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
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:
+ Increased emphasis on provision of comprehensive PMTCT services in the lower level facilities and
strategies to increase the uptake of HIV testing and counseling to male partners of women attending ANC
services.
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
This activity supports key attributions in human capacity development through the training of health care
service providers on PMTCT and other HIV prevention and care topics in order to equip them with
knowledge and skills to provide quality PMTCT services. These service providers include doctors, nurses,
counselors, clinical officers, nutrition officers, social workers and health record clerks.
COP 2008
1. LIST OF RELATED ACTIVITIES
This activity relates to activities in Counseling and Testing and HIV/AIDS Treatment: ARV Services.
2. ACTVITY DESCRIPTION
IRC will continue to support implementation of PMTCT of HIV to the refugee population and surrounding
local population in Kakuma, Lokichoggio and Kalokol areas of the Turkana district in Rift Valley Province.
Though the HIV prevalence in this region is relatively lower than the rest of the country, estimated at 0-1%
among women attending antenatal clinic services, the area is greatly underserved. Turkana district is an
arid, vast and remote land with poor infrastructure, limited social services and high poverty rates. The total
population of the target area is 625, 475 people (of which 212,662 or 34% are refugees). IRC is one of the
very few agencies working towards enabling this community to access HIV care and support services. In FY
2009, the program will continue supporting implementation of PMTCT services in the current four facilities
covering all of Turkana District, and will provide HIV counseling and testing to 13,969 (56%) of 25,019
pregnant women and provide a complete course of antiretroviral prophylaxis to 866 (69%) of 1,251 HIV-
positive women. Of the 935 women half of them or 468 will receive AZT from 28weeks followed by AZT,
3TC and NVP prophylaxis during labour, and AZT plus 3TC for one week thereafter, while 187 women will
receive HAART. The rest, 280 will receive single dose nevirapine only. IRC will continue to strengthen
follow up and care of the HIV infected-exposed mother infant- pairs through the Comprehensive PMTCT
framework, and will continue to support improved service delivery data management in line with the
standardized Ministry of Health (MOH) reporting tools. 3739 spouses of the pregnant women will be
reached with CT services. IRC supports the implementation of PMTCT activities as part of the
Comprehensive HIV/AIDS prevention and care program in Kakuma Refugee Camp and the surrounding
region in Turkana District under the umbrella of the UNHCR, and works with the local African Inland Church
in the expansion of services to the local community. Using this platform, the program will continue to
support the follow up of HIV-positive women and their infants in the postnatal period through strengthening
postnatal care services at facility level to include improved access to Family Planning services. The current
package of care for the mother includes regular follow up, linkage to family planning services, OI
prophylaxis and counseling on correct infant feeding practices; infant additional care activities include OI
prophylaxis using Co-trimoxazole starting at six weeks of age, and DBS for HIV- PCR (Early Infant HIV
Diagnosis-EID). The program will target 935 HIV exposed infants for DBS, and will work with the HIV/AIDS
treatment program to ensure linkage to pediatric HIV care services for all eligible infants. The program will
support the training of 50 service providers on PMTCT including lay counselors and Community Health
workers.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will contribute to PEPFAR goals for primary prevention and care by contributing 1.4% of overall
2009 Emergency Plan targets for Kenya in meeting the health needs of women in this special group
(refugee setting).
3. LINKS TO OTHER ACTIVITIES
This activity links to IRC activities in HIV ART and care services, Counseling and testing services and
Palliative Care: TB/HIV care services. The program will establish clear linkages to ensure that all HIV-
positive pregnant women and HIV infected infants' access HIV care and treatment services, as well as
access TB screening services and treatment where eligible. The program will also encourage male partner
testing and will work with CT services to achieve this objective.
4. POPULATIONS BEING TARGETED
This activity targets children under five years, Adolescents aged 15-24, adults, discordant couples, people
living with HIV/AIDS, pregnant women, and refugees/internally displaced persons.
5. EMPHASIS AREAS /KEY LEGISLATIVE ISSUES ADDRESSED
This activity will increase gender equity in HIV/AIDS programs through providing PMTCT of HIV services to
pregnant women and their partners. This activity also includes emphasis on In-service training, Family
planning and safe motherhood by addressing the reproductive health needs of women accessing PMTCT
services. Programme managers and health care providers will identify, analyse and describe gender-related
issues that affect HIV transmission and MTCT. Gender related issues such as involvement of men and
gender-based violence will be targeted to increase programme equity and improve PMTCT.
