Nyandarua Chasp

NYANDARUA COUNTY
HIV & AIDS

STRATEGIC PLAN
(NCHASP 2016 – 2020)
NYANDARUA COUNTY
HIV AND AIDS
STRATEGIC PLAN
(NCHASP 2016 – 2020)
Location of Nyandarua County
Table of Contents
List of Figures and Tables................................................................................................................................ v
Acronyms and Abbreviations......................................................................................................................... vi
Foreword...................................................................................................................................................... viii
Preface........................................................................................................................................................... ix
Acknowledgement..........................................................................................................................................x
Executive Summary........................................................................................................................................ xi
Chapter 1: Introduction and Background Information on the County........................ 1
1.1 Background to the County...................................................................................................... 1
1.2 Demographic features............................................................................................................ 2
1.3 Economic conditions...............................................................................................................4
1.4 Health access and nutrition....................................................................................................4
1.5 Literacy....................................................................................................................................4
Chapter 2: Situational Analysis: HIV Situation in Nyandarua............................................ 5
2.1 Geographical prioritization.....................................................................................................5
2.2 Drivers of HIV in Nyandarua...................................................................................................6
2.3 Priority population for HIV in the County..............................................................................6
2.4 Past interventions in the County...........................................................................................8
2.5 Nyandarua County HIV program analysis .............................................................................9
Chapter 3: Purpose, Rationale, Development and Guiding Principles of the

Strategic Planning........................................................................................................... 11
3.1 Purpose of the NCHASP......................................................................................................... 11
3.2 Rationale................................................................................................................................ 11
3.3 Process of developing the NCHASP..................................................................................... 11

3.4 Guiding principles..................................................................................................................12
Chapter 4: Vision, Goal, Objectives and the Strategic Directions ..................................13
4.1 Vision, Mission, Core Values and Objectives.........................................................................13
4.2 Specific objectives................................................................................................................ 14
4.3 Strategic Directions.............................................................................................................. 14
Chapter 5: Implementation Arrangements...............................................................................34
Chapter 6: Monitoring and Evaluation of the NCHASP........................................................36
Chapter 7: RISK MITIGATION PLAN...................................................................................................... 37
Annex 1: Monitoring and Evaluation Framework for the NCHASP................................. 41
Annex 2: Resource Needed.................................................................................................................49
ANNEX 3: References.............................................................................................................................58
Annex 4: List of Drafting and Technical Review Team..........................................................59

List of Figures and Tables
Figures
Figure 1.1: Location of Nyandarua County in Kenya
Figure 1.2: Political and administrative units in Nyandarua County
Figure 4.1: County HIV coordination structure for delivery of the NCHASP
Tables
Table 1.1: County administrative units
Table 1.2: Top five diseases in Nyandarua County
Table 2.1: HIV situation in Nyandarua County
Table 2.2: Number of PLWHIV as per sub-counties in Nyandarua County
Table 2.3: Key HIV populations in Nyandarua County
Table 2.4: Vulnerable HIV populations in Nyandarua County
Table 4.1: Summary of SDA interventions
Table 4.2: Interventions for SDA 1
Table 4.4: Priority groups for HIV services in Nyandarua
Table 6.1: Monitoring & Evaluation Plan of the NCHASP
v
Acronyms and Abbreviations
AIDS Acquired Immune Deficiency CHW Community Health Worker

Syndrome
COH Chief Officer of Health
ANC Ante-Natal Clinic
eMTCT Elimination Mother-to-Child
ART Anti-Retroviral Treatment/Therapy Transmission (of HIV)
ARV Anti-Retroviral (drugs) FBOs Faith Based Organisations
BCC Behaviour Change Communication FSW Female Sex Workers
BMI Body Mass Index GBV Gender-Based Violence
CASCO County HIV/AIDs and Sexually GF Global Fund

Transmitted Diseases Coordinator
GIPA Greater Involvement of People
CBOs Community Based Organisations living with HIV and AIDS
CCC Comprehensive Care Centre HAART Highly Active Antiretroviral Therapy

(HIV and AIDS treatment)
CD4 Cluster Differentiation 4
HTC HIV Testing and Counseling
CDE County Director of Education
HTS Hiv Testing And Counselling
CDSS County Director of Social Services
HIV Human Immunodeficiency Virus
CECM County Executive Committee
Member HMIS Health Management Information
System
CHMT County Health Team
ICT Information Communication
CHPO County Health Promotion Officer Technology
CHRIO County Health Records and IDU Injecting Drug Users/Intravenous

Information Officer Drug Users
CHS Centre for Health Solutions IEC Information, Education,

Communication
vi
Nyandarua County HIV and AIDS Strategic Plan (NCHASP 2016 – 2020)
KDHS Kenya Demographic and Health NGOs Non-Government Organizations

Survey
OIs Opportunistic Infections
KENAPOTE Kenya Network of Positive Teachers
(KENEPOTE) HIV and AIDS OVC Orphans and Vulnerable Children
MC Male Circumcision PEP Post-Exposure Prophylaxis
M&E Monitoring and Evaluation PEPFAR President’s Emergency Plan for AIDS
Relief
MoEST Ministry of Education, Science &
Technology PLWHIV People Living With HIV
MoH Ministry of Health PMTCT Prevention of Mother-to-Child

Transmission of HIV
MOT Mode of Transmission
PWD People with Disability
MSM Men who have Sex with Men
SDA Strategic Direction Area
MTCT Mother to Child Transmission
SGBV Sexual and Gender Based Violence
NCHASP Nyandarua County HIV and AIDS
Strategic Plan TB Tuberculosis
NCPWD Nyandarua county people with

disability
vii
Foreword
N
yandarua County is located in the central part of Kenya and covers an
area of 3245.2 km2. The county borders the following counties: Laikipia
to the north, Nyeri to the east, Kiambu to the south, Murang’a to the
south east and Nakuru to the west.
The main economic activity in the county is crop and dairy farming, both at small
and large scale level. The county boasts of being a “food basket” supplying
potatoes, carrots and cabbages to other counties including Laikipia, Nakuru,
and Nairobi. The county hosts two key milk processing plants and a number
of milk cooling plants that supply milk to other processing factories outside
the county. Horticulture is also practiced across the county employing quite a number of
migrant workers mainly in the cut flowers sector for both local and export markets.
With agriculture being a main economic stay for the county, there was no defined urban
population in the past since most of the county residents would come to town to sell and buy
their farm produce and inputs respectively then later retreat back to their farms. However, with
the advent and implementation of devolution, the county is experiencing an emergence of towns
and the urban population is steadily growing.
Just like in any development, there are challenges and within the Nyandarua County Integrated
and Development Plan 2013 – 2017, we have singled out HIV and AIDS as one of the cross cutting
issues that remains an obstacle to sustained development of the county hence calling for more
efforts in responding to the scourge that apart from affecting development also inflicts suffering
to those infected and affected. I am therefore glad that the CEC - Ministry of Health and his team
have taken the leap to develop this HIV and AIDS Strategic Plan for Nyandarua County.
It is my pledge as the Governor to spearhead the harnessing for resources to implement this
strategic plan. I call upon all the respective CEC members to embrace it as a cross cutting agenda
that affects their ministries, the members of the County Assembly to pass any necessary legislation
required and allocate resources to support the HIV response, the Members of Parliament through
their Constituency AIDS Committee and the Senator to lead in advocacy activities. Finally I wish
to invite development partners, Non-Governmental Organizations and other stakeholders to
support us in this worthwhile cause.
H.E. Daniel Waithaka Mwangi

