Project Title: Kenya Fiscal Year 2008 Country PEPFAR Operational Plan (COP)
Field Programs Funding by Account
Allocated as of February 2008
Allocated June 2008
Allocated as of June 2008
GHCS - State
Subtotal: Field Programs Funding
GHCS - State
Subtotal: Field Programs Funding
New Subtotal: Field Programs Funding
Subtotal: GHCS Central Programs
Grand Total: Field & Central Funding
HIV/AIDS Epidemic in Kenya
Adult (aged 15-49) HIV Prevalence Rate: 6.1% (UNAIDS, 2006)
Estimated number of People Living with HIV: 1,300,000 (UNAIDS, 2006)
Estimated number of Orphans due to AIDS: 1,100,000 (UNAIDS, 2006)
Country Results and Projections to Achieve 2-7-10 Goals
Total # Individuals Receiving Care and Support Total # Individuals Receiving ART End of FY 2004* 172,200 17,100 End of FY 2005** 397,000 44,700 End of FY 2006*** 546,000 97,800 End of FY 2007**** 743,600 166,400 End of FY 2008***** 697,661 169,260 End of FY 2009***** 1,105,300 250,000
Total # Individuals Receiving Care and Support
Total # Individuals Receiving ART
End of FY 2004*
End of FY 2005**
End of FY 2006***
End of FY 2007****
End of FY 2008*****
End of FY 2009*****
* "Engendering Bold Leadership: The President�s Emergency Plan for AIDS Relief.� First Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, March 2005.
** �Action Today, a Foundation for Tomorrow: The President�s Emergency Plan for AIDS Relief.� Second Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U. S. Department of State, February 2006.
*** "The Power of Partnerships: The President�s Emergency Plan for AIDS Relief.� Third Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February 2007.
**** "The Power of Partnerships: The President's Emergency Plan for AIDS Relief." 2008 Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, January 2008.
***** Projections from FY 2008 Country Operational Plan
Program Description/Country Context:
Kenya has a severe generalized epidemic with estimated adult HIV prevalence of 6.1%, translating into 1.2 million HIV-infected individuals over age 15 and approximately 150,000 aged 15 and under. While the rate of new infections appears to have decreased, HIV-related mortality remains high, and an estimated 80,000 Kenyans died of AIDS in 2006. Deaths to date have left 1.1 million children orphaned by AIDS. The Kenyan epidemic varies significantly from region to region, with Nyanza Province affected by prevalence rates approximating those in some Southern Africa nations. Women are nearly twice as likely as men to be infected.
Although the majority of HIV transmission in Kenya now occurs through heterosexual contact in the general population, certain groups including intravenous drug users, uniformed personnel, HIV-infected partners in discordant relationships, men who have sex with men, long-distance transport workers, and people in prostitution require special prevention interventions.
In preparing the final PEPFAR Operational Plan for the first phase of PEPFAR, the USG has placed increased emphasis on prevention, including new opportunities such as male circumcision and an innovative public-private partnership for healthy youth, and on health and mitigation interventions that can delay the need for antiretroviral treatment (ART) by slowing disease progression.
All PEPFAR funding for Kenya is carefully and strategically targeted to the following interventions in support of country-level and global 2-7-10 targets.
Prevention: $106,571,603 ($95,686,375 Field; $10,885,228 Central) (22.0% of prevention, care and treatment budget)
The PEPFAR prevention portfolio for Kenya includes medical/technical interventions to improve blood safety, reduce exposure through safer medical injection, and prevention of mother-to-child transmission (PMTCT). The longer-standing sexual transmission interventions include abstinence and be faithful programs (AB) and condoms and other prevention activities.
FY 2008 funding for PMTCT will enable PEPFAR to expand the number of sites providing HIV testing and counseling. Women who test positive will receive a full course of prophylaxis to interrupt vertical transmission, with the majority receiving more efficacious regimens including AZT. This intervention will keep infants from being infected with HIV, and women will receive ART. The USG will also provide training and/or supportive supervision to health workers.
FY 2008 funding will support significant improvements in blood safety and injection practices. The USG will continue to work with Kenya�s six regional blood transfusion centers and four satellite centers to ensure safe blood is collected. A major innovation in 2008 will be providing HIV test results to donors, consistent with our commitment to the Government of Kenya (GOK) goal of universal access to HIV counseling and testing (CT). Safe injection practices will achieve national scale in 2008, will be implemented in all provinces of Kenya, and key staff will be trained in injection safety in priority districts. The GOK will continue to complement USG efforts with significant procurement of auto-disable syringes.
The more visible elements of the prevention portfolio involve efforts to reduce sexual transmission, which remains the source of at least 90% of new infections in Kenya. USG Kenyas's theme for 2008 planning was �No Missed Opportunities,� and all PEPFAR programs, particularly those focused on care and treatment, will be increasingly effective partners in prevention. All partners receiving funding for work with orphans and vulnerable children (OVC) will ensure access to age-appropriate prevention programs in light of the high risk of OVC acquiring HIV infection. Funding for the AB portfolio has increased to provide funding for the healthy youth initiative. In addition new interventions will be identified by the consortium of public and private, and local and international partners committed to the initiative. The combination of increased funding and new programming approaches will result in a large increase in the number of young people reached with AB messages and improved linkages with other prevention programs for reaching sexually active adults.
The USG has increased FY 2008 funding for other behavioral prevention programs. These activities include rapidly expanding access to male circumcision services, with a focus on very high prevalence Nyanza Province where the majority of men are not circumcised, and to expanding access to evidence-based prevention for people in prostitution. Rapid expansion of positive prevention programs to support those already infected � especially the 50% of couples who live in discordant relationships � is also planned. The USG will also link alcohol prevention to many prevention efforts.
Care: $135,507,515 ($132,003,819 Field; $3,503,696 Central) (28.0% of prevention, care and treatment budget)
Kenya�s care and mitigation efforts include CT, closely linked to prevention and treatment programs; tuberculosis (TB)/HIV programs to identify and care for those who are co-infected; support for OVC),; effective programs to integrate TB and HIV programs for rapid diagnosis of HIV among those with TB and vice versa, and treatment of TB among those who are HIV positive; and community-support and mitigation services to strengthen households affected by AIDS, health services to prevent and treat opportunistic infections (OIs), prevention with positives; and end-of-life care when treatment fails or is unavailable.
With strong U.S. technical and financial support, Kenya continues to provide global leadership in expanding CT services beyond traditional voluntary counseling and testing (VCT). To support the MOH goal of reaching 80% coverage by 2010, the USG will rapidly expand family counseling and testing by providing CT services to OVC, sexual partners of individuals who already know their HIV status, and family members of patients receiving care and treatment services. As per Ministry of Health (MOH) and WHO guidelines, provider-initiated CT in medical settings will also be a priority area. CT activities (including testing in TB and PMTCT programs) will be supported by improved laboratory infrastructure and purchase of required stocks of HIV rapid test kits.
FY 2008 innovations in the OVC program include the requirement that all OVC programs introduce age-appropriate HIV prevention support, and expansion of the Mwangalizi Project. This project, launched with FY 2007, recruits and trains HIV positive adults who are successfully managing their own treatment to be �accompagnateurs� for children without consistent care managers in their own homes. Working closely with the Department of Children�s Services, we will expect all PEPFAR implementing partners to offer more robust responses that seek to integrate prevention as well as meet all six GOK priority OVC services: health, nutrition, education, protection, psychosocial support, and shelter.
FY 2008 funding has increase for palliative care (which includes community support/mitigation services as well as clinical care other than ART and hospice), a deliberate response to the unmet needs of Kenyans struggling with the effects of HIV and AIDS. Funds will be used to provide wider use of cotrimoxazole prophylaxis, improved linkages between community and clinic settings, and greater availability of medications to prevent and treat OIs. GOK nutritionists will be trained about the interaction between nutrition and HIV, the impact of poor nutrition on disease progression, the role of diet and micronutrients in improving treatment outcomes, and options for nutritional support. Efforts to improve home-based care (HBC) will continue to expand, with a special emphasis on promoting consistent implementation of the sound guidelines promulgated by the MOH and wider availability of better equipped HBC kits.
TB/HIV programs will provide TB treatment and cotrimoxazole prophylaxis to co-infected Kenyans. In some parts of the country, over 90% of TB patients are also HIV positive, and diagnostic HIV testing in TB care settings has become the standard of care so that as many individuals as possible are referred to care and treatment. USG uniformed services programs will increase emphasis on TB diagnosis among the military and in prisons and other institutional settings where both guards and inmates are at increased risk. In FY 2008, the USG will continue to expand to include TB centers in mission hospitals, to scale up diagnostic CT nationally, and to roll out additional TB sites where ART is offered.
Treatment: $241,327,394 ($230,921,714 Field; $10,405,680 Central) (49.9% of prevention, care and treatment budget)
Dramatic expansion of access to ART in Kenya continues with 166,400 people (including at least 15,251 children) on antiretroviral (ARV) drugs by September 2007. In less than four years, ART has shifted from a peripheral interest to the very heart of the PEPFAR program. The combined country and headquarters-allocated budget for ARV drugs, ART, and laboratory infrastructure � supplemented by host government, Global Fund, and other sources � will make continuous, high-quality treatment available to virtually all who need it by the end of the 2008 implementation period. Treatment priorities include maintaining procurement of generic ARV drugs at over 70% of the value of all purchases and accommodating maturing treatment profiles by doubling the percentage of drug procurement committed to second-line regimens.
This final phase of further scale up will be closely coordinated through the National AIDS and STI Control Programme (NASCOP) within MOH. Consistent with USG Kenya's Five-Year Strategy, USG inputs include assistance with planning and development of strategies, policies and guidelines; support for centralized activities such as drug procurement and delivery, training, and enhancement of laboratory capacity; direct and indirect support is provided to nearly all ART sites in Kenya through collaboration with NASCOP.
Turning earlier investments in pediatric treatment into greatly increased numbers of children on ART will be a top priority, with a special emphasis on very young children. In light of the Clinton Foundation commitment to procure all pediatric ARV drugs, the USG will emphasize greatly expanded early infant diagnosis.
Strengthened support for health systems will be a continuing priority. Larger PEPFAR partners will strengthen sites within a region and the relationships between those sites, will improve regional functions such as quality assurance, and will offer supportive supervision to networked sites. Networks are now well defined in all regions and are overseen by NASCOP Provincial ART Officers (PARTOs). PARTOs, most of whom are physicians, determine which sites become treatment centers, provide supervision, work to strengthen treatment networks, and conduct periodic meetings where health care providers can share experiences and receive continuing medical education. Investments in this area prioritize procurement and human resources to expand laboratory services in Kenya, with an increasing number of facilities receiving quality assurance and training for personnel.
All treatment programs will be supported to expand Positive Prevention programs. Clinicians will continue involvement in a multi-country demonstration project, patients will be employed and trained to facilitate prevention support groups, partner testing will be expanded, and HIV positive children will receive age-appropriate HIV prevention interventions linked to their clinical care.
Other Costs: $51,388,092
Resources invested in Other Costs primarily fulfill USG's commitment to effective management and monitoring of the substantial American investment in the response to AIDS in Kenya. Funding allocated to strategic information (SI) includes targeted allocations to increase the capacity of both the MOH and the National AIDS Control Council (NACC) to implement one monitoring and evaluation framework. Data collected from USG programs strengthens the national system. The USG will complete analysis and begin application of results from the 2007 Kenya AIDS Indicator Survey, which includes an unprecedented number of biomarkers. In addition to partially funding the important 2008 Kenya Demographic and Health Survey, the USG will continue support to the already strong annual surveillance efforts conducted in antenatal clinics and among patients with sexually transmitted infections (STIs).
The USG also invests in systems strengthening and policy analysis. The USG provides contract employees needed to fill critical vacancies in PEPFAR-supported health settings. In addition, the USG will continue to support networks of people living with HIV/AIDS (PLWHA) � including positive teachers, religious leaders, Muslim women, and ART patients � so that they can provide mutual support to one another and become effective participants in the policy councils of their nation to promote accountability, efficiency, and transparency. USG personnel will be actively engaged in trying to assure that Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria (Global Fund) resources are used wisely and efficiently in Kenya. The USG will continue technical and financial assistance to implement revised administrative structures to support Global Fund planning, procurement, and programming while equipping PLWHA and civil society representatives to effectively participate in the Country Coordinating Mechanism (CCM).
Following a Staffing for Results exercise conducted for 2008 operational, Mission management and heads of agencies responded to concerns about workload of American and Kenyan USG employees who oversee PEPFAR. Critical technical and administrative staffing gaps were identified and are accommodated within the FY 2008 management and staffing budget.
Other Donors, Global Fund Activities, Coordination Mechanism:
The USG is the main donor to HIV interventions in Kenya, exceeding the combined inputs of other donors by a factor of eight. The United Kingdom�s Department for International Development is the next largest bilateral donor and the World Bank is the largest multilateral funder. Other development partners particularly active in the response to AIDS in Kenya include the Japanese International Cooperation Agency and the German Development Corporation.
The Global Fund has approved HIV grants totaling nearly $130M, with approximately $49M disbursed to the GOK as of September 28, 2007. The USG participates in the Global Fund CCM and all relevant Interagency Coordinating Committees dealing with HIV and other health issues. USG technical staff also works closely with both the multi-sectoral NACC and NASCOP.
Other donors, and in some cases the GOK, may perceive PEPFAR as so large that they can reduce their HIV commitments. USG Kenya has added a position for External Relations and Policy in the Coordination Office to redouble our efforts in donor coordination and public diplomacy to ensure all parties understand that HIV cannot be the exclusive purview of USG.
The USG and other development partners are vitally interested in assuring that Kenya receives maximum resources from the Global Fund and that it has the capacity to use those resources rapidly and effectively. For that reason, FY 2008 efforts will include continued and expanded focus and resources on defining the best systems for planning and using these important funds to prevent new infections and prolong the lives of Kenya already infected with HIV. As noted above, a priority for 2008 will be equipping PLWHA and civil society representatives to be optimally effective participants in the CCM.
Program Contact: PEPFAR Country Coordinator Warren Buckingham
Time Frame: FY 2008 � FY 2009
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