COUNTY Government of KIAMBU DEPARTMENT of HEALTH SERVICES HIV & AIDS Strategic Plan

COUNTY Government of KIAMBU DEPARTMENT OF HEALTH SERVICES HIV & AIDS Strategic Plan

2015/2016 - 2018/2019

“Re-Orienting HIV & AIDS Control in a Devolved System of Government”

COUNTY Government of KIAMBU DEPARTMENT OF HEALTH SERVICES HIV & AIDS Strategic Plan

2015/2016 - 2018/2019

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” Any part of this document may be freely reviewed, quoted, reproduced or translated in full or in part, provided the source is acknowledged. It may not be sold or used for commercial purposes or for profit. Table of Contents

Acronyms and abbreviations iv Foreword vi Preface viii Acknowledgments x Executive Summary xi CHAPTER 1: BACKGROUND ON KIAMBU COUNTY 1 Chapter 2: SITUATION ANALYSIS 5 2.1 Drivers to HIV epidemics 6 2.2 Past HIV and AIDS control activities 7 2.3 Strength, Weakness, Opportunity and Threat Analysis 7 CHAPTER 3: RATIONALE, STRATEGIC PLAN DEVELOPMENT PROCESS AND THE GUIDING PRINCIPLES 9 3.1 Rationale 10 3.2 Development process 10 3.3 Guide to the Strategy Development. 11 CHAPTER 4: VISION, GOAL AND OBJECTIVES OF THE Kiambu County HIV STRATEGIC PLAN 12 4.1 Vision: 13 4.2 Goal: 13 4.3 Objectives 13 CHAPTER 5: COUNTY STRATEGIC DIRECTIONS 14 5.1 Strategic Direction 1: Reducing New HIV Infections 15 5.2 Strategic Direction 2: Improving Health Outcomes and Wellness of People Living With HIV 21 5.3 Strategic Direction 3: Using Human Rights based Approach to Facilitate Access to Services 24 5.4 Strategic Direction 4: Strengthening Integration of Community and Health Systems 26 5.5 Strategic Direction 5: Strengthen Research Innovation and Information Management to meet the County HIV Strategy Goals. 28 5.6 Strategic Direction 6: Promote Utilization of Strategic Information for Research and Monitoring and Evaluation to Enhance Programming 30 5.7 Strategic Direction 7: Increasing Domestic Financing for Sustainable HIV Response 33 5.8 Strategic Direction 8: Promoting Accountable Leadership for the Delivery of the KCHASP 34 CHAPTER 6: IMPLEMENTATION ARRANGEMENTS 36 County HIV Coordination Mechanism 37 Implementation Plan 39 CHAPTER 7: MONITORING AND EVALUATION PLAN 42 CHAPTER 8: RISK AND MITIGATION PLAN 45 ANNEXES 48

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” iii Acronyms and abbreviations

ACSM Advocacy, Communication and Social Mobilisation

AIDS Acquired Immune Deficiency Syndrome

ART Antiretroviral Treatment

CACC County AIDS Control Coordinator

CASCO County AIDS and STI coordinator

CCC Comprehensive Care Centre

CHTS Community HIV Testing Services

CHAC County HIV and AIDS Committee

CSO Civil Society Organisations

EMTCT Elimination of Mother to Child Transmission

FBO Faith Based Organisations

FSW Female Sex Workers

HCBC Home and Community Based Care

HIV Human Immunodeficiency Virus

HPV Human Papilloma Virus

IPD In Patient Department

KASF Kenya AIDS Strategic Framework

KCHASP Kiambu County HIV and AIDS Strategic Plan

KHSSIP Kiambu Health Sector Strategic and Investment Plan

MCA Member of the County Assembly

MSM Men having Sex with Men

NACC National AIDS Control Council

NASCOP National AIDS and STI Control Program

OPD Out Patient Department

iv KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) PEP Post Exposure Prophylaxis

PrEP Pre Exposure Prophylaxis

PLHIV People Living with HIV

PLWD People Living with Disability

RRI Rapid Result Initiative

SCACC Sub County AIDS Control Coordinators

SCASCO Sub County AIDS and STI Coordinators

SDP Service Delivery Point

STI Sexually Transmitted Infections

TOWA Total War against HIV and AIDS

VCT Voluntary Counselling and Testing

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” v Foreword

Kiambu County is one of the 47 counties created through the devolved system of government by the Constitution of Kenya 2010. The county has a diverse background comprising of urban and rural set-ups. In terms of HIV, Kiambu County is ranked among the 18 high burden counties with a prevalence rate of 3.8 %1. Although at National level there is a notable decline in this prevalence, HIV continues to be a threat to health and overall development of the county. It remains the leading cause of mortality and morbidity in the county2 hence the need for concerted efforts in reversing the trend.

The development and subsequent launch of the Kiambu County AIDS Strategic Plan (KCHASP), covering the period 2014/15 to 2018/19, is the culmination of many months of preparation by the county health services department, working in collaboration with development partners and implementing partners, to deliver a better framework for a strengthened county HIV response.

This collaborative approach emphasises on the growing awareness among all stakeholders that the challenges of HIV in Kiambu County can only be successfully addressed by working together through a team and not as individuals. It is my strong conviction that the participation by individuals from all sectors, and representation of a wide range of organisations, will ensure dynamic county action that will yield desirable results in HIV prevention, care and treatment for Kiambu County .

The development of this Kiambu County HIV and AIDS Strategic Plan 2016 – 2018/2019 demonstrates the County government’s commitment in controlling the scourge. I am glad this strategic framework is aligned to the recently launched Kenya AIDS Strategic Framework 2014/2015 – 2018/2019, the Kenya HIV Prevention Roadmap and the Kiambu County Health Sector Strategic and Investment Plan. It is my sincere hope that through its implementation it will contribute to the recently endorsed global Sustainable Development Goals.

To date, the county has made significant progress in the fight against HIV. However, as observed from the Modes of HIV Transmission Study (MoT) report of 2008 and Kenya AIDS Indicator Survey (KAIS) in 2012, there are still major challenges faced by

1 Kenya AIDS Strategic Framework 2014/2015 – 2018/2019 2 Kiambu Health Sector Strategic and Investment Plan 2014 - 2018

vi KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) the county in the fight against HIV. For example, the HIV prevalence for the county still remains high, new HIV infections have been estimated at 2,931 among the adults and 96 among the children which is unacceptably high. The total number of infected population is over 46,000. There is, therefore, a need to double the efforts on HIV prevention as a move to turn off the tap of new infections. It is encouraging to note that the strategic plan will focus attention on the prevention of new infections, while at the same time providing care, support and treatment for people living with HIV.

The aim of this Strategic Plan is to achieve countywide universal access to quality integrated services at all levels, to prevent new HIV infections, reduce HIV-related illnesses and deaths and mitigate the effects of the epidemic at households and communities.

This strategic plan will guide our HIV interventions over the next three years and serves as an expression of the county’s commitment and determination to address HIV and AIDS not only as a medical and health challenge, but also as cultural, social and economic challenge that affects all sectors of our society and every family.

It also addresses the complexities of our practices in sexuality, relationships, culture, beliefs and attitudes that influence the transmission of infections, responsiveness to infection and illness and the overall interventions against stigma and discrimination of persons infected and affected by HIV. This strategic plan is, therefore, about us, and is for us, as a community and county. This, therefore, requires a joint effort in the fight against HIV and AIDS to ensure that the plan is translated into concrete, focused and sustained action and results in the present and the future.

In this regard, my government is committed to facilitating achievement of the results articulated in this strategic framework through increasing domestic financing that includes enhancing private public partnership and, in consultation with the county assembly, review the relevant by- laws to raise funds locally.

In conclusion, I would like to thank the NACC, the County Health Management Team, Sub- County Health Management Teams, University of Nairobi-CRISSP, APHIA Plus Kamili, Centre for Health Solutions (CHS) and all stakeholders involved in making this strategic plan a reality. It is through this collaborative action that we will realise our vision of a “HIV free society” in Kiambu County .

H.E. WILLIAM KABOGO Governor, Kiambu County

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” vii Preface

The Kiambu County HIV&AIDS Strategic Plan (KCHASP) is the latest move by the County Department of Health Services, with support from partners as guided by National AIDS Control Council, to provide a strategic framework for the implementation and coordination of HIV& AIDS response in the county. In developing this Strategic Plan, the county relied on the Kenya AIDS Strategic Framework (KASF) and Kiambu County Health Sector Strategic and Investment Plan (KHSSIP). In addition, it reflected its structure in line with the devolved system of government by giving the county government under the leadership of the Governor, greater ownership and coordination in the control of HIV in the county.

Kiambu County recognises the importance of a county strategic plan in confronting the challenges posed by HIV, mounting a technically sound county response and mobilising all stakeholders towards achieving the desired results.

This strategic plan comes after the release of Kenya AIDS Indicator Survey (KAIS) 2012 with consideration of the emerging changes in the epidemic as evidenced by the Modes of Transmission Study (MoT) in 2008 which pointed to new patterns of infections, with the majority occurring among couples. From KAIS 2012, it is also evident that HIV prevalence in the county has dropped slightly from 4.2% and stabilised at 3.8%. This new evidence-based information has to be addressed to keep the county on the right track and to enhance our focus in achieving development objectives as anchored in Vision 2030.

I am delighted that the county strategic plan clearly shows that we are using evidence to implement programs that will reap maximum benefits. The resources to confront HIV are limited and the challenge, therefore, is to link them with results in order to realise the objectives of this strategic plan. The county strategic plan is based on five programmatic areas operating as an integrated programme.

First the Key Population program will focus on specific interventions targeting, male and female sex workers and other vulnerable groups and drivers of the epidemic.

Care and treatment program on the other hand will ensure that there is universal access to ART and care while also ensuring adherence and subsequent viral load suppression.

viii KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) HIV Testing and Counselling as an entry point to HIV care must focus on increasing access to HTC, employing tactics to enhance universal acceptance and overall HTC coverage while aiming at 100% linkage to care. The program will design audience specific approaches to increase HTC.

The ultimate goal of the strategic plan is to reduce new infections and, therefore, the PMTCT arm will be very instrumental in ensuring that all HIV positive gestating mothers access ART for purposes of reducing mother to child transmission. This, coupled with increased access to family planning for HIV positive women of reproductive age, will go a long way in tackling new infections in Kiambu County .

Youth friendly services will also be brought to focus in this strategic plan as a way of advocacy for primary prevention and tailored provision of quality healthcare among the youth. The strategic plan will also advocate for multi-sectoral response while ensuring that partners are coordinated under one framework. The community-based HIV programs will be revitalised to enhance community engagement and capacity towards Universal Access and strengthening social transformation into a HIV competent society.

The strategic plan will provide direction on the implementation, coordination and monitoring of HIV prevention, care and treatment services in Kiambu.

The KCHASP’s vision is “A prosperous and nationally competitive county free of new HIV infections, stigma and AIDS related deaths.” Its overall goal is “to contribute to the KHSSIP objective of eliminating communicable condition through universal access to comprehensive HIV prevention, treatment and care.”

The overarching aim of the KCHASP is to cascade and customise the KASF strategic objectives and directions giving due regards to the local context and situations in Kiambu County . With the requisite governance, strategic information and accountability, there is no doubt that the strategic plan will achieve its objectives.

DR. JONAH MANJARI MWANGI County Executive Committee Member For Health, Kiambu County

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” ix Acknowledgements

Strategic planning for HIV is a process that has proved to be invaluable for the county department of health services as far as planning and strategizing on relevant, sustainable and cost-effective program interventions are concerned. It gives us the opportunity to review the work we have done, affirm our success, critically review whatever could have been done better and chart our course for the future. By its very nature, strategic planning for HIV and AIDS involves an enormous amount of risk-taking requiring honesty, courage, energy and vision.

The active process of developing this strategic plan started in June 2015 and was a monumental task following the launch and subsequent dissemination of the Kenya AIDS Strategic Framework (KASF) in the county.

We, therefore, wish to acknowledge the contributions of the various individuals and organisations whose passion, efforts, intellectual finesse and exceptional dedication put together this valuable document for Kiambu County . There have been many rigorous and spirited discussions with all stakeholders around the programmatic areas.

Everyone around the table – CEC health, Chief officer, CHMT, the County HIV TWG, SCHMT, Partners, County Assembly Representatives, Non-Governmental organisations and Community Based Organisations, People Living with HIV, People with Disabilities, Key population representatives, the elderly and all other stakeholders – have brought their best efforts to bear upon these consultations. It is from these engagements that we have put forth a vision, setting us on a trajectory that will assure our prominence in the county and national HIV arena.

Through thoughtful visioning, we have formulated a comprehensive strategic plan, which will act as the compass guiding us towards delivering Universal Access to HIV services.

We wish to acknowledge with deep gratitude all the contributors to this successful strategic plan.

The Department of Health Kiambu County wishes to renew its commitment to abiding by the highest standards of governance and effective programming as it coordinates the county response to advance efforts in making our county free of HIV.