Governor, Nyandarua County.
viii
Preface
T
he development and subsequent launch of the Nyandarua County AIDS
Strategic Plan, covering the period 2015/16 to 2019/20, is the culmination
of many weeks of preparation by the County Department of Health,
working in collaboration with development and implementing partners, to
deliver a better framework for a strengthened County HIV response.
This collaborative approach emphasizes the growing awareness among all
stakeholders that the challenges of HIV and AIDS in Nyandarua County can
only be successfully addressed by working together. It is my strong conviction
that the participation by individuals from all sectors, and representing a
wide range of organizations, will ensure dynamic county action that yields
desirable results in HIV interventions in Nyandarua County.
This strategic plan will guide our HIV interventions over the next five years. It
is an expression of our commitment and determination to face HIV and AIDS
not only as a medical and health challenge, but also as a cultural, social and
economic challenge that affects all sectors of our society and every family.
It also addresses the complexities of our sexuality, our relationships, our
culture, beliefs and attitudes that influence the transmission of infections, our
reactions to infection and illness, whether and how we support, stigmatize
and discriminate against each other. This strategic plan is therefore, about us,
and is for us, as a community and a county. Let us now, and in the years ahead,
join together to ensure that the plan is translated into concrete, focused and
sustained action and results.
In conclusion, I would like to thank the technical working group that
spearheaded this process. I also wish to reiterate the commitment and
support of the County Government of Nyandarua in ensuring successful
implementation of this strategic plan
Dr Peter. K. Mbugua
County Executive Committee, Member – Health
Nyandarua County.
ix
Acknowledgements
N
yandarua County Government would like to take this opportunity to
express its deep appreciation and sincere thanks to all who participated
in the development of the NCHASP 2015/16 – 2019/20 without whose
contribution it would not have been possible to have the strategic plan in
place. Many individuals gave their time and technical inputs which we value.
First and foremost we thank the Governor, Nyandarua County Hon. Daniel
Waithaka Mwangi for providing an enabling environment; the CEC, Member
for Health, Dr Peter Mbugua, for prioritizing HIV/AIDS and allowing the team
to work on its strategic plan; and Dr Zakayo Kariuki Gichuki, the County
Director for Health for providing the administrative support to the technical
drafting team. Thanks are also due to Dr. Joram Muraya, the County AIDS and
STI Coordinator, for providing technical leadership to the drafting team.
We also wish to acknowledge partners that supported the process and
provided technical inputs. In this respect we mention the representation
of APHIA plus Kamili, CHS, VIDHA, the MCAs Representative, Maendeleo ya
Wanawake, PLWHIV, KENEPOTE, PLWD, the Youth and Hope Valley Family
Institute.
We also wish to recognize the National AIDS Control Council for providing
national leadership to counties through the Kenya AIDS Strategic Framework
with which they oriented members of the technical team as a first step in
developing the NCHASP, the financial and technical support to the drafting
team through the Regional HIV Coordinator – Gladys Sang, and further support
through the technical support team of Moses Mathu and Ben Adika who
We appreceiate ensured technical completeness, and Njeri Gachiri for budgeting for the
strategic plan.
NACC for providing
To all we say – Ahsanteni Sana.
national leadership
to counties through
the Kenya AIDS Strategic
M.D. Irungu, Chief Officer, Medical Services
Framework with which they Nyandarua County.
oriented members of the
technical team as a first
step in developing the
NCHASP
x
Executive Summary
F
ollowing the launch of the Kenya AIDS Strategic Framework (KASF 2014/2015 –
2018/2019), the stage was set for counties to develop and domesticate the strategic
plan into their own context and it is with this background that the NCHASP was
developed. With a HIV prevalence of 3.8% and an estimated 13,000 adults and 1,300
children living with HIV, the disease remains a challenge hence calling for a structured
intervention.
Within this HIV strategic plan for Nyandarua, Chapter 1 gives the reader an introduction
and background of the county in terms of the population of the county in age categories
that have been linked to HIV, the socio-cultural and economic environment that has an
indication on the disease transmission, and the health situation in the county.
Chapter 2 deals with the HIV situation in the county, giving a breakdown of the sub-
counties that contribute the highest burden of the disease for prioritization, examines
critically the drivers of HIV, the priority population as defined by the KASF – key and
vulnerable populations, outlines the past HIV control program activities and discusses the
program analysis through an examination of the strengths, weaknesses, opportunities
and threats to the HIV program.
Chapter 3 gives the purpose of the strategic plan, the rationale behind its development,
the development process and the guiding principles.
Chapter 4 paves the way and provides the strategic directions to be followed in the
implementation of the HIV program in Nyandarua County, setting out the vision as “A
county free of new HIV infections, discrimination and AIDS related deaths” and the goal
of the NCHASP that is “To contribute to the reduction of morbidity and mortality in
Nyandarua County through a comprehensive HIV prevention, treatment and care program
by 2019”. The objectives as aligned to the KASF are: [1] Reduce new HIV infections by 50%
by 2020; [2] Reduce AIDS related mortality by 40% by 2020; [3] Reduce HIV related stigma
and discrimination by 50% by 2020; [4] Increase domestic financing of HIV response by
40% by 2020. Under this chapter the strategic interventions are discussed where the
context and the interventions under each thematic area – biomedical, behavioural and
structural - are provided.
Chapter 5 lays out the implementation arrangement of NCHASP within the context
of a devolved system of governance under the leadership of the Governor and other
supporting structures with Chapter 6 indicating how this strategic plan will be monitored
and evaluated over the 5 years period. The M&E framework is contained in the annexure.
xi
Chapter
1 Introduction and
Background Information
on the County
1.1 Background to the County
1.1.1 Location and size
N
yandarua County is located in the central part of Kenya and covers an
area of 3245.2 km2. It lies between latitude 0°8‘ to the North and 0°50‘
to the South and between 35° 13‘ East and 36°42‘ West. The county
borders the following counties; Laikipia to the north, Nyeri to the east, Kiambu
to the south, Murang’a to the south east and Nakuru to the west.
1.1.2 Administrative and political units

The county is divided into five administrative sub-counties that also represent
political constituencies, namely Kinangop, Kipipiri, Ol’Kalou, Ol’Joro Orok and
Ndaragwa. Kinangop is the largest sub-county in terms of surface area with
6 divisions and 16 locations while Ol’Joro Orok is the smallest sub-county as
shown in Table 1.1 below.
Table 1.1: County administrative units
Constituency Sub-County Area No. of electoral No. of No. of

(km2) wards divisions locations
Kinangop Kinangop 822.0 8 6 16
Kipipiri Kipipiri 543.7 4 3 12
Ol’Kalou Ol’Kalou 586.7 5 8 21
Ol’Joro Orok Ol’Joro Orok 389.1 4 4 8
Ndaragwa Ndaragwa 653.6 4 4 13
Source: Nyandarua County Integrated Development Plan (NCIDP)
1
Figure 1.2: Political and administrative units in

Nyandarua County
1.2. Demographic features
1.2.1 Population size and composition
Population in the county stood at 596,268 as at
the last national population census of 2009. This
comprised 292,155 males and 304,113 females. The
population is growing at 2.4% annually so the 2013
projected population for the county was 656,348
persons - 321,593 males and 334,755 females.
The population is projected to grow to 688,618

and 722,498 persons in 2015 and 2017 respectively
with 43% of the population being below 15 years
while over 69% of the population will be below 30
years. There is no significant difference between
the male and female population as there are
104 females for every 100 males.
1.2.2 Projected population for selected

age groups
Under one year: The population under one year
was 17,669 in 2013 and this is projected to increase
to 18,538 and 19,450 in 2015 and 2017 respectively.
This calls for promotion of post natal and nutritional
activities to lay a good health foundation to this
age cohort. This is the age group to be targeted
in the prevention of mother to child transmission
(PMTCT) which is currently at 6.2%. The aim is to
There is no reduce MTCT to below 5%. Emphasis in this cohort
significant is prevention of vertical transmission through the
prongs of eMTCT.
difference
Under five years: In 2013 the projected population
between the
for the under five years is 91,987 with 46,833 being
male and female male and 45,144 being female. This group accounts
population as there for 14% of the total population. The mortality rate
in this group is at 51 deaths per 1000 live births.
are 104 females for The HIV prevalence is estimated to be 0.9% in the
every 100 males. age cohort below 14 years. Nyandarua County
contributes an estimated 29 new paediatric HIV
2
infections per year (below 14 years). The bulk of and religious leaders. The cohort is targeted using
transmission in this age group is vertical (MTCT). adolescent package of care and youth friendly
Emphasis in this cohort will mainly entail early services.
diagnosis and initiation to care and treatment
Reproductive age group (15-49 years): This forms
including nutritional support. Interventions
the reproductive age group and therefore most
targeting OVCs start in this cohort.
sexually active cohort. This group comprises
Pre-primary school age group (3-5 years): This females of the reproductive age. The projected
group has a total population of 60,410 persons female population in this category was 157,926 in
which represents 9.2% of the total population. 2013 and was projected to increase to 165,691 in
2015 and 173,838 in 2017. This implies that, with
Primary school going age group (6-13 years): The
declining infant mortality rates, the high increase
2013 projected population for this age group
of the females in this age group will contribute
was 153,186 comprising 77,670 males and 75,516
to increased population in the county. This calls
females. This population, which accounts for
for an increase in maternal and child health-care
23.3% of the total county population, is expected
services as well as measures to reduce the fertility
to increase to 160,718 and 168,621 in 2015 and
rate. This will be the target group for eMTCT of
in 2017 respectively. The increase in population
HIV and family planning programs. The highest
for this group calls for the expansion of existing
numbers of new HIV infections occur in this cohort
primary education facilities and provision of more
estimated to be over 800 new infections per year.
learning and teaching materials. The HIV prevalence
This cohort also has the highest estimated HIV
is estimated to be 0.9% in the age cohort below
prevalence at 3.9%.
14 years. The bulk of HIV transmission in this age
group is vertical (MTCT). Emphasis in this cohort Age group (15-64 years): This is the productive
will mainly entail early diagnosis and initiation to or labour force population of the county. The
care and treatment including nutritional support. total labour force was 344,300 (52.4%) comprising
This cohort is also targeted under the OVCs 164,734 males and 179,566 females in 2013. The
programmes. population in this group is projected to rise to
378,991 persons in 2017. There are more females
Secondary school going age group (14-17 years):
than males in this category. A large proportion
The existing projected population in this age
of this population, mainly between 15-25 years is
group was 61,050 comprising 31,546 males and
either in secondary schools or at the tertiary level.
29,505 females. This population accounts for 9.3%
The bulk of the labour force is either unskilled or
of total county population and is expected to
semi-skilled and is mainly engaged in agricultural
rise gradually to about 64,052 and 67,202 in 2015
activities, public transport industry either as
and 2017 respectively. This cohort contributes to
motorbike riders (boda boda), touting or as drivers.
a significant horizontal transmission. This group
The highest numbers of new HIV infections occur
comprises adolescents who are experimenting
in this cohort contributing to an estimated over
with sex and therefore at risk of getting infected.
800 new infections per year. This cohort also has
This cohort requires a lot of health education
the highest HIV prevalence at 3.9%.
from parents, teachers, health workers, leaders
3
1.3 Economic conditions Table 1.2: Top five diseases in Nyandarua County
No. Disease No. of cases

The main economic activity is crop and dairy
farming both at small and large scale level. The 1 Other diseases of the 362,028
respiratory system
major crops grown in the county include potatoes,
2 Skin diseases 76,364
carrots and cabbages. These are sold to both
3 Diarrhea 39,991
within the county and in other counties including
Laikipia, Nakuru and Nairobi. There are two key 4 Arthritis, joint pains etc 35,630
milk processing plants namely Brookside Dairy and 5 Pneumonia 34,504
Olkalou Dairy. There are also a host of milk cooling Source: Nyandarua DHIS 2015
plants that supply milk to other milk processing
1.4.3 Nutritional status
factories outside the county. Horticulture is also
practiced across the county employing quite a On nutrition, 35% of children under five are
number of migrant workers mainly in the cut stunted, while the proportion of severely
flowers sector for both local and export markets. stunted children is 14%. Stunting is highest (46%)
Other economic activities in the county include in children aged 18-23 months and lowest (11%)
quarrying and timber logging. in children aged less than six months. A higher
proportion of male children of less than five years
are stunted compared with female children. This
1.4 Health access and nutrition reflects a need to supply vitamin supplements to
young children in order to improve their health.
1.4.1 Health access
The stunting is attributed to high levels of poverty
There are two Level-Four public health facilities at 46.3%. There is therefore need to reduce
in the county, one mission hospital, three nursing the poverty levels through increasing income
homes, seven Level-Three health facilities, 32 per household to address the nutritional status
Level-Two facilities and 50 private clinics. The of children. Wasting, which is a sign of acute
doctor population ratio is 1:155,188 while the nurse malnutrition, is far less common (7%) while 16%
population ratio is 1:2,150. The average distance to of the children are underweight.
the nearest health centre is 3.2 km. In the county,