6. COVERAGE AREA
The geographical focus for this activity is the Kakuma Refugee Camp and selected Faith based facilities in
the surrounding region of Turkana District in Rift Valley Province.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14840
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14840 4150.08 HHS/Centers for International 6956 305.08 $80,000
Disease Control & Rescue
Prevention Committee
6911 4150.07 HHS/Centers for International 4235 305.07 $50,000
4150 4150.06 HHS/Centers for International 3225 305.06 $30,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Family Planning
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $20,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
+ IRC will also integrate specific messages targeting adult men and women and the reduction of multiple
concurrent partners into their AB program.
+ IRC will also target rural older men and women above the age of 45 in their AB programs in the larger
Turkana Districts that host the Kakuma Refugee Camp.
This activity relates to activities in Counseling and Testing (#6912), Condoms and Other Prevention
(#6910), Prevention of Mother-to-Child Transmission (#6911), Palliative Care: Basic Health Care and
Support (#6909) and HIV/AIDS Treatment: ARV Services (#6914)
2. ACTIVITY DESCRIPTION
The International Rescue Committee (IRC) will provide abstinence and Be Faithful education to 48,099
refugees and members of the host community and train 200 people to deliver AB education. As the sole
implementing partner for the health sector in Kakuma under the UNHCR umbrella since 1997, IRC will
continue implementing a comprehensive prevention, care and treatment program in Kakuma Refugee
camp, targeting a population of 271,000 people in the areas Kakuma, Lokichoggio and Kalakol, of which
91,000 are refugees. IRC will intensify community involvement by training refugee counterparts as
volunteers to provide the services to the community. Intensive community mobilization activities will be
carried out as part of health outreach services to educate the community on the benefits of AB in HIV
prevention. In line with its new strategy, IRC will strengthen the capacity of local partners such as the
African Inland Misison and the Kakuma Mission to undertake components of activities previously solely
implemented by IRC. IRC has so far trained a community resource pool of religious and community leaders
and refugee volunteers to deliver prevention interventions. These volunteers will receive update training to
acquire participatory skills that would enhance greater community participation. The community outreaches
will be carefully segmented so that age-appropriate interventions are delivered. In line with this, age
appropriate information, education and communication (IEC) materials will be developed and utilized within
the population. Young refugees separated from their families will be a special target as there are many
unaccompanied youth and young adults in the camp, commonly referred to as the Lost Boys of Sudan.
These unaccompanied youth will be involved in activities that provide a peer support mechanism such as
youth clubs. Comprehensive youth centers established through other partner support will be utilized for
targeted youth interventions. Parents and supportive adults will be involved in selected program activities to
enable them support youth in adopting safer sexual behavior. Activities for in-school youth will be developed
and the teachers involved in delivering AB messages as well. Youth will be trained in participatory
approaches such as magnet theatre. This activity will also target humanitarian aid workers in Kakuma and
Lokichoggio through a workplace intervention. These workers are usually separated from their families for
long periods of time, rendering them vulnerable to concurrent and other forms of multiple partnerships. IRC
has been operational in Kenya since 1992, focusing initially on health outreach activities in Kakuma
Refugee Camp. Currently there are approximately 16,000 individuals infected by HIV in Turkana
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
These activities are consistent with the Kenya Five-Year Strategy which focuses on HIV prevention in youth
and will work with to provide a supportive adult environment that will reach the youth and young married
persons from amongst the 48,099 beneficiaries with AB messages and train 200 to deliver this education.
4. LINKS TO OTHER ACTIVITIES
IRC is implementing a comprehensive program in the Kakuma refugee camp, with links to IRC's OP activity
(#6910); IRC CT activity (#6912); IRC PMCT activity (#6911); and IRC Care and treatment activities
(#6909) and (#6914). Youth and young married people are served through these other program activities as
appropriate through a strengthened referral system inside Kakuma camp. In the two host community sites at
Lokichoggio and Kalokol, this activity links to CT and OP where integrated outreaches are conducted.
5. POPULATIONS BEING TARGETED
This activity will provide a major focus on younger children and youth ages 10 to 18 both through primary
and secondary schools as well as men and women of reproductive age. It will target mobile populations
including the refugee and the nomadic host communities. Many of the young people living in the refugee
camp have had their educations disrupted and can be considered out-of-school youth. Community leaders,
program managers, religious leaders and refugee counterpart volunteers will be targeted. In-school
programs will closely work with teachers.