DR. STEPHEN NJUGUNA WAIGURU Chief Officer of Health, Kiambu County

x KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Executive Summary

The Kiambu County HIV and AIDS Strategic contributed 15% of new infections, injecting Plan (KCHASP) was developed to provide drug use accounts for 3.8% while health facility- a framework for the implementation, related infections contributed 2.5 % of new coordination and monitoring of HIV and AIDS cases. control activities in the county. The KCHASP supports the Kiambu Health Sector Strategic This strategic plan’s emphasis is on applying and Investment Plan (KHSSIP) 2014–2019 an effective coordinated response that is that provides the overall framework for the tailored to Kiambu County . It is evidence County Department of Health strategy. It is also based and provides comprehensive high- developed in line with the Kenya AIDS Strategic quality combination prevention, treatment and Framework (KASF) 2014/2015 – 2018/2019. care services, mobilisation and strengthening communities for ‘AIDS competence’. The County Health Management Team is to coordinate an efficient and effective HIV The KCHASP has outlined the Kiambu County response in Kiambu County . In building on this HIV profile where the prevalence stands role and seeking to forge a stronger response at 3.8%. Thus, a total of 47,994 people are in the coming years, the County Health estimated to be living with HIV in the county1. Department in partnership with a wide range Statistics show that 29.6 % of men and 13.8% of partners and stakeholders, developed the of women in the county have never been County AIDS Strategic Plan 2014/15-2018/19, tested for HIV (KDHS, 2014). While there is whose vision is: ‘A HIV-free County’. great improvement in skilled birth attendance among the general population, delivery in Kiambu County is experiencing a mixed health facilities remains a challenge. Statistics and geographically heterogeneous HIV show that among pregnant women who tested epidemic. Its characteristics are those of positive for HIV, 61% of them delivered at both a ‘generalised’ epidemic among the home. mainstream population, and a ‘concentrated’ epidemic among key populations. The pattern The KCHASP has identified the drivers to the emerging is of highly variable epidemiological HIV epidemic in Kiambu County who include dynamics geographically with respect to female and male sex workers, men who have modes of transmission and with substantial sex with men (MSM), people who inject drugs age and sex differentials. The HIV epidemic (PWID) and other vulnerable populations like affects all sectors of the economy and is adolescents and young women from both the equally a developmental challenge as it is an urban and rural settings in the county. There epidemiological challenge. are marked key HIV hotspots that include Thika town, Ruiru town, Kiandutu slums and According to Modes of Transmission Study Githunguri Township which mainly attract (MoT 2008) most new infections (44%) occur sex workers. Through the Drop In Centres in couples who engage in heterosexual activity (DICs) established in Thika Town and Kikuyu, within a union or regular partnership. Men and Men having sex with Men (MSM) and People women who engage in casual sex contributed injecting drugs have been identified. 20% of new infections, while sex workers and their clients contributed 14%. Men who have In developing strategies to target all the sex with men (MSM) and prison populations population, the KCHASP undertook a profile

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” xi segmentation of the key and vulnerable including establishing more DICs and reach out population as guided by the KASF. It was to institutions of higher learning to strengthen realised that there are two distinct populations and integrate HIV services. in terms of knowledge on HIV, access to services, cultural practices and economy- rural The following are the objectives of the and urban. In this regard, the KCHASP will KCHASP: target rural population with more outreach HIV services, develop strategies for increasing 1. Reduce new HIV infections by 75%. access to skilled birth attendance aimed at 2. Reduce AIDS related mortality by 25%. improving the maternal and infant child health 3. Reduce HIV related stigma and outcomes and integrate HIV in school health discrimination by 50%. programs. For the urban population, we will 4. Increase domestic financing of the HIV continue to strengthen access to HIV services response to 50%.

The KCHASP has adopted the strategic directions provided by KASF as follows:

Strategic Direction Area Specific objective Key intervention area SDA 1: Reducing new HIV infections To identify and target the priority Increase coverage of combination populations for HIV services HIV prevention services, prioritise the population and identify the geographical location SDA 2: Improving health outcomes and To improve HIV services for PLHIV Increase HTS and adherence to ART well-being of all people living with HIV SDA 3: Using a human rights based To increase equitable access to HIV Identify and remove barriers to HIV services approach to facilitate services for PLHIV, services to PLHIV through a HRBA key populations and other priority groups in all sectors SDA 4: Strengthening integration of health To strengthen linkage between Strengthen HIV information education services and community systems health services and community activities, establish more community units, systems for HIV response increase outreach to those with limited access to health services SDA 5: Strengthening research and To strengthen research so as to Generate home grown HIV data and innovation to inform the Kiambu HIV have information for innovations information Strategic Plan SDA 6: Promoting the utilization of strategic To strengthen monitoring and Strengthen M&E capacity and use of data information for research, monitoring and evaluation of the KCHASP evaluation to enhance programming SDA 7: Increasing domestic financing for a To mobilise for resources for the Domestic resource mobilisation activities sustainable HIV response implementation of the KCHASP SDA 8: Promoting accountable leadership To strengthen the leadership Improving coordination, strengthen HIV for delivery of the KCHASP and coordination of Kiambu HIV advocacy and increase participation strategic plan The KCHASP has also provided an implementation plan that includes all the timing of activities to be implemented over the 3 years period. This will form the basis for tracking progress during the planned quarterly review meetings.

xii KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 01 BACKGROUND ON Kiambu County

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 1 Kiambu County is one of the 47 counties created through the devolved system of governments by the constitution of Kenya 2010.

Location Kiambu County is located in Central Kenya. It borders Murang’a County to the North and North East, Machakos County to the East, Nairobi County to the South, Nakuru County to the West, and Nyandarua County to the North West. It covers an area of 2,543.4 square Km. Temperatures range from a minimum of 12.8°C to a maximum of 24.6°C with an average of 18.7°C. The average rainfall is 989mm per annum. Its road network is Bitumen Surface (1,358 km), Gravel Surface (682.6 km), Earth Surface (430.1 Km).

Figure 1.1: Map of Kiambu County

2 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Demographic Kiambu County has a total population of 1,732,689 which is distributed in the 12 sub- counties. The highest population is concentrated in the urban centres while a lesser population is settled in the rural settings. The population growth rate for the county is estimated at 1.6% per year and, therefore, its population is projected to be at 1,849,471 by the end of the FY 2017/2018. (Source: Kiambu County Health Sector Strategic and Investment Plan 2014- 2019)

Table 1: Catchment Population Trends

Sub County Units Population trends Year 1 Year 2 Year 3 Year 4 Year 5 1 Gatundu South 121,876 123,879 125,916 127,986 130,090 2 Gatundu North 107,392 109,158 110,952 112,776 114,630 3 Juja 126,800 128,884 131,003 133,157 135,346 4 Thika Town 176,486 179,387 182,336 185,334 188,381 5 Ruiru 215,600 219,144 222,747 226,409 230,131 6 Githunguri 157,722 160,315 162,951 165,629 168,352 7 Kiambu Town 116,024 117,932 119,870 121,841 123,844 8 Kiambaa 154,829 157,375 159,962 162,592 165,265 9 Kabete 149,892 152,356 154,861 157,406 159,994 10 Kikuyu 133,854 136,054 138,291 140,565 142,876 11 Limuru 139,970 142,271 144,610 146,988 149,404 12 Lari 132,245 134,419 136,629 138,875 141,159 Total 1,732,689 1,761,175 1,790,128 1,819,557 1,849,471

Health Status Kiambu County has a health workforce of The major challenges facing the county in 4,025 from different medical cadres. Majority, health investment include among others: (3,354) work in public health facilities. It also has 487 non-medical staff. The county has a a) Inadequate health personnel. total of 315 health facilities. Amongst these facilities 85 are public, 53 are FBO/ NGOs b) Erratic supply of health products. and 177 are private. This clearly shows that the private sector is indeed a major partner in c) Poor health infrastructure. healthcare. d) Inadequate public health facilities.

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 3 Causes of death Causes of ill health (disease or injury) National County-specific National County-specific No Condition No Condition No Condition No Condition 1 HIV and AIDS 1 Pneumonia 1 HIV and AIDS 1 URTI 2 Perinatal conditions 2 Diarrhoea and GE 2 Perinatal conditions 2 Diarrhoea diseases 3 Lower respiratory 3 HIV and AIDS 3 Malaria 3 Pneumonia infections 4 Tuberculosis 4 Meningitis 4 Lower respiratory 4 HIV and AIDS infections 5 Diarrhoea diseases 5 Hypertension 5 Diarrhoea diseases 5 RTA 6 Malaria 6 TB 6 Tuberculosis 6 Hypertension 7 Cerebrovascular disease 7 Diabetes 7 Road traffic accidents 7 Diabetes 8 Ischemic heart disease 8 Neonatal sepsis 8 Congenital anomalies 8 Heart conditions 9 Road traffic accidents 9 Heart conditions 9 Violence 9 TB 10 Violence 10 Malnutrition 10 Unipolar depressive 10 Skin diseases disorders

4 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 02

SITUATION ANALYSIS

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 5 Significant progress has been made in the A Kiambu County HIV prevalence survey is fight against HIV in Kenya with statistics also proposed to be conducted to establish showing a drop in prevalence rate by 2% the true state of HIV infection in the county. while new infections among children almost The strategy will also seek to invest in halved. However, HIV continues to contribute prevention to ensure places with low to high mortality rates, burdening household prevalence rate maintain the status. and straining the national health systems. Kiambu County is rated among the 18 high burden counties and contributes 3% of all the 2.1 Drivers of HIV epidemic HIV infections in Kenya. With a HIV prevalence Kiambu County has three unique population of 3.8%, the county is rated 10 out of the groups comprising of the key population, 47 counties in Kenya1. At county level; the the vulnerable population and the general KHSSIP) singles out HIV and AIDS related population. The key population comprises of infections as the leading cause of mortality the female and male sex workers, men who and morbidity. According to the Kenya HIV have sex with men, people who inject drugs Estimates 2015, the following are the HIV and a portion of long distant truck drivers. The indicators for Kiambu County : vulnerable population includes adolescents and young women both in the urban and rural areas as well as those in school and out of Indicator No / % school. Total Population (2013) 1,760,692 HIV adult prevalence (overall) 3.8% The high rates of urbanisation and HIV Prevalence among women 5.6% settlement following the construction of Thika Superhighway and the many tertiary HIV Prevalence among men 2.0% institutions in the county has greatly Number of adults living with HIV 44,200 contributed to the increase in new infections. Number of children living with HIV 3,794 The proximity of Kiambu County to Nairobi Total number of people living with HIV 47,994 City County which has a HIV prevalence of 6.8% (ranked 8th nationally) and also falls in % of people never tested for HIV by 2009 44% the high incidence counties has influence over Kiambu County . This is because it offers % of HIV Positive pregnant women who do not deliver in a health facility 61% access to affordable housing thus attracting members of key populations. New adult HIV infections annually 2,994 New Paediatric HIV infections 85 Economic activities brought by the good road networks in the county have brought about high rates of settlements in the county. The This strategy will focus on the locations with vast plantations of coffee, tea and horticulture high burden of HIV to get as many people also attract immigrant workers who normally started on ART especially in the urban areas don’t live with their families. This population while scaling up HIV testing in rural areas pressure in the county has brought about a underserved by health facilities. This will be mushrooming of informal settlements (slums) achieved through community outreaches to where the living conditions predispose identify new infections. women and children to rampant sexual and gender based violence.

1 Kenya AIDS Strategic Framework 2014/2015 – 2018/2019

6 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Early sexual debut remains a key HIV its efforts towards HIV control activities, challenge, with women and girls aged achievements and challenges in order to chart 15–24 years accounting for 21% of new HIV the way forward as outlined below. infections2. It is worth noting that Kiambu County hosts many institutions of higher learning including Mount Kenya University, Strengths Gretsa University, Kenyatta University, Thika HIV control activities have been on-going in Technical Training Institute, Medical Training the county with the support of the county College and Thika School of Medical and government. The county government retained Health Sciences thus making it a host to a the functional structures from the central large vulnerable population. government at the county and sub county levels. In addition, Kiambu County is lucky to Alcohol and drug abuse that is rampant have well trained staff. especially among the youth is also a key driver to new HIV infections in urban areas. CBOs and FBOs whose capacity was built through the TOWA funds and supportive The rural girls aged 15–24 years lack access partners offer a good entry point for scaling to health services and are exposed to sexual up HIV activities at the community level in the exploitation and gender based violence county. The county is also a beneficiary of the making them a vulnerable population too. Beyond Zero Campaign truck donated by the First Lady. This is aimed at reducing mother to child transmission of HIV. 2.2 Past HIV and AIDS control activities The county has also implemented innovative HIV and AIDS control activities have been approaches to fight HIV infections like the on-going in Kiambu County under the establishment of Drop-In Centres3 for key leadership of District Technical Committee populations and the implementation of the (DTC) where the Constituency AIDS Control Kenya Mentor Mother program4. Kiambu Coordinators (SCACCs) have been key in the County also hosts a number of private areas of advocacy and HIV prevention. Key hospitals that have opened satellite clinics HIV prevention activities include increasing such as the Aga Khan, Mater and Gertrude community awareness and engagement and Children Hospital. Male circumcision is condom distribution. Counselling, testing and traditionally practiced among members of the treatment are offered in 66 public and private community and is culturally valued as a part of facilities in the county. initiation to manhood.

A number of NGOs, CBOs and FBOs have continued to support HIV prevention and Weaknesses treatment activities notably through the A challenge in coordination and integration USAID, Total War against HIV and AIDS and of HIV activities is a key weakness to PEPFAR funding. the program. This is manifested through insufficient partners’ reporting, lack of or weak 2.3 Strengths, Weaknesses, Opportunities and Threats 3 Drop In Centres were established in Thika (SASA Centre and University of Nairobi MARPS program) and in Kikuyu, as user friendly Analysis services where the key populations could access HIV services In developing this strategy, there was need 4 Kenya Mentor Mothers Program – Mothers who are HIV positive and to re-examine the status of the county in have accepted their status attached to another mother tested positive to mentor and be able to adjust to the situation. 2 KAIS 2012

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 7 technical working groups and skewed partner HIV interventions. The county also boasts of presence in the county - either over or under a strong presence of community based and representation in some locations. Non-Governmental organisations that support the HIV response. Erratic supply of some HIV commodities eg condoms, inadequate infrastructure like CCCs, youth friendly clinics and inadequate Threats skilled staff especially counsellors who do not Practices like polygamy and multiple sexual have clear terms of reference or schemes of partners, poor health seeking behaviour, high service are other factors that may affect the poverty and low literacy levels remain major fight on HIV. Negative attitude and high levels threats to HIV control in Kiambu County . of stigma and discrimination among the health High poverty levels is evident though there providers as well as the community is also a is high circulation of money in the county major weakness to the program. arising from various transactions for instance land sale and businesses. Proximity to Nairobi The programme has also been affected by city via the good road networks supports inadequate funding that has largely been thriving of activities that open up avenues activity-based through the implementing for sex work. While the mushrooming of partners while there are no budget lines for private health clinics offers an opportunity to the HIV programming. Lack of documented increasing access to services it also poses a HIV information based on county specific threat if the quality of HIV services remains research is also hampering innovation and substandard. targeted interventions.

