Kenya

AIHA initiated activities under the CDC1950 grant in Kenya (October 2019), Tanzania and Zambia, (April 2020), Nigeria (May 2020), Guatemala (July 2020), Haiti (October 2020), the Dominican Republic (October 2020), and the Philippines (2020) the goal of which is to strengthen Key Population (KP) and Civil Society (CSO) led organizations’ capacity to deliver services to vulnerable populations to stem the spread of HIV/AIDS through various prevention, care and treatment initiatives. The project also provides KP-led organization with the skills and abilities to enable them to operate as primary recipients (and sub-grantors) of US/PEPFAR and other donor funding. 

AIHA is conducting this work in collaboration with CDC/Atlanta and respective CDC Country Offices and National KP Consortia. 

CDC1950 also operated in Thailand and Laos where the primary focus of AIHA’s work was on index testing.

Once KP-led organizations in-country have been identified, the first step in the process is to conduct an assessment of organizational capacity. AIHA has used the Organizational Capacity Assessment (OCA tool), a self-assessment that each KP-led or KP-competent organization interested in participating in this project needs to complete to determine gaps and training needs. 

In late 2019, the OCA forms submitted by the 29 CSOs were analyzed and then shared along with recommendations with the national KP networks. This helped determine the list of 15 KP-led CSOs to be included in the project and informed the development of an organization-specific training plan. 

The most common gaps identified were in Project, Finance, Human Resources and Organizational management. Due to COVID19 pandemic, AIHA has been conducting trainings on priority areas via a set of webinars followed by one-on-one mentorships. All CSOs are welcome to listen to webinars but one-on-one mentors has been offered to 15 organizations selected for the project.

In April 2020, AIHA – in collaboration with AVAC and the CDC – arranged stakeholders’ consultations with the KP Consortium of Kenya to discuss the needs of KP-led organizations and identify priorities for training and mentorship. 

Trainings were delivered by local consultants in very close collaboration with the KVP Forum.

In Year 1 AIHA conducted trainings in Project, Finance and Human Resources Management via online trainings. Trainings on Strategic Planning, Governance and Advocacy were delivered by AVAC. All trainings were followed by mentorships.

Key results of Project Year 1 included: 

• Organizational Capacity Assessment competed. 29 CSOs participated, 15 selected for mentorship;
• 37 participants attended the 5-days training on Finance Management;
• 35 participants attended the 3-days training on Project Management;
• 35 participants attended the 3-days training on Project Management;
• AVAC provided 3 above-mentioned trainings online and 136 participants from 29 CSOs attended three online trainings
• 244 mentorship hours were delivered by local mentors upon completion of the training

In Project Year 2 AIHA focused on the following:

Objective 1: Strengthen financial resiliency through planning for diversified sources of revenue 

In accordance with gaps identified in Year 1, AIHA delivered six trainings in Year 1. In Year 2 AIHA delivered the ToT on-line training on Social Enterprise and diversified sources of revenue followed by another course for CSOs. All trainings were followed up with in-country based mentorship. Upon completion of the training on Social Enterprise, participants submitted draft business plans that included a social enterprise scheme (e.g. a profit-generating activity). 

Objective 2: Build capacity to implement and sustain social enterprise schemes

Small grants were provided to CSOs to address their capacity development needs.

Key results:

Key Results of OCA-informed Training and Mentorship Programs:

• Kenyan CSOs participated in Capacity Trainings: Governance, Strategic Planning, Advocacy, Finance Management, Project Management, Human Resources, and Social Enterprise
• Organizational Capacity Assessment competed. 29 CSOs participated, 15 selected for mentorship;
• 37 participants attended the 5-days training on Finance Management;
• 35 participants attended the 3-days training on Project Management;
• 35 participants attended the 3-days training on Human Management;
• AVAC provided 3 above-mentioned trainings online and 136 participants from 29 CSOs attended three online trainings
• 244 mentorship hours were delivered by local mentors upon completion of the training

