informal and formal worksite interventions, community outreach by PLWA,

mobile VCT, life skills education for youth, high-risk outreach and transport corridor activities will all serve as

means through which messages will be conveyed. In particular, the project will capitalize on PSI's

experience in targeting informal worksites, market places, and "hot zones" where high-risk behavior is

common. Street theater, interactive games, PLWA testimonials, outreach sessions and community

mobilization will be used to convey messages that include consistent and correct use of condoms, knowing

one's status and knowing your partner's status. APHIA II community level partner capacity for undertaking

prevention and behavior change activities will also be strengthened, such that messages can be conveyed

widely through implementing partners and undertaking home and community support activities. It is

expected that 74,000 individuals will be reached with community HIV/AIDS outreach prevention programs

that are focused on more than just abstinence and/or being faithful, while 275 persons will be trained in the

same. At the same time, 15 condom outlets will be installed to provide easy access.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute significantly to the overall 2007 PEPFAR OP targets for Kenya. By specifically

focusing on men and youth, this activity will significantly contribute to PEPFAR goals for primary prevention

through the integration of prevention into all community outreach for treatment and care.

4. LINKS TO OTHER ACTIVITIES

Support to Prevention/Other Behavior Change will be one component of a package of integrated support at

health facility and community levels in the region, holistically addressing HIV prevention, treatment and

care. It is specifically linked to palliative care, basic health care (#8936), counseling and testing (#8976),

and palliative care, TB/HIV (#9072).

5. POPULATIONS BEING TARGETED

This activity targets both adults and youth, with additional emphasis on worksites to reach men as well as

high-risk groups and persons frequenting/working in "hot spots". It will target special populations such as

bar maids to improve their HIV risk awareness, their rights as bar maids and how they can protect

themselves from acquiring HIV infection. Implementing-Partner counterparts from NGOs, CBOs, FBOs and

schools will be targeted for training to implement prevention programs.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will be consistent with national policies regarding other prevention and will specifically address

gender to improve gender equity in HIV programming as well as address male norms and behavior that

often hinder uptake of prevention activities.

7. EMPHASIS AREAS

This activity includes major emphasis on worksites and minor emphases implementing-partner capacity

building, linkages with other sectors and initiatives and training. With $150,000 in plus-up funding APHIA II

Nairobi/Central will expand their activities to target 100,000 high-risk youth by training 50 peer educators.

HIV prevention activities targeting glue-sniffing youth, a growing IDU population, and other alcohol and

susbstance abusers will be expanded in Nairobi and Central province. With $250,000 they will focus on HIV

prevention with 100,000 male and female sex workers to promote alternatives to commercial sex work as

well as protective barriers to prevent HIV transmission, both with commercial partners and steady

boyfriends/girlfriends and husbands/wives. To do this they will train 50 adults. In addition they will use

$100,000 to expand support in HIV prevention and supportive services to 20,000 victims of gender-based

violence in Nairobi and central province through the Nairobi Womens Hospital and outreach centers and

train 20 health workers and community participants.

Funding for Care: Adult Care and Support (HBHC): $385,000

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

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

The APHIA II Nairobi/Central HBHC activities will relate to HIV/AIDS treatment services (#8765),

Counseling and Testing (#8976), Other Prevention (#8874), OVC (#9056), TB/HIV care activities (#9072),

AB (#8731), PMTCT (#8729) and Strategic Information (#8870).

2. ACTIVITY DESCRIPTION

This activity relates to care and support for people and families affected by HIV/AIDS under the APHIA II

Nairobi/Central Province Project. In FY 2008, Pathfinder International (PI) and its partners will target 13,000

people with home and community based palliative care in Nairobi and Central Province. Palliative care

(basic) will include a comprehensive package of community home-based care consisting of home nursing,

clinical care, nutrition, STI/HIV prevention, education, OVC care, paralegal support and protection,

psychosocial and spiritual support and links to income generating activities. PI will work with local

implementing partners including established NGOs, CBOs, and FBOs. PI will strengthen the technical and

institutional capacity of partners and build collaborative working relationships with a variety of stakeholders

to encourage effective, efficient programming. Gender and youth issues will be addressed. PLWHA will be

involved to ensure expansion and high quality of care and support programming. To promote GIPA, PLWHA

will be recruited through implementing partners such as KENWA and others as CHWs, as they can be

particularly effective not only in improving the quality of services but also in combating the serious issue of

stigma.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This APHIA II Nairobi/Central activity will reach 13,000 clients and 200 individuals will be trained to provide

palliative care through 50 service outlets. This APHIA II Nairobi/Central activity responds to NACC's priority

areas #2 "Improve the quality of life of people infected and affected by HIV/AIDS" and #3 "Mitigation of socio

-economic impact". It is expected that the APHIA II- Nairobi/Central will adhere to GOK policies and

guidelines and participate in national-level HIV technical working groups.