Opportunities Devolution offers a perfect opportunity to HIV prevention, care and treatment as it brings the control of resources closer to the community and shortens the decision making processes. The availability of a pool of trained personnel that can be engaged in HIV control activities and the presence of institutions of higher learning within the county is a guarantee for potential capacity to conducting HIV related research. A rapidly growing and vibrant private sector comprising of financial institutions, small industries, horticulture and other untapped resources offer an opportunity for private public partnership in funding HIV programs. The county has partners who are ready to support it such as the Global Fund through Kenya Red Cross Society, USAID through AphiaPlus Kamili and CDC through Centre for Health Solutions-Kenya and University of Nairobi-CRISSP. Implementation of the community strategy also offers an opportunity to scale up community based

8 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 03 RATIONALE, STRATEGIC PLAN DEVELOPMENT PROCESS AND THE GUIDING PRINCIPLES

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 9 3.1 Rationale helps in setting up of coordination mechanism while also defining the role of partners and Following the introduction of devolved system other stakeholders in HIV and AIDS activities of governments, there was re-organisation of in Kiambu. The Kiambu HIV Strategic Plan leadership and governance structures and the will be implemented in line with the KHSSIP devolution of services. Health is one of the hence covers the period 2016 – 2018/2019 functions that was devolved. This meant that when both will be reviewed and harmonised counties had to take more responsibilities in in line with the national KASF. HIV prevention and treatment among other disease burdens. It is with this in mind that the Kenya AIDS Strategic Framework (KASF) 3.2 Development process 2014/2015–2018/2019 was developed and The process of developing the KCHASP the function of each level of government commenced after the NACC held a KASF outlined. Dissemination of the KASF has dissemination meeting at the Coconut Grill subsequently been rolled out to counties and Hotel Thika on 21st and 22nd April 2015 where guidelines given to counties to develop their 5 TOTs were trained. During the meeting, own county specific HIV strategic plans based guidelines for developing the county specific on the national framework. It is on this basis strategic plan were disseminated and a that Kiambu has developed its own county technical team was formed to spearhead the strategic plan. drafting of the strategic plan.

Although the implementation of HIV and The dissemination meeting was followed by AIDS control activities has been on-going a technical stakeholders’ retreat supported by in the county, and there being systems and NACC on 24th and 25th June 2015 at Nokras structures set up to coordinate the efforts of Hotel, Murang’a where the Kiambu County HIV response, the development of KCHASP Assembly Health Committee was represented provides an opportunity for the county to by the Chairman and the Vice Chairman of the take stock of the activities undertaken in committee of Health. The technical drafting the past, determine the strengths, review team undertook a SWOT analysis of the the weaknesses and seize the available current HIV and AIDS control activities that opportunities while recognizing the threats was documented, reviewed the context of to be addressed by the program. It is also the HIV control activities under the 8 strategic a critical time to establish and re-orient its directions provided by the KASF before structures and operations within the devolved choosing the best suited option for Kiambu system of government. County . After the two days meeting, a zero draft of the KCHASP was compiled. Before In 2014, Kiambu County launched its County its review, the County HIV TWG held a retreat Health Sector Strategic and Investment and worked to align it to the Kiambu Health Plan (KHSSIP) 2014 – 2019. The plan singles Strategic and Investment Plan at the Luke out HIV and AIDS as the leading cause of Hotel, Thika in January 2016 through NACC morbidity and mortality in the county hence support. Significant changes were made on a priority intervention area. While the KHSSIP the format of the plan. The zero draft was provides the overall strategic direction for then circulated to the technical team for peer accelerating the attainment of universal review. This was followed by a second peer health coverage 2014–2019, the KCHASP review and a validation of the final plan. provides a framework for the implementation, coordination and monitoring of HIV and AIDS control activities in Kiambu County . It also

10 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 3.3 Guides to the Strategy communities, agricultural farms, quarry Development. miners and building materials transporters with deliberate program for HIV prevention After a situation analysis, the following were and treatment. They have been identified the guiding principles to be considered as as vulnerable population based on their they had a direct implication on developing the economic activities. strategic plan: Scale up best practices in HIV and AIDS control: – These includes; Implement a multi-faceted HIV and AIDS control program: – The program should take Kenya Mentor Mothers Program and Drop in cognisance of the fact that Kiambu County Centres. plays host to 3 unique populations that are non-homogenous and that no one approach Strengthen the positive living networks to may suit all the groups. The county has also reach out to more PLHIV. two distinct characteristics- the urban and rural areas all with unique characteristics. Ride on the TOWA program as a base for engaging the active CBOs and FBOs in HIV Target the rural areas: The program should control. concentrate its effort in the rural areas where there is more stigma, poor access to Increase HIV and AIDS control activities health facilities, limited knowledge and other in institutions of higher learning: – Given practices that increase vulnerability to HIV the presence of many institutions of higher infections. learning in the county (Universities and colleges) there is need to implement HIV Implement HIV control activities targeting prevention and increase access to treatment the adolescent and young women: – Given services within these institutions. This is that the major towns in Kiambu County are where most of the vulnerable population of home to many education institutions and 15–24 year old young girls and women who business points for the young women, there contribute to 21% of the new infections can is need to lay emphasis on implementing the be reached. school HIV control programs targeting the youth and young women, female sex workers Strengthen the coordination of HIV and and their clients. AIDS control activities: – With the devolution of health services, it is necessary to re-orient Conduct more in-depth research: and structure HIV and AIDS control and also Given the proximity of Kiambu to Nairobi strengthening the coordination of partners’ where MSM and people who inject drugs efforts. The governors and other leadership contribute new infection, there is need to structures need to understand and provide understand the extent of influence these the leadership role in HIV control within the groups have to Kiambu County . county.

Generate more information on HIV and stigma Make community empowerment an among the different population characteristics integral component in HIV control: – given that some of them have limited access Through community education, increasing to health services hence lack of health facility the literacy level and mitigating poverty, many based data to inform on HIV prevalence. vices that contribute to vulnerability and lack of awareness can be tackled. Integrate HIV control with economic activities: – This includes targeting business

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 11 04 VISION, GOAL AND OBJECTIVES OF THE Kiambu County HIV STRATEGIC PLAN

12 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Building on the KHSSIP and guided by the 4.3.1 Specific objectives KASF, the county has outlined its vision, goal and objectives as follows: 1. To identify and target the key and priority populations for HIV services; a) Gap in identification; – Mapping the 4.1 Vision: number of sex workers in Kiambu, A prosperous and nationally competitive drivers of the epidemic and key county free of new HIV infections, stigma and populations. AIDS related deaths. b) Geographical hotspots (populations).

2. To improve health outcomes and wellness 4.2 Goal: of PLHIV. Contribute to the KHSSIP objective of eliminating communicable conditions through 3. To increase equitable access to universal access to comprehensive HIV comprehensive health services for PLHIV prevention, treatment and care. through upgrading of all PMTCT sites to ART sites.

4.3 Objectives 4. To strengthen integration of health and 1. Reduce new HIV infections by 75%. community systems for HIV response.

2. Reduce AIDS related mortality by 25%. 5. To strengthen HIV related research for evidence based interventions. 3. Reduce HIV related stigma and discrimination by 50%. 6. To strengthen monitoring and evaluation of Kiambu HIV Strategic Plan. 4. Increase domestic financing of the HIV response to 50%. 7. To mobilise resources for the implementation of Kiambu HIV Strategic As articulated in the KASF, the Kiambu Plan. County Strategic Plan will adopt the following strategic directions; 8. To promote accountable leadership of Kiambu HIV Strategic Plan.

SDA 1: Reducing new SDA 2: Improving health SDA 3: Using a human rights SDA 4: Strengthening HIV infections outcomes and well-being of all based approach to facilitate integration of health services people living with HIV services for PLHIV, key and community systems populations and other priority groups in all sectors SDA 5: Strengthening SDA 6: Promoting the SDA 7: Increasing domestic SDA 8: Promoting accountable research and innovation utilisation of strategic financing for a sustainable HIV leadership for delivery of the to inform the Kiambu information for research, response. Kiambu County HIV strategic HIV strategic plan monitoring and evaluation to plan enhance programming.

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 13 05 COUNTY STRATEGIC DIRECTIONS

14 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 5.1 STRATEGIC DIRECTION Contribution of new HIV infections in Kenya 1: REDUCING NEW HIV Group HIV New infection INFECTIONS contribution Women above 24 years 49% Priority Population Men above 24 years 37% Sex Workers (FSW) 14% According to KASF, the priority population Men who have sex with 15% comprises of categories of the population Men that mainly contribute to new HIV infections People who Inject drugs 3.8% as key and vulnerable population. Risk of HIV is not equal for all populations. The priority populations disproportionately contribute high numbers of new HIV infections. Key population Justification/ Profile

Men having sex These populations have been Key Populations with other men identified through the DICEs that were established by partners in Thika and The Key Population is defined as groups who Limuru due to their specific higher risk behaviour People who inject They are thought to be residing in the are at an increased risk of acquiring HIV drugs peri-urban towns within Kiambu. infection, irrespective of the epidemic type For the PWIDs there is need to conduct a baseline survey since there is no or local context. Legal, cultural and social county specific data. barriers related to their behaviour increase their vulnerability to HIV. This group comprises Sex workers They move into the county and are attracted by high circulation of money of men who have sex with men (MSM), due to various economic activities people who inject drugs (PWIDs) and female – livestock trade, land sale and sex workers (FSW) (KASF, 2015). Combined, horticulture etc. this group contributes 30% of the new HIV infections.

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 15 Vulnerable population

The vulnerable population is a group whose social context increases their vulnerability to HIV infection risks and includes adult women (24- 49 years) and young women (15-24 years, prisoners and PLHIV (KAIS, 2012).

The young women and girls contribute up to 21% of all new infections nationally and are heterogeneous; found among key populations, discordant couples, and people living with HIV, in and out of school and across all geographic areas.

Table 2: Vulnerable populations for HIV new infection in Kiambu County .

Type of Rural Urban population Adults Females over Married with casual jobs and low income A literate woman with good level of education and mostly in a 25 years and low level of education. They are key monogamous marriage though with potential multiple relationships. breadwinners for their families with their Urban slum: She is single with children, have many uncertainties of spouses working in urban areas. A sizable what the days hold, part time casual jobs and involved in sex work to number also not married but cohabiting supplement income or for incentives (food, favours, and jobs). with married men. Adult males over 25 Men with low level education. Engaged Urban working or looking for jobs. Higher levels of education and years in casual jobs like boda boda, some in informed. Indulge in alcohol, MSM, they have various economic steady relationships. Have relations with activities, informed and up to date technologically. multiple sex partners. Working on steady Peri-urban: in drugs, casual work, and literacy level is low. Most of relationship and some could be married. By them not married, indulge in casual relationship, mis-used politically, the fact of being in rural areas they sexually can form gangs. entertain the single women. Young women and In school both secondary and colleges. Urban in school both secondary and colleges. Indulge in sexual girls 15-24 years Some could be drop-outs. activities early. Some could be married and have children. Indulge in cross generation sex and transactional sex e.g. Mpango wa Some are in casual work like house girls. kando or sponsors, sex for favours in schools and at work. They can be used for sexual favours. More educated and up to date technologically. High uptake of Can be having more than one sexual emergency pills. partner. They have variety of economic activities including white colour jobs. Teenage pregnancies and procure unsafe They have multiple sex partners. abortion. They have access to information that facilitate decision making. Start sexual activities early Peri-urban Some are in school, some working and still in school. Indulge in sex work at an early age. Could be having children. Poor housing, they act as drug traffickers. Some have children and others procure unsafe abortion. Young men 15-24 Some are in school. Some have dropped High education level, in college and high school. Well informed. years out. Love entertainment and social life. Up to date technologically they use Some are married. it positively or negatively e.g. pornography. Some are in to alcohol. Indulge in drugs and substance abuse including trafficking. Some are into casual work including Sexually active and more exposed. They have steady relationship and bodaboda. can have more than one sex partner. Sexually exploited by their older sex Peri-urban partners. Variety of economic activities. Low education levels could be school dropout. Indulge in crime, sexually active. Some could be street boys. Work in casual jobs. High uptake of second generation liquor. Some are married and have children. Can easily be manipulated.

16 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Type of Rural Urban population Young Adolescent They are in school, are vulnerable to They are in school. They are vulnerable to sexual abuse but lower than 10-14 years sexual abuse. Low education level. Mainly rural areas. Higher education level. Exposed to technology, including engaged in household work. Some are drop pornographic materials. They can be used for drug trafficking. outs. In learning mode. Peri-urban Have responsibilities assigned by the parents. Still in school some are drop out. Indulge in sex at an early age. At risk of sexual abuse. Truck drivers Mushrooming truck drivers and parking - spots, including guest houses.

Positive health and dignity prevention Elimination of mother to child transmission is a priority area in this KCHASP. In Kiambu, There are 47,994 people estimated to be 61% of HIV positive pregnant women do not living with HIV in the county. There is need deliver in health facilities while 3,794 children to support this population and meaningfully in Kiambu are living with HIV7. All 4 prongs of involve them in reduction of the new EMTCT should be implemented at a higher infections. This will be done through supporting scale to achieve this goal including preventing health facilities to implement integrated, high HIV infections among adolescents and girls of quality, equitable, accessible and sustainable reproductive health age. comprehensive HIV Prevention, Care, Treatment and Support services in the county. The prevention with positive components has already demonstrated results from its implementation.