Key Results for Capacity Building Grants:

• 10 Kenyan KP-led CSOs were awarded Organizational Capacity min-grants
• 10 of 10 KP-led CSOs successfully completed their Organizational Capacity min-grants:
• 3 CSOs developed their 1st Organizational Strategic Plans
• 2 CSOs developed their 1st Board Charter and provided Board Trainings
• 2 CSOs developed their 1st Human Resource Policies and Manuals 
• 1 CSO created a GBV Care Manual for KP-led Communities
• 1 CSO developed their 1st M&E Framework
• 1 CSO developed their 1st Advocacy and Communication Strategic Plans

Key Results of Social Enterprise Initiative:

• 14 CSOs and 19 participants were trained in social enterprise.
• 4 ToTs KP representatives were trained in social enterprise from (MSM, FSW, Trans, and Prisoner populations)

Kenyan CSOs will share their experiences, lessons learned and recommendations for follow-up in an on-line Learning Exchange Forum scheduled for November 2021.

In late 2015, AIHA was selected by CDC/Kenya as an implementing partner of the DREAMS Initiative, an ambitious public-private partnership between PEPFAR, the Bill and Melinda Gates Foundation, and Nike’s Girl Effect.

AIHA is collaborating with the Kenya Conference of Catholic Bishops (KCCB) to implement the DREAMS Initiative in the Western Kenya counties of Siaya, Homa Bay, and Migori. Covering 21 county assembly wards in Siaya, two in Homa Bay, and four in Migori, AIHA’s DREAMS project consists of seven different evidence-informed behavioral, biomedical, and structural HIV prevention interventions layered and delivered to adolescent girls between the ages of 10 and 14.

One of the interventions, Social Asset Building, is implemented by trained mentors who work with groups of up to 30 adolescent girls. Mentors meet with girls once a week in a Safe Space, such as a school or community center. There, they are free to talk about health, peer pressure, economic hardships, and other challenges identified by the girls themselves. AIHA and KCCB collaborate with two other CDC DREAMS implementers that focus on girls and young women ages 15-24.

Over the course of implementing our holistic, multi-layered evidence-based approach to addressing girls, their parents or caregivers, and the greater community through DREAMS, AIHA has attained the following results:

• 68,000+ Girls reached through Social Asset Building activities
• 39,700+ Girls received HIV counseling & testing
• 56,000+ Community members trained in gender norms through the SASA! Intervention
• 19,900+ Parents & caregivers trained in Families Matter!
• 26,100+ Girls received education subsidies and support
• 1,600+ Girls referred to follow up care for gender-based and/or sexual violence
• 19,500+ Girls received financial capability training
• 27,800+ Girls in target communities participated in HIV and GBV prevention interventions – 9,400+ boys participated as well!

As in many developing countries, Kenya’s network of more than 2,500 public health laboratories perform only the most basic tests, with more advanced testing performed at national central laboratories. The country’s public health laboratory network is challenged by a severe lack of resources, including a limited workforce that is further hampered by a dearth of experienced managers, inadequate equipment and information technology including HIV-related diagnostics, poorly maintained facilities, and a weak quality management system.

In 2015, PEPFAR identified a large capacity gap in Kenya’s lab technicians and biomedical engineers and equipment technicians (biomeds) to properly conduct routine preventive maintenance, safety calibration, and repairs. As a result, the majority of lab equipment not currently under service contract is either not functioning or is at risk of producing inaccurate test results — which consequently could yield inaccurate diagnoses and improper treatment.

A 2013 survey conducted in Kenya revealed 70 percent of lab equipment then in use was not calibrated; an even higher percentage was not validated; 34 percent was not in use; and 17 percent was simply not functioning.

To help the country address these challenges, AIHA initiated a partnership to build the capacity of biomeds under the Ministry of Health’s National Public Health Laboratories (NPHLS) in 2016. The Kenyan partners are working with experts at the University of Texas Medical Branch (UTMB) and San Jacinto College.

