The Kenya Ministry of Public Health and Sanitation (KMOPHS) assures national service delivery through the dissemination of funding, technical support, and M&E. KMOPHS has contributed to reduced morbidity, mortality and the improvement in a number of health indicators. Still many Kenyans are exposed to a broad, heavy disease burden including a high child mortality from malaria, HIV andTB. KMOPHS faces challenges in addressing these health burdens including inadequate financial and human resources, poor physical infrastructure, inefficient support systems, and poorly coordinated responses to public health problems. In accordance with the Kenya GHI Strategy, KMOPHS plans to address these challenges by coordinating and integrating a high impact national response to reduce disease burden particularly among women and children. To build sustainability and transition the program to country ownership, the program seeks to: a) strengthen the KMOPHS capacity to plan, implement, manage, and monitor programs that address critical public health needs; b) support the implementation of national public health programs; c) conduct public health surveillance and epidemiological assessments; d) incorporate surveillance, epidemiological, and evaluation data into operational public health programs, policies and guidelines; and e) disseminate the results of surveillance and program planning, execution and evaluation results. KMOPHS will work across Ministries to coordinate disease-specific and broader national public health programs to increase cost effectiveness. This partner has not used PEPFAR funds for vehicle purchase in the past and is not requesting funds for vehicle purchase in FY12. This activity supports GHI/LLC.

Ministry of Public Health and Sanitation (MOPHS) will use the funds to support, coordinate, and oversee the national implementation of all facility, community, and home based HIV care and support programs for people living with HIV/AIDS including health care workers and others providing services to people living with HIV in Kenya.

The funds will be channeled through the technical departments and divisions as appropriate. The Family Health Department will coordinate the nutrition and reproductive health issues (including cervical cancer screening and management) among all partners in the provision of care for people with HIV (through national level meetings such as the National TWG and stakeholders forums) and supervision of care and support services in Government of Kenya (GOK) and other facilities. The Technical Planning and Performance Monitoring Department roles include monitoring of quality of care and support services. This department will work with relevant MOPHS divisions to support and coordinate relevant research studies to advance evidence based interventions for care and support issues.

The Disease Control Department houses the National AIDS and STI Coordination (NASCOP) office, which has a system in place to supervise regional HIV/AIDS treatment activities and programs. NASCOP will establish care and treatment services at additional sites and conduct program evaluations and accreditation. The department also has specific divisions that provide national expertise and oversight on tuberculosis, leprosy and lung diseases, non-communicable diseases, and malaria control in accordance with the GHI Kenya Strategy. NASCOP will distribute HIV prevention materials for health care providers that incorporate consistent messages regarding HIV status disclosure, partner testing, and condom use to prevent sexual transmission. Specific guidelines for prevention and treatment of opportunistic infections, including sexually transmitted infections, HIV prevention in care settings, and management of nutrition interventions will be revised, updated, printed, distributed and disseminated as needed.

Other activities include improvement and strengthening of referral systems and care linkages between the community and facility based activities; support of strategies that address client retention in the HIV program including the use of community outreach, decentralization of care and treatment services to lower level health facilities to increase access and reduce waiting lists at provincial and district hospitals; and improved coordination with other sources of support such as the Global Fund for AIDS Tuberculosis, and Malaria.

The MOPHS activities coordinated and carried out by the various departments and divisions (such as the vaccine and immunization, child and adolescent) are linked to Counseling and Testing, PMTCT, Adult and Pediatric ARV Services, Strategic Information and TB/HIV activities in Kenya. These activities are also closely linked to the Management Systems of Health (MSH) supported logistics/systems strengthening, particularly for the Kenya Medical Supplies Agency for the procurement of OI drugs.

The Division of TB and Lung Disease (DLTLD) and National AIDS and STI Control Program (NASCOP), under the Ministry of Public Health and Sanitation (MOPHS), are responsible for establishing TB/HIV policy, development of TB/HIV training curriculum, and providing overall implementation of collaborative TB/HIV activities in Kenya, as prioritized in Kenyas 5-Year National AIDS and TB Strategic Plans

In 2010, DLTLD registered 105,781 TB cases. Of these, 34%, 31% and 17% constituted smear positive, smear negative, and extra-pulmonary disease, respectively. TB treatment success rate for patients registered was 86.4%. 90% of the registered TB patients were tested for HIV. The average national HIV prevalence among TB patients was 41%, although it was as high as 75% in some settings. In 2010, DLTLD identified 57,224 HIV co-infected TB patients, of whom 97% and 47% received cotrimoxazole and ARVs respectively. Integration of TB/HIV services in many settings and increased decentralization of ART points have prepared the ground for improved ART access for TB patients, regardless of CD4 counts. To initiate and expand TB screening in HIV care and treatment clinics, implementing partners supported widespread distribution and use of new MOH screening tools for both adults and children. Kenya has developed and adapted the new national IPT implementation guidelines/tools to kick-start implementation of IPT. Drug susceptibility testing (DST) for TB re-treatment cases reached 70% and 112 MDRTB patients were put on treatment.

