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

REFERENCES TO TARGETS AND BUDGETS

The only change in the narrative is in references to emphasis areas, and provision of mother (mama) packs

to pregnant women to encourage hospital deliveries (because Western province has one of the lowest

hospital delivery rates in the country).

1. LIST OF RELATED ACTIVITIES

This activity links to ARV services (#8826), palliative care (#8931), TB/HIV (#9068), (counseling and testing

services (#8777), Abstinence and Be Faithful (#8994) and Condoms and other prevention activities (#8927).

2. ACTIVITY DESCRIPTION

This activity will continue the expansion of PMTCT services in public sector and faith-based health facilities

in Western Provinces building on the support previously provided through USAID's AMKENI

EngenderHealth, Family Health International IMPACT, the Catholic Medical Mission Board and Elizabeth

Glaser Pediatric AIDS Foundation Call to Action Projects in the region. In most of the facilities across the 10

districts, counseling and testing will be provided to 133,727 pregnant women and antiretroviral prophylaxis

to 10,380 HIV-positive women. Of the positive women, 5190 will receive AZT, 2076 HAART and 3114 single

dose nevirapine for prophylaxis. 5190 infants will be targeted with PCR for early infant diagnosis. Service

delivery will continue to incorporate best practices including the opt-out approach for testing, rapid testing

and appropriate referrals for care, treatment and support. Priority will be given to the provision of integrated

services, including family planning, reproductive health, maternal and child health and the management of

opportunistic infections. Mama packs will be provided to pregnant women to encourage hospital deliveries.

Effective referral linkages will be established to support postnatal follow up of HIV+ mothers and exposed

infants including early infant diagnosis and ART. Significant changes from 2006 will include emphasis on

universal counseling and testing of antenatal clients; the use of more efficacious regimens for ARV

prophylaxis and the establishment of referral linkages for the provision of HIV treatment, care and support

for HIV infected mothers and immediate members of the child's family. As mentioned above emphasis will

also be put on early infant diagnosis, ART for infected mothers, babies and their families, male involvement

and greater involvement of people living with HIV/AIDS as care givers and lay counselors. These program

refinements will improve the geographic coverage for services within the districts and strengthen the service

delivery networks. Emergency Plan funds will be used to increase the supported sites to at least 150 and

train 300 service providers in PMTCT and in HIV stigma reduction. This activity will use the Ministry of

Health's WHO/CDC-based curriculum, comply with Ministry's clinical and reporting guidelines, and

participate in the MOH's Technical Working Group to ensure coordination of activities between the public

and private sectors. Support to infrastructure development, procurement of medical equipment and

improved data collation will enhance service provision. Facilitative supervision by the District Health

Management Teams (DHMT) and innovative deployment of health workers will improve service quality.

Behavior change communication (BCC) activities amongst rural community members will focus on stigma

reduction, psychosocial support, promotion of antenatal care services, facility based deliveries and PMTCT

services. Operations research to determine and test appropriate interventions for HIV stigma reduction

among community members will be conducted.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

PMTCT in this geographical area will significantly support PEPFAR goals for primary prevention and care

by contributing 11% of 2007 overall Emergency Plan PMTCT targets for Kenya. Increase in number of sites

contributes to the program's efforts to achieve district wide coverage for services. Support to high volume

health centers and district hospitals will significantly strengthen networks for PMTCT and PMTCT plus

services. Access to services and linkages to sites where medical treatment and care are provided will

encourage rural women in underserved communities to attend ante natal care services. Subsequently

health workers will be able to plan for post natal follow up of HIV positive women, infants and their family

members. This APHIA II Western activity also contributes substantively to Kenya's 5-year strategy of

encouraging pregnant women to know their status, availing services which can reduce mother-to-child

infections and providing critical links to HIV/AIDS treatment as a step towards preserving the family unit. It

also contributes to the strategy to integrate testing with other health services and improving the referral links

among all of these services.

4. LINKS TO OTHER ACTIVITIES

These activities will link to APHIA II Western CT activities, other prevention, BHCS activities and ARV

services. PMTCT services include counseling and testing which is largely diagnostic, provision of ARV

prophylaxis, and appropriate referrals for the management of opportunistic infections and HIV/AIDS

treatment. This activity will also conduct operations research on stigma reduction.

