Coptic Mission Hospital (CMH) provides high quality, family-oriented medical and psychosocial services for people infected with and affected by HIV in Nairobi and Nyanza. Objectives include: optimize treatment outcomes through support of psychosocial well-being; prevent HIV transmission; and establish the administrative, technical, and physical capacity of the CMH to deliver HIV care. The goal and objectives are linked to Kenyas Partnership Framework (PF) and GHI strategies and are directly aligned to PF pillars 1-3, prevention, care and mitigation, treatment, and systems strengthening. Strategies to reduce maternal and child mortality and eliminate MTCT include supporting family planning integration into HIV clinics.Cost efficiency efforts include: integration of services, use of existing evidence-based efficient strategies, task shifting, implementing facility-based training/mentorship as opposed to offsite training, evaluating cost effective strategies for defaulter management, lab networking, mobilization, strengthening and implementing IT systems to produce reports and provide timely access to information, and implementing accounting system to ensure accuracy and track expenses.CMH is a local FBO partnering with the MOH in various aspects of the HIV program. Capacity-building strategies are aimed at strengthening sustainable local systems for effective transition of technical support from CMH to MOH. CMH will continue to build its capacity in M&E of the program by sending its key staff for training and courses in grants management and administration.

CMH procured 7 vehicles in between FY 07-10. CMH program will procure 4 vehicles with FY12 funds to support service implementation and replace some which are grounded. This activity supports GHI/LLC.

Coptic Mission Hospital (CMH) will support two sites in Nairobi province (Ngong Hope Centre & Industrial Hope Centre) and one site in Nyanza province (Maseno Hope Centre). Nairobi Province has a HIV prevalence of 8.8% and 15.3% in Nyanza. By March 2011, CMH had cumulatively enrolled 17,212 in HIV care; of these 10,309 are active. Cotrimoxazole was provided to 9,550 patients, which is 93% of active patients.

CMH will work with the Ministry of Health (MoH) at the provincial, district, and health facility level, to plan, coordinate, implement and ensure provision of quality HIV care and support to 10,139 current adult patients in FY12 and 11,910 current patients in the FY13.

CMH will offer comprehensive care and support package of services including: HIV testing to partners and family members of index patients and enrolling or referring/linking those that test HIV positive to care and support; provision of Basic Care Kit (safe water vessel, multivitamins, insecticide-treated mosquito nets, condoms, chlorine for water treatment and educational materials); therapeutic nutrition (FBP) to all enrolled HIV positive patients; prevention with positives(PwP); and family planning and reproductive health services including cervical cancer screening for all enrolled women.

CMH in collaboration with MoH will support targeted capacity building (training and mentorship) for health care workers and offer continuous medical education on care and support, e.g. OI diagnosis and treatment. CMH will identify areas with staff shortages, support recruitment of additional staff, and support good commodities management practices to ensure uninterrupted supply of commodities.

CMH will also support ongoing community interventions for HIV infected individuals, including peer education and use of support groups to provide adherence messaging; effective and efficient defaulter tracing and follow up to improve retention in all facilities; referral and linkages to community based psychosocial support groups; water, sanitation and hygiene programs; economic empowerment and income generating activities (IGAs); home based care services; gender based violence support programs; vocational training; social and legal protection; and food and nutrition and/or food security programs.

CMH 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.

CMH will do cohort analysis and report retention rates as required by the National AIDS & STI Control Programme (NASCOP). CMH will continue to strengthen data collection and reporting at all levels to improve reporting to NASCOP and PEPFAR. New generation indicators will be adopted and CMH will support the development and use of electronic medical records system in accordance with NASCOP guidelines. Quality of care indicators (CQI, HIVQUAL) will be used for monitoring the quality of HIV care and support services. Indicators will be integrated into routinely collected data and results used to evaluate and improve clinical outcomes. CMH will support joint Annual Operation Plan (AOP) planning, implementation, monitoring and evaluation, and health system strengthening to facilitate sustainability.

Coptic Mission Hospital (CMH) will support two sites in Nairobi province (Ngong Hope Centre & Industrial Hope Centre) and one site Nyanza province (Maseno Hope Centre). CMH has been supporting TB/HIV services in the 3 sites in line with the Ministry of Health Division of Leprosy, Tuberculosis and Lung Disease (DLTLD) and the National AIDS and STI Control Program (NASCOP) since 2010.

