Kisii County Hiv & Aids Strategic Plan (Kchasp)

KISII COUNTY HIV & AIDS STRATEGIC PLAN (KCHASP)

2014/15 – 2018/19 1 KISII COUNTY HIV & AIDS STRATEGIC PLAN

2014/15 – 2018/19 Table of Contents

Table of Contents Abbreviations and Acronyms 4 List of Figures and Tables 6 Preface 7 Acknowledgements 9 Executive Summary 10

Chapter 1 13 Background Information 13 1.1 Introduction 13 Kisii Map 14 Pictorial 15 1.2 The evolution of HIV & AIDS response in Kisii County 16

Chapter 2 17 Situational Analysis 18 2.1 Population and Demographics 17 2.2 HIV Epidemiology of Kisii County 17 Gaps and Challenges Analysis (Biomedical, Behavioural, Structural) 18

Chapter 3 20 Rationale, Strategic Plan Development Process and the Guiding Principles 20 3.1 Purpose 20 3.2 Process of Developing the HIV Plan 20 3.3 Guiding Principles 21

Chapter 4 24 Vision, Mission, Objectives and Strategic Directions 24

Strategic Directions 25 Strategic Direction 1: Reducing HIV new infections 25 Strategic Direction 2: Improving health outcomes and wellness of people living with HIV 32 Strategic Direction 3: Using a human right-based approach to facilitate access to services 36 for PLHIV, KPs and other priority groups in all sectors Strategic Direction 4: Strengthening integration of community and health systems 41

Strategic Direction 5 43 Strengthening research, innovation and information management to meet KCHASP goals

Strategic Direction 6: Promoting utilization of strategic information for 45 research and monitoring and evaluation to enhance programming

Strategic Direction 7: Increasing domestic financing for a sustainable 48 HIV response in Kisii County

Strategic Direction 8: Promoting accountable leadership for delivery 50 of the KCHASP results by all sectors and actors

Chapter 5 53 Implementation Arrangements 5.1 HIV coordination structure for KCHASP delivery – county level 53 5.2 Roles of stakeholders 54

Chapter 6 Monitoring and evaluation of the plan 55

Chapter 7 Risk and mitigation plan 57

Annexes Annexe 1: Results Framework 59 Annexe 2: Resource Needs 79 Annexe 3: Resource Materials 80 Annexe 4: List of Drafting Technical Review Team 81

Abbreviations and Acronyms

AIDS Acquired Immune Deficiency Syndrome FSW Female Sex Worker

ANC Antenatal Clinic GBV Gender-Based Violence

ART Antiretroviral Treatment/Therapy GoK Government of Kenya

ARV Anti-Retroviral Drugs HBC Home-Based Care

BCC Behaviour Change Communication HBTC Home-Based Testing and Counselling

CACCs Constituency AIDS Control Committees HCBC Home and Community-Based Care

CBO Community Based Organization HCW Health Care Worker

CCM Country Coordination Mechanism HIV Human Immunodeficiency Virus

CHAC County HIV Committees HMIS Health Management Information System

CHEWs Community Health Extension Workers HPV Human Papilloma virus

CHV Community Health Volunteers HR Human Resources

CSO Civil Society Organization HTS HIV Testing (and counseling) Services

DICE Drop in Centre IEC Information, Education and Communication

DHIS District Health Information System IPC Infection Prevention and Control

EBI Evidence-Based Intervention KAIS Kenya AIDS Indicator Survey

eMTCT Elimination of Mother-to-Child Transmission KASF Kenya AIDS Strategic Framework

FBO Faith-Based Organization KARP Kenya AIDS Response Programme

5 KCCB Kenya Conference of Catholic Bishops PEP Post-Exposure Prophylaxis

KCG Kisii County Government PITC Provider-Initiated Testing and Counselling

KDHS Kenya Demographic and Health Survey PLHIV People Living with HIV and AIDS

KEPH Kenya Essential Package for Health PMTCT Prevention of Mother–to-Child Transmission

KNASP Kenya National AIDS Strategic Plan PrEP Pre-Exposure Prophylaxis

KP Key Populations PwD People/Persons with Disabilities

MDAs Ministries, Departments and Agencies PHDP Positive Health, Dignity and Prevention

M&E Monitoring and Evaluation RBM Results-Based Management

MIPA Meaningful Involvement of PLHIVs SASCOS Sub County AIDS and STI Coordinator

MIEPA Meaningful Involvement and Empowerment SGBV Sexual and Gender-Based Violence

of PLHIVs SRH Sexual and Reproductive Health

MoE Ministry of Education STI Sexually Transmitted Infection

MoH Ministry of Health SW Sex Workers

MoT Modes of Transmission TBD To be Determined

MSM Men who have Sex with Men TOWA Total War against HIV and AIDS

MSW Male Sex Worker TWG Technical Working Group

NACC National AIDS Control Council UNAIDS Joint United Nations Programme on HIV & AIDS

NASCOP National AIDS & STI Control Programme

VCT Voluntary Counselling and Testing NCDs Non-Communicable Diseases

WHO World Health Organization NGO Non-Governmental Organizations

OVC Orphans and Vulnerable Children

6 List of Figures and Tables

Figure 1.1: Kisii County – Gini Coefficient by Ward

Figure 5.1: HIV coordination structure for Kisii County

Figure 6.1: HIV and AIDS response flow chart for Kisii County

Table 2.1: WHO’s six building blocks of health systems strengthening framework

Table 4.1: Granulation of HIV per sub-county in Kisii County

Table 4.2: Donor contribution to HIV fight in Kisii County

Table 7.1: Risk and mitigation planning activities

7 Preface

he County Government of Kisii presents the Kisii County HIV & AIDS Strategic Plan (KCHASP) for 2014/15-2018/19. This is a product of a highly consultative process involving all stakeholders in the response to HIV and AIDS. This Thighly interactive process ensured that the KCHASP addresses current needs and epidemic trends in Kisii County, drawing on new global and national knowledge and information on HIV and AIDS. The technical working team that assisted the county to develop this plan included specialists on various HIV issues. Kisii County’s approach is to mainstream these concerns at all levels, and indeed, to mainstream our HIV and AIDS response into our county development agenda. There were also specialists in Monitoring and Evaluation, Resource Mobilization Costing and HIV prevention.

The Kisii County HIV & AIDS Plan (KCHASP) uses a results based approach and evidence based planning. This has not only brought new thinking and a sharpened focus, but also facilitated mainstreaming of the “Three Ones” principles.

In developing a Kisii County HIV & AIDS Strategic Plan (as opposed to a Medium Term Plan - MTP), Kisii has shifted the planning paradigm from focusing on service delivery only, to understanding how the service delivery efforts will lead to changes in the lives of the targeted audiences, and therefore impact on the epidemic itself. In so doing, Kisii County has identified county priorities and articulated county targets (results) that all stakeholders will collectively contribute to. In this new strategy, we have mainstreamed gender and human rights in the implementation, and monitoring and evaluation strategies.

As a county, we have made significant progress in the fight against HIV, however, as we have seen from the Modes of HIV Transmission Study (MoT) in 2008, and Kenya AIDS Indicator Survey (KAIS) in 2012, we still face major challenges ahead. HIV prevalence in the county is among the highest in the country, new HIV infections have been estimated at 5,976 annually, which is unacceptably high. We

8 must all double our efforts in HIV prevention to turn off the tap of new infections. I am happy to note that the strategic plan will focus attention on the eight strategic directions as provided by the Kenya AIDS Strategic Framework (KASF).

The KCHASP presents an opportunity for the county response to be more effective in preventing infections, enhancing care, treatment and support, and mitigating the impact of HIV and AIDS, and if we succeed, in making an impact in the development agenda of the county. Kisii county Government aims to sustain the success rate in treatment of people living with HIV, ensuring that Orphans and Vulnerable Children enjoy equal rights and care, and scaling up effective evidence-based prevention strategies. The KCHASP further supports systems strengthening across all levels to sustain the collaboration and achievements gained by the county, including strengthening monitoring and evaluation efforts. Kisii County Government will strengthen its monitoring and evaluation efforts to enable implementers to recognize and reinforce good performance, and improve or reprogram activities that are not on track, to ensure that the response delivers on the intended results. This is an exciting time when there are opportunities to increase the resource base to fund an effective response to the development challenges posed by the epidemic in collaboration with our development partners.

It is our responsibility to ensure an enabling policy and legal environment for the effective county HIV response implementation. KCHASP provides a comprehensive strategy for the effective management and control of the HIV and AIDS epidemic and its direct consequences in Kisii County; all the stakeholders are encouraged to use it as a tool and roadmap in the expanded county response to HIV and AIDS.

HON. SARAH OMACHE COUNTY EXECUTIVE COMMITTEE MEMBER FOR HEALTH KISII COUNTY

9 Acknowledgements

he successful development of the first Kisii County HIV & AIDS Strategic Plan (2014/15– 2018/19) involved a long consultative process Twith stakeholders. Subsequent completion was made possible by the joint efforts of organizations and individuals whose participation needs to be acknowledged.

First, the County Government wishes to acknowledge with gratitude the valuable contribution of a number of individuals and organizations who made the process a success. We wish to express special thanks and appreciation to the members of the technical working group, namely; Dr. Richard Onkware, Mary Rogito and Yunia Nyaisu, (MoH) Misheal Oyunge and Ibrahim Nyachae (CACC); Kizito Mukhwana, Dr. Elizabeth Katiku, Dr. William Ringera, Judy Omare and Beatrice Moseti (CARE Kenya); Rev James M. Mogire and Ezekiel Rasugu (FBO); Fredrick Ongaki (ICL); Joshua Simba (KCG); Jamal Obwoge (NEPHAK); Gordon Okello, Monica Chan and Daniel Yongo (IRDO); Pauline G. Okemwa (Kisii University); Roselyne Igwora (KCCB-KARP); Kavutha Mutuvi (UNWomen); Harriet Kongin (UNAIDS) and Caleb Owino (IMC) for their dedication, hard work and availability, especially when they were called upon at short notice.

We would also like to thank all Development Partners including UNAIDS,UN-Women and CARE Kenya for their financial support and technical assistance. We also appreciate the Kisii County Government, Civil Society Organizations, Faith-Based Organizations and religious leaders for their valuable contributions towards completion of this document.

Special appreciation goes to the NACC regional officer for the coordination and who worked tirelessly for long hours to ensure the success of this process.

We acknowledge the support from all county leaders under the guidance of His Excellency the Governor James Omariba Ongwae, of Kisii County, towards the development of this fundamental document. It is our expectation that similar support/effort will be provided for during the implementation of the Kisii County HIV & AIDS Strategic Plan.

“Let us now join together, mobilize the necessary resources and implement the strategies as outlined in this document.”

Dr. Geoffrey Otomu County Director of Health KISII COUNTY 10 Executive Summary

he Kisii County HIV & AIDS Strategic is also cognizant of, and builds on national policies Plan (KCHASP) was developed to provide and frameworks including the Constitution of the a framework for the implementation, Republic of Kenya of 2010, which provides for the coordination and monitoring of HIV and right of every Kenyan to attain the highest possible TAIDS response in the County. levels of health care, Vision 2030 which describes HIV and AIDS as “one of the greatest to socio-economic The process of developing the KCHASP commenced development in Kenya”, Kenya Health Policy 2012- after the National AIDS Control Council held a KASF 2030 and County Integrated Development plan 2013- dissemination meeting at the Grabo County Hotel 2017. in Migori County on the 12th and 13th of August 2015 and subsequent formation of a 10-member The KCHASP has outlined the Kisii County HIV profile technical team to spearhead the drafting process of where the prevalence of 8.0% (Kenya Prevention the strategic plan. This was followed by two other Revolution Roadmap). It is estimated that 63,715 technical team retreats at Jumuia Resort on the 6th people are living with HIV of which 7,715 are children. and 9th October 2015 and 26th to 29th October 2015 The HIV prevalence in women is higher (8.5%) than at Waterpark Resort with support from the UNAIDS, that of men (7.3%). Annual new infections stands at UNWOMEN, CARE Kenya and NACC. 5,976 (adult: 4891, Children 1085) (DHIS; Kenya HIV County Profile 2014) The purpose of this document is to outline the County priorities for the County response to HIV and AIDS The KCHASP has identified the drivers to the HIV for the period 2014/15 to 2018/19. These priorities epidemic in Kisii County are generally understood to are based on the evidence accumulated locally and include: Key populations such as sex workers (female, are augmented by international best practices. The male & transgender), casual heterosexual sex, some overall philosophy behind the Kisii County HIV & socio-cultural practices like “house entering” where AIDS Strategic Plan is one of prioritization, focus, widows exchange sexual partners, casual laborers, and intensification. It is through collective and soapstone carvers, banana/sugarcane sellers, concentrated efforts around these priorities that we Adolescents and young women (cross generational will be able to maximize the impact of the County sex) and Stigma and discrimination of People Living response. The process of developing this document with HIV. was highly consultative, generating an in-depth Despite some modest gains in the HIV response in picture of the epidemic and its response. the county, significant gaps and challenges remain The KCHASP is responsive to international and to be addressed or overcome. These main gaps and Regional HIV Rights agreements, policies and challenges include under-funding of prevention Declarations, including global obligations such as the strategies; limited capacities for prevention as well SDGs, UNGASS and Universal Access targets to HIV as implementation and management; perennial & AIDS services, the Abuja Declaration of Heads of shortage of HIV commodities; weak community and States, and ILO conventions, among others. KCHASP health linkages, ownership of the HIV response and

11 participation; insufficient targeted interventions; The following are the objectives of the KCHASP: weak strategic information management; and 1. To increase access to health care services for insufficient scale up of treatment, care, and support. HIV prevention. Taking this situation as the starting point, the priority 2. To strengthen community and health systems areas were built and refined through dialogue and capacity for Universal Access to quality, inputs provided across sectors and at all levels of the comprehensive and sustainable HIV and AIDS County response. In order to maximize the impact services. over the next five years, listed below (in no particular 3. To effectively coordinate, harmonize and align order) are areas that must be the focus of the County stakeholder support to the County response at response: all levels. • Preventing new infections 4. To strengthen and sustain political leadership • Systems strengthening; (health and and commitment on HIV and AIDS at all levels. community systems) 5. To improve the ethical and legal environment to • Strategic information management and support the County response. research 6. To strengthen the information management • Scaling up treatment, care and support system of the County response to enhance information sharing and utilization. 7. To increase access to HIV and AIDS The KCHASP has aligned the vision, goal and comprehensive quality treatment, care and objectives to the KASF as follows: vision – support services. “Accessible, Caring and High Quality HIV Health Care Services to mitigate stigma and HIV & AIDS 8. To enhance County ownership of the HIV burden in Kisii County”. While the overarching goal response by allocation of resources in the is to have an effective, efficient and robust HIV & implementation of the KCHASP. AIDS response within the county that will improve 9. To promote non-discriminatory delivery of HIV the entire continuum of care and treatment, reduce services to vulnerable and key population. structural barriers for all populations and build upon evidence based prevention interventions”.

12 The KCHASP has adopted the KASF 8 Strategic Directions as follows:

Strategic Direction Area Specific Objectives Key Intervention Area

SDA 1: To identify and target the priority Increase coverage of combination populations for HIV services HIV prevention services, prioritize Reducing new HIV infections the population and identify the geographical location. SDA 2: Improving health outcomes and To improve HIV services for PLHIV Increase HTS and adherence to ART well being of all people living with HIV SDA 3: Using a human rights based To increase equitable access to HIV Identify and remove barriers to HIV approach to facilitate services for PLHIV, services to PLHIV services through a HRBA. key populations and other priority groups in all sectors SDA 4: Strengthening integration of health To strengthen linkage between health Strengthen HIV information education services and community systems services and community systems for activities, establish more community HIV response units, increase outreach to those with limited access to health services. SDA 5: Strengthening research and To strengthen research so as to have Promote the generation of domestic innovation to inform the Kisii HIV strategic information for innovations. HIV data and information. plan SDA 6: Promoting the utilization of To strengthen monitoring and Promotion of consumption and strategic information for research, evaluation of the KCHASP utilization of domestic data. monitoring and evaluation to enhance programming. SDA 7: Increasing domestic financing for a To mobilize for resources for the Domestic resource mobilization sustainable HIV response. activities. implementation of the KCHSP. SDA 8: Promoting accountable leadership To strengthen the leadership and Improve coordination, strengthen HIV for delivery of the KCHASP coordination of KCHASP. advocacy and increase participation

The Kisii County HIV & AIDS plan is a forward looking 6. Improved ethical and legal environment for HIV document that frames the County’s response in and AIDS. terms of what it should look like by the year 2019. 7. Increased availability of quality, comprehensive Thus, the Overall Strategic Outcomes for the period and harmonized information on the response to are: the epidemic. 1. Improved utilization of health care services for 8. Improved utilization of information by HIV prevention. partners for policy development, advocacy and 2. Communities empowered to effectively programming. respond to HIV and AIDS. 9. Improved basic and operational research, 3. Improved access to quality HIV and AIDS monitoring and evaluation of the HIV and AIDS services. response. 4. Partners aligned to County priorities and held 10. Improved access to comprehensive quality accountable. treatment, care and support services 5. Adequately resourced County response.