In 2012, DLTLDs priorities include scaling up the Three Is, early initiation of HAART for HIV+ TB patients, integration of TB/HIV services, systems strengthening, and introduction of new technology to improve MDR-TB surveillance and diagnosis of HIV-driven TB. Efforts will be made to ensure GoK and Global Fund TB funding complement PEPFAR, GHI and other donor support. DLTLD will concentrate on getting more eligible TB/HIV co-infected patients onto ART and intensify, in collaboration with NASCOP and other partners, TB screening for HIV+ persons identified in HIV care settings. DLTLD will ensure widespread distribution/use of MOH TB infection control guidelines/tools to protect patients and health providers. DTLD plans to expand access to TB preventive treatment (IPT) in selected sites. Emphasis will be placed on developing regional trainers who will provide classroom training and mentorship of health care workers at the facility level in order to build the capacity and confidence of clinicians and ensure sustainability.

In 2011/12, Kenya will conduct a national anti-TB drug resistance survey, strengthen TB diagnostic services, support construction of a new central reference TB laboratory (CRTL), and decentralize TB culture capacity and improvement of bio-safety levels at the CRTL. Other priorities include: introduce geneXpert technology for more efficient detection of TB and DR TB; evaluate diagnosis and management of TB in children; develop regional laboratory centers of excellence in Nyanza, Eldoret, Kericho and Coast General Hospitals; and strengthen community TB strategy. In support of MDRTB diagnosis and management, DLTLD will develop 2 MDRTB treatment centers in Coast and Nyanza Provincial General Hospitals. DLTLD will improve patient referrals/tracking systems and expand support for establishment of electronic TB and HIV reporting systems to improve patient referrals, tracking, linkages, and program evaluation.

The Ministry of Public Health and Sanitation (MOPHS) will oversee the scale up, expansion and implementation of all pediatric HIV care and support programs for the under 15 year olds in Kenya. MOPHS will support the coordination of all partners in the area of pediatric antiretroviral treatment (ART) provision (through national level meetings such as the National ART task force), and supervision of pediatric treatment in Government of Kenya (GOK) supported and other facilities.

MOPHS, through NASCOP, is heading a technical group that has developed a psychosocial package of care for pediatrics and is currently developing an adolescent care package to include disclosure activities, adherence counseling, PWP, provision of reproductive health services, substance abuse counseling, and support for transitioning into adult services and teaching of life skills. Linkages of children to various community programs including OVCs, education, and legal and social services will be provided. Other activities will include development of referral systems and care linkages for HIV positive mothers identified through the PMTCT programs, decentralization of care services to lower level health facilities to increase access, and linkages to community activities to support the needs of the HIV infected children and adolescents.

MOPHS will work though the Division of Child Health and Division of Reproductive Health, which are currently working jointly to integrate pediatric HIV into child survival interventions including: growth and development monitoring; immunization; nutritional assessment, counseling and support; safe water, sanitation and hygiene interventions; and malaria screening, treatment and provision of insecticide-treated nets in malaria endemic areas. MOPHS will continue to coordinate the provision of and national scale up of nutritional assessment and counseling activities for all children including provision of food complement and supplements and preventive packages.

MOPHS will continue to improve the national system for tracking the number of children receiving care and support. The national supervisory structure includes a core staff at a national level that consists of a small technical and administrative staff, and an expanding staff responsible for monitoring and evaluation activities. The Provincial AIDS and STI coordinating officers (PASCO) coordinate and provide supportive supervision to regions and facilities. The PASCOs are responsible for assisting with establishment of services at additional sites, conducting site evaluations and accreditations, and supervising ART programs. MOPHS will oversee the linkage of HIV treatment and prevention activities to the Kenya Pharma/Chemonics supported logistics/systems strengthening and the Kenya Medical Supplies Association (KEMSA).

MOPHS will also support the development and strengthening of laboratory networks for Early Infant Diagnosis (EID), quality assurance, and staff training for health care workers.

The National Public Health Laboratory Services will coordinate laboratory services nationally including laboratory commodities management, equipment maintenance, policy formulation, technical guidance in quality management systems, laboratory information system and specimen referral systems with the KMOPH Laboratory services.