6. KEY LEGISLATIVE ISSUES ADDRESSED
The primary legislative issue addressed in this project is increasing gender equity in HIV/AIDS programs as
well as addressing male norms and behaviors. It will focus on reducing violence and coercion particularly
sexual violence affecting young girls and women in a refugee camp setting.
7. EMPHASIS AREAS
This activity has a major emphasis on human resources and a minor emphasis on community mobilization,
information, education and communication, local organizational capacity development and training as
detailed in the activity description above. It will also work towards developing networks and linkages
between local organizations and various service segments. IRC will work with local community leaders to
strengthen local organizational capacity. The factors that increase project costs include the insecurity,
isolation, distance between locations, severe lack of infrastructure in the district, difficulty in recruiting and
retaining qualified staff, and higher staff salaries to compensate for the hardship location. Project costs
reflect the current lack of local capacity and need to build sustainable partnerships with local partners.
Continuing Activity: 14841
14841 4805.08 HHS/Centers for International 6956 305.08 $192,500
6913 4805.07 HHS/Centers for International 4235 305.07 $150,000
4805 4805.06 HHS/Centers for International 3225 305.06 $75,000
* Addressing male norms and behaviors
Table 3.3.02:
+ IRC will continue to expand their AB interventions to include specific messaging targeting adult men and
women specifically with the objective to reduce the number of multiple concurrent partners in both the
Kakuma Refugee Camp and in the larger host community.
This activity relates to activities in Abstinence and Be Faithful Programs (#6913), Counseling and Testing
(#6912), Prevention of Mother-to-Child Transmission (#6911), Palliative Care: Basic Health Care and
Support (#6909) and HIV/AIDS Treatment: ARV Services (#6914).
Founded in 1933, the International Rescue Committee (IRC) is a leading non-sectarian, voluntary
organization providing relief, protection and re-settlement services for refugees and victims of oppression or
violent conflict. IRC is committed to freedom, human dignity and self-reliance. This commitment is reflected
in well-planned resettlement assistance, global emergency relief, rehabilitation and advocacy for refugees in
33 countries around the world 21 offices in America that assist resettling refugees. IRC has been
operational in Kenya since 1992, focusing initially on health outreach activities in Kakuma Refugee Camp
(KRC); from 1997, IRC became the sole implementing partner for the entire health sector in KRC, under the
operational umbrella of UNHCR. With additional support from CDC, IRC started the implementation of an
HIV/AIDS prevention and care program in Turkana District in KRC in September 2001 and in Lokichoggio
(Loki) in February 2004 and Kalakol July 2005. Turkana district is an arid, vast and remote land where
government infrastructure and social services are weak, poverty is high, and local pastoralists exist only
with great difficulty. The total population of the target areas (Kakuma, Lokichoggio and Kalakol) for this
program is 271,000 people (of which 91,000 are refugees). Currently there are approximately 16,000
individuals infected by HIV in Turkana, of which less than 1% are receiving any form of care and support.
IRC is one of the few agencies working to meet these needs. The International Rescue Committee (IRC)
will continue a comprehensive HIV prevention and care program for refugees and the host population in the
Kakuma refugee camp, and in Lokichoggio and Kalokol in northeastern Kenya. IRC will enhance community
involvement and mobilization, capacity building of partners and IRC staff, involvement of PLWHAs to foster
a partnership between different players to ensure a sustainable prevention program. Messages promoting
condoms and safer sexual behavior will reach 60,000 refugees, nomads, and humanitarian workers. 232
persons will be trained in the delivery of effective HIV prevention services. 70 condom outlets will be
established. Young refugees separated from their families will be a special target as there are many
unaccompanied youth and young adults in the camp, commonly referred to as the Lost Boys of Sudan. An
important focus on the OP activity will be Positive prevention. Targeted interventions such as STI screening
and treatment for individuals with HIV and their partners as well as behavioral interventions for individuals
with HIV will be provided so that the project puts considerable prevention efforts to persons with HIV. This
activity will link closely with counseling and testing that will actively promote knowledge of sero-status as the
first step to positive prevention.
60,000 at risk persons will be reached. 232 people will be trained and 70 condom outlets established.
IRC is implementing a comprehensive program in the Kakuma refugee camp, with links to International
Rescue Committee AB activity (#6913); International Rescue Committee CT activity (#6912); International
Rescue Committee PMCT activity (#6911); International Rescue Committee ARV Services activity (#6914);
and International Rescue Committee HBHC activity (#6909).
