The Lea Toto Program (LTP) is a project of the Children of God Relief Institute (COGRI), an organization based in Nairobi, offering services to children living with HIV/AIDS. With funding from USAID, Lea Toto program provides services to families with HIV positive children in the main informal settlements in Nairobi Province. The goal of the Lea Toto Project is to mitigate the impact of HIV/AIDS and decrease the risk of HIV transmission by providing and facilitating the implementation of a comprehensive home based care package.This will be achieved through the following five objectives:1. To enhance the provision of high quality medical care, nutritional support and counseling services to 8,500 HIV+ children and their families by 2012.2. To provide a package of social support services to at least 70% of the needy HIV+ children and their families3. To enhance the organizational capacity of all Lea Toto staff to design, monitor and coordinate quality care services for HIV+ children and their families4. To enhance capacity of the target local communities to provide care and support to HIV + children and their families.5. To enhance the capacity of the target communities to carry out preventive measures through negotiation, support and maintenance of safe behavior. This activity supports GHI/LLC and is completely funded with pipeline funds in this budget cycle.

The project will support a minimum package for home and community based care in line with NASCOP guidelines. The services will include nursing care and palliative care; clinical care with an emphasis on treatment literacy and sustainability; family care and support (including psychosocial support, access to reproductive health services, and initiatives to strengthen food security and proper nutrition); trainings for health care workers, CHWs and peer educators; and establishing proper linkages and referrals to ensure clients access additional services as necessary. Lea Toto program will reach 1,000 OVC in the village and 500 in the community. Those to benefit from the project as OVC will constitute children aged 0-17 years while ensuring both girls and boys have equal chances of benefiting from the project. The project will provide food/nutritional and household support, life skills training, career guidance and talent development.Those aged 18 years and above will be considered as beneficiaries on home based care and support. The project will establish a community managed revolving fund/micro credit to offer loans to the grown up OVCs to start small business enterprises and become independent after obtaining the relevant trained skills from the village. The loans will also be offered to the surrounding communities particularly the caregivers to start cottage industries and other income generating activities. CHWs will be trained in accordance to the National guidelines and assigned to OVC/HBC households while project staff will make periodic follow-ups to those within the community to ensure retention on the program. Children within the village will be followed up by counselors/social workers within the Village. The mature OVC will receive ASRH information and services.

Lea Toto Project will provide care and support services to (4,750) orphans and vulnerable children (OVCs) with high quality home based care and other support services. This activity is a continuation of the project which was started in September 1999, and implemented in selected slums in Nairobi in Kangemi, Kariobangi, Kibera, Kawangware, Dandora and Mukuru. The Program is expanding to include 3 more centers; 2 in Nairobi. The activity will also improve the organizational capacity of the Lea Toto program to deliver high quality care and counseling and other support services for HIV+ children and their families. Lea Toto Project will work with trained community workers at the activity sites and will provide or facilitate access to a range of services for families and OVC care givers. It is anticipated that these services will include training around OVC support; anti-retroviral treatment, education, psycho-social support including succession planning, nutritional support, empowering of the caregivers through self-help Groups and eventually referral for micro-business training for family income support and other Micro credit services at the K-REP Development Agency (KDA). This activity will strive to strengthen the ability of targeted local communities to prioritize needs of HIV+ children and their families and carry out activities to meet these needs. 23,750 family members and 4750 children will receive high quality home based care and other support services and 500 caregivers will be trained.

This activity will contribute to the Kenya 5-year strategy, will increase the number of OVCs receiving HIV/AIDS care and support, and will reach 23,750 family members of OVC.

This activity targets orphans and vulnerable children, caregivers of OVC, grandmothers, and community health volunteers. The key legislative issues being addressed is stigma and discrimination through enhanced medical and psychological wellbeing, and demonstrated improved quality of life. This activity also addresses the wrap around issue of food. The program progressively seeks ways to enhance sustainability of the support to the orphaned and vulnerable children by among other promoting establishment support groups and self-help groups for caregivers. Through this groups as well as individual caregivers initiative, economic empowerment initiatives are being implemented.