5. POPULATIONS BEING TARGETED

This APHIA II Western activity targets adults of reproductive health age, pregnant women, family planning

clients, infants, and HIV positive pregnant women. BCC activities will involve community leaders and

community based organizations to increase demand for services amongst community members. Strategies

to improve quality of services will target private and public health doctors, nurses, mid wives and other

health care workers such as clinical officers and public health officers in both public and faith based

facilities.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This APHIA II Western activity will increase gender equity in programming through partnering with women's

groups in the design of community mobilization approaches. The behavior change communication (BCC)

activities will promote a family approach to PMTCT to address male norms, encourage male participation

and help reduce stigma and discrimination. Increased availability of services with appropriate referrals for

PMTCT plus will also reduce stigma.

7. EMPHASIS AREAS

This APHIA II Western activity includes emphasis on human capacity development through training, quality

assurance and supportive supervision within MOH and private facilities to manage and supervise programs.

Support to strategic information will be provided as well as linkages created to family planning, safe

motherhood, malaria and TB programs.

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:

+ prime partner PATH has been competitively selected to implement the activity

+ $200,000 of this activity supports the healthy youth initiative and is programmed with funds from the $7

million FY 08 plus up

+ geographic coverage has been expanded to include all 14 districts

+ the KARHP methodology will be rolled out in collaboration with the Ministry of Education, Ministry of

Health and Ministry of Gender, Sports, Culture and Social Services

+ peer education activities will be rolled out with the Kenya Girl Guides Association

+ AB funds totaling $23,000 will contribute to the sensitization of teachers as a worksite population linking

with additional OP and OHPS funds for a $150,000 activity to reach 750 teachers and train 20 more

+ most-at-risk populations in Malaba and Busia along the Mombasa-Kampala transport corridor will be

targeted with prevention activities using a "cluster" approach

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

(#8927), HIV/AIDS Treatment: ARV Services (#8826), and Counseling and Testing (#8777).

2. ACTIVITY DESCRIPTION

$200,000 of this activity supports the healthy youth initiative and is programmed with funds from the $7

million FY 08 plus up.

APHIA II Western uses both traditional and public channels to reach out to the in-school and out-of-school

youth on AB. These include music, drama, one-to-one counseling and peer education. APHIA will continue

to strengthen KARHP activities in 800 existing schools with one teacher each that has been trained and will

train an additional 400 teachers in 400 new schools in 2008 (100 secondary and 300 primary), making a

total of 1200 teachers trained. (This training will also include a review and dissemination of the Education

Sector Policy for HIV/AIDS.) Each of the teachers trained from these schools will recruit and train 20 student

peer educators totaling 24,000 trained within the school setting. They will pass on AB messages to 5

students each per month for a total of 1,440,000 students reached. APHIA has taken the project to scale by

facilitating formation of provincial youth committees under the auspices of the provincial Director of

Education with technical support of the provincial public health officer and provincial director of youth affairs

for the coordination of youth in-school and out-of-school activities. This committee meets every quarter for

review of activities and progress-monitoring. APHIA II Western has developed a register of schools which

indicates the presence or absence of Straight Talk, Scouts and Girl Guide Clubs or other health clubs as a

way of determining existing structures through which AB messages may be disseminated to youth in

schools. APHIA will also begin to work with the Kenya Girl Guides program and determine how to best

integrate these groups into ongoing APHIA activities such as the teacher/youth program above. Peer

education encourages involvement of the youth in school around health risk behavior by building and linking

with existing structures and encouraging positive adult attitudes and behavior among the teachers and

parents.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA AB in this geographical area will contribute

substantively to the Kenya Five-Year Strategy for primary prevention which puts youth first to protect them

from infection. The child-to-child program provides significant support for appropriate messages to pre-

adolescents and their families.

4. LINKS TO OTHER ACTIVITIES This activity carries forward previously approved activities in the 2006

COP and 2007 COP in Western province, including counseling and testing (#8777), OP (#8927) and ART

(#8826). Community media messages will encourage safer behavior and promote CT.

5. POPULATIONS BEING TARGETED This activity targets girls, boys, adolescents (in and out of school),

adults, and teachers.

6. KEY LEGISLATIVE ISSUES ADDRESSED This activity will address male norms and behaviors, reducing

violence and coercion through peer family programs aimed at changing social norms.

7. EMPHASIS AREAS This activity primarily emphasizes community mobilization/participation through peer

education by youth advocates with a minor emphasis on training of youth, parents and community leaders

as detailed in the activity description in Section 1 above. Local civil society organizations will be

strengthened to carry out these activities, and information, education and communication materials will be

disseminated as appropriate and needed.

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 to all 14 districts in Western Province

+ OP funds totaling $29,000 will contribute to the sensitization of teachers as a worksite population linking

with AB and OPHS funds for a $150,000 activity to reach 750 teachers and train 20 more.

+ APHIA II Western will work with select health facilities, police, uniformed services, opinion leaders and

others on issues of gender-based violence.

