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: 2009 2010
Updated April 2009 Reprogramming. Increased by $1,150,000. Partnership Framework: Based on a recent
QA assessment on USG MC programs, additional funding will be given to those partners who have low cost
per MC performed, long wait lists, smaller pipelines and longer cooperative agreement horizons. Demand in
CRS's CMMB sites is overwhelming, and additional funds will be used to meet this demand and expand
services to more FBO facilities.
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:
+ MC roll out will be scaled up from the current 6 larger faith-based facilities in the 6 districts to smaller faith-
based facilities within Luo Nyanza.
COP 2008
1. ACTIVITY DESCRIPTION
In response to the Kenya National AIDS Strategic Plan Priority 1, prevention of new infections including
targeted focus on Kenyan youth, AIDSRelief will address adolescent reproductive health through promoting
education for the boys and girls through Medical Male Circumcision Plus Model (MMC+). This model
provides access to medical male circumcision plus adolescent reproductive health and HIV education
focused on Kenyan youth and will be implemented within traditionally non-circumcising communities in
Nyanza province. MMC+ aims to delay the onset of sexual debut, while promoting abstinence and/or
practice of safe sex. Adolescent boys and girls between the ages of 10-14 and 15-24 will be targeted with
structured week-long behavior change education classes focusing on adolescent reproductive health and
HIV education. Out of the 1,200 boys, an estimated 900 boys will opt for circumcision during this week-long
course. Parents will be also be targeted with voluntary counseling and testing services. This initiative will
contribute to the reduction of new HIV infections by circumcising 900 boys, as well as through targeted
behavior change communication focused on promoting abstinence and delayed sex debut among the youth.
The key objective is to provide access to medical male circumcision plus (MMC+) adolescent reproductive
health education. AIDSRelief supports scale-up of quality care and treatment services at 21 faith-based
local partner treatment facilities (LPTFs), with 40 decentralized locations, across five provinces of Kenya.
The AIDSRelief Consortium led by Catholic Relief Services (CRS) in partnership with Catholic Medical
Mission Board (CMMB), the Institute of Human Virology of the University of Maryland (IHV) and Constella
Futures brings to the AIDSRelief team years of experience in delivering ART to local faith-based partner
treatment facilities, in collaboration with Kenya Episcopal Conference (KEC), Christian Health Association of
Kenya (CHAK) and the Ministry of Health through the National AIDS and STI Control Program.
2. CONTRIBUTION TO OVERALL PROGRAM AREA
This initiative will contribute to the reduction of new HIV infections by circumcising 900 boys, as well as
through targeted behavior change communication focused on promoting abstinence and delayed sex debut
among the youth. The key objective is to provide access to medical male circumcision plus (MMC+)
adolescent reproductive health education. Key activities proposed are: 6 AIDSRelief LPTFs providing
MMC+ in Nyanza Province; Curriculum developed in collaboration with NASCOP; 1,560 youth participating
in MMC+ (1,200 boys and 360 girls [100-300/LPTF]); 900 boys circumcised; 2,400 parents/guardians
provided with education on HIV prevention and VCT; 2 community leaders engaged in MMC + activities at
each site; 68 individuals will be trained to provide messaging and services, including 6 to 8 clinical officers
and/or nurses trained in proper circumcision procedures.
3. LINKS TO OTHER ACTIVITIES
This activity links to comprehensive HIV care and treatment services, facility-based and mobile VCT, and
community-based prevention activities provided by government and mission facilities in Nyanza Province.
Linkages to other CRS program areas include: PMTCT, Abstinence/Be Faithful, Palliative Care (Basic
Health Care and Support), Palliative Care (TB/HIV), HIV/AIDS Treatment (ARV Services), ARV drugs, and
Counseling and Testing.
