Usaid Kenya Ampathplus Quarterly Progress Report

USAID KENYA AMPATHPLUS QUARTERLY PROGRESS REPORT

APRIL 30, 2015 This publication was produced for review by the United States Agency for International Development.

AMPATHplus Quarterly Narrative Report Quarter 2, 2014-2015

USAID KENYA AMPATHPlus FY 2015 Q2 PROGRESS REPORT

01 January, 2015 – 31 March, 2015

Award No: AID-615-A-12-00001

Prepared for Dr. James Batuka United States Agency for International Development/Kenya C/O American Embassy United Nations Avenue, Gigiri P.O. Box 629, Village Market 00621 Nairobi, Kenya

Prepared by AMPATHPlus Moi Teaching and Referral Hospital, Nandi Road. AMPATH BUILDING PO BOX 4606, 30100, ELDORET, KENYA TEL: 254 53 2033471/2 FAX: 254 53 2060727

DISCLAIMER The authors’ views expressed in this report do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

AMPATHplus Quarterly Narrative Report Quarter 2, 2014-2015

I. AMPATHPlus EXECUTIVE SUMMARY ...... 8

II. KEY ACHIEVEMENTS (Qualitative Impact) ...... 10

III. ACTIVITY PROGRESS (Quantitative Impact) ...... 15

IV. CONSTRAINTS AND OPPORTUNITIES ...... 31

V. PERFORMANCE MONITORING ...... 32

VI. PROGRESS ON GENDER STRATEGY ...... 34 VII. PROGRESS ON ENVIRONMENTAL MITIGATION AND MONITORING ...... 34 VIII. PROGRESS ON LINKS TO OTHER USAID PROGRAMS ...... 35 IX. PROGRESS ON LINKS WITH GOK AGENCIES ...... 38

X. PROGRESS ON USAID FORWARD ...... 38

XI. SUSTAINABILITY AND EXIT STRATEGY ...... 39

XII. GLOBAL DEVELOPMENT ALLIANCE ...... 42

XIII. SUBSEQUENT QUARTER’S WORK PLAN ...... 42

XIV. FINANCIAL INFORMATION ...... 44

XV. ACTIVITY ADMINISTRATIONError! Bookmark not defined.

XVII. GPS INFORMATION ...... 45

See attached document (Appendix 3)...... 45

AMPATHplus Quarterly Narrative Report Quarter 2, 2014-2015

XVIII. SUCCESS STORY GUIDELINES & PREP SHEETS ...... 45 ANNEXES & ATTACHMENTS (MAXIMUM 10 PAGES) ...... 46

AMPATHplus Quarterly Narrative Report Quarter 2, 2014-2015

ACRONYMS AND ABBREVIATIONS

AIDS Acquired Immune Deficiency Syndrome ALARM Advances in Labour and Risk Management AMPATH Academic Model Providing Access to Healthcare AMRS AMPATH Medical Records System ANC Ante-Natal Care AOTR Agreement Officer Technical Representative APHIA AIDS Population and Health Integrated Assistance ART Antiretroviral Therapy BCC Behavior Change Communication BTL Bilateral Tube Ligation BMI Body Mass Index CB-DOTS Community Based Directly Observed Treatment Short course CD4 Cluster of Differentiation 4 CDC Centers for Disease Control CHC Community Health Committee CHMT County Health Management Team CRIO County Records Information Officer CHV Community Health Volunteer CME Continuous Medical Education CORPS Community Own Resource Persons CT Counseling and Testing CTF Community Therapeutic Feeding CTX Cotrimoxazole CWC Child Welfare Clinic DASCO District AIDS & STI Coordinating Officer DBS Dry Blood Sample DCOP Deputy Chief of Party DHMT District Health Management Team DHRIO District Health Records and Information Officers DL Distance Learning DLTLD Division of Leprosy, Tuberculosis and Lung Disease DMOH District Medical Officer for Health DMLT District Medical Laboratory Technologist DPHN District Public Health Nurse DRH Division of Reproductive Health DTC Diagnostic Testing and Counseling EBI Evidence informed Behavioural Interventions EID Early Infant Diagnosis EmOC Emergency Obstetrical Care EMTCT Elimination of Mother-to-Child Transmission of HIV

AMPATHplus Quarterly Narrative Report Quarter 2, 2014-2015

EQA External Quality Assurance FLTR Find Link Treat Retain FMP Families Matter Program FP Family Planning FPI Family Preservation Initiative GESP Group Empowerment Service Provider GISE Group Integrated Savings Enterprise GCLP Good Clinical Laboratory Practice GOK Government of Kenya HCT Home Based Counseling & Testing HIV Human Immunodeficiency Virus HMIS Health Management Information Systems HREC High Risk Express Care HTC HIV Testing and Counseling IEC Information, Education and Communication ICF Intensive Case Finding IMCI Integrated Maternal and Child Illnesses IPT Isoniazid Prophylaxis Therapy IQC Internal Quality Control KEMSA Kenya Medical and Supplies agency KENAS Kenya National Accreditation Services KEPH Kenya Essential Package for Health KMMP Kenya Mentor Mothers Program KPs Key Populations LMIS Logistic Management information System LREC Low Risk Express Care LTFU Lost To Follow Up M&E Monitoring and Evaluation MNCH Maternal Neonatal and Child Health MDR TB Multi Drug Resistant Tuberculosis MUCHS Moi University College of Health Sciences NACC National Aids Control Council NASCOP National AIDS & STI Coordinating NCD Non Communicable Disease NHIF National Hospital Insurance Fund OJT On-the-Job Training OVC Orphans and Vulnerable Children PAC Post Abortion Care PHC Primary health Care PALWECO Program for Agriculture and Livestock in Western Communities PHCT Perpetual Home based Counseling and Testing PHDP Positive Health, Dignity and Prevention PITC Provider initiated testing and counselling PLHA People living with HIV/AIDS

AMPATHplus Quarterly Narrative Report Quarter 2, 2014-2015

PTB Pulmonary tuberculosis PLHA People living with HIV/AIDS PTB Pulmonary tuberculosis PwP Prevention with Positives PLUS People-centered Leadership Universal access Sustainability PMTCT Prevention of Mother to Child transmission RH Reproductive Health SCRIO Sub-County Records Information Officer RHTC Rural Health Training Centre RSPO Research Sponsored Projects Office SLMTA Strengthening Laboratory Management towards Accreditation TAT Turnaround Time TOT Training of Trainers USAID United States Agency international Development VMMC Voluntary Medical male Circumcision WASH Water Sanitation and Hygiene WFP World Food Program WHO World Health Organization WAN Wide Area Network WWAN Wireless Wide Area Network

AMPATHplus Quarterly Narrative Report Quarter 2, 2014-2015

I. AMPATHPLUS EXECUTIVE SUMMARY

Qualitative Impact

In the second quarter of 2014/2015, several HIV prevention activities were implemented. HIV testing and counseling (HTC) services at the community level were provided with perpetual home-based counseling and testing (PHCT) as the major activity. PHCT implementation was done in thirteen sub-counties. Mobile VCT services targeting specific populations were also conducted. Evidence-informed behavioral interventions (EBIs) namely RESPECT-K, Positive Health, Dignity and Prevention (PHDP), and Families Matter Program (FMP) were implemented. These activities targeted the youth, key populations (KPs) and the general population Site Improvement Monitoring System (SIMS) tools were used to track progress in implementation of different program components in addition to other existing program monitoring mechanisms. Several SIMS sensitization meetings and assessments were conducted in collaboration with USAID, with numerous areas identified as strengths and others as needing improvement. The main focus for the prevention of mother-to-child HIV transmission (PMTCT) program this quarter was the roll-out of the Maternal Child Health (MCH) based Option B+ PMTCT services from the traditional AMPATH CCC Model. As a crucial first step to this transition we carried out a Needs Assessment on selected health facilities in all 8 counties covered by AMPATHPlus. Preliminary findings show that there are major gaps in skills in PMTCT care, space for counselling to accord confidentiality and workload and these cut across most counties facilities whose data has been presented. During the quarter the PMTCT team successfully scaled up weekend couples counselling in 4 other main facilities (Busia, Port Victoria, Teso & Khunyangu), as a result to more couples being captured in the pilot facility (MTRH) To ensure that women have an increased choice about the size of their families and timing of their children, the program supported family planning radio talk shows in West Pokot. To emphasize these messages and meeting the family planning demand created as a result, we trained selected community health volunteers, from all communities in West Pokot on community distribution of family planning commodities. To ensure that the counties continue to draw major gains from the BeMONC trainings during this and previous quarters, BeMONC mentorship in Busia and Trans Nzoia counties emphasized on quality of care to clients. As a result, the two counties have put in place a mechanism of following selected process of care indicators on a monthly basis. By the end of the quarter, Kitale county referral hospital, Kapsara district hospital and Kwanza health centres were the only facilities (out of 31 facilities sampled in Trans Nzoia county) that met the seven signal functions for BeMONC.

We continued to strengthen commodity management activities in all AMPATH supported facilities. We carried out two Quality Improvement (QI) sensitization meetings for Trans Nzoia and Busia counties. This was coordinated by the QI department, and facility in-charges; CASCOS, SCASCOS, and AMPATH county co-ordinates were present.

Quantitative Impact

We counseled and tested 194,025 individuals during the quarter through PITC, PHCT, MVCT, and PMTCT screening. Of those counselled and tested in PITC, 997 were identified as being from Key Populations (KP ). Our emphasis in this quarter was in scaling up testing in children. During this quarter 15,735 children were tested through PITC with 259 (7.9%) being HIV- positive. In PITC more generally 3263 individuals were HIV positive, including 1892 women, 1112 men, 122 male children and 137 female children.

There was a marked increase in the number of pregnant women with known HIV status (including those tested for HIV and received results) in the current quarter (Q2 of FY2015= 35707) as compared to 25857 in Q1of FY2015 which surpassed the quarterly target of 26520. This could be attributed to the increased continuous mentorship and support supervision activities in the quarter.

Through MCH, the percent of children less than 5 years old fully immunized increased from 91.5% (21,712) last quarter to 96.9% (25,968) this quarter. The percent of women having 4 ANC visits dropped from 64.7% last quarter to 57.2% this quarter. This performance reflects the country’s performance of 58% of pregnant women going for the recommended 4 ANC visits according to KDHS 2014 highlights. The reporting rate for facility contraceptive consumption increased significantly to 90.8% a trend that was also observed across the country with an average of 81% of all facilities in Kenya reporting. The Couple Years of Protection (CYPs) increased from 31,590 last quarter to 38,264 this quarter.

Constraints and Opportunities  In areas where the Families Matter Program (FMP) has been implemented, FMP graduates are active in referring clients for health services such as VMMC, post-GBV care, and HIV testing and Counseling  Integration of Site Improvement Monitoring System (SIMS) into routine HIV prevention activities creates a culture of continuous quality improvement. A multidisciplinary approach to technical assistance is the most effective and efficient and way to improve quality of service.

Subsequent Quarter’s Work Plan PITC has planned a RRI, targeting high volume facilities and intends to roll out internal SIMS in sites that have not been reached. The Care and Treatment program will conduct sensitization of county focal persons and facility in-charges on the rapid advice guideline and HIV management. The lab will pursue accreditation ISO15189-2012.

II. KEY ACHIEVEMENTS (QUALITATIVE IMPACT)

HIV Prevention:

During the quarter, five groups of FMP classes started in Bunyala, Trans Nzoia West, Teso North and Butula Sub-Counties. All the required six classes will be completed and reported in the next quarter. Quarterly meeting between program staff and the 10 FMP facilitators was conducted to enhance the quality of FMP sessions. Trained PHCT Counselors continued with implementation of RESPECT-K, an intervention that targets populations who are disproportionately at high risk of acquiring new HIV infections and sexually transmitted infections (STI). The aim was to enhance client’s risk perception and support the development of an individualized risk reduction plan. This was carried out in four Sub-Counties: Kisumu West, Bunyala, Teso North, and Trans Nzoia West. The Prevention team held a meeting with the 12 RESPECT-K facilitators to review data and discuss challenges in implementation of RESPECT-K.