21% of the households travel up to one kilometre 1.5 Literacy
to access health service, 78% travel between 1.1 The county literacy rate is 86.3%. This is the county
km and 4.9 km while those who travel above five population that can read. However, the proportion
kilometres account for 1% of the population. of the population that can write is 85.2% while the
proportion that can read and write is 83.8%. This
1.4.2 Morbidity implies that about 13.7% of the population cannot
The five most common diseases in order of read and would be the target for adult education
prevalence in the county are shown in Table 1.2. basic literacy programmes.
4
Chapter
2 Situational Analysis: HIV

Situation in Nyandarua
W
hile major progress has been made in the fight against HIV and
AIDS in Kenya, the pandemic remains a major problem especially
across different counties. Nyandarua County is classified within
the 28 medium incidence counties and is ranked 18th out of the 47 counties
in Kenya. It has an adult HIV prevalence of 3.8% with about 13,000 adults and
1,300 children living with HIV as shown in Table 2.1 below. The adult male and
female HIV prevalence stands at 2.2% and 5.6% respectively.
Table 2.1: HIV situation in Nyandarua County
Indicator Numbers / Percentage

Total population 646,876
Overall adult HIV prevalence 3.8%
HIV prevalence among women 5.5%
HIV prevalence among men 2.2%
Number of adults living with HIV 13,000
Number of children living with HIV 1,305
Total number of persons living with HIV 14,305
Percentage of people never tested for HIV by 2012 50%
Percentage of HIV pregnant women who do not deliver 14 %
in a health facility (KDHS 2014)
Source: Kenya HIV County HIV Profiles, 2014
2.1 Geographical prioritization

Within the county, Kinangop contributes to the highest number of PLWHIV
(44.5%) in the followed by Nyandarua Central (Ol’Kalou) at 24.5%, Nyandarua
North at 14.8%, Kipipiri at 8.6% and lastly Ol’joro Orok at 7.2% . This is shown in
Table 2.2.
5
Table 2.2: Number of PLWHIV as per sub-counties prevails. Observations have been made that the
in Nyandarua County flower farms employ more of the female than male
workers which sets a scenario for competition
No. Sub-County No. of Percentage
PLWHIV among women for the few men available. When
there is an increased demand for flowers during
1 Kinangop 2,966 44.5 international holidays like Valentines day and
Mother’s Day the flower farms employ more
2 Nyandarua 1,635 24.5
personnel and incidences of women seeking
Central
employment and male supervisors sexually
3 Nyandarua 988 14.8 exploiting the women in return for employment
North have been discussed as potential drivers to HIV.
4 Kipipiri 579 8.6 Poverty: Driven by poverty most women engage

in female sex work. However in the Nyandarua
5 Ol’joro Orok 480 7.2
context female sex work is unique. Women are
Total 6,663 100 engaged in full time employment, business or in
the farms during the day but go out at night for
Source: CCC data Nyandarua DHIS 2015 commercial sex work in the neighbouring towns of
Nakuru, Naivasha and Nyahururu. There are no full
time sex workers in the county.
2.2 Drivers of HIV in Nyandarua
Urbanization: with the advent of devolution
Major towns: Nyandarua County has unique drivers the county is witnessing rapid urbanization and
of HIV due to its geographic location as well as the opening up of towns that were otherwise dormant.
social-economic conditions. The central location The construction of roads and other infrastructure
of the county bordering major towns of other is fueling HIV in the county.
counties makes the county more prone to cross-
Cold climate: In the social quarters, the cold
county transmission of HIV. The neighbouring
climate in Nyandarua County is seen as a driver to
towns of Nyahururu, Nakuru and Naivasha are also
HIV as people will be heard seeking to pair up for
major towns with Nakuru and Naivasha having a
warmth at night during which sexual acts happen.
HIV prevalence of 5.3%. This is due to their position
on the main highway from Nairobi to western
Kenya thus offering employment and business 2.3 Priority population for HIV in
opportunities to the residents of Nyandarua the County
County.
There are 2 categories of priority populations as
Migrant workers: Nyandarua County being
defined by the KASF, the Key Populations (KPs)
predominately an agricultural area hosts large and
and the vulnerable groups.
small scale horticultural farms that include flower
farms which offer employment opportunities. This Key populations
has given rise to migrant workers who work and
This group is defined as persons who engage in
reside within the county without their families
risky HIV activities and include female sex workers
hence creating an environment where casual sex
(FSWs), Men having sex with Men (MSM) and
6
Persons who Inject Drugs (PWID). In Nyandarua County there exists FSWs. However, little is known about
MSM and PWID as discussed in Table 2.3 below.
Table 2.3: Key HIV populations in Nyandarua County
Female Sex Workers Female sex work is unique in the Nyandarua context given that the women who engage
in it have full time undertakings either as business women or tendering their farms during
the day but go out in the night to supplement their income. Due to proximity to the
major towns of Nakuru, Naivasha and Nyahururu that can be accessed through reliable
public transport, female sex workers go to these towns where more opportunities
exist. This scenario of female sex work makes it difficult to isolate and target the FSWs
for interventions calling for more innovations to understanding the dynamics through
operational research.
MSM and PWID It is assumed that these groups exist but no such information exists as a key population
for HIV in Nyandarua. This calls for more indepth study.
2.4.2 Vulnerable populations: This group comprises persons whose social context increases their
vulnerability to HIV risks. The KASF lists them as young women 15 – 24 years, truck drivers, PLWHIV,
pregnant women and children living with HIV, and persons in prison settings. In the Nyandarua County
context the vulnerable populations are discussed in table 2.4 below.
Table 2.4: Vulnerable HIV populations in Nyandarua County
PLWHIV There are 13,000 adults living with HIV in Nyandarua County (Kenya County HIV Profile,
2014). With an adult population of 344,300 persons and only 47.7% (161,182) aware of
their HIV status, it means 52.3% (182,472) are not aware of their HIV status. This calls for
intensification of HTS activities especially among first testers.
Pregnant women and There were about 478 and 1,305 pregnant and children living with HIV in 2013
children living with HIV respectively.
Young women (15 – 24 They are likely to be attending high school or in a tertiary institution and could have had
years their first sexual experience at 15 years. It is worth mentioning that the local culture
encourages circumcised boys to have their first sex debut after circumcision “kuhura
mbiro” that is more likely to happen with their peers, that is girls. Given the high literacy
rate they are empowered and can negotiate sex.
7
Adolescents They comprise the youth out of school, in school or in the tertiary institutions.
and young people (male) Nyandarua has only tertiary institution – Kenya Medical Training College and a number of
polytechnics. The youth who are out of school form the majority of the unskilled labour
force such as the boda boda riders or the farm hands. Others are engaged in timber
logging, charcoal burning and quarry work.
Most boda boda riders are class eight dropouts who either own or are given motorbikes
in return for small daily remittances to their owners and are hence classified among the
“well off” group especially in the rural areas. They are therefore able to easily attract
women who have lower incomes comparatively. The issue of “familiarity” between
these boda boda riders and their clients tends to create bonding and eventually a
relationship develops. Situations have been noted where motorbike transport riders are
offered sex for “free transport” when the female sex workers fail to get clients at night.
Truck drivers, loaders The county is an agricultural area (food basket) that supplies farm products – potatoes,
and middlemen (farm carrots, cabbages and maize to bigger markets outside the county including Nairobi and
produce brokers) as far as Mombasa. This has given rise to middlemen who broker for farm produce on
behalf of the traders outside the county. The middlemen move around farms identifying
where the produce is ready for sale and link the farmers to the traders who then come
and collect the produce often loading the trucks late into the night. Within this trade, the
vulnerable groups include drivers, loaders and the middlemen who make quick money
and spend it late in the night with FSWs.
OVCs Nyandarua County has an OVCs population of 55,000, with some being orphaned due
to HIV hence the need to be targeted for HIV services. This vulnerable population is also
highly exposed to rape and other sexual vices as they are unable to protect themselves.
In the OVCs group, 11,000 are under cash transfer, 3,700 under Hope Valley support and
3500 under Broad Vision support.
Past interventions in the County