+ APHIA II Western will also expand their activities with CSWs and MSMs in Western.

1. LIST OF RELATED ACTIVITIES

This activity relates to all other program area activities for APHIA II Western-PATH: Abstinence and Be

Faithful Programs (#8994), Counseling and Testing (#8777), HIV/AIDS Treatment: ARV Services (#8826),

Orphans and Vulnerable Children (#9073), Palliative Care: TB/HIV (#9068), and especially in the areas of

Palliative Care: Basic Health Care and Support (#8931) and Prevention of Mother-to-Child Transmission

(#8738).

2. ACTIVITY DESCRIPTION

In FY08, APHIA II Western will reach 700,000 individuals with OP messages, train 2,500 people and

distribute condoms through 70 condom outlets. Over the past years APHIA II Western has worked in

partnership with the community in promoting behavior change beyond abstinence and being faithful as well

as demand for HIV/AIDS, RH, TB, MCH, malaria services and gender through multi-prong approaches. In

the COP 08 APHIA II Western will continue to promote dialogue and interaction at the community level,

including ABC. The approach employs the use of Community Health Workers (CHWs) from the district to

the village level. Each CHW conducts a serious of dialogue groups in their community. In COP 08 the

number of village CHWs will increase to 4520. The sub-locational Community Health Workers with the

responsibility of monitoring the Village CHWs will be 188 in number and each will have a maximum of 10

villages linked to them. The project will strengthen and/or form 1760 VHC in COP 08 from the initial 1380

VHC in the previous years. CHWs will make more than 1.5 million contacts with the dialogue groups. In

addition, the health facilities and the CORPS are significant outlets for condom distribution and promotion

and it is the responsibility for the Public Health Office and the sub-locational CORP to ensure that the

condoms are available in the community and during outreaches. The CHWs are recruited within proximity of

the imperative sites to create a referral network between the community and health facilities within the sub-

locations. The CHWs also play an important role in conducting auxillary activities via community linkages

with health facilities and worksites. Family communication will continue to be enhanced through 250 family

discussion groups who will promote HIV/AIDS prevention by utilizing other behavior change beyond

abstinence and being faithful. These peer family facilitators will reach out to a father, mother and 2

adolescent children in each family. In tandem with the faith based organizations 800 older married women

mentors will continue to conduct dialogue groups with young married adolescent women to provide

education on HIV/AIDS, reproductive health, family planning and couple counseling and testing. The

capacity of women groups will also be strengthened through support of their livelihood with the aim of

reducing gender biases and retrogressive cultural norms to enhance their capacity to negotiate for safer

sex. APHIA has expanded its prevention activities to reach out to high risk populations such as low-income

community women; commercial sex workers, beach communities and transport workers. Men will continue

to be targeted through the formal and informal worksite programs. By COP 08, approximately 10 worksites

will be identified with 400 worksite peer educators trained to conduct dialogue groups with employees. In

COP 08, this program will expand to include 5 more companies and 200 more worksite motivators. APHIA

will attempt to target teachers via the worksite program either via teachers unions or learning institutions.

Worksites programs will be complemented with materials for worksites on ABC. Further, 192 youth magnet

theatre members from 24 theatre troupes will be trained or re-trained in ABC to reach out-of-school youth.

The project will continue to facilitate the integration of HIV/AIDS and RH messages in the music festivals

that has reached an estimated number of 120,000 young people in primary and secondary schools. APHIA

will also establish a gender-based violence program in COP 08. This may include the following type of

activities: training of police and local leaders to sensitize and create an improved environment form women

to report GBV or rape; making PEP available at health centers; establishing rape hotlines and ensuring

psychosocial counseling services are made available. All community work will be complemented by a

series of health newsletters and community radio and used as a mechanism of magnifying behavior change

and sharing information. In addition, the continued community work will be supported by a BCC Advisory

Committee that meets regularly, as well as change teams throughout the region who help guide and solicit

improvements in programs, as well as recognize and utilize success stories.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This APHIA Western TBD activity will contribute substantially to the 2007 Emergency Plan risk reduction

strategy. This activity also provides significant support to Kenya's 5-year strategy, KNASP 2006-2010,

which focuses on primary prevention and calls for attention to the increased vulnerability of women.

Through increased access to integrated services with linkages to HIV services, women and other

community members will be encouraged to utilize these services. This activity also provides significant

support to Kenya Essential Package for Health (KEPH) and National Health Sector Strategic Plan 2005-

2010 (NHSSP).