Between October 2010 and March 2011, the 2,714 adult HIV patients received TB treatment. Patients who received HIV testing counseling were 3,627 and 2,714 TB HIV co-infected patients were identified.

In FY12 and FY 13, CMH will intensify efforts to detect TB cases through clinical exams and laboratory investigations as well as ensure successful TB treatment through provision of appropriate treatment. CMH will ensure that each facility providing TB/HIV services has adequate and well trained clinical staff supported by well equipped and staffed laboratory, including sputum specimen transport where laboratory services are unavailable. CMH will ensure that adequate supplies of anti-TB drugs are available and that the national TB treatment guidelines are followed. All TB patients on treatment will be monitored both clinically and through periodic sputum examination.

To reduce the burden of HIV in TB patients, CMH will ensure that at least 95% of TB patients are screened for HIV and 95% TB-HIV co-infected patients are put on cotrimoxazole and ARVs as early as possible regardless of the CD4 count as per the national guidelines. CMH will support the one stop model that provides integrated TB and HIV services in all TB clinics. All TB clinics will be stocked with cotrimoxazole and ARVs. 50 and 40 HCWs will be trained in FY12 and FY13 respectively.

To reduce the burden of TB in HIV infected patients, CMH will support intensified TB screening for 9,012 in FY12 and 10,586 in FY13 HIV infected persons identified in their HIV care settings. 451 co-infected patients identified in FY12 and 551 co-infected patients identified in FY13 will be put on TB treatment and those without active TB will be provided with Isoniazid Preventive Therapy (IPT) as per national IPT protocol.To strengthen TB infection control in HIV settings, CMH will ensure that the national IC guidelines are available at all sites and training of staff on IC is done. CMH will support scaling up of at least 2 components of the national TB infection control strategy in HIV care settings, one of which will be fast tracking of patients with cough for expedited diagnostic work up and treatment.

To improve surveillance and management of drug-resistant TB, CMH will support timely transport of sputum specimens of TB retreatment cases from health facilities to the central reference laboratory for drug susceptibility testing and ensure return of the results to those facilities. CMH will also support scaling up of drug-resistant treatment sites thus expanding access to MDRTB treatment.

CMH will support expansion of prevention with positive (PwP) services in TB clinics, TB/HIV control activities in the prisons, strengthening linkages between facility and community-based services, and improving patient referrals and tracking systems. To strengthen HVTB program monitoring, CMH will support reporting of selected custom indicators to assist with program management and evaluation and monitoring of new activities.

Coptic Mission Hospital (CMH) is in year 2 of a 5-year cooperative agreement and will support two sites in Nairobi Province (Ngong Hope Centre & Industrial Hope Centre) and one site in Nyanza Province (Maseno Hope Centre). Nairobi province has a HIV prevalence of 8.8% and 15.3% in Nyanza. CMH has been supporting pediatric care activities in the 3 sites since 2010. As of March 2011, CMH had enrolled 1,197 children into care of whom 695 were active and on cotrimoxazole prophylaxis.

In FY 12 and 13, CMH will provide care and support services to 1,060 and 1,267 children currently on care respectively. CMH will provide comprehensive, integrated quality services, and scale up to ensure 89 HIV infected infants are put on ARV prophylaxis and all HIV exposed children access pediatric care services.

The focus of pediatric care services will be provision of comprehensive, integrated quality services including strengthening the use of the Mother-baby booklet, early infant diagnosis, universal provider initiated testing and counseling, and ensure those identified HIV infected are linked to care and ART services.

CMH will ensure children enrolled in care receive quality clinical care services including clinical history and physical examination; WHO staging, CD4 tests, and other basic tests; opportunistic infection diagnosis, prophylaxis and management; TB screening; pain and symptom relief and management; and psychosocial support. Additional key care services will include nutritional assessment, counseling and support based on the WHO and IYCF guidelines (including provision of therapeutic or supplementary feeding, support to children with growth faltering, provision of vitamin A, zinc, and de-worming); provision of safe water, sanitation and hygiene interventions (WASH) in the community and in health facilities; and malaria screening, treatment and provision of long lasting insecticide treated nets in malaria endemic areas.