HIV and AIDS control activities have been on- (CACCs) each based at the sub-county level. The
going in the county, previously within the district county has been implementing key HIV prevention
set-up that has now been restructured following activities that include increasing community
the implementation of the devolved system of awareness and engagement, condom distribution
governance in 2010 and which was actualized while HIV services – counseling, testing and
in 2013. The county has a County AIDS and STI treatment - are being offered in all public facilities
Coordination system with 5 Sub-County AIDS and and complimented by private health facilities. A
STI Coordinators, and in addition with support number of NGOs, CBOs and FBOs have continued
from NACC, it has 5 Constituency AIDS Committees to support HIV prevention and treatment activities
8
in the county. They include APHIA Kamili, CHS, Nyandarua County HIV program
VIDHA, KENEPOTE and Hope Valley Family
Institute.
analysis
In developing this strategic plan it was paramount
The county has implemented the following
that major strengths and weaknesses of the
structural interventions in response to HIV and
current HIV program be reviewed, and the threats
AIDS:
and opportunities analyzed so as to inform on the
1. Capacity building for its health workforce to future direction of the HIV program in Nyandarua
create a competent, motivated and adequately County.
staffed workforce to deliver HIV services
integrated in the essential health package. Strengths
2. Strengthen health service delivery system at The county boasts of a well trained staff in almost
county levels for the delivery of HIV services all health facilities on HIV issues and these include
integrated in the essential health package HTC counselors, PMTCT counselors, clinicians
through the construction and establishment and nurses. The county has 27 CCCs and a fairly
of more health facilities. good health facility coverage with only 1% of
3. Improve access to and rational use of quality the community having to travel over 5 kms to
essential products and technologies for HIV access a health facility that offers VCT and PMTCT
prevention, treatment and care services with services, and it has a well and efficient integrated
support from NASCOP, Kenya Pharma and referral system. The county has also benefited
KEMSA. from the Beyond Zero mobile ambulance donated
courtesy of the First Lady of Kenya that is used to
4. Strengthened community service delivery system
for the provision of HIV prevention, treatment increase access to prevention of mother to child
and care services through the continued transmission services. Efforts have been made
HIV education and promotion and lately the to scale up PMTCT services in all health facilities
establishment of community health units. including faith based and private hospitals and
clinics, continuing with mobile/statistic VCT
5. Implemented a unified and functional M&E
services, training more counselors and supervisors
framework under the county through the
and mobilizing the communities to utilize PMTCT,
Nyandarua District Health and Information
VCT and ART services.
System (DHIS).
6. Improve timely identification and linkage to Weaknesses
care for persons diagnosed with HIV. The county faces a low uptake and linkage HTS
7. It is also maximizing on the efficiencies and as well as a higher ARV dropout rate that can
effectiveness of an integrated HIV, TB/SRH be attributed to inadequacy in health staffing
prevention response, through embarking on required to initiate follow up of the patients. While
providing IPT to the PLWHIV who screen TB the county may be having a number of partners –
negative, and also screening of all HIV clients CBOs, FBOs and community organizations engaged
for TB at every visit. in HIV and AIDS activities, it lacks an effective
9
coordination mechanism hence each organization AIDS activities offer an opportunity for better
group undertaking their own different activities coordination and harmonization of interventions.
in isolation resulting in wastage of resources The increased awareness on HIV and AIDS offers
and duplication of roles. While there is a steady an opportunity to continue with the programs.
and reliable supply of male condoms, there is a The increased number of PLWHIV offers an
shortage of female condoms despite there being opportunity of bringing on board HIV advocates
a demand from the locals. Other weaknesses that can be used in HIV education and promotion
include inadequate resource allocation towards activities. The county boasts of being a “food
the community strategy programs hence poor basket” hence an opportunity for improving the
linkage with the community, delayed disbursement communities’ nutrition status. The OVC program
of funds for supportive supervision, shortage of in the county is well supported through the
health workers, inadequate storage space desired Constituency Development Fund (CDF) and the
at CCC, and erratic supply of test kits and reporting County Government especially through payment
tools. Lack of appropriate referral mechanism for of school fees hence providing an opportunity
clients and mechanism for defaulters tracing, lack to link it to the National Health Insurance Fund
of properly established home based care support (NHIF).
system and stigma /discrimination on HIV also
remain high. Threats
High consumption of illicit alcoholic brews and
Opportunities drugs in the county increases the chances of
Devolution offers a perfect opportunity to engaging in casual sex and default in taking ARV.
HIV prevention and treatment as it brings the Others include high unemployment and poverty
control of resources closer to the community and levels that continue to expose a big population
shortens the lengthy decision making processes. to exploitations sexually, violence, rape etc. The
The presence of partners engaged in HIV and doctrines of some of the church in the county
that do not support use of condoms make their
followers to ignore their usage even when they
are engaging in risky sexual behaviours. Increase
Devolution in extramarital affairs (commonly referred to as
mpango ya kando) also pose a threat to HIV in
offers a perfect
the county. There is also a potential withdrawal
opportunity to of development partners from the county as they
HIV prevention focus their efforts in the high burden counties
and treatment as thereby posing a threat to HIV control with the
it brings the control scaling down of interventions.
of resources closer to
the community and
shortens the lengthy
decision making
processes.
10
Chapter
3 Purpose, Rationale,
Development and
Guiding Principles of the
Strategic Planning
3.1 Purpose of the NCHASP
T
he purpose of the plan is to guide the county is responding to HIV
epidemic in the next five years, i.e. 2015/16 - 2019/20 with the aim of
achieving the set targets under KASF. This plan will also serve the
purpose of mobilizing resources and setting of priorities.
3.2 Rationale
Following devolution, the National Government developed the KASF to
address the HIV and AIDS issues for the period 2014/15 - 2018/19 in the counties.
Consequently, each county was to develop its own HIV and AIDS strategic
plan to respond to the diversity of HIV epidemic at the county level hence the
Nyandarua County HIV and AIDS Strategic Plan (NCHASP).
3.3 Process of developing the NCHASP

NCHASP is developed from KASF which was developed by NACC in consultation
with National and county stakeholders and then disseminated to the counties
to support Kenya Vision 2030. Four objectives with eight strategic directions
to guide the county in developing its own county specific HIV strategic plan
were identified.
The process of preparing the NCHASP was highly consultative and started
with a meeting of the relevant stakeholders. Stakeholders from public
11
sector institutions, the private sector, civil society organizations (NGOs, FBOs and CBOs),
organizations of PLHIV, and the communities were involved in the preparation of the plan.
The county stakeholders listed above were actively involved in the process. County HIV
statistics were applied to determine the priority intervention areas. In the process the plan
was shared with the County Executive and the County Assembly for approval.
3.4 Guiding principles

1. Right based and gender transformation
2. Evidence based, high impact and scalable interventions
3. Multi-sectoral accountability
4. Result based planning and delivery of the NCHASP priority interventions.
The county
stakeholders listed
above were actively
involved in the
process.
12
Chapter
4 Vision, Goal, Objectives

and the Strategic
Directions
Vision
A County
free of new
HIV infections,
discrimination and
AIDS related
Goal deaths.
To contribute
to the reduction of
morbidity and mortality in OBJECTIVES
Nyandarua County through 1. Reduce new HIV
a comprehensive HIV infections by 50% by 2020
prevention, treatment 2. Reduce AIDS related
and care program by mortality by 40% by 2020.
2019. 3. Reduce HIV related stigma and
discrimination by 50% by 2020.
4. Increase domestic financing
of HIV response by 40%
by 2020.
13
4.2 Specific Objectives

1. To identify and target the priority populations for HIV services
2. To increase access to services to PLHIV
3. Reduce HIV related stigma and discrimination for 38.9% to 19% by 2019
4. To strengthen linkage between health services and community systems for HIV response
5. To strengthen research so as to have information for innovations
6. To strengthen monitoring and evaluation of the Nyandarua HIV strategic plan
7. To mobilize for resources for the implementation of the Nyandarua HIV strategic plan
4.3 Strategic Directions

Table 4.1: Summary of SDA interventions
SDA Intervention
SDA 1 Reducing new HIV infections.
SDA 2 Improving health outcomes and well-being of all people living with HIV.
SDA 3 Using a human rights based approach to facilitate services for PLHIV, key populations and other priority
groups in all sectors.
SDA 4 Strengthening integration of health services and community systems.
SDA 5 Strengthening research, innovation and information management to inform the Nyandarua HIV and AIDS
Strategic Plan.
SDA 6 Promoting the utilization of strategic information for research, monitoring and evaluation to enhance
programming.
SDA 7 Increasing domestic financing for a sustainable HIV response.
SDA 8 Promoting accountable leadership for delivery of the Nyandarua County HIV strategic plan by all sectors
and actors.
14
SDA 1: Reducing new HIV infections
Context
In Nyandarua County, approximately 50% of the people do not know their HIV status thus calling for the
scaling up of HTC. There are 131 facilities that offer HTC, of which 64 are run by the County Government
and the rest are managed by FBOs and the private sector. While health promotion activities have been
on-going, the main challenge is communication that targets persons with special needs for example sign
language for the deaf and dumb, Braille for the blind with the county lacking such capacity among its
health workers. This is required in HTC, adherence counseling and any other communication for persons
with special needs.
Strategic Direction 1: Reducing new HIV infections in Nyandarua County
KASF Objective: Reduce new HIV infections by 75%
NCHASP Sub-Activity / Geographic

Key Activity Target Population Responsibility
Results Intervention Location
Biomedical Interventions
Reduce HIV Increase access to Increase targeted High facility client All the sub- CASCO
infections HTS services to the PITC at service with high index of counties Partners
by 50% in key and vulnerable delivery points suspicion such as
CPHO
Nyandarua populations. through targeted boda boda riders,
HTC counselors
County community based men and flower farm
testing. workers
Introduce night Men and FSWs COs
“moonlight”
testing.
Undertake outreach Flower farms,
HTS. business community,
schools and colleges
Provision of Ensure regular Key and vulnerable
condoms. supply and populations
distribution of
condoms.
Intensify PMTCT to Prevention of new Pregnant women
reduce MTCT from HIV infections
6.2% to less than 5%. among women.
Integrate FP
services at the CCCs.
Improve post Provide PEP to SGBV SGBV survivors
exposure care. survivors.
15
NCHASP Sub-Activity / Geographic

Key Activity Target Population Responsibility
Results Intervention Location
Reduce HIV Behavioural Interventions
infections Develop and Promote condom General population All sub-counties MoH
by 50% in implement the use.
Nyandarua communication plan Train community
County for HIV prevention. groups.
Print and distribute
IEC materials.
Community sensiti-
zation on HTS.
Conduct school
health programs,
talent days and
tournaments.
Print and distribute
IEC materials.
Structural Interventions
Increase services to Establish youth Adolescents and All sub-counties MoH
the youths. friendly clinics. young persons.
Gender, Culture
& Social
Services
Install condom Procure and install General population
dispensers at condom dispensers
strategic places e.g. at strategic places.
boda boda sheds.
There are 131 facilities that offer

HTC, of which 64 are run by the
County Government and the rest
are managed by FBOs and the
private sector.
16
SDA 2: Improving health outcomes and well-being of all PLWHIV

Context
Nyandarua County has 27 ART sites, 32 PMTCT sites and 56 TB treatment sites. Out of the 27 ART
treatments sites, 2 are Central ART sites, 1 stand-alone site and 24 satellites. As of December 2015, 5600
clients were on ART against the target of 12,000. Viral load uptake was at around 50% in the same period
against a target of over 100%. Linkage to care was at an average of 70% against the target of 100% and
retention to care was at above 80% during the year. Activities that have been ongoing include:
• Patient escorts to improve linkage
• Phone follow up for clients referred to ensure better linkage
• Sample referral to minimize patient referral
• Close viral load monitoring for patients on care for initiation to treatment and treatment supports
• Psychosocial groups, adherence counseling
• ICF and IPT initiation to those eligible
• HIV testing among all TB patients
• HIV testing among all pregnant women attending ANC
• Defaulter prevention
• Client appointment diaries
• Defaulter identification
• Phone defaulter tracing and physical defaulter tracing
• Cervical cancer screening (VIA VILLI) and screening of DM and hypertension.
Nyandarua County experiences low paediatric enrolment, low PMTCT uptake, late ART initiation which
is attributed to accessibility to ART sites, high levels of HIV related stigma and discrimination impacting
negatively on the county’s HIV response.
Viral load uptake was at around 50%

in the same period against a target
of over 100%. Linkage to care was
at an average of 70% against the
target of 100% and retention to care
was at above 80% during the year.
17
Interventions for SDA 2: Improving health outcomes and wellness of all PLWHIV in Nyandarua County
KASF Objective: Reduce AIDS related mortality by 25%
NCHASP Results Key Activity Sub-activity / Target Geographical Responsibility