Emphasis areas are Training and Community Mobilization and Participation. It is expected that the trainings will have a ripple effect on the ability/capacity of the caregivers and community health Volunteers to care for the orphaned and vulnerable children especially those infected with or exposed to HIV. Enhanced community mobilization will ensure that necessary care for the orphans and vulnerable children will be timely to avert mortality at an early age and effectively manage the HIV and AIDS situation. This will also strengthen early identification for infected children, referral mechanisms for children with complicated medical or psychosocial cases, subsequently ensuring effective care for all OVCs whether infected or affected.

This activity will involve 100% screening of all the children enrolled in the program for TB. Those found infected will be initiated on treatment in partnership with Government health facilities. All Lea Toto centers are TB treatment centers. In addition households where TB cases are identified will be mobilized to get screened and where necessary seek treatment. The TB treatment in Lea Toto was started in 2006 to provide a one stop shop for HIV positive children who were found to have TB. This was necessary since HIV patients are susceptible to TB hence it was necessary Lea Toto screen all the children under its care periodically. Initially the children were referred to GOK facilities but that posed a challenge of adherence as well as monitoring. Lea Toto sought the help of GOK for the supply of commodities and capacity building for its staff to provide TB treatment. The starting of TB treatment has also helped to reduce time spend seeking services because the children are attended to while coming for the other services provided by the program. Through the home visits, program staff are able to monitor adherence to both TB and ARV treatment as well as Monitoring cases of advance drug reaction if any. 160 health workers will be trained on HIB/TB related issues to ensure that they are effective in their management. This activity will contribute to the Kenya National AIDS strategic plan 2009/10 -2012/2013 outcome 2 increase the proportion of TB patients who are HIV infected and are on ART. This is done through provision of TB testing and counseling and follow up to ensure adherence to treatment as done at Lea Toto centers. Further counseling of TB patients on prevention of transmission is emphasized. Linkages for referral especially other family members is done as well as ensuring that the Health workers in the program are conversant with the reporting requirement especially capturing TB patients on ART as well as ensuring that all PLHIV are screened for TB. TB screening and treatment is among services outlined in the minimum package for health care for facilities in Kenya. This program area will target HIV positive infants and children, care givers, community health workers and program staff. The major emphasis area is training, with a minor emphasis on community mobilization and participation. TB screening and treatment for those infected, adherence to treatment and mobilizing affected households to get screening will be emphasized.

This activity will result in (35,000) family members and (8,000) children receiving high quality facility and home based care and other support services. The facility-based activities will include strengthening of facilities that are already serving as network referral centers for pediatric HIV care. Activities will include HIV related laboratory tests, OI prophylaxis and strengthening pharmaceutical management. Lea Toto will also strengthen the ability of targeted local communities to prioritize needs of HIV+ children and their families and carry out activities to meet these needs. The goal of the Lea Toto Project is to mitigate the impact of HIV/AIDS and decrease the risk of HIV transmission through the provision of a comprehensive home based care package. Some of the activities include group therapy sessions, life skills training, post disclosure clubs, recreational activities, coping skills, disclosure meetings, support group meetings and follow up counseling sessions. Life skills training sessions which are held with children aged between 7 and 16 years to address issues related to drug adherence basic hygiene and nutrition. The activity will further prepare perinataly infected adolescents for discharge from Pediatric clinics to adult comprehensive care centers. The activity will also improve the organizational capacity of the Lea Toto program to deliver high quality care and counseling and other support services for HIV+ children and their families. This activity will contribute to the Kenya 5-year strategy and increase the number of people receiving HIV/AIDS care and support. Specifically, (8,000) 5,000 will be provided with HIV-related palliative care, 1200 trained to provide palliative care and 10 service outlets will provide care.This activity is linked to CT (HVCT) and ART (PDTX) activities implemented by COGRI / Lea Toto and also linked to other USG ART activities in the ARV Services program area. It will target people affected by HIV/AIDS including Caregivers, HIV positive infants and children, OVCs and PLWHAs.