13 CHAPTER 1

Background Information on the County

1.1: Introduction

isii County is one of the forty seven counties in Kenya. It shares common borders with Nyamira County to the North East, Narok County to the South and Homa Bay and Migori Counties to the West. The County lies between latitude 0 degrees 30‘ and 1 degrees South, and longitude 34 degrees 38‘ and 35 degrees East. The County covers a total area of 1,317.5km2 and is divided into nine constituencies namely: Kitutu Chache North, Kitutu Chache South, Nyaribari Masaba, Nyaribari KChache, Bomachoge Borabu, Bomachoge Chache, Bobasi, South Mugirango and Bonchari. It has 9 Sub-Counties (constituencies), which are subdivided into 45 electoral wards. The county has 24 divisions, 75 Locations and 190 sub-locations. The County has an estimated population of 1,236,966 (2012). This represents 597,934 and 639,032 – males and females respectively. By 2017, this population is expected to rise to 1,367,049 persons (660,810 males and 706,239 females). The poverty level in the County is placed at 51 percent compared to the national poverty index which is at 43.8. The county is estimated to have 125,000 orphans and vulnerable children (County Integrated Development Plan, 2013-2017). Kisii County has a HIV prevalence of 8.0% (Kenya Prevention Revolution Road map). It is estimated that 63,715 people are living with HIV of which 7,715 are children. The HIV prevalence in women is higher (8.5%) than that of men (7.3%). Annual new infections stands at 5,976 (adult: 4891, children 1085) (DHIS; Kenya HIV County Profile 2014). Kisii County inhabitants are predominantly of the Kisii ethnic community. They practise traditional Female Genital Mutilation/Cut (FGM) in secrecy and with the use of unsterilized paraphernalia. This is a contributing factor in the new infections among adolescents and young girls in the county. Consequently, this has contravened the legal rights of the girl-child. In the recent past, health

14 Fig 1.1: Kisii County Map

15 Kisii County

16 workers have been participating in the malpractice Prevention of Mother–To-Child Transmission for economic gains. (PMTCT) services were rolled out in the year 2003 HIV & AIDS has a major socio-economic impact after the health care providers underwent a PMTCT in the County, it poses a negative impact on the training organized by NASCOP. The trained personnel agricultural sub-sector which is a major economic introduced HIV counseling and testing (use of rapid activity employing over 80 percent of the County’s HIV test kit) and provision of single dose Nevirapine population. HIV & AIDS related mortality of the skilled to pregnant mothers to be taken at the onset of and experienced staff and farmers has resulted in labour in mother and child clinics. Soon after more low production particularly of food crops. This has service providers were trained on PMTCT and more affected food security at household and county level. sites started offering PMTCT services. Currently 90% of the facilities in Kisii County and 100% of public HIV & AIDS has also negatively impacted on the health ones are offering PMTCT services. sector. HIV & AIDS related morbidity has resulted in an increase in the number of people seeking health Care and treatment services were started in KTRH, services thus household resources are diverted to by then known as Kisii District Hospital in October health care (The first County Integrated Development 2004, led by the then hospital physician, who Plan 2013-2017 Kenya) . ensured that all the HIV-positive patients admitted in the ward with HIV-related illness received ARVs which were available in the pharmacy at a cost of 1.2: The evolution of HIV & AIDS Kshs. 500. Follow up was done on monthly basis. response in Kisii County The services provided for the People Living with HIV The HIV services provision started in year 2000 at Kisii and AIDS (PLHIVs) were not accurately documented District Hospital currently known as Kisii Teaching and reported since the reporting systems was not and Referral Hospital (KTRH). The programme was in place and clients were strictly attended to by the supported by NASCOP and Liverpool VCT. The facility Medical Superintendent. Despite the fact that there carried out HIV voluntary counseling and testing, was a lot of reported stigma and discrimination while the counsellors were trained and certified by directed toward the PLHIVs. The trained counsellors NASCOP. offered the service to the clients while attaching the new clients to the newly formed psychosocial In the wards, HIV testing started much earlier support groups. with minimal counselling; ELIZA test was used for diagnostic HIV testing. The HIV testing was not well As the number of clients increased, HIV clinic structured, the results were not disclosed to the was set up in one of the rooms in the outpatient clients/patients. However, the test results enabled department. CDC/KEMRI supported the the doctors to manage clients with opportunistic implementation and additional staff was trained infections effectively. Later on, the Ministry of Health on the HIV service provision. Afterwards, MERLIN (MoH), with the support from partners was able came in to supplement the efforts of the MoH as the to train more counsellors on HIV counselling and number of clients increased and by setting up a new testing. This resulted in HIV Testing (and counseling) HIV Clinic structure at the KTRH. Extra health care Services (HTS) being scaled up to other higher personnel were trained; consequently, this led to volume facilities such as Gucha, Oresi, Keumbu, the decentralization of ART services to high-volume Marani, Hema and Kegogi among others. health facilities such as Keumbu, Gucha, Oresi, Marani among others. Currently, 80% of the facilities in Kisii County are offering ART services.

17 CHAPTER 2

Situational Analysis

sex, some socio-cultural practices such as “house 2.1 Population and demographics entering”, where widows exchange sexual partners. The County has an estimated population of 1,236,966 Other are key populations such as sugarcane cutters, (2012). This represents 597,934 and 639,032 – males soapstone carvers, banana/sugarcane sellers, and females respectively. By 2017 this population adolescents and young women (cross generational is expected to rise to 1,367,049 persons – 660,810 sex) and stigma and discrimination of People Living males and 706,239 females (County Integrated with HIV. Development Plan, 2013-2017). According to the Kenya Demographic Health Survey of 2014, about 78.2% of women and 64.8% of men in 2.2 HIV epidemiology of Kisii County Kisii County had tested and received results for HIV by 2013. The overall HIV prevalence among adults and children was 8.0% translating into 63,715 PLHIV in There is a need to scale up HIV testing in the County Kisii County out of which 56,000 are adults and 7,715 to reach the untested population, counsel to reduce are children. The HIV prevalence among women in the risk for those who test negative and link those Kisii County is higher (8.5%) than that of men (7.3%). who test positive to care and treatment programmes. Over the years, the women living in the County have This will ensure that those who are HIV negative been more vulnerable to HIV infection than men. are counselled on better ways to ensure they stay (County HIV profile, 2014). This can be attributed to negative, while those who are HIV positive will be male dominance in the Kisii Community setting. taken through the process of positive living and also the need to adhere to treatment. Disclosure methods The drivers of the epidemic, (being verified through can also be taught to those who turn HIV positive the consultation process and programming data) during the testing visits hence reducing the stigma are generally understood to include: Commercial associated with HIV. Sex workers (female, male), casual heterosexual

18 Currently, Kisii County is among the counties with elimination of mother to child transmission of HIV. relatively high HIV prevalence which currently stands The county has a 56% gap to be met in order to at 8.0%, with an estimated 4,891 new HIV infections in achieve reduction of EMTCT rates. Currently the adults and 1,075 new HIV infections in children. Kisii County EMTCT rates are at 8% which is high above is ranked at number 42 out of 47 counties in terms of the National target of 5% (and twice the regional rate the HIV burden (HIV and AIDS Profile - Kisii County). of 4%) (County HIV service delivery profile, 2014). This Consistent and proper use of condoms can reduce scenario is attributed to (but not limited to) some the risk of HIV and other sexually transmitted mothers declining to take up EMTCT services (mainly infections by more than 90 per cent. In Kisii County, due to stigma), lack of commitment from private low condom use may pose a significant risk of HIV health facilities in provision of the comprehensive infection to the population. However, 81.7 % of the HIV care services, low level of disclosure among women and 89.8% of men in Kisii County believe that partners, knowledge gap and staff attitude among condom use can prevent HIV transmission (Kenya other reasons. Demographic Health Survey, 2014) In Kisii County, adult ART coverage is at 34% (18906) Therefore, low uptake of condoms in Kisii County can while paediatric ART coverage is at 28% (2064). be attributed to the perennial shortage of condoms This is much lower than the national coverage supply in the County. for both adults and pediatrics which is at 81% and 38% respectively (DHIS, Kisii County profile, Kenya In Kisii County, approximately 55% of individuals had HIV estimates). Using the 90:90:90 strategy, 45,360 their first sexual intercourse before the age of 15, an adults and 6,250 children are in need of ART. The indication of early sexual debut (County HIV profile, County is ranked 42 out of 47 and 43 out of 47 in ART 2014). coverage among adults and children respectively. According to the “Kenya Fast Track Plan to End HIV Approximately 1,352 adults and 492 children died of and AIDS among Adolescents and Young People, AIDS-related conditions in 2013. (Kenya HIV County 2015”, in Kisii County it is estimated that 13,079 Profiles, 2014) adolescents aged 15-24 years are living with the virus, while approximately 5,012 do not know their HIV status and could be contributing to the new Gaps and challenges analysis infections in this age group. (biomedical, behavioral, structural) Looking at the County’s need analysis, there are 4,118 The gap analysis for Kisii County health service HIV-positive mothers in need of ARVs, but currently provision is based on the World Health Organization’s the coverage is at 44% using the national Elimination six building blocks of health system strengthening of Mother-To-Child Transmission. EMTCT targets framework that promotes the HIV service delivery.

19 Table 2.1: WHO’s six building Blocks of Health System Framework

WHO’s Six Pillars of Gap and Challenges Analysis Health

Service Delivery • Limited integration of HIV services into routine health services • Insufficient scale-up of treatment, care and support • Inadequate supportive infrastructure to enhance ART monitoring like Viral Load Machine, i.e. space, reagents, personnel etc • Inadequate EBI’s targeting different age groups • Unstructured programmes towards eradicating HIV-related stigma and discrimination • Outdated social cultural beliefs and norms that fuel the epidemic of HIV for example FGM • Inadequacy of service to mitigate SGBV among the vulnerable populations i.e. Orphans & SW • Inadequate infrastructure (physical, HR & information technology) to accommodate specific HIV services namely care and treatment, Dice for KP etc. • Under utilization of HIV online platforms for HIV related emergency services within the county. • Weak community and health linkages/referral, i.e. defaulter tracing

Human Resource • Low coverage of Kenya Mentor Mothers Programme • Inconsistent capacity building of service providers in HIV-related updates • Insufficient technical Capacity in the management of HIV and AIDS patients i.e. newly employed staff

Information • Lack of research that can be used to inform the existing gaps. • Underutilization of the social and main stream media platforms for example the local radio stations, newsletters etc. Peer influence and misinformation, among the youths and adolescents. • Insufficient use of strategic information, data demand and use for decision making and irregular performance review mechanism.

Medical Products • Erratic and inadequate supply of HIV/STI related commodities Vaccines and • Weak HIV commodity management and supply chain systems within the county. Technology

Financing • Inadequate budgetary/ funding allocation towards TB-HIV & AIDS activities.

Leadership and • HIV Testing (and counseling) Services HIV Testing (and counseling) Services Limited policy documents Governance that enhance oversight of health services • Poor involvement mechanism for the religious/cultural leaders on HIV prevention within the community i.e. on condom use - Lack of political will and buy-in on some of the HIV activities e.g. the KP interventions - Poor parenting to the adolescents on sexual reproductive health. • Inadequate budgetary/ funding allocation towards TB-HIV & AIDS activities. • Poor accountability structures on HIV received funds at the periphery. - Unreliable structures to oversee the HIV & AIDS activities on the ground.

20 CHAPTER 3

Rationale, Strategic Plan Development Process and the Guiding Principles

3.1 Purpose Specifically, the plan will guide the Ministry of Health together with other implementing partners Strategic Plans were introduced as a performance in enhancing its performance and service delivery, management tool to enable public and private sector stimulating strategic thinking, providing a basis institutions to focus their work strategically and to for resource mobilization, and allocation as well as enhance efficiency and accountability in the use of contribution to the attainment of the Kenya Vision resources. The strategic management paradigm 2030 and the County Integrated Development Plan has largely been successfully implemented with (CIDP) goals and aspirations. tangible results. The policy plan of the HIV response is defined by the Constitution of Kenya, 2010 (which establishes a right “to the highest attainable 3.2 Process of developing the HIV Plan standard of health”) and the resulting devolution of The KCHASP was developed in four stages as follows: the responsibility for the implementation of most i) Joint end-term review of the Kenya National health services, including the HIV response at county AIDS Strategic Plan III (KNASPIII) level. The national development strategy, Kenya Vision 2030, underscores the importance of health ii) Development and Dissemination of the Kenya as a key building block in transforming Kenya into a AIDS Strategic Plan (KASF) successful middle-income country; the HIV policy of iii) Development, Review and Validation of Kisii 1999, which defines HIV as a disaster and provides County HIV & AIDS Strategic Plan (KCHASP) a framework for a multi-sectoral response; and the iv) Costing of the Strategic Plan. Kenya Health Policy that prioritizes the elimination of communicable diseases. The process was broadly participatory and involved stakeholders from communities, Civil Society This Strategic Plan lays the foundation for the Organizations (Impact Research and Development county’s response to HIV at both county and sub- Organization, CARE Kenya, I Choose Life and county levels’ priorities for a five-year period. International Medical Corps), People Living with HIV

21 (NEPHAK), private sector, and development partners health status. The strategy takes into consideration (including United Nations agencies of UNAIDS and equity-motivated interventions that seek to allocate UN-Women), tertiary institutions of learning (Kisii resources preferentially to people with the worst University) Faith-Based Organization (Church of God health status or largest disease burden. This & Kisii Assemblies of God), and County Government requires increased understanding and the need to of Kisii. Stakeholders were involved through technical influence the redistribution of resources for health working groups and programme consultations. and specifically for HIV interventions. Technical review, conducted by a team of reviewers, was coordinated by NACC. 4. Enhanced focus on key population

Commitment to accelerate and scale up HIV 3.3 Guiding principles prevention among key population such as Commercial The key principles that will guide this county HIV Sex Workers and their clients and Men who have Sex strategy plan are based on the desire to move towards with Men (MSMs). more results-based planning and management and will include: 5. Universal health access Universal health access aspires to provide a specified 1. Delivery of integrated services package of health benefits to all members of a In order to leverage scarce resources and to deliver society with the end goal of providing financial risk value for money and enhance sustainable quality protection, improved access to health services and services, Health Sector HIV and AIDS services improved health outcomes. This is more critical for must be integrated into shared health care delivery HIV and AIDS services where the impact is greatest infrastructure so that resources (human, financial in the poorest segment of the population. To achieve and material) and facilities are used wisely to this, the health sector will require a strong, efficient reap economies of scale. The strategy provides for and well-run health system; a system for financing increased integration of HIV and AIDS services in the health services; access to essential medicines general health care system, especially at the service and technologies; and sufficient human resource delivery levels and health system interventions. capacity in the form of well-trained, motivated health workers. This strategy depends on the success of other health sector initiatives/strategies 2. Coordination of multi-sectoral HIV response such as the County Health Strategic and Investment Commitment to forge consistent and effective Plan (CHSIP), 2013/2014-2018/2019 and the Health partnership and collaboration with development Financing Strategy HFS. partners, the private sector, and civil society through harmonized and aligned ways of working to support 6. Rights of vulnerable groups and the HIV & AIDS response at all levels. The sub-county gender-based approach HIV Coordinators (CACCS) and SASCOS will guide the coordination and implementation of the key HIV While more women than men are seen to access interventions in this plan. HIV testing and ART services, they are on the other hand disproportionally affected by HIV and AIDS as well as other social determinants for health (higher 3. Equity prevalence, incidence, poverty, low education). This is Equity in access to health services aims to address in turn compounded by gender-based discrimination unnecessary, avoidable and unfair differences in and violence. Commitment to promote and protect

22 the rights of women, children, young people, and 10. Accountability reduce their vulnerability to HIV is the key issue in Strong, accountable and effective leadership at this plan. all levels of the KCHASP delivery is critical for the efficient implementation of this strategic plan. The 7. Leadership and stewardship of the county strategy provides structures to ensure accountability response to government, funding partners and the Strong political leadership and stewardship of the communities served in terms of resource utilization, county HIV & AIDS response and commitment to service provision and health outcomes achieved at transparency and prudent management of financial all levels of the health sector. This will ensure that and other resources at all levels of the response. all actors are doing the right thing the right way.