Intervention population Location
Increase Increase Use of client escorts PLWHIV All sub-counties MoH – CASCO
enrolment to coverage from testing points
care within 3 to care and to CCCs to ensure
CNO
months of HIV treatment and those testing positive
diagnosis from reduce the loss are enrolled to their
64% to 90% in the cascade preferred facility. COs
for children, of care
adolescents and Strengthen facility and
adults community linkages with
inter- and intra- facility
referral protocols and
linkage strategies.
Increase the number of

ART sites to minimize
referrals.
Open two additional Ndaragua and

central ART sites. Ol’Joro Orok
Commodity security.
Improve clinic setting for

privacy.
Improve One stop shop for all

retention health services at the All sub-counties
to care and CCC.
treatment.
Maintenance of patient
appointment dairies.
Prompt defaulter tracing

and documentation.
18

Increase Timely initiation Close clinical,

enrolment into on ART. immunological
HAART from 70% monitoring of patients All sub- counties
PLWHIV
to 90% on care for timely
identification of eligible
patients. MoH
Seamless supply of
lab commodities and CMLT
maintenance of lab All sub-counties
equipments. PLWHIV
Reducing the TAT for lab

tests results.
Intensify TB TB screening during PLWHIV All sub-counties MoH – CASCO

case finding. each visit. CTB, LO
Increased Gene expert

utilization.
Initiation of IPT to all

eligible persons.
Timely treatment of TB/

HIV co-infected.
Provide Nutritional assessment

nutritional during every clinic visit.
MoH
assessment and All sub-counties
support to all Provide food by PLWHIV
PLWHIV. prescription. CNO
Nutritional counseling.
19

Increase Early Screening for DM for

enrolment into detection and clients with suggestive
HAART from 70% management of symptoms.
to 90% co-morbidities
in HIV patients Take blood pressure in
(diabetes, every patient during
hypertension each clinic visit. PLWHIV
and cervical
Cervical cancer
cancers). MoH
screening among all All sub-counties
female patients on CCC-
VIA VILLI. CMLT
Prevention and Administration of septrin PLWHIV CNO

management of prophylaxis.
opportunistic COs
infections (OIs). Early opportunistic PLWHIV
infection detection and
treatment.
Early detection Close clinical and PLWHIV All sub-counties

and appropriate laboratory monitoring of
intervention to adverse reactions.
adverse drug
reactions.
Behavioural Interventions
Develop and Community ACSM. PLWHIV MoH – CASCO

implement a
communication All sub counties
Community CNO
guide for HIV
treatment and
care for PLWHIV COs
20

Increase Develop and Strengthen pre- and PLWHIV All sub counties MoH
enrolment into implement a post-test counseling.
HAART from 70% communication
Engagement of religious Community CMLT
to 90% guide for HIV
treatment and leaders.
care for PLWHIV CNO
Patient treatment
literacy training.
COs
Educating clients on
early warning signs of
OIs and health seeking
behaviour.
Adherence counseling.
Strengthen peer support

(treatment supporters).
Health worker training

on stigma reduction,
client confidentiality and
privacy.
21
SDA 3: Using a human rights approach to facilitate access to services for PLHIV,
KPs and other priority groups in all sectors
Context
With a HIV and AIDS stigma and discrimination index of 38.9% according to the National HIV Stigma
and Discrimination Index 2014 that is considered to be moderate, Nyandarua County will continue to
endeavour to reduce this level to a much lower level by 50%. The county has identified the following
priority groups for HIV services based on the justification outlined in Table 4.4 below.
Table 4.4: Priority groups for HIV services in Nyandarua
Priority population Justification
PLWHIV PLWHIV are often stigmatized to disclose their status and even when they disclose
the fear of discrimination remains a challenge and reality. Within Nyandarua County
there are 40 psychosocial groups formed for PLWHIV. However this is not adequate to
cater for the total number of PLWHIV in the county if the ideal number of 30 members
forming a psychosocial group is followed.
OVCs Some of the OVCs are orphaned due to loss of both parents from HIV and hence they
are also living with HIV and need HIV services. For those orphaned from other causes,
they also need protection and health care services. Currently in Nyandarua County there
are 2 CBOs supporting OVCs with support from APHIA plus Kamili (Hope Valley Family
Institute and Engineer Progressive Board) and they support 7,200 OVCs. There is need to
strengthen the coordination between the MoH, Ministry of Education, and Ministry of
Gender, Culture and Social Services.
Sexual and Gender Survivors of sexual and gender based violence need post exposure services (counseling
Based Violence and treatment) through a system that respects and secures their privacy without
survivors stigmatization or any form of discrimination. They also require a supportive environment
to go through any medico-legal process.
PLWD PLWD are often forgotten in the planning and implementation of services across board.
Most of the services are not sensitive to their needs including HIV education programs.
There are 11,685 persons living with disabilities in the county, of whom 1,595 have
hearing challenges, 2,276 are speech impaired, 3,443 are visually impaired, and 2,377
are mentally challenged. Of these, 5,303 are physically impaired while 1,994 have other
impairments. Working with the NCPLWD they will be targeted for HIV services.
School going children Nyandarua County recognizes that school going children living with HIV need to be
supported as they continue with medication including within the school environment
hence have prioritized them for HIV support.
22
Strategic Direction 3: Using a human rights approach to facilitate access to services for PLHIV, KPs and other priority
groups in all sectors
KASF Objective: Reduce HIV related stigma and discrimination by 50%
NCHASP Results Key Activity Sub-activity / Target Geographic Responsibility

Intervention Population Location
Reduce Increase access to Provide HTS to the PLWHIV1, County wide MoH
HIV related HTS services to the priority groups. PLWD2, OVC3, County wide
stigma and priority groups. SGBV survivors
NCPLWD
discrimination
from 38.9% to
19% by 2019 CBOs
FBOs
Provide HIV pre- MoH

and post-exposure NPS
prophylaxis for
County
SGBV survivors and
Commissioner
link them to legal
Office of the
services.
Prosecutor
Develop and Implement the General County wide MoH

implement communication population
communication plan for addressing
plan to promote human rights
the rights of issues.
PLWHIV in the
community.
Strengthen the Strengthen the PLWHIV County wide MoH

existing and form existing and form
more psychosocial more psychosocial
Gender, Culture
support groups groups for
& Social Services
and literacy classes PLWHIV.
for PLWHIV.
23
Strategic Direction 3: Using a human rights approach to facilitate access to services for PLHIV, KPs and other priority
groups in all sectors
KASF Objective: Reduce HIV related stigma and discrimination by 50%
NCHASP Results Key Activity Sub-activity / Target Geographic Responsibility

Reduce Form a county HIV Collaborate PLWHIV, OVCs, County wide MoH
HIV related and AIDS tribunal. with the office PLWD, SGBV NPS
stigma and of the County survivors
County
discrimination Attorney and the
Commissioner
from 38.9% to County Assembly
Office of the
19% by 2019 for legislative
Prosecutor
purposes.
Enhance MoH
coordination MoEST
between the
Ministries of
Health, Education,
and Gender,
Culture and Social
Services.
Capacity building. Training of Para- Community, County wide MoEST

legals at the FBOs, CBOs,
community level NGOs
to educate and
champion the
rights of PLWHIV
and KPs in the
community.
Sensitize teachers School children County wide

on the care of living with HIV
school going
children living with
HIV.
24
SDA 4: Strengthening the integration of health and community systems

Context
Community strategy remains a key pillar for the linkage of health and community system of all the health
services in Nyandarua County. However, the community strategy in the county has continued to receive
minimal funding hence it is inadequately structured. Ideally the county should be having 129 Community
Units (CUs) based on the population of 648,876 with 1 CU covering 5,000 persons but it currently has 68
CUs in a varied state of operation hence calling for the establishment of more CUs.
The County is also experiencing a situation where some of the partners that are critical in linking health
services at the community level are pulling out and this includes APHIA plus Kamili. They are strategically
pulling out from medium burden HIV counties to high burden counties. This is bound to reverse the gains
made in HIV response in the county.
Nyandarua County finds itself in a unique situation due to its proximity to large referral hospitals
neighbouring the county that include Rift Valley Referral Hospital in Nakuru County and Nyahururu
Referral Hospital in Laikipia County. PLWHIV often prefer to seek treatment and are enrolled to CCCs in
these counties but they ought to be referred to CUs in Nyandarua County. This calls for more discussions,
collaboration and cooperation at inter-county level if this linkage is to be realized between Laikipia,
Nyandarua and Nakuru through the Council of Governors and NASCOP. It is also worth mentioning that
some of the facilities in Nyandarua County receive their ART supplies from central sites in Laikipia County.
Health promotion on HIV has been continuing in an effort to educate and inform the community on the
need to prevent HIV and access services, however there is a weak linkage to services. For example the
youth forums educate boda boda riders on the use of condoms and need for HTS but are unable to offer
the services because they lack condoms for distribution alongside the messages and do not have an
inventory of where the HTS can be provided. This calls for more linkage to services in line with the delivery
of key HIV messages through a HIV communication guideline for the county.
The county has benefited from the Beyond Zero ambulance courtesy of the Kenya’s 1st Lady initiative and
this is used to deliver HIV services to the community.
The other challenge faced by the county in ensuring health and community system integration is the
shortage of health workers.
The County is also experiencing

a situation where some of the
partners that are critical in linking
health services at the community
level are pulling out and this
includes APHIA plus Kamili.
25
Strategic Direction 4: Strengthening the integration of health and community systems
KASF Objectives: 1] Reduce new HIV infections by 50%; 2] Reduce AIDS related mortality by 25%; 3] Reduce HIV related
stigma and discrimination by 50%; 4] Increase domestic financing of HIV response by 50%
NCHASP Key Activity Sub-Activity / Target Geographic Responsibility

