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  • Financial Incentives to Increase Pediatric HIV Testing Pilot Study


    The aim of the pilot study is to evaluate the feasibility, acceptability and costs of a financial incentive intervention to motivate pediatric HIV testing in Western Kenya. The study will evaluate 3 cash incentive values and determine percent uptake of testing. A post-test questionnaire will explore parental satisfaction, mechanisms of incentive effectiveness and the impact of testing on emotional health and pediatric healthcare utilization.

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    The Division of Reproductive Health (DRH) within the Ministry of Public Health and Sanitation
    (MOPHS) with assistance from FHI 360 and financial support from United States Agency for
    International Development (USAID) undertook a review of adolescent and youth reproductive
    health programs in the country through a desk review, a mapping of youth serving organizations
    (YSOs), and interviews with stakeholders from the YSOs and development partners. The goal
    was to identify the key organizations involved in adolescent and youth sexual and reproductive
    health (AYSRH), compile a general inventory of their activities, and begin to assess the degree
    to which they are using evidenced-based interventions that are ready for national scale-up. This
    review was designed to enhance the DRH’s ability to coordinate AYSRH activities in the
    Kenya has multiple policies and guidelines that favor provision of information and services to
    young people, but these documents are not integrated well into services. Multiple ministries are
    involved in the process, adding to the challenges in this field. In addition to the MOPHS, the key
    ministries and government agencies with interest in AYSRH are Ministry of Medical Services
    (MOMS), Ministry of Youth Affairs and Sports (MOYAS), Ministry of Education (MOE),
    National Coordinating Agency for Population and Development (NCAPD), National AIDS and
    STD Control Program (NASCOP), and Kenya Institute of Education (KIE) among others.
    Out of the 67 YSOs and 13 development partners identified in the review, 45 organizations and
    nine development partners responded with information through a telephone interview or email.
    The findings reiterated the fact that many young people are sexually active and are at risk of
    adverse reproductive health outcomes that subsequently affect achievement of life goals and
    optimum contribution to national development. Many youth initiate sexual intercourse early,
    have multiple partners and often do not use protection during sex. In general, young people are
    unlikely to seek health services, and when they do they are likely to get inadequate services.
    This health system has been slow to evolve to accommodate the needs of this age group both
    from program and service delivery perspectives. Some service providers lack the skills and
    positive attitudes needed to serve youth.
    Most YSOs operate within the highly populated areas of the country with Nairobi having the
    highest concentration of implementers (26 out of the 45 interviewed). They mainly target in- and
    out-of-school youth aged 10-24 years, in both rural and urban areas. The main program
    approaches they use to reach youth include peer education, edutainment, service delivery
    (including outreach services), youth support structures, mass media, ICT, edusports, life skills
    education, mentorship, adult influencers, and advocacy for policy review or change. These
    approaches are usually not implemented singly but in combination, such as peer education with
    mass media and service delivery.
    In the survey, the YSOs identified the following main gaps in AYSRH in terms of program and
    service delivery

  • Benefits and Costs of Integrating Sexual-Reproductive Health and HIV services in Kenya and Swaziland

    There are many well-established reasons that support the rationale for integrating or linking
    sexual and reproductive health (SRH) and HIV services in developing countries with generalized
    HIV epidemics - primarily in sub-Saharan Africa. Yet the evidence base for the impact of
    integrated service delivery on health outcomes and costs remains weak. Partly this is a result of
    methodological difficulties.
    There is an emerging body of literature addressing the challenges of using randomized controlled
    trials to assess the impact of public health interventions. Particularly in cases such as the Integra
    Initiative, where the causal chain (between intervention and outcome) is long, and where there
    are is a broad range of outcomes that need to be explored, and where there is already some a
    degree of integration occurring in some clinic settings, attempting to conduct a randomized
    controlled trial is not appropriate. Consistent with evaluation designs described by Habitat and
    colleagues, the Integra design includes evaluation of performance and impact to try to make two
    types of causal inference: adequacy and plausibility.
    Evaluation of adequacy will assess whether the expected changes in provision, service utilization
    and cost-effectiveness have occurred in intervention facilities. Evaluation of impact will assess
    the plausibility that changes in service, health and behavioral outcomes are due to the Integra
    Initiative. The case for such plausibility will be built from the following strands of evidence:
     Comparing findings in 'intervention' facilities with those in facilities chosen as
    'comparison' sites prior to the evaluation
     Exploring a dose-response relationship between the measured extent of integration and
    the study outcomes
     Measuring changes in performance over time, to demonstrate a logical sequence between
    the intervention (integration) and outcomes.
     Measuring change in each step of the logic model - a prerequisite for any attribution to
    the intervention
     Triangulating findings from a mix of research methods to capture a range of perspectives
    and insights from different disciplines.
    The study will employ a controlled pre- and post-test quasi-experimental, or non-randomized,
    design and utilizes multiple research methods (cohort study, community survey, clinic
    assessments, costing tools and qualitative interviews). Since the research is being conducted in
    real-life health delivery settings where programmatic contamination is possible due to ongoing
    health programme interventions over the study period, the control group will be referred to as a
    'comparison group', for which outcomes will be compared over time up to two years after