The activities implemented by IRC in this program area will work to prevent HIV infection among adult men
and women, most at risk populations including refugees, humanitarian aid workers and transport workers
transiting to southern Sudan (a form of migrant workers), underserved and nomadic populations of Turkana
district, and commercial sex workers and their clients. Many of the young people living in the refugee camp
have had their educations disrupted and can be considered out-of-school youth. IRC will work with local
community organizations and community, program, religious leaders and refugee counterpart volunteers. It
will also target the Turkana host community, a largely rural community. People living with HIV/AIDS will also
be targeted as well as varied cadre of public health care workers both within and outside the refugee
camps.
The primary legislative issue addressed in this project is addressing gender equity in HIV/AIDS programs,
addressing male norms and behaviors and reducing violence and coercion, particularly sexual violence
affecting young refugee girls and women.
This activity includes major emphasis on human resources and minor emphasis on community mobilization/
participation, development of network systems, information education and communication and training as
detailed in the activity description above. The factors that increase project costs include the insecurity,
reflect the current lack of local capacity and need to provide trainings and other capacity building support to
partners in the district.
Continuing Activity: 14842
14842 4149.08 HHS/Centers for International 6956 305.08 $132,500
6910 4149.07 HHS/Centers for International 4235 305.07 $125,000
4149 4149.06 HHS/Centers for International 3225 305.06 $175,000
Refugees/Internally Displaced Persons
Table 3.3.03:
+ New activity emphasis on prevention with positives among patients coming for care and treatment
This activity relates to activities in Adult ARV Services, Pediatric Care and Support, Pediatric ARV Services,
TB/HIV, Counseling and Testing, and PMTCT.
International Rescue Committee (IRC) will maintain and scale-up the provision of palliative care services to
2,000 HIV-infected adults at 5 sites (Kakuma refugee camp, Kakuma Mission hospital, Kalokol, Lokichoggio
and Lodwar District Hospital) in Turkana District, Rift Valley Province, targeting both refugees and the local
population. Turkana District, the largest district in Kenya, is home to a pastoralist community that is livestock
dependent, highly mobile, and has extremely limited access to health services, especially those for
HIV/AIDS. The district lies on the main truck route between Mombasa and the relief operations in
northwestern Kenya and southern Sudan (via Lodwar, Kakuma, and Lokichogio). Lokichogio is the main
transit center for refugees from Sudan and a base for provision of refugee services. The area is remote,
with a population characterized by high rates of absolute poverty and food poverty. General health services
are limited and poorly distributed throughout the district. IRC will support a package of services that includes
clinical evaluation and laboratory monitoring, provision of cotrimoxazole prophylaxis, treatment of
opportunistic infections, nutritional support and improved access to safe drinking water and malaria
prevention interventions. Fifty health care workers will also be trained to provide palliative care services.
IRC will build on established programs that are currently providing care for people with HIV at health centers
within the refugee camps to provide treatment for refugees. It will also build upon existing collaborative
relationships with health facilities supported by the Africa Inland Church and Catholic Diocese to provide
treatment for the local population. They have a strong relationship with the local mission hospital, relying on
the hospital for operating theatres, OB/GYN care, and other services. They are already collaborating with
the mission hospital to build capacity related to provision of basic health services for adults living with HIV.
IRC will expand care programs by providing technical support, supporting staff salaries, training staff,
conducting laboratory evaluation, and providing adherence counseling and monitoring. IRC has been
implementing an HIV/AIDS prevention program and outreach to hard-to-reach populations and rural
communities in this area since September 2001. The IRC is still uniquely suited to provide care in refugee
situations and remote areas. They will continue to build on very substantial existing medical capacity in the
camps. Targets are modest because of the extreme remoteness of these areas, and the challenges
associated with conducting activities in the refugee camps.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA.
These activities will contribute to expansion of access to IRC-supported palliative care services for adults
with HIV, strengthened human resource capacity to deliver adult ARV treatment, and a strengthened
referral network for provision of ART.
These activities will link to adult ARV treatment services, pediatric ARV services, pediatric care and support,
Counseling and Testing services, and PMTCT provided by IRC, and ARV scale up supported through
National AIDS and STD Control Program.
This activity targets refugee local populations, especially adults living with HIV/AIDS. HIV rates are high
among the locals in Turkana. Although the prevalence of HIV is lower in the refugee populations, HIV
infection is now the leading cause of adult death in this group. IRC is mindful of concerns related to
continuation of care in the event of repatriation and has the appropriate collaborations in place to facilitate
access continued care for repatriated refugees.