Results Intervention Population Location
Increase Strengthening and Strengthen the General County wide MoH

access to the establishment of existing non population
HIV services more functional CUs. functional CUs.
CBOs
by the Establish new CUs.
community
Train more
through CUs FBOs
Community
from 68 to 129
Volunteers on home
CUs
based HIV care.
Conduct more Develop and

outreach services implement a schedule
using the Beyond for the Beyond Zero
Zero ambulance ambulance.
Lobby for the Staff recruitment to County Public

recruitment of more improve the overall Service,
health staff force. staff population ratio MoH, CBOs,
for all cadres.
NGOs, FBOs
Develop and imple- Implement the General County wide MoH

ment a HIV com- communication plan population CBOs
munication plan for for scaling up access
FBOs
scaling up access of to health services to
health services to the the community.
community.
Provide HIV services Provide HTS through General County wide MoH
through the CUs. the CUs. population
Distribute condoms CBOs
through the CUs.
FBOs
26
SDA 5: Strengthening research, innovation and information management to

inform the NCHASP goal
Context
Evidence based planning and programing is important in ensuring innovation, efficiency and accuracy
in HIV response. Nyandarua County relies on nationally conducted HIV studies, mainly the Kenya AIDS
Indicator Survey 2012 and the Kenya HIV County Profile 2014, in developing the strategy. Within the county,
the Nyandarua District Health Information System (DHIS) provides county specific data that is generated
from health facilities (as discussed under SDA 6). It is safe to state that the research platform within the
county is not well established and coordinated even though research remains a national agenda. The
county however has some research question that may help in developing innovative and evidence based
interventions as outlined in Table 4.7 below.
Strategic Direction 5: Strengthening research, innovation and information management to inform the NCHASP goal
KASF Objectives: 1] Reduce new HIV infections by 50%; 2] Reduce AIDS related mortality by 25%; 3] Reduce HIV related
NCHASP Key Activity Sub-Activity / Intervention Target Geographic Responsibility

Results Population Location
Three HIV Establish a county Have the HIV research General County wide CHRIO
studies HIV research agenda discussed on a population
conducted agenda under the regular basis.
to inform M&E TWG.
on the HIV
planning and Undertake a HIV Estimate the condom
programing in structural research. requirement and
Nyandarua distribution channels.
Undertake a HIV Understand the dynamic General County wide CHRIO

behavioural study. of FSWs in Nyandarua population
County.
Undertake a Establish if MSM and General County wide CHRIO

biomedical study. PWID are a key population population
in Nyandarua County.
27
SDA 6: Promoting the utilization of strategic Information for research,

monitoring and evaluation to enhance programing of the NCHASP
Context
Effective data collection, transmission and analysis is important to inform on HIV decision making,
policy formulation, planning and implementation. Nyandarua County collects two sets of HIV data
at health facility level and community level. The health facility data is collected through Health
Records Officers (HROs) with support for data clerks stationed at health facilities. The data is
then fed into the District Health Information System (DHIS) on a monthly basis. Through support
of NACC, community based HIV data is collected from CBOs, NGOs and other stakeholders
implementing community based HIV activities. The data is relayed through the five Constituency
AIDS Control Coordinators stationed in the sub-counties that double up as constituencies and
then sent to the Regional HIV Coordinator Region 18 for verification before being entered into the
national database for decision and policy making.
As indicated under SDA 4, the county, based on its proximity to referral health facilities from other
counties notably Nakuru and Laikipia, experiences a situation where the county residents prefer
to seek treatment from these facilities that have better facilities. This way, the true reflection of
the health situation in the county including PLWHIV is not captured in the DHIS. Other challenges
in data collection, monitoring and reporting include: Inadequate reporting tools, limited resources
to conduct data review meetings, inaccurate data collection, and limited number of facilities that
have been automated through the Electronic Medical Register (EMR) on 12 facilities. There is a
potential reduction in the number health record staff involved in data collection with the pull out
of partners’ support in data collection.
Other challenges in data collection,

monitoring and reporting include:
Inadequate reporting tools, limited
resources to conduct data review
meetings, inaccurate data collection, and
limited number of facilities that have
been automated through the Electronic
Medical Register (EMR) on 12 facilities.
28
Strategic Direction 6: Promote the utilization of strategic information for research, monitoring and evaluation of
the NCHASP
KASF Objectives: 1] Reduce new HIV infections by 50%; 2] Reduce AIDS related mortality by 25%; 3] Reduce HIV
related stigma and discrimination by 50%; 4] Increase domestic financing of HIV response by 50%
NCHASP Results Key Activity Sub-Activity / Target Geographic Responsibility

Data on HIV is Strengthen the Conduct M&E Health County wide MoH
available for County Health capacity assessment workers
use to inform Records and and development in
CHRIO
on the NCHASP Information the county.
implementation System
Partners
NACSOP
NACC
Conduct periodic
data quality audits,
verification and
support supervision.
Procure and Health

distribute reporting facilities
tools.
Strengthen Build the capacity of Health County wide

the capacity health workers on workers
of health data collection and
workers in data reporting.
collection.
29
SDA 7: Increasing domestic financing for a sustainable HIV response in

Nyandarua County
Context
The past funding for HIV activities in the county has been through the national government and continues
to be so much so with NASCOP through KEMSA providing the essential supplies ART, condoms, IEC
materials and activity based funding for capacity building, data quality assurance and supervision.
NACC funding has been channeled to support community activities including the World AIDS Day
commemoration every year, support to the CACC to undertake supervision, office running and transport
operating costs. With the reality that national HIV and AIDS funding is donor dependent and diminishing
with time, the need for increasing domestic funding is necessary. Currently the County Government is
paying for the salaries of health workers engaged in HIV response activities, caters for allowances and
transport incurred by the staff during supervision though this remains inadequate. Other forms of County
HIV support is seen in the establishment of infrastructure with more health facilities being constructed
through the county budget and the Constituency Development Funding by the Governor’s Office and the
respective Members of Parliament. The MoH will continue to lobby for more resource allocation for HIV
activities from the county budget.
Currently the County Government is
paying for the salaries of health workers
engaged in HIV response activities, caters
for allowances and transport incurred by
the staff during supervision though this
remains inadequate.
30
Strategic Direction 7: Increasing domestic financing for a sustainable HIV response in Nyandarua County
KASF Objectives: Increase domestic financing of HIV response by 50%
NCHASP Results Key Activity Sub-Activity / Target Geographic Responsibility

Increase Establish Develop an CEC Health County wide Governor

domestic a county accountability
funding for domestic framework at
MCAs
HIV response kitty for HIV county level to
in Nyandarua response. ensure alignment
County by 10% by of resources for HIV Private sector
the year 2020 response priority.
Create strategic
Private Public
Partnerships for
HIV resource
mobilization.
Develop policy briefs

to strengthen good
governance of the
HIV response.
Lobby the County PLWHIV County wide MoH

Assembly and the
public to incorporate
Civil society
HIV activities during
public participation
forums using
PLWHIV.
Conduct advocacy County County wide MoH

meetings with the leadership
county leadership
PLWHIV
to build and sustain
high level political
commitment for HIV
response.
31
SDA 8: Promoting accountable leadership for delivery of the NCHASP by all

sectors and actors
Context
Accountable, transparent and inclusive leadership is key for the delivery of the NCHASP; it requires
political goodwill, inclusion of all the interested parties - civil society, communities and PLWHIV. With
the advent of devolution it is imperative that the Governor and other elected leaders are involved in
providing leadership of HIV response in the county. Guided by the KASF, the Governor “shall implement
national and county legislation to the extent that the legislation require and is responsible for the delivery
of a range of services, planning and prioritization of resource allocation to address HIV burden”. Under the
Governor there shall be other structures: the County Executive Committee, the County HIV Committee,
County HIV ICC, County HIV Coordination Unit, County KASF Monitoring Committee and Sub-County /
Constituency HIV Committees as shown in Figure 4.1 below. In the revised NACC structure, Nyandarua
County is clustered under Region 18 which includes Laikipia and Samburu counties. NACC has seconded 5
CACCs, one in each of the sub-counties / constituencies.
The National AIDS Control Council provides the Secretariat of the County HIV Coordination Unit while
articulating the national policy and strategy direction in HIV response and coordination prevention
activities. NACSOP through the CASCO and Sub-CASCOs provides technical support in HIV treatment and
care.
Figure 4.1: County HIV coordination structure for delivery of the NCHASP
County Executive Committee

(Governor)
County HIV Committee

(Chaired by the Health CEC)
Secretariat County HIV Coordination Unit

NACC Director through the (NACC)
RHC (Region 18)
County HIV ICC 5 Sub-County / Constituency HIV

County HASP
(All partners in the County & Committees (Kinangop, Kipipiri,
Monitoring Committee
Health stakeholders’ forum Ndaragwa, Ol’Kalou, Ol’Joro Orok)
32
KASF Objectives: 1] Reduce new HIV infections by 75%; 2] Reduce AIDS related mortality by 25%; 3]Reduce HIV related
Key Sub-Activity / Interventions

NCHASP Geographical
Responsibility
Results Activities Location
Biomedical Behavioural Structural
NCHASP is County HIV Biomedical Behavioural County Executive Entire County Governor
well coordi- units and TWG TWG meets Committee con- CASCO
nated and committees meets on on a quarterly vened and holds
NACC
progress convene a quarterly basis. regular meetings
NASCOP
monitored and hold basis. to review the
regular progress of the CEC Health
meetings. NCHASP imple-
mentation.
County HIV
Committee
constituted and
holds quarterly
review meetings.
County HIV
Coordination
Unit constituted
and holds regular
meetings.
County NCHASP
Monitoring
Committee
convened and
holds regular
meetings.
Sub-County /
Constituency
HIV Committee
constituted and
holds regular
meetings.
33
Chapter
5 Implementation
Arrangements
5.1 Introduction
T
he NCHASP implementation shall be multi-sectorial comprising the
public, private and civil society institutions. Measures shall be put in
place to ensure all stakeholders are accountable both financially and
programmatically. The county as shown in SDA 8 Figure 4.1 will have the
following committees:
• County Executive Committee - Chaired by the Governor
• County HIV Committee - Chaired by the CEC Member for Health
• County HIV Coordination Unit - NACC structure with 3 coordination units:
– County ICC
– County KASF Monitoring Committee
– Sub-County HIV Coordination Committees
All the committees and units will have distinct functions and terms of reference
as follows:
5.2 County Executive Committee