4. POPULATIONS BEING TARGETED
AIDSRelief seeks to roll out Medical Male Circumcision Plus (MMC+) for Nyanza Province at Maseno
Mission Hospital, Kendu Adventist Hospital, St Camillus, St Joseph-Nyabondo, St Joseph-Migori, and
Tabaka Mission Hospital given that the province has the highest prevalence of HIV/AIDS in Kenya. The
general population, including adult men and women of reproductive age are targeted with AB messages.
Children and youth, and particularly adolescent boys are targeted with appropriate messages and services.
These activities will target parents to help ensure that a supportive adult environment is promoted for a
comprehensive youth prevention approach.
5. EMPHASIS AREAS / KEY LEGISLATIVE ISSUES ADDRESSED
This activity addresses abstinence and being faithful and other prevention strategies through reproductive
health education during male circumcision sessions. The activity will address gender, specifically targeting
male norms and behaviors and increasing gender equity in HIV/AIDS programs. Additionally, the program
will address human capacity development through training and task shifting, and will contribute to local
organization capacity building.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16836
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16836 16836.08 HHS/Health Catholic Relief 6934 3670.08 $300,000
Resources Services
Services
Administration
Emphasis Areas
Gender
* Addressing male norms and behaviors
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.07:
+ New activity emphasis on prevention with positives among patients coming for care and treatment
services.
1. LIST OF RELATED ACTIVITIES
This activity relates to activities in Adult ART Services, Pediatric Care and Support, Pediatric ART Services,
and TB/HIV.
2. ACTIVITY DESCRIPTION
Catholic Relief Services (CRS) supported sites are implementing a variety of community-based activities to
support the understanding of, enrollment in, and adherence to care and treatment programs. The
consortium has provided extensive support for monitoring and evaluation, allowing timely reporting to both
PEPFAR and the Kenya National Program. The implementing consortium includes CRS, Catholic Medical
Mission Board, Futures Group, the Institute of Human Virology at the University of Maryland, and the
Interfaith Medical Alliance. The consortium has established agreements with a number of mission facilities
in Kenya, and has supported rapid scale-up of treatment at these facilities. By March 2008, over 45,000
adults were receiving palliative care services. In FY 2009, CRS will expand services currently supported
both by Track 1 funds and in country funds to support palliative care for 71,500 adults at 25 service delivery
sites and over 65 satellite sites throughout Kenya. There will be 120 individuals trained to provide HIV
palliative care. CRS supports mission hospitals in several geographic areas with a standard package that
includes funds for staff salaries, training of staff, laboratory evaluation, adherence counseling and
monitoring, drugs for prevention and treatment of opportunistic infection, and end of life care.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
These activities will contribute to expansion of adult palliative care services for clinically qualified HIV-
positive adults, strengthen human resource capacity to deliver HIV care, and an improved referral network
for provision of these services.
4. LINKS TO OTHER ACTIVITIES
These activities link to adult ARV treatment, pediatric ART treatment, pediatric care and support, and
TB/HIV services supported by CRS, to a variety of services provided by mission facilities in Kenya
(including testing and counseling services and prevention of mother to child transmission services), and in
many cases to facilities in the Ministry of Health system.
5. POPULATIONS BEING TARGETED
These activities target adults living with HIV/AIDS.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This activity addresses stigma and discrimination through community sensitization activities.
7. EMPHASIS AREAS
This activity includes minor emphasis in commodity procurement, community mobilization, development of
networks/linkages/referral systems, human resources, quality assurance and supportive supervision,
strategic information, and training.
Continuing Activity: 14745
14745 4924.08 HHS/Health Catholic Relief 6934 3670.08 $1,068,000
6855 4924.07 HHS/Health Catholic Relief 4213 3670.07 $250,000
4924 4924.06 HHS/Health Catholic Relief 3670 3670.06 $190,000
Table 3.3.08:
ACTIVITY UNCHANGED FROM COP 2008
This activity relates to activities in Palliative care: Basic Health Care and Support, ARV Services, TB/HIV,
and OVC.