Implementation of Community and Clinical Positive Health, Dignity and Prevention (PHDP) continued in four and seven counties respectively. Support supervision was carried out by the program staff in facilities within Uasin Gishu (Ziwa, Moi University, Burnt Forest, Huruma, Uasin Gishu District Hospital, G.K. Prison, Turbo, Soy and Moi’s Bridge) and Nandi (Mosoriot).

In order to effectively plan for the HIV prevention needs among Key Populations, the Prevention team in collaboration with NASCOP and other MOH staff conducted mapping of hotspots and size estimation of female sex workers (FSWs). This was done in Kitale and Malaba. The Prevention department participated in sensitizing County and Sub-County HMTs on use of Site Improvement Monitoring System (SIMS). This was done in Uasin Gishu County, Trans Nzoia West and Kisumu West Sub-Counties. Subsequent internal assessments were conducted to evaluate compliance with the SIMS requirements. Joint meetings bringing together the PHCT team, County/Sub-County MOH teams and health facility representatives were held in Uasin Gishu County. The meetings provided an opportunity to discuss progress reports and share challenges in PHCT implementation. Field support supervision led by SCHMT (SCASCO, SCPHN, SCMLT, SCHRIO and HTC Coordinator) was conducted in Teso North, Bungoma East and Mt. Elgon.

Numerous efforts have been put into place to increase linkage to care among individuals testing HIV-positive. In facilities where dedicated staffs exist, HIV counselors physically hand over clients to the Comprehensive Care Clinic (CCC). PITC counsellors was also scaled up to support this. Care Navigators based at the CCC and composed of people living with HIV (PLHA) who counsel and support those newly testing positive has been helpful, and this program is being rolled out to more facilities. In addition, a Peer Navigator intervention is ongoing in the medical wards to improve in-patient linkage and ART adherence.

HIV Care, Treatment, and Support: Training of trainers (TOT) for the New Guidelines was carried out in Kitale for Trans Nzoia County in conjunction with FUNZO Kenya. One of the key goals of the quarter was to reactivate Quality Improvement (QI) activities in Kisumu and Busia counties following training by USAID- ASSIST last year. We conducted QI follow-ups on QI activities in Trans Nzoia and introduced the concept of QI in Uasin Gishu. Our QI is done through an integrated approach to technical assistance whereby a team of technical experts from QI, adult/paediatric care and treatment, PMTCT and MCH visited facilities that had performed poorly in the last quarterly report to provide onsite mentorship to facility staff. We noted marked improvements in efficiency and effectiveness of technical assistance (TA) by AMPATHPlus staff. A multidisciplinary approach to technical assistance is the most effective and efficient and way to improve quality of service. By sensitizing county personnel there is better support from the county health management teams as they are able to join the TA team at facilities. Access to data in a consumable format is still a challenge for many facilities especially those supported by AMRS. Data consumption is a major challenge for all sites.

AMPATHPlus established an adolescent HIV clinic in Quarter and we are working hard to scale it up and find new space in MTRH after the existing one was cleared to make way for the New Childrens’s hospital. Policies, New Encounter forms have been put in place.

Twenty social workers were trained on paralegal issues, human rights, sexual and Gender based violence, inheritance and land laws among other issues. The training enhanced the participants’ capacity to offer support to clients whose rights are infringed due to their status. Additionally, the safety net team developed protocols on GBV. Five QI teams were formed in the quarter to improve service delivery for orphans and vulnerable children (OVC). One of the teams collaborated with the county government of Uasin Gishu and constructed a toilet block in Koibarak primary school. In addition Sosiot Caregiver Group supported 21 OVC with school fees payments, purchase of school uniforms and other scholastic items as a result of engaging in poultry keeping. The FPI program carried out vetting, selection and training of Group Empowerment Service Provider (GESP) in eight counties. The GESP provides groups trainings, follow ups and monitoring in the community. GESP is a strategy that aims to build sustainability by creating community self-reliance in service provision. Eighty two GESP groups were identified and engaged. AMPATHPlus partnered with Dow Agro sciences to train AMPATH staff and Government agriculture extension workers on agronomics. Twenty three officers (16 AMPATH staff) were trained. In collaboration with the World Food Program (WFP) AMPATH trained farmer groups on agronomic practices, post-harvest handling, marketing, leadership and group dynamics. This resulted in 80 farmer groups accessing structured markets such as NCPB, WFP and schools among others. The proceeds were used to meet various household needs such as school fees, enrollment to NHIF and purchase of agricultural inputs among others.

Prevention of Mother-to-Child HIV Transmission (PMTCT): The main focus for the prevention of mother-to-child HIV transmission (PMTCT) program this quarter was the roll-out of the Maternal Child Health (MCH) based Option B+ PMTCT services away from the AMPATHPlus traditional CCC Model. As a crucial first step to this transition we carried out a Needs Assessment on selected health facilities in all 8 counties covered by AMPATHPlus to determine the readiness of health facilities to integrate PMTCT services within MCH. Preliminary findings show that there are major gaps in skills in PMTCT care, space for counselling to accord confidentiality and workload and these cut across most county facilities whose data has been presented. For the coming quarter, we hope to train at least two service providers from selected facilities and continue supporting the TOT training and regional training for service providers in the counties. To enhance the follow up of mother baby pairs, PMTCT team embarked on the HIV exposed infant (HEI) follow-up exercise and successfully managed to pair up HEI to their mothers/guardians and ensured that those infants who became HIV positive were linked to care in 5 high burden counties (Bungoma, Busia, Kisumu, Trans Nzoia & West Pokot). In the current quarter ending March, 2015, PMTCT team successfully scaled up weekend couples Counselling in 4 other main facilities (Busia, Port Victoria, Teso & Khunyangu), as a result to more couples being captured in the pilot facility (MTRH) Maternal-Child Health and Family Planning: During the quarter, we continued to work closely with the counties in ensuring strengthening of MCH and FP services at both the community and facility levels. In the community, households continue to receive key MCH and FP messages from community health volunteers with particular emphasis on early identification of pregnancy and appropriate linkage to ANC and PMTCT services. To ensure that women have an increased choice about the size of their families and timing of their children, the program supported family planning radio talk shows in West Pokot. To emphasize these messages and meeting the family planning demand created as a result, we trained selected community health volunteers, from all communities in West pokot on community distribution of family planning commodities.

A total of four hundred and seven outreaches and fifty seven school health program on MCH/FP were conducted in Busia, West Pokot, Elgeyo Marakwet and Bungoma counties. The support for these activities has been increased for the subsequent quarters to allow most health facility to conduct outreaches. In the facilities, we continued to provide mentorship and on the job trainings to healthcare workers on MCH and FP services. To ensure that the counties continue to draw major gains from the BeMONC trainings during this and previous quarters, BeMONC mentorship in Busia and Trans Nzoia counties emphasized on quality of care to clients. As a result, the two counties have put in place a mechanism of following selected process of care indicators on a monthly basis. By the end of the quarter, Kitale county referral hospital, Kapsara district hospital and Kwanza health centres were the only facilities (out of 31 facilities sampled in Trans Nzoia County) that met the seven signal functions for BEmONC.

Health Systems Strengthening Laboratory: The AMPATH Care Lab Creation after separating from the AMPATH Research Lab has continued to become a lot more efficient with dramatic improvement in the tests carried out and improved turnaround times. This quarter saw more staff training and mentorship as well as more dedicated and refocused. We continue to nurture this lab with great technical support from USAID and support from Walter Reed and CDC. The three USG have continued to create support and partnerships in the HIV Lab network.

Data: We were fortunate to bring on a board aq new M and E advisor into the AMPATH family to fill the big data and M and E leadership gap and we have already noted great improvement in this department. We look forward to turning around and improving data use for quality improvement. The forms and concepts team were able to complete programming, piloting and implementation of the adult initial and return encounter forms version 6.09 which aligns data collection within the program to the MOH 257. Preparation for piloting point-of-care (POC) data collection POC took place including form development, setting up infrastructure, informing the required personnel, and testing of the POC systems took place. We hope to be able to demonstrate this innovative and exciting approach to data collection at Moi Teaching and Referral Hospital by the end of the next quarter. During monitoring of server performance for decentralized sites, it was established that they are no longer able to efficiently synchronize data between AMPATH Center and the sites. Evaluation indicates that the amount of data has increased and the capacity of the server is limited. It is possible that the same will continue to quarter three. Progress on rolling out universal IDs in AMPATH supported clinics in on-going. For all the said sites ready for implementation, this has been scheduled for quarter Pharmacy: We continued to strengthen commodity management activities in all AMPATH supported facilities. We carried out two Quality Improvement (QI) sensitization meetings for Trans Nzoia and Busia counties We emphasized accurate and timely reporting and ordering to ensure a smooth flow of supply of antiretrovirals and medications for opportunistic infections. After the meetings, the facilities did a self-assessment using the SIMS tool provided by USAID, after which we addressed gaps detected such as documentation, reporting, standard operating procedures etc. USAID also conducted an assessment in Busia and Chulaimbo, where Pharmacy department managed to score dark green score (exceeds expectations). Quality Improvement and SIMS: Quality improvement teams have been set up including members from care and treatment, PMTCT and MCH. In-depth discussion on retention of patients in care with subsequent development of a work plan to address the same has been taking place. Some flexibility was allowed for facilities with good retention to address other gaps such as initiation of eligible patients on ART. In-depth discussions on option B-plus coverage with some flexibility allowed for facilities with good coverage to address other existing gaps such as partner testing. Following the quality improvement QI training in Trans Nzoia

county, a county-wide follow up meeting was held to assess progress on QI activities. During this meeting QI representatives from various facilities had a chance to share progress on indicators they had been working on and brainstorm on feasible solutions to common challenges. Sensitization on SIMS has been successfully carried out for CHMT members and CCC in-charges in the following counties: Busia, Kisumu and Trans Nzoia. During the sensitization, participants were given an overview of the objective of SIMS and taken through each section of both the facility and community tools. Each CCC in-charge was then given a copy of the SIMS tool and dashboard to be used for feedback and self-assessment in their respective facilities. Representatives from community units were also given the community tool and dashboard for self-assessment of community activities. Following self-assessment, the dashboards were to be collected and verified by the sub-county coordinators, forwarded to the county coordinator and then forwarded to AMPATHPlus central for prompt follow-up of gaps identified in each facility/community unit. So far we have received dashboards from Trans Nzoia County and await Busia and Kisumu. In addition to this, since the initiation of SIMS, a total of 5 sites have been assessed in collaboration with a team from USAID (MTRH, Malaba dispensary, Webuye sub-county hospital, Chulaimbo sub-county hospital, Busia County referral hospital). A summary of gaps identified in the 5 facilities since we began SIMS including action plans can be found in Annex 4.