4. LINKS TO OTHER ACTIVITIES

This activity carries forward previously approved 2007 COP activities of APHIA II Western - TBD. The OP

activities link to other all other program area activities for APHIA II Western PATH, including AB (#8994), CT

(#8777), ARV Services (#8826), OVC (#9073), TB/HIV (#9068), and especially in the areas of HBHC

(#8931) and PMTCT (#8738). STI prevention and treatment services form an integral part of PMTCT and

palliative care.

5. POPULATIONS BEING TARGETED

This activity targets adults, family planning clients, pregnant women, people living with HIV/AIDS,

community leaders, doctors and nurses in both public and private sector, other health care providers

namely clinical officers and community-based organizations. It also targets men and women in the work

place, male and female sex workers and their partners and clients, and other high-risk populations including

truck drivers and out-of-school youth.

Activity Narrative:

6. KEY LEGISLATIVE ISSUES ADDRESSED

The behavior change communication activities for STI and HIV prevention will promote gender equity

through partnering with women's organizations in the design and implementation of community activities.

The activity will address male norms and behavior including multiple sexual partners through community

interventions. It will also address issues of stigma and discrimination.

7. EMPHASIS AREAS

The actual emphasis of this APHIA II Western activity will be elaborated during the CA award but will

include community mobilization/participation, training, development of networks and referral systems, and

local organization capacity development. Unallocated funds in the amount of $100,000 will enable APHIA II

Western to expand support in HIV prevention and supportive services among high-risk adults including

commercial sex workers and their clients and transport workers. Programs will target 20,000 adults with

alternatives to sex work as well as protective barriers to HIV transmission, both with commercial partners

and steady boyfriends and husbands. They will train 50 peer educators to work with this target population.

Plus-up funds in the amount of $100,000 will enable APHIA II Western to expand support in HIV prevention

and supportive services where the incidence of victims of gender-based violence is reportedly high.

Through awareness creation, targeted support services integrated with care and support programs, anti-

rape campaigns and education and training for the police in Western province, they will train 50 police,

community leaders and womens groups to reach 120,000 people including youth. Further activities targeting

high-risk youth will be carried out with $100,000. Building on the KAHRP project which targeted in-school

youth, they will utilize a cross-sectoral approach, collaborating with the Ministries of Youth Affairs, of Home

Affairs and of Gender, Sports and Culture. They will target sexually active out-of-school youth in particular,

utilizing community theatre and other interventions. They will train another 100 peer educators and

community leaders to reach 120,000 high-risk youth.

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

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

The APHIA II Western HBHC activities relate to HIV/AIDS Treatment/ARV Services (#9073), TB/HIV care

activities (#9068), AB (#8994), PMTCT (#8738) and Strategic Information (#8855).

2. ACTIVITY DESCRIPTION

In the FY 2008 COP APHIA II Western will continue to provide, and expand, care and support to PLWHA.

Activities will include 1) providing PLWHA and their families with a comprehensive package of home-based

and community support 2) increasing the capacity of public and private health facilities to provide quality

services for the management of opportunistic infections 3) upgrading laboratories in several districts to

improve treatment for opportunistic infections and referrals to comprehensive care centers 4) providing

psychosocial support through facility and community based support groups for PLWHA 5) providing

livelihood support skills to PLWHA and their households through establishment of backyard kitchen

gardening and dairy farming 6) Reduce stigma and encourage positive living through Ambassador of hope

and channel of hope models targeting PLWHA and religious congregations respectively, 7) business skills

training for PLWHA and their households through linkages with community based micro finance institutions

(MFI) and 8) providing organizational capacity building and sub grant 16 CBO/FBO to be able to implement

community based care and support to the PLWHA. EGPAF will ensure that at the facility level,

cotrimoxazole and (where indicated- fluconazole) prophylaxis becomes part of basic standard of care for

HIV infected patients. EGPAF and JHPIEGO will also ensure that the procurement of OI drugs is done at

the central level (as is the case with ARVs). The partner will also ensure that the basic care includes

activities that enhance prevention with positives, as well as active TB screening in all HIV infected patients.

More clients will be linked to ARV and ARV and DOTS adherence will be stepped up in FY 2008. It is

expected that 20,000 HIV positive individuals will be provided with standard basic care, and 180 caregivers

will be trained to provide HIV-related palliative care.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to the FY 2008 Emergency Plan result by increasing the capacity of skilled health

workers to provide care and treatment. It will enable service providers to identify and provide treatment to

the large numbers of HIV infected patients who are potential candidates for ART. Through increased access

to integrated services with linkages to HIV services, women and other community members will be

encouraged to utilize services. It will also contribute to Kenya's 5-year strategy emphases of developing

effective linkages between prevention, care and treatment services within an integrated network. With

respect to mitigation of socio-economic impact, the activity will contribute to the program area through

behavioral change, improve living standards, provide better planning and organizational abilities for income

generating activities (IGAs) productivity through the training provided to them by the project. There will be

reduced stigmatization against HIV/AIDS infected and affected persons reduced where non-infected

recognize the infected persons doing better economically and socially.