4. LINKS TO OTHER ACTIVITIES

Linkages to clinical services will be established through a two-way referral system and will include HIV/AIDS

treatment services (#8765), Counseling and Testing (#8976), Other Prevention (#8874), TB/HIV care

activities (#9072), AB (#8731) and PMTCT (#8729). Clinical supervisors and other health care providers will

reinforce clinic to community referrals by being kept up-to-date on local resources for psychosocial,

economic, legal and food security support. PI will link with local partners such as K-Rep to address

economic insecurity through microfinance and business skills training. Implementing partners will

collaborate with local programs and agencies to address food insecurity and nutrition needs.

5. POPULATIONS BEING TARGETED

This activity targets people and families affected by HIV/AIDS. Local implementing partners will be targeted

for training and capacity building. Health care providers will be targeted for sensitization and training related

to home-based care. CHWs and caregivers will be trained and receive periodic refresher training.

Groups/Organizations targeted include community-based and faith-based organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address issues of stigma and discrimination

by improving the health and lives of the PLWAs, allowing them to provide increased care for their children

and potentially return to work.

7. EMPHASIS AREAS

This activity includes major emphasis on quality and expansion of home-based care, linkages between

community and formal health care sector, development and strengthening of networks and referral systems.

Funding for Care: TB/HIV (HVTB): $250,000

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

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

This activity will be linked to ARV services (APHIA II Nairobi/Central), Basic Health Care services (#8936),

CT Services (#8976) and other TB/HIV activities (#7001).

2. ACTIVITY DESCRIPTION

This activity relates to support for strengthening and expanding palliative care in clinical settings addressing

TB and HIV. Pathfinder International (PI), the lead partner in APHIA II Nairobi/Central will develop and

implement new interventions, expanding and integrating service delivery in Year 1 and Year 2 sites targeted

under the APHIA II Nairobi/Central Project and adding new ones. In 2008, 52 sites (17 in Central and 35 in

Nairobi) will be supported in provision of TB/HIV services. Through these sites, Intensified TB screening

for 6500 HIV patients and HIV screening for 3000 TB suspects/patients will be offered as a standard of care

in all the facilities; approximately 1500 TB patients will be identified as being infected with both TB and

HIV. Emphasis will be on filling gaps in service delivery and linking to community based services. TB

prevention, treatment and care programs will be strengthened and effective linkages made between TB and

HIV services. Service quality and supervision at all levels of facility care and referral will be improved. Drug

supply management, case management, records systems, supervision and community-based

adherence/follow-up will be strengthened. All health facilities targeted by the project will provide OI

treatment, including TB, cotrimoxazole prophylaxis, and nutritional support. APHIA II Nairobi/Central will

work to expand diagnostic and DOTS case management capacity. According to GOK policy, all HIV+

patients will be screened for TB, and all TB patients tested for HIV. Malteser International a PI partner, will

provide guidance for training of nurses and community health workers, annual refresher training on

TB/HIV/AIDS care and education and basic training on clinical observation and case management. In 2008,

200 health workers will be trained to provide treatment for TB to HIV infected individuals PI will ensure that

cotrimoxazole prophylaxis, de-worming, intermittent treatment for malaria, and ITNs are provided at all HIV

care sites in collaboration with KEMSA and PSI. Lab staff will be trained to be more responsive to the needs

of TB patients. In FY 2008 PI will pilot ART provision in TB clinics in an effort to decentralize and treat

patients where they are presenting for care pending successful piloting of this activity in 2007. In both

Nairobi and Central 1500 HIV infected people will be administered TB therapy, 200 health care workers will

be trained in TB/HIV services from a total of 20 sites.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will result in 1500 persons accessing TB/HIV services in Nairobi and Central, as well as better

prevention and control of urban TB in Nairobi.