III. ACTIVITY PROGRESS (QUANTITATIVE IMPACT)

Result Area 1.1: Prevention-Counseling and Testing Intermediate Result 1.1.1: All individuals living in designated AMPATH catchments will know their HIV status. Expected Outcomes: A reduction in the incidence of new HIV infections by 50% over 5 years

Key Indicator 1: Number of individuals counseled and tested for HIV through Perpetual Home-based Counseling and Testing (PHCT) and MVCT

Implementation of PHCT continued in the following (7) counties: Bungoma (Mt. Elgon and Bungoma East sub-counties), Busia (Bunyala, Butula, Teso North and Matayos sub- counties), Elgeyo Markwet (Keiyo North sub-county), Kisumu (Kisumu West sub- county), Nandi (Nandi North sub-county), Trans Nzoia (Trans Nzoia West sub-county) and the entire Uasin Gishu County. The HTC outreaches were mobile VCTs targeting specific populations such as students, boda boda riders and prisoners in Uasin Gishu (Sirikwa Hotel, Kimumu, KIM College, and Raiply Woods Eldoret) and Trans Nzoia West Sub-County (Matisi Primary School). In Teso North, Busia County, VCT services continued to be offered at the Malaba Safe Stop Container targeting truck drivers, female sex workers as well as members of the general population. During the quarter two period, a total of 53,288 (F – 29,731 and M – 23,557) individuals were tested through PHCT, and MVCT combined. Of those tested, 648 (1.2%) were found to be HIV positive and 421 (65.0%) individuals were enrolled to HIV care. One hundred and forty two (142) presumptive TB cases were identified by the PHCT Counsellors in the homes and their sputum collected for TB microscopy. Twelve (12) smear positive cases were found and linked to care and treatment. A total of 78 HIV exposed infants were identified and were all referred for care through the mothers. Twenty two (22) DBS samples for PCR were collected out of which 3 tested positive for HIV. Condom education and promotion was conducted; 675,490 male condoms and 1,891 female condoms were distributed across 78 condom service outlets while others were distributed by counselors during PHCT and mobile VCT outreaches as part of HIV prevention. A total of 18,850 deworming tablets were issued to children under five years.

INDICATOR TITLE: Number counseled and tested for HIV through Perpetual Home-based Counseling and Testing (PHCT) and Mobile Voluntary Counseling and Testing (MVCT) Combined

Results Achieved Baseline in the prior Reporting Period End of Project July – Sept. 2014 Period January - March 2015 Target Oct – Dec. 2014 Achieved Achieved Target Achieved Target

Gender W(Women); M F M F M F M F M F M (Men) Bungoma 1,336 1,066 3,151 2,325 3,413 2,438 3,185 3,026 39,500 30,500 County Busia County 9,215 7,557 9,144 7,112 12,870 9,193 9,629 7,872 113,000 93,000 Elgeyo Marakwet 828 577 597 423 729 521 465 264 19,000 15,500 County Kisumu County 1,341 1,035 2,104 1,827 3,063 2,188 1,521 1,111 29,500 22,500

Nandi County 369 233 864 417 1216 869 1,226 468 16,000 12,500 Trans Nzoia 4,998 3,596 5,344 3,904 5,889 4,206 5,617 3,345 112,000 93,000 County Uasin Gishu 7,492 6,164 5,860 4,683 9,263 6,617 8,088 7,471 202,000 182,000 County

Total 25,579 20,228 27,064 20,691 36,515 26,082 29,731 23,557 531,000 449,000

Result Area 1.1: Prevention – Evidence-informed behavioral interventions (EBIs) Intermediate Result 1.1.2: All individuals living in designated AMPATH catchments will have improved knowledge of HIV transmission risks and behaviors that can reduce the risk of HIV acquisition. Expected Outcomes: A reduction in the incidence of new HIV infections by 50% over 5 years

Key Indicator 2: Number of HIV infected individuals provided with minimum Positive Health, Dignity and Prevention (PHDP)

The minimum package in clinical PHDP refers to the provision of adherence counseling and any other 3 PHDP messages. PHDP services including adherence counseling, partner testing, support for disclosure, condom provision, family planning and STI screening were provided by clinicians and other healthcare workers to the eligible clients seen at AMPATH clinics. In community PHDP (CPHDP), minimum package refers to the provision of condom education and demonstration and any other 3 PHDP messages. The service providers trained in CPHDP from Uasin Gishu, Kisumu, Bungoma and Busia counties continued reaching their peers within support groups with PHDP messages at the community level. A total of 3,576 (F - 2,429; M – 1,147) persons living with HIV were reached with the minimum package for community PHDP. On the other hand, 57,836 (F - 39,513; M - 18,323) persons living with HIV were reached with minimum package for clinical PHDP. The table below indicates the number of individuals aged ≥15 years reached with both clinical PHDP services and community PHDP messages.

INDICATOR TITLE: Number of HIV infected individuals provided with minimum PHDP package

Results achieved in Baseline Reporting Period FY 2015 the prior period July – Sept. 2014 January - March 2015 Target Oct - Dec 2014

Achieved Achieved Target Achieved Target Gender W(Women); M (Men) F M F M F M F M F M

Bungoma County 4,219 1,786 2,558 1,858 1,355 645 3,371 1,244 6,000 4,000

Busia County 14,534 7,077 15,040 7,434 3,760 1,790 16,796 8,152 9,000 6,000

Elgeyo Mar. County 1,002 414 794 290 322 153 782 301 200 100

Kisumu County 2,699 1,422 3,579 1,829 474 226 3,516 1,765 3,000 2,000

Nandi County 1,648 771 1,283 550 406 194 1702 790 1,500 700

Trans Nzoia County 3,998 1,572 3,551 1,409 373 177 3,302 1,444 3,000 1,500

Uasin Gishu County 18,335 8,686 12,905 5,868 2,439 1,161 12,473 5,774 12,000 6,000

Total 46,435 21,728 39,710 19,238 9,315 4,435 41,942 19,470 34,700 20,300

Result Area 1.2: Care and Treatment Intermediate Result 1.2.1: All individuals testing HIV-positive will be linked to HIV care. Expected Outcomes: A reduction in the incidence of new HIV infections by 50% over 5 years

Key Indicator #3: Number of adults and children newly enrolled

The clinical department has chosen to highlight the no. of adults and children newly enrolled into care in the quarter. The number of individuals newly enrolled was 3656 up from 2917 during the last quarter. Adults are 93% while children are 7% and females contributed 68% while males were 32%. The median CD4 at enrolment for women was 322 compared to 270 for men. The median CD4 percentage for pediatrics at enrolment was 14% for boys and 20% for girls; details are provided in the table below:

INDICATOR TITLE: Number of adults and children newly enrolled End of FY 2016 Baseline Oct-Dec2014 Jan-Mar2015 Apr-Jun2015 Jul-Sept2015 FY 2015 Target Project Target Target Achieved Target Achieved Target Target Target Target Target W M W M W M W M W M W M W M W M W M

Gender: 5126 2991 3,226 3671 3,226 3,226 12,903 Women (W), Men (M) Overall 3416 1710 2014 977 1934 1292 2498 1176 1934 1292 1934 1292 7735 5168 BUNGOMA 111 119 133 71 77 52 151 77 77 52 77 52 308 208

BUSIA 1345 592 417 225 498 331 494 273 498 331 498 331 1992 1324 ELGEYO MARAKWET 133 70 155 69 60 40 135 50 60 40 60 40 240 160 KISUMU 103 66 102 63 156 103 136 73 156 103 156 103 624 412 NANDI 49 27 52 22 34 24 52 19 34 24 34 24 136 96 TRANS NZOIA 628 325 454 208 363 242 644 249 363 242 363 242 1452 968 UASIN GISHU 940 442 609 273 673 450 755 366 673 450 673 450 2691 1800

WEST POKOT 107 69 92 46 73 50 131 69 73 50 73 50 292 200

Result Area 1.3: HIV Care and Support Services Intermediate Result 1.3.1: Provide quality social support services to clients within designated AMPATH catchment areas and provide a minimum of one social support service to 70% of patients screened Expected Outcomes: Adult patients/families no longer seeking social support services and are self-reliant During the quarter there was a significant increase in the number of adult clients assessed for social support compared to the previous quarter. A total of 10,135 (6,286 female, 3,849 male) were assessed. 91.5%, 9,278 (5452 female, 3814 male) of those assessed were provided with least one social support service, majority being women. The OVC program served 30,104 children (14,848 female, 15,256 male) which represents about 99% of all active OVCs ever enrolled. 72.0% of the patients received Nutrition Assessment and Counseling (NACS), exceeding the quarters’ target of 70%. This was a remarkable increment from 43.2% in the previous quarter. 3,480 clients (2,719 female, 761 male) received Agricultural and Business interventions through trainings and capacity building initiatives. In a leverage collaboration with the World Food Program through Agricultural Market and Linkage (AMAL) initiative an additional 1,570 (802 female, 669 male) were supported and trained. As a result WFP bought 1,420MT from the farmers’ groups. Of these farmers, over 200 AMPATH patients benefitted directly from the sale of their produce. Despite lack of adequate supply of therapeutic feeds from the Nutrition and HIV Program (NHP) 1,285 undernourished patients received therapeutic feeds through the AMREF TB program, and KEMSA. Further, a total of 2,705 eligible clients were given nutrition education and counseling in the community, exceeding the quarterly target of 1,860 and the previous quarter’s (1,555). Sixteen sessions (16) on nutrition education were administered to children of school-going age (59.2% of the quarterly target), in four counties.

Key Indicator #4: Number of clients and beneficiaries enrolled into the National Health Insurance Fund

UNIT Geographic Location Activity Title Date W M Subtotal Kisumu West, Mt Elgon, Bungoma East, Bunyala, Number of clients Busia, Nambale, Butula, Teso North, Trans Nzoia Support clients with businesses supported with Jan - Mar 2015 2,527 709 3,236 East, Kwanza, Trans Nzoia West, Keiyo North, interventions businesses interventions Nandi North, Eldoret East, Eldoret West, Wareng,

Kisumu West, Mt Elgon, Bungoma East, Bunyala, Number of clients Busia, Nambale, Butula, Teso North, Trans Nzoia Support clients with agricultural supports with agricultural Jan - Mar 2015 994 721 1,715 East, Kwanza, Trans Nzoia West, Keiyo North, interventions interventions Nandi North, Eldoret East, Eldoret West, Wareng,

Results Reporting End of Achieved Reporting Period Reporting Period Period FY 2015 FY 2016 Activity Number of clients and Baseline Prior Periods Reporting Period 31-Dec-14 31-Mar-15 30-Jun-15 30-Sep-15 Target Target Target beneficiaries enrolled on Achieved health Insurance Achieved Target Achieved Target Target Target Target Target Target Sex*: Women (W), Men (M) W M W M W M W M W M W M W M W M W M W M W M

BUNGOMA 720 294 445 355 720 290 210 245

BUSIA 960 145 435 250 960 145 1195 645

ELGEYO MARAKWET 122 45 15 25 120 45 50 20

KISUMU 191 30 90 105 190 30 55 20

TRANS NZOIA 780 95 320 225 780 95 150 125

UASIN GISHU 1650 255 500 285 1650 255 775 390

NANDI 85 15 10 5

Total 4423 864 1890 1260 4430 860 2445 1450

Key Indicator #5: Number of children receiving services in a) at least 3 of the core areas, and b) fewer than 3 core areas

INDICATOR NUMBER UNIT DISAGGREGATE BY: Geographic Location Activity Title Date W M Subtotal Kisumu West, Mt. Elgon, Marakwet East, o Continuous Assessing and Marakwet West, Keiyo South, Keiyo North, Number of allocation of school fees to Pokot South, Pokot North, Pokot Central, Pokot OVCs needy OVCs Jan - Mar West, Kiminini, Saboti, Endebess, Kwanza, 320 335 665 receiving school o Monitoring attendance and 2015 Cherangany, Teso, Matayos, Budalangi, Butula, fees support performance of school fees Soy, Turbo, Moiben, Kesses, Ainapkoi, beneficiaries Kapseret, Chesumei. Kisumu West, Mt. Elgon, Marakwet East, Number of Marakwet West, Keiyo South, Keiyo North, o Assessment fitting and OVCs receiving Pokot South, Pokot North, Pokot Central, Pokot procurement of school Jan - Mar school West, Kiminini, Sabaot, Endebess, Kwanza, uniforms to needy OVC 350 365 715 2015 uniform, in Cherangany, Teso, Matayos, Budalangi, Butula, o Distribution of school uniforms primary school Soy, Turbo, Moiben, Kesses, Ainapkoi, Q=750 A=3,000 Kapseret, Chesumei. Results Reporting Reporting FY End of Number of children Reporting Period FY 2015 Baseline Achieved Prior Reporting Period 31-Dec-14 Period Period 2016 Activity receiving services 31-Mar-15 Target in a) at least 3 of Periods 30-Jun-15 30-Sep-15 Target Target the core areas, and b) in fewer than 3 Achieved Target Achieved Target Achieved Target Target Target Target Target core areas Sex*: Women (W), Men W M W M W M W M W M W M W M W M W M W M W M (M)

a)10 a)15 a)10 a)15 a)50 a)38 a)28 a)28

b)10 b)10 b)10 b)10 a)50 a)50 b)36 b)40 a)50 a)50 b)43 b)58 BUNGOMA b)30 b)30 b)30 b)30 a)991 a)1006 a)991 a)1006 a)900 a)900 a)1016 a)1029 a)900 a)900 a)1021 a)1022