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 17 5.1.4 INTERVENTIONS FOR REDUCING NEW HIV INFECTIONS

KASF objective KCHASP Key Activity Sub-Activity/ Intervention Target Geographic areas Responsibility Results Population by County/sub- Biomedical Behavioural Structural county Reduce new HIV Reduced number Increased Offer HTS to general population Promote peer education and Scape testing in all the health care facilities General population All sub counties CHMT and infections by 75% of new HIV access to treatment support Implementing infections in the targeted HTS partners county for the general population- OPD & Inpatient, MCH Reduce new §§ Provision of key commodities §§ Regular outreach and contact §§ Mapping of Key and priority populations Key population (MSM, Urban areas (Thika, Ruiru, County Department of HIV infections including lubricants and condoms with key populations §§ Sensitise and engage communities and leaders IDU and Sex workers) Kiambu, Githurai, Limuru, Health, Partners among the Key for key populations §§ Through peer based education such as religious leaders and elders on key Kikuyu) Population §§ Screening and management of and treatment support populations on HIV to reduce stigma and increase HPV STIs among FSW/MSM and §§ Behaviour change intervention service uptake Hepatitis B and C for PWID. using specific interpersonal tools §§ Capacity building and mentorship of health care §§ Alcohol screening and addiction and techniques including Braille providers support & sign language §§ Establishment of more drop-in centres §§ Scale up STI management in all §§ Offer harm reductions §§ Strengthen HIV Care unit health facilities interventions §§ Strengthening of alcohol related laws §§ Provide Pre- and post-exposure §§ Address social cultural barriers §§ Rural women economic empowerment prophylaxis services that increase risk of HIV infection §§ Implement SGBV prevention and response §§ Capacity building and mentorship among communities program of health care providers in the §§ Address issues of violence §§ Implement cash transfers to keep girls in school institutions against key population through and social protection to vulnerable populations appropriate crisis response §§ Initiate workplace protection policy, mechanism §§ Strengthen protection of rights and empower §§ Accelerate access to social key and vulnerable populations e.g. create drop equity and justice for priority in centres population §§ Engage private sector to formalise a system to §§ Male involvement in HIV complement service delivery prevention and EMTCT(Initiate male mentors) Reduce new §§ HIV Testing Services §§ Implement evidence based Establish youth and adolescents wellness clinics Youth and Adolescents Rural areas County Department of HIV infections §§ Promote skilled birth attendance interventions like sister to sister Health, Partners among §§ Cancer and HPV screening & health choices adolescents §§ Offer outreach HIV services §§ Reach out the women through and the Youth §§ Mother to mother support groups the women groups §§ Conduct outreach activities §§ Establish youth and adolescents §§ Peer to peer outreach in Hold a consultative meeting with representative of Adolescent and young Urban areas County Department friendly clinical services institutions institutions of higher learning to develop strategies women (15 to 24 years) of Health, Partners, §§ Offer age appropriate §§ Life skills education for integrating HIV services in the institutions. MOEST, Institutions of contraceptives, condoms, §§ HIV and reproductive health higher learning microbicides awareness in schools or in the Develop innovative approaches for targeting §§ Vulnerable urban Both rural and urban National Transport §§ Offer HPV screening and community vulnerable population with HIV services (truckers, men above 15 years areas. Safety Authority education. prisoners, boda boda operators, sand harvesters) §§ Vulnerable young (NTSA), County men and women Government, aged 15 – 24 years Ministry of Trade & Environment. Reduction Strengthen Increase number of EID sites §§ Health education to antenatal Strengthen EID management systems Children below 18 All sub counties Health department of new HIV Early infant and post-natal mothers months and implementing infections among diagnosis partners children

18 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 5.1.4 INTERVENTIONS FOR REDUCING NEW HIV INFECTIONS

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 19 Leverage opportunities through creation of synergies with other sectors of HIV prevention

Other sector Justification Recommended actions Responsibility Education It provides an opportunity where we can Increase knowledge on HIV County Department tap on a captive audience comprising of a and HIV status, STI and of Health, Partners school going population HPV among teachers and students Matatu SACCOs and Touts, drivers and conductors of matatu Target them for services; County Department NTSA. Bodaboda and boda bodas have been identified as a use them to convey HIV of Health, Partners SACCOS vulnerable population. Through NTSA, they prevention and treatment have formed SACCOs and this can be an messages; Peer education entry point to highlight their vulnerability and role model and target them for services Private sector Employ staff who could be HIV positive and Advocate for the provision County Department institutions: commercial, require services, has a captive audience for of HIV services and establish of Health, Partners, manufacturing work place HIV programs work place HIV programs, Private sector Resource mobilisation Institutions of higher This is where young women age 15 – Integrate HIV services, STI County Department learning (universities) 24years can be found and HPV screening among of Health, Partners, them. Institutions of higher learning Faith based organisations, Resource mobilisation, spiritual Provide psychosocial support County Department CBOs, donors and NGOs nourishment for stigma reduction. of Health, Partners Resource mobilisation Private clinics Offer health services to the general Use them to increase access County Department population to HIV services of Health, Partners Clubs, youth groups, As an OCG they provide a captive audience Engage them in HIV County Department women groups, interest that can be used in social mobilisation communication activities of Health, Partners groups activities in HIV in the community

20 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 5.2 STRATEGIC DIRECTION Gaps related to quality of care and 2: IMPROVING HEALTH treatment services and viral suppression: OUTCOMES AND WELLNESS Quality of care, limited use of electronic OF PEOPLE LIVING WITH HIV medical records, evidence informed interventions at facility level and viral load Context monitoring need improvement. In addition, there is limited co-ordination and support Gaps affecting the health outcomes as to quality of care by other sectors such as identified in the KASF include, the gaps in the learning institutions, nutrition, legal and social cascade of care from identification, linkage, services. retention and viral suppression. These include limited access to and unequal geographical Despite HTC being the way to increase distribution of services, human resource prevention and treatment 44% of people in inadequacies, poor referral and tracking Kiambu County had never tested for HIV mechanisms, commodity and supply related in 2009. challenges and limited infrastructure for information management systems. According 1,207 adults and 180 children died of HIV to KASF, the reachable number for ART is related conditions in Kiambu County in 2013. 46,000 people. However, only 24,000 adults have been put on ART. Kiambu County has ART coverage among adults is higher than been noted to serve other neighbouring the national average while 34% children living counties like Murang’a, Nairobi and Machakos with HIV in the County in need of ART are not with ART services. receiving treatment.

The ART coverage of children in the area within Kiambu County is low with more than Table: Annual HIV Treatment Situation in 1,000 children yet to be identified. The county Kiambu targets 90% identification of these children by COUNTY ADULT HIV TREATMENT ACCESS ANNUALLY 2019. Adults in need of ART 23, 890 Adults receiving ART 24, 104 Diagnosis and linkage to care: Late or lack of HIV diagnosis and suboptimal linkage to County ART adult coverage 102% care is a challenge. For key populations, legal National ART adult coverage 79% barriers, stigma, criminalisation and negative Number of Adults who died of AIDS 1,520 health care provider attitudes reduce access related conditions in 2013 to care. COUNTY CHILDREN HIV TREATMENT ACCESS ANNUALLY Children in need of ART 3, 041 Care and treatment coverage: There is Children receiving ART 2,011 disproportionately lower coverage of ART in children and adolescents. Sub-optimal County ART children coverage 66% integration of screening, prophylaxis and National ART children coverage 42% management of co-infections and co- Number of Children who died of 114 morbidities result in high attrition of those AIDS related conditions in 2013 enrolled. Persons living with HIV experience stigma impacting on disclosure and adherence, particularly among key and priority populations.

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 21 5.2.2 INTERVENTION FOR IMPROVING HEALTH OUTCOMES AND WELLNESS OF PEOPLE LIVING WITH HIV

KASF KCHASP Key Activity Sub-Activity/ Intervention Target Geographic Responsibility objective Results Population areas by Biomedical Behavioural Structural County/sub- county Reduce AIDS Increased number To identify and §§ Increase the number of health §§ Sensitise the community to reduce §§ Improvement of the existing CCI to make them child §§ People living All sub counties County Government related mortality of targeted priority target the priority facilities offering ART HIV stigma and discrimination friendly with HIV and partners by 25% populations populations for HIV §§ Upgrading PMTCT sites to §§ To increase access to care and §§ Establish a HIV referral laboratory in Kiambu County §§ General accessing HIV services ART sites treatment §§ Strengthen referral and defaulter tracing systems population, services §§ Increase access to HIV related §§ Sensitisation of community/religious leaders and information through community stakeholders in regard to HIV outreach services §§ Develop innovative approaches to integrate the use of ICT in HIV services especially increasing adherence to ART §§ Strengthening HIV commodity supply chain systems and resource mobilisation §§ Establish one more DIC to offer care and treatment §§ Early infant diagnosis §§ Increase community awareness on §§ Sensitisation of the care givers of children living with Paediatrics and County Government, §§ Increase paediatric ART the importance of ART adherence. HIV Adolescents NASCOP and partners, coverage from 66% to 100% §§ Improve the Health seeking §§ Strengthening Paediatric and adolescent support CCIs §§ Adherence support to care behaviour of care givers of children groups and treatment living with HIV §§ Increase the number of CCCs in Kiambu §§ Establish 2 model CCSs sites in Kiambu §§ Build the capacity of health care workers on paediatric HIV management §§ Improve the existing paediatric facilities to make them child friendly Increased Timely initiation of Initiate all eligible clients on Increase level of treatment literacy Increase number of ART sites All eligible clients All sub counties County health number of clients ART to all eligible ART among clients department and accessing ART clients implementing partners Increased Strengthen Strengthen health care provider Promote peer support among clients Strengthen support groups Clients on care and All sub counties County health adherence among adherence for support on adherence through ART department and client on ART clients already mentorship implementing partners enrolled Improved retention Improve client §§ Strengthen client monitoring §§ Promote communication among §§ Strengthen the use of referral directories in the ART All clients on care All sub counties County health rates of client retention rates and timely referrals clients and care providers sites and treatment department and on Care and §§ Conduct continuous quality §§ Anti-stigma campaigns in the §§ Establish and strengthen quality improvement teams implementing partners treatment improvement audit and community §§ Strengthen psychosocial support groups in the health transfers §§ Strengthen advocacy against facilities and in the community §§ Establish a multi-disciplinary HIV and AIDS related stigma and §§ Strengthen inter-sectoral collaboration response to HIV in-patient HIV clinical team discrimination and AIDS

Improved quality Improve the quality §§ Build the capacity of health Strengthen involvement of clients in §§ Establish a HIV referral laboratory in Kiambu County . Lab end users All sub counties County Department of of care for PLHIV of care for PLHIV care workers on paediatric management decision §§ Develop innovative approaches to integrate the use of Health and Partners HIV management ICT in HIV management §§ Conduct audits on all HIV related deaths

22 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 5.2.2 INTERVENTION FOR IMPROVING HEALTH OUTCOMES AND WELLNESS OF PEOPLE LIVING WITH HIV

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 23 5.3 STRATEGIC DIRECTION stimulating an increased demand for HIV health 3: USING HUMAN RIGHTS services. The county government as a duty bearer BASED APPROACH TO has equally not put in adequate and deliberate FACILITATE ACCESS TO measure to address the needs of all those SERVICES affected by HIV. For instance, youth friendly clinics in health facilities are lacking hence depriving the Context youths of services. Through partners support, DICs have been introduced in three sites (SASA The Constitution of Kenya guarantees the human Centre-Thika, University of Nairobi MARPs right of every citizen. In conforming with this and Kikuyu) to offer HIV services to the key constitutional guarantee, HIV services should aim population. The DICs are offering services to an at reducing stigma and discrimination, reducing appreciable key population of 4,547 persons (as sexual and gender based violence, increase the at 31st October 2015) exemplifying the program’s protection of human rights and increase social success in reaching out to potential contributors inclusion for PLHIV, key and vulnerable populations. to new HIV infections.