Catholic Relief Services (CRS), within AIDSRelief, (a consortium of, Catholic Medical Mission Board,
Futures Group, Interchurch Medical Assistance, and the Institute of Human Virology at the University of
Maryland) will continue provision of ART services to approximately 33,200 patients, (total of 15,040 new
patient and 39,840 ever) at 25 service delivery sites and over 65 satellite sites throughout Kenya. These
patients are in addition to the 14,500 that will be supported through Track 1 funding for this partner. CRS
provides on-site preceptorship that builds clinical, adherence counseling, and laboratory skills. Institutional
capacity is also strengthened through support for strategic information systems, commodities management,
and finance and administrative management capacities. CRS collaborates with various in-country
organizations (government, FBO, NGO) for additional training resources. Leveraging of other resources
through wrap-around programs will increase access to clean water, provide insecticide treated bed-nets,
and support improved nutrition. By working with faith-based CBO's firmly embedded in communities, CRS
ensures that the community supports the health facility by reducing HIV/AIDS stigma, contributing to
continuity of care.120 health care workers will be trained. CRS supports salaries for comprehensive teams
providing HIV treatment, ensuring that each point of service has at least the minimum amount of staffing
required by the National AIDS and STD Control Program (NASCOP) for an ART program. In line with the
national dialogue regarding an increased role of nurses in AIDS treatment, CRS is focusing on mentoring
and training nurses. CRS also funds the costs of laboratory examinations for all patients on ART at
supported sites including CD4 counts as necessary for monitoring patients on treatment. ARVs are supplied
to the sites through the distribution system of the Mission for Essential Drugs and Supplies (MEDS). The
CRS consortium has established agreements with a number of Mission facilities in Kenya, and has
supported rapid scale up of treatment at these facilities. By June 2008, more than 20,000 adults were
accessing ART as a result of Track 1 and in-country funding awarded to this partner.
CRS activities will contribute to expansion of adult ARV treatment for clinically qualified HIV-positive
patients at faith-based facilities. CRS will strengthen human resource capacity to deliver adult ARV
treatment, tighten linkages between prevention, care, and treatment activities, and strengthen referral
networks for AIDS services.
The overall program activity links closely to adult Palliative care and TB/HIV services currently supported by
CRS, adult ART services supported by this partner through in-country funding, and ART services
coordinated by and supported through the National AIDS and STD Control Program (NASCOP). Specific
facilities have also developed linkages, for example Nazareth has established treatment referral linkages
with Nyeri District Hospital (supported by. There are also linkages to CRS-supported OVC programs as part
of the USAID-supported APHIA II.
These activities target adults living with HIV/AIDS. Public health care providers, including doctors, nurses,
pharmacists, laboratory workers are targeted with increased HIV care and treatment knowledge and skills.
Activities also target community- and other faith-based organizations (Kenya Episcopal Conference,
Christian Health Association of Kenya) and community and religious leaders.
This activity addresses legislative issues related to stigma and discrimination through community
sensitization activities.
networks/linkages/referral systems, human resources, local organization capacity development, quality
assurance, quality improvement and supportive supervision, strategic information and training.
Continuing Activity: 14747
14747 4271.08 HHS/Health Catholic Relief 6934 3670.08 $7,732,000
6854 4271.07 HHS/Health Catholic Relief 4213 3670.07 $3,900,000
4271 4271.06 HHS/Health Catholic Relief 3670 3670.06 $2,810,000
Table 3.3.09:
ACTIVITY UNCHANGED FROM COP 2008:
This activity relates to activities in Adult ART Services, Adult Care and Support, Pediatric ARV Services,
Pediatric Care and Support, PMTCT, and TB/HIV.