4. LINKS TO OTHER ACTIVITIES

Clinic-based palliative care is one component in a comprehensive treatment and care approach under

APHIA II, such that clients will benefit from long term ART as appropriate and linkages to community

services. Linkages will also be made with the NLTP and VCT sites.

5. POPULATIONS BEING TARGETED

This activity targets in-patients and clients of DTC, TB-ward patients and clients of home and community

support services who are referred for clinical care by community health workers. Health care providers

including Doctors, Nurses and Other Health care workers will be targeted for training using national

curricula.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address stigma and discrimination against persons infected with HIV.

7. EMPHASIS AREAS

This activity includes major emphasis on Quality assurance and supportive supervision with additional focus

on training; development of networks/linkages/referral systems

Funding for Care: Orphans and Vulnerable Children (HKID): $1,650,000

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 counseling and testing (#8976), ARV Services (#8765) and palliative care: Basic

Health Care and Support (#8936).

2. ACTIVITY DESCRIPTION

This activity relates to expanded support to be provided to OVC. Pathfinder International (PI), the lead

partner in APHIA II Nairobi/Central, will partner with Christian Children's Fund (CCF) to provide integrated,

age-appropriate services to build resilience of children infected with and affected by HIV/AIDS. Emphasis

will be placed on development of healthy and supportive home and community environments where OVC

and guardians/families have access to psychosocial support, education, health and nutrition services,

economic livelihood support, shelter and protection from exploitation and abuse. Institutional capacity and

technical expertise of implementing partners will be strengthened. OVC support will be integrated with and

linked to the project's home and community support. Village Health Committees and implementing partners

will identify OVC, who are often in the same households as those individuals receiving home-based care

and support.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

It is anticipated that in FY 2008 a total of 13,600 OVC in Nairobi and 20,000Central (total 33,600) will be

reached. Training of individuals in caring for OVC will cover 1,400 people in Nairobi and 2,100 in Central

(total caregivers 3,500). A total of 50 implementing partners (IP) (20 in Nairobi; 30 in Central) will be

supported to provide care and support for OVC. Caretaker support groups will include OVC needs (8 in

Nairobi and 12 in Central). This will contribute to the overall 2008 emergency Plan OVC targets for Kenya.

4. LINKS TO OTHER ACTIVITIES

This activity will be linked with other Pathfinder International APHIA II activities in the areas of counseling

and testing (#8976), ARV Services (#8765) and Palliative Care: Basic Health Care and Support (#8936) in

both Central and Nairobi Provinces.

5. POPULATIONS BEING TARGETED

This activity targets orphans and vulnerable children, caregivers, Community Health Workers, guardians

and educators involved with OVC. Capacity building efforts with the local communities will focus on the

community and religious leaders as well as partnering with other community and faith based groups that

exist in the area.

6. KEY LEGISLATIVE ISSUES ADDRESSED

Issues addressed are stigma and discrimination and the wrap around services in food and education.

7. EMPHASIS AREAS

This activity includes major emphasis in the development of the local organization and minor emphasis in

the areas of community mobilization and participation.

Funding for Testing: HIV Testing and Counseling (HVCT): $750,000

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:

+ geographic coverage has been revised and expanded to include additional districts in the Nairobi and

Central Province

+ target population will be expanded to include OVCs

+ APHIA II Nairobi and Central will expand counseling and testing services within the province and include

outreach services provided through existing and new VCT sites that are integrated within health facilities.

The CT services will include door to door VCT and testing of family members of the infected individuals

receiving care and treatment within the facility.