CMH will support integration of HIV services into routine child health care and survival services in the MCH including growth and development monitoring; immunization as per the Kenya Expanded Program on Immunization guidelines; case management of diarrhea, pneumonia, and other childhood illnesses; and community outreach efforts. CMH will a support newborn care by supporting hospital delivery, ensuring that there is provision for newborn resuscitation and care (thermal care, hygiene cord care), and prophylactic eye care. Exposed children management and follow up will continue to be supported and will include enrollment, HIV testing (PCR-DNA and antibody testing) as per the national guidelines, provision of Nevirapine throughout the breastfeeding period, follow up and retention, and linking HIV positive children to care and ART services.

CMH will support hospital and community activities to support the needs of adolescents including support groups to enhance disclosure, adherence messaging, PwP, substance abuse counseling, support for transitioning into adult services, and teaching life skills. Commodity access and infrastructure development will be supported. CMH will strengthen pediatric data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR.

The Hope Centre for infectious Diseases (COPTIC) has three centers where they offer ART services and also provide testing and counseling both as VCT and PITC. Provider Initiated Testing and counseling approach is used in the outpatient clinics in their two sites in Nairobi and one in Maseno, Western Kenya. They also offer Home based testing and counseling during their outreach services. The total number of clients served in the past one year is 3,627 offered testing and counseling.The program has had staff trained in PwP data management and quality management.

In 2012 Coptic hospital will be supported to integrate PITC fully into their clinical services and to expand PITC in outpatient services as well as serve communities around their static sites. This will start with a modest target of 5,000 which is based on their past performance. Out of this 20% will be couples and 60 % will be new testers. Coptic Hospital has well established ART service and this will be used as a platform for enhanced PwP.

The program will continue to use the national testing algorithm for testing and counseling.

The national M&E framework is used including use of national registers and data collection tools and reporting will be through the DHIS in future. Quality services is ensured by adherence to national guidelines, use of national certified kits and participation in the external quality assurance through proficiency testing run by the government.Quarterly review meetings for the program will be conducted and improvements made as necessary for greater impact.

Promotional activities will be by IEC materials and community mobilization in the area of coverage. The national communication strategy will enhance mobilization.

COPTIC implements comprehensive prevention, care and treatment programs in Nairobi province. In FY 2012/13, COPTIC will expand HIV prevention services to include evidence based behavioral interventions (EBIs) for specific target populations in clinical settings at comprehensive care center (CCC), TB and Maternal Child Health (MCH) clinics as part of HIV combination prevention programs. The EBIs will include Positive Health and Dignity Prevention (PHDP) targeting adult male and female and adolescents living with HIV (PLHIV); and Sister to Sister EBI (S2S) targeting sexually active HIV negative women attending the MCH clinics.

PHDP is an ongoing 5-10min group and individual level intervention that targets PLHIV in clinical and community settings. This mechanism will support this intervention which constitutes of ART adherence counseling and support; partner and family testing; provision of PEP to the discordant spouse; treatment for prevention once approved; safer pregnancy counseling and provision of modern contraception; sexual risk reduction counseling including reduction of sexual partners, alcohol counseling, promoting of consistent and correct condom use; Sexually Transmitted Infections (STI) screening and treatment and using meaningful involvement of people living with HIV/AIDS (MIPA). The efficacy of PHDP has been shown to be 68% in preventing transmission of HIV, and 96% in treatment for prevention.

S2S is a 20 minute individual level intervention that targets women of reproductive age that focuses on self efficacy, safer sex negotiation skills and condom use. Condoms are 80% effective in heterosexual relationships when used correctly and consistently.

COPTIC will use HVOP funding to recruit and support appropriate peer educators/counselors to reinforce prevention messages delivered by health providers as a feasible model for task-shifting in the provision of PHDP in clinical settings, and specifically promote MIPA. It will support placement of 5 Peer Educators at the MCH, TB and CCC Clinics in hospitals, and 2 Peer educators at health centres and provide appropriate counseling space. One of the peer educators will do regular client home follow up to strengthen ART adherence.

Approximately 1.6 million Kenyans are PLHIV. The Kenya AIDS Indicator Survey 2007 showed 6% of couples to be in discordant relationships. Nairobi province HIV Prevalence is high (8.8%). COPTIC will reach 5711 (60%) PLHIV in FY2012 and 7840 (70%) in FY 2013 with a minimum package of PHDP. It will implement S2S EBI on a pilot basis.