4. LINKS TO OTHER ACTIVITIES

This activity is linked to the Basic Care Package TBD (#8849), HIV/AIDS Treatment/ARV Services (#9073),

TB/HIV care activities (#9068), AB (#8994), PMTCT (#8738) and Strategic Information (#8855).

5. POPULATIONS BEING TARGETED Two populations are being targeted: 1) People affected by

HIV/AIDS (including Caregivers, HIV positive children and infants, HIV/AIDS-affected families and People

living with HIV/AIDS) and 2) Groups/Organizations (including community-based organizations, country

coordinating mechanisms and faith-based organizations. The clients are members of financial services

associations (FSA) or other organized groups such as post test clubs or Home based care groups in each

district.

6. KEY LEGISLATIVE ISSUES ADDRESSED

The main legislative issue is the reduction of Stigma and Discrimination of PLWHAs by improving their

health and increasing the possibility of returning to work to contribute to their families' welfare. This activity

will increase gender equity ensuring better coverage of women and children who are more

disproportionately affected by HIV/AIDS. There is a wrap around for food and microfinance/micro credit.

7. EMPHASIS AREAS

The area of major emphasis is the Development of Network/Linkages/Referral Systems by building

providers' capacity to offer high quality clinical palliative care and support services, and by reinforcing

quality assurance linkages with the Ministry of Health. Minor emphasis includes Quality Assurance and

Supportive Supervision, Training and Linkages with Other Sectors and Initiatives by strengthening systems

to link clients to other HIV/AIDS resources, including home based and psychosocial care.

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

REFERENCES TO TARGETS.

1. LIST OF RELATED ACTIVITIES

This activity links with other HVTB activities by Indiana University (#6900) as well as other USG partners.

These activities are linked with activities in HTXS (#8826), HBHC (#8931), PMTCT (#8738), and OVC

(#9073).

2. ACTIVITY DESCRIPTION

APHIA II Western will continue to provide technical assistance to a majority of health facilities within all

districts in Western Province, providing TB and HIV collaborative services. This assistance will increase

management, as well as technical, capacity of staff at these sites improving quality and productivity. The

COP 2007 APHIA II activities are to provide TB diagnostic and curative services as well as cross referral to

HIV care services. With increased emphasis on Provider initiated testing and counseling, it is expected that

all TB clinics should offer HIV testing to all their clients. The detailed 2008 activity will be determined

through discussions with the District and Provincial Health Management teams. However, it is imperative

that the 2008 COP activity will consolidate past assistance, taking them forward in terms of improved

programming through innovation, expansion and integration with other program areas. It is expected that

Intensified TB screening for 10000 HIV patients and HIV screening for 2000 TB suspects/patients will be

offered as a standard of care in all the facilities; approximately 1000 TB patients will be identified as being

infected with both TB and HIV in about 32 sites. In 2008, the APHIA II Western will continue to support the

training of staff in various skills in TB/HIV management. The local health ministry will be supported to

supervise facilities and providers towards enhancing quality of care. At all the ART sites, point persons for

provider-initiated testing and counseling are to be in place by the end of COP 2007. These shall continue to

be empowered to coordinate the testing activities at the various entry points including TB clinics within the

facilities.

The APHIA II Western will continue to participate in the Ministry of Health's (MOH) Technical Working

Group to ensure coordination of site selection, project activities, monitoring and evaluation and linkages

between these sites. They will comply with MOH clinical and reporting guidelines and will use the national

training curriculum. APHIA II Western will also support each of the 14 districts to carry out Quality

assurance for sites.

In FY 2008 activities will ensure active TB screening for HIV infected patients, HIV testing for TB patients

will be intensified, emphasis on Cotrimoxazole prophylaxis for all HIV infected TB clients, piloting of ART in

TB clinics, and an increase in the number of sites that can appropriately do IPT. As a result of the 2008

activity, it is expected that 2,000 new clients will be provided with TB/HIV services and a 100 of service

providers trained to provide these services. Diagnostic HIV testing for all TB patients will be on an "opt out"

principle. Guidelines on HIV testing and universal precautions - consent, confidentiality and counseling - will

be observed as part of standard universal practice

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This APHIA II Western activity will provide clinical prophylaxis and treatment for TB to 2,000 people, thus

contributing to the national TB/HIV targets, and train 100 health workers in TB/HIV related activities in 10

health care facilities in Western Province. These set of activities will contribute to the results of strengthened

delivery of integrated HIV and TB services, including strengthened referral systems, improved diagnostics

and treatment of TB among HIV-positive patients and of HIV in TB patients, and strengthened capacity of

health workers to provide integrated HIV and TB services. APHIA II Western activities will contribute to the