1. LIST OF RELATED ACTIVITIES

This activity is related to activities in HIV/AIDS treatment services (#8765), abstinence and be faithful

(#8731), TB/HIV care (#9072), OVC (#9056), HBHC (#8936), other prevention (#8874), PMCT (#8729) and

strategic information (#8870)

2. ACTIVITY DESCRIPTION

In 2008, APHIA II Nairobi/Central will reach 200,000 individuals with counseling and testing services

including PITC, VCT, and HBCT through 75 outlets and 500 providers trained. This activity relates to

support to be provided to increase VCT coverage while taking account of the need to emphasize diagnostic

testing and counseling (DTC) as well. New VCT sites may be needed, for example, in large companies

where employees lack easy access. Mobile VCT will complement fixed sites. Youth friendly services will be

emphasized. Where possible, VCT will be integrated with facility and community level treatment and social

support services for individuals testing positive and with prevention activities for discordant couples and

individuals testing negative. DTC will be scaled up in support of the National AIDS and STI Control

Program. Year 1 will see expansion and strengthening of DTC in imperative site facilities, PMTCT and blood

transfusion sites and in district hospitals and health centers with laboratory capacity. A subcontractor will

train counselors from target facilities and work with GOK and NGO counterparts to ensure supervision.

Individuals who test positive will be systematically referred to CCC and higher levels for comprehensive

testing and linkages to community services. Pathfinder will liaise with NASCOP to ensure HIV test kit

supply. It is anticipated that in FY 2007, 31,900 people in Nairobi will be tested in 40 sites while 9,100 will

be tested in Central in 10 sites. In Nairobi in FY 2007, 86 people will be trained in counseling and testing

while Central will have 54 people trained as counselors.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to COP 07 Counseling & Testing targets for Kenya. Integrating promotion of VCT

into all community outreach for treatment and care will significantly contribute to PEPFAR goals for primary

prevention.

4. LINKS TO OTHER ACTIVITIES

Support to counseling and testing will be a linchpin activity in APHIA II resulting in increased numbers of

individuals accessing care, treatment and support and in strengthening prevention efforts. The APHIA II

Nairobi and Central Provinces activities will relate to HIV/AIDS treatment services (#8765), abstinence and

be faithful (#8731), TB/HIV care (#9072), OVC (#9056), HBHC (#8936), other prevention (#8874), PMCT

(#8729), and strategic information (#8870)

5. POPULATIONS BEING TARGETED

This activity targets a wide range of population groups, including, for DTC, those receiving other clinical

services, and for VCT, the general population, with emphasis on sexually active individuals, youth, and high

risk groups such as bar workers, matatu and other transport workers. Health service providers will be

targeted for training. All efforts are in coordination with the National AIDS control program staff. Community

based and faith based groups will also be targeted in the community mobilization of CT services.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address gender, stigma and discrimination through post test clubs and legislation related to

protection of human rights and confidentiality.

7. EMPHASIS AREAS

This activity includes major emphasis on capacity building of C&T providers and CHWs. The activity

emphasizes VCT as a major prevention strategy. IPs, CORPS and other community level implementing

partners are key to its success. Training is a major emphasis area and this activity will train 140 people to

implement CT activities. Minor emphasis is also in community mobilization.

Funding for Treatment: Adult Treatment (HTXS): $1,950,000

N/A (exempt)

Funding for Strategic Information (HVSI): $275,000

THIS IS AN ONGOING ACTIVITY.

The only change to the program since approval in the 2007 COP is

+ the planned development of improved tools and models for collecting, analyzing and disseminating

HIV/AIDS behavioral and health monitoring information including health facility surveys, plan to conduct

operations research that will illuminate areas of data management requiring strengthening and

development. This activity also includes the development of data quality improvement plan, training data

point persons on DQA tools and implementation of regular data quality audits at sampled health facilities

and community level programs. Targets and funding levels have also changed.

1.LIST OF RELATED ACTIVITIES

This activity is related to the strategic information activities to be carried out by University of North

Carolina/MEASURE Evaluation (#7098), NASCOP (#7002), and TE/TBD (#9220).

2.ACTIVITY DESCRIPTION

This activity will strengthen the provincial and district level Health Management Information Systems

(HMIS) currently in use by MOH at health facilities and Community Based Program Activity Reporting

(COBPAR) currently being rolled out at Constituency AIDS Control Committees (CACCS) levels by NACC

through 3 key components. Component 1: Support APHIA II NAIROBI-CENTRAL/PATHFINDER

INTERNATIONAL and MOH program data collection processes for performance reporting needs (quarterly,

semi-annual, annual). This component will support a participatory, coordinated and efficient data collection,

analysis, use and provision of information to track achievement of APHIA II NAIROBI-