Inadequate knowledge on health related rights The county as the duty bearer of human rights among the general population is a key barrier to should guarantee the provision of HIV services to

5.3.2 Intervention areas for using human rights based approach to facilitate access to services

KASF KCHASP Results Key Sub-Activity/ Intervention Target Population Geographic Responsibility objective Activity areas by Biomedical Behavioural Structural County/sub- county Reduce §§ Increased number of DIC Establish 4 Strengthen and establish more Empower communities i.e. Form stakeholders’ forums to identify and Key population including Kiambu County County Government and partners HIV related (from 2 to 4) DICEs DICs to offer HIV services to the police, MCAs, religious leaders address HRBA gaps the youth, adolescents stigma and §§ KP friendly services key populations. through various forums and young women, PLHIV, discrimination established in public health MSMs, SW, PWID by 50% facilities Community empowered against Empowered Sensitisations of CHVs on HIV Improved awareness on stigma Strengthen the legal and policy environment for General population Kiambu County County Government and partners stigma and discrimination Community and AIDS technical module & discrimination HRBA to HIV services within the county. Health Sensitise the village leadership volunteers on HRBA to HIV services Provision of youth friendly Establish toll free health §§ Implementation of School Health policy Adolescents and young Kiambu County County Government and partners services in public health information desk §§ Enhanced school health program people facilities §§ Develop innovative strategies for providing youth friendly HIV services including the integration within the youth empowerment centres Train health care workers on Training & Conducting regular CMEs Change negative attitude of Adoption of the HIV Prevention and Control Act Health workers and Kiambu County Government and partners Key Populations mentoring of Strengthen Linkages and HCW general population health care referrals workers §§ Training of Health workers on Formation of key populations §§ Capacity build heath providers to use sign Health workers, key Kiambu County National Council for Persons with HRBA to HIV services and adolescent support groups language populations, PLWD Disabilities (NCPWD), Kenya §§ Develop innovative §§ Liaise with other sectors to strengthen HIV Society for the Blind, Kenya approaches for providing information access to PLWD Institute for Special Education PLWD with HIV services and National policies and legal programs including access to National Police Service, Ministry framework domesticated for IEC materials. of Interior, Civil Society – county specific policies and laws CLARION, FIDA, KNHRC, Nairobi GBRC County Government and partners

24 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) all. There remains a challenge of access to health Litigation: In mitigating cases of sexual and services that is limited by physical presence, gender based violence, there exists national distance and road network. Where such services policies and guidelines but elaborate and are accessible, social marketing and accountability functional systems at the county level are weak. has not been undertaken. Health care service Cases of SGBV are viewed as being tedious, providers have minimal sensitisation on the expensive and the legal representation not need for client centred or client driven service well structured among the victims, health care provision. This is coupled with the low availability workers and the National Police Services (NPS). and capacity to use materials and approach for PWD such as Braille for Visually Impaired Persons The NPS has made significant strides in (VIP), sign language among others. establishing gender desks but this is not the case at health facilities. Health facilities are Negative cultural practices are still deeply also crippled with shortages of equipment and entrenched in the community. These include early facilities to collect specimens that can be used marriages among young girls that are rampant, as evidence in initiating medico-legal action for women, (being ‘less empowered), continue to SGBV cases. The situation is worsened by poor experience wide spread gender based violence reporting of cases and communities resorting to and social exclusion from participation in decision local negotiations to resolve reported cases. making. 5.3.2 Intervention areas for using human rights based approach to facilitate access to services

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 25 5.4 STRATEGIC DIRECTION 5.4.2 INTERVENTION AREAS IN STRENGTHENING INTEGRATION OF COMMUNITY AND HEALTH SYSTEMS

4: STRENGTHENING KASF objective KCHASP Results Key Activity Sub-Activity/ Intervention Target Geographic Responsibility INTEGRATION OF COMMUNITY Population areas by Biomedical Behavioural Structural County/sub- AND HEALTH SYSTEMS county §§ Reduce new §§ Establish toll §§ Strengthen the §§ Scale up the §§ Develop a HIV §§ Strengthen/sensitise the General Kiambu County County Context HIV infections free health integration of community provision of communication community health workers population Government and by 75% information and health system home and strategy for §§ Build a competent and partners Provision of universal health coverage to §§ Reduce services through provision of community Kiambu motivated workforce citizens by 2030, as articulated in the Kenyan AIDS related §§ Strengthen interactive sessions based care for §§ Behaviour §§ Strengthen the referral mortality by Community eg dialogue days and HIV through change and system from the facility to the 2010 Constitution and further reaffirmed by 25% Strategy community action days Community Units mentorship of community and vice versa Sessional Paper No. 7 of 2012 on Universal §§ Reduce §§ Improve referrals §§ Procurement of §§ Integration of the health workers §§ Empower the CHEW’s in the Health Care, is a key developmental HIV related and linkages adequate reporting tools role of facilities facility and in the community commitment by the government. The stigma and between §§ Motivation of CHVs within the §§ Implementing Partners to use KNASP III ETR and Kenya Health Sector discrimination community and through trainings and community the laid out structures in the by 50% health systems certification § Capacity health ministry. Strategic and Investment plan 2014- 2030 § §§ Strengthen §§ Involvement of CHVs development §§ Mapping of all stakeholders and (KHSSP) indicated that Kenya’s healthcare CBHIS during NIDs Providing strengthening the established system is characterised by lack of adequately §§ Deployment of §§ Engagement of SACCOs the health networks trained personnel, uneven distribution of specialised staff in advocacy workers with §§ Linkage with organisations of health personnel geographically and across in the CCCs §§ Regular contact with HIV education, PLHIV § Better informed community leadership literacy and § Training of the CHVs on HIV and the health sector; low staff morale, poor § § and empowered §§ Registration of empowerment. Aids Technical Module leadership and inadequate financing. It is also community Community units as §§ Integration of HIV §§ Creation of awareness affected by weak governance systems, lack members CBOs for sustainability testing at ANC, campaigns for the general of accountability, weak and uncoordinated §§ Closer §§ Advocate for HIV as a MCH & CWC population collaboration top priority among the clinics linkages and referrals, weak collaboration and §§ Empower and regularly update Health Kiambu County County with community community co-ordination between and across both public the peer educators workers and Government and leadership, §§ Establish more community community partners and private sector health systems, lack of §§ Religious leaders health units/strengthen the health units capacity for planning and monitoring including etc. existing community units data analysis, and use of strategic information §§ Strengthen the communication and lack of M & E tools for community health and feedback system between services. In Kiambu heavy workload is also an the health workers and in the issue among the health care workers. community §§ Monitor quality improvement using a consolidated tool in the KCHASP, therefore, aims to build a strong and facility and in the community sustainable system for HIV service delivery §§ Integration of HIV testing in all at county level through specific health and facility departments community systems approaches, actions and §§ Integrate HIV information and interventions to support the HIV response. education as part of the school health program The main aim is to improve not only general §§ Lobby for employment of more health outcomes but HIV response outcomes, HTC providers in the health considering that HIV services are delivered facility and in the community within existing health and community systems.

The community in Kiambu is engaged in facilitate/support the community strategy. working towards their health through the However, the existing Community Health Community Strategy. Community Health Units need more capacity building, additional volunteers work at level one of health delivery technical support as well as financial and link the community with level two of the facilitation. Additionally, more community health system. The Kiambu County Health health units need to be established to cover Services Department and other stakeholders areas where there are gaps.

26 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 5.4.2 INTERVENTION AREAS IN STRENGTHENING INTEGRATION OF COMMUNITY AND HEALTH SYSTEMS

KASF objective KCHASP Results Key Activity Sub-Activity/ Intervention Target Geographic Responsibility Population areas by Biomedical Behavioural Structural County/sub- county §§ Reduce new §§ Establish toll §§ Strengthen the §§ Scale up the §§ Develop a HIV §§ Strengthen/sensitise the General Kiambu County County HIV infections free health integration of community provision of communication community health workers population Government and by 75% information and health system home and strategy for §§ Build a competent and partners §§ Reduce services through provision of community Kiambu motivated workforce AIDS related §§ Strengthen interactive sessions based care for §§ Behaviour §§ Strengthen the referral mortality by Community eg dialogue days and HIV through change and system from the facility to the 25% Strategy community action days Community Units mentorship of community and vice versa §§ Reduce §§ Improve referrals §§ Procurement of §§ Integration of the health workers §§ Empower the CHEW’s in the HIV related and linkages adequate reporting tools role of facilities facility and in the community stigma and between §§ Motivation of CHVs within the §§ Implementing Partners to use discrimination community and through trainings and community the laid out structures in the by 50% health systems certification §§ Capacity health ministry. §§ Strengthen §§ Involvement of CHVs development §§ Mapping of all stakeholders and CBHIS during NIDs Providing strengthening the established §§ Deployment of §§ Engagement of SACCOs the health networks specialised staff in advocacy workers with §§ Linkage with organisations of in the CCCs §§ Regular contact with HIV education, PLHIV §§ Better informed community leadership literacy and §§ Training of the CHVs on HIV and and empowered §§ Registration of empowerment. Aids Technical Module community Community units as §§ Integration of HIV §§ Creation of awareness members CBOs for sustainability testing at ANC, campaigns for the general §§ Closer §§ Advocate for HIV as a MCH & CWC population collaboration top priority among the clinics §§ Empower and regularly update Health Kiambu County County with community community the peer educators workers and Government and leadership, §§ Establish more community community partners §§ Religious leaders health units/strengthen the health units etc. existing community units §§ Strengthen the communication and feedback system between the health workers and in the community §§ Monitor quality improvement using a consolidated tool in the facility and in the community §§ Integration of HIV testing in all facility departments §§ Integrate HIV information and education as part of the school health program §§ Lobby for employment of more HTC providers in the health facility and in the community

Moreover, the community members are There also exists a good number of civil involved in the management of health service organisations within the community. facilities. All these efforts are geared towards These organisations play a major role in the integrating the community and health sub-implementation of HIV and AIDS related systems. services such as community mobilisation, CHBC and anti-stigma and discrimination campaigns.

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 27 5.5 STRATEGIC DIRECTION 5: there was a realisation that there exists little STRENGTHEN RESEARCH information on the HIV status in Kiambu and INNOVATION AND if any information exists, it is not available INFORMATION MANAGEMENT at the disposal of the county’s Department TO MEET THE COUNTY HIV of Health. Whereas partners implementing STRATEGY GOALS. HIV programs have conducted studies be it baseline, mid-term or end line studies, the Context reports or findings have not been shared. County health workers have in most instances To develop this county strategic plan, much participated in undertaking such studies but of the data used has been drawn from the not involved in owning the findings. national surveys like the Kenya AIDS Indicator Survey (2012), Kenya Demographic Health Whereas the county has established a Health Survey and the county profiles. Within the Research and Development Unit at the CHMT county, apart from the health facility data, level, there is a need to establish under it

5.5.2 Intervention areas in Strengthening Research Innovation and Information Management to meet the Kiambu County HIV Strategic Goals

KASF KCHASP Results Key Activity Sub-Activity/ Intervention Target Geographic Responsibility objective Population areas Structural Biomedical Behavioural §§ Reduce new §§ Available data for increased §§ Identify barriers to HIV testing and §§ Establish a HIV research, evaluation §§ Conduct facility operational research on HTS §§ Undertake a research on Health Care All the 12 Sub The County Government, HIV infections capacity for decision making access to ART and Monitoring sub unit under uptake, Linkage and undertake a Kiambu stigma and discrimination, providers Counties Implementing partners and by 75% §§ Efficient data and report delivery §§ Establish HIV services status for the County Health Research and County HIV indicators baseline survey social exclusion and human and the research institution §§ Reduce key indicators Development Unit that is cascaded to §§ Granulate the epidemic in terms of rights violation Community AIDS related §§ Establish operational resource the sub-county level. geographical and population distribution §§ Identify key barriers to HIV mortality by centre ( Website, library) §§ Mobilisation of resources for HIV §§ Identify barriers to ART, retention and testing and access to ART. 25% §§ Establish a Research Evaluation research adherence. §§ Establish the impact of §§ Reduce and monitoring unit §§ Undertake an end term review of the §§ Determine reasons for delayed lab results alcohol and substance HIV related §§ Determine effective and efficient Kiambu County HIV Strategic Plan (PCR and Viral load). abuse on HIV among the stigma and models of HIV services integration §§ Collaborations with research §§ Determine models of integration for Key young people discrimination §§ Determine the effectiveness of institutions in the county to finance Population services §§ Determine the effectiveness by 50% task shifting and its impact of and conduct HIV and AIDS related §§ Determine model for HIV infected adolescent of interventions addressing §§ Increase the delivery of HIV services (Peer research support to improve retention and adherence. poor linkage to HIV care domestic educators, Mentor Mothers and §§ Determine reversible causes of ART for PLHIV financing lay HTS Providers) treatment failure ( 2nd line treatment failure) of the HIV Combination prevention package §§ Undertake a combined preventive §§ Establish the availability of §§ Identify cost effective strategies to utilise §§ Determine the key gaps in PLHIV and All the 12 Sub MOH, NACC, NASCOP, response to available package study combination prevention strategies in the social media to improve HIV prevention the community knowledge, the Public Counties MOE, County Governments, 50% Health care settings and research outcomes attitudes and practices in Universities and HIV response Implementing partners Document effective models of §§ Document effective model §§ Establish the factors that influence Key All sub County Government, engagement with the county of engagement with county the participation and ownership community counties Research Institutions and leadership for sustainability and leadership on HIV response of HIV response among the county leaders, Implementing partners ownership of HIV response leadership Health facility Document areas of HIV information §§ Document community gaps in the managers gaps in the Community (Knowledge, knowledge, attitude and practices attitude and practice) relating to HIV response

Documented status of domestic §§ Establish the status and level of §§ Determine the level of resource §§ Identify main sources of funding for HIV §§ Establish the knowledge HIV All sub County Government, financing for HIV response in the domestic financing in the county allocation for HIV response in the response in the health care settings and attitudes of Stakeholders counties Implementing partners, county is available for HIV response county stakeholders in domestic and county Health/HIV stakeholders §§ Identify key stakeholders involved in financing of HIV response leadership financing HIV response in the county

28 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) a sub unit for the HIV research and this be knowledge, attitudes and practices relating cascaded to the sub county levels for effective to HIV. This has not been established in the coordination. county and thus a need to conduct a study in this area. To ensure efficient coordination and promote sustainability of the HIV response in the With the shift to increased domestic financing county, the roles and responsibilities of for the HIV response following dwindling different leaders and stakeholders need to financial support from the international be clear. There is thus a need to establish community, there is a need to adequately effective model of engagement and a level of establish sustainable mechanisms for HIV ownership. financing domestically. There are many stakeholders in the county who are willing to The community contribution in the response contribute to the response. Many are already and mitigation of the effects of the epidemic doing so though without a clear coordination can largely be attributed to their level of mechanism.