BUSIA b)245 b)245 b)245 b)245 b)300 b)300 b)281 b)336 b)300 b)300 b)381 b)404 ELGEYO a)1690 a)1658 a)1690 a)1658 a)1600 a)1600 a)1675 a)1660 a)1600 a)1600 a)1688 a)1683

MARAKWET b)244 b)256 b)244 b)256 b)300 b)300 b)245 b)258 b)300 b)300 b)267 b)269

a)28 a)22 a)28 a)22 a)50 a)50 a)34 a)26 a)50 a)50 a)29 a)31

KISUMU b)28 b)26 b)28 b)26 a)30 b)30 b)34 b)25 a)30 b)30 b)50 b)47 a)1463 a)1492 a)1463 a)1492 a) 500 a) 500 a)1470 a)1512 a) 500 a) 500 a)1483 a)1515

TRANS NZOIA b)202 b)200 b)202 b)200 b)350 b)350 b)213 b)203 b)350 b)350 b)220 b)204 a)4683 a)4671 a)4683 a)4671 a)4550 a) 4550 a)4694 a)4676 a)4550 a) 4550 a)4803 a)4791

UASIN GISHU b)2429 b)2538 b)2429 b)2538 b)2500 b)2500 a)2430 b)2547 b)2500 b)2500 b)2487 b)2579 a)461 a)478 a)461 a)478 a)1450 a)1450 a)461 a)478 a)1450 a)1450 a)481 a)505

NANDI b)233 b)248 b)233 b)248 b)350 b)350 b)236 b)253 b)350 b)350 b)241 b)244

a)1458 a)1583 a)1458 a)1583 a)1400 a)1400 a)1546 a)1776 a)1400 a)1400 a)1537 a)1784

WEST POKOT b)215 b)188 b)215 b)188 b)300 b)300 b)67 b)67 b)300 b)300 b)89 b)92 a)10784 a)10925 a)10784 a)10925 a)10500 a)10500 a)10946 a)11195 a)10500 a)10500 a)11070 a)11359

Total b)3606 b)3766 b)3606 b)3766 b)4160 b)4160 b)3552 b)3729 b)4160 b)4160 b)3778 b)3897

Result Area 2: Reduce maternal, neonatal and child mortality Intermediate Result 2.1: Pregnant women testing HIV positive and their infants identified early and referred for care Expected Outcomes: Reduce maternal-to-child transmission by <3% annually within selected catchments Key Indicator #6: Number of pregnant women with known HIV status (Including women who were tested for HIV and received results) There was a marked increase in the number of pregnant women with known HIV status (including those tested for HIV and received results) in the current quarter (Q2 of FY2015= 35,707) as compared to 25,857 in Q1of FY2015which surpassed the target of 26520. However, there was a drop in the proportion of women on antiretroviral (ART) prophylaxis: Q2 67.83% (1027/1514) compared to Q1 86.62% (926/1069) against the target of >93%.

INDICATOR TITLE: Number of pregnant women with known HIV status (Including women who were tested for HIV and received results) Results This Achieved Reporting Reporting Reporting Period Q4 End of Project Baseline Prior Periods Period Q3 Period Q2 30/Sep/15 Target Q1 30/Jun/15 31/Mar/15 31/Dec/14 FY 2015 Q4 Achieved Target Achieved Target Achieved Target Achieved Target 30/Sept Overall 31214 25857 26520 35707 TBD Bungoma 3570 2202 2590 3505 TBD TBD Busia 4710 2394 3963 4011 TBD TBD Elgeiyo Marakwet 4386 3548 3588 4829 TBD TBD Kisumu 273 157 261 294 TBD TBD

Nandi 391 37 322 363 TBD TBD Trans Nzoia 5555 7180 6413 8084 TBD TBD Uasin Gishu 7238 6185 4450 9997 TBD TBD West Pokot 5091 3820 4935 4624 TBD TBD

Key Indicator #7: Percent of HIV-positive pregnant women provided with anti-retroviral

INDICATOR TITLE: Percent of HIV-positive pregnant women provided with anti-retroviral to reduce the risk of mother to child transmission during pregnancy & delivery Results Achieved This Reporting FY End of Prior Reporting Reporting Period Q4 FY 2016 Baseline Period Q3 2015 Project Periods Q Period Q2 30/Sep/15 Target 30/Jun/15 Target Target 1 31/Mar/15 31/Dec/14 Q4 Achie 30/Sept/1 Achieved Target Achieved Target Target Achieved Target Achieved Target ved 4 73.62% 86.62% 67.83% County 93% TBD (776/1054) (926/1069) (1027/1514) 61.76% 80.95% 57.83% Bungoma 93% (63/102) (51/63) (48/83) 70.81% 64.75% 59.65% Busia 93% (228/322) (158/244) (210/352) Kisumu 102.08% 82.81% 85.71% 93% (Maseno (49/48) (53/64) (48/56)

division)

Elgeiyo 74.44% 100.00% 40.16% 93% Marakwet (67/90) (39/39) (51/127) Nandi 47.62% 100.00% 100.00% (Kosirai 93% (10/21) (18/18) (11/11) Division) 76.33 95.85% 77.31% Trans Nzoia 93% (129/169) (208/217) (259/335) 77.20% 95.57% 72.92% Uasin Gishu 93% (193/250) (389/407) (369/506) 71.15% 58.82% 70.45% West Pokot 93% (37/52) (10/17) (31/44)

Result Area 2: Reduce maternal, neonatal and child mortality Intermediate Result 2.2.1: Pregnant women and their infants identified early and referred for care as needed. Expected Outcomes: Maternal, infant, and child mortality decreased by 50% within 5 years within selected catchments. Through MCH, the percent of children less than 5 years fully immunized increased from 91.5% (21,712) last quarter to 96.9% (25,968) this quarter. The percent of women having 4 ANC visits dropped from 64.7% last quarter to 57.2% this quarter. This performance reflects the country’s performance of 58% of pregnant women going for the recommended 4 ANC visits according to KDHS 2014 highlights. From data reported from the community units, the percent of women delivering with a skilled provider was 62.9% (from 59.2% in Quarter 1). This is on target and in agreement with the KDHS 2014 highlights which indicated that 62% of births were conducted by a skilled birth attendant. The number of children below 5 years with diarrhea who received ORT was 34,144 in quarter 1 but was on target this quarter with 37,971 children under 5 years with diarrhea receiving oral rehydration salts this quarter. In Trans Nzoia County, 100% of all mothers who came to deliver in facilities received oxytocin for AMTSL. Out of all these mothers, only 64% of them had partographs appropriately filled. Only 65% of them had their blood pressure monitored 4 hourly during labour. In terms of newborn resuscitation, out of all with an APGAR <7 or with irregular shallow breathing or had a pulse <60/min, 93% of them received appropriate resuscitation.

In the family planning program, 232 community health volunteers across the entire West Pokot County were trained in community based distribution of contraceptives. The reporting rate for facility contraceptive consumption increased significantly to 90.8% a trend that was also observed across the country with an average of 81% of all facilities in Kenya reporting. The Couple Years of Protection (CYPs) increased from 31,590 last quarter to 38,264 this quarter. A total of four hundred and seven outreaches and fifty seven school health program on MCH/FP were conducted in Busia, West Pokot, Elgeyo Marakwet and Bungoma counties. The support for these activities has been increased for the subsequent quarters to allow most health facility to conduct outreaches.

Key Indicator #8: Percent of women attending 4 ANC visits

PERCENT OF WOMEN ATTENDING 4 ANC VISITS INDICATOR # UNIT DISAGGREGATE BY: Location, event, date and gender Geographic Location Activity Title Date W M Subtotal Percent of ’Community health Volunteers integrated 17th to 21st women Trans Nzoia County 64 66 130 MCH/FP/PMTCT refresher training’’ September 2014 attending 4 ANC visits Totals 64 66 130

Results in Reporting Reporting Reporting Prior This Reporting Period 31- Period Period Period End of Activity Baseline Periods Mar-15 30-Jun-15 30-Sep-15 31-Dec-15 FY 2014 Target FY 2015 Target Target

Achieved Target Achieved Target Target Target Target Target Target Bungoma (Bungoma East 52.3% 43.8% 50% 48% (869) 50% 50% 50% 50% 50% 50% and Mt.Elgon ) (690) Busia (Teso North, Bunyala 89.7% 43.8% 60% 66.1% (1,506) 60% 60% 60% 60% 60% 60% and Butula) (1,811) 50.4% 43.8% 46.6% (1,165) Elgeyo Marakwet (1,055) 50% 50% 50% 50% 50% 50% 50% 56.7% 59.9% 46.1% (117) Kisumu (Kisumu West) (134) 50% 50% 50% 50% 50% 50% 50% Nandi (Chesumei) 43.8% 55.3% 50% 66.7% (146) 50% 50% 50% 50% 50% 50%

(235)

71.7% 43.8% 74.9% (1,567) Trans Nzoia (1,473) 60% 60% 60% 60% 60% 60% 60% 53.4% 43.8% 56.3% (2,656) Uasin Gishu (1,794) 50% 50% 50% 50% 50% 50% 50% 88.8% 43.8% 53.2% (747) West Pokot (720) 50% 50% 50% 50% 50% 50% 50% 64.7% 43.8% 57.2% (8773) Summary (7,912) 60% 60% 60% 60% 60% 60% 60%

Key Indicator #9: Number of children <5 years with diarrhea who received oral rehydration therapy

NUMBER OF CHILDREN <5 YEARS WITH DIARRHEA, WHO RECEIVED ORT UNIT DISAGGREGATE BY: Location, event, date and gender Geographic Location Activity Title Date W M Subtotal Number of 150th Feb to 15th children <5 years West Pokot County (Central, North, 76 40 116 ‘OJT and mentorship on IMCI guidelines’’ March with diarrhea, West and South Pokot) who received 76 40 116 ORT Totals

Reporting Reporting Reporting Results in This Reporting Period 31- Period Period Period End of Activity Baseline Prior Periods Mar-15 30-Jun-15 30-Sep-15 31-Dec-15 FY 2014 Target FY 2015 Target Target

Achieved Target Achieved Target Target Target Target Target Target Bungoma (Bungoma East and 1,331 1,331 Mt.Elgon )

Busia (Teso North, Bunyala 3,860 3,860 and Butula)

Elgeyo Marakwet 6,470 6,470

Kisumu (Kisumu West) 7,899 202 36,000 202 36,000 36,000 36,000 28,000 28000 84,000

Nandi (Chesumei) 322 306

Trans Nzoia 3,840 5,765

Uasin Gishu 8,772 8,188

West Pokot 9,338 9,512

Summary 7, 000 34,135 36,000 37,971 36,000 36,000 36,000 28,000 28,000 84,000

Key Indicator #10: Reporting Rates for Family Planning Commodities

PERCENT REPORTING RATES FOR FAMILY PLANNING COMMODITIES INDICATOR # UNIT DISAGGREGATE BY: Location, event, date and gender Geographic Location Activity Title Date W M Subtotal Percent West Pokot County (West Sub- 27th February reporting for ‘FP Data Review meeting’ counties) 2015 family planning Totals commodities