8. Decentralization 11. Quality Continued devolution of resources and key In the roadmap of KCHASP implementation, quality responsibilities, including planning, organizing, will be ensured by working according to national coordinating and control of service delivery to county standards and guidelines aimed at improving the and sub-county government authorities, health health status of individuals and communities. facilities and community-based organizations from Specifically, the health sector will work towards the wards to the sub-counties and hospitals where increasing HIV preventive measures, reducing health services are provided. suffering due to AIDS and increasing client satisfaction, while ensuring that services rendered are effective and efficient. The focus on quality will 9. Rights and Meaningful Involvement of further be enhanced and centered on evidence- People Living with HIV (MIPA and MIEPA) based medicine and rational public health decision This plan seeks for protection and promotion of making. the rights and access of PLHIV to comprehensive prevention, treatment, care and support services 12. Sustainability and local ownership as well as reduction of stigma and discrimination. The strategy prioritizes sustainability of interventions, The health sector recognizes the important role that results and outcomes with a focus on approaches for can be played by PLHIV and has strived to ensure financing HIV and AIDS services, management of their involvement early in the process i.e. from the financial, material and human resources, community review process of the KASF and its dissemination ownership, organizational development, service to development of this Kisii County HIV Strategic availability, coverage, and accountability to ensure the Plan. The interventions in this strategic plan provide efficiency, efficacy and effectiveness of health sector for meaningful involvement and empowerment of HIV and AIDS interventions. Different elements and PLHIVs in all the implementation and monitoring domains of sustainability will be monitored using of the multi-sector HIV response. All actors at sub- Sustainability Index and Dashboard. county level, including wards, health facilities (both public, faith-based and private) are expected to adhere to this guiding principle.

23 13. Public Private Partnership planning policies that make the County Government the sole provider and financier of health services. The Strategy promotes partnership with all Development of a county PPP policy, health sector stakeholders, taking full advantage of the synergies PPP strategy and recognition of PPP as a key success provided by each stakeholder group. Going forward, factor for the five-year strategic plan, 2015-2019, will the county Government will aggressively pursue lead to a more sustainable (and diversified) health Public and Private Partnerships (PPP) in health financing situation. Currently, the health sector care delivery. The County Government will support HIV and AIDS strategy promotes PPP in all aspects appropriate policies, infrastructure development including financing, implementation and progress and maintenance as well as plug human capital and monitoring. skills gaps. This will stop the hangover of central

24 CHAPTER 4

Vision, Mission, Objectives and Strategic Directions

Vision

Accessible, Caring and high quality HIV health care services to mitigate stigma and HIV & AIDS burden in Kisii County.

Mission Statement

To improve health status through the prevention of new HIV infections and the promotion of healthy lifestyle and to consistently improve the health care system by focusing on access, equity, efficiency, quality and sustainability.

Objectives

1. To increase access to health care services for HIV prevention. 2. To strengthen community and health systems capacity for universal access to quality, comprehensive and sustainable HIV and AIDS services. 3. To effectively coordinate, harmonize and align stakeholder support to the county response at all levels. 4. To strengthen and sustain political leadership and commitment on HIV and AIDS at all levels. 5. To improve the ethical and legal environment to support the county response. 6. To strengthen the information management system of the county response to enhance information sharing and utilization. 7. To increase access to HIV and AIDS comprehensive quality treatment, care and support services. 8. To enhance county ownership of the HIV response by allocation of resources in the implementation of the KCHASP. 9. To promote non-discriminatory delivery of HIV services to vulnerable and key populations. Strategic Directions

Strategic Direction 1: sugarcane sellers, adolescents and young women (cross generational sex). Reducing HIV new infections (e) Stigma and discrimination of People Living Kisii County has an estimated population of 1,259,489 with HIV. with a HIV Prevalence of 8.0% (Kenya Prevention Revolution Roadmap; 2014). It is estimated that 63,715 people are living with HIV, of which 7,715 are children. Key Intervention 1: The HIV prevalence in women is higher (8.5%) than Granulate the HIV epidemic to intensify prevention that of men (7.3%). Despite the resources and HIV efforts to priority geographies and populations reduction interventions that the county has put in place, the annual new infections stand at 5,976; 4,891 In Kisii County, a high prevalence of HIV is noted adults and 1,075 children (DHIS; Kenya HIV County among communities living along the administrative Profile 2014). borderline. This could be associated partly but not exclusively to cross-infection at the border regions. The county still has much to be done in combating this It is observed that some health facilities such as epidemic. This can be done by enhancing HIV testing Mosocho Dispensary, Raganga HC, Matongo Health and identification of newly infected people, improving Centre and Nyabiosi Dispensary have recorded high linkage and referral systems, decentralizing HIV positivity in HTS (6%). A joint inter-county effort services to the periphery, promoting sexual behaviour should be put in place to sensitize the populations change and male involvement just to mention a few. living at the border lines both within and without the Currently, Kisii County is among the counties with county so as to reduce the high incidences occurring a high HIV incidence with an estimated 4,891 new in these regions. HIV infections occurring in adults and 1075 new HIV It is theorized that Key Populations such as sex infections occurring in children annually. workers and priority groups such as adolescents The following can be considered as drivers of HIV & and young adults are among the drivers of the AIDS epidemic in the county: HIV epidemic in Kisii County. According to service (a) Sex workers (female, male & trans-gender) and delivery data, it is estimated that there are 4,000 their clients. FSWs in Kisii town alone and their estimated HIV Prevalence is 10.1%. HIV positivity in the chest clinic (b) Casual heterosexual sex. is from 25% to 40% (TB program data). (c) Some socio-cultural practices such as “house The county should put more effort in geographical entering” where widows exchange sexual locations with high HIV prevalence as well as partners at will though not universally accepted. implement comprehensive package services for key (d) Presence of priority populations such as and priority populations. sugarcane cutters, soapstone carvers, banana/

26 Table 4.1: Granulation of HIV per sub-county (Kisii County)

Sub-County Population (2015) Estimated no of PLHIVs HIV Prevalence (Kenya HIV and AIDS Estimates 2014)

South Mugirango 191,193 7023

Bonchari 130,006 4775

Kitutu Chache South 164,791 6053

Kitutu Chache North 122,674 4506 8.0%

Bomachoge Chache 110,063 4043

Bomachoge Borabu 126,148 4911

Bobasi 215,320 7909

Nyaribari Masaba 140,013 5143

Nyaribari Chache 147,167 5406

27 Key Intervention 2: Adopt and scale up effective evidence-based combination prevention

Interventions for scaling up evidence-based combination HIV prevention

KASF KCHASP Target Key Activity Sub Activity/ Geographic Responsibility Objective Results Population Intervention Areas by county/Sub- County

BIOMEDICAL INTERVENTIONS

Reduce new Reduce new General Offer innovative • Innovative HIV testing • Kisii County MoH HIV infections HIV infections Population and evidence- and counseling (HTS) (9 Sub- by 75% by 75% based HIV models Counties) Implementing prevention and • Linkage of those Partners care activities. testing HIV positive to care and early ART Kisii County initiation Government • Prevention and management of co- infections and co- morbidities • Support and ensure safe circumcision practices among the traditionally circumcising communities • Offer gender-based violence care services including post-exposure prophylaxis (PEP) for survivors

Key Roll out package • Provision of key • Kisii County MoH Populations of care for Key commodities including (9 Sub- Implementing and vulnerable Populations and lubricants and condoms Counties) Partners groups vulnerable groups • Screening and management of HPV among FSW/MSM and Hepatitis B and C • Scale up STI management in all health facilities • Provide pre- exposure prophylaxis services(once approved by the Ministry of Health) Adolescents Implement • Innovative HIV and STI • Kisii County Kisii County and Young package of testing (9 Sub- Government Women services for AGYW • Establish youth Counties) MoH (AGYW) friendly clinical services Implementing • Offer age appropriate Partners contraceptives, condoms, and microbicides. • Offer HPV screening and education • Increase access to sexual and reproductive health services • Offer behaviour change interventions in order to delay early sexual debut

28 KASF KCHASP Target Key Activity Sub Activity/ Geographic Responsibility Objective Results Population Intervention Areas by county/Sub- County Reduce new Reduce new PLHIV Offer package • Offer HTS to partners • Kisii County Kisii County HIV infections HIV infections and sero- of services and families of all HIV (9 Sub- Government by 75% by 75% discordant for PLHIV and positive clients Counties) couples sero-discordant • Provide ART to the MoH couples infected partner and adherence support Implementing • Provide pre-exposure Partners prophylaxis (once approved by the Ministry of Health). • Active monitoring of viral load for the HIV + partners and offering viral load counselling as an independent package

Children and Implement • Integrate early infant pregnant strategies to diagnosis of HIV with women living identify and retain immunization services with HIV HIV-positive • Deliver all 4 prongs pregnant and of EMTCT at 100% lactating women of health facilities and their infants. countrywide. Offer comprehensive Adopt new interventions to prevent national and WHO HIV among young guidelines on women; ensure all eMTCT HIV-positive women of reproductive health age have access to family planning; • Integrate EMTCT with MNCH services. Ensure all pregnant and lactating women are initiated on ART and all HIV-positive children are offered ART. • Integrate HIV testing in FP/PN clinics, Integrate early infant diagnosis of HIV with immunization services. • Integrate eMTCT with MNCH services etc). • Offer GBV services including services for post-rape and incest among children. • Treat all persons infected irrespective of CD4 levels and PrEP for those at high risk for transmission/ acquisition of HIV.

29 KASF KCHASP Target Key Activity Sub Activity/ Geographic Responsibility Objective Results Population Intervention Areas by county/Sub- County

BEHAVIOURAL INTERVENTIONS

Reduce new Reduce new General • Implement • Stigma reduction • Kisii County Kisii County HIV infections HIV infections Population strategies to campaigns (9 Sub- Government by 75% by 75% address HIV • Risk reduction Counties) related stigma counseling and skill MoH • Promote life building skill programs • Male and among vulnerable female condom populations demonstration, distribution and skill building

Key • Behaviour • Regular outreach • Kisii County Kisii County Populations change and contact with Key (9 Sub- Government and vulnerable intervention Populations through Counties) groups using specific peer based education, MOH interpersonal treatment and support Implementing tools and • Offer harm reduction Partners techniques interventions to including those in vulnerable populations Braille AGYW Implement • Offer peer-to-peer • Kisii County Kisii County evidence-based outreach in school or (9 Sub- Government interventions (EBI) outside school Counties) MoH for adolescents • HIV and RH related Implementing and young women education in school or Partners and provide HIV in the community and RH related • Implement life skills education in programs for youth schools in school and out of school

PLHIV Implement • Implement Positive • Kisii County Kisii County and sero- appropriate Health dignity and (9 Sub- Government discordant evidence-based Prevention (PHDP) Counties) couples behavioral • Offer peer outreach MOH interventions. and support services to create treatment Implementing and rights awareness Partners as well as PSSGs to enhance adherence Children and Implement Kenya • Psycho-social and • Kisii County Kisii County Pregnant Mentor Mother peer support services (9 Sub- Government Women Living Program for pregnant women Counties) with HIV • Infant and young MOH children feeding strategies Implementing • Empowerment Partners of caregivers of orphans vulnerable children and other stakeholders on rights of children in regard to HIV & AIDS

30 KASF KCHASP Target Key Activity Sub Activity/ Geographic Responsibility KASF KCHASP Target Key Activity Sub Activity/ Geographic Responsibility Objective Results Population Intervention Areas by Objective Results Population Intervention Areas by county/Sub- county/Sub- County County

BEHAVIOURAL INTERVENTIONS STRUCTURAL INTERVENTIONS

Reduce new Reduce new General • Implement • Stigma reduction • Kisii County Kisii County Reduce new Reduce new Children and Provide an • Implement • Kisii County Kisii County HIV infections HIV infections Population strategies to campaigns (9 Sub- Government HIV infections HIV infections Pregnant enabling gender-based (9 Sub- Government by 75% by 75% address HIV • Risk reduction Counties) by 75% by 75% Women Living environment for violence prevention Counties) related stigma counseling and skill MoH with HIV programming and response MoH • Promote life building programmes skill programs • Male and • Address the issue Implementing among vulnerable female condom of violence against Partners populations demonstration, Key Populations distribution and skill through appropriate building crisis response mechanisms • Implement stigma reduction campaigns • Strengthen linkages between Key • Behaviour • Regular outreach • Kisii County Kisii County communities and Populations change and contact with Key (9 Sub- Government facilities and vulnerable intervention Populations through Counties) • Men involvement in groups using specific peer based education, MOH eMTCT interpersonal treatment and support Implementing • Implement tools and • Offer harm reduction Partners programmes to keep techniques interventions to girls in school and including those in vulnerable populations social protection of Braille vulnerable families AGYW Implement • Offer peer-to-peer • Kisii County Kisii County • Strengthen evidence-based outreach in school or (9 Sub- Government protection of rights interventions (EBI) outside school Counties) MoH and empower key for adolescents • HIV and RH related Implementing and vulnerable, and young women education in school or Partners populations such as and provide HIV in the community creation of drop- and RH related • Implement life skills in centres, rights education in programs for youth awareness schools in school and out of • Establish youth- school friendly centres • Engage private sector to formalize PLHIV Implement • Implement Positive • Kisii County Kisii County a system to and sero- appropriate Health dignity and (9 Sub- Government compliment the discordant evidence-based Prevention (PHDP) Counties) service delivery couples behavioral • Offer peer outreach MOH system and reporting interventions. and support services requirements to create treatment Implementing • Protection from and rights awareness Partners cultural issues/ as well as PSSGs to practices that are enhance adherence directly linked to HIV, Children and Implement Kenya • Psycho-social and • Kisii County Kisii County e.g. FGM Pregnant Mentor Mother peer support services (9 Sub- Government • To initiate IGAs for Women Living Program for pregnant women Counties) Key Populations and with HIV • Infant and young MOH vulnerable groups children feeding • Promote post- strategies Implementing test HIV clubs • Empowerment Partners and psycho-social of caregivers of support groups orphans vulnerable • Initiate children and other programmes to stakeholders on rights address inter- of children in regard to generational sex HIV & AIDS

31 Key Intervention 3: Maximise efficiency in service delivery through integration

Interventions for increasing knowledge of HIV status and linkage to other services

Intervention Areas Recommended Actions Responsibility

Adopt population and • Strengthen facility-based PITC and ensure linkage to care. Kisii County Government geography- specific • Deliver routine community-based HTS for priority and key HTS populations. MOH approaches • Deliver door-to-door testing and community-based testing at population scale in high prevalence areas. Implementing Partners • Undertake high yield and effective strategies for HTS for targeted geographic areas and populations.

Strengthen HIV • Strengthen early infant HIV diagnosis and innovative Kisii County Government diagnostic diagnostics strategies. infrastructure • Invest in adequately skilled staff, commodity security and MoH and system quality assurance mechanisms. Implementing Partners

Strengthen linkages • Obligate HTS points to account for linkage to prevention Kisii County Government to care and treatment programmes, care and treatment. • Utilize Community Link Persons/peer educators (CLPs) MoH and Community Health Volunteers (CHVs) to link diagnosed individuals with facilities and support groups. Implementing Partners • Strengthen engagement and leadership of PSSGs of people living with HIV to mobilize and facilitate HTS.

Key Intervention 4: Interventions for strengthening integration and linkages of services to catalyse HIV prevention outcomes

Interventions for strengthening integration and linkages of services to catalyze HIV prevention outcomes

Intervention Areas Recommended Actions Responsibility

Integrate HIV • Integrate comprehensive HIV prevention messages, condom Kisii County Government prevention distribution, pre-and post-exposure prophylaxis, GBV and into routine health fertility intention interventions into health services such as MOH care immunization, reproductive, maternal, neonatal and child delivery mechanisms health as appropriate. Implementing Partners • Strengthen capacity of service providers and increase demand for delivery of HIV prevention services including active engagement of private sector for eMTCT.

Strengthen • Equip and utilize peer educators, community health and Kisii County Government community outreach workers with commodities to effectively deliver and health facility- stigma free prevention and provide effective referral for MoH level services. linkages • Strengthen engagement and leadership of faith communities, Implementing Partners people living with HIV, County/Sub-County administrators, councils of elders and political leaders for HIV prevention knowledge and interventions.

32 Key Intervention 5: Intervention targeting prevention of HIV in health care setting

Interventions for increasing knowledge of HIV status and linkage to other services Interventions targeting prevention of HIV in health care setting

Intervention Areas Recommended Actions Responsibility Intervention Areas Recommended Actions Responsibility

Adopt population and • Strengthen facility-based PITC and ensure linkage to care. Kisii County Government Improve blood and • Capacity building health care workers on infection prevention Kisii County Government geography- specific • Deliver routine community-based HTS for priority and key injection safety and implement PEP programme for health care workers. HTS populations. MOH • Encourage blood donors to come for HIV results at regional MOH approaches • Deliver door-to-door testing and community-based testing at blood transfusion centres. population scale in high prevalence areas. Implementing Partners • Ensure quality assurance mechanisms for injection safety to Implementing Partners • Undertake high yield and effective strategies for HTS for eliminate HIV transmission in health care settings. targeted geographic areas and populations.