PEPFAR and the Kenya National Program. The implementing consortium includes Catholic Relief Services,
Catholic Medical Mission Board, Futures Group, The Institute of Human Virology at the University of
Maryland, and the Interfaith Medical Alliance. The consortium has established agreements with a number of
mission facilities in Kenya, and has supported rapid scale-up of treatment at these facilities. By March 2008,
approximately 4,500 children were receiving palliative care services. In FY 2009 the CRS will expand
services currently supported both by Track 1 funds and in country funds to support palliative care for 7,900
children at 25 service delivery sites and over 65 satellite sites throughout Kenya. There will be 120
individuals trained to provide HIV palliative care. CRS supports mission hospitals in several geographic
areas with a standard package that includes funds for staff salaries, training of staff, laboratory evaluation,
adherence counseling and monitoring, drugs for prevention and treatment of opportunistic infection, and
end of life care.
These activities will contribute to expansion of pediatric palliative care services for clinically qualified HIV-
positive children, strengthen human resource capacity to deliver HIV care, and a strengthen referral network
These activities link to pediatric ARV treatment (#6853, #6854), other areas, and TB/HIV services (#8843)
supported by CRS, to a variety of services provided by mission facilities in Kenya (including testing and
counseling services and prevention of mother to child transmission services), and in many cases to facilities
in the Ministry of Health system.
These activities target children living with HIV/AIDS. Care services for children with HIV have been
established or expanded at all sites. The ability to diagnose and provide care for very young children has
also been established through a relationship with Kenya Medical Research Institute (KEMRI); filter paper
samples are transported to the KEMRI lab for infant testing.
Table 3.3.10:
This activity relates to activities in Palliative care: Basic Health Care and Support (#6855), ARV Services
(#6853), TB/HIV (#8843), and OVC (#9048, #9029).
Catholic Relief Services (CRS), within AIDSRelief (a consortium of, Catholic Medical Mission Board,
Maryland) will continue provision of pediatric ART services to approximately 4,600 children, (total of 3,000
new patients bringing the total to 5,500 served) at 25 service delivery sites and over 65 satellite sites
throughout Kenya. These children are in addition to the 1,450 that will be supported through Track 1 funding
for this partner. CRS provides on-site preceptorship that builds clinical, adherence counseling, and
laboratory skills. Institutional capacity is also strengthened through support for strategic information
systems, commodities management, and finance and administrative management capacities. CRS
collaborates with various in-country organizations (e.g., government, FBO, NGO) for additional training
resources. The leveraging of other resources through wrap-around programs will increase access to clean
water, provide insecticide treated bednets, and support improved nutrition. By working with faith-based
CBO's firmly embedded in communities, CRS ensures that the community supports the health facility by
reducing HIV/AIDS stigma, contributing to continuity of care. In addition, 120 health care workers will be
trained as part of this activity. CRS supports salaries for comprehensive teams providing HIV treatment,
ensuring that each point of service has at least the minimum amount of staffing required by the National
AIDS and STD Control Program (NASCOP) for an antiretroviral treatment (ART) program. In line with the
and training nurses. CRS also funds the costs of laboratory examinations for all children on ART at
supported sites, including CD4 counts as necessary for monitoring children on treatment. Antiretroviral
(ARV) drugs are supplied to the sites through the distribution system of the Mission for Essential Drugs and
Supplies (MEDS). The CRS consortium has established agreements with a number of Mission facilities in
Kenya, and has supported rapid scale up of treatment at these facilities. By June 2008, more than 2,000
children were accessing ART as a result of Track 1 and in-country funding awarded to this partner.
CRS activities will contribute to expansion of pediatric ARV treatment for clinically qualified HIV-positive
children at faith-based facilities. CRS will strengthen human resource capacity to deliver pediatric ARV
The overall program activity links closely to pediatric palliative care and TB/HIV services currently supported
by CRS, pediatric ART services supported by this partner through in-country funding, and ART services
coordinated by and supported through NASCOP. Specific facilities have also developed linkages, such as
Nazareth which has established treatment referral linkages with Nyeri District Hospital (supported by
#6867). There are also linkages to CRS-supported OVC programs as part of the USAID-supported APHIA II
(#9048, #9029).