This activity addresses legislative issues related to provision of care and treatment for refugee populations
and stigma and discrimination.
This activity includes minor emphasis in commodity procurement, human resources, local organization
capacity building, community mobilization, quality assurance and supportive supervision, logistics, and
training.
Continuing Activity: 14843
14843 4148.08 HHS/Centers for International 6956 305.08 $200,000
6909 4148.07 HHS/Centers for International 4235 305.07 $100,000
4148 4148.06 HHS/Centers for International 3225 305.06 $62,000
Table 3.3.08:
ACTIVITY UNCHANGED FROM COP 2008
This activity relates to activities in Palliative Care: Basic Health Care and Support, Counseling and Testing,
and PMTCT.
International Rescue Committee (IRC) will maintain and scale-up existing HIV prevention, care, and
antiretroviral treatment services serving both refugee and local populations in Turkana District, Rift Valley
Province, Kenya. ARV services will be offered at 5 sites in Kakuma refugee camp, Kakuma Mission
hospital, Kalokol, Lokichogio and Lodwar District Hospital in Turkana District, Rift Valley to 1,300 adults with
advanced HIV infection, including 500 new patients (bringing the total ever provided with services to 1,560);
additionally, 50 health care workers will be trained. Turkana District, located in Rift Valley Province, is the
largest district of Kenya, and is home to a pastoralist community which is livestock dependent, highly
mobile, and has extremely limited access to health services, especially HIV/AIDS services. The district lies
on the main truck route between Mombasa and the relief operations in northwestern Kenya and southern
Sudan via Lodwar, Kakuma, and Lokichogio. Lokichogio is the main transit center for Sudanese refugees
and a base for provision of refugee services. The area is remote, with a population characterized by high
rates of absolute poverty (74%) and food poverty (81%). General health services are limited and poorly
distributed throughout the district. IRC will build on established care programs for HIV-infected refugees and
others at refugee health center camps, and will build on existing collaborative relationships with health
facilities supported by Africa Inland Church to provide local treatment. Activities will be conducted in close
collaboration with the Provincial ART Officer responsible for the northern part of Rift Valley Province. IRC
will establish ART programs by providing technical support, supporting staff salaries, staff training,
laboratory evaluation, and adherence counseling and monitoring. ARVs will be supplied to the sites through
the USG central distribution system currently done through the Mission for Essential Drugs.
IRC has been implementing an HIV/AIDS prevention program and outreach to hard-to-reach populations
and rural communities in this area since September 2001. They are uniquely suited to provision of care in
refugee situations/remote areas and will build on very substantial existing medical capacity in the camps.
They have a strong relationship with the local mission hospital, relying on the hospital for operating theatres,
OB/GYN services, and other services, and have previously worked with the mission hospital to build
capacity related to provision of basic health services for people with HIV. By March 2008, IRC had 583
adults on ART. Targets are modest because of the extreme remoteness of these areas, and the challenges
These activities will contribute to; expansion of access to adult ARV treatment for clinically qualified HIV-
positive adult, strengthened human resource capacity and a referral network for provision of adult ARV
treatment.
This activity relates to adult HIV prevention and non-ART treatment services supported by IRC: Palliative
Care: Basic Health Care and Support, Counseling and Testing, and PMTCT and coordination of adult ARV
scale up supported through NASCOP.
The target populations for this activity are the refugees and the local populations in the areas noted above.
HIV rates are high among the local Turkana. Although the prevalence of HIV is lower in the refugee
populations, HIV infection is now the leading cause of adult death in this group.
capacity building, community mobilization, quality assurance, and supportive supervision, logistics, and
Continuing Activity: 14846
14846 4809.08 HHS/Centers for International 6956 305.08 $350,000
6914 4809.07 HHS/Centers for International 4235 305.07 $280,000
4809 4809.06 HHS/Centers for International 3225 305.06 $220,000
Table 3.3.09:
ACTIVITY UNCHANGED FROM COP 2008:
This activity relates to activities in ARV Services (#6914), Adult Care and Support, Pediatric ARV Services,
Counseling and Testing (#6912), and PMTCT (#6911).