2008 Emergency Plan result for increased availability of TB/HIV services. It will enable service providers to

identify the large numbers of HIV infected patients who are potential candidates for TB treatment and vice

versa. It therefore contributes to Kenya's 5-year strategy emphases on improved case detection and

treatment for TB plus enhancing the linkage to HIV care and treatment.

4. LINKS TO OTHER ACTIVITIES

This activity links with other HVTB activities by Moi University School of Medicine Network (#6900) as well

as other USG partners. These activities are linked to all other APHIA II Western program areas such as

HTXS (#8826), HBHC (#8931), PMTCT (#8738), and OVC (#9073) in Western Province.

5. POPULATIONS BEING TARGETED

General population, Health workers, PLWHA with dual TB/HIV infections.

6. KEY LEGISLATIVE ISSUES ADDRESSED

Increased availability of CT in clinical settings and increased access to HIV-related care for TB patients will

help reduce stigma and discrimination.

7. EMPHASIS AREAS

Major emphasis is training, with minor emphases in Community mobilization/participation, development

referral systems, local organizations capacity development, and IEC. APHIA II Western with these

additional Plus Up funds will intensify provider-driven DCT in health care settings seeking to enhance

testing in TB diagnostic centres that currently do not provide ART services. These facilities are largely

health centres and dispensaries that offer TB diagnostic services but are not providing ART. HIV positive

patients identified via these activities will be referred to nearby treatment sites. This will complement the

current DCT program that has intensified testing in facilities where both TB and ART services are provided

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

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in counseling and testing (#8777), TB/HIV (#9068), PMTCT (#8738) and

Palliative Care: home based care (#8931).

2. ACTIVITY DESCRIPTION

The majority of Kenya's 1.7 million orphans, having lost one or more parents to AIDS, live in precarious

conditions. OVC are frequently left behind in terms of education, life skills, access to health services and

nutrition, and they are at greater risk of HIV infection and domestic violence. The FY 2007 COP activity

addressed OVC needs within the context of the six essential elements of OVC support. These essential

services were agreed upon by all stakeholders and include: nutrition, education, health, protection,

psychosocial support, basic material needs and livelihood capacity building. In order to ensure an agreed

upon level of quality for each of these services, all seven are being defined by the OVC ITT and OVC

PEPFAR stakeholders. The FY 2006 focus of AED/Speak for the Child Program was to train household

mentors through community based organizations to support OVC. AED has implemented global health

programs for more than 30 years and planned to work with existing local implementing partners in the new

districts to enroll new OVC and extend services to older OVC. In its scale up AED/Speak for the Child

program selected experienced community based organizations (CBOs) with extensive outreach to OVC.

CBOs were to recruit and train household mentors in the SFC program, establish school, health clinic, and

pharmacy agreements and procure commodities. Trained mentors visit households weekly to facilitate

household problem-solving with caregivers on issues of health, nutrition, and psychosocial care. In FY 2006

COP, the COPHIA activity applied approaches and activities to include: a Community Health Worker role in

monitoring health; training service providers in pediatric HIV/AIDS; strengthening linkages to specialized

pediatric services; 2-way clinic-community referrals; vocational training; provision of uniforms, books and

shoes; linking secondary students to bursaries; nutrition education; food production; income generating

activities; training teachers in child counseling; support to community based counselors, paralegals and

support groups; obtaining clothing and housing improvements; and involving the community for improved

linkages with relevant services. The FY 2006 COP focus for World Vision Kenya activity included training of

church leaders, traditional birth attendants, youth peer educators, community psychosocial counselors,

PMTCT service providers and community based organizations/faith based organizations (CBO/FBO) staff in

providing HBC, supporting voluntary counseling and testing (VCT) services, providing food aid and

treatment of infections for needy HIV-positive orphans and vulnerable children (OVC), life skills training for

older OVC, micro-enterprise development for foster families and assisting with the payment of OVC school

fees. This FY 2008 COP APHIA II Western activity will continue the expansion of support for orphans and

vulnerable children in Western Province, building on the support previously provided through USAID's

World Vision, COPHIA, and AED projects. The detailed activity will be enunciated through discussions with

the consortia that will be awarded the cooperative agreement.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

The FY 2008 activities will reach 42,500 OVC and train 4,250 caregivers. The APHIA II Western will

respond to the National OVC Action Plan by mobilizing communities, building family and community

capacity to protect and care for OVC, and improving access to health, education, food and shelter. The

APHIA II Western will ensure that GOK policies and guidelines are utilized and communicated, and staff

participates in national level HIV Technical Working Groups.