This committee will be: -
• Chaired by the Governor of Nyandarua County.
• Responsible for the implementation of national and county legislation to
the extent that the legislation require.
• Responsible for the delivery of a range of services, planning and
prioritization of resource allocation to address HIV burden in Nyandarua
County.
34
5.3 County HIV Committee strategic framework at county level, working

closely with the County Health Management Team
It shall be accountable to the Governor of and the various line ministries department at
Nyandarua County for the performance of their the county level with a direct link with the NACC
functions and the exercise of their powers on Secretariat at the national level.
matters relating to HIV.
Terms of Reference
Membership
• Ensure quarterly County ICC HIV meetings are
The committee shall be chaired by the County held and follow through on County ICC HIV
Health Executive with membership from the actions.
sub-county HIV committees, HIV partners,
• Ensure HIV agenda is active in the CHMT.
implementers, PLWHIV and other special interest
groups in Nyandarua as appointed by the CEC • Regular engagement of all state and non-
Health. state actors within the county in planning,
prioritization, implementation, monitoring,
Terms of Reference and evaluation of HIV and AIDS programmes.
The County HIV Committee shall be the custodian • Strengthening linkages and networking
of the NCHASP and will: among stakeholders and providing technical
• Hold meetings on a quarterly basis to review assistance, facilitation and support for KASF
the implementation plan. delivery.
• Be responsible for the effective delivery of • Monitor County legislation to ensure all Bills
the HIV response at the county level through are HIV discrimination compliant.
periodic review and monitoring of the SCHASP. • County HIV ICC.
• Approve the county HIV targets and plan.
• Review and present the County HIV Budget. 5.5 County KASF Monitoring
• Set the County HIV agenda. Committee
• Receive reports on SCHASP progress from the • Shall comprise the sub-committees of the
monitoring committee. 4 strategic areas – Prevention, Treatment,
• Receive reports from the County ICC KCASP Human Rights and System Strengthening. The
and the routine Monitoring Committee. sub-committees shall themselves be made
up of the technical persons and institutions
responsible for different areas.
5.4 County HIV Coordination
• The Public Sector Working Group (education,
Unit agriculture, gender, law and order, transport,
This unit will be the responsibility of the NACC prison) shall facilitate and monitor the results.
Secretariat at the county level. The unit shall
coordinate the day to day implementation of the
35
Chapter
6 Monitoring and
Evaluation of the
NCHASP
T
he NCHASP ideally should cover the period 2014/2015 – 2018/2019 in line
with the national KASF. However following a delay in the development
and launch of this strategic plan its implementation will practically
reflect on the period 2016 – 2020 covering 5 years.
The NCHASP will be monitored and evaluated as follows:
1. During the National Kenya AIDS Indicator Survey in 2016 that is undertaken
countrywide by the NACC.
2. Mid-term Evaluation: this will be conducted in mid 2018 through a review
of the set mid-term target as outlined in the M&E Annexure 1.
3. End term Evaluation will be undertaken at the end of 2020 against the set
or revised target following the mid-term evaluation.
Both the mid and end term evaluations will be done though a desk review of
the Nyandarua DHIS 2 and also the engagement of an independent consultant.
During the review of the national KASF expected between 2018/2019, the
NCHASP will also be aligned to the KASF and hopefully they will run concurrently
in future.
Table 6.1: Monitoring & Evaluation Plan of the NCHASP
Year 1 Year 2 Year 3 Year 4 Year 5

Jan to Dec 2016 Jan to Dec 2017 Jan – Dec 2018 Jan to Dec 2019 Jan to Dec 2020
KAIS X
Mid-term X
Evaluation
End term X
Evaluation
36
Chapter
7 RISK MITIGATION PLAN
Risk Category Risk Name Status Probabil- Impact Risk Response Responsibility When
ity (1-5) (1-5) Average
score
Technological Partners lack Active- risk 3/5 4/5 Mitigate- CHAC and Y1
Capacity is being budget Implementing
actively moneys for partners
monitored training
Low integra- Active- risk 3 3 3 Adopt and County Y1-Y5
tion of ICT into is being strengthen Government,
HIV program- actively use of ICT in NASCOP
ming monitored HIV program- ,Implementing
ming partners
Lack of some Active- risk 3 3 3 Fast track County Y1-Y5
key indicators is being incorporating Government,
in the DHIS actively the missing NASCOP,
monitored indicators Implementing
partners
Financial Limited finan- Active- risk 3 4 3.5 Lobby with CoH, CHAC Y1-Y5
cial resources is being the county
for HIV pro- actively assembly for
gramming monitored budgetary
allocation
Political Weak Political Active- risk 2 2 2 Demand County Y1-Y5
accountability is being political ac- Government,
actively countability NACC
monitored
Inconsistent Passive 2/5 3/5 Reduce-by CEC health, Y1- Y5
and insuffi- risk, its be- Constantly CHAC
cient political ing actively engaging the
good will. monitored. political class.
37
score
Operational Inconsistent Active- risk 2 4 3 Right County Y1-Y5
and inad- is being forecasting, government,
equate supply actively quantification NASCOP,
of HIV com- monitored and procure- KEMSA,
modities. ment Implementing
partners
Inadequate Active- risk 2 3 2.5 Increase the CASCO, Y1-Y5
care and treat- is being number of Implementing
ment centers actively Care and Partners
monitored treatment
centers in
the county
to improve
access
Youth and Active- risk 2 3 2.5 Integrate and CDH ,Imple- Y1-Y5
adolescent is being strengthen menting
friendly ser- actively youth / partners
vices monitored adolescent
friendly ser-
vices
Inconsistent Active- risk 2 4 3 Right County Y1-Y5
and inad- is being forecasting, government
equate supply actively quantification , NASCOP
of HIV com- monitored and procure- ,KEMSA
modities. ment ,Implementing
partners
Inadequate Active- risk 2 3 2.5 Increase the CASCO, Y1-Y5
care and treat- is being number of Implementing
ment centers actively Care and Partners
monitored treatment
centers in
the county
to improve
access
Youth and Active- risk 2 3 2.5 Integrate CDH ,Imple- Y1-Y5
adolescent is being and strength- menting
friendly ser- actively en youth / partners
vices monitored adolescent
friendly ser-
vices
38
score
Operational Inadequate Active- risk 2 3 2.5 Recruit new CPSB,CoH Y1-Y5
trained per- is being staff , deploy ,CDH,CASCO
sonnel to offer actively rightfully and
HIV services monitored offer continu-
in the health ous capacity
facilities-All building
cadres
Inadequate Active- risk 2 2 2 Strengthen County Y1-Y5
community is being the commu- government,
mobilization actively nity health Implementing
activities monitored strategy partners
towards HIV
response
Lack of sup- Inac- 4 4 4 Initiate and County Y1-y5
port for key tive –No sustain pro- Government,
population monitoring grams for key Implementing
programs in place populations partner
Inadequate Active- risk 2 3 2.5 Recruit new CPSB,CoH, Y1-Y5
trained per- is being staff , deploy CDH,CASCO
cadres
Inadequate Active- risk 2 2 2 Strengthen County Y1-Y5
community is being the commu- government,
mobilization actively nity health Implementing
activities monitored strategy partners
towards HIV
response
Lack of sup- Inac- 4 4 4 Initiate and County Y1-y5
port for key tive –No sustain pro- Government,
population monitoring grams for key Implementing
programs in place populations partner
Inadequate Active- risk 2 3 2.5 Recruit new CPSB, CoH, Y1-Y5
trained per- is being staff , deploy CDH,CASCO
cadres
39
score
Operational Data quality / Active- risk 2 3 2.5 Conduct CoH, CASCO, Y1-y5
data utilization is being regular DQAs CHRIO,
challenges actively and quarterly Implementimg
monitored M/E review partners
meeting
Stigma and dis- Active- risk 4 4 4 Conduct anti County Y1-Y5
crimination is being stigma cam- government,
actively paigns Networks of
monitored PLHIV, Com-
munity, FBOs
Knowledge Active- risk 2 3 2.5 Countinous CASCCO, Y1 –
gaps amongst is being capacity Implementing Y5
HCWs (capac- actively building and partners
ity building) monitored mentorship
Legislation Lack of legisla- Active – 2 3 2.5 Develop and Department Y1-Y5
tion on HIV Risk NOT operational- of Health, Net-
related issues being ize the HIV works of PLHIV
and stigma actively related bills and County
monitored Assembly
Committee on
health
Inadequate Active Lobby County Assem- Y1 –
legislation to (legislation ) bly and CEC Y5
support (KP support from Health
and vulnerable the
groups.
Lack of politi- likely 4/5 4/5 Lobby and Y1 –
cal goodwill, advocate to Y5
Lack of sup- political class
portive poli-
cies – work-
place and Key
population
40
A nnex
1 Monitoring and
Evaluation Framework
for the NCHASP
KASF objective: Reduce new HIV infections by 75%
NCHASP Key activity Indicator Baseline & Mid-term End term Responsibility
result source target target
Reduce HIV Increase access to HTS Increase in the 50% 75% 90% CACCs
infections services to the key and percentage of key and
by 50% in vulnerable populations. vulnerable populations
Nyandarua who know their HIV
County status.
Increase access Number of condoms 100,000 150,000 200,000 CACCs
to HIV prevention distributed to key and
commodities vulnerable populations.
Increase access to HIV Increase the percentage 20% 40% 60% CACCs
prevention messages. of people reached
with HIV prevention
messages.
Increase access to HTS Number of functional 0 2 5 CECM Health
by the adolescents and youth friendly clinics
young people through established.
youth friendly clinics.
Increase access Number of condom 0 100 200 CACCs
to HIV prevention dispensers installed at
commodities through strategic points.
condom dispensers.
41
KASF objective: Reduce AIDS related mortality by 25%
NCHASP result Key activity Indicator Baseline & Mid-term End term Responsibility
source target target
Increase Biomedical Interventions

enrolment to care
within 3 months Increase the Increase in the % of 64% 80% 90% CASCO
of HIV diagnosis number of PLWHIV PLWHIV initiated on
from 64% to 90% initiated on ART. ART.
for children,
Improve the Increase in the % of 80% 85% 90% CASCO
adolescents and
number of PLWHIV one year retention of
adults
retained on care PLWHIV on care and
and treatment. treatment.
Intensify TB case Number of PLWHIV 70% 80% 90% CASCO

finding. screened for TB and
initiated on treatment
as per the guidelines.
Provide nutritional Number of PLWHIV 53% 65% 90% CASCO

assessment and on nutritional
support to all support.
PLWHIV.
Develop and Number of PLWHIV 0 40% 80% CHPO

implement a reached with a key
communication message on HIV care
guide for HIV and treatment.
treatment and care
for PLWHIV.
Increase the Number of functional 27 28 30 CDH

number of ART ART sites established.
sites to minimize
referrals.
Open 2 additional Number of functional 2 3 4 CDH

central ART sites. central ART sites in
Nyandarua.
42
Strategic Direction 3: Reducing HIV related stigma and discrimination by 50%
KASF objective: To reduce HIV related stigma and discrimination by 50%
NCHASP result Key activity Indicator Baseline Mid- End Responsibility