Results in Reporting Reporting Reporting Prior This Reporting Period 31- Period Period Period End of Activity Baseline Periods Dec-14 31-Mar-15 30-Jun-15 30-Sep-15 FY 2014 Target FY 2015 Target Target

Achieved Target Achieved Target Target Target Target Target Target Bungoma (Bungoma East 94.6% 88.9% 80% 91.7% 80% 80% 80% 80% 80% 80% and Mt.Elgon )

Busia (Teso North, Bunyala 62.3% 89.1% 80% 95.9% 80% 80% 80% 80% 80% 80% and Butula)

Elgeyo Marakwet 61% 38.8% 80% 70.5% 80% 80% 80% 80% 80% 80%

Kisumu (Kisumu West) 87.5% 90.5% 80% 95.2% 80% 80% 80% 80% 80% 80%

Nandi (Chesumei) 100% 85.5% 80% 100% 80% 80% 80% 80% 80% 80%

Trans Nzoia 47.4% 40.5% 80% 94.4% 80% 80% 80% 80% 80% 80%

Uasin Gishu 66.2% 57.9% 80% 80.3% 80% 80% 80% 80% 80% 80%

West Pokot 27.3% 90.6% 80% 98.3% 80% 80% 80% 80% 80% 80%

Summary 68.3% 72.7% 80% 90.8% 80% 80% 80% 80% 80% 80%

IV. CONSTRAINTS AND OPPORTUNITIES

Prevention: Implementation of Healthy Choices for a Better Future (HCBF) EBI in Bunyala sub-county, Busia County did not take place as planned. Several meetings were held with NASCOP and follow-up made with the Ministry of Education to obtain the green light for roll out of activities in Bunyala Sub-County. The Prevention Department submitted a write-up to the Ministry of Education detailing the HCBF intervention and the roll out plans by AMPATH. An appointment has been secured for a joint meeting between AMPATH, NASCOP and the Ministry of Education to help find a feasible solution. This will be followed up in the next quarter. Lack of MOH registers for HTC outreaches particularly the MOH 362 registers for PHCT outreaches was experienced across all sites where PHCT activities were done. This was caused by the high demand based on monthly consumption in PHCT and this has compelled the program to resort to photocopies which cannot be properly stored or monitored. Insufficient copies of community referral tools hampered effective documentation of referrals from community to health facilities for other services. The Department however, intends to print more copies of the tool to mitigate this challenge.

Care and Treatment: The differences in median CD4 at enrolment between men and women may be explained by poor health seeking behavior exhibited by men who cause them to present late, in addition to the early screening of mothers for HIV at MCH, labour ward and child welfare clinics. The differences in children are interesting and could be an indication that disease progression in paediatric males is faster than in paediatric females. This will need further research though. Use of the SIMS tool has helped to improve the quality of care for patients.

Support: All Children have the ability to perform well in school, despite their background given the support possible. Performance tracking for all children in school is very important. This will flag out in good time children who are either missing school or not performing well academically for early and timely interventions. GISE sessions for caregivers and group formation, has enabled them overcome their fears on table banking. At the same time; it has reduced the stigma associated with HIV/AIDS since group membership is communal. Comparison of number of groups formed in sites that has GESP and those who doesn’t have GESP shows that the sites with GESP has much more groups compared to those sites that has no GESP. In addition there is significant change in number of groups formed in sites with GESPs compared to the number of groups formed in the same sites a year ago. Sites with GESPs has more groups compared to those without GESPs hence the need to replicate the model to other sites. Nutrition Therapeutic feeds was not supplied by the Nutrition and HIV Program (NHP). The inconsistent supply of the feeds slowed down the recovery of some of the patients that had earlier been started on treatment. The increase in the NHIF monthly premiums for

the self-employed from the current KES. 160 to KES. 500 slowed the enrolment into the scheme. Some beneficiaries find it difficult to raise the amount per month given other competing basic needs and the prevalent high poverty levels in the peri-urban areas. Acquisition of legal documents for the OVC in some regions was still a challenge especially in West Pokot and Elgeyo Marakwet counties. Budgetary constraints could not allow social workers to effectively address emergency needs of vulnerable cases. There are fewer Food security interventions in the west Pokot County and compounded with the recent security concerns, activities in the interior regions of the county was generally slow.

V. PERFORMANCE MONITORING

Data and M and E: We found out that data being entered into DHIS is incomplete and we are strengthening completeness and accuracy of DHIS by focusing support in this area. We found weaknesses particularly in MTRH Facility and are working hard now to understand the weaknesses and improve as an priority. SIMS: Sensitization of facility in-charges and SCHMT/CHMT on SIMS tool was done. Assessment of compliance to the tool’s requirements was done at Chulaimbo and Busia health facilities. SIMS sensitization and assessment in HTC by USAID was done in Busia, Kisumu west, Trans Nzoia, and Uasin Gishu counties. This aimed at achieving quality outcomes and linking clients to care and treatment. SIMS sensitization was done for all counties, targeting senior county departmental heads. This was geared towards identification of gaps in service delivery. Using the same tool in continuous self- monitoring, the outcomes informed the changes which were made on the tools, patient flow, filing and protocol development which were done in all departments.

HIV Testing: Counsellor Supervisors randomly visited each Counsellor for Observed Practice session with a client(s). This ensures that there is adherence to HIV testing protocols and standards, and there is adequate documentation. A quarterly meeting for the supervisory team was done to discuss progress reports and challenges. In addition, data review meetings were held at each site to review and analyze data per site. Several spot checks were also done by the supervision team to ensure quality data is collected by Counselors.

Care and Treatment: Clinical mentorship continues through the programs’ medical officers, the county coordinators and the clinical supervisors. Continuous quality checks were done through the printing of patient summary sheets to assist in pointing out any discrepancies with lab results and regimens patients are on. Data department tags and returns to clinic incomplete or inconsistent encounter forms for correction before entry into the EMR. The data team regularly monitored the data quality through data quality checks and verifications. In this quarter, all the county coordinators Monitoring and

Evaluation staff at County level provided support to all departments and hence the improved outcomes.

Support: Joint supervision and monitoring of safety net department activities was done in Busia, Kisumu and Bungoma in the quarter. The supervision identified the need to strengthen the integration process and improve interventions and service delivery to clients. The supervision team enhanced the use of non-clinical referral forms in all facilities visited. In nutrition, the key performance monitoring activities included the SIMS assessment and supportive supervision in 15 facilities. SIMS was carried out in Busia and Chulaimbo. Chulaimbo was rated and exceeding expectation (Dark green) while Busia was rated as needing improvement (Yellow). Specific measures have taken to improve nutrition categorization of patients. Supportive supervision was carried out in MTRH, Pioneer, Uasin Gishu, Osieko, Chulaimbo, Matayos, Busia, Port Victoria, Teso, Angurai, Khunyangu, Bumala A, Mukhobola, Webuye. The other 13 facilities that were not directly visited were supervised by the respective county coordinators. SIMS was carried out in Busia and Chulaimbo. Chulaimbo was rated and exceeding expectation (Dark green) while Busia was rated as needing improvement (Yellow). Specific measures have been taken to improve nutrition categorization of patients. In view of the SIMS assessment done the following measures have been put in place in order to improve the performance in the Food and Nutrition Domain. MNCH: Community data collection and management was streamlined in community units in Busia, Trans Nzoia, West pokot and Kisumu Counties during the 5 day Community health volunteer (CHW) training. During these sessions, 454 CHVs were retrained on data collection using the Community health worker service delivery log- book (MOH 514) and the Community health worker household register (MOH 513). Gains from this exercise have been demonstrated through improved community reporting in these specific counties. Trans Nzoia and Busia counties were trained during the quarter on monthly tracking of BeMONC activities. During this continues tracking, for process of care indicators will be emphasized on. These indicators are percent of clients who received oxytocin for AMTSL; percent of clients with partographs filled appropriately; percent of clients with BP monitored 4 hourly during labour and percent of newborns requiring resuscitation who underwent resuscitation. Pharmacy: We continue to work hand in hand with facility staff, in-charges and county coordinators to ensure smooth running of commodity management activities and that standards are kept. Training: The Training department has an operational performance monitoring plan guided by a performance matrix for planning, managing and documenting training data. In order to monitor performance in training delivery we ensured that training data of all the participants is timely and sufficiently documented, reviewed and further reported for internal and external use. As a department we also participated in a program wide performance feedback meeting where we disseminated performance information to key internal audience through reports and oral briefs.

VI. PROGRESS ON GENDER STRATEGY

To effectively address gender related socioeconomic challenges facing clients seeking social support services in AMPATH, gender analysis was carried out during the training of 44 community based groups. The training covered leadership skills, group dynamics and gender mainstreaming. The gender narrative involved examining of gender differences and inequalities among members of different communities and the impact of these gender-based inequalities on the lives of men and women and the health seeking behavior. The analysis was based on social, economic and cultural domains that define relationships of men and women in most communities. The scope of analysis entailed: i. Access and control of resources: information, skills, education, and natural resources such as land and the control women and men have over the inputs and outputs (benefits) of their labor. sexual division of labor, ii. Knowledge, beliefs, and perceptions (norms), which influence how men and women are socialized from childhood and the degree of access to different types of knowledge by either gender. iii. Practices and participation (roles) in community affairs focusing on how actual behaviors and norms vary by gender and how much autonomy is accorded to enable participation in and benefit from development initiatives including health, education, and agriculture.

Gender analysis exercise assisted in determining the needs and preferences of men and women. In addition, it enabled health workers understand how class, ethnicity, faith, age, and socioeconomic and other factors interact with gender to produce different and usually discriminatory responses against women in particular. Gender inequities tend to aggravate the conditions of marginalized and at-risk populations, further increasing their vulnerability and impoverishment. This exercise informed the development of the gender protocols that will help in the development of the AMPATH Gender Policy. Training on Gender is scheduled in the third quarter in collaboration with World Food Program. The training will target the AMPATH Management team and the Safety Net staff.

VII. PROGRESS ON ENVIRONMENTAL MITIGATION AND MONITORING

This quarter the IEE team conducted baseline assessments in Busia, Bungoma, Kisumu and Trans Nzoia counties. We found that most facilities have adequate waste receptacles, the color coding of bins is practiced, most facilities have adequate waste management structures in place, and most facilities hold CMEs on a weekly basis. Public Health Officers were requested to include waste management topic in the May schedule. Challenges identified were that there was no protective clothing for waste

handlers, personnel not been trained on waste management in the past three years, bin liners were not adequate in all facilities, posters and guidelines on waste management were not available, some facilities without incinerators have challenges disposing hazardous waste, and waste is not properly segregated at source

VIII. PROGRESS ON LINKS TO OTHER USAID PROGRAMS

In this quarter, the training office worked with FUNZOKenya a national training mechanism and Moi University College of Health Sciences (MUCHS) and delivery of the 6 trainings listed below. During the quarter, MCH/FP attended a joint technical working group meeting in Nairobi for planning on monthly monitoring of BEmONC for the country. During the quarter, we also worked with APHIAplus Western in Busia county in training the Busia County health team on BEmONC assessment. We continue to receive support from USAID-ASSIST for Quality Improvement activities. KEMSA is in the process of taking over the supply chain of ARVs and OI medications from Kenya Pharma. We are working hand in hand with them to ensure that the transition is smooth and that supply of the drugs continues smoothly. We are also working with other partners like MSH especially in the rollout of the upgraded ADT (Version 3.3). We participated in the Chiefs Breakfasts in January and March 2015.

