Goals and objectives: Mechanism goal is to strengthen the response of local indigenous organizations to establish operational organizational systems that foster successful and sustainable HIV/AIDS programs. This goal is achieved through building their technical, managerial and financial capacity to be able to deliver quality HIV programs following national guidelines. At the end of the project, these local organizations should be able to acquire funding and manage programs to implement HIV prevention programs. These objectives are linked to three GHI principles: encouraging country ownership by building the capacity of local organizations; building sustainability through health systems strengthening; and building partnerships with private sector, CSOs and CBOs.

Cost-efficiency strategy: The LVCT capacity development model, which includes assessment of needs, coaching and mentorship, is unique as there are no consultancy costs as it is implemented by LVCT staff with content expertise.

Transition to country partners: LVCT is an indigenous Kenyan organization, one of the pioneer recipients of PEPFAR funding, and a leader in HIV interventions informed by research. The LVCT subpartners are helped to build partnerships and network with relevant government of Kenya agencies. They use the national monitoring and evaluation framework and tools. One of the key outputs of this cooperative agreement is to help the sub-partners be able to apply, access and manage funds on their own for sustainability.

Vehicle information: The partner has purchased 2 vehicles; One in FY 2006 to support field activities and one in FY 2008 to support HTC campaigns.

This activity supports GHI/LLC.

"The Ungana Project is a capacity building program to improve the technical, managerial and financial capacity of local indigenous organizations to implement quality HIV prevention care and support services. These organizations most of them community based, do not have the capacity to respond to these essential functions for an effective health system. LVCT carries out a participatory gaps analysis by working with the organizations to identify gaps and weaknesses. They then employ a mentorship approach in building the capacity of this organization that were recruited in a competitive solicitization process. The mentorship is done by the LVCT staff who is engaged in similar functions as part of their job specifications at LVCT in their other Coag management activities. LVCT has concentrated in strengthening the organizational systems as well as technical support to ensure that they provide quality service. Specific activities include strengthening governance systems to comply with statutory requirements, sound financial policies and procedures laid down an, the management of the organizations streamlined by focusing on strategic policy development to guide operations, and training of staff to be able to provide quality HIV services.

Achievements include 7 sub-partners developed strategic plans. Disco-k supported to launch their strategic plan; 13 sub-partners clearly differentiated the roles and responsibilities of the Board of trustees & Management resulting to strengthened, active BOTs. 13 sub-partners developed /revised key organization policy documents - E.g. constitution, HR, finance and procurement policies

9 sub-partners had legal audits carried out on their organizations. All13 sub-partner complying with statutory requirements. 13 sub-partners aligned program reporting to national M&E structures.

In 2012 the remaining sub partners will be helped to develop their strategic plans, the emphasis will now be put in implementation of the structures that have been put in place; continued guidance in proposal writing, sound financial management and transparent managerial factions as well as quality services. Two more organizations are being recruited this year and the same process will be employed.

Monitoring and evaluation are conducted through site visits which are conducted one to three times per quarter with every sub-grantee. Objectives of the visit are shared prior to the visit, findings are discussed at the visit reports are written and shared with the prime and the sub- partner and corrective actions put in place. These are reviewed at the next visit. The prime shares quarterly report with CDC where performance is also reviewed."

Objectives and approaches

LVCT will contribute to the prevention of HIV transmission by providing AB HIV prevention and other evidence based interventions to potential blood donors while mobilizing for safe blood supply in the country. It will work within the Kenya National Blood Transfusion Service (KNBTS) policy and the blood donor mobilization strategy and in line with approaches that will be guided by the National Blood Donor Services sub-committee of the KNBTS Advisory Committee. LVCT will work closely with KNBTS regional centers to ensure they achieve the set blood donation targets in the regions.

This partner will work comprehensively within the target population to ensure maximum reach of potential blood donors. It will train a pool of mobilizes that will reach all market segments of blood donors including the youth in schools and out-of-school; colleges and universities; the working and those in faith based or community based groups. Those reached will be given HIV prevention messaging; healthy lifestyles including nutrition and donor education on all aspects of blood donation. Additionally LVCT will support establishment of blood donor clubs among the youth such as Pledge-25 as well as among the adult population. It will also support donor counseling and in collaboration with NBTS help in donor results notification and referral of those needing care and treatment. It will create a culture of regular blood donation among those found to be safe and free of transfusion transmissible infections.