4. LINKS TO OTHER ACTIVITIES

OVC activities are an element of home and community support. Prevention is a cross-cutting theme. CHWs

link clients with PMTCT, ART and non-ART services and provide follow-up. This activity is linked to the

APHIA II for Palliative Care: home and community support (#8931), counseling and testing (#8777), TB/HIV

(#9068), and PMTCT (#8738).

5. POPULATIONS BEING TARGETED

Individuals infected and affected by HIV/AIDS, OVC - especially the girl child and caregivers. By focusing on

building the local capacity of caring for the OVC efforts will also target community and religious local leaders

as well as partnering with community and faith based organizations.

6. KEY LEGISLATIVE ISSUES ADDRESSED

Increased gender equity in HIV/AIDS will be addressed by ensuring the girl child receives equitable OVC

services. Wrap around services in the area of food and education will also be addressed by building the

local capacity along other existing community institutions in serving the needs of the OVC.

7. EMPHASIS AREAS

Major emphasis area is in development of network/linkages

referral and minor emphasis is training and community mobilization as well as in local organization capacity

and development.

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 Western

Province

+ target population will be expanded to include OVCs

+ APHIA II Western will expand counseling 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 (#8826), Abstinence and Be Faithful

Program (#8994), OVC (#9073), HBHC (#8931), HVTB care activities (#9068), OP (#8927), PMCT (#8738),

and strategic information (#8855).

2. ACTIVITY DESCRIPTION

In 2008, through APHIA II Western, it is expected that 150,000 individuals will receive CT services in 50

sites and 300 providers trained. USG has previously supported HVCT activities in Western Kenya through

USAID projects. In 2006 COP, USAID's APHIA II TBD activity was funded to build on activities approved in

2005 and implemented through World Vision. The activity aimed at increasing access to VCT services,

particularly among underserved and hard-to-reach populations in a few districts in Western Kenya by

forging partnership with community-based organizations (CBOs) and faith-based organizations (FBOs) to

mobilize communities for VCT and make appropriate referrals to MOH-supported Specialist Centers

(clinics). The facilities also offered diagnostic counseling and testing services, and treatment including

ARVs. The second assistance was through the FY 2006 USAID'S ACCESS project implemented by

JHPIEGO. The main aim of the activity was to continue to promote the availability and delivery of high

quality counseling and testing services in public Ministry of Health (MOH) facilities. The MOH's National

Guidelines for Counseling and Testing in clinical and medical settings were to be disseminated in selected

districts of Western Province and orientation provided to about 100 health workers. Subsequently these

health workers would give service orientation to 500 health workers using a cascade on-the-job (OTJ)

approach. The activity would promote the availability of diagnostic counseling and testing (DCT) in Ministry

of Health facilities and strengthen referrals and linkages to care, treatment, and prevention. The third

previous support was through the 2006 APHIA II TBD activity that consisted of activities approved in 2005

and implemented through FHI/IMPACT. The 2006 APHIA II TBD activities was to provide counseling and

testing services through existing static sites, expanded testing in clinical settings, and increased outreach

services. Increasing access to antiretroviral therapy dictates that CT efforts quickly transform to

accommodate active case finding through provider initiated testing (PIT) in clinical settings, in addition to the

more passive client initiated testing (CIT). The activity was to ensure that existing integrated VCT sites are

used to support these efforts in the interim but strengthened to support DTC efforts (e.g. supporting start up

activities, providing testing for partners and other family members of index patients, providing ongoing

counseling, providing bedside counseling, consolidating CT returns, and managing HIV test kit supplies etc)

in the future. The detailed 2007 activity will be determined through discussions with the consortia that will be

awarded the cooperative agreement. However, it is imperative that the 2007 COP activity will consolidate

these past assistance, taking them forward in terms of improved programming through innovation,

expansion and integration with other program areas. It is expected that 40,000 individuals will receive CT

services in about 40 sites and about 100 providers trained.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to the 2007 Emergency Plan result for increased availability of diagnostic

counseling and testing through training of health workers. It will enable service providers to identify the large

numbers of HIV infected patients who are potential candidates for ART. It therefore contributes to Kenya's 5

-year strategy emphases of encouraging Kenyans to learn their status and developing strong links between

counseling and testing and HIV services for those who are HIV positive and in need of health care.