  • Assessing the Availability and Quality of Comprehensive Post-Rape Care Services for Child Survivors of Sexual Violence in Nyeri and Nakuru Counties –Kenya

    Nakuru and Nyeri Counties, KenyaCarolyne AjemaLVCT HealthTo document services offered to child survivors of sexual violence in public health facilities in Kenya To assess the capacity of public health facilities to deliver health services to child survivors of sexual abuse. Assess the quality of care offered to child survivors of sexual violence in health facilities in the country 4. Identify possible ways of improving the availability and quality of services offered tochild survivors of sexual violence in the country
  • Integrating HIV PrEP into combination HIV Prevention in Kenya (IPCP – Kenya project)

    Kisumu, Homa Bay, Machakos, Nairobi and NakuruNduku KilonzoNACCExplore acceptability and willingness to take HIV PrEP, understand perceptions of HIV risk, barriers and motivators to uptake and adherence to HIV prevention services with PrEP among young women, MSM, FSW 2. Assess the perceived feasibility, barriers and opportunities to delivering PrEP as part of a defined package of HIV prevention interventions among health service providers and stakeholders 3. Characterize HIV risk among young women to identify metrics for HIV prevention and, in particular, PrEP indication and develop a tool for risk assessment through secondary analysis of routine LVCT service delivery data 4. Assess the deliverability and potential cost effectiveness of integrating PrEP into targeted packages of interventions to young women, MSM, and FSW. a. Identify delivery options, requirements for proposed packages of interventions including HIV PrEP to target populations b. Determine cost effectiveness of each delivery option when integrated with targeted and optimal package of behavioural, biomedical and structural intervention for each population
  • Extent of risk and protective factors for child abuse in Kajiado primary schools and the roles of parents and teachers in prevention

    Kajiado CountyCarolyne AjemaLVCT HealthTo conduct a desk review of current school based interventions aimed at preventing child abuse and develop an appropriate intervention to be tested in Kenya. To identify the types and forms of child abuse cases in primary schools. To identify factors that expose children to abuse in primary schools. To identify factors that could prevent violence in primary schools. 5. To establish the role of teachers and parents in preventing child abuse
  • Assessing acceptability and feasibility of Intimate Partner Violence (IPV) screening and support in HIV programs.

    Nairobi, Embu and Machakos Erick SakwaLVCT HealthTo determine the barriers/challenges of routine screening of women in community based HTC settings. To determine the acceptability and feasibility of utilization of the IPV and Alcohol screening tool in practice To establish the feasibility of routine screening and a brief counseling intervention in increasing uptake of referral to appropriate post IPV services among women who test positive for IPV.
  • Gender Capacity Building

    Nduku KilonzoNACCTo review and collate the existing gender audit reports within the context of the National HIV response of Kenya To assess the feasibility of a model on gender integration into civil society organizations working in the HIV field. To determine acceptability of a model on gender integration into HIV among selected civil society organizations. To find out the enablers and barriers to gender integration and make recommendations
  • Describing and Documenting the Sexual & Reproductive Health And HIV/AIDS needs of Sex Workers in Kenya

    Thika, Isiolo,Malindi, Machakos,Kisumu,Nanyuki,Nairobi Mutisya PraxedesLVCT HealthTo determine Socio-economic context for the sex workers To determine the Sexual & RH and HIV/AIDS levels of Knowledge To determine the perceptions of Health workers towards present Health Services To determine the factors that influence the uptake and access to Health services To determine the present role of organizations in engaging Public Health and Human Rights policies
  • Describing the standards for ‘custody-of-evidence’ chain for post rape care services in Kenya

    Kitui and Karachunyo District HospitalsCarolyne AjemaLVCT HealthTo describe the current practices and gaps in the collection, storage, analysis, documentation and transportation of evidence collected from survivors at the hospitals and police stations in the context of sexual violence. ii. To design and test an evidence chain model applicable to the Kenyan system for obtaining and transporting samples from the primary health facilities to the government chemist. iii. Evaluate the model developed for functional custody of evidence chain suited for the Kenyan context.
  • The PRC costing study

    Nduku KilonzoNACCTo determine the cost of sexual violence interventions in the public health sector. ii. To determine the expected costs for scaling-up post rape care services in the public health sector. iii. To provide a platform for policy engagement for stakeholders in assessing the achievability of the proposed scale-up plans