Quality assurance for EBIs will be promoted through appropriate training and certification of peer educators using approved national curricula, standard job-aids and guidelines and regular supervision.

COPTIC will work with appropriate national Technical Working Groups to support integration of HIV prevention into care and treatment programs in clinical settings. These programs will also be linked to other HIV community programs. PLHIV will be specifically linked to STI and FP services, as necessary, through patient escorts.

Monitoring of PHDP and S2S will be done through the review/input of COPTIC implementation plan, analysis of KePMS data, quarterly reviews, semiannual and annual reports. Evaluation will be conducted through operation research of combination HIV prevention and periodic surveys (Kenya Demographic and health survey, Kenya Indicator AIDS Survey, Kenya Service Provision Assessment).

Coptic Mission Hospital (CMH) will support PMTCT in 3 sites. Since 2010, CMH has been implementing PMTCT services in two sites in Nairobi province (Ngong Hope Centre & Industrial Hope Centre) and one site in Nyanza Province (Maseno Hope Centre). By end of March 2011, CMH had counseled and tested 291 pregnant women and given ARV prophylaxis to 690 HIV positive pregnant women.

In FY12, CMH will offer HIV counseling and testing to 996 pregnant women at ANC and give ARV prophylaxis to 164 HIV infected pregnant women. The HIV infected women will receive a CD4 test after undergoing a WHO clinical staging. CMH will give HAART to all eligible HIV positive pregnant women in line with the revised PMTCT national guidelines. In FY13, CMH will increase the number of pregnant women counseled to 1,014, offer ARV prophylaxis to 104 pregnant women and 89 infants, and do EID for 89 infants.

CMH will focus on 4 prongs of PMTCT: primary prevention; family planning; ARV prophylaxis to all HIV positive pregnant mothers and exposed infants; and care and treatment to eligible HIV positive mothers, partners and children. The Minimum care package will include health and HIV education, individual/ family HIVCT, clinical/laboratory monitoring and assessment, OI screening and treatment, ARV prophylaxis and treatment for both mother and baby, nutritional support, psychosocial support, PWP, follow up, retention, and referral and linkages. CMH will incorporate TB screening into routine antenatal care.

CMH will reach 304 of 1st visit ANC attendees with couple CT to identify discordant and concordant couples to improve primary prevention and facilitate linkage to HIV care and treatment for the eligible. CMH will support integration of ART in MCH clinics, access to FP/RH services, and establish or strengthen infection control and waste management activities.

CMH will support hospital delivery through provision of delivery beds and sterile delivery packs, training, working with CHWs and TBAs to promote community- facility referral mechanism, health education, and community services providing skilled birth attendance.

CMH will support safe infant feeding practices as per national guidelines and support enrollment and follow up of 89 of babies born to HIV infected mothers to access CTX, ARV prophylaxis, and EID services using the HIV exposed infant register till 18 months. CMH will facilitate ART initiation for those who test positive before 2 years.

CMH will adopt efficient retention strategies for mothers and babies by supporting use of diaries and registers for tracking defaulters, having a structured mentorship and supervision plan (training 30 HCP in FY12 and FY13), enhancing data quality and streamlining M&E gaps including orientation of new MOH ANC/maternity registers, and utilization of data at facility level for program improvement and quarterly progress reports to CDC.

Program quality and proficiency testing will be emphasized to validate PMTCT results. CMH will train HCWs on PMTCT and provide orientation to the revised PMTCT and infant feeding guidelines and engage in community activities for demand creation for health services such as male involvement with couple CT services.

Coptic Mission Hospital (CMH) will support treatment in 3 sites located in Nairobi and Nyanza provinces. Nairobi and Nyanza provinces have an estimated population of 3.1 and 5.4 million people respectively with an estimated adult HIV prevalence of 8.8% and 14.9% respectively compared to the national 7.1%. Since 2004, CMH has been supporting adult treatment in 3 sites and had initiated 7,796 adults on ART with 7,700 active as of 2011 SAPR.

In FY12, CMH will jointly work with the Ministry of Health (MoH) to continue supporting provision of quality adult HIV treatment services in the 3 sites in line with MoH guidelines to 8,852 patients currently receiving ART and 1,579 new adults resulting to cumulative 10,622 adults who have ever been initiated on ART. In FY13, this number will increase to 10,038 currently receiving ART and 1,597 new adults resulting to 12,219 adults who have ever been initiated on ART.