Continuing activities

Coordinate scale up of laboratory capacity for ART monitoring, OI diagnosis and TB smear microscopy and culture to match service demands and increase access

Institutionalize specimen referral networks within MOPH to improve diagnostic efficiency for ART monitoring, Early Infant HIV diagnosis (EID), TB/HIV resistance testing, viral load and TB culture

Support laboratory program coordination and support supervision at all levels

Support development, review and dissemination of laboratory policies and guidelines for point of care diagnosis, monitoring and accreditation

Support sustainability in technical capacity through staff training in Quality management systems (QMS), leadership skills, bio-safety, mentorship, FELTP, exchange programs among internal and external laboratories

Support enrollment expansion of external quality assurance (EQA) programs for ART

Support national scale up of laboratory stepwise accreditation program to ensure equity in all counties

Support for the National reference laboratories to provide technical expertise and specialized testing services in HIV related diagnostic testing

Strengthening of paper-based Laboratory Information Systems (LIS) and electronic LIS at public health laboratories to streamline data collection, storage, analysis, reporting and integration of Laboratory information management systems (LIMS) with Health Management information system (HMIS)

Strengthen the Central Data unit to manage laboratory strategic information and collect 80% of reportable indicators

Strengthen data collection and reporting in commodity supply and consumption for accurate forecasting, planning and budgeting

Coordinate implementation of bio-safety and bio-security activities within MOPH laboratories in each county

New activities

Support standardization of testing methodology and laboratory equipment maintenance and service policy

Support decentralization and coordination of laboratory services to county level in the devolved system of government

Support implementation of quality assurance in rapid HIV testing to 5000+ sites through the multi-step saturation approach and develop guidelines and policies

Support an integrated quality assurance program for HIV, TB, malaria and microbiology

Support the laboratory accreditation steering committee and collaborate with Department of Standards Regulation and Kenya National Accreditation System (KENAS) to provide technical guidance and streamline laboratory accreditation within GOK structures and systems

Coordinate implementation of point of care testing for CD4 and other diagnostic testing and monitor effectiveness

Support sustainability in equipment maintainace by training of biomedical engineers to provide quality equipment maintenance including support for service contracts for specialized type of maintenance

Indicators will be the number of clinical labs with capacity for HIV diagnosis and ART monitoring (135); number of staff trained in-service (40) number of labs accredited and; (2) activity implementation monitoring will be performed on quarterly basis.

The main objective of this activity is to strengthen the MOHs capacity to collect, analyze, interpret and use data. Various capacity building initiatives are carried out through NASCOP and the division of Health Information Systems (HIS).

NASCOP

NASCOP supports coordination of partner activities, supervision and development of policy guidelines related to HIV/AIDS programs. Through this mechanism, CDC supports the strengthening of data collection, analysis and use for routine M&E reporting, HIV and STI surveillance and program evaluation. MOH staff capacity building is a key component of this activity through CDC TA as part of the PF. The MOH deploys skilled epidemiologists, data managers and other cadres of staff as their commitment to the PF. NASCOP recently conducted an assessment of the countrys readiness to use routine PMTCT data to monitor trends in the HIV epidemic. NASCOP, in collaboration with implementing partners, is currently rolling out revised M&E tools for HIV programs nationally. These include summary registers and individual patient data collection forms.

Working with the ADAM Consortium, NASCOP completed the development of M&E training curriculum and will train health workers to use it. NASCOP and implementing partners will conduct routine data QA at randomly selected sites to ensure high quality data. This will be done in collaboration with regional and county health and management teams.

In FY2012, NASCOP will, together with stakeholders, implement the recommendations of the assessment of PMTCT data to monitor HIV epidemic in Kenya. These include training nurses/counselors on HIV testing SOP and on data quality. NASCOP will also play a leading/coordination role in the implementation of the Kenya AIDS Indicator Survey (KAIS) and MARPs surveillance. The survey report will be launched in FY 2012, followed by dissemination workshops. NASCOP will continue to coordinate the HIV quality of care improvement work and together with HIV-Qual International roll out QA/QI activities in 3 additional provinces, bringing the total to 6.

NASCOP will oversee the scale up of EMR coverage to about 600 health facilities across the country in the next two years, supported by partners such as ITECH and Futures Group.

NASCOP will also conduct program evaluation and operational research to identify initiatives that work. In addition, they will analyze existing data and prepare abstracts and manuscripts for publication.

HIS Division

The division of Health Information Systems (HIS) is jointly hosted within the two MOHs. The HIS is responsible for collecting, storing, analyzing, and reporting data for the entire health sector. The HIS division also coordinates the development and review of all data collection tools (registers, forms, cards) for the health sector, in collaboration with the USG and partners.

In the FY 2012, the HIS division will undertake the following:

(i)

Continue the national rollout of the District Health Information System DHIS. This includes training of health workers as well as county, regional and national officers on the aggregate reporting tool.

(ii)

Distribute the integrated reporting tools for the health sector. Health workers will be trained on the use of these tools to ensure high quality of data.

(iii)

Regular updating of the master facilities list, including geo-codes to enable mapping of facilities.

(iv)

Overall coordination of HIS activities in Kenya.