Integration with other activities

HIV AB and other prevention messaging will be integrated in the blood donor mobilization activities. Those seeking only to know their status will be referred to the HCT program; conversely those people found to be HIV negative and are eligible to donate will be informed of blood donation activities and encouraged to become regular blood donors. Those found to be HIV positive from the blood donation program will be referred for care and treatment. They will be encouraged to disclose and engage in partner referral or Prevention-with-the-positives interventions.

Coverage and scope

The activities will cover all potential blood donors from 16 years to 65 years in line with KNBTS policy guidelines. The partner will cross-cut all blood donor market segment but will primarily target safer donors (avoiding populations perceived to be most-at-risk). The geographical coverage for this activity will be national and as guided by KNBTS based on the needs. Through this grant LVCT will mobilize 80,000 units of blood in collaboration with NBTS while reaching at least 200,000 people with HIV prevention and healthy lifestyles messages.

Country ownership and Sustainability

The program is mainly led by local staff and will be working to enhance the work of KNBTS which is a local MOH organization led by Kenyans. The partner will work with sub partners to train community people to work as mobilizes even beyond the time of the project. Secondly it will promote formation of blood donor clubs that will out-live the life of the project. Lastly once the culture of regular blood donation is inculcated people will continue to donate even in the absence of the partner.

In COP 2012, the Ungana mechanism will implement a wide range of evidence-informed behavioral interventions (EBIs) adopted and adapted for national dissemination and to be integrated in combination prevention. Ungana is a capacity building program with a wide range of local organizations that target priority populations. The populations that will be targeted in this mechanism are youth in school and parents with adolescents of both sexes. This mechanism will cover Nairobi, Eastern and Central regions of the country where the partner local organizations are located.

Families Matter Program (FMP) is a 5 weekly session intervention targeting parents with children age 9-12 years. The goal of FMP is to reduce sexual risk behavior among adolescents, including delaying onset of 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 their children get older. The intervention also links parents to other critical evidence-based interventions including HTC and VMMC. Quality assurance of FMP is promoted through rigorous training and certification of facilitators, ongoing process monitoring with standardized tools, and quality assurance site visits by a capacity building agency. A total of 1000 youth and parents will be reached.

Healthy Choices I (HC I) 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. HC I consists of 8 modules of approximately one hour each. It can be delivered in 4 sessions of 2 hours each or in 8 sessions of 1 hour each. Quality assurance of HC is promoted through rigorous training and certification of facilitators, ongoing process monitoring with standardized tools, and quality assurance site visits by a capacity building agency. The total youth in school aged 10-14 that will be reached through HC 1 are 1,100.

Being faithful interventions will be promoted among 744 HIV discordant couples.

Process evaluation will be done as determined and developed by the technical working group and the national program and the impact evaluation will be done in larger surveys like the Demographic health survey incorporating HIV markers.

For further quality assurance, LVCT has put in place for all sites the following: use of approved national curricula; emphasis of importance of fidelity to the respective curricula; use of trained and certified pair of gender balanced facilitators; trainings on EBIs are conducted by certified national trainers; observed practice of implementation is done soon after training; use of standardized, national data tools at every stage of EBI implementation; and regular field visits by trained program staff to check on delivery of EBIs and offer support supervision.

Targets are tracked on a monthly basis through respective field reports. Results are analyzed on a quarterly basis. Monitoring and evaluation will be conducted with EBI approved data capture / monitoring tools. Field staff will send reports on a monthly basis; these reports will be compiled into an overall report quarterly which will be submitted to CDC.

The Ungana Project is a capacity building program to improve the technical, managerial and financial capacity of local indigenous organizations to implement quality HIV interventions. HTC is offered as part of the combination prevention services. The local organizations are in Nairobi (prevalence 7.0%), Eastern (prevalence 3.5%) and Central (4.6%) provinces.

The CBOs target different populations depending on their original inception agenda; some discordant couples, others female sex workers, yet some youth and general population with emphasis on rural men and women. Coverage for couples has remained poor at paltry 16% and yet data show that the driver of the epidemic in Kenya is infection occurring in marriages and sexual partners. The approaches to HTC include client initiated in community settings and provider initiated approaches in health facilities where the target coverage is 80% for inpatients and 50% for outpatients. Other PITC approaches include workplace and moonlight services in strategic hot spots to target key populations.

In the last year the program reached 394,000 clients who were tested and counseled (91,000 clients in CITC and 303,159 clients in PITC). In 2012 the program has a target of 329,000 individuals reached with testing and counseling services divided a s follows 263,000 in PITC,1 VCT- 32,900; workplace - 3290 and mobile- 29,610, with 30% being couples.

A total of 171 providers were trained in PITC while 45 providers were offered refresher training in HTC integration and re-testing recommendations and additional 1000 providers were taken through CMEs covering PITC, quality management and integration of services.

The program uses the national testing algorithm. Referral uptake among clients remain a challenge and the strategies used to improve this are use updated, comprehensive referral directories available in all sites., PLHIV CHWs are used to make follow up, they make home visits where possible, use phone calls and send short messages (sms) to clients to ensure referral uptake. The clients are followed up and tracked for 3 months and a register is maintained to ensure referral uptake.

The program follows the national quality management guidelines and participates in the proficiency testing quarterly and collection of DBS for the 20th client tested and counseled per counselor. Support supervision is carried out for the service providers on continuous basis.

The program develops work plans and conducts biannual data quality audits and monthly data supervision is carried out and this informs the program implementation improvement.

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. New indicators like couples tested, discordant couples, MARPs and people with disability have been incorporated in the national tools and the program captures these.

Promotional activities for demand creation include the print and electronic media; for specific populations like the youth, social media is used through face book. A hot line is operated that has a national reach. Mass media is used for the general population and peer led mobilization is used for the MARPs. Mobilization is also carried out in churches and couples hot spots aiming at couples.

In COP 2012, Ungana will implement a wide range of EBIs which will have been adopted by the country for combination prevention. Ungana is a capacity building program with a wide range of local organizations that target different populations in their areas of operation with HIV interventions. Most of the EBIs await adaptation and adoption by the country but the following have been identified for adaptation.

Healthy Choices II (HCII) targets both in and out of school youth aged 13 17 years and aims to delay sexual debut, promote secondary abstinence or have protected sexual intercourse, by providing knowledge and skills on correct and consistent condom use, handling peer pressure, and learning ones HIV status. HC II consists of 8 modules of approximately one hour each. It can be delivered in 4 sessions of 2 hours each or in 8 sessions of 1 hour each.

Eban/Connect is a six session, relationship-based intervention that teaches couples including those discordant, techniques skills to enhance the quality of their relationship, communication, and shared commitment to safer sexual behaviors and will allow couples to work together to solve shared problems.

RESPECT targets ages 20-24 females and 30-44 males with STI. It has 2 brief individual sessions targeting general population and youth, originally for heterosexual negative persons. It focuses on reduction of STDs/HIV, risk reduction, condom use and clients understanding of personal risk

Sister to Sister is a brief (20-minute), one-on-one, skill-based HIV/sexually transmitted disease (STD) risk-reduction behavioral intervention for sexually active women 18 to 45 years old. The purpose of Sister to Sister is to: provide intensive, culturally sensitive health information to empower and educate and help women understand the various behaviors that put them at risk for HIV and other STDs; and enhance womens knowledge, beliefs, motivation, confidence, and skills to help them make behavioral changes that will reduce their risk for STDs, especially HIV

PwP is an individual intervention promoting positive living and strategies to reduce HIV transmission and re-infection, promotes enrolment to care and treatment, drug adherence, family planning, continued counseling and promotes partner testing and disclosure of status as well as proper and consistent condom use.

These populations are most at risk of HIV infection and have the prevalences higher than the national average. The female sex workers do not have the skills for negotiation for safe sex and this increases their vulnerability. Sex is not discussed in family relationships and further couples do not know each others HIV status and HIV discordance is high in the country about 45% of HIV infected persons.

Quality assurance of all these interventions is promoted through rigorous training and certification of facilitators, ongoing process monitoring with standardized tools, and quality assurance site visits by a capacity building agency. Appropriate evaluation modalities will be developed by the Technical working group to assess the impact.

Gender: The Ministry of Gender, Children and Social Development (MOGCD),Ministry of Health and other Stakeholders to define a comprehensive national package of services for victims of Gender-Based Violence (GBV) and harmonize Monitoring and Evaluation of GBV services.