Table 1. Trainings undertaken by AMPATHPlus with FUNZOKenya What Meeting Who were Dates Location Purpose Outcome involved Family Planning Nurses and COs 23rd to Bungoma To train HCWs Successfully (LAPM) Training 27th County in the family attended February, planning 2015 ART Guidelines TOT Nurses, COs, 4th to 6th Trans To cascade the Successfully Training Nutritionists, March, Nzoia new ART attended Lab Scientists, 2015 county revised MLTs guidelines Family Planning Nurses 2nd to 6th Trans To train HCWs Successfully (LAPM) Training March, Nzoia in the Family attended 2015 county Planning ART Guidelines TOT Nurses, COs 12th to Bungoma To cascade the Successfully Training and MLTs 14th County new ART attended March, revised 2015 guidelines ART Guidelines Nurses, COs, 19th to Turkana To cascade the Successfully Service Provider Pharm Techs, 21st county new ART attended Training Counselors and March, revised MLT 2015 guidelines PMTCT TOT Nurses and Cos 23rd to AMPATH To train county Successfully

Training – Trans 27th Centre PMTCT TOTs attended Nzoia, UG, March, Bungoma, Turkana, 2015 Kakamega, Kisii, Migori, Siaya, Kisumu and Homabay counties

Our support programs participated in numerous USAID-related activities. They are listed below: Table X. USAID-related activities undertaken by the Safety Net Programs Agency Activity Date Outcome location Catholic Relief Training & Jan - Mar More people in All counties Services consultations on 2015 the community micro-financing can access loans models and save APHIA plus Support to OVC Jan - Mar 102 OVC school Webuye western through school fees 2015 fees paid payment FLEP Aphia plus School fees Jan - Mar Orphans and Busia county payment 2015 Vulnerable children are able to access secondary school education. Asian Vegetable In-country 19 - 20th To establish a Nairobi Research and stakeholders March 2015 possibility of Development consultation deploying Center (AVRDC) meeting on vegetable kit deploying vegetable project in 2 kit project counties in Western Kenya APHIA plus Community Jan - Mar The office of the Webuye western meeting on 2015 chiefs and

protecting girls to children officers stay in school due to spearheaded a high rates of school plan to sensitize drop out communities and enforce the law on perpetrators

Hope Africa HIV testing Jan - Mar Orphans and Uasin Gishu under Hope sensitization and 2015 Vulnerable International training of children are adolescents on able to access adherence and life secondary skills school education. Women peace Promotion of girl Jan-March Sensitization of West Pokot link child education 2015 community and campaign members on against FGM and the importance early marriage of protecting the girl child, rescue centers available and emphasis on the legal part of breaking the same. URC Q.I learning March 2015 Q.I teams made Uasin Gishu session presentations (Eldoret) and all group members interacted with the various activities Hequeendo School fees March 2015 47 OVC received Misikhu cbo (Aphiaplus support school fees western) support Needs assessment meeting Eldoret prisons Distribution of Feb 2015 32 women and Kibulgeny Department soap, sanitary children towels and benefitted beddings to the mothers with children Health Rights CHVS sensitization March,2015 General Cheptongei on PMTCT agreement on (Keiyo) implementation the and enrollment of harmonization

children of service delivery and referral

IX. PROGRESS ON LINKS WITH GOK AGENCIES

We continue to work closely with pharmacists working in the (MOH) facilities to strengthen existing structures required for smooth delivery of pharmacy services. In several facilities the pharmacy staff is deployed in both the CCC and hospital pharmacies. We able to worked with MOH divisions; National AIDS and STI Control Program (NASCOP) and Reproductive and Maternal Health Service Unit (RMHSU) formerly DRH both regionally and nationally in providing technical leadership in the trainings including teaching. The Prevention Department participated in the HIV testing and counseling (HTC) Technical Working Group to revise the HTC guidelines. AMPATHPlus made great strides in working together with county stakeholders as indicated in the table below. Other Ministry of Health and Government of Kenya activities participated in are listed in Annex 4.

Table 2. Involvement of county stakeholders in AMPATHPlus

Date What meeting Who attended Where

10th Feb 2015 Trans Nzoia County and Trans Nzoia County Leadership Kitale AMPATHPlus Meeting /AMPATHPlus 10th Feb 2015 West Pokot County and West Pokot County Leadership Kapenguria AMPATHPlus Meeting /AMPATHPlus 11th Feb 2015 Busia County and AMPATHPlus Busia County Leadership Busia Meeting /AMPATHPlus 11th Feb 2015 Kisumu County and AMPATHPlus Kisumu County Leadership Kisumu Meeting /AMPATHPlus 12th Feb 2015 Elgeiyo Marakwet County and Elgeiyo Marakwet Leadership Kisumu AMPATHPlus Meeting /AMPATHPlus 12th Feb 2015 ART Taskforce Meeting NASCOP/USAID/IPs/Counties Nairobi 13th Feb 2015 Bungoma County and AMPATHPlus Bungoma County Leadership Bungoma Meeting /AMPATHPlus 16th Feb 2015 Uasin Gishu County and Uasin Gishu County Leadership Eldoret AMPATHPlus Meeting /AMPATHPlus 19th Feb 2015 Nandi County and AMPATHPlus Nandi County Leadership Kapsabet Meeting /AMPATHPlus

X. PROGRESS ON USAID FORWARD

Continued support of our local subcontractor Anglican Church has continued to gain marks. Our administrative arms the RSPO has continued to be strengthened by the yearly audits with great

lessons learned. The ERP implementation has continued to strengthen RSPO and processes have become easier and more transparent. When it is fully implanted we see management of programs and grants not only from USAID but all other grants including research will be managed more efficiently.

XI. SUSTAINABILITY AND EXIT STRATEGY

The safety net services are continuously collaborating with various stakeholders in empowering groups in agribusiness, business, farming, bee keeping, goat-rearing among other ventures. As a program it is our main aim to ensure that households are engaged in activities that lead self-sustenance using the resources available at the household level. These activities include:  Supporting OVC households to attain individual independence is ongoing. This has contributed to the graduation of some out of the program. Alignment is being done towards the social support services offered by the Government of Kenya like the OVC CT, cash transfer for the elderly, CDF among others. Communities are continuously being encouraged to support their OVC. The capacities of QI teams and AAC are continuously being strengthened to support OVC.  Mentoring of our local partner in West Pokot to take up responsibility of caring of OVC in future.  Linking community support groups with National and County governments for social support programs and trainings.  Encouraging clients to enroll with the National Hospital insurance fund. A number Clients and their dependents who have enrolled with NHIF no longer seek waiver support services in case of hospitalization.  Youth friendly clubs have been formed in all counties. The clubs will assist in addressing challenges faced by young people who receive care and support hence reducing spread of HIV/AIDS.  Community participation in care and support is a critical sustainability and exit strategy for AMPATH. Through groups, communities were mobilized and encouraged to participate in healthcare related activities such as enrollment to health insurance schemes, sanitation and behavior change among others. Through groups, clients are able to mobilize own resources to address pressing economic challenges hence being sustainable. GISE is an example of such strategy which is a form of Village Saving model (Table Banking). GISE groups that have been able to mobilize some reasonable funds have been linked to more structured microfinance institutions and banks to access more loans for expanding their business and buying of farm inputs in bulk. GESPs ensure group

follow ups and are given a stipend by the same groups – GESPs are trained as TOT by FPI so as to deliver GISE activities in their community.

In this quarter, the Zuri Health pilot insurance technical support program oversaw its first full quarter of operations, including enrollment and delivery of benefits to eligible members. The program focused its activities on customer service and delivering benefits to eligible members. A summary of milestones achieved is in the below discussion, and the accompanying table at the end of this summary. We track revenue, membership volume, benefits (the costs are currently listed on a fee for service basis), and a few ratios (explanations in the footers below the table). Table 3: Zuri Health – Key Performance Indicators Summary

Revenue and active member numbers have been relatively stable across all months, while utilization of services has increased month-on-month. We’ll discuss more on this topic below, but we think we’re seeing the real effects of adverse selection – many members drop out after the first month (presumably the healthy ones), while sick members remain in the pool. There is a tremendous amount of member churn (turnover) month to month, which we’ll explain in more detail below. Second, we’d like to point you to some trends to watch regarding our enrollment and utilization patterns.  Enrolment: The majority of members drop out after the first month of enrolment. On average, 73% of members who join in the first month make a payment and then drop out of the program, effectively donating 100 KSh to the program. Regardless of the month joined, this has been a consistent trend (see Table 4). In Table 4, you’ll see for the 369 members who joined in October 2014, only 95 (26%) remained as active members in November, and for new members who joined in November, only

41 (20%) remained as active members in December, and so on and so forth. The trend appears to stabilize after the first month, however, and we see members who stay for a second month consistently remain as members long-term.

 Facilities: Port Victoria is the most active site by volume, revenue, and benefits consumed. 64% of members, 66% of revenue, and 78% of benefits were consumed by Port Victoria registered members in March.

 Benefits: Benefits are being consumed at a high rate. We should expect benefits to eclipse premiums collected within 1-3 months. We noted earlier that 73% of members who join in the first month make a payment and then drop out of the program, effectively donating 100 KSh to the program. By end March, this pool of “one off” premiums, i.e., premiums that were paid but not ever used beyond the waiting period, constituted 42% of all premium revenue collected. Without this revenue, we have effectively spent as much as we have collected by the end of March (approximately 140,000 KSh collected by and spent on “active” members by end March). At the current trend, we see 1-3 months before we will have provided more benefits than what has been collected (see Table 5 for both premium and benefits month-to-month).

Table 5:

XII. GLOBAL DEVELOPMENT ALLIANCE

Not applicable.

XIII. SUBSEQUENT QUARTER’S WORK PLAN

In the next quarter, the Prevention team will continue rolling out the implementation of selected EBIs and will also reach the targeted populations with prevention messages. Strengthening and expansion of community-based prevention programs will also be done. Below are specific activities to be carried out:

 Conduct meetings with Peer educators to share targets and results  Conduct outreach supervision for the FSW Peer Educators  Train peer educators and introduce drop-in-centre services in Kitale  Conduct supportive supervision in collaboration with MOH CHMTs and SCHMTs  Monitor outreach for FSWs and MSMs  Continue to track progress and evaluate implementation of both clinical PHDP, community PHDP, FMP and RESPECT-K activities

 Perform program monitoring using both community and facility SIMS tools  Conduct routine Data Quality Assurance

Provider Initiated Testing and Counseling has planned a RRI, targeting high volume facilities. The goal will be to increase testing in children to at least 50% outpatient & 100% inpatient, targeting MCH & Sick child clinics. PITC intends to roll out internal SIMS in sites that have not been reached.

The Care and Treatment program will conduct sensitization of county focal persons and facility in-charges on the rapid advice guideline and HIV management.

We plan to have a 2 day intensive training for facility staff on the ADT which was upgraded in the last two months. This will be done from 23rd to 25th April in collaboration with Management Science for Health (MSH). The lab will pursue accreditation ISO15189-2012. They will continue Mentoring site labs where lab services has been devolved on Good Clinical Laboratory Practices. The lab will continue offering refresher courses on GCLP mentorship/training for every personnel in the AMPATHPlus care lab, provide application training for care lab staff on various platforms, and provide refresher trainings on various aspects to the staff in the satellite laboratories.

XIV. FINANCIAL INFORMATION

Financial Information.docx

XVII. GPS INFORMATION

See attached document (Appendix 3).