This mechanism aims to strengthen the Biomedical Engineering Department of Ministry of Health. PEPFAR has invested heavily in equipment but there has not been a matched investment in management of this health equipment. Technology in Healthcare is emerging as a real challenge due to rapid technological changes that impact Medical Equipment. Medical Engineering staffs are not able to manage most of modern technology due to lack of manpower development programs to keep abreast with technology. Over the years the ministry of health has received medical equipment of diverse technology through either direct procurement by the ministry or donations resulting in a lack of standardization and non availability of spare parts or skills to repair the equipment. In addition the skill development for Engineers has not kept in pace with new technology and as a result equipment is non functional throughout the system. Policies on management or disposal of obsolete equipment are weak or nonexistent and e waste is also becoming a problem. The existing MOPHS cooperative agreement will be used as the mechanism for strengthening the system. The Bio-Medical Engineering Division is a fully functional division within the ministry of health. The Division consists of a team at the Headquarters which provide technical and administrative support to Bio-Medical personnel deployed in provincial, district and sub-district hospitals across the country. Alongside this Division is a Unit for supply of Medical Spare parts. The spare part unit has four branches situated in Nairobi, Nyeri, Mombasa and Kisumu. Ensuring availability of appropriate, functional, safe and effective Medical equipment and plant through selection of appropriate technology during purchase of new equipment, carrying out preventive maintenance and repair as well as function and safety tests on existing equipment is the core mandate of the biomedical engineering department with an overall objective of promoting proper diagnosis, treatment and care for the patient. Activities supported through this mechanism will include:

Development of policy and guidelines on management of medical equipment.

?

Establishment of inventories by developing web based inventory management systems

?

Upgrading of skills of biomedical engineers

?

Supervision, monitoring and evaluation of biomedical engineering departments at county level

?

National assessment of equipment at all levels

?

Equipping of Medical engineering with appropriate test and calibration equipment.

Strengthening the biomedical engineering departments will have positive spillover effects on all service delivery areas and the coverage will be national.

The Ministry of Public Health and Sanitation (MOPHS) objective, to reduce HIV incidence through appropriate policy guidance and implementation of interventions, includes the intervention of Voluntary Medical Male Circumcision (VMMC). MOPHS technical staff, stationed at National AIDS and STI Coordination Program (NASCOP), will oversee the VMMC program implementation. The VMMC program began in 2008, with an objective of circumcising and reaching 80% of uncircumcised men aged 15 49 years by 2013. NASCOP provides leadership, coordination, and policy direction to all HIV intervention programs in Kenya, including the VMMC program. Since 2008, VMMC services have been provided, through PEPFAR implementing partners working at the Ministry of Health (MoH) facilities, to over 300,000 males.

NASCOP roles are to provide policy direction, coordination, advocacy and implementation oversight of the VMMC program. The continuing activities under this planning period include supporting both National and sub-national VMMC TWGs and sub-committees for technical oversight and coordination. Regular support supervision visits for the VMMC program will be conducted quarterly by the VMMC technical team in collaboration with CDC prevention technical advisors to ensure safety and adherence to quality and standards in the delivery of services in 4 priority regions of Nyanza, Western, Turkana and Nairobi, these regions have low male circumcision rates and high HIV prevalence. MOPHS will undertake sensitization and mobilization and advocacy campaigns targeting religious, cultural, provincial administration and leaders in order to increase demand for MC in line with the VMMC communication strategy. Additionally, MOPHS will review/update/develop guidelines, protocols, curriculums and IEC materials that will result in a strengthened and sustained VMMC program in Kenya.

NASCOP will host annual planning meetings and with the collaboration of CDC and schedule verification visits by NASCOP VMMC team to assess the accomplishments toward the program objectives.

Objectives/Approaches

The MOPHS Injection Safety program through NASCOP will contribute to the prevention of medical transmission of HIV (and other blood borne pathogens) through sharps and other medical waste. This will contribute in achieving the third Kenya National AIDS Strategic Plan (KNASP-III) goal of eliminating HIV transmission in healthcare settings in the next two years. NASCOP will coordinate and monitor the implementation of all national policies, standards, guidelines and strategic plans for injection safety and health care waste management in the country. It will support the scale up of injection safety and safety of other related procedures such as phlebotomy by various partners country-wide. It will lead the development and implementation of post-exposure prophylaxis (PEP) and occupational safety policies and guidelines for health workers. It will support universal access to PEP services and commodity security for IPC and injection safety commodities. It will also support integration of Injection Safety and Infection Prevention and Control (IPC) as well as bio-safety and safe medical waste management practices into HIV services and other existing health programs. This is in line with the Global Health Initiative core principle of health systems strengthening.

Scope of activities and targets

NASCOP will implement a national injection safety program targeting health workers with some support to community interventions. KMOPHS will support:

Development of a post-exposure prophylaxis (PEP) and health workers occupational safety policy and guidelines (4 documents); roll out of IPC/Biosafety coordination committees in 25 counties; roll out of post exposure prophylaxis to all health facilities; sharps injury and PEP surveillance systems leading to 50% reportage rates; supervision for IPC and healthcare waste management nationally and provide 4 reports annually.

Coordinate 4 quarterly meetings on technical working group (TWG) on prevention of HIV in health care settings.

Support a community communication campaign to reduce injection demand and ensure safe injection safety and medical waste disposal practices.

Advocacy for IPC and injection safety at national and other forums.