Strengthen HIV • Strengthen early infant HIV diagnosis and innovative Kisii County Government Medical waste and • Strengthen waste segregation and disposal in all levels of Kisii County Government diagnostic diagnostics strategies. IPC management the health system to minimize risk of infection. infrastructure • Invest in adequately skilled staff, commodity security and MoH • Improve the availability and accessibility of appropriate IPC MoH and system quality assurance mechanisms. equipment and infrastructure in all health care settings. Implementing Partners Implementing Partners

Deliver targeted and • Offer couples/partners HTS with supported disclosure Kisii County Government integrated HIV testing options. and counselling • Deliver integrated HTS and other packages which includes: MoH TB screening, family planning services, cervical cancer screening, other health checks such as blood pressure/sugar, Implementing Partners weight and include other risk-reduction services (counselling, condoms with lubricants, STI screening) for priority population. Strategic Direction 2: Key intervention areas • Identify and retain high risk individuals for regular HTS and screening. Improving Health Outcomes and • Intensify efforts to identify PLHIV (discussed • Scale up Positive Health Dignity and Prevention (PHDP) interventions. Wellness of All People Living with HIV in Strategic Direction 1). In Kisii County, adult ART coverage is at 34% (18906) • Improve timely linkage to care for persons Strengthen linkages • Obligate HTS points to account for linkage to prevention Kisii County Government to care and treatment programmes, care and treatment. while pediatric ART coverage is at 28% (2064). This is diagnosed with HIV. • Utilize Community Link Persons/peer educators (CLPs) MoH much lower than the national coverage for both adults and Community Health Volunteers (CHVs) to link diagnosed • Increase coverage of care and treatment and individuals with facilities and support groups. Implementing Partners and pediatrics which is at 81% and 38% respectively reduce loss in the cascade of care. • Strengthen engagement and leadership of PSSGs of people (DHIS, Kisii County profile, Kenya HIV estimates). living with HIV to mobilize and facilitate HTS. • Scale up interventions to improve quality of Using the 90:90:90 strategy; there are 45,360 adults care and improve health outcomes. and 6,250 children in need of ART. The County is ranked at position 42 out of 47 and 43 out of 47 in ART coverage among adults and children respectively. Expected output Approximately 1,352 adults and 492 children died of • Immediate linkage to care and treatment up to AIDS-related conditions in 2013. (Kenya HIV County 90% upon HIV diagnosis. profiles, 2014). • Increased ART coverage to 90% for both adults and children. • Increased retention rates for newly enrolled and active clients. • Increased viral load suppression to 90% among clients enrolled on care.

33 Key intervention 1: Improve timely linkage to care for persons diagnosed with HIV Inadequate identification of PLHIVs leads to low linkage to care and treatment. Therefore, targeted HIV testing and counselling strategies will be utilized to increase the detection rate for HIV-positive clients. Most clients are lost within the treatment cascade due to poor linkage and follow up. The County needs to strengthen referral and linkage mechanisms for these clients.

Interventions for improved timely linkage to care for persons diagnosed with HIV

KASF KCHASP Target Key Activity Sub Activity/Intervention Geographic Responsibility Objective Results Population Areas by County/Sub- County Increased Increased Children Living Intensify • Community mobilization • Kisii County MoH linkage to linkage to with HIV identification and and health education of care (9 Sub- Implementing care and care and retention in care givers. Counties) Partners treatment up treatment up of children Living • Intensified case finding Kisii County to 90% within to 90% within with HIV by testing children in MCH, Government 3 months of 3 months of outpatient, special clinic and HIV diagnosis HIV diagnosis wards with unknown status. • Improved identification Increased Increased follow-up of HEI such ART coverage ART coverage as in maternity wards, to 90% for to 90% for immunization clinics etc. both adults both adults • Age-specific psychosocial and children and children support group and activities • Implement disclosure guidelines for children. Adolescents Roll out • Provide youth friendly • Kisii County MoH and Youth adolescent’s services, psychosocial and (9 Sub- Implementing package of care peer support. Counties) Partners • Utilize technology including social media for education, recruitment and retention in care. • Implement disclosure guidelines for adolescents. Ministry of Health) Key • Roll out KPs • Mainstream KPs • Kisii County Kisii County Populations package of programming in health (9 Sub- Government and vulnerable service for Key facilities. Counties) MoH groups Populations and • Integrate care services in Implementing vulnerable groups drop-off centres. Partners Adults Intensify • Targeted HIV testing • Kisii County Kisii County identification and models. (9 Sub- Government retention in care • Improve referral and Counties) MoH for adults living patient management system Implementing with HIV and infrastructure. Partners • Implement patient retention strategies (treatment literacy sessions, peer and psychosocial support). • Strengthen facility and community linkages with inter- and intra-facility referral protocols and linkage strategies. • Establish effective tracking system of clients. PMTCT • Implement • Strengthened male • Kisii County Kisii County Mothers PMTCT guidelines involvement for PMTCT (9 Sub- Government on testing. outcomes Counties) MoH • Roll out KMMP. Implementing Partners

34 Key intervention 2: Increase coverage to care and treatment and reduce the loss in the cascade of care The county aims to increase ART coverage from 54% to 90% as well as improving the ART retention from 68% to 90% by 2019 in line with 90:90:90 targets (DHIS) . This will be achieved through proposed interventions as tabled below:

Interventions for increasing coverage to care and treatment and reduce the loss in the cascade of care

Key • Scale up key population • Kisii County Kisii County Populations friendly HIV care and treatment (9 Sub- Government and services. Counties) MoH vulnerable • Demystify myths and Implementing groups misconception that fuel Partners HIV related stigma and discrimination. • Improve HIV services for people with disabilities, poor women and children. Adults Decentralization of • Capacity building of HIV • Kisii County Kisii County ART services and service providers. (9 Sub- Government ensure commodity • Infrastructure improvement Counties) security (screening and diagnostic MoH equipment for TB, NCDs, malnutrition, opportunistic Implementing infections together with those Partners for HIV). • Improve management of NCDs among PLHIV. • Scale up prevention and interventions for TB, OIs and other co-morbidities, water and sanitation-related diseases, vaccinations for preventable diseases (cervical cancer, hepatitis, pneumococcal)..

35 KASF KCHASP Target Key Activity Sub Activity/Intervention Geographic Responsibility Objective Results Population Areas by County/Sub- County Increased Increased PMTCT Decentralization of • Implement KMMP • Kisii County Kisii County linkage to ART Mothers PMTCT services to all intervention to improve (9 Sub- Government care and coverage health facilities retention of the mother/baby Counties) treatment to 90% pair. MoH up to 90% for both within 3 adults and Implementing months children Partners of HIV diagnosis

Key Intervention 3: Improve quality of care and treatment outcomes The county will strengthen systems to improve quality of care and health outcomes through routine analysis and use of health and programme data as well as strengthening facility support and oversight for quality HIV services. The county experiences challenges such as HIV-related stigma, defaulting, poor adherence to medication, poor ART monitoring, and lack/poor dose adjustment for children as well as delays in switching clients to second line.

Interventions for increasing coverage to care and treatment and reduce the loss in the cascade of care

KASF KCHASP Target Key Activity Sub Activity/Intervention Geographic Responsibility Objective Results Population Areas by County/Sub- County Reduce Increased PLHIV To improve • Strengthen capacity of • Kisii County MoH mortality access to quality of care facilities to monitor quality of (9 Sub- Implementing by 25% and monitoring care and utilize care data for Counties) Partners HIV and AIDS treatment decision making Kisii County compre- outcomes • Scale up use of electronic Government hensive quality medical records (EMR) treatment, • Implement periodic surveys and cohort analysis care and • Strengthen supply systems support and ensure commodity security services. • Implement periodic monitoring for adherence and disclosure To improve • Strengthen laboratory • Kisii County MoH laboratory networks (9 Sub- Implementing capacity and • Put in place systems to Counties) Partners infrastructure assure quality and monitor adherence to laboratory protocols • Improve laboratory equipment, supplies, space, personnel

Support • Promote age and population • Kisii County Kisii County community based specific treatment education in (9 Sub- Government adherence community and other non- Counties) MoH health facility based settings Implementing • Use innovative mobile and Partners web-based technology to increase adherence and follow up options • Scale up use of people living with HIV peer support strategies • Strengthen defaulter tracing mechanisms • Implement community PHDP

36 Strategic Direction 3 • Inadequate County legal and policy environment for protection and subsequent promotion of the Using a Human Rights Approach to rights of priority and key population and people Facilitate Access to Services for PLHIV, living with HIV. KPs and other Priority Groups in all Sectors • Gender-based violence and social exclusion. • Inadequate protection from stigma and Safeguarding human rights is an essential part of discrimination in the Public and Private sector. improving the quality of life of those infected and affected by HIV & AIDS. HIV hits the hardest where human rights are least protected. People have the Key intervention areas right to know how to protect themselves; how to • Remove barriers to access of HIV, SRH and obtain treatment, care and support if infected: and to rights information and services in public and be educated on the treatments available to them. private entities. According to the Constitution of Kenya 2010 Chapter • Improve County legal and policy environment 4 - Article 43(a), 2 and 3 states that: for protection and promotion of the rights of • Every person has the right to the highest priority and key populations and people living attainable standard of health which includes with HIV. the right to healthcare services including • Reduce and monitor stigma and discrimination, reproductive health care. social exclusion and gender-based violence. • A person should not be denied emergency • Improve access to legal and social justice and treatment. protection from stigma and discrimination in • The state should provide appropriate social the public and private sector. security to persons who are unable to support • Enhancing access to HIV services. themselves and their dependants.

Expected Output Kisii County Stigma and Discrimination Index stands at 35% according to Kenya National HIV and AIDS 1. Reduced reported stigma by 50 % Stigma and Discrimination Index Survey of 2014. The 2. Reduced self-reported HIV related stigma and stigma situation can be attributed to the following: discrimination by 50% • Barriers to access of HIV information in public 3. Reduced levels of sexual and gender-based and private facilities. violence for PLHIV, KPs, women, men, boys and girls by 50%

37 Key Intervention 1: Intervention Areas for Using Human Rights Based Approaches to Facilitate Access to Services

Interventions Areas for Using Human Rights Based Approaches to Facilitate Access to Services

KASF KCHASP Target Key Activity Sub Activity/ Geographic Responsibility Objective Results Population Intervention Areas by County/Sub- County An enabling Reduced Sensitization The facility in charges • Healthcare County CDH, COH legal and policy reported stigma of general to sensitize health care workers environment by 50 % and targeted workers on reducing necessary for populations stigmatizing attitudes in a robust HIV with anti- healthcare settings. response at the stigma national and awareness county level to messages ensure access to services by persons living with HIV

Implement programmes Priority County CHAC aimed at reducing stigma populations and discrimination against priority populations.

Encourage religious Religious leaders County IRC leaders to promote acceptance of priority groups as part of their community.

Develop community groups General County Implementing and forums and utilize Population partners and persons living positively KCG to campaign against HIV-related stigma and discrimination.

Reduced self- Implement Promote the PLWHIV to PLHIV County CDGSD,NEPHAK reported HIV structural enroll in support groups related stigma interventions and ensure they register and discri- that empower with the Department of mination by PLHIVs Social Services. 50%

Remove Develop policies to protect Sexual and County MoH barriers to priority population when Gender- Based access of HIV, accessing HIV-related Violence (SGBV) SRH and rights services. survivors to information and services in private and public entities

Strengthen and establish Key Populations County County more DICs to offer HIV Government services to the Key Implementing Populations. Partners

38 KASF KCHASP Target Key Activity Sub Activity/ Geographic Responsibility Objective Results Population Intervention Areas by County/Sub- County An enabling Reduced self- Remove The CEC health to Key and County CEC Health, legal and policy reported HIV barriers to formulate a policy to vulnerable CHAC environment related stigma access of HIV, protect priority populations populations necessary for and discri- SRH and rights when accessing HIV and a robust HIV mination by to information health services. response at the 50% and services Empower communities General County County national and in private and through various forums Population Implementing county level to public entities and provision of IEC. Partners ensure access to services by Promote use of peer PLHIV County CHAC, CASCO persons living counselors/educators with HIV and mentor mothers to enhance uptake of HIV services. Male engagement in Male partners County CRHC HIV, SRH programs and of women living interventions and offer with HIV and ANC them services. clients

Integrate HIV information Religious County IRC and encourage service institutions uptake in religious settings.

Sensitize lawmakers on County Assembly County CEC (HEALTH) the need to enact non- members discriminatory regulations and services

Develop and disseminate General County CHAC population specific and population user friendly information including Braille, Kiswahili and Kisii. Work closely with regional General County IRC religious leaders to population integrate their religious teachings with HIV information and service uptake. Utilize county publications General County CHAC and local media channels population to disseminate HIV information. (County Journal, County News) Reduced levels Educate communities on Communities County Implementing of sexual and gender and legal issues Partners gender-based violence for PLHIV, Key Populations, Educate communities on General County CSFP women, men, legal issues, rights and population CHPO boys and girls gender during barazas and by 50% social gatherings

39 KASF KCHASP Target Key Activity Sub Activity/ Geographic Responsibility Objective Results Population Intervention Areas by County/Sub- County An enabling Reduced levels Improve Utilize community units General County CSFP legal and policy of sexual and county legal to discourage negative population environment gender-based and policy traditional beliefs and necessary for violence for environment practices. a robust HIV PLHIV, Key for protection response at the Populations, and promotion Sensitize county assembly County Assembly County CHAC, CEC national and women, men, of the rights members and executives members and Health county level to boys and girls of priority, Key on the need to enact laws, executives ensure access by 50% Populations regulations and policies to services by and PLHIVs that prohibit discrimination persons living and support access to HIV with HIV prevention, treatment, care and support. The county assembly to County Assembly County CHAC, CEC review the existing laws members and Health and execute the existing executives policies to ensure they impact the response to HIV positively. These should be consistent with the constitution, national laws and policies. Sensitize lawmakers and County Assembly County CHAC, CEC law enforcement agencies members, Health on HIV and consequences executives of their implementation and implementation of laws in the provision of HIV services to priority populations. Enrol PLHIV, OVCs, Key PLHIV, OVCs, County Social Services Populations and other Key Populations Department, priority groups into and other priority CSOs, CACC the social protection groups programmes Facilitate discussions and General County CHAC, CSOs negotiations among HIV population service providers, those who access services and law enforcement agencies to address law enforcement practices that impede HIV prevention, treatment, care and support services. Ensure implementation of General County CHAC, CSOs HIV workplace programs population for law makers and enforcers.

Sensitize individual Healthcare County COH healthcare workers, health workers and care administrators and administrators healthcare regulators on their own human rights and skill and tools necessary to ensure patient rights are upheld.

40 KASF KCHASP Target Key Activity Sub Activity/ Geographic Responsibility Objective Results Population Intervention Areas by County/Sub- County

An enabling Reduced levels Improve Hold the county County govt. County CHAC, CSOs legal and policy of sexual and county legal government accountable Administrators environment gender-based and policy for their constitutional and necessary for violence for environment statutory obligations. a robust HIV PLHIV, Key for protection response at the Populations, and promotion Advocate for HIV Tribunal County NACC/CACC national and women, men, of the rights decentralization of HIV county level to boys and girls of priority, Key tribunal to the county. ensure access by 50% Populations to services by and PLHIVs In collaboration with other General County CHAC persons living stakeholders, non-state population with HIV actors to implement programs aimed at upholding their rights of priority populations.

Sensitization of police, Police, health County CSOs and Public health care workers, Civil care workers, entities Societies and legal groups Civil Societies CRHC on SGBV support. and legal groups

Strengthen linkages with SGBV survivors CASCO, CAC psychosocial support groups for SGBV survivors.

Link SGBV survivors to SGBV survivors CACC, CSOs, gender response units within the county.

Reduce and The county government to PLHIV County CHAC, NEPHAK monitor conduct measurement of stigma and HIV related stigma through discrimination, People Living with HIV social and GBV Stigma Index including in health care settings and communities.

Conduct a county baseline PLHIV County CHAC survey to document the magnitude and nature of human rights violation and gender disparities in the context of HIV.

Educate communities on Communities County CDGSS gender and legal issues affecting HIV.

41 Strategic Direction 4: During the strategic plan period 2015/16 Strengthening Integration of -2018/19,the county aims to review existing Community and Health Systems coordination structures at the county and sub-county levels for appropriateness and clarity of roles and Health and community systems consist of all responsibilities, support integrated HIV and aids organizations, people and actions whose primary plans and improve on collaboration, partnerships intent is to promote restore and maintain health. and networking among implementing partners at all Failing or inadequate health and community systems levels. are one of the main obstacles to scaling up HIV and AIDS systems. Key intervention areas Health agenda in the Kisii County is driven via a health strategy but this is yet to be rolled out to all villages. 1. Provide a competent motivated and adequately The county has 110 CUs (38%) out of the expected staffed workforce at the county and sub- 293; the units are linked to 105 facilities across the county levels to deliver integrated HIV services county. The county has a total of 450 registered at different tiers. Community-Based Organizations (CBOs) and Faith- 2. Strengthen health service delivery system Based Organizations (FBOs). These groups are at county and sub-county levels to deliver active and implementing HIV activities through self integrated HIV services at different tiers and donor funding. There are 214 community link 3. Improve access to and rational use of quality persons/peer educators attached to GOK health essential products and technologies for HIV facilities and FBO/NGO in the county and 40 mentor prevention, treatment and care services. mothers in all high volume health facilities. These structures support task shifting activities as well as 4. Strengthen community service delivery system patient retention strategies. at county and sub-county for the provision of HIV prevention, treatment and care service. The key gaps in community systems are low CU coverage, inadequate financing to support community structures, weak community facility linkages, weak Expected output leadership and governance, weak planning and • Improved health workforce for HIV response at monitoring capacity and low capacity of community county and sub-county levels. structures. • Increased number of health facilities ready to Kisii County has a total of 169 Health facilities (GOK provide KEPH-defined HIV and AIDS services. 117, FBO 31, private 21). Out of these, 127 facilities • Strengthened HIV commodity management are ART sites. through effective and efficient management of The county health care system is characterized by medicine and medical product. lack of adequately trained personnel, inequitable • Strengthened community-level AIDS distribution of health personnel geographically and competency. across the health sector, low staff morale; weak supply chain for HIV commodities and inadequate financing.