CMH in collaboration with MoH will support in-service training of 50 and 40 health care workers in FY 12 and 13 respectively, identify human resources and infrastructure gaps and support in line with MoH guidelines, and support good commodities management practices to ensure uninterrupted availability of commodities.

CMH will support provision of comprehensive package of services to all PLHIV including ART initiation for those eligible; laboratory monitoring including biannual CD4 testing and viral load testing for suspected treatment failure (through strengthened laboratory network); cotrimoxazole prophylaxis; psychosocial counseling; referral to support groups; adherence counseling; nutritional assessment and supplementation; prevention with positives (PwP); FP/RH; and improved OI diagnosis and treatment including TB screening, diagnosis, and treatment.

CMH will continue to support ongoing community activities for HIV infected individuals including peer education and use of support groups to strengthen adherence, effective and efficient retention strategies, referral and linkages to psychosocial support groups, economic empowerment projects, Home Based Care, and food and nutrition programs. CMH will adopt strategies to ensure access and provision of friendly HIV treatment services to all, but in particular youth and special populations, through supporting peer educators, support groups, disclosure, partner testing and family focused care and treatment.

CMH will do cohort analysis and report retention rates as required by the national program and discuss the analysis results with facility staff in order to improve program performance. CMH will adapt the quality of care indicators (CQI, HIVQUAL) for monitoring the quality of HIV treatment services and integrate them into routinely collected data, use the results to evaluate and improve clinical outcomes, and support short term activities that increase impact and improve patient outcomes.

CMH will continue to strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. Use of an electronic medical records system will be supported and strengthened.

Coptic Mission Hospital (CMH) will support pediatric HIV treatment in Nairobi. Since 2004, CMH has been supporting pediatric treatment in Ngong Hope Centre, Industrial Hope Centre in Nairobi and Maseno Hope Centre in western Kenya and had initiated 590 children on ART and 576 were active as per 2011 SAPR.

In FY12, CMH will jointly work with the Ministry of Health (MoH) to continue supporting expansion and provision of quality pediatric HIV treatment services in the 3 sites in line with MoH guidelines to 775 children currently receiving ART and 155 new children resulting to cumulative 930 children who have ever been initiated on ART. In FY13, this number will increase to 870 currently receiving ART and 139 new children resulting to 1,069 children ever initiated on ART.

CMH will support comprehensive pediatric ART services including growth and development monitoring; immunization as per the Kenya Expanded Program on Immunization; management of childhood illnesses; OI screening and diagnosis; WHO staging; ART eligibility assessment; laboratory monitoring including 6 monthly CD4, hematology, and chemistry (through strengthening of lab networks); Pre-ART adherence and psychosocial counseling; initiation of ART as per MoH guidelines; Toxicity monitoring; treatment failure assessment through targeted viral load testing; Adherence strengthening; enhanced follow up and retention; support EID as per MoH guidelines; PITC to all children and their care givers attending child welfare clinics; support family focused approach; community outreach efforts; and integration of HIV services in other MNCH services.

CMH will support hospital and community activities to support the needs of HIV infected adolescents: support groups to enhance disclosure and adherence messaging, PwP, substance abuse counseling, teaching life skills, providing sexual and reproductive health services, and support their transition into adult services. CMH will additionally support short term activities to increase impact and improve patient outcomes.

CMH will support in-service training of 50 and 40 HCWs in FY 12 and 13 respectively, continuous mentorship and capacity building of trained health care workers on specialized pediatric treatment including management of ARV treatment failure and complicated drug adverse reactions. CMH will identify human resources and infrastructure gaps and support in line with MoH guidelines and support good commodities management practices to ensure uninterrupted availability of commodities. Linkage of ART services to pediatric care services, PMTCT, TB/HIV, community programs, and other related pediatric services will additionally be optimized.

CMH will continue to strengthen data collection and reporting at all levels to increase and improve reporting to NASCOP and PEPFAR. Additionally, CMH will review data and evaluate programs to inform programming and decision making. Use of an electronic medical records system will be supported and strengthened. CMH will strengthen local capacity as part of the transition plan to MOH for sustainable long-term HIV patient management in Kenya.