Support medical training colleges and universities to integrate IPC practices into all their pre-service and in-service training curricula.

NASCOP will work closely with the Biosafety Program to harmonize their approach and strategies. In addition to the above, the following activities will be supported:

Strengthening of a national Biosafety office; Facilitate 4 meetings of Biosafety TWG; Establish an M&E system for Biosafety in Kenya; Support implementation of policy guidelines on Biosafety; Ensure support supervision of biosafety activities 4 times annually and coordinate biosafety trainings nationally by other partners.

Country ownership, M&E, partnerships

NASCOP is led by Kenyan staff and will support training of local training of trainers (TOT) to develop country owned sustainable programs. Additionally it will leverage on current public-private partnership (PPP) and explore others that will contribute to improved safety in health programs. It will strengthen M&E for injection safety activities and use data obtained to make better programmatic decisions.

This mechanism supports, supervises and monitors national abstinence programs targeting youth 10-19 and faithfulness programs targeting discordant couples and men 30-44 at risk of having multiple partners. It will take the lead in developing national policies, guidelines, and packaged evidence-informed behavioral interventions (EBIs). The mechanism will enable MoPHS to take leadership through coordinating the EBI Technical Working Group (TWG). The mechanism will lead a four pronged approach to ensure standardized abstinence and faithfulness EBIs throughout the country through: (1) systematically assessing interventions currently in use to determine if they include characteristics found in effective programs; (2) identifying behavioral interventions developed and rigorously evaluated with demonstrated efficacy for translation into packages for scale up; (3) systematically adapting EBIs developed in other countries to ensure they are appropriate for Kenyan priority populations and repackaging for scale-up; (4) developing operational research to improve the functioning and effectiveness of EBIs. All EBIs will be used to reinforce or compliment biomedical and structural interventions as part of combination prevention. This mechanism will coordinate the development and distribution of trainings and printed packages of abstinence and faithfulness EBIs.

The mechanism will support the scale up of Families Matter Program (FMP) and Healthy Choices 1 (HC1). FMP is a parent-focused EBI for parents, guardians, and other primary caregivers (hereafter referred to as parents) of preadolescents ages 912 years. Delivered in 5 weekly sessions to give parents time to internalize new information and practice skills, the program promotes parental monitoring and effective parent-child communication on sexual topics and sexual risk reduction. The goal of FMP is to reduce sexual risk behavior among adolescents, including delaying sexual debut, by training parents to deliver primary prevention messages to their children. More effective parental communication can help to delay their childrens sexual behavior and increase protective behaviors as children age. FMP also links parents to other critical interventions including HTC and VMMC. HC1 targets in-school youth aged 10-14 years and aims to delay sexual debut by providing knowledge and skills to negotiate abstinence, avoid negative peer pressure, avoid or handle risky situations and to improve communication with a trusted adult. HC1 consists of 8 modules of approximately one hour each. The mechanism will also support for national scale up the adapted Stepping Stones for males aged 30-44 who are at risk for engaging in multiple partnerships. Stepping Stones includes 17 sessions male peer groups implemented over 3 to 12 weeks. Sessions will involve discussions on a variety of sexual health topics including gender-based violence and faithfulness. Peer groups build assertive communication skills by leading presentations on exercises from the Stepping Stones program. 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.

Monitoring will be done through analysis of partner EBI TWG minutes and Kenya HIV/AIDS Program Monitoring System data analysis. Evaluation will be conducted through operation research of combination HIV prevention and periodic surveys.

One of Kenyas goals by 2013 is to reach 80% of persons knowing their HIV status, as reflected in the Kenya National Aids Strategic Plan (KNASP III). This mechanism will be responsible for the formulation, dissemination and implementation of policies and guidelines regulating the practice of HIV testing and counseling (HTC) in the country. Special focus areas will be: strengthening couple testing and counseling and identification of discordant couples with subsequent linkage to treatment and care; provision of quality HTC services; and stronger and effective referral strategies for clients who receive testing and counseling. Policy and implementation guidelines for newer approaches like self testing will be developed and rolled out to targeted populations.

The Ministry of Public Health and Sanitation (MOPHS) will coordinate and lead the HTC technical working group (TWG) to share their expertise on HTC, policy formulation and guideline development. Training and certification of service providers will be conducted through development of appropriate training curricula and establishment of quality standards in HIV service provision. MoPHS will continue to identify and encourage innovative approaches in both client-initiated and provider-initiated HTC settings. The reach and coverage for PITC will be increased to 80% of inpatients and 50% of outpatients. Community approaches will be strengthened and rural men specifically targeted. HTC will be integrated as part of combination prevention for greater efficiency and effectiveness in HIV prevention. Home based HTC will be done in areas with high population density and high HIV prevalence. Quality services are key in the implementation of HTC services. MoPHS will monitor quality assurance (QA) through the implementation of quality assurance management guidelines and the implementation of the WHO multistep approach. Through the WHO multistep approach, QA will be strengthened through the development of standardized curriculum, new and refresher trainings, supervision, use of approved kits, using correct algorithm and certification of service providers. A database of all service providers will be developed and training tracked in a timely manner to ensure all service providers are well trained and receive updates. QA audit teams will be strengthened in all counties. Strategies for effective referrals and linkage of clients to prevention, care and treatment services will be prioritized, and guidelines for integration with other community services will be developed. This mechanism will give guidance on the use of shorter acting rapid test kits so as to reduce client workload experienced by service providers. Strong collaboration will be established with laboratory services for quality assurance in HIV testing. A comprehensive communication strategy will be developed for wider coverage and to improve the demand for HTC services. This mechanism will support MoPHS devolved services to the county level of administration in line with Kenyas new constitution.

Monitoring will be done through analysis of partner HTC TWG minutes and Kenya HIV/AIDS Program Monitoring System (KePMS) data analysis. Evaluation will be conducted through periodic surveys including Kenya AIDS Indicator Survey, Kenya Service Provision Assessment and Kenya Demographic and Health Survey.

The Ministry of Public Health and Sanitation (MOPHS) supports, supervises and monitors national prevention programs toward reducing HIV incidence through appropriate policy guidance and implementation of combination prevention interventions. Populations include discordant couples, youth 15-24 years, males 30-44 years, women attending Maternal Child Health clinics, individuals with STIs, PLHIV, widows/widowers and most-at-risk populations (MARPs).

MoPHS will lead development of national policies, guidelines, and packaged evidence-informed behavioral interventions (EBI). All EBI will reinforce biomedical and structural interventions as part of combination prevention. It will lead a multi-sectoral technical working groups (TWG), constituting of all stakeholders. It will provide technical leadership in the scale up of HIV combination prevention interventions including treatment for prevention and Pre-exposure Prophylaxis. MoPHS will lead scaling up of Positive Health and Dignity Prevention (PHDP) EBI, size estimation and mapping for MARPs.

MoPHS will lead a four pronged approach to ensure national standardized prevention EBIs: 1) systematically assess interventions currently in use to determine if they include characteristics found in effective programs; 2) identify EBI developed and rigorously evaluated with demonstrated efficacy for translation into packages for scale up; 3) adapt EBIs developed in other countries to ensure they are appropriate for Kenya and repackaging for scale-up; 4) operational research to improve EBIs.

This mechanism supports EBI for above priority populations. Specific EBI include PHDP, Healthy Choices 2 (HC2), Sister to Sister (S2S), Respect, Eban, and START. PHDP is an ongoing group and individual level EBI for PLHIV in clinical and community settings, focusing on partner testing, risk reduction, condom use, disclosure, adherence, STI reduction and family planning. HC2 targets in and out of school youth 13-17 yrs and focuses on safer sex, condom use, negotiation and communication skills. S2S is a 20 minute individual level EBI targeting sexually active women focusing on self efficacy, negotiation skills and condom use. START targets incarcerated males delivered at 6 pre and post release sessions. It focuses on HIV/STI education, safe sex/condom provision at post release, assessment of personal risk and linkage to services. Eban is a couple and group level EBI targeting sero-discordant couples. It is 8 weekly 2 hour sessions focusing on risk assessment, enhancing couple communication and shared health responsibility. Respect has 2 brief individual sessions targeting general population. It focuses on reduction of STDs/HIV, risk reduction, condom use and clients understanding of personal risk. MoPHS will also support roll out of other EBIs identified for MSM and video-led EBI such as Safe in the City.

Quality assurance of all EBI is promoted through rigorous training and certification of facilitators, support supervision, and site visits. MoPHS will provide technical support across regions including joint stakeholder meetings and regular visits to assure quality implementation of programs.

Monitoring of EBI will be done through partner reporting, Kenya HIV/AIDS Program Monitoring System data analysis, TWG and stakeholder meetings. Evaluation will be conducted through periodic surveys in Kenya demographic and health survey, Kenya Indicator AIDS Survey, and Kenya Service Provision Assessment.

This mechanism will support a national-level leadership, coordination and monitoring of comprehensive programs for people who inject and use drugs (PWID). The HIV burden among people who inject drugs in Kenya is 2-4 times that of the general population. Overall HIV prevalence among PWID is 18.3% and 30% among the needle sharing subpopulation. Beyond the risk of transmission through needle sharing, PWID also have sexual relationship with non-PWID. The Government of Kenya is implementing both syringe exchange programs (NSP) and medicated assistance therapy (MAT) as evidence-informed interventions to reducing injecting drug use and HIV incidence. The Ministry of Public Health and Sanitation (MOPHS) in collaboration with UNODC, the Ministry of Medical Services, Division of Mental Health Services and the National Coordinating authority against drug and alcohol Abuse (NACADAA) is leading policy formulation, introduction and scaling up of NSP and MAT. Policy formulation and development of guidelines for drug-addiction treatment, roll-out plan and quality standards will be put in place. MoPHS will centrally procure Needles and syringes and MAT and carefully control supply to health facilities and identified community service organizations (CSOs) serving PWID.