2. ACTIVITY DESCRIPTION International Rescue Committee (IRC) will maintain and scale-up provision of
palliative care services to 200 HIV-infected children at 5 sites in Turkana District, Rift Valley Province
(Kakuma refugee camp, Kakuma Mission hospital, Kalokol, Lokichoggio and Lodwar District Hospital), that
target both refugees and the local population. Turkana District, the largest district in Kenya, is home to a
pastoralist community that is livestock dependent, highly mobile, and has extremely limited access to health
services, especially HIV/AIDS services. The district lies on the main truck route between Mombasa and the
relief operations in northwestern Kenya and southern Sudan (via Lodwar, Kakuma, and Lokichogio).
Lokichogio is the main transit center for refugees from Sudan and a base for provision of refugee services.
The area is remote, with a population characterized by high rates of absolute poverty (74%) and food
poverty (81%). General health services are limited and poorly distributed throughout the district. IRC will
support a package of services that includes clinical evaluation and laboratory monitoring, provision of
cotrimoxazole prophylaxis, treatment of opportunistic infections, nutritional support and improved access to
safe drinking water and malaria prevention interventions; 50 health care workers will also be trained to
provide palliative care services. IRC will build on established programs that are currently providing care for
children with HIV at health centers within the refugee camps to provide treatment for refugees and will build
on existing collaborative relationships with health facilities supported by Africa Inland Church and other
FBOs to provide treatment for the local population. IRC will expand care programs by providing technical
support, supporting staff salaries, training staff, conducting laboratory evaluation, and providing adherence
counseling and monitoring. IRC has been implementing an HIV/AIDS prevention program and outreach to
hard-to-reach populations and rural communities in this area since September 2001. They are uniquely
suited to provide care in refugee situations and remote areas and will build on very substantial existing
medical capacity in the camps. They have a strong relationship with the local mission hospital, relying on
the hospital for operating theatres, OB/GYN care, and other services, and are already collaborating with the
mission hospital to build capacity related to provision of basic health services for people with HIV. Targets
are modest because of the extreme remoteness of these areas, and the challenges associated with
conducting activities in the refugee camps.
These activities will contribute to expansion of access to IRC-supported palliative care services for people
with HIV, strengthened human resource capacity to deliver ARV treatment, and a strengthened referral
network for provision of ART.
These activities will link to pediatric ARV treatment services (#6914), Counseling and Testing services
(#6912), and PMTCT (#6911) provided by IRC, and to coordination of ARV scale up supported through
National AIDS and STD Control Program (#7004).
5. POPULATIONS BEING TARGETED.
This activity targets the refugees local populations, especially people living with HIV/AIDS. HIV rates are
high among the locals in Turkana. Although the prevalence of HIV is lower in the refugee populations, HIV
Table 3.3.10:
This activity relates to activities in Palliative Care: Basic Health Care and Support (#6909), Counseling and
Testing (#6912), and PMTCT (#6911).
antiretroviral treatment (ART) services serving both refugee and local populations in Turkana District, Rift
Valley Province, Kenya. Antiretroviral (ARV) drugs will be offered at 5 sites (i.e., Kakuma refugee camp,
Kakuma Mission hospital, Kalokol, Lokichogio and Lodwar District Hospital) in Turkana District to 130
children with advanced HIV infection, including 116 new children. This brings the total number of children
ever provided with services to 156. In addition, 50 health care workers will be trained. Turkana District,
located in the Rift Valley Province, is the largest district in Kenya and is home to a pastoralist community
that is livestock dependent, highly mobile, and has extremely limited access to health services, especially
those for HIV/AIDS. The district lies on the main truck route between Mombasa and the relief operations in
transit center for Sudanese refugees and a base for provision of refugee services. The area is remote, with
a population characterized by high rates of absolute poverty (74%) and food poverty (81%). General health
services are limited and poorly distributed throughout the district. IRC will build on established care
programs for HIV-infected refugees and others at refugee health camps and existing collaborative
relationships with health facilities supported by the Africa Inland Church and other FBOs to provide local
treatment. Activities will be conducted in close collaboration with the Provincial AIDS and STI Coordinating
Officer that is responsible for the northern part of Rift Valley Province. IRC will establish ART programs by
providing technical support, staff training, supporting staff salaries, laboratory evaluation, and adherence
counseling and monitoring. ARVs will be supplied to the sites through the USG central distribution system,
which is currently done through the Mission for Essential Drugs. IRC has been implementing an HIV/AIDS
prevention and outreach program for hard-to-reach populations and rural communities in this area since
September 2001. They are uniquely suited for provision of care in refugee situations/remote areas. In
addition, IRC will build on the substantial medical capacity that exists in the camps. They have a strong
relationship with the local mission hospital, relying on the hospital for operating theatres, OB/GYN, and
other services. They also have previously worked with the mission hospital to build capacity related to
provision of basic health services for people with HIV. Targets are modest because of the extreme
remoteness of these areas, and the challenges associated with conducting activities in the refugee camps.