42 Intervention Areas in Integration of Community and Health Systems

Interventions Intervention Areas in Integration of Community and Health Systems

KASF Objective KCHASP Results Key Activity Sub Activity/Intervention Geographic Responsibility Areas by County/Sub- County

Build a strong and Improved health Provide a • Recruitment, redistribution, The County Kisii County sustainable system workforce for HIV competent capacity building, performance Government for HIV service response at county motivated and review and motivation of competent delivery through and sub-county adequately and skilled health care workers in Chief Officer specific health levels staffed all tiers (ALL HR issues) Health Services community systems workforce at • Implementing domestic health approaches, actions County and staff retention policy that takes County Public and interventions Sub-County into account the additional burden Service to support the HIV levels to deliver of HIV. response integrated HIV • Design a community system that Board Partners services at can integrate and motivate the different tiers. community health volunteers and care givers in the implementation of HIV programmes. • Task sharing and mentorship for skills transfer. • Train CHVs, equip CUs and motivate them.

Increased number Strengthen • Upgrade the infrastructure for The County Kisii County of health facilities health service all community units in county to Government ready to provide delivery system meet the basic standards for HIV (Health sector) KEPH-defined HIV at County and service provision at level 1. and AIDS services Sub-County • Integration of HIV referral and Implementing levels to deliver linkages services in to mainstream partners integrated HIV health services services at • Improve accessibility to different tiers comprehensive HIV services to the key populations and vulnerable groups • Mainstreaming of HIV in all sectors

• Develop a HIV commodity The County • Kisii County management and supply chains Government monitoring at county. (Health sector) • Capacity building of • Implementing procurement staff to enhance partners efficiency of HIV commodities • Distribution of adequate and functional HIV diagnostic equipment (VL, CD4...) that are well maintained (service contracts) and adoption of new technologies e.g. point of care CD4, self-testing • Introduction of facility-based IT systems to manage and monitor HPT supplies and link with national and county MOH Information System • Review and strengthen laboratory systems for effective diagnosis and monitoring of ART, especially for early detection of toxicities and treatment failure • Decentralization of comprehensive

43 KASF Objective KCHASP Results Key Activity Sub Activity/Intervention Geographic Responsibility Areas by County/Sub- County

Build a strong and Increased number Strengthen HIV services including laboratory The County sustainable system of health facilities health service networks to all health facilities, for HIV service ready to provide delivery system especially the lower level (Tier 2). delivery through KEPH-defined HIV at County and specific health and AIDS services Sub-County community systems levels to deliver approaches, actions integrated HIV and interventions services at to support the HIV different tiers response Strengthened Strengthen • Set aside a financial kitty for HIV The County Kisii County community-level community & AIDS community services Government AIDS competency service delivery (Health sector) • Empowering communities to system at ensure capability and capacity to county and take responsibility of their health. Implementing sub-county for partners the provision of • Monitoring Community and HIV prevention facilities to ensure that they adhere ,treatment and to laid down standards on the care services implementation of HIV activities • Conduct capacity building trainings to strengthen institutional capacity for implementation of community and workplace actions and services at all levels

Strategic Direction 5: Kisii County among other counties in Kenya has Strengthening Research, Innovation participated in National researches such as KDHS and Information Management to meet and KAIS. In spite of these, there seems to be lacking KCHASP Goals an institutional body to coordinate the research activities. Research provides critical evidence on the basis of which strategic decisions and interventions are undertaken. A county research strategy is to be Key Intervention Areas formulated to prioritize research projects and ensure • Resourcing and implementing HIV research that research undertaken is driven by demand. agenda informed by county strategic plan. The research strategy shall ensure a balance • Increase evidence-based planning and between clinical and social science research in programming. line with the multi-sectoral approach adopted by the county response. Overall research will provide in-depth analysis of key issues and information Expected output gaps that are identified through monitoring and • Increased evidence-based planning and evaluation. programming by 20%. Kisii County is endowed with tertiary Educational • Increased capacity to conduct HIV research in Institutions, particularly in Kisii town, and one of the county by 50%. its key mandate is to conduct Research. Moreover

44 Intervention areas in Strengthening Research, Innovation and Information Management to Meet KCHASP Goals

Intervention areas in Strengthening Research, Innovation and Information Management to Meet KCHASP Goals

KASF KCHASP Key Activity Sub Activity/ Target Geographic Responsibility Objective Results Intervention Population Areas by County/Sub- County Identification Increased Establish and Strengthen and expand Research County County Executive and imple- evidence- operationalize Kisii the mandate and scope TWG Committee (CEC) mentation of based county research of the already existing high impact planning and Technical Working ethics and research research programming. Group (TWG) committee in the county priorities, innovative programming and capability and capacity strengthening to conduct research Increased Organize scientific Conduct operational Research County Kisii County capacity to retreats for review of research in the county on stakeholders Government conduct HIV existing and concluded various thematic areas (KCG), research in research of HIV Stakeholders, the county. Universities Conduct county HIV County KCG, dissemination forum stakeholders. Stakeholders, of HIV research in the Universities county

Strengthen county HIV Research County KCG, research capacities stakeholders Stakeholders, including epidemiological Universities surveillance, good laboratory, clinical practice and ethics

Develop a county Identify County HIV and Research County CEC HIV research agenda AIDS research priorities TWG through consultative process by involving all the key stakeholders to complement it. Promote Establish an interactive Research County CEC dissemination and web-based County HIV stakeholders utilization of research research hub findings

Hold bi-annual Research County CEC dissemination of stakeholders research findings and quarterly review meetings by different actors including publication of abstracts Encourage research and Research County CEC, CHAC utilization of its findings stakeholders

Increased utilization of Research County CEC, CHAC research findings on stakeholders the identified gaps and related priorities

45 KASF KCHASP Key Activity Sub Activity/ Target Geographic Responsibility Objective Results Intervention Population Areas by County/Sub- County Identification Increased Mobilize resources Develop policies to Research County CEC, CHAC, and imple- capacity to for the HIV research attract public, private stakeholders County Assembly mentation of conduct HIV agenda partnerships in HIV high impact research in research research the county. Advocate for resource Research County CEC, CHAC priorities, allocation from the stakeholders innovative consolidated funds programming across the relevant and capability sectors in the County and and capacity National budget strengthening to conduct Promote partnership Research County CEC, CHAC research with learning Institutions stakeholders to prioritize HIV sector research needs

Strategic Direction 6: Situation analysis Promote Utilization of Strategic The county has Monitoring and Evaluation (M&E) Information for Research, Monitoring systems and structures which are borrowed from the and Evaluation to Enhance then national Ministry of Health. Programming The county uses the District Health Information Monitoring and Evaluation is very crucial for System (DHIS2) which hosts the facility-based data. the achievement of the KCHASP. It provides the The system has been able to capture most of the HIV background necessary to ensure that objectives are facility-based data within the county. However, the achieved. During the formulation of the strategy, system is not designed to capture data for the specific the implementation plan indicators and projections groups of interests, i.e. key population data. are sometimes based on past experiences. The community based HIV programme is being These, however, may change in the course of the captured by the COBPAR system hosted by NACC. implementation and thus a management control However ,this data is not easily accessed by the system which will be necessary to ensure the plan is interested parties. effective. Further, development partners, NGOs and some CBOs The implementation of the strategic plan shall have developed their own parallel M&E systems which therefore be closely monitored and evaluated to are not in the spirit of the Three- Ones Principle. ensure accomplishment. The county Monitoring and Evaluation systems are The monitoring of HIV & AIDS process will help characterized by the following;: to determine whether the implementation is on course and establish the need for any amendment / • Lack of a clear and defined functional monitoring adjustments in the light of any changes. and evaluation framework. Monitoring, follow-up and control systems will be • Insufficient monitoring and evaluation tools on established at all levels, including: HIV & AIDS at the county and sub-county levels. • Progress reports • Lack of monitoring and evaluation Technical Working Groups (TWGS) • Review meeting • Insufficient funds for monitoring and evaluation • Budgets and budgeting control systems and activities in the county and sub-county. report forms.

46 Key intervention areas • -Establish multi-sectoral and integrated real time HIV platform to provide updates on HIV • Strengthen M&E capacity to effectively track epidemic response accountability at county and the KCHASP performance and HIV epidemic sub-county levels dynamics at all levels. • Expected output M&E Information Hubs • Ensure harmonized, timely and comprehensive integrated at county levels and providing routine and non-routine monitoring systems comprehensive information package for to provide quality HIV data as per county and decision making. sector priority information needs.

Interventions for Promoting the Utilization of Strategic Information for Research and Monitoring and Evaluation to Enhance Programming

Interventions for Promoting the Utilization of Strategic Information for Research and Monitoring and Evaluation to Enhance Programming KASF KCHASP Key Activity Sub Activity/ Target Geographic Responsibility Objective Results Intervention Population Areas by County/Sub- County M&E Strengthen the Conduct M&E capacity M&E system County CDH To improve Information county HIV M&E assessment and data quality, Hubs system development in the demand, integrated at County. access and county level use of data and providing a for decision comprehensive making at information county and package health facility for decision levels making

Increased Increase access to Establish functional Implementing County CHAC utilization a centralized M&E multi-sectoral HIV M&E Partners of strategic system in Kisii coordination structure information County and partnerships at to inform HIV county and sub- county response at all level. county levels Conduct periodic data Internal County CHAC quality audits, verification implementers and support supervision.

Utilization of the HIV County County CEC Situation Room for leadership CDH decision making.

Procure and distribute Health facilities reporting tool to health facilities on timely basis. Implementing Partners Strengthen a county M&E County M&E County CDH, CHAC Information Hub Unit

Data management Strengthen county M&E Implementation County CDH, CHAC and reporting systems to the new Partners governance structure with involvement of other implementing partners.

47 KASF KCHASP Key Activity Sub Activity/ Target Geographic Responsibility Objective Results Intervention Population Areas by County/Sub- County To improve Increased Data management Health Department Health facilities County CDH, CHAC data quality, utilization and reporting to establish a M&E Implementing demand, of strategic unit to conduct Partners access and information capacity assessment use of data to inform HIV and development at for decision response at all county level in terms of making at county levels personnel, infrastructure county and , comprehensive county health facility HIV M&E systems, levels guidelines, tools and SOPs Develop, print and Ministry County CDH, CHAC distribute M&E tools for of Health collection of HIV data. Implementing Partners Strengthening on- Implementation County CDH, CHAC line reporting, other Partners data transmission technologies and utilization of electronic medical records Improve data quality in M&E County CDH, CHAC terms of timeliness and department completeness of M&E reports from various sub-systems Coordination of All actors to adhere to Implementation County CDH,CHAC data flow County HIV reporting Partners obligations

Enhance regular M&E Implementation County CDH,CHAC supervision Partners

Promote routine Implementation County CDH, CHAC and non-routine HIV Partners information systems

Scale up coverage of Implementation County CDH, CHAC on-going HIV programs Partners surveillance and surveys

M&E department to M&E County CDH, CHAC Strengthen periodic department data quality audits and verify, harmonize and create linkage between data collection tools and databases Establish Use HIV strategic Implementation County CDH, CHAC multi-sectoral information to inform Partners and integrated policy and programming real-time HIV platform to provide Harmonize M&E Implementation County CDH, CHAC updates on HIV information hubs at Partners epidemic response County and sub-county accountability levels Establish a multi- Implementation County CDH, CHAC sectorial HIV progra- Partners mming web-based data management system

48 Strategic Direction 7: mobilization to tackle the HIV pandemic in line with the KASF 2014/15-2018/19. Increasing Domestic Financing for a Sustainable HIV Response in Kisii During the financial year 2013/14 to date, the county County has been operating with limited resources in the implementation of core HIV programmes. Partners The County Government has funded HIV programmes supported most sub-counties in the implementation through different sectors since the onset of of annual costed work plans on HIV for the county. devolution. The diverse programmes have been The county has seen an improved quality care of implemented through a multi-sectoral approach in PLHIV and well managed clinical care services in partnership with other stakeholders among them comprehensive care centres as well as community CARE (K), IRDO, IMC and KCCB-KARP. Even with services. This partnership has immensely these minimal resources, the county has been able to contributed to the strengthening of the health care realize meaningful results on active implementation systems at county and sub-county levels. Capacity of HIV interventions by all the actors in the third for health workers and community volunteers has strategic plan (KNASP III). However, in the fourth been improved and networking for stakeholders era as counties devolve the health services including enhanced as well as infrastructure upgraded for HIV, the Kisii County Government is putting in place care and treatment of PLHIV structures and strategies through the development The table 11( below) shows the financial support and eventual launching of Kisii County HIV Plan available from different partners since 2013/14 to the to guide planning, implementation and resource current 2015/16 financial years.

Table 4.2: Donor contribution to HIV fight in Kisii County

Name of Donor contribution to HIV fight in Kisii County Key activities/ Organisation interventions FY 2013/14 FY 2014/15 FY 2015/16 (in USD) (in USD) (in USD)

Kisii County Government 10,310 56700 20000 HIV workplace policy development and outreach campaigns. CARE (K) 4.7m 4.7m 4.8m HIV & AIDS comprehensive care, prevention and treatment, capacity building and health care system strengthening IMC 50,000 113,005 287,985 Key population, adolescents and young women targeted programmes IRDO 92,785 61,855 0ngoing Key population and adolescents KCCB-KARP 269,070 248,453 461,000 Provision of high quality of HIV comprehensive care, treatment and prevention services at faith-based affiliated sites. Daraja Mbili Vision 78,000 54,000 93,000 HIV and AIDS prevention, care and support Mwanyagetinge Care & 41,657 35,091 58,461 HIV and AIDS prevention, OVC Support Initiative Support, care and support

Total 5,191,822 5,156,099 5,432,461

49 However, the above resources were not sufficient for This strategic plan therefore, seeks to guide the the implementation of the HIV specific annual work County Government through different sectors to plans for respective financial years. mobilize resources to help finance the various key Currently the estimated number of PLHIV is 63,715, HIV priorities in the County. out of which 28,214 adults and 3,853 children are in need of ART. Annual adult new infections is at Key interventions areas 4,891 and that for children is 1,075 whereas the HIV prevalence stand at 8.0 % according to KAIS 2012. 1. Coordination of all resources available for The total number of people who are receiving ART the HIV response in Kisii County to avoid in Kisii county are 14,798.The average resources that duplications of efforts. county needs to sufficiently provide comprehensive 2. Innovative and sustainable domestic HIV HIV programme in a year is USD 20M across all the financing options in the county. sub-counties. This translates to an annual deficit of 3. Maximize efficiency of existing HIV delivery approximately USD 15M. options for increased value and results within Financial Sustainability existing resources. As a guiding principle, no credible, evidence-based, 4. Aligning HIV resources/investment to strategic costed HIV and AIDS and STI sector plan which plan priorities. should go unfunded. The County wishes to create a predictable and sustainable financial resource for the Expected outputs implementation of all HIV interventions. Resources from development partners shall be harmonized to 1. Increased domestic financing for HIV response align with policies, priorities and fund programmes by 75%. where there are financial gaps as envisaged in the 2. Sustainable funding for HIV responses. county plan.

Interventions for Innovative and Sustainable Domestic HIV Financing Options for Kisii County

KASF Objective KCHASP Results Key Activity Sub Activity Geographic Responsibility Areas by County/Sub- County

Increase domestic Increased county Innovative and • Participation in the annual county 9 Sub Counties KCG financing by 50% financing for HIV sustainable budget-making cycle to ensure response by 75% domestic HIV resource allocation. (All levels of Implementing (USD 15m) financing • Strengthen public private the county Partners options in the partnership engagement at all and national county. levels at the county and sub-county governments). Development through regular PPP forums. Partners • Initiate an annual AIDS lottery programme. Community • Organize high level engagement with the county stakeholders to County Assembly advocate for domestic financing. • Build and enhance capacity of National civil society organization to achieve Government self financing and sustainability.

50 KASF Objective KCHASP Results Key Activity Sub Activity Geographic Responsibility Areas by County/Sub- County Increase domestic Increased county Coordination of • Creation of an Information Hub County financing by 50% financing for HIV all resources for the county to track resources Government response by 75% available for the from all partners (grand check through the (USD 15m) HIV response system). Health Services in the county to • Carry out cost-benefit analysis sector avoid duplication on the HIV & AIDS programmes of efforts. Maximize • Align the HIV and AIDS response KCG efficiency within the local context. of existing • Promote effective cost-saving Implementing HIV delivery models of HIV /AIDS service Partners options for delivery. increased value and results within existing resources. Aligning HIV • Carry out a needs assessment n KCG resources/ key priority interventions. investment to • Consolidate and direct HIV Implementing strategic plan resource allocations of different Partners priorities agencies.