This activity will result in counseling and testing of 3,500 children and at least 1,000 adults in 10 existing voluntary counseling and testing centers situated near the project centers selected slums of Nairobi. In addition, 30 VCT counselors will be trained in order to improve the organizational capacity of the Lea Toto program to deliver high quality care and counseling services for HIV+ children and their families. Referrals for VCT services which are mainly through self, CHWs, caregivers, community leaders and other institutions within the program area will be strengthened. Program Counselors and Community Based Counselors (CBCs) will carry out continuous dissemination of prevention information both during Voluntary Counseling and Testing and in any other counseling and / or group therapy session organized by the project. These group therapy sessions include life skills training, disclosure meetings, support group meetings follow up counseling sessions and Mentorship program for teenagers before they graduate to adults comprehensive care centers (CCCs).

This activity will contribute to the Kenya 5-year strategy and increase the number of people counseled and tested for HIV/AIDS by training 15 VCT counselors and testing3,500 children and at least 1,000 adults. This will be in line with outcome1: Reduced risk behavior among the general, infected, most at risk and vulnerable population; specifically the program will contribute to the High level outputs 1., 2., and 3., that is, uptake of HIV prevention among the most productive age group of 15 64 years, knowledge of HIV status and increase of proportion of pregnant women accessing PMTCT services.Targeted population include the General population (men and women), Families affected by HIV and AIDS including HIV positive infants and children, orphaned and vulnerable children due HIV and AIDS, care givers, community health workers and Community Based Counselors mostly living in the informal settlements within Nairobi.This activity will work to reduce stigma and address discrimination faced by individuals infected or affected by HIV/AIDS. This activity will address issues on disclosure of ones status to partner and family members. In providing holistic services to the child the program will among others enhance legal support its beneficiaries in matters of care and protection, succession and the general promotion of child rights.Training of VCT counselors to enhance their ability to provide quality HIV/AIDS services that are responsive to the clients needs is the major emphasis area while community mobilization and participation are the minor emphasis areas. Given the field experiences the program will strengthen home visitation for regular counseling and testing services for identified households who are highly vulnerable to infection with HIV and with an aim to increase coverage of CT services (ensuring siblings of infected children are also counseled and tested for timely inte

This activity will expand established programs in targeted slums in Nairobi to include 9 centers; 8 in Nairobi informal settlements. As a result of these activities, 3000 individuals will receive antiretroviral therapy 300 will initiate treatment during the year, with the total of people ever treated reaching 3000, and 160 health care workers will be trained in the provision of antiretroviral therapy. These activities will include strengthening of facilities that are already serving as network referral centers. Activities will include procurement of laboratory services and strengthening rational pharmaceutical management. COGRI Lea Toto will track numbers of children served and will report nationally.

The Children of God Relief Institute (COGRI)/Lea Toto Project was started in September 1999, and the first phase was implemented for 2 years in Kangemi. Following evaluations that were conducted in May 2001 and May 2006, further extensions were granted. The current phase started in March 2009. In the present extension phase, the program seeks to provide treatment services for 3000 HIV+ children in 8 centers in Nairobi.This activity will contribute to the Kenya 5-year strategy and increase the number of children on antiretroviral therapy, responds to OGAC objectives of increasing the number of children on ART. This is in line with the Outcome 2: Proportion of eligible PLHIV on care and treatment increased and sustained: Expected higher level outputs for this outcome are proportion of eligible PLHIV enrolled on ARV increased and proportion of TB patients who are HIV infected on ART increased and increase PLHIV receiving nutritional support.

The major emphasis area is training, with a minor emphasis on community mobilization and participation. The major emphasis area is HIV and AIDS progression monitoring through periodic testing for CD4 counts and Viral loads for timely initiation on ART, adherence training and counseling and emphasis on disclosure.