By March 2008, IRC had 37 children on ART. There are continuing plans to put more emphasis on pediatric
ART.
These activities will contribute to expansion of access to pediatric ARV treatment for clinically qualified HIV-
positive children, strengthened human resource capacity and a strengthened referral network for provision
of pediatric ARV treatment.
This activity relates to pediatric HIV prevention and non-ART treatment services supported by IRC:
Palliative Care: Basic Health Care and Support (#6909), Counseling and Testing (#6912), and PMTCT
(#6911) and coordination of pediatric ARV scale up supported through the National AIDS and STD Control
Program.
populations, HIV infection is now the leading cause of adult deaths in this group.
Table 3.3.11:
This activity relates to activities in Counseling and Testing , Prevention of Mother-to-Child Transmission ,
Adult Care and Support , Pediatric Care and Support, and Adult and Pediatric ARV Services.
The International Rescue Committee (IRC) will support TB/HIV services for patients at approximately 5 sites
in Kakuma Refugee camp, Kakuma Mission hospital, Lokichogio, Kalokol and Lodwar District Hospital in
Rift Valley Province, targeting both refugee and local populations. Intensified TB screening for 250 HIV
patients and HIV screening for 500 TB patients will be offered as a standard of care in all the facilities.
Funds will support refresher training of laboratory staff and improvement of basic laboratory microbiology
capacity in order to meet the increased needs for TB testing. 10 health care workers will be trained to
provide clinical prophylaxis and/or treatment for TB to HIV-infected individuals. Funds will support expanded
and strengthened delivery of integrated HIV and TB services including strengthened referral systems.
Additional activities will include community mobilization and dissemination of educational materials to
patients. IRC will maintain data concerning the numbers of people served and will report both nationally and
through the Emergency Plan.
and rural communities in this area since September 2001. They are uniquely suited to provide care in
refugee situations and remote areas. IRC will also build on a substantial, existing medical capacity in the
camps. They have a strong relationship with the local mission hospital, relying on the hospital for operating
theatres, OB/GYN care, and other services, and are already collaborating with the mission hospital to build
capacity related to provision of basic health services for people with HIV. Targets are modest because of
the extreme remoteness of these areas, and the challenges associated with conducting activities in the
refugee camps.
These activities will contribute towards the provision of integrated HIV/TB services for dually infected
patients care by reducing TB morbidity and mortality in HIV-infected individuals and also reducing HIV
related morbidity and mortality in TB patients co-infected with HIV. These activities will strengthen referral
systems, improve diagnostics and treatment of TB among HIV-positive patients and strengthen capacity of
health workers to provide integrated HIV and TB services.
The overall program activity links closely to Adult Care and support , pediatric care and support,
Adult/pediatric ARV/ART Services currently supported by this partner and TB activities support by DLTLD.
These activities target people living with HIV/AIDS, including refugees. Public health care providers,
including doctors, nurses, pharmacists, laboratory workers will receive training in the diagnosis and
management of TB using government guidelines.
This activity addresses legislative issues related to stigma and discrimination through community
sensitization activities.
This activity includes minor emphasis in commodity procurement, development of networks/linkages/referral
systems, community mobilization, human resources, local organization capacity development, quality
assurance, quality improvement and supportive supervision, and training.
Continuing Activity: 14844
14844 12458.08 HHS/Centers for International 6956 305.08 $50,000
12458 12458.07 HHS/Centers for International 4235 305.07 $25,000
Table 3.3.12:
+ In FY 2008 IRC will expand their support for CT beyond the refugee camp. They will support PITC training
for all health facilities in the Kakuma and Lokichoggio areas.
+ IRC will also implement other CT approaches such as Mobile CT and Home Based CT. Because of
security concerns this can only be done within the refugee camp. Technical support will be provided by
other PEPFAR funded partners who have adequate experience in HBCT. In this regard they will leverage
resources from HIV prevention and care.
+ in FY 2008 IRC will expand their support for CT beyond the refugee camp. They will support PITC training
This activity relates to activities in AB, HBHC, ART, OP, and PMCT.