Strategic Direction 8 capacity of the County structures need to be built to manage HIV programmes and resources need to be Promoting Accountable Leadership for distributed equitably within the County. Delivery of the KCHASP Results by all Sectors and Actors Many agencies and organizations are making valuable contributions to HIV prevention and control but their Kisii County has sufficient political leadership in work is not well coordinated. response to HIV & AIDS, especially the office of the In the context of dwindling resources from donors and Governor. There has been insufficient political drive partners, there is increased need for the County to own from the county assembly to encourage and mobilize the HIV response. The implementation of KCHASP the population to take seriously the threat posed by will require prudent governance practices that will the HIV epidemic. HIV has been mainly seen as a be responsible and accountable in leadership of the health issue and other sectors have not been fully multi-sectoral HIV and AIDS response. This will go a involved in addressing the epidemic. long way in ensuring effective and efficient resource There is good evidence that an HIV epidemic can be allocation and subsequently create transparency contained with strong political will, with a pragmatic and accountability. Setting HIV response as a county approach, and the effective mobilization of resources. priority and a strategic development issue at all levels To succeed in dealing with HIV pandemic, the County in the county, and enforcing its implementation, Assembly needs to have a political commitment requires a sustained leadership, commitment and by passing legislation and policies focusing on coordination from the executive and other governing prevention and management of HIV and AIDS. Leaders bodies. at all levels need to be encouraged to keep HIV high The county embraces effective coordination on the County agenda and share information about throughout the implementation cycle of this plan. the epidemic with their wards and sub-counties. The

51 Key intervention areas Expected outputs 1. Build and sustain high-level political • Good governance practices and accountable commitment for strengthened county leadership entrenched for the multi-sectoral ownership of the HIV response. HIV and AIDS response at all levels. 2. Entrench good governance and strengthen • Effective and well-functioning stakeholder co- multi-sector and multi-partner accountability ordination and accountability mechanisms in to deliver KCHASP results. place and fully operationalized at county and 3. Establish functional HIV co-ordination sub-county levels . mechanism at county and sub-county levels. • An enabling policy, legal and regulatory framework for the multi-sectoral HIV and AIDS response, strengthened and fully aligned to the Constitution of Kenya 2010.

Interventions for Strengthening County HIV Coordination Mechanism

KASF KCHASP Results Key Activity Sub Activity Geographic Responsibility Objective Areas by County/Sub- County

Promote good • Good governance Build and • High level engagement with the The entire Office of the governance practices and sustain high- office of the Governor and Members of county Governor practices accountable level political the County Assembly (MCAs) to obtain leadership commitment for Political will and commitment in the County Executive entrenched for the strengthened implementation of the strategic plan. multi-sectoral HIV county • High level engagement of MCAs Members of the and AIDS response ownership of the and the County Assembly executive to County Assembly at all levels HIV response. create awareness on the County HIV responses. • Effective and • Enact legislation that are HIV county well-functioning -specific based on the priorities. stakeholder co- • Entrenching HIV response in all ordination and county sectors/ devolved units. accountability • Gender mainstreaming in advocacy mechanisms in and programme activities including place and fully youth, women and accelerated eMTCT operationalized at strategies. county and sub- • Institutional coordination and county levels ownership of the Kisii County HIV Strategic Plan. • An enabling policy, Entrench good • Joint KCHASP annual The entire County legal and regulatory governance implementation review meetings with county Government- framework for the and strengthen the stakeholders ,implementers and County Health multi-sectoral HIV multi-sector and partners involved in the HIV & AIDS Services and AIDS response, multi-partner response within the county. strengthened and accountability • Regular update meetings to ensure NACC fully aligned to to delivery accountability for performance and the Constitution of of KCHASP results by all implementing partners NASCOP Kenya 2010. results at the county.

52 KASF KCHASP Results Key Activity Sub Activity Geographic Responsibility Objective Areas by County/Sub- County Promote good • An enabling policy, Establish • Hold regular county and sub-county The entire County governance legal and regulatory functional HIV stakeholders for a to create awareness county Government- practices framework for the coordination on key HIV interventions envisaged in County Health multi-sectoral HIV mechanism at the strategic plan. Services and AIDS response, county and sub- • Tracking and monitoring of the strengthened and county levels resources during the strategic plan NACC fully aligned to implementation, monitoring and the Constitution of evaluation. NASCOP Kenya 2010. • Build capacity of stakeholder networks to promote strong accountable institutions that hold duty bearers accountable for HIV response. • Annual joint HIV /AIDS program review at the county level.

53 CHAPTER 5

Implementation Arrangements

5.1 HIV coordination structure for will be mandated with different tasks and roles in KCHASP delivery – county level the delivery of the strategic plan. The coordination infrastructure of the KCHASP will be an all-inclusive The multi-sectoral county response will be managed one. This infrastructure will be coordinated at by various structures at different levels. Each level different levels as shown in the organogram below.

H. E. The Governor

County Executive

County HIV Committee CEC Health, Director Health Services, COAC, CASCO FBO rep

CHC Unit of NACC CHMT

County HIV ICC KCHASP Monitoring Committee Sub-County/ 1. Care Kenya Membership Constituency 2. IMC 1. County KCHASP Monitoring HIV Committee 3. ADRA-KENYA Committee membership 1. CACC Coordinator 4. ICL • Care & treat rep 2. PLHIV 5. CHAK • Human rights 3. Key Populations 6. KARP • Research 4. Youth 7. IRDO • Prevention 5. Persons with disability 8. RED CROSS System strengthen N-NGO 6. Health Strategy –County 9. KisiI University • Public Sector W. Groups Government. 10. MWANYAGETINGE Care (Education, Agriculture, 7. FBO representatives And Initiative Prisons, University, 8. National Government 11. Daraja Mbili Volunteers Labour, Social Services, representatives Youth Children) 9. Community Elder 12. CACC/SASCO 10. MYWO 11. SASCO

Fig 5.1: HIV coordination structure 54 5.2 Roles of stakeholders Health Services and co-chaired by the Director of Health Services and the sub-counties shall The various stakeholders in the organogram shall be represented in this committee. have the following (but not limited to) roles: • Create and strengthen partnership for an expanded response to HIV & AIDS in Kisii Governor County. • Responsible for legislation and resource • Formulate HIV agenda for the County allocation for financing of the KCHASP.

Sub-County/Constituency Committees CEC Health Services • Coordination of HIV at the sub-county or • Budgeting and resource allocation to specific constituency level. annual plans for HIV interventions. • The coordinator shall be a member of the • Provide strategic leadership during KCHASP SHMT. implementation period. • Receive and disseminate KCHASP to the • Accountable to the Governor on all matters community. including performance and updating of the situation room. The partners, CBOs, FBOs and the private sector forms part of the structure for holistic management CHC Unit of NACC of the HIV in communities, not leaving out the PLHIV • Shall sit in the CHMT and update the Director of and other vulnerable population such as PWDs and Health on all matters pertaining to coordination the youth. of HIV activities in the county. At the lowest level, the sub-county/constituency HIV • Support HIV stakeholders fora at county and coordinating committee is constituted and operates sub-county levels. within the structures of ensuring devolved structures are functional. • Oversee continuous monitoring and evaluation of all aspect of the KCHASP. • The office bearer shall be the secretary of the HIV ICC County HIV committee. • Annual review of county achievements of the plan. County HIV Committee • Documenting of the emerging issues during the implementation period. • Accountable to the Governor on its functions and performances. • Documenting of the best practices and lessons learnt during the implementation of the • The committee shall be chaired by the CEC KCHASP.

55 CHAPTER 6

Monitoring and Evaluation of the Plan

Monitoring and evaluation of the Kisii HIV & AIDS A multi-sectoral response database will be multi-sectoral plans will focus on tracking the established at the county level to enhance data progress towards attaining of desired results. A storage and retrieval. Information dissemination will multi-sectoral HIV & AIDS monitoring and evaluation be strengthened through the established web-based system will be strengthened to improve programme data hub, report publications and review meetings. performance. Outcomes and impacts of the multi- The county data hub will be linked to the national sectoral response will be monitored and evaluated Monitoring and Evaluation (M&E) hub. by conducting surveillances, surveys, and studies. Emphasis will be given to monitor the epidemic Monitoring and Evaluation Sub-systems trends and driving behavioural, socio-cultural and socio-economic factors to match the response to The various subsystems that will provide data to the the epidemic. Moreover, appropriate indicators will NACC unified system as in the table below. be selected with clear targets for each thematic Table 6.1: Monitoring and Evaluation sub-systems area for whole implementation period. Levels Roles and Responsibilities A multi-sectoral response monitoring and evaluation Health facilities Health facilities will provide the routine plan will be developed and implemented through service delivery data through the DHIS. This joint efforts in a coordinated manner, in line with the information will be fed to the County HIV hub. principle of “Three Ones”. NACC is responsible for Community The community health workers will provide the coordination of the multi-sectoral monitoring Units the routine service delivery & programming and evaluation, and will convene quarterly through data through the CBHIS. This information will be fed to the County HIV hub the County HIV Committee and annual joint review meetings, and conduct semi-annual and annual Civil Society The Civil Society organizations/Private Organizations/ Sector will provide the routine service joint support supervision at the county level. A mid- Private Sector delivery & programming data to their term review and final evaluation of KCHASP will respective sub-counties, who will in turn feed this information to the County HIV hub also be conducted. Ministry of Health data collection tool and reporting formats will be adopted and Non-Routine The non-routine date sources; surveys, Data(Surveys, surveillances, estimates and studies, the harmonized to facilitate data summarization and Surveillances, findings will be fed into the County HIV analysis. Studies & hub directly after the findings are officially Estimates) published.

56 Kisii County HIV and Aids Response Data Flow Chart Diagram The following diagram depicts how data will flow from service delivery points through to County HIV Data Hub and eventually to the NACC unified M&E system.

NACC UNIFIED M & E SYSTEM

COUNTY SURVEYS, SURVEILLANCE, STUDIES AND ESTIMATES COUNTY HIV DATA HUB SUB-COUNTY MOH (DHIS) KCASF EVALUATIONS Mid and End-term Programme

CBHIS NACC SUB COUNTY (SCACCS)

HEALTH FACILITIES

COMMUNITY CIVIL SOCIETY PRIVATE UNITS ORGANISATIONS SECTOR (CHEWS/CHW)

COMMUNITY / BENEFICIARIES

Fig. 6.1: Aids response flow chart CHAPTER 7

Risk and Mitigation Plan

Table 7.1: HIV Risk and Mitigation Planning Activities

Risk Category Risk Name Status Probability Impact Risk Response Responsibility When (1-5) (1-5) Average score Technological Personnel lack Active - risk 3/5 4/5 3.5 Mitigate- budget CEC Health Year 1 Capacity and is being moneys for skills to use actively training and equipment monitored procurement of equipment Inadequate equipment Political Inconsistent Passive 2/5 3/5 2.5 Reduce - by CEC Health Continuous and insufficient risk - being constantly political good actively engaging the will monitored political class Operational Inconsistent Active - 4/5 5/5 4.5 Reduce - CMLC and inadequate Being implementing supply of HIV monitored the pull system commodities of commodity and have emergency funds to replenish the supplies

Legislation Inadequate Active 4/5 5/5 4.5 Lobby County legislation to (legislation) Assembly and support (KP support from CEC Health and vulnerable the County groups Assembly Environmental Change in Passive 2/5 3/5 2.5 Mitigate County weather -procuring Government patterns-rain vehicle that can manage the terrain Social Stigma Active 4/5 5/5 4.5 Mitigate CEC Health

Economical • Inflation Active 3/5 3/5 3 Adopt – no CEC Health action

• Competing Active 2/5 3/5 2.5 Prioritize CEC Health priorities for same resources

58 Risk Category Risk Name Status Probability Impact Risk Response Responsibility When (1-5) (1-5) Average score Organizational • Limited Active 2/5 4/5 3 Capacity building County Year 2 /human capacity Director of factors Health • Human Passive 3/5 3/5 3 Reduce - staff County Year 2 resource rationalization Director of capital. and trainings Health • Poor Active 2/5 4/5 3 Reduce - County Year 2 leadership promoting good Director of governance Health and leadership through accountability • Lack of Active 2/5 2.5/5 2.25 Support County Year 2 cohesion at establishment of Director of community CSO,CBOs Health level. • Lack of Clarity Active 2/5 3/5 Design job Human Year 2 over roles and description and resource responsibilities. performance personnel contract Strategic/ • Terrorism and Active 1/5 3/5 2/5 Transfer - Security Year 2 commercial insecurity Insurance agencies scheme and/ or hire security services Undertake security and risk assessment. Put appropriate measures in place (maximize opportunity to work remotely)

59 Annexes

Annex 1: Results Framework The logical framework for the plan is based on a prioritized list of strategic options that would ensure the attainment of the stated targets. It attempts to indicate the time relationship between the various strategic options and objectives and attempts to harmonize activities to harness synergy between different interventions. The logical framework assumes that there will be adequate resources to implement the proposed interventions in a timely manner.

STRATEGIC DIRECTION 1: REDUCING NEW INFECTIONS

KASF KCHASP Key Activity Sub activity Indicator Baseline Mid Term End Term Responsi- Objective Results and source Target Target bility

BIOMEDICAL INTERVENTIONS

Reduce Reduce Offer • Innovative Percentage KDHIS 25% of 50% of CHMT new HIV new HIV innovative HIV testing and of people new OPD new OPD Implementing infections by infections and evidence- counselling accessing clients and clients and Partners 75% by 75% based HIV (HTS) models HTS within 90% IP 100% IP prevention the county tested tested and care activities. • Linkage of Percentage KDHIS 90% 100% those testing of HIV- Linkage Linkage HIV-positive to positive care and early people linked ART initiation. to care and treatment. • Prevention Percentage KDHIS 90% Co- 95% Co- and mana- of patients infected infected gement of treated of OI cases cases co-infections infections screened screened and co- and and treated morbidities (TB treated & Cryptococcal)

• Offer gender Number of KDHIS 50% of the 100% of based violence GBV cases victims the victims care services offered PEP who report who report including Post at the at the Exposure health health Prophylaxis facility facility (PEP) for survivors

60 KASF KCHASP Key Activity Sub activity Indicator Baseline Mid Term End Term Responsi- Objective Results and source Target Target bility Reduce Reduce Roll out • Provision Number KDHIS Number Number MOH new HIV new HIV package of of key of people of eligible of eligible infections by infections care for Key commodities accessing within the within the Implementing 75% by 75% Populations including condoms and population population Partners and lubricants and lubricants vulnerable condoms groups • Screening and Percentage KDHIS management of FSW/MSM of HPV among screened of FSW/MSM and Hepatitis B Hepatitis B and C and C • Scale up STI Number KDHIS 100% of 100% of management of health health health in all health facilities facilities facilities facilities providing STI offering offering STI care package STI services services

STRATEGIC DIRECTION 2: IMPROVING HEALTH OUTCOMES AND WELLNESS OF ALL PEOPLE LIVING WITH HIV

KASF KCHASP Key Activity Sub activity Indicator Baseline Mid Term End Term Responsi- Objective Results and source Target Target bility

BIOMEDICAL INTERVENTIONS

Reduce Reduce Offer • Innovative Percentage KDHIS 25% of 50% of CHMT new HIV new HIV innovative HIV testing and of people new OPD new OPD infections by infections and evidence- counselling accessing clients and clients and Implementing 75% by 75% based HIV (HTS) models HTS within 90% IP 100% IP Partners prevention the county tested tested and care activities. • Linkage of Percentage KDHIS 90% 100% those testing of HIV- Linkage Linkage HIV-positive to positive care and early people linked ART initiation. to care and treatment. • Prevention Percentage KDHIS 90% Co- 95% Co- and mana- of patients infected infected gement of treated of OI cases cases co-infections infections screened screened and co- and and treated morbidities (TB treated & Cryptococcal)

61 KASF KCHASP Key Activity Sub activity Indicator Baseline Mid Term End Term Responsi- Objective Results & source Target Target bility Reduce Reduce Roll out • Provision Number KDHIS Number Number MOH new HIV new HIV package of of key of people of eligible of eligible infections infections care for Key commodities accessing within the within the Implementing by 75% by 75% Populations including condoms and population population Partners and vulnerable lubricants and lubricants groups condoms • Screening and Percentage KDHIS management of FSW/MSM of HPV among screened of FSW/MSM and Hepatitis B Hepatitis B and C and C • Scale up STI Number KDHIS 100% of 100% of management of health health health in all health facilities facilities facilities facilities providing STI offering STI offering STI care package services services Implement • Innovative HIV Number of KDHIS 10 facilities 20 facilities Implementing package of and STI testing youth- friendly established established Partners services for • Establish spaces Adolescents youth friendly established and Young clinical services at the health Women services within the county. • Offer age Percentage KDHIS 30% of 30% of appropriate of women the total the total contraceptives, and men of population population condoms, and reproductive eligible eligible microbicides. age accessing accessed accessed FP services with FB with FB within the service service county. • Increase Number NASCOP At least 50% of access to of APOC one person health sexual and sessions trained per workers reproductive rolled out facility on trained on health services. within the APOC APOC health service delivery points within the county. • Offer package Number of DHIS 100% 100% Kisii County of services discordant Government- for sero- couples discordant families MoH couples accessing HTS at the health Implementing facilities Partners within the county. Implement • Number of DHIS 100% 100% Kisii county strategies facilities within Government- to identify integrated and retain MCH services MoH HIV pregnant as a one-stop and lactating shop within Implementing women and the county Partners their infants