These activities target children and infants living with HIV/AIDS including. Treatment services for children
with HIV continue to be established or expanded at all sites. Services for diagnosis and treatment of very
young children are being established through a relationship with Kenya Medical Research Institute
(KEMRI); filter paper samples are transported to the KEMRI lab for infant testing (currently with PCR).
Public health care providers, including doctors, nurses, pharmacists, laboratory workers are targeted with
increased HIV care and treatment knowledge and skills. Activities also target community- and other faith-
based organizations (Kenya Episcopal Conference, Christian Health Association of Kenya), and community
and religious leaders.
Table 3.3.11:
This activity relates to activities in Palliative Care: Basic Health Care and Support and ARV Services.
Catholic Relief Services (CRS), within AIDS Relief, (a consortium of Catholic Medical Mission Board,
Maryland) will support HIV/TB services for HIV patients at 25 service delivery sites throughout Kenya. CRS
will offer TB screening to 6,000 HIV patients and HIV testing for 3,000 TB patients. Refresher training of
laboratory staff will be initiated and basic laboratory microbiology capacity will be improved in order to meet
the increased needs of TB testing. Twenty-five health care workers will be trained to provide clinical
prophylaxis and/or treatment for TB to HIV-infected individuals.
These activities will contribute towards the provision of integrated HIV/TB 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, and Adult
and Pediatric ARV/ART services currently supported by CRS.
These activities target people living with HIV/AIDS. Public health care providers, including doctors, nurses,
pharmacists, laboratory workers will receive training in the diagnosis and management of TB using
government guidelines.
Continuing Activity: 14746
14746 8843.08 HHS/Health Catholic Relief 6934 3670.08 $2,900,000
8843 8843.07 HHS/Health Catholic Relief 4213 3670.07 $300,000
Table 3.3.12:
This activity relates to activities in ARV Drugs and ARV Services.
Catholic Relief Services (CRS) will assist with the forecasting and procurement of additional antiretroviral
(ARV) drugs needed to treat 190,000 Kenyans. This is in addition to $1,000,000 allocated through the track
one funding. Two other major partners - Mission competitive procurement/TBD and Management Systems
for Health/Rational Pharmaceutical Management Plus (MSH/RPM Plus) will maintain primary responsibility
for the procurement and distribution of pharmaceuticals nationally and under the Emergency Plan. Together
with in-country USG staff, these major partners are primarily responsible for the quantification and tracking
for ARVs procured with Emergency Plan funds. This alternate procurement mechanism through CRS will
help avoid supply shortages and treatment interruptions.
These activities are essential to maintaining a full and uninterrupted supply of HIV/AIDS related
pharmaceuticals and commodities.
These activities will coordinate with other partners (Mission Competitive Procurement/TBD, KEMSA,
MEDS, MSH/RPM Plus) involved in ARV drug procurement and complement all activities listed in the ARV
services program area.
This activity targets men, women, and children with HIV.
6. EMPHASIS AREAS
This activity includes a major emphasis in commodity procurement
Continuing Activity: 19894
19894 19894.08 HHS/Health Catholic Relief 6934 3670.08 $500,000
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Total Planned Funding for Program Budget Code: $29,546,334
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Key Result 1: An improved integrated procurement and logistics management system for laboratory supplies and reagents to
support equipment procurement and distribution, staff training, and reagent supply for ten million HIV tests, 500,000 sputum
microscopy, 1.4 million syphilis tests, and 1.5 million HIV clinical diagnostic and monitoring tests.
Key Result 2: Support MOH in implementation of the Medical Laboratory Services 2005-2010 Strategic Plan.
Key Result 3: Improved quality assurance for services at 60 MOH laboratories and more than 1,500 sites providing HIV rapid
testing in support of HIV prevention and treatment programs.
Key Result 4: Improved laboratory physical infrastructure, human resources, and information management systems at all levels of
laboratory service delivery.
CURRENT PROGRAM CONTEXT
The Emergency Plan (EP) supports the National Public Health Laboratory Services (NPHLS) and other laboratory service
providers to offer a broad range of testing services to support HIV prevention, care, and treatment programs. In Kenya, the EP
Five-Year Strategy is focused on the strengthening and capacity building of national lab systems with emphasis on: (1) strategic
planning; (2) improving diagnostic capability for opportunistic infections (OIs); (3) improving antiretroviral therapy (ART) diagnosis
and monitoring; (4) development of the three reference laboratories; (5) infrastructure improvement; (6) strengthening quality
assurance systems; (7) human resource capacity development; (8) strengthening laboratory networking and referral systems; (9)
enhancing laboratory management information systems; (10) supporting national rollout of rapid HIV testing; and (10) improving
procurement and logistics management of equipment and supplies.
In 2009, the EP will continue support to the central microbiology reference lab. In addition, the EP will support expansion of the
diagnostic testing capabilities in selected microbiology labs to implement assays for the diagnosis of cryptococcal meningitis and
other OIs, such as through cryptococcal antigen testing.
In 2009, HLAB will support 10 million rapid HIV tests, 500,000 TB screening tests, and 100,000 tests for opportunistic infections in
HIV-positive persons.
To date, the EP has supported rollout of rapid HIV testing to 5,090 sites and early infant diagnosis (EID) capacity to 3 sites. In
2009, PEPFAR will expand EID capacity to two additional sites, expand haemoglobin screening to 200 sites, and increase access
to CD4 services. An integrated quality assurance will be applied to all lab services supporting the program. The USG team will
continue supporting rollout of rapid HIV testing and counseling (HTC) services in various settings. In addition, improvements will
be made in assuring the supply of HIV test kits, monitoring performance of laboratory systems, and administration of proficiency
testing and retesting.
Strengthening technical and managerial human resource capacity remains a key EP priority. In 2008, the in-service training
curriculum for medical laboratory technologists at the Kenya Medical Training College was reviewed, and new modules covering
HIV testing, treatment monitoring, quality assurance, and management were introduced. Training modules were standardized for
acid-fast bacilli smear microscopy and ART monitoring. In 2009, KMTC will be supported to deliver the revised curricula. From
2006-08, over 1,200 lab technologists attended short courses to improve testing proficiency, and 36 received standardized
management training; in 2009, in- and pre-service training support will be provided for enhancing the capacity of local institutions
and building a sustainable system.
In 2008, EP support for the NPHLS was in line with the Maputo Declaration and involved procurement of standardized equipment
and supplies and development of site-level logistic management tools. In 2009, the EP will continue to strengthen the national
logistics and supply chain management system for lab supplies at all levels.
Increasingly, laboratory-related procurement will be centralized for all partners through SCMS. The EP will also work with the
GOK, KEMSA, and the TBD Kenya Pharma Project to ensure coordinated procurement and monitoring of stocks of reagents and
supplies. In 2008, the National HIV Reference Laboratory (NHRL), the Central Microbiology Laboratory and the 8 provincial
laboratories will have been renovated, and 10 new district laboratories will have been built. The EP will also strengthen the
general capacity of provincial and district hospitals through development and use of SOPs, participation in External Quality
Assurance (EQA) programs, and training in bio-safety systems. Moreover, in 2009, the EP will support strengthened HIV
surveillance through centralized procurement of supplies and commodities by SCMS.
Seven provincial/regional laboratories and 18 high-volume CD4 testing labs are enrolled in an external quality assessment
program administered by the UK National External Quality Assessment Service. In 2009, in-country administration and data
handling of this program will be transitioned to the NHRL. In addition, this program will be extended to other facilities through a yet
to be determined partner. The NHRL provides retesting of 10% of samples QA of rapid HIV testing sites. This approach, however,
has made it impossible to re-test all samples in a single laboratory. This activity has been decentralized to the provincial level and,
in 2009, the EP will support the development of an integrated Quality Assurance plan aligned with Kenya's national standards and
integrated quality monitoring systems. The EP will support the process of laboratory accreditation within the NPHLS, starting at
the central level in 2009.