This mechanism will support strengthening access to comprehensive services for PWID and PWUD as per the countrys and PEPFARs guidelines. MoPHS will provide national technical oversight, through the Most-at-risk (MARPs) Technical working group (TWG). Specific interventions include (1) NSP (2) MAT and other drug dependence treatment (3) ARVs (4) HTC (5) Prevention and treatment of STIs (6) Condoms for drug users and their partners (7) targeted prevention education and IEC materials (8) vaccination, diagnosis and treatment of viral hepatitis (9) prevention, diagnosis and treatment of TB. These services will target drug users and their injecting and sexual partners. Special attention will be paid to women who use drugs owing to their associated sexual risk behavior in sex work and transactional sex and the high burden of stigma they bear. Service providers will receive training on harm reduction approaches and MAT. This will build upon the current Treatment initiative of providing drug dependence treatment to health care providers. The priority geographic locations will be the Coastal province towns, Nairobi and Kisumu. Two national drug dependence treatment centers ie Mathare Hospital and Coast Provincial general hospital will be supported as key referral and treatment centers. NASCOP will support on-going capacity strengthening of health providers, CSOs and program personnel across the regions.

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

Monitoring will be done through analysis of partners Kenya HIV/AIDS Program Monitoring System (KePMS) data analysis, MARPs TWG updates, partners semiannual and annual reports. Evaluation will be conducted through implementation science that will be initiated in year 2 following the roll-out to improve service delivery and also through periodic surveys (Kenya Demographic and health survey, Kenya Indicator AIDS Survey, and Kenya Service Provision Assessment).

National PMTCT activities are coordinated by Ministry of Public Health and Sanitation (MOPHS) through the National AIDS and STI Control Program (NASCOP). In APR 2010 national coverage was 81% CT, 78% maternal and 63% infant ARV prophylaxis, 55% Early Infant Diagnosis (EID) with an MTCT rate of 8%. NASCOP, with stakeholders, has developed an elimination of MTCT (e-MTCT) framework focusing on three key elements: health system strengthening, community systems strengthening, and effective partnerships to strengthen PMTCT.

MOPHS will spearhead policy guidelines and supportive supervision that will lead to roll out and implementation of the new guidelines, scale up of PMTCT services from the current 4,500 sites to all 6,000 health facilities in Kenya, integration of HIV/Reproductive health services within the MCH, transition from WHO Option A to Option B plus (HAART for life) for all HIV positive pregnant mothers, and safe infant feeding options. MOPHS will work jointly with Division Reproductive Health (DRH) and Division of Child Health (DCH) to enhance integration of PMTCT into maternal and child services including: EID, immunization, growth monitoring, insectide-treated nets (ITNs), safe water, follow up of HIV exposed infants until confirmatory HIV test at 18 months, initiation of care and ART for HIV infected infants within MCH, family planning, IYCF, and cancer screening.

MOPHS with DRH/DCH will convene stakeholders meetings for the PMTCT TWG and for guidelines review. MOPHS is developing a PMTCT training curriculum and will support use of ANC/maternity registers, HEI Register, and Mother-Baby Booklet. NASCOP will provide leadership for the national roll out of the eMTCT framework and comprehensive integrated PMTCT services addressing all four PMTCT prongs, including provision of family planning services and couples counseling and testing.

The Provincial PMTCT TWGs working at the district level will be supported to enhance community participation, coordinate partner activities, review district plans, and support use of program data for programming.

A comprehensive plan for supportive supervision to all the regions will be strengthened by facilitating Provincial and District AIDS and STI coordinating Officer (PASCOS and DASCOS) to provide supportive supervision to improve PMTCT services. Strategies to reduce maternal and child mortality, in accordance with Kenya GHI Strategy, will be supported including: increasing hospital delivery from a current 43% to 80%; increasing immunizations; preventing/promoting treatment for the leading causes of child mortality including pneumonia, malaria, diarrhea, malnutrition, measles, HIV/AIDS and tuberculosis; and leading causes of maternal mortality including hemorrhage, infections, and unsafe abortions.

MOPHS will support infrastructure improvement, equipping facilities including provision of delivery beds and delivery packs, hiring staff, safe water, and carrying out community sensitization. MOPHS will work closely with Division of Family Health to strengthen community units and the community strategy to create demand for services and to work with the private sector to ensure coordinated, efficient and timely reporting to the national program and to PEPFAR. To optimize PMTCT uptake, MOPHS will support national strategies to promote male involvement and couple counseling and testing in order to strengthen Prevention with Positives.

Ministry of Public Health and Sanitation (MOPHS) coordinate all ART activities including development and implementation of ART policies, guidelines, and training curriculums. MOPHS chairs the national ART taskforce. By June 2011, approximately 450,000 adults were receiving ART in over 1000 treatment sites.

MOPHS supports mentorship and supportive supervision to improve quality of care and data. MOPHS has developed a training curriculum, ART guidelines, and adopted quality of care indicators (HIVQUAL) for monitoring the quality of HIV treatment services and to improve clinical outcomes.

MOPHS will continue to oversee the implementation of all HIV care and ART programs for people living with HIV in Kenya, which includes training of 200 health care workers, coordination of all partners in the area of ART provision and supervision of treatment in Government of Kenya (GoK) supported and all other facilities. MOPHS will also continue to coordinate with other sources of support such as Global Fund and Clinton Foundation.

MOPHS will improve the national system for tracking the number of people receiving ART and provide financial and administrative support to the Provincial AIDS and STI coordinating Officer (PASCO) who coordinate regional HIV activities. The PASCOs are responsible for establishment of services at additional sites, conducting site evaluations and accreditations, and the supervision of ART programs. All activities are closely linked to other GoK and PEPFAR supported HIV treatment and prevention activities, the networks of care in the Private and Mission sectors, and Kenya Pharma/Chemonics supported logistics/systems strengthening (particularly for the Kenya Medical Supplies Association). Emphasis will be placed on developing regional trainers who will provide training and mentorship of health care workers at the facility level.

MOPHS will continue to support implementation of HIV prevention activities in clinical care settings, development of referral systems and care linkages for HIV positive mothers and infants identified, and decentralization of care and treatment services to lower level health facilities to increase access and reduce the waiting list at the provincial and district hospitals. These activities are essential to the overall implementation and coordination of HIV treatment programs in Kenya. MOPHS supported activities are essential to the formation and strengthening of linkages needed in the network model and to the development of a sustainable system to provide HIV treatment in Kenya.

All partners have been encouraged to extend efforts to further strengthen linkages by coordinating with and supporting all ART activities by participating in national efforts such as policy/guideline revision and national stakeholders meetings. This activity includes emphasis on development of networks, human resources, policy and guidance development, quality assurance and supportive supervision, training, and strengthening use of electronic medical records system and strategic information.

Monitoring and evaluation of the adult ART program will be strengthened through the revision of data collection tools and supporting prompt, accurate reporting. MOPHS will support the planned Longitudinal Survey of Adult Care and Treatment in Kenya. The outcome of this survey will be used to inform adult program outcomes and strategies to improve the national pediatric program.

The Ministry of Public Health and Sanitation (MOPHS) through the National AIDS and STI Control Program (NASCOP) oversees the implementation of all HIV care and antiretroviral treatment (ART) programs for people living with HIV/AIDS in Kenya. NASCOP will continue to oversee and coordinate the implementation of all pediatric HIV antiretroviral treatment programs for the under 15 year olds in Kenya. NASCOP will continue coordinating other sources of support for pediatric ART treatment from including the Global Fund and Clinton Foundation. NASCOP will coordinate all partners who provide pediatric ART including chairing the national ART task force and supervising the pediatric treatment activities in Government of Kenya (GOK) supported and private sector facilities.

In order to improve quality of care for children on ART, regular national stakeholders and regional meetings of pediatric ART providers will be supported. NASCOP will maintain a supervisory structure including central staff at a national level and field staff responsible for monitoring and evaluation activities in the health facilities. Administrative support to the Provincial AIDS and STI coordinating officers (PASCO) will be strengthened so that they can carry out regional support supervision and coordination of pediatric HIV/AIDS treatment activities including: tracking and decentralization of pediatric ART to increase access and reduce congestion at the Provincial and District hospitals, conducting site evaluations, and accreditation. NASCOP will continue to support the development of standard protocols, job aids, and the finalization and dissemination of new pediatric treatment guidelines.

To improve on the quality of pediatric/adolescent care and treatment, NASCOP will lead the Technical Work Group (TWG) in development of a package of care for HIV infected adolescents. Dissemination of this package and that of the already developed psychosocial package will be done including training of health care workers.

Emphasis will be placed on developing regional trainers who will provide classroom training and mentorship of health care workers at the facility level in order to build the capacity and confidence of clinicians. Working with the Divisions of Child Health and Reproductive Health, NASCOP will support the integration of pediatric HIV services at the maternal and child health clinics (MCH) in order to optimize identification and enrollment into care of HIV positive children. Strategies to strengthen the use of the Mother-baby booklet, universal provider-initiated testing and counseling, and family testing will be developed and implemented. These will support program effectiveness by improving identification and linkages to ensure the exposed child is enrolled into HIV care and receives all routine child health services, including immunizations and malaria prevention. The national system for documenting and tracking the children will be strengthened to ensure linkage to care and ART services and maximize retention.

Monitoring and evaluation of the pediatric program will be strengthened including the revision of the data collection tools and ensuring prompt, accurate reporting. The ongoing Longitudinal Survey of Pediatric Care and Treatment in Kenya (LSPCTIK) and dissemination of the findings will be supported. This data will be used to inform on pediatric program outcomes and inform strategies to improve the national pediatric program.