Adopt new national and WHO guidelines on eMTCT

62 KASF KCHASP Key Activity Sub activity Indicator Baseline Mid Term End Term Responsi- Objective Results & source Target Target bility

Reduce Reduce • Deliver all • Offer package Number CHIS 80% 90% Kisii county new HIV new HIV 4 prongs of of services of health Government- infections infections eMTCT at for sero- facilities by 75% by 75% 100% of health discordant offering MoH facilities couples PMTCT services and Implementing basic HIV care Partners package • Ensure all Number of KDHIS 90% of all 100% of all pregnant pregnant pregnant pregnant and lactating and lactating and lactating and lactating women are women women women initiated on initiated on initiated on initiated on ART and all ART and all ART ART HIV positive HIV-positive children are children offered ART offered ART • Offer GBV Percentage KDHIS 50% of the 100% of the services of GBV cases victims who victims who including offered PEP report at the report at services for health facility the health post-rape and facility incest among children

63 BEHAVIOURAL INTERVENTIONS

Key activity Behavioural Indicator Baseline and Mid Term End Term Responsibility interventions source Target Target

• Implement • Stigma • Number of stigma 35% National HIV 10% 10% Kisii County strategies to reduction reduction campaigns & AIDS Stigma Government- address HIV campaigns held & Discrimination related stigma Index

• Promote life skill • Risk reduction Number of skill Not Available 15,000 TBD 30,000 MoH programmes counseling and building sessions sessions sessions Implementing among skill building held within the Partners vulnerable county FBOs ,CBOs populations

• Male and Number of condoms KDHIS 50% of the 80% of the female condom distributed within eligible eligible demonstration, the county health population population distribution and facilities skill building

• Behaviour • Regular Percentage of CHIS 75% 100% Kisii County change outreach and KPs reached with Government-MoH intervention contact with key messages, Implementing using specific Key Populations treatment and partners reports Implementing interpersonal through peer supported within the (Impact research Partners tools and based education, county for development techniques treatment and Percentage of DSA organizations MOH including those support addicts reached and and International in Braille • Drug and enrolled for support Medical Corps) Implementing substance (rehabilitated) Partners screening and addiction support

Implement • Offer peer-to- Number of peer –to CHIS evidence-based peer outreach in –peer outreaches 4320 sessions 8640 interventions school or outside conducted in and held sessions (EBI) for school outside school within held adolescents and the county young women • HIV and RH Number of HIV/RH MoEST and provide HIV related education sessions held 4320 sessions 8640 and RH related in school or in held sessions education in the community held schools • Implement life Number of schools MoEST 10 schools with 20 schools skills programs with life skills every sub- with every for youth in programs within the county has a life sub-county school and out of county skills program has a school life skills program

64 Key activity Behavioural Indicator Baseline and Mid Term End Term Responsibility interventions source Target Target Implement • Support Number of PSSGs MoEST 264 528 Ministry of Social appropriate the formation formed Services evidence-based of PSSGs MOH behavioural to enhance interventions. adherence • Implement Percentage of health KDHIS/CHIS 50% of health 90% of the Positive facilities offering facilities health Health Dignity PHDP services offering PHDP facilities and Prevention within the county services offering (PHDP) services PHDP services Implement • Offer psycho- Number or CHIS 50% offering 90% Offering Kisii County Kenya Mentor social and peer percentage of psycho-social psycho- Government-MOH Mother support services facilities offering services social Implementing Programme for pregnant psycho-social services Partners women within services within the the health county facilities • Infants and Percentage of HIV DHIS 80% 90% young children exposed infants feeding exclusively breast strategies feeding in the first 6 months

STRUCTURAL INTERVENTIONS

Key activity Behavioural Indicator Baseline and Mid Term End Term Responsibility interventions source Target Target

Provide an • Implement Number of GBV Not Available 90, (2) Sessions 180, (4) Kisii County enabling gender-based prevention and per ward Sessions per Government-MoH environment for violence response program ward Implementing programming prevention being conducted Partners and response programmes • Implement Number of MoE 45 45 programmes programmes 1 per ward in to keep girls initiated and being the 45 per ward in school and implemented social protection of vulnerable families • Engage Number of sessions Not Available 18 forums held 39 forums private sector the private public to formalize partnerships a system to stakeholder forums compliment the conducted within the service delivery county system and reporting • Protection from Number of Not Available 180 Sessions 360 Sessions cultural issues/ campaigns practices that are conducted against directly linked to traditional practices HIV, e.g. FGM fueling HIV i.e. FGM within every sub- county

65 Structural Indicator Baseline and Mid Term End Term Responsibility interventions source Target Target Implement • Innovative HIV Number of Not Available 180 Sessions 360 Sessions Kisii county package of and STI testing campaigns Government-MoH services for conducted against Implementing Adolescents traditional practices Partners and Young fueling HIV i.e. FGM Women within every sub- county • Establish youth Number of Youth KDHIS 10 facilities 20 facilities friendly clinical friendly spaces established established services established at the health services within the county • Offer age Percentage of KDHIS 30% of the total 30% of appropriate women and men of population the total contraceptives, reproductive age eligible population and condoms accessing FP services accessed with eligible within the county FB service accessed with FB service • Increase Number or NASCOP At least one 50% of access to sexual percentage of APOC person trained health and reproductive sessions rolled out per facility on workers health services. within the health APOC trained on service delivery APOC points within the county Offer package • Offer regular Number or DHIS 100% 100% Kisii County of services for scheduled HTS percentage of Government-MoH sero- discordant to partners and discordant couples couples families of all HIV families accessing Implementing positive clients HTS at the health Partners facilities within the county • Provide ART Percentage of HIV- DHIS 100% 100% to the infected Positive patients partner and accessing HAART adherence treatment in all support health care facilities within the county Implement • Integrate Early Number or CHIS 75% 100% Kisii County strategies infant diagnosis percentage of Government-MOH to identify of HIV with facilities within and retain immunization integrated MCH Implementing HIV pregnant services with services as one Partners and lactating MNCH stop shop within the women and county their infants • Deliver all 4 Number or CHIS 80% 90% prongs of EMTCT percentage of health Adopt new at 100% of health facilities proving national and facilities PMTCT services WHO guidelines and basic HIV care on eMTCT package • Ensure all Number or KDHIS 90% of all 100% of all pregnant and percentage of pregnant pregnant lactating women pregnant and and lactating and lactating are initiated on lactating women women initiated women ART and all HIV are initiated on ART on ART initiated on positive children and all HIV positive ART are offered ART children are offered ART

66 Key activity Behavioural Indicator Baseline and Mid Term End Term Responsibility interventions source Target Target Adopt new • Offer GBV Percentage of GBV KDHIS 50% of the 100% of the Kisii County national and services cases offered PEP victims who victims who Government- WHO guidelines including report at the report at the MOH on eMTCT services for post- health facility health facility Implementing rape and incest Partners among children FBOs ,CBOs • Implement • Stigma Number of stigma 35% National HIV 10% 20% strategies to reduction reduction campaigns & AIDS stigma & address HIV campaigns held Discrimination related stigma Index • Risk reduction Number of skill Not Available 15,000 TBD 30,000 • Promote life counseling and building sessions sessions sessions skill programs skill building held within the among county vulnerable populations • Male and Number of condoms KDHIS 50% of the 80% of the female condom distributed within eligible eligible demonstration, the county health population population distribution and facilities skill building • Behaviour • Regular Percentage of KP CHIS 75% 100% Kisii County change outreach and reached out with key Government intervention contact with messages, treatment Implementing MoH using specific Key Populations and supported within Partners reports. Implementing interpersonal through peer the county (Impact research Partners tools and based education, Percentage of DSA for development MOH techniques treatment and addicts reached and Organization and Implementing including those support enrolled for support International Partners in Braille (rehabilitated) Medical Corps) • Drug and substance screening and addiction support

Implement • Offer peer-to- Number of peer –to CHIS 4320 sessions 8640 Kisii County evidence-based peer outreach in –peer outreaches held sessions Government- interventions school or outside conducted in and held MoH (EBI) for school outside school within Implementing adolescents and the county Partners young women • HIV and RH Number of HIV/RH MOE 4320 sessions 8640 and provide HIV related education sessions held held sessions and RH related in school or in held education in the community schools • Implement Number of schools MoE 10 schools with 20 schools life skills with life skills every sub- with every programmes programmes within county has a life sub-county for youth in the county skill program has a school and out of life skills school programme

67 Key activity Structural Indicator Baseline and Mid Term End Term Responsibility interventions source Target Target Implement • Support Number of PSSGs 264 528 Ministry of Social appropriate the formation formed Services evidence-based of PSSGs behavioural to enhance MoH interventions adherence • Implement Number of health KDHIS/CHIS 50% of health 90% of Positive Health facilities offering facilities health Dignity and PHDP within the offering PHDP facilities Prevention county services offering (PHDP) PHDP services Implement • Offer Psycho- Number or CHIS 50% offering 90% Offering Kisii County Kenya Mentor social and peer percentage of psycho-social psycho- Government-MOH Mother support services facilities offering services social Implementing Program for pregnant psycho-social services Partners women within services within the the health county facilities • Infant and Percentage of DHIS 80% 90% young children HIV exposed feeding infants exclusively strategies breastfeeding in the first 6 months Provide an • Implement Number of GBV Not Available 90, ( 2 ) 180, (4) Kisii County enabling gender- based prevention and sessions per sessions per Government-MoH environment for violence response program ward ward Implementing programming prevention being conducted Partners and response programs • Implement Number of MOE 45 45 programs to programmes 1 per ward in keep girls in initiated and being the 45 per school and implemented ward social protection of vulnerable families • Engage Number of sessions Not Available 18 forums held 39 forums private sector the private public to formalize partnerships a system to stakeholder forums compliment conducted within the the service county delivery system and reporting requirements • Protection from Number of Not Available 180 sessions 360 sessions cultural issues/ campaigns practices that are conducted against directly linked to traditional practices HIV, e.g. FGM fueling HIV, i.e. FGM within every sub- county

68 STRATEGIC DIRECTION 2: IMPROVING HEALTH OUTCOMES AND WELLNESS OF ALL PEOPLE LIVING WITH HIV

KASF KCHASP Key Activity Sub activity Indicator Baseline Mid Term End Term Responsi- Objective Results and source Target Target bility

Reduce Increased Intensify • Intensifying EID Percentage KDHIS 25% of 50% of Kisii County AIDS- linkage to identification at MNCH of people new OPD new OPD Government- related care and and retention accessing clients and clients and MoH mortality treatment in the care HTS within the 90% IP 100% IP Implementing by 25% up to 90% of children county tested tested Partners within 3 living with months HIV of HIV • Adherence Adherence Patient Blue 100% 100% diagnosis counseling to the rate Card care givers • Community Percentage 85%, facility 100% 100% follow up and of defaulters defaulter defaulter tracing) traced and registers brought back to care.

• Establish child Percentage 11 health 61 health 122 friendly spaces of health facilities facilities health facilities with (DHIS) facilities child friendly spaces • Intensified case Proportion of 37% (KDHIS) 64% 90% finding by testing children of children in MCH, unknown HIV outpatient, status tested. special clinic and wards with unknown status • Improved Proportion of 70% 80% 90% identification HEIs followed follow-up of up on care up HEI such as in to 18 months maternity wards, immunization clinics etc. Roll out • Provide youth Number TBD TBD TBD adolescent’s friendly services, of ART site care package psycho-social s offering and peer adolescents support. support group • Sensitization Percentage 5% healthcare 100% 100% of APOC to of health workers healthcare care workers providers sensitized • Utilize Number of Nil 61 122 technology social media including platforms social media created for for education, education, recruitment and recruitment retention in care and retention in care

69 Key activity Structural Indicator Baseline and Mid Term End Term Responsibility interventions source Target Target Intensify Mainstream KPs Number of health 1 4 9 Kisii County identification and programming in facilities mainstream Government-MoH retention in the health facilities KPs programming care of children Implementing living with HIV Partners Intensify • Proportion Percentage of PLHIV 80% 90% 100% identification and HIV+ linked to linked for follow up retention in care care within the and treatment for adults living facility with CCC with HIV No indicated • Implement Proportion of site Percentage of sites 90% 100% 100% Kisii county PMTCT implementing with ART integrated Government-MOH guidelines on PMTCT in MCH testing guidelines Implementing Partners

Key Intervention 2: Increase coverage to care and treatment and reduce the loss in the cascade of care

Decentralize • Proportion • Percentage 98% 100% 100% Kisii County HIV services for of facilities Coverage of HIV Government-MoH children to all providing HIV services for children health facilities services for Implementing including private children Partners and faith based FBOs ,CBOs facilities Roll out package • Proportion • Percentage 50% 80% 100% Kisii County of services for of facilities Coverage of Government-MoH adolescents and providing adolescent package youth. adolescent of services for Implementing package of children Partners services Decentralization • Proportion of • Percentage 99% 100% 100% Kisii County of ART services facilities offering Coverage of ART Government-MoH and ensure ART services sites commodity Implementing security Partners Decentralization • Proportion of • Percentage 100% 100% 100% of PMTCT facilities offering Coverage of PMTCT services to all PMTCT services sites health facilities

Key Intervention 3: Improve quality of care and treatment outcomes

To improve • Proportion • Percentage of 98% 100% 100% Kisii County quality of care of facilities facilities observing Government-MoH and observing standards of care monitoring standards of Implementing treatment care Partners outcomes

To improve • Proportion Percentage of 80% 90% 100% County laboratory of facilities facilities with Government capacity and with improved improved laboratory infrastructure laboratory capacity Implementing capacity partners

70 STRATEGIC DIRECTION 3: USING A HUMAN RIGHTS APPROACH TO FACILITATE ACCESS TO SERVICES FOR PLHIV, KPs AND OTHER PRIORITY GROUPS IN ALL SECTORS

KASF KCHASP Key Activity Sub activity Indicator Baseline Mid End Responsi- Objective Results and Term Term bility source Target Target An enabling Reduced Sensitization The facility Number of TBD 164 324 CDH, COH legal and reported of general in charges to healthcare policy stigma by 50 % and targeted sensitize health workers environment population care workers sensitized necessary with anti- on reducing for a stigma stigmatizing robust HIV awareness attitudes in response at messages healthcare the national settings. and county Implement Number of TBD CHAC level to programs aimed programmes ensure at reducing implemented access to stigma and services discrimination by persons against priority living with populations. HIV Reduced Implement Promote the Number of TBD CDGSD, self-reported structural PLHIV to enroll in PLHIVs enrolled NEPHAK HIV related interventions support groups in support stigma and that empower and ensure they groups discrimination PLHIVs register with the by 50% Department of Social Services. Remove Develop policies Number TBD MoH barriers to to protect priority of policies access of HIV, groups when developed to SRH and rights accessing HIV- protect priority to information related services population and services in private and public entities Strengthen and Number 2 5 10 County establish more of DICEs Government DICs to offer HIV established Implementing services to the Partners KPs Empower General TBD County communities population Government through Implementing various forums Partners and provision of IEC Integrate HIV Religious TBD IRC information institutions and encourage Sensitize law Number of TBD 3 6 CEC (Health) service uptake makers on the County Assembly sessions sessions in religious need to enact sensitization settings nondiscriminatory held sessions regulations and services

71 KASF KCHASP Key Activity Sub activity Indicator Baseline Mid End Responsi- Objective Results and Term Term bility source Target Target

An enabling Reduced levels Integrate HIV Educate Number of SGBV TBD 3 6 CEC (Health) legal and of sexual and information communities on Report sessions sessions policy gender-based and encourage gender and legal environment violence for service uptake issues necessary PLHIV, key in religious for a populations, settings robust HIV women, men, response at boys and girls the national by 50% and county Improve Sensitize county Number of legal TBD 3 6 CEC level to county legal assembly policies enacted sessions sessions ensure and policy members and access to environment executives on the services for protection need to enact by persons and promotion laws, regulations living with of the rights and policies HIV of priority that prohibit groups, Key discrimination Populations and support and PLHIVs access to HIV prevention, treatment, care and support. The county Number of TBD 1 2 CDH, COH assembly to existing laws review the existing reviewed laws and execute the existing policies to ensure they impact the response to HIV positively. These should be consistent with the constitution, national laws and policies. Sensitize Number of TBD 6 12 CHAC lawmakers and sessions held sessions sessions law enforcement agencies on HIV and consequences of their implementation and implementation of laws in the provision of HIV services to priority populations. Enrol PLHIV, Number of TBD 5 10 CASCO OVCs, Key social groups Populations and enrolled in other priority social protection groups into the programmes social protection programmes

