HIV SERVICE DELIVERY SUPPORT ACTIVITY (HSDSA) CLUSTER 3 BASELINE REPORT 11 June 2018 This document was produced for review by the United States Agency for International Development.HIV Services It Deliverywas prepared Support Activity by (HSDSA) Jhpiego – Activity, Johns Baseline Hopkins Report University affiliate. 1 HIV SERVICE DELIVERY SUPPORT ACTIVITY (HSDSA) Contract No. 72061518C00001 Submitted to: USAID Kenya and East Africa Date: 11 June 2018 Submitted by: Jhpiego Corporation Sub-contractors/Implementing partners: LVCT Health, Amethyst Technologies LLC, Cloudburst Group Contracting Officer’s Representative: Dr Maurice Maina Contracting Officer: Nya Kwai S. Boayue DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. HIV Services Delivery Support Activity (HSDSA) – Activity Baseline Report 2 TABLE OF CONTENTS ACKNOWLEDGEMENT ............................................................................................. 6 ACRONYMS ................................................................................................................. 8 GLOSSARY OF KEY TERMS ...................................................................................... 9 EXECUTIVE SUMMARY ...........................................................................................10 1. BACKGROUND .....................................................................................................11 HSDSA Project Technical Approach ................................................................................................... 11 HSDSA Project Results Framework .................................................................................................... 12 PURPOSE AND OBJECTIVES OF BASELINE ASSESSMENT ............................12 2. METHODOLOGY ..................................................................................................14 2.1 Key Project indicators and Differentials Explored .................................................................... 14 2.2 HSDSA Cluster 3 Baseline Assessment Approach .................................................................... 15 2.3 Data Management and Analysis ..................................................................................................... 16 2.4 Baseline Assessment: Stakeholder Meetings ............................................................................... 16 2.5 Ethical Consideration ....................................................................................................................... 16 2.6 Challenges and limitations ............................................................................................................... 16 3. KEY FINDINGS ......................................................................................................18 3.1 Desk Review ....................................................................................................................................... 18 3.2 Organizational Capacity Assessment ............................................................................................ 30 3.3 Health Facility Assessment .............................................................................................................. 34 3.4 APHIAPLUS KAMILI project End-line Survey ............................................................................ 38 4. ACTIVITY LEARNING AGENDA .......................................................................40 5. CONCLUSION AND RECOMMENDATIONS ...................................................41 Annex A: Indicator Reference Sheet ...............................................................................43 Annex B: Activity Indicator Tracking Table ...................................................................................... 48 ANNEX C: Health Facility Assessment Tables ................................................................................. 51 Annex C: HSDSA Cluster 3 Supported Health Facilities ............................................................... 54 Annex D: OCA capacity gaps and plans ............................................................................................ 60 HIV Services Delivery Support Activity (HSDSA) – Activity Baseline Report 3 LIST OF TABLES Table 1: Distribution of Vulnerable AGYW by ward: in Biashara and Ngoliba wards ....................................................... 18 Table 2: Distribution of Vulnerable AGYW by age groups: in Biashara and Ngoliba wards ............................................. 18 Table 3: HIV Population projections 2016, 2018 in Cluster 3 counties ................................................................................. 19 Table 4: HIV positive case identification by County against annual targets by COP17 SAPR .......................................... 21 Table 5: Baseline HIV Positive by County, Age bands and Gender in Cluster 3 (COP17 SAPR) .................................... 21 Table 6 Number of tests and yield per testing modality (Oct’17 – Mar’18) ......................................................................... 22 Table 7 Number of Partner Notification Services (PNS) sites by County at COP 17 SAPR ............................................ 22 Table 8: Linkage to treatment by Gender and Age-bands.......................................................................................................... 23 Table 9: County contribution on newly initiated clients on ART (TX_NEW) ..................................................................... 23 Table 10: County contribution on newly initiated clients on ART (TX_NEW) .................................................................. 23 Table 11: Newly enrolled and current on ART in Cluster 3 counties .................................................................................... 24 Table 12: HIV testing among pregnant women ............................................................................................................................. 24 Table 13: HIV testing among HIV Exposed Infants ....................................................................................................................... 25 Table 14: Baseline Viral load suppression rates in nine Cluster 3 counties in COP16 ....................................................... 25 Table 15: Baseline Viral load suppression rates in nine Cluster 3 counties in COP17 SAPR ........................................... 26 Table 16: Baseline Viral Load Suppression Rate by County and Age bands in Cluster 3 (COP16) ................................ 26 Table 17: Baseline Viral Load Suppression Rate by County and Gender in Cluster 3 (COP16) ..................................... 27 Table 18: Baseline Viral Load Suppression Rate by County and Gender in Cluster 3 (COP 17 SAPR) ........................ 28 Table 19: Differentiated service Models: Health facilties Implementing DCM in COP17 SAPR ...................................... 28 Table 20: Number of Facilities with Viremia clinics by county in Cluster 3 .......................................................................... 29 Table 21: Number of Facilities with Electronic Medical Records by county (COP 17 SAPR) in Cluster 3 ................. 29 Table 22: Number of Facilities with PSSGs by County in Cluster 3 ........................................................................................ 30 Table 23: Planning and Budgeting, Performance (May 2018) ..................................................................................................... 30 Table 24: Leadership and Governance, Performance (May 2018) ........................................................................................... 31 Table 25: Human Resources for Health, Performance (May 2018) ......................................................................................... 31 Table 26: Health Information System (HIS), Performance (May 2018) ................................................................................... 32 Table 27: Five year Plan to improve OCA capacity scores ........................................................................................................ 32 Table 28: Distribution of Health facilities by County .................................................................................................................. 34 Table 29: Health facilities sampled by KEPH Levels ..................................................................................................................... 34 Table 30: Availability of specific HIV Services at HFs in Cluster 3 ........................................................................................... 34 Table 31: Service Delivery points offering HTS Services at ...................................................................................................... 35 Table 32: Baseline SIMS Scores (COP16) in selected 10 HFs in Murang’a & Tharaka-Nithi Counties .......................... 36 Table 33: Household Interviews Completed ................................................................................................................................. 38 Table 34: Among antenatal and post-natal mothers interviewed by county ......................................................................... 38 Table 35: Ever heard of HIV/AIDs and knowledge of HIV Prevention 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