XVIII. SUCCESS STORY GUIDELINES & PREP SHEETS

JOHN’S STORY John is a child who came into contact with our staff initially at Iten clinic in Q4 2013- 2014. He didn’t know his HIV status at the time, but he had serious eye problems that hindered his school attendance due to poor eye sight. At some point, he could barely see. The guardian was resistant to HIV testing for John, which the clinician thought was necessary at the time. Various referrals within were done. The efforts of the children office were pulled to expedite service delivery and to save Johns eye sight. Eventually, HIV testing was done and the results were positive. Being a maternal orphan, he lives with the father and a step mother, who were both referred for HIV testing. They were extremely resistant and they didn’t want to support John in any way. At this point, John was gradually losing his eyesight. They were asked to take John to Moi Teaching and Referral Hospital for further management, but the guardians were very hostile. They didn’t even allow the social worker into their homestead for follow up. It took the intervention of the children’s office to get the father take John for further management. He required urgent eye surgery and the father could not raise any amount. A letter was done to the Hospital Director, who granted a waiver for the surgery, which was done successfully. John’s eyesight is now restored and he has re-enrolled back to school. He has accepted his status and is adherent to medication. He is a member of the adolescent group in Iten clinic and a role model to his peers. He will be sitting his KCPE this year. His father and step mother have since accepted their HIV positive status and are accessing care through the Iten CCC. MOONLIGHT GROUP LANGAS Moonlight Group Langas started on 18.01.2011 after AMPATH’s Family Preservation Initiative (FPI) transformed its microfinance to village saving and loan association (GISE) Group Integrated Savings for Empowerment. A normal meeting day for them starts a show of very organized group .some members of the group with small plots also benefited from the ALVs project whereby besides getting trained on proper agronomic practices. They were also given African leafy vegetables Seeds. The group is already registered with social services and plans are at advanced stage for them to get a loan from women enterprise fund. To ease the struggles of paying bill on hospitalization a good number of the members are registered with NHIF. Below is an individual member’s story and how she has benefitted from FPI interventions:-

MARY (a group member) Mary is a small scale farmer with a small farm where she does maize farming and a small kitchen garden. She received ALVS seeds and got training on general agronomic practices. She been able to have vegetables for consumption and a small quantity for sale at Langas market which sells at 10 bunches per week on average receiving Ksh 600. With all this she has savings of Ksh 6050 with the GISE group. Last season she got a small loan from the group and was able to purchase seeds and fertilizer she is expecting a better harvest this season and 3 sack gardens where she receives vegetables for home consumption.

ANNEXES & ATTACHMENTS (MAXIMUM 10 PAGES)

Annex I: Schedule of Future Events

ART Guidelines 27th to 29th April Bungoma Bungoma NASCOP Health workers -Various Cadres Service Provider 2015 Group 1 3 Days (Doctors,Nurses,Clinical Training Officers,HRIOs,Lab Techs, Nutritionists) ART Guidelines 4th to 6th May Uasin Gishu Moi Health workers -Various Cadres Service Provider 2015 University NASCOP (Doctors,Nurses,Clinical Training 3days Officers,HRIOs,Lab Techs, Nutritionists) ART Guidelines 8th to 10th June Trans Nzoia Kitale NASCOP Health workers -Various Cadres Service Provider 2015 3 days (Doctors,Nurses,Clinical Training Officers,HRIOs,Lab Techs, Nutritionists) ART Guidelines 6th to 8th May Bungoma Bungoma NASCOP Health workers -Various Cadres Service Provider 2015 Group 2 3 Days (Doctors,Nurses,Clinical Training Officers,HRIOs,Lab Techs, Nutritionists) PMTCT Training 15th to 19th Uasin Gishu Moi NASCOP Health workers -Various Cadres for service June 2015 University 5 days (Doctors,Nurses,Clinical providers Officers,HRIOs,Lab Techs, Nutritionists) ART Guidelines 13th to 15th May Turkana Lodwar NASCOP Health workers -Various Cadres Service Provider 2015 3 days (Doctors,Nurses,Clinical Training Officers,HRIOs,Lab Techs, Nutritionists) PMTCT Training 25th to 29th May Turkana Lodwar NASCOP Health workers -Various Cadres for Service 2015 5 days (Doctors,Nurses,Clinical providers Officers,HRIOs,Lab Techs, Nutritionists) PMTCT Training 6th to 10th July Bungoma Bungoma NASCOP Health workers -Various Cadres for Service 2015 5 days (Doctors,Nurses,Clinical providers Officers,HRIOs,Lab Techs, Nutritionists)

PMTCT Training 20th to 24th July Trans Nzoia Kitale NASCOP Health workers -Various Cadres for Service 2015 5 days (Doctors,Nurses,Clinical providers Officers,HRIOs,Lab Techs, Nutritionists) Family planning 3rd to 7th Turkana Lodwar NASCOP Health workers - Various cadres Training August 2015 5 days (Nurses, COs, Mos) Regional 10th September NorthRift Moi 1day Stakeholders Symposium 2015 University

Annex 2: Table of Ministry of Health-related activities undertaken during the quarter No Agency Activity Date Outcome Location 1. KALRO (Kenya Collaboration in research, Jan - Mar Trained groups Busia, Kisumu, Agriculture and agricultural & value addition on newly Bungoma Livestock Research activities introduced counties Organization) maize seeds varieties which are resistant to striger weeds and can do well in striger prone areas 3. YEF (Youth Sensitization/training/linkages Jan - Mar Clients access Enterprise Fund) and loaning clients to funds 4. WEF (Women Sensitization/training/linkages Jan - Mar Clients access Busia, Kisumu, Enterprise Fund) and loaning clients to funds Bungoma counties 4. Social services Cash transfer support Jan - Mar OVC and Elderly Busia county (Ministry of Labour) members able to meet basic needs 6. MOALF (Ministry of Agricultural extension Jan - Mar Better farming Trans nzoia Agriculture, practices Livestock and Fisheries) Provision of subsidized Jan - Mar Improved yields Busia fertilizer for food crops Provision of seeds (soya, Jan - Mar Improved yields Busia, millet, sorghum, cow peas) and food Khunyangu, security Chulaimbo 7. MOH Hospital bills waiver Jan - Mar Improved All counties access to

healthcare by the vulnerable Community Palliative care Jan - Mar Improved Bungoma sensitization community response to Nakuru care Review of the Nutrition and Jan - Mar Revised TB guidelines national nutrition and TB guidelines

No Agency Activity Date Outcome Location Nutrition and HIV training Jan - Mar 30 MOH and Eldoret AMPATH health care workers trained on the new nutrition and HIV guidelines 8. Hand in Hand Recruitment of groups for Jan - Mar Access to funds Busia Eastern Africa training to benefit from for income Uwezo fund. generating activities. 9. Police Department Arrest of perpetrators of Jan - Mar Enforcement of Uasin Gishu SGBV. the law county 10. Children Department Committal of children in need Jan - Mar Improved Uasin Gishu of care and protection into children’s county shelters. safety. AAC meetings Jan - Mar Representatives of all AAC teams in the various counties attended the Quarterly meetings Mapping of stakeholders in Jan - Mar Meetings were All counties the various counties held with the various implementing partners and the way forward for collecting the data was agreed upon. Most counties implemented the activity in collaboration with the department of children services.

No Agency Activity Date Outcome Location Enrollment of OVC in NHIF Jan - Mar 40 ovc enrolled Uasin Gishu and cash transfer (Burnt Forest) School fees support, March 2015 50 OVC Webuye DCOs Defilement case, Child supported with office support bursary from the presidential initiative. Defilement case referred to the police after the children’s department 11. The Judiciary Access to justice through Jan - Mar Improved Uasin Gishu litigations. parental county responsibilities, convictions against perpetrators. 12. local administration facilitation of acquisition of Jan - Mar 2015 Meetings were West Pokot and and registration of birth and death certificates held with the Elgeyo births and deaths stakeholders on Marakwet facilitation of acquisition of legal documents for caregivers and OVC. Further sensitization was done in chiefs barazas and other community fora 13. Ministry of Working with teachers on Imparted life All counties education and formation and follow up of 4k skills training in Ministry of clubs in schools Jan - Mar 2015 children. Agriculture Improved food security in their households’ Has also improved on their health as a result of

No Agency Activity Date Outcome Location advocating for the key health messages such as hand washing 14. Ministry of interior Food Donation Jan-Mar 90 households Weiwei and coordination of received a bag National of maize each Government 15. Hand in Hand Recruitment of groups for Jan - Mar Access to funds Busia Eastern Africa training to benefit from for income Uwezo fund. generating activities. 16. Local Administration facilitation of acquisition of Jan - Mar Focused West Pokot, and Registration of birth and death certificates meetings were Nandi, Elgeyo births and deaths held specifically Marakwet with the registration officers and the chiefs to facilitate continuous processing of birth and death certificates 17. Ministry of Working with teachers and Jan - Mar Imparted life Uasin Gishu, education and school children on formation skills training in Elgeyo Ministry of and follow up of agriculture children. Marakwet, Agriculture (4k ) clubs in schools Bungoma

18. Bungoma County Seed and fertilizer distribution March, 2015 400 bags Bokoli, Maraka, government distributed to Webuye OVC households and those affected by HIV 19. SIMS sensitization Sensitization of all senior March, 2015 All senior Uasin Gishu Uasin Gishu Senior county heads of departments county heads Pioneer social county heads of were sensitized hall departments and empowered to

No Agency Activity Date Outcome Location TOT their various sub counties 20. SIMS sensitization Sensitization of all senior March, 2015 All senior Busia county Busia Senior county county heads of departments county heads hall heads of were sensitized departments and empowered to TOT their various sub counties 21 National Master TOT 2nd -6th 3 PMTCT staff Nairobi training on PMTCT February 2015 trained curriculum 22. SIMS sensitization 3rd February, SIMS roll out- Kitale 2015 Trans Nzoia 23 Integrated Data Review of Busia county data 4th -12th Identification of Matayos, Teso Review meeting February,2015 data quality North, Butula & issues Bunyala sub count 24. Training of regional TOT training on PMTCT - 27th Roll out of Ampath plus TOT on PMTCT curriculum march,2015 Option B+ Centre curriculum

Annex 3: Lab tests done by county

INDICATOR TITLE: Expand laboratory capacity to perform routine laboratory monitoring and diagnostic tests for AMPATH patients

Perform routine laboratory monitoring October – Reporting Period January – and diagnostic tests for July- December 2014 March 2015 AMPATH patients. Sept2014 Gender: #of tests #of tests #of tests Women (W), Men (M) Bungoma County HIV Elisa 25 45 0 DNA-PCR 122 99 101 Syphilis diagnostics(RPR) 0 0 0 CD4 counts 0 1 0 Viral load tests 1706 656 1018 SGPT 0 0 0 Creatinine 0 0 0 Haematology (CBC) 0 0 0 Busia County HIV Elisa 7 70 0 DNA-PCR 0 2 0 Syphilis diagnostics(RPR) 0 1 0 CD4 counts 918 632 655 Viral load tests 2 2 1 SGPT 0 0 0 Creatinine 0 0 0 Haematology (CBC) 66 64 99 Elgeyo County HIV Elisa 0 0 0 DNA-PCR 31 31 38 Syphilis diagnostics(RPR) 0 0 0 53

CD4 counts 45 30 60 Viral load tests 441 155 91 SGPT 0 0 0 Creatinine 0 0 0 Haematology (CBC) 0 0 0 Kisumu County HIV Elisa 10 6 0 DNA-PCR 2 0 1 Syphilis diagnostics(RPR) 0 0 0 CD4 counts 211 125 193 Viral load tests 89 0 0 SGPT 0 0 0 Creatinine 0 0 0 Haematology (CBC) 1 0 0 Nandi County HIV Elisa 2 4 2 DNA-PCR 11 14 10 Syphilis diagnostics(RPR) 0 1 0 CD4 counts 111 114 160 Viral load tests 419 340 707 SGPT 0 1 0 Creatinine 0 1 0 Haematology (CBC) 27 10 0 Uasin Gishu County HIV Elisa 120 70 71 DNA-PCR 429 359 457 Syphilis diagnostics(RPR) 29 66 90 CD4 counts 1126 727 2086 Viral load tests 4531 2365 6618