Initially, the partnership focused on building national-level capacity in Nairobi, with planned step-down training to the PEPFAR priority counties of Homa Bay, Kisumu, Migori, and Siaya. In 2017, AIHA expanded the project to six new counties: Busia, Bungoma, Kakamega, Kisii, Nyamira, and Turkana.

Using a multi-step approach, AIHA and our partners are working to implement a sustainable in-service training program that includes short courses and distance- learning opportunities for biomeds, with a specific focus on preventive maintenance and repair skills for all levels of equipment. In this manner, the project will strengthen the capacity of the NPHLS and county-level biomedical engineering workshops in support of Kenya’s efforts to improve HIV diagnostics and care and attain the global 90-90-90 targets.

AIHA and our partners created a technical working group with members drawn from the Ministry of Health, educational institutions, government standards boards, CDC/Kenya, partner institutions, and other implementing partners and stakeholders to guide project implementation and developed an auxiliary equipment training curriculum focused on non-automated equipment critical to the HIV clinical cascade, which was used to train 10 biomeds on non-automated equipment, six on refrigeration; and six as master trainers. Components of the non-automated training included facility lab managers to help building trust between the two cadres — which represents an ongoing challenge because lab managers have frequently said that they do not believe biomeds have the skills required to work on their equipment.

In 2017, NPHLS conducted a rapid response intervention (RRI) to prepare 43 labs for accreditation. AIHA supported trained biomeds from our project sites to conduct the required equipment repairs and preventive maintenance at 24 of those labs across 14 counties. These biomeds worked on 385 pieces of equipment, a function had previously been outsourced at great cost.

By working within the partnership infrastructure, partnering with public sector organizations such as Ministry of Education and the Teachers Service Commission, and utilizing a training-of-trainers approach, this AIHA partnership under our Twinning Center Program consistently leveraged more than 400,000 volunteer hours a year prior to the graduation of DePaul in 2013.

Based on the success of this long-standing partnership, AIHA began providing direct funding and technical support to KCCB’s efforts to carry out their prevention programming targeting young people in Kenya. In late 2015, this program ended and AIHA transitioned to the DREAMS Initiative project in Homa Bay and Siaya counties in which KCCB is still a partner.

During implementation of this dynamic and highly successful youth HIV prevention intervention, partners adopted a three-pronged approach to effectively reach children — particularly those at greatest risk for contracting HIV.

The flagship Making Life’s Responsible Choices curriculum builds on standard HIV prevention information and activities included in the Kenyan Ministry of Education, Science, and Technology’s National AIDS Education Syllabus, but also incorporates evidence-based behavior change interventions with Catholic doctrines and teachings drawn from Kenya’s rich and unique cultural heritage. In this manner, the intervention helps arm children with the tools they need to safeguard their health and wellbeing. Since its launch, the Making Life’s Responsible Choices program has enjoyed the strong support of pupils, teachers, parents, and policymakers alike. The program has also been fully embraced by the Muslim community and other religious denominations in Kenya.

During project implementation, the Making Life’s Responsible Choices intervention was being delivered in some 1,700 Catholic and public-sponsored primary schools within 25 of Kenya’s 26 Catholic dioceses. Partners trained 3,732 teachers to deliver the program and more than 770,000 pupils were reached.

The Families Matter! Program — which was piloted in Machakos Diocese in 2009 and in Meru Diocese in 2010 — aims to increase family involvement in promoting abstinence and behavior change by training parents how to talk with their children about human sexuality, STIs, and HIV/AIDS.

Adapted from the Parents Matter! program developed by the US Centers for Disease Control and Prevention, Families Matter! equips adult caregivers with the communication and parenting skills they need to successfully support behavior change for children and young adults. Partners delivered Families Matter! to more than 5,000 parents and guardians and a like number of their children through the efforts of trained facilitators.

Both interventions — along with other services, support, and mentorship — are currently being delivered to adolescent girls, young women, and their parents or caregivers through AIHA’s DREAMS project.