With support from CDC, International Rescue Committee (IRC) has implemented HIV counseling and
testing (CT) and other HIV/AIDS intervention programs for refugees at Kakuma Camp and neighboring
communities in Turkana District in Northwestern Kenya since 2001. The CT component of the IRC program
in Turkana is implemented at four outlets whose capacities will be expanded to provide CT more people
during FY 08. During this period, 150 additional counselors and health workers will be trained and deployed
at these sites and there will be a shift of focus towards providing CT within medical settings as part of
clinical care. Through these efforts, IRC will provide CT to 10,000 people during FY 2008 HIV positive
individuals identified in this CT program will be referred to care and treatment outlets operated in the same
geographical area by IRC through support from the President's Emergency fund. CT services target the
local community, comprised primarily of the nomadic Turkana tribe, humanitarian aid workers, refugees,
fishermen from Lake Turkana, commercial sex workers, and the youth. With the signing of the peace
agreement in Sudan and the expectation of eventual returning home of the Sudanese refugees, significant
emphasis is given to building the capacity of Sudanese nationals, to enable them to initiate similar programs
when they return home. Founded in 1933, the IRC is a leading non-sectarian, voluntary organization
providing relief, protection and re-settlement services for refugees and victims of oppression or violent
conflict. IRC is committed to promoting freedom, human dignity and self-reliance. This commitment is
reflected in well-planned resettlement assistance, global emergency relief, rehabilitation and advocacy for
refugees in 33 countries around the world. IRC has been operational in Kenya since 1992, focusing initially
on health outreach activities in Kakuma Refugee Camp. Since 1997, IRC has been the sole implementing
partner for the health activities in Kakuma, under the operational umbrella of UNHCR. With additional
support from CDC, IRC started an HIV/AIDS prevention and care program in Kakuma in September 2001,
in Lokichoggio in February 2004, and in Kalokol in July 2005. Remote and arid, Turkana district covers a
vast area where government infrastructure and social services are weak and poverty is high. The Local
people are mainly nomadic pastoralists, but the weather is harsh and rainfall unpredictable. This poverty
situation is worsened by insecurity and cattle rustling. The total population in the target area is 271,000
people, of whom 91,000 are refugees. Currently there are an estimated 16,000 HIV infected individuals in
Turkana, with less than one percent receiving any form of care. IRC is one of the few agencies working to
meet these needs.
CT activities implemented by IRC in this geographical area will result in CT for 10,000 people who will be
served in varied settings, including health facilities and stand-alone CT outlets. IRC activities will also result
in the training of 150 additional CT service providers. IRC's activities will contribute 2% of the overall USG
CT target for Kenya in FY 2007. However this activity will also contribute to Kenya's Five-Year Strategy
which encourages Kenyans to learn their status and supports development of strong links between CT care
service provision for those who are HIV positive and in need of health care.
IRC CT activities in Kakuma are part of a comprehensive program and will be linked to other services the
IRC will offer in AB, OP, PMTCT, HBHC and ART activities in Kalokol and Lokichoggio. These services will
be provided through IRC's partner, the African Inland Church. AIC is well-positioned to identify and
implement strategies for linkage in these two locations.
This activity targets the highly underserved populations in the Turkana District of Northern Kenya. Specific
groups targeted for CT activities include the nomadic/pastoralist local community, fishermen, truck drivers,
refugees, relief workers and commercial sex workers. These nomadic populations and the commercial sex
workers are particularly at risk for HIV infection. Relief workers who often live apart from their families while
serving among refugees are also at increased risk of infection. In providing HIV services to refugees, efforts
will focus on identifying opinion leaders in the refugee community who will encourage the refugee
community to utilize available services.
The primary legislative issue addressed in this project is under the "other" category for refugees and other
nomadic, underserved groups. Legislative issues regarding gender equity and reducing discrimination will
also be addressed through advocacy and health outreach.
7. EMPHASIS AREAS This activity includes major emphasis on human resources and minor emphasis on
infrastructure, quality assurance, community mobilization and training as detailed in the activity description
above. The factors that increase project costs include insecurity, isolation, distance between inhabited
Activity Narrative: areas, poor infrastructure, difficulty in recruiting and retaining qualified staff, and the higher staff salaries
needed to compensate for the hardship in this location. Project costs reflect the current lack of local
capacity and need to provide trainings and other capacity building support to partners in the district.
Continuing Activity: 14845
14845 4774.08 HHS/Centers for International 6956 305.08 $200,000
6912 4774.07 HHS/Centers for International 4235 305.07 $200,000
4774 4774.06 HHS/Centers for International 3225 305.06 $200,000
Table 3.3.14:
