Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 12076
Country/Region: Kenya
Year: 2010
Main Partner: Not Available
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: HHS/CDC
Total Funding: $0

This Implementing Mechanism will implement evidence-based public health programs on important human infectious diseases, with an emphasis on HIV/AIDS, Malaria, Emerging and Re-emerging Infectious Diseases, Neglected Tropical Diseases, Tuberculosis, Influenza and other diseases with pandemic potential as well as Environmental Health Issues, Chronic Diseases, Maternal and Child Health, Public Health Preparedness, Bio-safety, Injury Control and Prevention.

The activities carried out by this IM will address all four core pillars of the KNASP III:

Pillar 1: Health Sector HIV Service Delivery

Pillar 2: Sectoral Mainstreaming of HIV and AIDS

Pillar 3: Community/Area-based HIV Programmes

Pillar 4: Governance and Strategic Information

This TBD will translate epidemiological and project evaluation findings into public health practice in the Republic of Kenya and ensure sharing of expertise and lessons learned with other nations, non-governmental agencies and academic institutions. Other contributions to Health Systems Strengthening include planning, implementation and evaluation of public health interventions and projects that lead to improved health outcomes for targeted populations, as well as dissemination of surveillance, intervention planning, execution and evaluation results through written publications, oral presentations, or other means.

This TBD's strategy is to become more cost-efficient over time (e.g. coordinated service delivery, PPP, lower marginal costs, etc.): leveraging funds received from other organizations to reduce reliance upon USG funds or implementation and evaluation of HIV/AIDS related activities.

Funding for Care: Adult Care and Support (HBHC): $0

Nyanza province, which has a population of about 5.1 million people, carries the highest HIV burden in Kenya, with an estimated adult HIV prevalence of 14.9% (compared to the national 7.1%), and ~500,000 people are living with HIV, and ~130,000 requiring ART. Nairobi province has a HIV prevalence of 8.8%. The New Nyanza Provincial General Hospital (NNPGH) is the referral hospital for the province.

Since 2003, the Kenya Medical Research Institute (KEMRI) has been supporting HIV activities in Nyanza and Nairobi provinces. The current KEMRI cooperative agreement will end in September 2010 and a new procurement is in process.

The TBD partner will support the NNPGH in Nyanza Province, and the International Emerging Infectious Disease Program directed Tabitha Clinic in Nairobi. Bondo District, which is being transitioned this year, will be fully supported by Columbia University Mailman School of Public Health (ICAP) in FY10. Support of Siaya District will be transitioned to ICAP, while that of Mathare clinic to the TBD clinical services partner.

By March 2009, the NNPGH had ever enrolled 15,000 adults on care. In FY10 the TBD partner will ensure provision of HIV care services to 26,000 adult patients receiving care and support.

TBD partner will continue to support the NNPGH to offer quality HIV care, and to serve as a model and mentorship site for the province. The partner will also continue to build the capacity for the hospital to offer specialized treatment, including management of complicated opportunistic infections, drug adverse reactions and cancer chemotherapy.

The TBD partner will offer a comprehensive package of services to all HIV+ patients at health facility level, including clinical assessment for ART eligibility; provision of ART for those eligible; laboratory monitoring with biannual CD4 testing; cotrimoxazole prophylaxis; psychosocial counseling, including, positive living and referral to support groups; adherence counseling; nutritional assessment and supplementation; secondary prevention (prevention with positives [PwP], including support for family testing for spouses/partners and children; supportive disclosure, adherence counseling ,risk reduction counseling including condom provision, alcohol counseling,, family planning counseling and provision or referral of services; STI diagnosis and treatment, etc.) Provision of a BCK (safe water system, multivitamins, insecticide-treated mosquito nets, condoms, and educational materials); improved OI diagnosis and treatment, including TB screening, diagnosis and treatment; and pain management with non-steroidal inti-inflammatory drugs. Cryptococcal antigen testing and opioids for pain management will be made available at the NNPGH.

Ongoing community prevention interventions for HIV+ individuals, including education by peer educators, use of support groups to provide prevention messaging and defaulter tracing and follow up will continue to be supported. The

TBD partner will collaborate with other partners supporting the community strategy to ensure linkage and provision of community components of HIV services, including ongoing income generating programs.

The TBD partner will adapt the quality of care indicators for monitoring the quality of HIV care services that will be developed by NASCOP, and integrate them into routinely collected data.

The TBD partner will adopt strategies to ensure access and provision of friendly services to youth, elderly and disabled populations. Strategies to increase access of care services by men will be employed, including supporting male peer educators, mentors and support groups, and supporting women to disclose and bring their male partners for testing and care and treatment.

The TBD partner will continue to strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. With guidance from the national PEPFAR office, the new generation indicators will be adopted. Use of an electronic medical records system will be supported and strengthened.

Funding for Treatment: Adult Treatment (HTXS): $0

Nyanza province, which has a population of about 5.1 million people, carries the highest HIV burden in Kenya, with an estimated adult HIV prevalence of 14.9% (compared to the national 7.1%), and ~500,000 people are living with HIV, and ~130,000 requiring ART. Nairobi province has a HIV prevalence of 8.8%. The New Nyanza Provincial General Hospital (NNPGH) is the referral hospital for the province.

Since 2003, the Kenya Medical Research Institute (KEMRI) has been supporting HIV activities in Nyanza and Nairobi provinces. The current KEMRI cooperative agreement will end in September 2010. Therefore, in COP10 CDC will solicit a new partner (To Be Determined-TBD) to support the services that KEMRI has been supporting.

The TBD partner will support HIV adult treatment services, at the NNPGH, and the International Emerging Infectious Disease Program directed Tabitha Clinic in Nairobi. Bondo District, which is being transitioned this year, will be fully supported by Columbia University Mailman School of Public Health in FY10. Support of Siaya District will be transitioned to ICAP, while that of Mathare clinic to University of Maryland.

In FY10 the TBD partner will ensure provision of HIV treatment services to 15,000 adult patients receiving ART. The TBD partner will work with the Ministry of Health at the provincial, district and health facilities levels, to jointly plan, coordinate and implement adult HIV treatment services.

In FY10 the TBD partner will support the NNPGH to offer quality HIV treatment, and to serve as a model and mentorship site for the province. The partner will also continue to build the capacity for the hospital to offer specialized treatment, including management of patients with ARV treatment failure and complicated drug adverse reactions.

HIV trainings will continue to be supported, ensuring training for 120 health care workers, through both classroom training and mentorship. The TBD partner, working with the provincial Ministry of Health team, will offer continuous medical education for HIV treatment at the provincial hospital to health care workers in the province. The TBD partner will work with the MOH to identify areas with staff shortages, and support recruitment of additional staff.

The TBD partner will offer a comprehensive package of services to all HIV+ patients at health facility level, including clinical assessment for ART eligibility; provision of ART for those eligible; laboratory monitoring with biannual CD4 testing; cotrimoxazole prophylaxis; psychosocial counseling, including, positive living and referral to support groups; adherence counseling; nutritional assessment and supplementation; secondary prevention (prevention with positives [PwP], including support for family testing for spouses/partners and children; supportive disclosure, adherence counseling ,risk reduction counseling including condom provision, alcohol counseling, family planning counseling and provision or referral of services; STI diagnosis and treatment, etc.); provision of a BCK (safe water system, multivitamins, insecticide-treated mosquito nets, condoms, and educational materials); improved OI diagnosis and treatment, including TB screening, diagnosis and treatment; and pain management with non-steroidal inti-inflammatory drugs.

Use of viral load testing for monitoring ART treatment failure has been successfully piloted in Nyanza province, with KEMRI taking lead. The TBD partner will continue to support viral load testing in the province, and work with the National AIDS and STI Control Program (NASCOP) to develop guidelines and expand access to other regions in the country.

Ongoing community interventions for HIV+ individuals, including education by peer educators and use of support groups to provide adherence messaging, and defaulter tracing and follow up will continue to be supported. The TBD partner will collaborate with other partners supporting community activities to ensure linkage and provision of community components of HIV services.

The TBD partner will adapt the quality of care indicators for monitoring the quality of HIV treatment services that will be developed by NASCOP, and integrate them into routinely collected data.

The TBD partner will adopt strategies to ensure access and provision of friendly HIV treatment services to youth, elderly and disabled populations. Strategies to increase access of ART by men will be employed, including supporting male peer educators, mentors and support groups, and supporting women to disclose and bring their male partners for testing and care and treatment.

The TBD partner will continue to strengthened data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. With guidance from the national PEPFAR office, the new generation indicators will be adopted. Use of an electronic medical records system will be supported and strengthened.

Funding for Testing: HIV Testing and Counseling (HVCT): $0

The aim of the mechanism is to contribute to the Kenya goal of accelerated testing and counseling by expanding and taking services to the communities. The mechanism will include both Provider initiated Counseling and testing services and client initiated services both at facility and community levels. The objective is to provide services in the high prevalence and low knowledge of HIV status areas and thus will concentrate on the Informal settlements of Nairobi. These are very densely populated with HIV prevalence which is above the national average. The second area is Nyanza province where the prevalence is double the national average. At the same time Provider initiated testing and counseling will be offered as a routine service provided to those who visit the health facilities both in patient and outpatient targeting 80 % and 50 % coverage in the two areas respectively. The visitors and relatives visiting their hospitalized relatives will also be targeted. Linkage will be made with the provincial and district comprehensive care centers to follow the index client in their homes and offer Testing and counseling to their families. The mechanism will use all the evidence based approaches ensuring quality in each namely, Home based testing, workplace, facility based and outreaches. Emphasis will be put on couple counseling and disclosure. Prevention activities will be integrated in the services thus male circumcision activities; education and referral will be provided as appropriate. The hard to reach populations like the MARPS will be an important component of the strategy and the program will integrate prevention activities with provision of counseling and testing services. The overall objective will be to achieve higher knowledge of HIV status by the communities and those positive will be linked to care and treatment services. The target to be tested and counseled will be 360, 000 clients and service providers to be trained and sensitized to provide services will be 1250.

Funding for Care: Pediatric Care and Support (PDCS): $0

Nyanza province, which has a population of about 5.1 million people, carries the highest HIV burden in Kenya, with an estimated adult HIV prevalence of 14.9% (compared to the national 7.1%), and ~500,000 people are living with HIV, ~ 10% being children. Nairobi province has a HIV prevalence of 8.8%. The New Nyanza Provincial General Hospital (NNPGH) is the referral hospital for the province.

Since 2003, the Kenya Medical Research Institute (KEMRI) has been supporting HIV activities in Nyanza and Nairobi provinces. The current KEMRI cooperative agreement will end in September 2010. Therefore, in COP 10 CDC will solicit a new partner to support the services that KEMRI has been supporting.

The TBD partner will support pediatric HIV Care services at the New Nyanza Provincial Hospital in Nyanza Province, and the International Emerging Infectious Disease Program directed Tabitha Clinic in Nairobi. Bondo District, which is being transitioned this year, will be fully supported by the Columbia University Mailman School of Public Health (ICAP) program in COP 10. Support of Siaya District will be transitioned to ICAP, while that of Mathare clinic to University of Maryland.

In FY 10 the TBD partner will ensure provision of pediatric HIV treatment services to 3000 children. The TBD partner will work with the Ministry of Health at the provincial, district and health facility levels, to jointly plan, coordinate and implement pediatric HIV services.

In FY 10 the TBD partner will continue to support the NNPGH to offer quality pediatric HIV care and treatment, and to serve as a model and mentorship site for the province. The partner will also continue to build the capacity for the hospital to offer specialized pediatric treatment, including management of children with ARV treatment failure, and complicated drug adverse reactions.

Pediatric HIV trainings will continue to be supported, ensuring training for 120 health care workers (HCW), through both classroom training and mentorship. The TBD partner, working with the provincial Ministry of Health team, will offer continuous medical education for HIV treatment at the provincial hospital to health care workers in the province. The TBD partner will work with the MOH to identify areas with staff shortages, and support recruitment of additional staff.

In FY 10 the TB partner will prioritize the identification of exposed/infected children < 5 years of age, through systematic provision of EID for those < 18 months of age at the MCH, PITC in clinical settings, family-testing through clinical and community HTC strategies, and the systematic use of the combined mother-child card at MCH. All exposed children until 18 months of age will be linked to pediatric care services and ART if HIV-infected. Per MOH guidelines, the TBD partner will support CTX for HIV+ children and for all exposed children until their HIV status is conclusively determined.

The TBD partner will offer a comprehensive package of services to all HIV+ children at health facility level, including clinical assessment for ART eligibility; provision of ART for those eligible; laboratory monitoring with biannual CD4 testing; cotrimoxazole prophylaxis; psychosocial counseling, supported disclosure and referral to the children support groups; adherence counseling; nutritional assessment and supplementation; secondary prevention for adolescents (prevention with positives [PwP], including adherence counseling ,risk reduction counseling including condom provision, alcohol counseling, family planning counseling and provision or referral of services; STI diagnosis and treatment, etc.); provision of a BCK (safe water system, multivitamins, insecticide-treated mosquito nets, condoms, and educational materials); improved OI diagnosis and treatment, including TB screening, diagnosis and treatment; and pain management with non-steroidal anti-inflammatory drugs. Pediatric TB case finding, diagnosis and treatment will be strengthened, and the cryptococcal antigen test will be made available.

Ongoing community interventions for HIV+ children, including use of support groups to provide adherence messaging, and defaulter tracing and follow up will continue to be supported. The TBD partner will collaborate with other partners supporting community activities to ensure linkage and provision of community components of pediatric HIV services.

The TBD partner will adapt the quality of care indicators for monitoring the quality of pediatric HIV services that will be developed by NASCOP, and integrate them into routinely collected data.

The TBD partner will continue to strengthened pediatric data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. With guidance from the national PEPFAR office, the new generation indicators will be adopted. Use of an electronic medical records system will be supported and strengthened. An ongoing evaluation of NNPGH program data will be completed in FY 09, and will inform the program on their performance, including clinical outcomes, and areas that require strengthening.

Funding for Treatment: Pediatric Treatment (PDTX): $0

Nyanza province, which has a population of about 5.1 million people, carries the highest HIV burden in Kenya, with an estimated adult HIV prevalence of 14.9% (compared to the national 7.1%), and ~500,000 people are living with HIV, ~ 10% being children. Nairobi province has a HIV prevalence of 8.8%. The New Nyanza Provincial General Hospital (NNPGH) is the referral hospital for the province.

Since 2003, the Kenya Medical Research Institute (KEMRI) has been supporting HIV activities in Nyanza and Nairobi provinces. The KEMRI cooperative agreement will come to an end in September 2010. Therefore, in COP 10 CDC will solicit a new partner to support the services that KEMRI has been supporting.

The TBD partner will support pediatric HIV Care and Treatment services at the New Nyanza Provincial Hospital in Nyanza Province, and the International Emerging Infectious Disease Program directed Tabitha Clinic in Nairobi. Bondo District, which is being transitioned this year, will be fully supported by the Columbia University Mailman School of Public Health (ICAP) program in COP 10. Support of Siaya District will be transitioned to ICAP, while that of Mathare clinic to University of Maryland.

In FY 10 the TBD partner will ensure provision of pediatric HIV treatment services to 2000 children. The TBD partner will work with the Ministry of Health at the provincial, district and health facility levels, to jointly plan, coordinate and implement pediatric HIV services.

In FY 10 the TBD partner will continue to support the NNPGH to offer quality pediatric HIV care and treatment, and to serve as a model and mentorship site for the province. The partner will also continue to build the capacity for the hospital to offer specialized pediatric treatment, including management of children with ARV treatment failure, and complicated drug adverse reactions.

Pediatric HIV trainings will continue to be supported, ensuring training for 120 health care workers (HCW), through both classroom training and mentorship. The TBD partner, working with the provincial Ministry of Health (MOH) team, will offer continuous medical education for pediatric HIV treatment at the provincial hospital to health care workers in the province. The TBD partner will work with the MOH to identify areas with staff shortages, and support recruitment of additional staff.

The TBD partner will support provision of a comprehensive package of services to all HIV+ children at health facility level, including clinical assessment for ART eligibility; provision of ART for those eligible; laboratory monitoring with biannual CD4 testing; cotrimoxazole prophylaxis; psychosocial counseling, supported disclosure and referral to the children support groups; adherence counseling; nutritional assessment and supplementation; secondary prevention for adolescents (prevention with positives [PwP], including adherence counseling ,risk reduction counseling including condom provision, alcohol counseling, family planning counseling and provision or referral of services; STI diagnosis and treatment, etc.); provision of a BCK (safe water system, multivitamins, insecticide-treated mosquito nets, condoms, and educational materials); improved OI diagnosis and treatment, including TB screening, diagnosis and treatment; and pain management with non-steroidal anti-inflammatory drugs. Pediatric TB case finding, diagnosis and treatment will be strengthened, and the cryptococcal antigen test will be made available.

The TBD partner will continue to advocate for exclusive breastfeeding for infants and nutrition education to all affected families. The TBD partner will adopt strategies to ensure access and provision of children friendly HIV treatment services.

Ongoing community interventions for HIV+ children, including use of support groups to provide adherence messaging, and defaulter tracing and follow up will continue to be supported. The TBD partner will collaborate with other partners supporting community activities to ensure linkage and provision of community components of pediatric HIV services.

The TBD partner will adapt the quality of care indicators for monitoring the quality of pediatric HIV treatment services that will be developed by NASCOP, and integrate them into routinely collected data.

The TBD partner will continue to strengthened pediatric data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. With guidance from the national PEPFAR office, the new generation indicators will be adopted. Use of an electronic medical records system will be supported and strengthened.

Funding for Strategic Information (HVSI): $0

The following strategic information activities will be supported under KEMRI:

Capacity building in data collection, entry, management, analysis, and utilization. This will include training in the use of EPI Info and other appropriate software and electronic reporting tools, e.g. handheld devices, for health workers and data handling staff to improve analysis, dissemination and utilization of strategic information, e.g. from surveillance, to strengthen HIV/AIDS policies and programs. This will also include rollout of the revised MOH registers and forms at facilities in Nyanza province.

Supporting data collection, management, analyses and distribution at the Demographic Surveillance Systems (DSS) in Nyanza and Nairobi to better understand the HIV/AIDS epidemic. These activities will include the development, piloting, and rollout of suitable software and piloting of innovative technologies. KEMRI will also continue to conduct mortality surveillance by cause at the two DSS sites through sample vital registration using Verbal autopsy (SAVVY).

Supporting the Division of Leprosy, TB and Lung Diseases (DLTLD) to roll out the PDA based electronic TB register to two more provinces following the evaluation of installations in Nyanza and Nairobi provinces. The inclusion of a GPRS module will enable direct submission of data from the field to a central database resulting in fast and secure data submission.

The above activities will complement national effort by other SI partners to strengthen the national informatics and M&E systems through ongoing capacity building and systems strengthening. Mortality surveillance will provide data on estimated deaths by cause and help in assessing the impact of PEPFAR programs on HIV related mortality. This is a new activity that was previously funded under USAID.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $0

Nyanza province, which has a population of about 5.1 million people, carries the highest HIV burden in Kenya, with an estimated adult HIV prevalence of 14.9% (compared to the national 7.1%), and ~500,000 people are living with HIV. The New Nyanza Provincial General Hospital (NNPGH) is the referral hospital for the province.

Since 2003, Kenya Medical Research Institute (KEMRI) has been supporting HIV activities in Nyanza and Nairobi. The current KEMRI cooperative agreement ends in September 2010. Therefore, in COP 10 CDC will solicit a new partner (TBD) to support continuation of services.

KEMRI has been supporting PMTCT services in Nyamira, Manga, Borabu, Gucha South, Kisii Central, Kisii South and Masaba districts of Nyanza Province. In the past, different partners have been supporting different program areas in the same geographic region and health facilities. Collaboration across these partners has been a big challenge, compromising the efficiency and cost-effectiveness of HIV service implementation. In COP 10, TBD partner will offer comprehensive HIV services.

The TBD partner will ensure provision of PMTCT services to 69,925 pregnant mothers. Decentralization of PMTCT services to all lower level facilities will be supported.

HIV trainings will be supported, ensuring training of 330 health care workers (HCW) in PMTCT, through both classroom training and mentorship. The TBD partner will work with the district and provincial Ministry of Health (MOH) teams, to offer continuous medical education for PMTCT. The TBD partner will work with the MOH to identify areas with staff shortages, and support recruitment of additional staff.

HIV CT services will be offered to 69,925 (93.4%) pregnant women attending antenatal, intra-partum, postpartum services. ARV prophylaxis will be provided to 3994 (93.4%) of HIV-infected pregnant women and their babies. All HIV-positive pregnant women will be staged by WHO Clinical Stage and by CD4 count.

Women in WHO stage 3 & 4 or with CD4 cell count <350 will be initiated on ART. AZT will be initiated from 28 weeks gestation for those in WHO stage 1 & 2 with CD4 cell count >350, and offer a minimum of Single dose nevirapine (SdNVP) to those who present late. Of all the HIV positive pregnant women, 50% should receive AZT and NVP, 30% should receive HAART either for their own treatment or as prophylaxis to cover breastfeeding period, and 20% should receive the minimum sdNVP. All the HIV-positive pregnant women who receive sdNVP will be given AZT and 3TC combination for one week post natally to cover the Nevirapine "tail" to reduce the development of NVP resistance. All exposed babies will receive sdNVP, 3TC for one week and AZT for six weeks. Nevirapine tablets will be dispensed to all HIV-positive pregnant women at first contact to minimize missed opportunities.

All HIV-positive pregnant women will receive a comprehensive package of HIV care and ART services, either at the MCH or HIV clinic. Linkage to the HIV clinic will be strengthened by use of peer counselors or mentor mothers. The comprehensive package of services will include clinical assessment for ART eligibility based on the national guideline; provision of ART for those eligible; laboratory monitoring with biannual CD4 testing; cotrimoxazole prophylaxis; psychosocial counseling; adherence counseling; nutritional assessment and supplementation; secondary prevention (prevention with positives [PwP], including support for family testing for spouses/partners and children; supportive disclosure, adherence counseling ,risk reduction counseling including condom provision, alcohol counseling, family planning counseling and provision or referral of services; STI diagnosis and treatment, etc.); provision of a BCK (safe water system, multivitamins, insecticide-treated mosquito nets, condoms, and educational materials); improved OI diagnosis and treatment, including TB screening, diagnosis and treatment.

Cotrimoxazole prophylaxis will be provided to all HIV exposed infants and their mothers. Counseling on infants feeding will also be provided. Exclusive breastfeeding for 6 months will be supported unless the HIV positive mother unless formula milk is AFASS (acceptable, feasible, affordable, sustainable and safe). The PMTCT services will be integrated into all maternity facilities. Emphasis will be placed on primary prevention for majority of women identified as HIV negative.

Early infant diagnosis of HIV will be done from 6 weeks. Infants who test HIV positive below 18 months will be initiated on antiretroviral treatment. Those who test HIV negative but continue to breastfeed will be covered by extended maternal HAART prophylaxis where feasible. Follow up of infants tested will be done to ensure linkage to care and treatment, and effort will be made to improve RH/STI integration into PMTCT services and linkage to family planning services.

Greater involvement of people living with HIV/AIDS through facility and community based psychosocial support groups, Mentor Mothers and PwP strategies will be enhanced. Strategies will be adopted to encourage partners to be tested and receive HIV services.

Efforts will be made to improve ANC attendance and hospital deliveries by working with existing community programs and organizations.

The TBD partner will adapt the quality of care indicators for monitoring the quality of PMTCT services that will be developed by NASCOP, and integrate them into routinely collected data.

The TBD partner will prioritize and support renovation of health facilities to improve space for provision of MCH and PMTCT services.

The TBD partner will strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. With guidance from the national PEPFAR office, the new generation indicators will be adopted.

Funding for Laboratory Infrastructure (HLAB): $0

KEMRI leverages its laboratory research expertise to build capacity of the National Public Health Laboratory Services and hospital based labs to support surveillance, prevention, and care and treatment of HIV/AIDS and TB. In the FY 2010, KEMRI's objectives under EP award will include: i) support for laboratory-based public health evaluations (PHE) and HIV/AIDS surveillance activities, ii) support regional specialized lab-based trainings iii) Provide mentorship support in laboratory technology to regional laboratories, especially in the Nyanza, western, Central, Eastern and Nairobi regions iv) Strengthen laboratory networks for sample referrals, v) evaluate tests and new technologies and pioneer the use of emerging technologies like PCR and HIV-drug resistance testing, vi) Strengthening quality assurance and proficiency testing for rapid HIV test procedures, clinical laboratory tests for monitoring of HIV treatment, and TB testing in district and provincial/regional hospitals, vii) Strengthen general laboratory capacities and efficiencies including supportive supervision, reference laboratory services, and validation of new laboratory tests and equipment, viii) support national infection prevention and bio-safety laboratory initiatives, ix) Support equipment maintenance and service for laboratory equipment at PEPFAR supported laboratories. These activities will contribute to PEPFAR II indicators through maintenance of quality testing at laboratories enabling attainment of WHO step-wise accreditation. The KEMRI Production unit will support national EQA activities. Quality of rapid and PCR based HIV testing are essential entry points for HIV positive persons into care and treatment programs. Close monitoring of anti retroviral therapy will enable timely detection of treatment failures. Increasingly treatment programs are requesting for viral load and drug resistance testing. These are expensive procedures and evaluation of available methodologies needs to be done to guide cost-effective decisions for public health implementation in Kenya. The activity will also support sample referral and split-sample testing to build quality and accessibility to lab services. These activities will continue to support the training of 200 individuals in the provision of lab-related services and will contribute to improvement of the capacity of 6 and 100 laboratories to perform PCR and CD4/ lymphocyte tests, respectively.

Funding for Care: TB/HIV (HVTB): $0

Nyanza province, which has a population of about 5.1 million people, carries the highest HIV burden in Kenya, with an estimated adult HIV prevalence of 14.9% (compared to the national 7.1%), and ~500,000 people are living with HIV. Nyanza also has high burden of TB, having 23,455 TB patients diagnosed in 2007, and a TB case notification rate of 443 per 100,000 population. Nairobi province has a HIV prevalence of 8.8%. The New Nyanza Provincial General Hospital (NNPGH) is the referral hospital for the province.

Since 2003, the Kenya Medical Research Institute (KEMRI) has been supporting TB/HIV activities in Nyanza and Nairobi provinces. The KEMRI cooperative agreement will come to an end in September 2010. Therefore, in COP 10 CDC will solicit a new partner (To Be Determined-TBD) to support the services that KEMRI has been supporting.

The TBD partner will support TB/HIV services at the New Nyanza Provincial Hospital in Nyanza Province, and the International Emerging Infectious Disease Program directed Tabitha Clinic in Nairobi. Bondo District, which is being transitioned this year, will be fully supported by the Columbia University Mailman School of Public Health (CU-ICAP) program in COP10. Support of Siaya District will be transitioned to CU-ICAP, while that of Mathare clinic to University of Maryland.

The TBD partner will ensure provision of TB/HIV services to enable 3000 TB patients to be tested for HIV, and 1800 TB/HIV co-infected patients to receive TB treatment and HIV care and treatment services. In FY10 the TBD partner will continue to support the NNPGH to offer quality TB/HIV services, and to serve as a model and mentorship site for the province.

The TBD partner will support training, sensitization, mentorship, regular review and stakeholder meetings and continued technical assistance through joint supervision visits by District GOK TB, HIV and laboratory teams. The TBD partner, working with the provincial Ministry of Health team, will offer continuous medical education for TB/HIV at the provincial hospital to health care workers in the province. The TBD partner will work with the MOH to identify areas with staff shortages, and support recruitment of additional staff.

To increase the number of TB patients accessing HIV testing services the TBD partner will ensure availability of HIV testing in all TB treatment facilities, and support provision of HIV testing to all TB patients in these facilities. To ensure access and provision of HIV care (including cotrimoxazole prophylaxis) and ART to all TB/HIV co-infected patients, referrals and linkage of TB/HIV patients to the HIV clinic will be strengthened. At the NNPGH an integrated model will be adopted where HIV care and treatment services will be offered at the TB clinic. TB screening for PLWHA attending HIV care and treatment services will be strengthened, by adopting the standardized TB screening tool that NASCOP will finalize in FY 09. Support will be provided to improve the laboratory capacity for quality sputum microscopy services through training of laboratory technologists on AFB microscopy using the national AFB microscopy manual, and collection of sputum slides and re-reading of the slides by the District medical laboratory technologists, as part of the sputum quality assurance system.

The TBD partner will support provision of a comprehensive package of HIV care and treatment services to all TB/HIV co-infected patients at health facility level, including TB treatment and monitoring (with sputum microscopy); cotrimoxazole prophylaxis; clinical assessment for ART eligibility; provision of ART for those eligible; laboratory monitoring; psychosocial counseling, including, positive living and referral to support groups.

Data will be analyzed on a regular basis to inform program performance. The TBD partner will adapt the quality of care indicators for monitoring the quality of TB/HIV services that will be developed by NASCOP, and integrate them into routinely collected data. With guidance from the national PEPFAR office, the new generation indicators will be adopted. Use of an electronic medical records system will be adopted at the NNPGH.

In collaboration with the NLTP and the Provincial TB coordinators, the TBD partner will continue support of a TB-MDR treatment center at the Nyanza provincial hospital, which will be initiated in FY 09. The program will additionally support purchase of MDR-TB drugs mainly for use the NNPGH.

The TBD partner will collaborate with other partners supporting the community activities to ensure linkage and provision of community components of TB and HIV services.