72 KASF KCHASP Key Activity Sub activity Indicator Baseline Mid End Responsi- Objective Results and Term Term bility source Target Target

An enabling Reduced levels Improve Sensitize Number of TBD 162 324 MoH legal and of sexual and county legal individual health workers policy gender-based and policy healthcare sensitized environment violence for environment workers, necessary PLHIV, key for protection healthcare for a populations, and promotion administrators robust HIV women, men, of the rights and healthcare response at boys and girls of priority regulators on the national by 50% groups, Key their own human and county Populations rights and level to and PLHIVs skill and tools ensure necessary to access to ensure patient services rights are upheld by persons Advocate for Number of None 1 1 CEC Health, living with decentralization HIV Tribunals CHAC HIV of HIV tribunal to decentralized the county

In collaboration Number of TBD County with other programmes Governments stakeholders, aimed at Implementing non-state actors upholding rights Partners to implement of priority groups programmes aimed at upholding their rights of priority populations Sensitization of Number of TBD 6 12 CHAC police, healthcare sensitization CASCO workers, Civil meetings held Societies and legal groups on SGBV support Link SGBV Percentage of TBD 50% 100% County survivors to SGBV linked to Governments gender response gender units Implementing units within the Partners county

Reduce and The County Number of TBD 1 3 monitor Government stigma index stigma and to conduct surveys discrimination, measurement conducted social and GBV of HIV-related stigma through PLHIV Stigma Index including in healthcare settings and communities. Conduct a county Number of None 1 1 baseline survey baseline surveys to document the conducted magnitude and nature of human rights violation and gender disparities in the context of HIV

73 STRATEGIC DIRECTION 4: STRENGTHENING INTEGRATION OF COMMUNITY AND HEALTH SYSTEMS

KASF KCHASP Key Activity Sub activity Indicator Baseline Mid End Responsi- Objective Results and Term Term bility source Target Target Build a Improved Provide a Recruitment, Percentage of TBD 20% 40% County strong and health competent, redistribution, competent new Government sustainable workforce for motivated and capacity building, health workers system for HIV response adequately performance hired. HIV service at county and staffed review and delivery at sub-county workforce motivation of Percentage of both national levels at county competent and health workers and county and sub- skilled healthcare capacity built levels through county levels workers in all specific to deliver tiers (All HR health and integrated HIV issues ) community services at systems different tiers. approaches, Developing The health No policy 1 policy 2 reviews County Public actions and domestic health domestic staff available document done on Service Board interventions staff retention retention policy developed the policy to support the policy that takes developed document HIV response into account the additional burden of HIV Design a Percentage TBD 20% 40% County community CHVs engaged Government system that can by the county integrate and human motivate the resource in community health the provision volunteers and of integrated care givers in the services. implementation of HIV programmes. Task sharing and Number of 20% 50% County mentorship for mentoring Government skills transfer. sessions conducted Train CHVs, equip Percentage of 40% 75% County CUs,and motivate CHVs trained, Government them. equipped and enrolled in community units Increased Strengthen the Upgrade the Number of TBD 600 1900 County number health service infrastructure for community Government of health delivery all community units whose facilities system at units in county to infrastructure (Health ready to county and meet the basic has been sector) provide sub-county standards for HIV upgraded to KEPH-defined levels to service provision meet basic HIV and AIDS deliver at Level 1. standards services integrated HIV for HIV services at management different tiers

74 KASF KCHASP Key Activity Sub activity Indicator Baseline Mid End Responsi- Objective Results and Term Term bility source Target Target Build a Increased Strengthen the Improve Percentage 75% 100% County strong and number health service accessibility to of KPs and Government sustainable of health delivery comprehensive vulnerable system for facilities system at HIV services to groups HIV service ready to county and the KPs and accessing delivery at provide sub-county vulnerable groups comprehensive both national KEPH-defined levels to HIV services and county HIV and AIDS deliver Mainstreaming of Percentage of 10% 50% 75% County levels through services integrated HIV HIV in all sectors. county sectors Government specific services at and units health and different tiers mainstreaming community HIV. systems approaches, Strengthened Improve Develop a HIV County HIV Non 100% 100% County actions and HIV access to commodity commodity exists Government interventions commodity and rational management and management (Health to support the management use of quality supply chains and supply Sector) HIV response through essential monitoring at chain effective products and county level. monitoring and efficient technologies system management for HIV developed. of medicine prevention, Capacity building Percentage of TBD 75% 100% Implementing and medical treatment and of procurement procurement Partners products.. care services. staff to enhance staff capacity efficiency of HIV built to enhance commodities. efficiency of HIV commodities. Distribution Percentage TBD 70% 100% County of adequate facilities Government and functional equipped with HIV diagnostic functional HIV equipment (VL, diagnostic CD4) equipment at sub-county and county referral points. Introduction of Percentage TBD 30% 50% County facility-based of facilities Government IT systems to installed with manage and facility based monitor HPT IT systems to supplies and link manage and with national monitor HPT and county MoH supplies information system. Strengthened Strengthen Set aside a Number of None 50% 100% County community- community financial kitty sustainable Government level AIDS service for HIV & AIDS community (Health competency delivery community units Sector) system at services. county and sub-county levels for the provision of HIV prevention treatment and care services.

75 KASF KCHASP Key Activity Sub activity Indicator Baseline Mid End Responsi- Objective Results and Term Term bility source Target Target Build a Strengthened Strengthen Empowering Number of TBD One One Implementing strong and community- community communities to meetings and session session Partners sustainable level AIDS service ensure capability action days held per held per system for competency delivery and capacity to conducted ward in a ward in a HIV service system at take responsibility quarter (a quarter delivery at county and of their health. total of 84 (a total both national sub-county sessions of 168 and county levels for the held) sessions levels through provision of held specific HIV prevention Monitoring Number of TBD One One County health and treatment and community and monitoring and visit per Government community care services. facilities to ensure follow-up visits quarter systems that they adhere conducted per approaches, to laid-down facility actions and standards on the interventions implementation of to support the HIV activities. HIV response

STRATEGIC DIRECTION 5: STRENGTHENING RESEARCH, INNOVATION AND MANAGEMENT OF INFORMATION TO INFORM KCHASP GOALS

KASF Objective KCHASP Key Activity Indicators Baseline and Mid Term End Responsi- Results source Target Term bility Target Identification and Increased Planning and Evidence-based 80% 50% 100% CEC Health implementation evidence-based programming planning and of high impact planning and of research programming research priorities, programming activities innovative by 20% programming and strengthening capability and Increased Training on Percentage of TBD 20% 50% CEC Health capacity to capacity to operation county staff trained conduct research conduct HIV research on operation research in the research county by 50%

STRATEGIC DIRECTION 6: PROMOTING UTILIZATION OF STRATEGIC INFORMATION FOR RESEARCH AND MONITORING AND EVALUATION (M&E) TO ENHANCE PROGRAMMING

KASF Objective KCHASP Results Key Activity Indicators Baseline and Mid Term End Responsi- source Target Term bility Target To improve M&E information M&E M&E information 1 1 1 CEC Health quality, demand, hubs integrated information hub integrated access and use of at county level hub integration data for decision and providing a making at county comprehensive and health facility information levels package for decision making Increased utilization Utilisation Utilization TBD 50% 100% COH of strategic of strategic of strategic information information information in HIV to inform HIV response at all response at all levels levels

76 STRATEGIC DIRECTION 7: INCREASING DOMESTIC FINANCING FOR A SUSTAINABLE HIV RESPONSE

KASF KCHASP Intervention Key activity Indicator Baseline Mid End Responsi- Objective Results Term Term bility Target Target (2017) 2019 Increase Increased Innovative and Participation in Number None 2 4 KCG domestic county sustainable the annual county of public financing financing for domestic HIV budgetary making participations by 50 HIV response financing cycle to ensure attended by 75% (USD options in the resource lobby. 15m) county

Strengthen Number of TBD 8 16 Implementing public private PPP forums Partners partnership organised engagement at all levels at the county and sub- counties through regular PPP forums Initiate an annual Number None 2 4 Development AIDS lottery of lottery Partners programme. programmes initiated Organize high Number of high TBD 4 8 Community level engagement level meetings with the county held with the stakeholders stakeholders to advocate for domestic financing. Build and Percentage TBD 50% 100% County enhance capacity of CSOs Assembly of civil society trained on self organizations sustainability to achieve self concepts financing and sustainability. Coordination of Creation of an Number of None 1 1 County all resources information hub functional Government available for for the county to information hub through HIV response track resources developed the health in the county from all partners services to avoid sector duplication of Carry out a cost- Report on cost TBD 100% 100% efforts. benefit analysis benefit analysis on the HIV & AIDS programs. Maximize Align the HIV and County HIV None 100% 100% KCG efficiency of AIDS response strategic plan existing HIV within the local developed and delivery options context disseminated for increased value and results within the existing resources Aligning HIV Carry out a needs Assessment TBD 100% 100% KCG resources/ assessment report investment to on key priority strategic plan interventions priorities

77 STRATEGIC DIRECTION 8: PROMOTING ACCOUNTABLE LEADERSHIP FOR DELIVERY OF KASF RESULTS BY ALL SECTORS AND ACTORS

KASF KCHASP Intervention Key activity Indicator Baseline Mid Term End Term Responsi- Objective Results Target Target bility (2017) 2019 Promote Good Build and High level Number of TBD 2 high level 4 high level Office of the good governance sustain high- engagement the high level engagement engagement Governor governance practices and level political with the office engagement held (2 meetings practices by accountable commitment of the governor done sessions per Held identifying, leadership for and members year) developing entrenched strengthened of the county and for the multi- county assembly to nurturing sectoral HIV ownership obtain p effective and AIDS of the HIV Political and response at all response will and committed levels commitment in leaders the impleme- for the HIV ntation of the and AIDS strategic plan response High level Number of TBD 4 sessions 8 sessions County engagement high level held held Executive for of MCAs and engagement Health the county with MCAs held assembly executives to create awareness on the county HIV responses

Enact Number of TBD 4 KCHASP 4 KCHASP NACC legislation that legislation coordination Coordination are HIV county- enacted on HIV structures structures specific based & AIDS constituted constituted on the priorities

Effective and Entrench good Joint KCHASP Number of None 2 4 well-functioning governance annual annual KCHASP stakeholder co- and strengthen implementation implementation ordination and multi-sector review review meetings accountability and multi- meetings held mechanisms in partner with the place and fully accountability stakeholders, operationalized for the to ,implementers zed at the delivery of and partners county and sub- KCHASP involved in the county levels results HIV & AIDS response within the county

Regular update Number of None 8 16 County meetings performance Government to Ensure and accountability accountability for performance meetings held and results by all implementing partners at the county

78 KASF KCHASP Intervention Key activity Indicator Baseline Mid Term End Term Responsi- STRATEGIC DIRECTION 8: PROMOTING ACCOUNTABLE LEADERSHIP FOR DELIVERY OF KASF RESULTS Objective Results Target Target bility BY ALL SECTORS AND ACTORS (2017) 2019 Promote Coordination of Creation of an Number of None 1 1 County KASF KCHASP Intervention Key activity Indicator Baseline Mid Term End Term Responsi- good all resources information functional Government Objective Results Target Target bility governance available for hub for the information hub through (2017) 2019 practices by HIV response county to track developed the health identifying, in the county resources from services Promote Good Build and High level Number of TBD 2 high level 4 high level Office of the developing to avoid all partners sector good governance sustain high- engagement the high level engagement engagement Governor and duplication of governance practices and level political with the office engagement held (2 meetings nurturing efforts. practices by accountable commitment of the governor done sessions per Held effective An enabling Establish Hold regular Number of None 8 16 NACC identifying, leadership for and members year) and policy, legal functional HIV county and stakeholders developing entrenched strengthened of the county committed and regulatory co-ordination sub-county fora conducted and for the multi- county assembly to leaders framework for mechanism at stakeholders nurturing sectoral HIV ownership obtain p for the HIV the multi- the county and Fora to create effective and AIDS of the HIV Political and AIDS sectoral HIV sub-county awareness and response at all response will and response committed levels commitment in and AIDS levels on key HIV leaders the impleme- response interventions for the HIV ntation of the strengthened envisaged in the and AIDS strategic plan and fully strategic plan response aligned to the Constitution of High level Number of TBD 4 sessions 8 sessions County Kenya 2010. engagement high level held held Executive for of MCAs and engagement Health Tracking and Number of None 2 4 NASCOP the county with MCAs held monitoring of M&E reports assembly the resources compiled and executives during the submitted to create strategic plan awareness on implementation, the county HIV monitoring and responses evaluation Annual joint HIV Annual HIV None 2 4 County Enact Number of TBD 4 KCHASP 4 KCHASP NACC /AIDS program & AIDS government legislation that legislation coordination Coordination review at the programme are HIV county- enacted on HIV structures structures county level review report specific based & AIDS constituted constituted on the priorities

79 Annex 2 Resource Needs

The resource needs to fully implement the Kisii County HIV & AIDS Plan is estimated at USD 215.9 Million for the five-year period. The cost will rise from USD 38.08 Million in 2014/15 to USD 45.94 Million in the final year of the strategic plan due to scaling up of the key HIV interventions. In estimating the resource needs, a macro- costing (down up) approach was used. The resource needs was based on the current Kisii County HIV burden.

Resources required for implementing KCHASP (in USD Millions)

Strategic Specific KCHASP % of 2014/15 2015/16 2016/17 2017/18 2018/19 Total Directions Intervention Resource Areas dedicated for the strategy SD1 HIV prevention 25.99% 9.90 11.27 12.72 14.23 15.42 63.53

SD2 Treatment and 53.37% 20.32 22.22 23.21 23.64 23.34 112.73 care

SD3 Social inclusion, 4.00% 1.52 1.98 2.46 2.99 3.55 12.50 human rights and gender

SD4 Health systems 6.35% 2.42 2.19 1.79 1.61 0.84 8.85

Community 3.65% 1.39 1.25 1.03 0.92 0.48 5.08 systems

SD7 & SD8 Leadership, 3.94% 1.50 1.52 1.48 1.40 1.26 7.17 governance and resource allocation

SD6 Monitoring and 1.84% 0.70 0.71 0.69 0.65 0.59 3.34 evaluation

SD5 Research 0.49% 0.19 0.21 0.23 0.25 0.26 1.14

Supply chain 0.37% 0.14 0.16 0.17 0.19 0.20 0.86 management

Grand Total 100.00% 38.08 41.51 43.80 45.87 45.94 215.19

80 Annex 3 Resource Materials

1. NACC, Kenya AIDS Strategic Framework 2014/2015-2018/2019

2. Kenya AIDS Strategic Framework Monitoring, Evaluation and Research Framework

3. NACC, NASCOP Kenya HIV County Profile, 2014

4. NACC, NASCOP Kenya HIV Estimates 2014

5. MoH, NACC, NASCOP Kenya Prevention Revolution Road Map, 2014

6. MoH, Kenya Health Policy 2012-2030

7. County Integrated Development Plan 2013/14 - 2017/2018

8. County Health Strategic and Investment Plan 2013/14 to 2017/2018

9. The Strategic Plan for the Engagement of the Office of the First Lady in HIV Control and Promotion of Maternal, Newborn and Childhealth in Kenya 2013/17

10. KASF Research Agenda, 2014/15 – 2018/19

11. NACC, Fast Track Plan to End HIV and AIDS Among Adolescents and Young People, 2015

12. Kenya Demographic Health Survey, 2014

13. Kenya AIDS Indicator Survey, 2012

14. NACC Kenya Stigma and Discrimination Index Report, 2014

15. Kisii County KASF Dissemination Report, June 2015

16. The Constitution of Kenya, 2010

81 Annex 4 List of Drafting and Technical Review Team

County drafting team 1. Dr. Richard Onkware – CASCO Kisii County 2. Kizito Mukhwana – CARE Kenya 3. Dr. William Ringera – CARE Kenya 4. Dr. Elizabeth Katiku – CARE Kenya 5. Judy Omare – CARE Kenya 6. Beatrice Moseti – CARE Kenya 7. Roselyne Igwora – KCCB-KARP 8. Yunia Nyaisu – MoH 9. Mishael Oyunge – MoH 10. Ibrahim Nyachae – MoH 11. Rev. James M. Mogire– FBO 12. Pauline Okemwa – Kisii University 13. Mary Rogito – MoH 14. Gordon Okello – IRDO 15. Monica Chan – IRDO 16. Caleb Owino – IMC 17. Joshua Simba – KCG 18. Jamal Obwoge – NEPHAK 19. Kavutha Mutuvi – UNWOMEN 20. Harriet Kongin – UNAIDS 21. Dennis Marwanga – NACC

Technical review team 1. Elly Assurah – KEMRI-RCTP - SEARCH Study 2. Prof. Boaz Nyunya – CDC

82 KISII COUNTY HEALTH SERVICES P.O BOX 92 KISII 40200 TELEPHONE: 0717025562 WEBSITE: www.kisii.go.ke/departments/health-services

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