CENTRAL/PATHFINDER INTERNATIONAL and MOH's district level Annual Operation Plan II objectives,

and inform decisions at the local, district and provincial levels, using standardized M&E/HMIS tools

approved by the MOH. Component 2: Strengthen community and facility based reporting systems being

rolled out by NACC and NASCOP. The component will support APHIA II NAIROBI-

CENTRAL/PATHFINDER INTERNATIONAL 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 83 local

organisations and facilities to collect, report, analyse, and use both routine facility and non-facility data for

planning and program improvement. Component 3: Take lead role in coordinating M&E activities in the

province to meet the information needs of USAID/Kenya, the Emergency Plan, MOH, NACC and other

stakeholders, in line with the "three ones" principle. APHIA II NAIROBI-CENTRAL/PATHFINDER

INTERNATIONAL 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 100 facility and community based data point staff on the new data

collection/reporting tools and data use for improving program performance, and hold provincial level

quarterly and annual stakeholders' information dissemination meetings. APHIA II Nairobi-Central/Pathfinder

International 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 Nairobi/Central provinces. These efforts should result into demonstrated evidence in increased

national level reporting by up to 60% from health facilities to NASCOP national database

3.CONTRIBUTIONS TO OVERALL PROGRAM AREA

The activity builds on the FY 2006 activities that support the national M&E systems as well as contributing

to the Emergency Plan's training outputs. In overall, the activity will provide technical assistance to forty

local organizations/health facilities in strategic information in addition to supporting the training of 110 SI

and program managers in M&E/HMIS, reporting and data use for program management.

4.LINKS TO OTHER ACTIVITIES

This activity is related to the strategic information activity to be carried out by University of North

Carolina/MEASURE Evaluation (#7098), where MEASURE Evaluation will be supporting NACC in rolling

out COBPAR system for community level reporting. It is also related to the strategic information to be

carried out by NASCOP (#7002), where NASCOP will rolling out Form 726, Form 727 and program specific

client registers for data collection and reporting at health facilities. It is also related to SI TE/TBD (#9220),

that will attempt to investigate the causes for low reporting rate by health facilities and recommend

strategies for achieving 100% reporting level by health facilities.

5.POPULATIONS BEING TARGETED

This activity targets host government workers and other health care workers like M&E and HMIS officers

responsible for data collection, analysis, reporting and use at both health facilities and community level.

Program managers are as well targeted for orientation on the role M&E program management.

6.EMPHASIS AREAS

The major emphasis area is Health Management Information Systems (HMIS) and minor areas include

Monitoring, evaluation, or reporting (or program level data collection) and Other SI Activities.

Funding for Health Systems Strengthening (OHSS): $100,000

THIS IS A NEW ACTIVITY.

1. ACTIVITY DESCRIPTION

USAID APHIA II Central/Nairobi began activities in Central/Nairobi in FY 2006. In FY 2008 APHIA II

Central/Nairobi will work to strengthen the dissemination of key Government of Kenya (GOK) policies and

guidelines, developed at national level, to the district level. In FY 2008 this will include working with the

Ministry of Education and other stakeholders to sensitize teachers about HIV/AIDS prevention and the AIDS

policy for the education sector. In addition APHIA II Central/Nairobi will support provincial and district health

systems strengthening by convening consultative meetings and various stakeholders' forums. The activity

will target to reach at least four of the districts in Central and four of the districts in Nairobi and also train 100

individuals on HIV-related policy development from both provinces.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to strengthening Government of Kenya systems on policy, planning and

budgeting. This will be done by enhancing dissemination and understanding of key government policies

and guidelines, which will be developed or reviewed nationally, out to the districts through provincial

channels.

3. LINKS TO OTHER ACTIVITIES

This activity will link to other APHIA II Central/Nairobi activities, particularly in AB and OP as well as USAID-

OHPS-HPI-TBD-2008 that will be developing and reviewing key policies and guidelines nationally.

4. POPULATIONS BEING TARGETED

This activity will target teachers through activities guided by the Ministry of Education particularly as regards

the dissemination of the AIDS policy for the education sector.

5. EMPHASIS AREAS / KEY LEGISLATIVE ISSUES ADDRESSED

The main emphasis area for this activity will be local organization capacity building via serving to enhance

the management and coordination capacity of district and provincial health management teams in at least

half of the districts in the provinces served by the implementer.