4. LINKS TO OTHER ACTIVITIES

THIS ACTIVITY CARRIES FORWARD PREVIOUSLY APPROVED ACTIVITIES, MAINLY APHIA II TBD IN

2006 COP. This activity links with the APHIA II Western Counseling and Testing activities will relate to

HIV/AIDS treatment services (#8826), Abstinence and Be Faithful Program (#8994), HKID (#9073), HBHC

(#8931), HVTB care activities (#9068), OP(#8927), PMCT (#8738), and strategic information (#8855)

5. POPULATIONS BEING TARGETED

This APHIA II Western TBD activity will target the general population: adult men and women of reproductive

age, and HIV/AIDS-affected families, underserved and hard-to-reach populations, particularly in rural

communities. It will also target MOH staff including program managers in the NASCOP, public health care

doctors and nurses, other health care workers including community health workers and non-governmental

organization.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will help to reduce stigma associated with HIV status by increasing the availability of routine

testing for diagnosis in medical settings. Gender is a key legislative issue addressed in this activity. This

includes activities supporting counseling that challenges norms about masculinity, delayed sexual activity

and reduced multiple sex partners for boys and men and transactional sex. The activity also include support

for testing and support services for victims of sexual abuse and violence, training on couple counseling, risk

assessment, stigma reduction, and supporting women to mitigate potential violence.

7. EMPHASIS AREAS

The major emphasis is on community mobilization and participation with minor emphases on development

of network/linkages/referral systems, local organization capacity development, and quality assurance and

supportive supervision. The minor emphasis is the development and implementation of referral systems,

quality assurance and supportive supervision for CT counselors. Another minor emphasis is in the area of

training.

N/A (exempt)

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

REFERENCES TO TARGETS AND BUDGETS.

The only changes to the program since approval in the 2007 COP include 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 level have also

changed.

1.LIST OF RELATED ACTIVITIES

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

Carolina/MEASURE Evaluation (#7098), strategic information activity to be carried out by NASCOP (#7002)

and strategic information TE/TBD (#9220).

2.ACTIVITY DESCRIPTION

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

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

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

through 3 key components. Component 1: Support APHIA II WESTERN /TBD and MOH program data

collection processes for performance reporting needs (quarterly, semi-annual, annual). This component will

support a participatory, coordinated and efficient data collection, analysis, use and provision of information

to track achievement of APHIA II WESTERN /TBD and MOH's district level Annual Operation Plan II

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

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

being rolled out by NACC and NASCOP. The component will support APHIA II WESTERN /TBD and MOH

to measure progress towards its contribution to the overall country's Emergency plan, National Health

Sector Strategic Plan II and Kenya National HIV/AIDS Strategic Plan goals and results frameworks. Specific

activities will include building capacity of 40 local organisations and facilities to collect, report, analyse, and

use both routine facility and non-facility data for planning and program improvement. Component 3: Take

lead role in coordinating M&E activities in the province to meet the information needs of USAID/Kenya, the

Emergency Plan, MOH, NACC and other stakeholders, in line with the "three ones" principle. APHIA II

WESTERN /TBD will organize district-level consensus building forums on M&E issues, distribute

standardized data collection and reporting tools, conduct regular data quality assurance processes at all

data generation points, train 120 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 Western/TBD will be held

accountable for tangible results, especially in increased use of harmonized data collection and reporting

tools at health facilities developed by MOH, increased data use in planning and at dissemination workshops

to various stakeholders, increased supportive-supervisory visits and routine data quality assessments at all

data collection points by M&E/HMIS officers, and improved coordination of M&E activities in Western

province. These efforts should result into demonstrated evidence in increased national level reporting by up

to 60% from health facilities to NASCOP national database.

3.CONTRIBUTIONS TO OVERALL PROGRAM AREA

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

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

five local organizations/health facilities in strategic information in addition to supporting the training of 75 SI

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

4.LINKS TO OTHER ACTIVITIES

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

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

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

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

specific client registers for data collection and reporting at health facilities. It is also related to SI TE/TBD

(#9220) that will attempt to investigate the causes for low reporting rate by health facilities and recommend

strategies for achieving 100% reporting level by health facilities.

5.POPULATIONS BEING TARGETED

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

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

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

6.EMPHASIS AREAS

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

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

THIS IS A NEW ACTIVITY.

1. ACTIVITY DESCRIPTION

USAID APHIA II Western began activities in Western in FY 2007. In FY 2008 APHIA II Western 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 Western 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

eight districts in the province and seek to train at least 40 individuals on HIV-related policy development.

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 Western 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 province served by the implementer.