In 2009, the EP will maintain support for AFB smear diagnostics, provision of LED microscopes for high-volume site support,
training, and EQA for TB tests. TB culture will be expanded to three provinces and new diagnostic tools to rapidly detect
rifampicin, and isoniazid resistance will be introduced. The Central TB Reference Lab (CRL) will build capacity for rapid
techniques for speciation and detection of MDR and X-MDR mycobacteria. In 2009, some CRL activities will be expanded to the
WRP-Kericho and KEMRI-Kisumu laboratories. The CRL will also aim for ISO15189 accreditation.
STATISTICS
The EP has directly supported the National HIV and TB Reference Laboratories, as well as eight provincial and 85 district
laboratories. Over 1,500 rapid HIV testing sites continue to be supported. From 2006-2008, the EP provided over 1.5 million HIV
monitoring tests, and 70 CD4 and 170 standardized haematology/chemistry machines in over 60 facilities. In 2009, the EP will
further expand these capacities and assist the MOH to operationalize a lab network.
SERVICES
The National Health Services Strategic Plan II 2006-2010 recognizes laboratory services as integral to the Kenyan health care
delivery system and laboratory tests as essential to supporting HIV prevention, treatment, and care programs. Laboratory systems
in Kenya are managed under the Division of Laboratory Diagnostic Services within the Ministry of Health (MOH). This division
manages the following laboratories: National Reference Laboratory (with responsibility for conducting reference laboratory testing
related to HIV serology, biochemistry and hematology, CD4 testing, and other services in support of HIV treatment, as well as
testing for surveillance activities); the CRL; the CML; a network of two referral hospital labs; eight provincial hospital labs; 20 high-
volume district hospital labs; more than 80 labs at other health facilities, and over 1,500 sites providing rapid testing for HIV.
Beyond this network, several laboratories support national and regional labs, including those at the Kenya Medical Research
Institute, the Indiana University-supported laboratory in Eldoret, a DOD-supported laboratory in Kericho, and CDC-supported
laboratories in Kisumu and Nairobi.
REFERRALS AND LINKAGES
Due to poor standardization and results disparities across facilities, the laboratory network overseeing the transfer of specimens
from the lowest to the highest testing level remains inefficient. The EP has engaged international and local partners to support key
aspects of laboratory infrastructure through networking and linkage building, which will continue in 2009. The Association of Public
Health Labs (APHL) will support expansion of the Laboratory Information Management Systems (LIMS) to include regional and
district laboratories, as well as implementation of a national quality management system. The American Society for Clinical
Pathology will support in- and pre-service training, HIV, chemistry, hematology and CD4 testing, as well as the development and
application of standards for MOH laboratories. The American Society for Microbiology will assist in strengthening lab diagnosis of
TB and OIs. All international partners will work with local, in-country organizations to promote technology transfer and
sustainability. SCMS will procure standardized equipment, high-volume commodities for central distribution, and, in collaboration
with Management Sciences for Health, will assist logisticians at NPHLS and KEMSA to quantify, order, and distribute high-volume
laboratory commodities, including rapid test kits, reagents and supplies for CD4 testing, and chemistry and hematology reagents
for standardized machines. SCMS will also provide financial support for commodity distribution to KEMSA.
Members of the laboratory technical working group will provide short-term technical assistance to the NPHLS in various areas.