SGPT 66 80 0 Creatinine 85 82 0 Haematology (CBC) 448 204 381 Trans Nzoia County HIV Elisa 2 0 0 DNA-PCR 201 223 243 Syphilis diagnostics(RPR) 0 0 0 CD4 counts 246 196 240 Viral load tests 2268 884 1585 SGPT 0 0 0 Creatinine 0 0 0 Haematology (CBC) 0 54 4 West Pokot County HIV Elisa 0 0 0 DNA-PCR 33 42 43 Syphilis diagnostics(RPR) 0 0 0 CD4 counts 0 0 1 Viral load tests 277 83 182 SGPT 0 0 0 Creatinine 0 0 0 Haematology (CBC) 0 0 0

Annex 4: Quality Improvement Gaps and Action Plans

DOMAIN/ % OF FACILITIES % OF ACTION PLAN INDICATOR SCORING RED FACILITIES SCORING YELLOW ADULT/ADOLESCENT TREATMENT ART 40.0% 0% -QI teams to actively monitor viral load MONITORING coverage among eligible patients through monthly sampling of files to check for a viral load result and charting progress made each month.Progress on this will be monitored centrally by Dr.Kenei/Dr.Some -Also streamlined dissemination of results especially for networked facilities so that VL results are sent for each patient on a separate sheet to facilitate filing of individual results.(Sylvia Kadima/Violet Wanyonyi to track progress on this and give feedback to clinical team) PATIENT 20.0% 20.0% -Diaries have been re-introduced across all TRACKING CCCs to facilitate daily booking of clients and (ART PATIENTS) prompt action by the outreach team for the missed appointments. BLOOD SAFETY,WASTE MANAGEMENT&INJECTION SAFETY Access to safe 0.0% 50.0% Busia county referral hospital using a manual blood system of recording. Waste 20.0% 20.0% Mentorship of the Biosafety officers on management waste management.This is being overseen by Violet Wanyonyi CARE AND SUPPORT Facility linkage 25.0% 50.0% -The retention workers at the facility have a to community list of CHVS, their villages and their phone care and numbers. They refer defaulters to the CHVs support services by phone contact. After the CHVs contact the defaulters, the information gathered is documented using the retention field follow- up form and filled in each patient’s file. -The AMPATH county and sub-county leadership have been tasked to profile all the community services available within their areas of jurisdiction and the complete directory will be available in respective sites by beginning of quarter 4. Patient tracking 20.0% 20.0% -Diaries introduced in to facilitate booking of Pre-ART appointments and prompt tracking of

Patients missed appointments TB/HIV ART Provision 20.0% 0.0% The TB/HIV teams are enhancing OJT and for HIV positive mentorship to all the affected facilities with paediatric TB special emphasis on pediatric care. Pediatric patients indicators for TB/HIV are now routinely monitored for all the sites. Proper documentation is also being emphasized. Facility linkage 50.0% 0.0% Emphasis of TB care cascade being an active to community part of community strategy will be care and continuously emphasized. Mechanisms to support services improve the integration of facility and community TB care services are being looked at. Resources from other partners e.g. GF/AMREF will help to improve on these processes. Isoniazid 100.0% 0.0% The AMPATH TB/HIV and Pharmacy teams Preventive are in constant communication with the Therapy national and county drug supply systems to get adequate stocks of INH for IPT. Once adequate stocks reach the facilities IPT will be re-emphasized across those sites in line with national and international best practices. Routine PITC for 20.0% 0.0% In liaison with the HIV teams and facilities, paediatric TB the weak links in the care of pediatric cases patients are being worked on. This includes establishing a system to ensure all HIV exposed and pediatric TB cases get the necessary HIV tests on time. TB diagnostic 40.0% 0.0% Proper documentation by the HIV team is evaluation being emphasized. The weak links in the cascade integration of TB and HIV like AFB and Xpert results feedback is being strengthened. OJT to the whole HIV and TB clinical and lab teams on proper diagnostic protocols is ongoing with training/sensitizations across the counties scheduled for this quarter.expert lab networking is being set up across all counties. TB infection 0.0% 20.0% Affected facilities will be taken through the control proper standards for IC with emphasis on IC committees, plans, regular minutedmeetings and focal person. IPC will be a key area in the next workplan. ART Provision 25.0% 0.0% Improved documentation in the TB register for HIV-positive and CCC patient charts is being emphasized.

adult and Tailored OJT and mentorship is being done adolescent TB to the identified weak areas. patient FAMILY PLANNING/HIV INTEGRATION Counseling on 25.0% 0.00% contraception for women at high likelihood of exposure to STIs FOOD & NUTRITION Adult Care and 20.0% 20.0% QI teams in the five facilities to track Treatment- nutrition assessment through monthly Nutrition sampling of files and charting progress over time Paediatric 20.0% 20.0% QI teams to track nutrition assessment Growth through monthly sampling of files and Monitoring charting progress over time GENDER Gender Norms 100.0% 0.0% Technical working group led by Dr.Juddy Wachira has been formed at Ampath central to facilitate development of policy and training on gender norms pending approval by CoP Post-Violence 50.0% 25.0% USAID to provide guidance for facilities that Care do not receive PEPFAR funds for post violence care regarding future assessments. HTC Compliance 20.0% 0.0% Refresher trainings have been planned for with National HTC cousellors in the respective facilities, testing testing protocols will be provided and Algorithm and successful linkage will be confirmed by using Strategy the referral form to update the 362 register.Applying QI principles to scale up testing in children aged 9mths and above. LAB Lab biosafety 20.0% 0.0% Organizing mentorship on bisafety/ biosecurity for facilities Quality 40.0% 0.0% Mentoring QA officers in facilities on management keeping propoer records on training i.e OJTs systems Quality Testing 20.0% 0.0% Mentoring QA officers to establish monitoring internal/external QC systems Results and 40.0% 0.0% Working closely with clinical team to have Information indivual results printed and filed in patient management files Test SOPs 20.0% 20.0% Mentoring facilities to develop SOPs

Testing 40.0% 0.0% Working with KEMSA &USAID to ensure Interruptions constant supply of reagents and consumables. OVC Early childhood 33.3% 0.0% -We have developed Sops for referral and development follow up for linkage from the facility to community and vice versa this will be distributed to the respective sites. -We have distributed referral booklets to community workers for documentation of referrals. -We have arranged the seating of social workers so reduce missed opportunities PAEDIATRIC CARE AND TREATMENT Adolescent 20.0% 40.0% -Policy document ,testing and disclosure support services SoPs to be developed or sourced from NASCOP and distributed to facilities.Dr.Apondi/Dr.Kenei to follow up. Paediatric ART 60.0% 20.0% -QI teams to monitor viral load coverage in monitoring paediatric files and chart monthly progress.The progress of which will be monitored centrally by Dr.Apondi through the county and subcounty coordinators.This is heavily dependent on separation of paediatric files in records department. Paediatric 33.3% 0.0% --The retention workers at the facility have a facility referral list of CHVS, their villages and their phone to community numbers. They refer defaulters to the CHVs care and by phone contact. After the CHVs contact support the defaulters, the information gathered is documented using the retention field follow- up form and filled in each patient’s file. -The AMPATH county and sub-county leadership have been tasked to profile all the community services available within their areas of jurisdiction and the complete directory will be available in respective sites by beginning of quarter 4. Paediatric TB 40.0% 0.0% -QI teams to monitor TB screening in screening paediatric files and chart monthly progress.The progress of which will be monitored by Dr.Apondi centrally through the respective county and subcounty coordinators Routine HIV 25.0% 0.0% -PITC counselor in Busia has set paediatric testing for testing as QI objective and is monitoring and children charting progress over time.This will be

monitored by Margaret Wandabwa(PITC manager) PMTCT ARVs at labour 40.0% 0.0% MTRH-ARVS availed at the 24hr pharmacy at and delivery RMBH to bridge for night clients. Malaba-ARVs have been availed at ANC to cater for emergency deliveries since the facility lacks Maternity ward. CTX for HEIs 0.0% 40.0% MTRH-planning rollout of integrating all PMTCT activities within MTRH MCH and availing CTX for infants. HEI register has already been availed for documentation purposes in module 4.

Early Infant 40.0% 20.0% Chulaimbo-to undertake OJT on proper Diagnosis filling of HEI register and mentorship on EID protocol adherence. Webuye-Fast-tracking PCR results and forward transmission of results to parents/guardians. Busia- Fast-tracking PCR results Enrollment of 25.0% 0.0% Webuye- All positive infants to be initiated HIV-infected on ART within MCH until exit at 24 months infants into ART and subsequently linked to ART Clinic, in services addition to providing SOPs on linkage to care. Supply chain 20.0% 0.0% Malaba- support supervision on commodity reliability(rapid timely reporting to avoid stock-outs. test kits) SITE MANAGEMENT-POLICY AND PRACTICE Patient rights 20.0% 60.0% -Patient rights charter has been distributed to all CCCs.Formal training on patient rights to be combined with training on stigma and discrimination. Stigma and 60.0% 20.0% -TWG set up to formulate a policy on stigma discrimination and discrimination and organize subsequent training on the same pending approval from the CoP. SITE MANAGEMENT QM-QI HIV QM/QI 40.0% 0.0% Quality improvement teams have been set up and mentored in MTRH and Webuye with QI activities currently ongoing to address retention, option B-plus coverage, partner testing, nutritional assessment and accurate documentation of partographs.

Community Site Dashboard Malaba Safe Stop Container

DOMAIN/ SCORE COMMENTS ACTION PLAN INDICATOR HTC

HIV testing Red Less than 14 PHCT supervisor doing closer supervision to Algorithm entries were ensure all adequate documentation and Compliance complaint compliance HTC referrals Yellow Only 56% 0f Regular supervision by PHCT supervisor at patients linked the site is currently ongoing to achieve complete linkage to care HTC Yellow 2 staff Names of counselor plus other PHCT proficiency enrolled in PT counselors have been forwarded for testing only one participation in the next round of PT in July completed 2015 HTC safety Yellow No Annual safety training conducted to all PHCT measures documentatio counselors in November 2014. n that all staff Documentation of the same filed. trained annually KEY POPULATIONS KEY POPULATIONS Monitoring Yellow Unique Population size estimates of FSW in Malaba outreach identifier for and also Kitale has been conducted in the all key last quarter 2. We are now working on populations setting up a database to use the unique missing identification codes for tracking services KP referral Red No tool in the Tentative Referral tool introduced and given system community to PEs; more customized referral tools are being printed in this quarter 3 Peer outreach Red Peer educators are currently being involved management in planning for activities and sharing of monthly results; Other components of peer outreach management activities are to be implemented in this quarter 3 Condom and Yellow No monitoring Plan for monitoring condom supply has been lube access on condom introduced and supply availability at point of service Service Red No tool in the Referral tool introduced and given to Peer referral

system community educators of FSWs PREVENTION PREVENTION Small group Red Work in progress to strengthen facilitation sessions for of Small Group Sessions HIV prevention SITE MANAGEMENT-PERFORMANCE MANAGEMENT SITE MANAGEMENT-PERFORMANCE MANAGEMENT Supporting Red Support supervision to community-based community cadres through onsite training and cadres supervision is currently being strengthened Community Red Work in progress governance Patient rights Red County coordinator(Oscar Busaka) to provide staff with hard copy of patients rights charter.Training will be combined with training on stigma and discrimination following approval by CoP. SITE MANAGEMENT QM/QI SITE MANAGEMENT QM/QI HIV QM/QI Red QI team now in place with documented System work plan to improve retention particularly among commercial sex workers in the risk reduction program Use of Data in Red QI team to improve retention among QI Activities commercial sex workers in the risk reduction program from 40% to 90%.Progress will be reviewed and charted monthly and commercial sex worker will be invited to attend QI meetings to give input on retention SITE MANAGEMENT-MONITORING AND REPORTING SITE MANAGEMENT-MONITORING AND REPORTING Patient/Benef Red A filling cabinet has been bought where iciary Records patients files and records are maintained in the container to ensure confidentiality DQA Red Regular DQAs have been instituted to ensure better quality data output. Results Red Systems are now in place for results Reporting reporting. A Reporting tool has facilitated reporting of testing results in MOH 362