5.5.2 Intervention areas in Strengthening Research Innovation and Information Management to meet the Kiambu County HIV Strategic Goals

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 29 5.6 STRATEGIC DIRECTION 6: Quality data in a timely manner for effective PROMOTE UTILIZATION OF evidence-informed decision making is STRATEGIC INFORMATION mandatory. This underpins the need to FOR RESEARCH AND strengthen M&E capacity at all levels to MONITORING AND generate and use evidence for decision EVALUATION TO ENHANCE making. Monitoring and evaluation of HIV PROGRAMMING and AIDS multi-sectoral response continues to rely on a variety of systems; data sources, Context routine/ periodic collection and collation systems which are supported and maintained Kenya relies to a great extent on population- by various stakeholders. based surveys to provide information on the HIV epidemic. The Kenya AIDS Indicator In Kiambu, the M&E system is faced with Surveys and the Kenya Demographic and gaps in strategic approach on co-ordination, Health Surveys and other special surveys ownership and meaningful data use for have in the past been key sources of national decision-making and planning among and sub-national HIV information. Data from various stakeholders. County ownership and these sources has been used in modelling and recognition of the importance of effective and generating trend analysis of key HIV related efficient M&E system need to be established. indicators. There is also a need to strengthen the existing county level M&E system so as to make it The HIV surveillance system in Kenya has more flexible to respond to the data needs been characterised by a set of high quality of the county government and to facilitate national level surveys (KAIS and KDHS) and generation of high quality and timely strategic facility based HIV sero-prevalence surveys. information for HIV response at all levels. The data from these sources is used to provide trends in HIV prevalence and Figure 4.2 is a demonstration of how data incidence. flows within Kiambu County .

To effectively address the specific needs for counties, there is need to cascade data collection and analysis up to county level. However, a major challenge facing Monitoring and Evaluation (M&E) has been over-dependence on external funding. This has often meant delays or incomplete implementation of planned M&E activities including population-based surveys. To ensure timely implementation of M&E activities at the county level, sustainable financing of M&E needs strengthening at all levels.

30 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Figure 4.2: Facility Based Information flow for Kiambu County HIV and AIDS Strategic Plan.

NACC

NASCOP COUNTY HRD

NATIONAL DHIS

SUB COUNTY HEALTH RECORDS OFFICE

HEALTH FACILITY

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 31 5.6 Strategic Direction 6: Promote utilisation of strategic information for research and monitoring and evaluation to enhance programming

KASF objective KCHASP Results Key Activity Sub-Activity/ Intervention Target Geographic Responsibility Population areas by County/ Structural sub- county

§§ Reduce new HIV §§ Increased §§ Improve on the §§ Establish functional dashboards on the HIV CACC, CASCO All the 12 Sub County infections by 75% availability access of strategic strategic information SCACCs, counties government, §§ Reduce AIDS related of strategic information §§ -Undertake quarterly support supervision SCASCOs NASCOP, NACC. mortality by 25% information through §§ Supportive and monitoring §§ Reduce HIV M&E to inform HIV supervisory visits §§ Mentorship related stigma and response §§ Collection of §§ Participate in the development of Kiambu discrimination by 50% §§ Strategy is accurate data, County Department of Health Newsletter. §§ Increase domestic implemented as data quality audits §§ Revive and strengthen the M&E technical financing of the HIV scheduled. and data review working group. response to 50% §§ Quality of HIV meetings §§ Stakeholders’ forum for dissemination of services is §§ Regular training and information at county and sub-county levels improved capacity building on §§ Conduct regular data review meetings §§ Data available for data tools §§ Harmonise and create linkages between programming and data collection tools and DHIS resources are well §§ Digitise registration of clients receiving care utilised in all the service points §§ Have an established regular data review system in the county §§ Mapping of all stakeholders

Baseline data for Plan and undertake a Undertake a Kiambu HIV baseline survey Health workers All the 12 sub County HIV programming is baseline survey counties Government and available. partners Progress report on Plan and undertake a Undertake a mid-line review of the KCHASP Stakeholders All the 12 sub County achievement of the mid-line review counties Government and strategy partners Information for Undertake an end line Undertake an end line review of the KCHASP Stakeholders All the 12 sub County review of the next review of the KCHASP. counties Government and strategic plan is partners available ICC makes informed Schedule and hold Hold quarterly M&E meetings and report to the CACC, CASCO All the 12 sub County HIV decisions quarterly meetings. County ICC SCACCs, counties government, SCASCOs NASCOP, NACC Information of health Compile articles and Prepare and publish a County Department of CACCs, CASCOs All the 12 sub County widely disseminated print health newsletter Health Newsletter. counties government, NASCOP, NACC

32 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 5.6 Strategic Direction 6: Promote utilisation of strategic information for research and 5.7 STRATEGIC DIRECTION 7: monitoring and evaluation to enhance programming INCREASING DOMESTIC KASF objective KCHASP Results Key Activity Sub-Activity/ Intervention Target Geographic Responsibility FINANCING FOR Population areas by County/ SUSTAINABLE HIV RESPONSE Structural sub- county

§§ Reduce new HIV §§ Increased §§ Improve on the §§ Establish functional dashboards on the HIV CACC, CASCO All the 12 Sub County Context infections by 75% availability access of strategic strategic information SCACCs, counties government, §§ Reduce AIDS related of strategic information §§ -Undertake quarterly support supervision SCASCOs NASCOP, NACC. mortality by 25% information through §§ Supportive and monitoring Following the actualisation of devolution and §§ Reduce HIV M&E to inform HIV supervisory visits §§ Mentorship release of funds to counties, much of the related stigma and response §§ Collection of §§ Participate in the development of Kiambu county funding on health has been set aside discrimination by 50% §§ Strategy is accurate data, County Department of Health Newsletter. and utilised for infrastructure development, § Increase domestic implemented as data quality audits § Revive and strengthen the M&E technical § § procurement of essential medical supplies financing of the HIV scheduled. and data review working group. response to 50% §§ Quality of HIV meetings §§ Stakeholders’ forum for dissemination of and staff remunerations. Minimal funding has services is §§ Regular training and information at county and sub-county levels been set aside for HIV activities specifically to improved capacity building on §§ Conduct regular data review meetings the commemoration of the World AIDS Day §§ Data available for data tools §§ Harmonise and create linkages between and support towards developing this strategic programming and data collection tools and DHIS plan by the county government. There has resources are well §§ Digitise registration of clients receiving care utilised in all the service points been insufficient domestic funding and a §§ Have an established regular data review general reliance on external funding. system in the county §§ Mapping of all stakeholders Previous funding for HIV activities were received from National AIDS Control Council Baseline data for Plan and undertake a Undertake a Kiambu HIV baseline survey Health workers All the 12 sub County (NACC), NASCOP and other partners though it HIV programming is baseline survey counties Government and available. partners is activity based. It has, however, been difficult to quantify the amount of funding due to lack Progress report on Plan and undertake a Undertake a mid-line review of the KCHASP Stakeholders All the 12 sub County achievement of the mid-line review counties Government and of proper coordination mechanism in the past. strategy partners Information for Undertake an end line Undertake an end line review of the KCHASP Stakeholders All the 12 sub County review of the next review of the KCHASP. counties Government and strategic plan is partners available ICC makes informed Schedule and hold Hold quarterly M&E meetings and report to the CACC, CASCO All the 12 sub County HIV decisions quarterly meetings. County ICC SCACCs, counties government, SCASCOs NASCOP, NACC Information of health Compile articles and Prepare and publish a County Department of CACCs, CASCOs All the 12 sub County widely disseminated print health newsletter Health Newsletter. counties government, NASCOP, NACC

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 33 5.7.2 Interventions for innovative and sustainable domestic HIV financing options for Kiambu County .

KASF objective KCHASP Results Key Activity Sub-Activity/ Intervention Target Population Geographic areas Responsibility by County/sub- Behavioural Structural county Increase domestic Policy on HIV Drafting and legislation Not applicable §§ Policy paper on domestic funding of County Director preventive All Sub Counties County government, financing of the HIV financing put in place. policy through the county HIV activities and Promotive services NASCOP, NACC response to 50% assembly Resource mobilisation Establish a resource Advocate for contribution from the county §§ Prepare and present a session paper Director preventive and All Sub Counties County government, team established mobilisation team government revenue collections on increasing domestic funding of Promotive services NASCOP, NACC Community participate in bike racing to raise HIV activities to the County Executive funds for HIV activities Committee Strengthened public Resource mobilisation Lobby for funding according to identified §§ Mapping private partners for HIV County department of Kiambu County County government and private partnerships gaps in the HIV activities programs support health and partners partners to contribute funds §§ Promote effective cost-saving models for HIV activities of HIV and AIDS service delivery through integration of HIV/RH, PMTCT, ANC/MCH activities

5.8 STRATEGIC DIRECTION 8: The operability of the KCHASP is dependent PROMOTING ACCOUNTABLE on entrenching good governance practices LEADERSHIP FOR THE that build accountable leadership capacity DELIVERY OF THE KCHASP for the multi-sectoral HIV and AIDS response while establishing effective stakeholder, intergovernmental and sectoral co-ordination Context mechanisms. The Constitution of Kenya 2010 provides a new legal and policy environment upon In the context of shrinking resources, there which the HIV response will be implemented. is increased call for ownership of the HIV Articles 10(2) and 73 outline key defining response by the country. County ownership elements of good governance and leadership of the HIV response has been identified as while Article 21 (3) bestows on all State including: A strong political engagement and organs and all public officers the duty to inclusive leadership; full engagement of civil address the needs of vulnerable groups within society, communities and people living with society. HIV; high quality strategic information; robust national strategic plans with smart investment County planning, prioritisation, decisions; strong partnership with a shared implementation, monitoring, resource responsibility and mutual accountability; allocation and budgeting of programmes and effective co-ordination, capacity development interventions in counties are functions under and integration of HIV into health and county the devolved government. Thus, counties development strategies. are responsible for implementation of HIV services and programmes across different High levels of political goodwill is required to sectors. effectively address the impact of HIV in Kenya. Most important is the need to leverage on on- going political priorities.

34 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 5.7.2 Interventions for innovative and sustainable domestic HIV financing options for Kiambu County .

5.8.2 Interventions for strengthening County HIV Coordination Mechanism

KASF objective KCHASP Key Activity Sub-Activity/ Target Geographic Responsibility Results Intervention Population areas by County/sub- Structural county §§ Reduce new HIV KCHASP in Development Develop and print General Kiambu County NACC, County infections by place and printing of 200 copies of the population Government. 75% the KCHASP KCHASP §§ Reduce AIDS Dissemination of related mortality KCHASP by 25% County HIV Formation and Hold quarterly CHMT and Kiambu County County government, § Reduce § oversight operationalization meetings partners NASCOP, NACC, HIV related committee in of the County HIV partners stigma and place Committee discrimination by 50% County HIV Formation and Hold Biannual CHMT and Kiambu County County government, §§ Increase Coordinating operationalization meetings for ICC partners NASCOP, NACC, domestic committees of the County ICC partners financing of the in place forum HIV response to Sub Formation and Support sub county CHMT and Kiambu County County government, 50% county HIV operationalization / constituency HIV partners NASCOP, NACC, Coordinating of the Sub County committees partners committees HIV coordination in place committee

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 35 06

IMPLEMENTATION ARRANGEMENTS

36 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) The KASF recognises that counties are responsible for implementation of HIV services and programmes across different sectors. It has within its coordination structure singled out the county governments as providing the link with the sub counties, HIV committees, implementers, PLHIV and special interest groups hence the need to provide a strategic communication framework to coordinate the efforts of all stakeholders.

County HIV Coordination Mechanism

County Government (Governor)

County Executive Committee

County HIV Committee IMPLEMENTATION Chair Health CEC ARRANGEMENTS

County HIV Regional Coordinating unit Coordinating Unit (CHMT) (NACC)

County HIV ICC (All HIV partners in County KCHASP Sub-County HIV the county& health Monitoring Committee Committees stakeholder forum members)

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 37 Roles and responsibilities • Setting the county HIV agenda.

Governor • Receiving reports on KCHASP progress The Governor shall implement national and from the monitoring committee. county legislation to the extent that the legislation requires. He is responsible for the • Forming sub TWG to review and advice on delivery of a range of services, planning and issues HRBA to HIV services. prioritisation of resource allocation to address HIV burden in Kiambu County . • Receive reports from county ICC KCHASP and routine monitoring committee. County HIV and AIDS Committee (CHAC) County HIV Coordination Unit It shall be accountable to the Governor, This will be the responsibility of the NACC Kiambu County for the performance of its Secretariat at the county level. The unit shall functions and the exercise of their powers on coordinate the day to day implementation matters relating to HIV. of the strategic framework at the county level, working closely with the County Health Management Team and the various line Membership ministry’s department at the county level with The committee shall be chaired by the a direct link with the NACC secretariat at the County Health CEC with NACC as secretariat. national level. Membership includes: CASCO, Chair Health Assembly, Partners, County Commissioner and or representative, CACC, FBO, PLHIV, Roles Youth and PwD. The committee can co-opt • Ensure quarterly county ICC HIV meetings three members. are held and follow through on county ICC HIV actions.

Roles: • Ensure HIV agenda is active in the CHMT. The county HIV committee shall be: • Regular engagement of all state and • The custodian of the KCHASP. non-state actors within the county in planning, prioritisation, implementation, • Holding meeting on a quarterly basis to monitoring, and evaluation of HIV and AIDS review implementation plan. programmes.

• Responsible for the effective delivery • Strengthening linkages and networking of the HIV response at the county level among stakeholders and providing through periodic review and monitoring of technical assistance, facilitation and the KCHASP. support for KASF delivery.

• Approving the county HIV targets and plan. • Monitor county legislation to ensure all bills are HIV non-discrimination compliant. • Reviewing and presenting County HIV Budget.

38 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Monitoring and Evaluation Unit • Ensuring the data collection, quality Once established, the unit will have terms of control, consolidation, interpretation and reference that will include: dissemination.

• Ensure that all the prerequisite tools and • Ensure the preparation and publication of materials for data collection are available at county Department of Health newsletter the point of collection at all times. on a bi-annual basis for dissemination of health articles, data and human interest • Building the capacity of health workers on stories. data collection and transmission.

Implementation Plan Strategic Area Activities 2016 2017 2018

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Strengthen program Lobby for recruitment of more staff. X X X X X X X X X X X X coordination, Continuous procurement of STI and HIV X X X X X X X X X X X X monitoring and supplies. evaluation Lobby for the constructing and equipping X X X X X X X X X X X X of more health facilities. Construction and expansion of storage X for health commodities including ART supplies. SDA 1: Reducing Continue offering HIV services to the X X X X X X X X X X X X new HIV infections general population at facility level. Establish 3 more DICs to offer HIV X X X services to the key population in urban centres. Increase outreach for the hard reach for X X X X X X X X X X X X HTS including use of the Beyond Zero Campaign. Implement EMTCT at health facilities. X X X X X X X X X X X X Develop innovative approaches for X targeting vulnerable population with HIV services (truckers, prisoners, boda boda operators, sand harvester) Hold a consultative meeting with X representative of institutions of higher learning to develop strategies for integrating HIV services in the institutions.

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 39 Strategic Area Activities 2016 2017 2018

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 SDA 2: Improving Increase the number of health facilities X health outcomes and offering ART centres wellness of PLHIV Sensitise the CCI network on HIV care X and management among OVC Train social workers of CCI on HIV X management among the OVC Improvement of the existing CCI to make X them child friendly Build the capacity of health care workers X on paediatric HIV management Establish 3 model CCCs in Kiambu. X X X Establish a HIV referral laboratory in X Kiambu County . Develop innovative approaches for X integrating the use of ICT in HIV services especially increasing adherence to ART. Support partners to implement the X X X X X X X X X X X X minimum package for PWP activities1 SDA 3: Using Formation of a sub TWG to review and X Human Rights advice on strengthening a HRBA to HIV based approach to services facilitate access to Hold a consultative meeting to X services strengthen the medico-legal structures to address SGBV cases in the county Training of Health workers on HRBA to X HIV services Sensitise the AAC on HRBA to HIV X services Develop innovative approaches for X increasing access to youth friendly HIV services including integrating HIV services to youth empowerment centres Develop innovative approaches of X increasing access to HIV services for PLWD. Establish a local arbitration mechanism X within the ICC SDA 4: Develop innovative approaches for X Strengthening increasing access to skilled birth integration of attendants and improve Maternal and community and Infant Child Health. health system Develop a HIV communication strategy X for Kiambu Establish more community health units X X X X X X X X X X X X Integrate HIV information and education X as part of the school health program.

40 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Strategic Area Activities 2016 2017 2018

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 SDA 5: Form the County Monitoring Unit to X Strengthening coordinate research, monitoring and Research, Innovation evaluation activities. and Information Undertake a Kiambu HIV baseline survey X Management to meet the KCHASP Undertake an end line review of the X KCHASP SDA 6: Promoting Undertake quarterly supervision and X X X X X X X X X X X X utilisation of monitoring strategic information Print and distribute M&E tools for X X X for research collection of HIV data monitoring and evaluation Hold quarterly M&E meetings and report X X X X X X X X X X X X to the county ICC Prepare and publish a County Department X X X X of Health Newsletter. SDA 7: Increasing Prepare and present a sessional paper X domestic financing on increasing domestic funding of for sustainable HIV HIV activities to the County Executive response. Committee Plan and hold a charity walk, run to raise X X X funds for HIV activities Hold an annual dinner gala for raising X X X funds for HIV activities Undertake a mapping of HIV partner’s X representation in Kiambu to identify gap areas. SDA 8: Promote Develop and print 200 copies of the X accountable KCHASP leadership for Hold a meeting to disseminate the X delivery of the KCHASP to the Kiambu County Executive KCHASP results by Committee all sectors Form the county HIV coordination unit X Form the County HIV ICC and hold X quarterly coordination meetings Hold a meeting to disseminate the X KCHASP to the private sector for enhancing private public partnership for HIV services in Kiambu. Support sub county / constituency HIV X X X X X X X X X X X X committees

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 41 07

MONITORING AND EVALUATION

42 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) The Monitoring and Evaluation section of the county’s department of health is not fully established. Currently there is only one staff attached to the section and is expected to serve all the programs. At the sub county level we have 12 Health Records and Information Officers (HRIOs) who collect health facility based data. The HRIOs are expected to receive and compile all the health related data including data from community health volunteers.

Past M&E activities on HIV have largely been supported from NACC in terms of HIV specific data collection and reporting on a routine basis including community based activities through Community AIDS Program Repors (CAPR form) as completed by CSO on a quarterly basis. Through NASCOP, health facility based data is collected and submitted on a monthly basis. In the absence of a well-structured M&E unit at the county level there is an obvious gap in the collection and use of strategic information to enhance programming.

The M & E plan will provide a robust plan for evaluating the Kiambu County HIV and AIDS Strategic Plan. Critical surveys, evaluations and surveillance will be undertaken to measure outcomes and impact of the strategic framework.

Table: Roles and responsibilities of Kiambu County M & E plan.

Institution Role Frequency Reporting Tool Service delivery points (Health facilities) Report HIV sector data Quarterly DHIS County health records and information Receive and compile all the health related data Monthly/Quarterly DHIS and CAPR form officer including data from community health volunteers County HIV coordination unit and county Provide the health sector HIV response data for Quarterly DHIS AIDS and STI coordinating officer (CASCO) use at the county level County government Annual evaluation surveys Annually Merge DHIS and CAPR form

Under the M & E framework of Kiambu • Community-based HIV response reporting County , a community based HIV information tool: The CAPR tool will be revised to system (CBIS) will be strengthened to address enable CBOs report against their planned some of the HIV data source challenges. outputs. The revised tool and guidelines for This system will report mainly behavioural completing the tool will be developed and and structural indicators comprising of the disseminated to the CBOs. following data tools: • CAPR data collection will continuously • Database of CSOs: The common HIV move towards integration with the database will include a civil society Community Health information system organisation (CSO) module to capture all (CHIS). CSOs implementing HIV activities in each county. CSOs captured in the database will be expected to report on their HIV interventions based on set guidelines.

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 43 Community Health information system (CHIS).

Figure: Kiambu County data and information flow for community based HIV response.

NACC

Region

Community AIDS Program Report (CAPR)

Civil Society Organizations

44 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) 08 RISK AND MITIGATION PLAN

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 45 Risk Risk Name Status Probability (1-5) Impact Risk Average Response Responsibility When Category (1-5) score Technical Non-integration of HIV and AIDS services Low scale integration 3/5 4/5 3.5 Enhance integration of HIV and AIDS County HIV Committee Y1 with other health services services Involvement of CHMT, Sub-County health management Teams and HMTs Unequal distribution of partner capacity Inequality in distribution of capacity 3/5 3/5 3 Mapping and harmonisation of of implementing partners implementing partners

Political Instability resulting from political interests Risk being monitored 2/5 3/5 2.5 Set up rescue centres for HIV and AIDS County HIV Committee Continuous related services Political impartiality Operational Logistical and staff challenges §§ Lobbying for additional logistical 2/5 3/5 2.5 Develop proposals for funding County HIV Committee Continuous Advancement in technology support 3/5 2.5 Identification of change agents §§ Adoption of ICT in health 2/5

Legislation CEC for Kiambu will legislate a legal policy Lobby for relevant legislations 2/5 3/5 2.5 Involving the legislative organs County HIV Committee Continuous framework - HIV policy, HIV financing and Seek goodwill of the political organs partner engagement. Financial Inadequate funding Over dependence on external 3/5 4/5 3.5 Lobby for percentage allocation for HIV County HIV Committee Y1 funding response Undeclared resource envelopes Use the KCSP for resource mobilisation

Social Religion believes and customs Stigma, religious and negative 3/5 3/5 3 Capacity build the CHU County HIV Committee Continuous social cultural factors Stakeholder engagement forums

46 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Risk Risk Name Status Probability (1-5) Impact Risk Average Response Responsibility When Category (1-5) score Technical Non-integration of HIV and AIDS services Low scale integration 3/5 4/5 3.5 Enhance integration of HIV and AIDS County HIV Committee Y1 with other health services services Involvement of CHMT, Sub-County health management Teams and HMTs Unequal distribution of partner capacity Inequality in distribution of capacity 3/5 3/5 3 Mapping and harmonisation of of implementing partners implementing partners

Social Religion believes and customs Stigma, religious and negative 3/5 3/5 3 Capacity build the CHU County HIV Committee Continuous social cultural factors Stakeholder engagement forums

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 47 ANNEXES

Results Framework

Strategic Direction 1: Reducing new HIV infections

KASF objective KCHASP Results Key Activity Indicators Baseline Mid Term End Term Responsibility Target Target Reduce new HIV Reduced number of new HIV infections Increase access to targeted HTS for the general population- §§ Percentage of people with known 56% 70% 90% County Government & infections by 75% among general population OPD & Inpatient, MCH HIV status among the general partners (Private clinics and population hospitals) Reduced number of new HIV infections §§ Increase access to targeted HTS for the key population §§ Percentage of key population that 56% 70% 90% County Government & among key population §§ Reduce new HIV infections among the key population know their HIV status. implementing partners §§ Percentage of new HIV infections 44% 30% 20% among key population Reduction of new HIV infections among §§ Reduce new HIV infections among adolescents and the §§ Number of new HIV infections 850 510 170 §§ County Department of adolescents and young women youth among adolescents and the youth Health, partners §§ Establishment of standalone youth friendly centres §§ Number of centres offering youth 0 1 1 §§ County Government, within the county friendly services tertiary institutions & §§ Integration of comprehensive youth targeted services in §§ Number of health facilities offering 3 24 36 partners health facilities comprehensive youth targeted §§ County Government, §§ Establish targeted youth friendly centres in tertiary services 2 5 tertiary institutions & institutions §§ Number of youth friendly centres in 0 partners tertiary institutions

Reduction of new HIV infections among §§ Reduce new infections among children §§ Number of new infections among 96 57 18 County Government & children §§ Upgrade HTS sites to ART sites children partners §§ Strengthen early infant diagnosis §§ Number of upgraded HTS sites 59 83 100 §§ Number of health facilities offering 59 90 100 comprehensive early infant diagnosis

48 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) ANNEXES

Results Framework

Strategic Direction 1: Reducing new HIV infections

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 49 Strategic Direction 2: Improving health outcomes and wellness of people living with HIV

KASF Objective KCHASP Results Key Activity Indicators Baseline End Term Target Responsibility

Reduce AIDS related mortality Increase number of targeted priority populations §§ To identify and target the priority populations §§ Number of categories of key populations 3 5 §§ County Government & partners 75% accessing HIV services for HIV services identified Increased number of clients accessing ART §§ Timely initiation of ART to all eligible clients §§ Number of clients receiving ART. 26,115 46,000 §§ County Government & partners Increased adherence among client on ART §§ Strengthen adherence for clients already §§ Percentage of clients adhering to scheduled visits 70% 95% §§ County Government & partners enrolled §§ Number of facilities implementing the “Brother’s Keeper” Initiative. 0 12 Improved retention rates of client on care and §§ Improve client retention rates §§ Number of facilities with over 90% retention 0 12 §§ County Government & Partners treatment rates §§ Establish and strengthen quality improvement §§ Number of facilities with quality improvement 16 50 §§ County Government & Partners teams teams §§ Conduct continuous quality improvement audit §§ Number of quarterly quality audits done. 16 50 §§ Anti-stigma campaigns in the community §§ Number of anti-stigma campaigns conducted 0 5 §§ County Government & §§ Strengthen psychosocial support groups in the §§ Number of psychosocial support groups whose implementing partners health facilities and in the community capacity has been built 25 50 §§ County Government , §§ Strengthen advocacy against HIV and AIDS §§ Number of advocacy forums held implementing partners and 0 3 related stigma and discrimination §§ Number of multi-sectoral HIV committees formed other stakeholders §§ Strengthen inter-sectoral collaboration §§ Number of health facilities with established 1 4 §§ County Government , response to HIV and AIDS multi-disciplinary in-patient HIV clinical team implementing partners and §§ Establish a multi-disciplinary in-patient HIV 2 12 other stakeholders clinical team §§ Build the capacity of health care workers on §§ Number of health care workers trained on 372 1,396 §§ County Government & partners paediatric HIV management paediatric HIV management. §§ Establish a HIV referral laboratory in Kiambu §§ Number of HIV referral labs established. 0 1 §§ County Government & partners County . §§ Develop innovative approaches to integrate the §§ Number of facilities which have adopted ICT use 50 100 §§ County Government & partners use of ICT in HIV management in HIV management §§ Conduct audits on all HIV related deaths §§ Number of health facilities conducting HIV related 0 24 §§ County health department & deaths audits implementing partners

50 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Strategic Direction 2: Improving health outcomes and wellness of people living with HIV

KASF Objective KCHASP Results Key Activity Indicators Baseline End Term Target Responsibility

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 51 Strategic Direction 3: Using HRBA to facilitate access to services for PLHIV, key population and other priority groups in all sectors KASF objective KCHASP Results Key Activity Indicators Baseline Mid Term End Term Responsibility Target Target Increase access to equitable Increase number of DIC (from 2 to 4) Establish 4 DICEs §§ Number of DICEs established 2 3 4 County Government & HIV services. KP friendly services to be established in public Establish KP friendly services in Public §§ Number of health facilities with key 0 12 25 partners health facilities facilities population friendly services County Government & partners Community to be empowered against stigma and Empowered Community Health Volunteers §§ Number of CHVs trained on stigma and 0 50 100 County Government & discrimination discrimination partners Provision of youth friendly services in public Strengthen provision of youth friendly §§ Number of health facilities providing 3 50 100 County Government & health facilities services in health facilities comprehensive youth friendly services partners Train health care workers on key populations Training & mentoring of health care workers §§ Number of HCW trained on key 25 75 150 County Government & population services partners National policies and legal framework Domesticate national policies and laws on §§ Number of policy documents 0 1 2 County Government & domesticated for county specific policies and stigma and discrimination domesticated partners laws

Strategic Direction 4: Strengthening Integration of health and community systems.