The Capacity Project will engage laboratory technologists to fill gaps in key network facilities, including hiring higher level
management staff for central data unit and lab quality assurance officers. In-country partners, including KEMRI, will provide
continuous support to the NPHLS, specialized referral testing (e.g. EQA testing, PCR testing for infant diagnosis, viral loads, and
TB culture and drug sensitivity testing), and day-to-day technical assistance with implementation of laboratory aspects of
evaluation and surveillance activities. Development partners supporting the NPHLS Strategic Plan include the GFATM, European
Union, DANIDA, and the Japan International Cooperation Agency. In addition, the Clinton Foundation provides all CD4 count
reagents at five high-volume health facilities, which act as nodal points for regional CD4 networks, as well as fully supporting EID
reagents.
POLICY
The EP supports development of the NPHLS national laboratory policy and integrated strategic plan. In line with the "Three Ones"
principles, a Laboratory Interagency Coordinating Committee was formed and the EP supports the secretariat. USG
representatives, implementing partners, and development partners sit on various committees and work collaboratively in
implementing the plan. The NPHLS Strategic Plan for Medical Laboratory Services of Kenya was launched in 2007 to harmonize
activities, build laboratory capacity, and ensure the delivery of efficient, effective, equitable, and affordable quality medical
laboratory services. The strategic plan objectives are to reorganize and strengthen (1) administrative and technical management
structures of the Division of Medical Laboratory Services (DMLS); (2) the provision of standardized quality laboratory services
throughout Kenya; (3) laboratory support systems; (4) laboratory quality assurance; (5) human capacity development; (6) legal
and regulatory systems; and (7) monitoring, evaluation, and research. Strengthening the foundation of laboratory infrastructure will
improve the system's capacity to support disease-specific programs (e.g. HIV, TB, malaria). Priorities for EP support in 2009
include strengthening logistics and supply management through SCMS and MSH, human resource capacity building, information
systems, QA, management systems at NPHLS, and general system strengthening.
MONITORING AND EVALUATION
LIMS are critical to effective routine management, monitoring, and accountability, and the current lack of routine LIMS present
challenges regarding EP and MOH reporting. The EP has supported the development of laboratory registers for national use. In
addition, it has augmented a computerized LIMS compatible with the national HMIS, which will soon be installed in three pilot
sites. In 2009, the LIMS will be further expanded to all provinces, 25 districts sites, and linked to the central data unit of the
NPHLS so as to capture surveillance data and monitoring and evaluation indicators for laboratory service provision. In 2009, the
central data unit of NPHLS will also be strengthened to handle laboratory strategic information for decision-making.
SUSTAINABILITY
EP support has strengthened the general capacity of NPHLS leadership and specifically targeted management and strategic
planning capacity to enable more efficient planning and resource utilization. Following the Kenya AIDS Indicator Survey, the
NHRL has gained the capacity to provide lab testing for HIV surveillance. Ongoing support to Kenya Medical Training College will
further enhance local capacity to provide high-quality training and ensure a steady supply of well-trained laboratorians.
International laboratory partners will be twinned with local organizations involved in training and quality management to enhance
transfer of technology and a rollout to local institutions.
WORK OF HOST GOVERNMENT
Donor coordination is a key component of the EP's strategy to optimize laboratory systems and resource management in Kenya.
The EP continues to support NPHLS coordination efforts through the Lab ICC and strengthening of management systems.
ACHIEVEMENTS AND OUTSTANDING CHALLENGES
Much has been achieved in terms of procuring equipment, supplies, building lab capacity to perform ART monitoring, surveillance
lab support to programs, and strengthening of lab systems; however, key challenges remain. Major barriers to implementation
include the weakness of structures, fragmentation and poor standardization of disease control program lines, multiple supervisory
visits using non-standard evaluation tools, and an over-reliance on proficiency testing. Inadequate laboratory physical capacity
remains a further impediment to decentralizing testing capability. In addition, some laboratory infrastructure is occupied by
research organizations and many service delivery labs are neither purpose-built nor adequately designed to accommodate
equipment or meet demand. Administratively, laboratory services are split between two ministries (Public Health & Sanitation and
Medical Services), presenting a further obstacle to integrated service delivery. Lastly, significant gaps remain in terms of LIMS.
Table 3.3.16:
