Operational Plan Report

Strategic Area

Budget Code	Planned Amount	On Hold Amount
Prevention	IDUP	Redacted	Redacted
Narrative:
The APHIA II follow on will be a national program covering all the eight provinces of Kenya. This activity will support implementation of IDU activities in select provinces. Injection drug users (IDUs), though relatively small in number in Kenya, are at disproportionately high risk for HIV infection. Many share needles and syringes and engage in unprotected, often transactional, sex often with multiple partners to support their drug dependency. IDUs are universally recognized as a "bridging" population, hastening the spread of HIV to the general population. The Modes of Transmission Study (MOT) conducted in 2008 indicates that most-at-risk populations (MARPS) contribute to more than one-third of new HIV infections in Kenya. According to KAIS 2007 IDUs contribute 3.83% of HIV prevalence in Kenya. This activity will build on the progress of APHIA II activities providing IDU and NIDU. Work at the community level has occurred primarily through the APHIA program. Outreach programs have been established in several geographical regions of Kenya to provide education and VCT testing for IDUs and NIDUs. Training and technical assistance has been provided to develop the capacity of each of the respective implementing NGOs at the community level. Some scale up has occurred in expanding coverage areas by each of the NGOs. Most of the activities are implemented in the Coast Province and in Nairobi. The overall objective of the APHIA II Follow on IDUs and NIDUs is to reduce the spread of HIV among the high-risk populations of drug and alcohol users. The program will utilize both recovering drug users as well as non-drug-users to make contact with addicts to establish behavior plans to reduce their risk of HIV. Other activities will include a comprehensive mapping exercise of IDU/NIDUs in the different regions of Kenya. Some regions already providing IDU/NIDU interventions will be able to strengthen their programs based the mapping results. In addition, current programs need to strengthen the technical programming in terms of mediation assisted treatment, addiction recovery treatment services, and improving skills in the area of HIV outreach behavior change interventions. Prevention with positives is also a targeted need for the IDU/NIDU population which will include an intensive case management program to follow HIV positive IDU/NIDU in their HIV treatment services. Such programs will track IDU/NIDUs through each level of their HIV treatment process and ARV adherence. The goal is to facilitate comprehensive wraparound services. Working with HIV treatment centers in identifying HIV positive substance abusers (IDU/NIDU & Alcohol) to provide HIV risk reduction services, dealing with ARV adherence issues, and offering addictions recovery treatment services. The APHIA II Follow-on program will continue supporting in- school drug abuse awareness and will continue supporting the development of community based alcohol education, treatment and support services. The APHIA II follow-on supported programs will continue to ensure effective referrals for relevant services, including HIV counseling and testing, HIV care and treatment services and male circumcision services. This activity supports the Kenya Partnership Framework by implementation of proven behavioral interventions optimally targeted to the sources of new infections and those most at risk groups, specifically IDU/NIDUs. . Budget allocation: Redacted. This activity will result in multiple awards
Strategic Area	Budget Code	Planned Amount	On Hold Amount
Prevention	MTCT	Redacted	Redacted
Narrative:
APHIA II follow on will be a national activity covering all eight provinces of Kenya with the goal of reaching more than 80% of expected pregnant women with PMTCT interventions, utilizing both facility and community based approaches. The TBD partner will support facilities to provide a comprehensive antenatal package for all pregnant women including screening, prevention and treatment for any infections, nutritional support, prophylactic ARVs, counseling on safe infant feeding, counseling and HIV testing of women and their partners. The TBD will utilize multiple approaches to reach women currently not accessing ANC due to challenges related to culture, stigma and inaccessibility due to vast distances to health facilities. Counseling and testing will be offered primarily to pregnant women in both ANC and labor and delivery, (including repeat testing in high prevalence areas). The CT services will be extended to other family members including children using the pregnant woman as the entry point. This will foster a family centered approach to care and treatment and help improve post natal follow up of the mother-infant pair. All HIV- infected pregnant women who will be enrolled into HIV care, and those eligible will initiate ART. In an effort to improve access to HIV care and treatment services including ART, the TBD partner will support the integration of HIV care and treatment into MCH for the mother and family by strengthening referral laboratory networks for CD4, decentralization and task-shifting. The use of this family-centered approach will improve retention in care and treatment. The partner will use national referral tools to link mothers and their families to palliative care, including TB services and home-based care; ART; malaria prevention activities; FP services; and income-generating activities. Mothers will be offered the most efficacious regimen according to the national guidelines. The TBD partner will use a combination of strategies, including working with other partners carrying out activities to promote male involvement in PMTCT. Such strategies, though not limited, will include reduction in concurrent partners, condom use, circumcision and couple counseling. The TBD partner, in collaboration with other partners, will support logistics to improve Early Infant Diagnosis (EID) as well the follow up of exposed infants by integrating the follow up with well child and immunization services. The partner will build upon existing Infant and Young Child Feeding (IYCF) strategies such as involvement of men, grandmothers, PLHIV peer educators, mother-to-mother support groups, and other community leaders at community level and explore the use of ARVs at facility level to make breastfeeding safer. The partner will conduct both in service training according to the national guidelines as well as ensure that a comprehensive supervision and mentorship program is set up to enhance on job skills. The partner will work meaningfully with people living with HIV/AIDS to promote the uptake of PMTCT interventions. Such groups will include Mentor Mothers whose roles and activities will be standardized using mothers to mothers (m2m) program tools. At the community level lay counselors will be trained to strengthen the delivery of PMTCT services and to provide continued support for the HIV-positive women and their families. The project will train community health workers to provide community components of PMTCT. The partner will provide updates/training to the PHMT and DHMT members to build their capacity to manage the PMTCT program. Under this strategy periodic meetings will be held at different levels as a part of a performance feedback process. The partner will be encouraged to use program level quality indicators to increase effectiveness. This activity supports the Partnership Framework, by supporting 100% coverage of PMTCT; a key priority will be to expand FP within PMTCT settings in support of the RH/HIV Integration strategy. Increased linkages to sexual and reproductive health/FP services will include skilled deliveries, cervical cancer screening and referral and screening and HIV testing for gender-based violence victims. Gender mainstreaming will ensure that the sexual and reproductive health needs of women focus on preventing unwanted pregnancies. Support to PMTCT will be one component of a package of integrated support at health facilities and communities, holistically addressing HIV prevention, treatment and care Budget allocation: Redacted. This activity will result in multiple awards.
Strategic Area	Budget Code	Planned Amount	On Hold Amount
Treatment	HVTB	Redacted	Redacted
Narrative:
APHIA II follow on will be a national activity covering all the eight provinces of Kenya targeting the HIV and TB co-infected adult and children population. In Kenya, tuberculosis (TB) is the leading cause of death of PLWH and HIV is the greatest factor behind the nearly 3-fold rise in the TB burden in the last 10 years. This activity will build on the progress of APHIA II activities providing HIV/TB services working through health facilities and communities. The overall objective of the APHIA II Follow on HIV/TB care project is to decrease the prevalence of TB in all areas served and integrate care of co-infected patients into a comprehensive program that meets the objectives of the Division of Leprosy, Tuberculosis and Lung Diseases (DLTLD) and NASCOP. This activity will support and strengthen what Kenya has adopted, the Global Stop TB Strategy emphasizing effective DOTS delivery with focus on HIV-associated and drug-resistant TB, health system strengthening (particularly primary care and laboratories) and closer engagement with patients and communities. The TBD partner will assist the provinces adapt the Management and Organizational Sustainability Tool HVTB (MOST HVTB) strategy to achieve FY10 national and EP goals. The mandates of the present national, provincial and district HVTB steering committees will be strengthened to make them more responsive to stakeholder needs. New steering committees will be established to cover new districts. The TBD partner will support coordination meetings, supervision, training, and strategic information. In Kenya, HIV testing for newly diagnosed TB patients is and will remain the standard of care; > 80% of patients are tested, and >90% of co-infected patients initiated cotrimoxazole (CTX). The TBD partner will target 100% of all co-infected patients for CTX and provide access to ART to 50% of those eligible. To reduce the TB burden in PLWH, 80% of HIV patients in each province will receive intensified TB case finding (ICF). ICF will start in select care and treatment sites before expansion to PMTCT and HIV testing sites. Select care and treatment clinics in at least 3 provinces will pilot the new adult TB screening tool and the pediatric TB screening tool. Patients diagnosed with active TB will receive rapid treatment and reduce further transmission. Patients without active TB will be considered for IPT in sites able to conduct/sustain patient adherence and document outcomes. The TBD partner will support CHW engagement for ICF, assist with family TB/HIV screening, and provide adherence support and patient education. Facility and community groups will provide a two-way referral and communication systems to coordinate outreach activities to identify/support co-infected patients and families. Community-based care will expand and link to PwP, community HIV testing, and ICF strategies. TB clinics will initiate PwP interventions such as supported disclosure, adherence counseling, condom use, and risk reduction counseling with linkages to family planning, STI, and medical male circumcision services. The TBD partner will support strengthening HVTB program monitoring and evaluation through development of electronic TB and HIV recording/reporting systems to improve patient referrals and programs linkages and evaluation. National and regional TB/HIV data review and coordination meetings will ensure that collected data collected are comparable and accurate. Efforts will support data use for planning, resource allocation and program improvement. This activity supports the Partnership Framework by increasing TB screening, detection and treatment in HIV care settings, and referral from TB settings so that at least 80% of co-infected eligible individuals are on ART. Support to HVTB will be one component of a package of integrated support at health facilities and communities, holistically addressing HIV prevention, treatment and care Budget allocation is Redacted. This activity will result multiple awards.

Implementing Mechanism Indicator Information

(No data provided.)

Implementing Mechanism Details

Mechanism ID: 12051	Mechanism Name: Youth HIV Combined Prevention Programs
Funding Agency: U.S. Agency for International Development	Procurement Type: Cooperative Agreement
Prime Partner Name: TBD
Agreement Start Date: Redacted	Agreement End Date: Redacted
TBD: Yes	Global Fund / Multilateral Engagement: No

Total Funding: Redacted
Funding Source	Funding Amount
Redacted	Redacted