KASF objective KCHASP Results Key Activity Indicators Baseline Mid Term End Term Responsibility Target Target §§ Reduce new HIV infections Established toll free health information §§ Strengthen the integration of community §§ Number of facilities with toll free 0 12 24 County government and by 75% services and health system through provision of information desks implementing partners §§ Reduce AIDS related interactive sessions eg toll free information mortality by 25% desks, dialogue days and community action §§ Reduce HIV related stigma days and discrimination by 50% Strengthened Community Strategy §§ Registration of community units as CBOs for §§ Number of CUs registered as CBOs 3 12 20 County government and sustainability §§ Number of SACCOS engaged for HIV implementing partners §§ Engagement of SACCOs in advocacy advocacy 0 5 10 §§ Motivation of CHVs through trainings and §§ Number of CHVs trained and certification certified 200 300 400 Improved referrals and linkages between §§ Improve the referral and linkage mechanisms §§ Number of facilities with functional 12 50 80 County government and community and health systems for HIV community referral and linkage implementing partners systems Strengthened CBHIS §§ Provision of adequate reporting tools §§ Number of facilities with functional 12 50 80 County government and CBHIS implementing partners Closer collaboration with community §§ Strengthen the integration of community §§ Number of community leaderships 0 2 4 County government and leadership, religious etc. and health system through provision of forums on HIV held implementing partners interactive sessions eg dialogue days and community action days. §§ Regular contact with community leadership

52 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Strategic Direction 3: Using HRBA to facilitate access to services for PLHIV, key population and other priority groups in all sectors KASF objective KCHASP Results Key Activity Indicators Baseline Mid Term End Term Responsibility Target Target Increase access to equitable Increase number of DIC (from 2 to 4) Establish 4 DICEs §§ Number of DICEs established 2 3 4 County Government & HIV services. KP friendly services to be established in public Establish KP friendly services in Public §§ Number of health facilities with key 0 12 25 partners health facilities facilities population friendly services County Government & partners Community to be empowered against stigma and Empowered Community Health Volunteers §§ Number of CHVs trained on stigma and 0 50 100 County Government & discrimination discrimination partners Provision of youth friendly services in public Strengthen provision of youth friendly §§ Number of health facilities providing 3 50 100 County Government & health facilities services in health facilities comprehensive youth friendly services partners Train health care workers on key populations Training & mentoring of health care workers §§ Number of HCW trained on key 25 75 150 County Government & population services partners National policies and legal framework Domesticate national policies and laws on §§ Number of policy documents 0 1 2 County Government & domesticated for county specific policies and stigma and discrimination domesticated partners laws

Strategic Direction 4: Strengthening Integration of health and community systems.

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 53 Strategic Direction 5: Strengthening Research and Innovation to inform on the KCHASP. KASF objective KCHASP Results Key Activity Indicators Baseline Mid Term End Term Responsibility Target Target §§ Reduce new HIV infections Available data for increased capacity for decision §§ Establish HIV services status for key Number of services status studies 0 1 2 County government & by 75% making indicators conducted partners §§ Reduce AIDS related Efficient data and report delivery §§ Establish a HIV research, evaluation Number of HIV research, evaluation and 0 1 1 County government & mortality by 25% and monitoring unit monitoring units established partners §§ Reduce HIV related stigma and discrimination by 50% Combination prevention package available §§ Undertake a combined preventive Number of combined preventive package 0 1 2 County government & §§ Increase domestic package study studies undertaken partners financing of the HIV Documented effective models of engagement with §§ Document effective model of Number of effective models of engagement 0 1 1 County government & response to 50% the county leadership for sustainability and ownership engagement with county leadership with county leadership documented implementing partners of HIV response on HIV response

Documented areas of HIV information gaps in the §§ Document community gaps in the Number of KAP studies in the communities 0 1 2 County government & Community (Knowledge, attitude and practice) knowledge, attitude and practices documented implementing partners relating to HIV response Documented status of domestic financing for HIV §§ Establish the status and level of Number of studies conducted to establish 0 1 2 County government, response in the county available domestic financing in the county for status of domestic financing implementing partners, and HIV response other stakeholders

Strategic Direction 6: Promote utilisation of strategic information for research and monitoring and evaluation to enhance programming. KASF objective KCHASP Results Key Activity Indicators Baseline End Term Target Responsibility

§§ Reduce new HIV infections §§ Increase availability §§ Improve on the access to strategic information §§ Number of institutions accessing HIV 0 120 County government & partners by 75% of strategic §§ Collection of accurate data, data quality audits and data review response strategic information §§ Reduce AIDS related information through meetings §§ Number of facilities conducting data 16 59 mortality by 25% M&E to inform HIV §§ Regular training and capacity building on data tools review meetings and DQAs §§ Reduce HIV related stigma response §§ Number of facilities capacity build on 106 200 and discrimination by 50% §§ Quality of HIV data tools §§ Increase domestic services is improved financing of the HIV §§ Baseline data for §§ Plan and undertake a baseline survey Number of baseline surveys undertaken 0 1 County health department and response to 50% HIV programming is other health stakeholders available.

§§ Progress report on §§ Plan and undertake a mid-line review Number of mid-term reviews undertaken 0 1 County health department and achievement of the other health stakeholders strategy

§§ Information for §§ Undertake an end line review of the KCHASP. Number of end term reviews undertaken 0 1 County health department and review of the next other health stakeholders strategic plan is available §§ ICC makes informed §§ Schedule and hold quarterly meetings. Number of quarterly ICC meetings held 0 8 County health department and HIV decisions other health stakeholders

54 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Strategic Direction 5: Strengthening Research and Innovation to inform on the KCHASP. KASF objective KCHASP Results Key Activity Indicators Baseline Mid Term End Term Responsibility Target Target §§ Reduce new HIV infections Available data for increased capacity for decision §§ Establish HIV services status for key Number of services status studies 0 1 2 County government & by 75% making indicators conducted partners §§ Reduce AIDS related Efficient data and report delivery §§ Establish a HIV research, evaluation Number of HIV research, evaluation and 0 1 1 County government & mortality by 25% and monitoring unit monitoring units established partners §§ Reduce HIV related stigma and discrimination by 50% Combination prevention package available §§ Undertake a combined preventive Number of combined preventive package 0 1 2 County government & §§ Increase domestic package study studies undertaken partners financing of the HIV Documented effective models of engagement with §§ Document effective model of Number of effective models of engagement 0 1 1 County government & response to 50% the county leadership for sustainability and ownership engagement with county leadership with county leadership documented implementing partners of HIV response on HIV response

§§ Progress report on §§ Plan and undertake a mid-line review Number of mid-term reviews undertaken 0 1 County health department and achievement of the other health stakeholders strategy

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 55 Strategic Direction 7: Increasing domestic financing for a sustainable HIV response.

KASF objective KCHASP Results Key Activity Indicators Baseline End Term Responsibility Target §§ Reduce new HIV Policy on HIV financing put in place. Drafting and legislation policy through the Number of legislation policies done 0 1 County director prevention, CASCO, infections by 75% county assembly COAC § Reduce AIDS related § Resource mobilisation team established Establish a resource mobilisation team Number of resource mobilisation teams 0 1 County director prevention, CEC, mortality by 25% established CASCO, COAC §§ Reduce HIV related stigma and discrimination Strengthened public private partnerships to Resource mobilisation Number of PPP partnerships established 0 1 County director prevention, CEC, by 50% contribute funds for HIV activities CASCO, CACC §§ Increase domestic financing of the HIV response to 50%

Strategic Direction 8: Promoting accountable leadership for delivery of the KCHASP results by all sectors and actors. KASF objective KCHASP Results Key Activity Indicators Baseline End Term Responsibility Target §§ Reduce new HIV KCHASP in place Development and printing of the KCHASP Number of KCHASP printed 0 500 NACC, county government. infections by 75% County HIV oversight committee in place Formation and operationalization of the County Number of county oversight committees 0 1 County government, NASCOP, NACC, §§ Reduce AIDS related mortality by 25% HIV Committee informed partners §§ Reduce HIV related County HIV Coordinating Committees in place Formation and operationalization of the County Number of County Coordinating Committees 0 1 County government, NASCOP, NACC, stigma and discrimination ICC forum formed partners by 50% Sub county HIV coordinating committees in Formation and operationalization of the sub Number of sub county coordinating committees 0 12 County government, NASCOP, NACC, §§ Increase domestic place county HIV coordination committee formed partners financing of the HIV response to 50%

56 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) Strategic Direction 7: Increasing domestic financing for a sustainable HIV response.

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 57

C u rre nt % 21.99% 48.23% 9.14% 6.35% 3.18% 0.79% 1.59% 7.94% 0.79% 100%

28.685

This is item based costing This annual finance needs for country 2014 from KASF estimation. Costing as per international III) price (Sources: NACP PLHIV in Kenya 1,600,000 PLHIV in Kenya the costing was (2015) countrybaseline for Kiambu estimates of which had 46,546 PLHIV which of to 0.041434375 translates national disease burden. e2 Esti m at 717.13 1348.20 315.54 114.74 71.71 57.37 43.03 172.11 28.69

Budget Notes § § § E ff o r t % 25% 47% 11% 4% 2.5% 2% 1.5% 6% 1% 100% 3766.48 40.01 144.45 35.95 80.02 25.01 40.07 735.41 1548.44 1117.12 2018/2019 K ia m bu e s Esti m at 6.308211375 13.8342705 2.62167225 1.820772375 0.911886 0.2279715 0.455943 2.276715375 0.2279715 28.68541388 3656.25 38.12 160.32 39.91 76.24 47.65 76.37 618.43 1568.02 1031.19 2017/2018 y 3429.16 35.48 170.30 42.46 70.96 53.08 85.06 510.13 1539.96 921.73 2016/2017 C ount r e s Esti m at 210.3 461.2 87.4 60.7 30.4 7.6 15.2 75.9 7.6

3184.87 32.46 174.83 43.59 64.92 64.64 103.78 409.76 1474.19 816.70 2015/2016 D is e as B u r d e n 0.02999625 0.02999625 0.02999625 0.02999625 0.02999625 0.02999625 0.02999625 0.02999625 0.02999625

2868.52 28.69 172.11 43.03 57.37 71.71 114.74 315.54 1348.20 717.13 2014/2015 P L HI V in K ia m bu 47994 47994 47994 47994 47994 47994 47994 47994 47994

100% 1% 6% 1.5% 2% 2.5% 4% 11% 47% 25% % o f re sou r c e e d f o r d e dicat e gy th e st r at y P L HI V in Ke nya 1,600,000 1,600,000 1,600,000 1,600,000 1,600,000 1,600,000 1,600,000 1,600,000 1,600,000

7.6 75.9 15.2 7.6 30.4 60.7 87.4 461.2 210.3 C ount r e s Esti m at Grand Total Supply chain management Leadership, governance and resource allocation Monitoring and evaluation Research Community systems Health systems Social inclusion, human rights and gender Treatment and Care Treatment HIV Prevention S p e ci f ic K ia m bu KCHASP I nt erve ntion Are as I nt erve ntion HIV Prevention Treatment and Care Treatment Social inclusion, human rights and gender Health systems Community systems Research Monitoring and evaluation Leadership, governance and Resource Allocation Supply chain management Total % Total

SD7 & SD8 SD6 SD5 SD4 SD3 SD2 SD1 SD SD s SD1 SD2 SD3 SD4

SD5 SD6 SD7 & SD8

Resource needs Costing Formulae and notes

58 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) References

District Health Information System, 2015

Kenya AIDS Indicator Survey, 2012

Kenya AIDS Strategic Framework 2014/2015 – 2018/2019, 2014

Kenya Fast Track Plan to End Adolescents AIDS and Young People

Kenya National Bureau Statistics. (2009). National Census.

Kiambu County Health Strategy Sector Integrated Plan, 2014

Kiambu County Integrated Development Plan 2013- 2017, 2014

MOH (2014). Kenya HIV County Profiles, 2014

National AIDS Control Council, 2012

National AIDS and STI programme, 2015

National Guidelines for HIV/STI Programming with Key Populations

Partners’ reports (KANCO, Hope World Wide, North Star Alliance), 2015.

“Re-Orienting HIV & AIDS Control in a Devolved System of Government” 59 List of Drafting and Technical Review Team

County Drafting Team Dr Mutile Wanyee County Department of County Director [email protected] Health Dr Evelyn Kimani County Department of County Head of [email protected] Health Programmes Josphat Maina County Department of CoACC [email protected] Health Charles Kamau County Department of CASCO [email protected] Health Rosalind Murugami County Department of County Ass. Director [email protected] Health Nursing Mc’darius Mbela County Department of SPHO-M&E/OSH [email protected] Health Dr Teresa Omwoyo University of Nairobi- Project Director [email protected] CRISSP Patrick Mosee Aphiaplus Kamili Regional [email protected] Coordinator Roman N. Kariuki Ruiru Sub County Dept of Youth [email protected] Josphat Karanja Ruiru Sub county PLHIV Rep [email protected] Wambaire Ndungu Musyoka Red cross Kenya M&E officer [email protected]

Technical Review Team Kibe Ranji NACC RHC [email protected] Elizabeth Kiilu Jaramogi Oginga TST [email protected] Odinga University Dr Dorothy Achieng University of Nairobi Lecturer [email protected]

60 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019) “Re-Orienting HIV & AIDS Control in a Devolved System of Government” 61 62 KIAMBU COUNTY HIV & AIDS Strategic Plan (2015/2016- 2018/2019)