& source term term
target target
To reduce the Biomedical Interventions

stigma index
from 38% Increase access to Number of the targeted 0 10 20 CACCs
(Moderate) to HTS services to the priority groups reached.
19% (Low) priority groups. with HTS.
Develop and Percentage of the 0% 40% 80% CHPO

implement a community reached with a
communication key message on the rights
plan to promote of PLWHIV.
the rights of
PLWHIV in the
community.
Strengthen the Number of psychosocial 0 20 40 CASCO

existing and form groups strengthened and
more psychosocial formed for PLWHIV.
support groups
and literacy classes
for PLWHIV.
Sensitize teachers Number of teachers 0 40 80 KENAPOTE

on support and trained on support and
care of school care of school children
children living with living with HIV.
HIV.
43
Strategic Direction 4: Strengthening the integration of health and community systems
KASF objectives: 1] Reduce new HIV infections by 50%; 2] Reduce AIDS related mortality by 25%; 3] Reduce HIV related

& source term term
target target
Increase Biomedical Interventions

access to HIV
services by the Train Community Number of PLWHIV 0 50 100 CACCs
community Volunteers on home receiving home based
through CUs based HIV care. HIV care.
from 68 to 129
CUs
Develop and Increase in the % of the - 30% 40% CHPO
implement a HIV community reached
communication plan with key HIV messages.
for scaling up access
of health services to
the community.
Strengthening Number of non - 39 68 CHP&P

the existing non functional CUs revived.
functional CUs.
Establish more Number of new CUs 68 80 100 CHP&P

functional CUs. established.
Conduct more Number people 0 15000 30000 CHFH

outreach services reached through
using the Beyond the Beyond Zero
Zero ambulance. ambulance.
Lobby for the Number of staff 0 100 300 CECM Health

recruitment of more recruited.
health workers.
44
Strategic Direction 5: Strengthening research, innovation and information management to inform the NCHASP goal
KASF objectives: 1] Reduce new HIV infections by 50%; 2] Reduce AIDS related mortality by 25%; 3] Reduce HIV related
NCHASP result Key activity Indicator Baseline & Mid-term End Responsibility
source target term
target
Three HIV studies Biomedical Interventions

conducted to
inform on the Establish if MSM A study on 0 1 1 CECM Health
HIV planning and and PWID are a the mode of
programing in key population in transmission in
Nyandarua Nyandarua County. Nyandarua County
undertaken and
results available.
Understand the Study on FSWs 0 1 1 CDH

dynamic of FSWs in done in Nyandarua
Nyandarua County. and results
available.
Establish a County Research remains 0

HIV research a key agenda in
agenda under the the M&E TWG and
M&E TWG. minutes available.
Estimate Study on 0 0 1 CDH

the condom the condom
requirement requirement
and distribution and effective
channels. distribution
channels done and
results available.
45
Strategic Direction 6: Promote the utilization of strategic information for research, monitoring and evaluation of
the NCHASP.
KASF objectives:
1] Reduce new HIV infections by 50%;
2] Reduce AIDS related mortality by 25%;
3] Reduce HIV related stigma and discrimination by 50%;
4] Increase domestic financing of HIV response by 50%

& source term term
target target
Data on HIV is Behavioural Interventions

available for
use to inform Build the capacity Number of 0 100 150 CHRIO
on the NCHASP of health workers health workers
implementation on data collection trained.
and reporting.
Procure and - - - CHRIO

distribute data
collection tools
Conduct periodic
data quality audits
46
Strategic Direction 7: Increasing domestic financing for a sustainable HIV response in Nyandarua County
KASF objectives: Increase domestic financing of HIV response by 50%
NCHASP Key activity Indicator Baseline Mid- End Responsibility

result & source term term
target target
Increase Behavioural Interventions

domestic
funding for Lobby the County Number of meetings 2 8 16 CECM Health
HIV response Assembly and the held between the
in Nyandarua public to incorporate County Assembly
County by HIV activities during and Department of
10% by the public participation Health per year.
year 2020 forums using
PLWHIV.
Conduct advocacy Number of advocacy - 2 4 CECM Health

meetings with the meetings held per
county leadership year.
commitment for HIV
response.
Develop an One framework - 1 1 COH

accountability developed.
framework at
county level to
ensure alignment
of resources for HIV
response priority.
Create strategic One committee - 1 1 CECM Health

private public formed.
partnership for
HIV resource
mobilization.
Develop policy briefs Number of policy - 2 4 CECM Health

to strengthen good briefs developed.
governance of HIV
response.
47
Strategic Direction 8: Promoting accountable leadership for delivery of the NCHASP by all sectors and actors
KASF objectives: 1] Reduce new HIV infections by 75%; 2] Reduce AIDS related mortality by 25%; 3]Reduce HIV related
NCHASP Key activity Indicator Baseline Mid- End Responsibility

result & source term term
target target
NCHASP Biomedical Interventions

is well
Biomedical TWG meet on Number of biomedical 4 8 16 CASCO
coordinated
a quarterly basis. TWG conducted and
and progress
minutes available.
monitored
Behavioral Interventions
Behavioural TWG meet Number of behavioural 4 8 16 CASCO

on a quarterly basis. TWG conducted and
minutes available.
County Executive Number of County 0 2 4 Governor

Committee convened Executive Committee
and holds regular meetings conducted
meetings to review the and minutes available.
progress of the NCHASP
implementation.
County HIV Committee Number of County HIV 1 8 16 CECM Health

constituted and holds Committee meetings
quarterly review conducted and
meetings minutes available.
County HIV Coordination Number of County 0 4 12 CECM health

Unit constituted and HIV Coordination Unit
holds regular meetings. meetings conducted
and minutes available.
County NCHASP Number of County 0 4 12 CHRIO

monitoring committee NCHASP monitoring
convened and holds committee meetings
regular meetings. conducted and
minutes available.
Sub-County / Number of sub- 0 20 40 CACCs

Constituency HIV county / constituency
Committees constituted meetings conducted
and hold regular and minutes available.
meetings.
48
A nnex
2 Resource Needs
Resources required for implementing the NCHASP 2016/17-2018/19 (in KSH millions)
SD 2016/17 2017/18 2018/19 Total % of resource

allocated
Strategic Direction 1 133.37 263.72 393.41 790.50 17.30%
Strategic Direction 2 905.29 1,123.82 1,337.50 3,366.61 73.66%
Total 1,061.97 1,530.56 1,977.77 4,570.30 100.00%
49
NCHASP result Key activity Indicator Baseline & Mid-term End term
Reduce HIV Increase access Increase in the 18,025,000 27,037,500 32,445,000

infections by 50% to HTS services percentage of key and
in Nyandarua to the key and vulnerable population
County. vulnerable who know their HIV
populations. status
Increase access Number of condoms 618,000 927,000 1,236,000

to HIV prevention distributed to key and
commodities vulnerable population
Increase access Increase the 105,540,349 211,080,698 316,621,047

to HIV prevention percentage of people
messages reached with HIV
prevention messages.
Increase access Number of functional 0 6,000,000 15,000,000

to HTS by the youth friendly clinics
adolescent and established.
young people
through youth
friendly clinic
Increase access Number of condom 0 500,000 1,000,000

to HIV prevention dispensers installed at
commodities strategic points.
through condom
dispensers.
Subtotal 124,183,349 245,545,198 366,302,047
Program management costs 7.4% 9,189,567.84 18,170,344.67 27,106,351.51
Total 133,372,917 263,715,543 393,408,399
50
Interventions for SDA 2: Improving health outcomes and wellness of PLWHIV in Nyandarua County
KASF objective: Reduce AIDS related mortality by 25%
Increase Increase the Increase in the % of 529,014,922 661,268,652 743,927,234

enrolment to number of PLWHIV initiated on
care within 3 PLWHIV initiated ART
months of HIV on ART
diagnosis from
64% to 90% Improve the num- Increase in the % of 39,228,201 52,099,954 62,060,240
for children, ber of PLWHIV one year retention of
adolescent and retained on care PLWHIV retained on
adults and treatment care and treatment.
Intensify TB case Number of PLWHIV 53,632,306 61,294,064 68,955,822

finding. screened for TB and
initiated on treatment
as per the guidelines
Provide nutritional Number of PLWHIV on 189,541,250 232,456,250 321,862,500

assessment and nutritional support.
support to all
PLWHIV
Develop and Number of PLWHIV 500,000 5,268,932 10,537,864

implement a reached with a key
communication message on HIV care
guide for HIV and treatment.
treatment and
care for PLWHIV.
Increase the Number of functional 27,000,000 28,000,000 30,000,000

number of ART ART sites established
sites to minimize
referrals
Open 2 additional Number of functional 4,000,000 6,000,000 8,000,000

central ART sites central ART sites in
Nyandarua
Subtotal 842,916,679 1,046,387,852 1,245,343,659
Program management costs 7.4% 2,375,834.21 77,432,701.08 92,155,430.79
Total 905,292,513 1,123,820,554 1,337,499,090
51
Strategic Direction 3: Reducing HIV related stigma and discrimination by 50%
KASF objective: To reduce HIV related stigma and discrimination by 50%
To reduce the Increase access Number of the 0 287,370 574,740

stigma index to HTS services targeted priority
from 38% to the priority groups reached with
(Moderate) to groups HTS
19% (Low)
Develop and Percentage of the 0 42,556,592 85,113,185
implement community reached
communication with a key message on
plan to promote the rights of PLWHIV
the rights of
PLHIV in the
community
Strengthen the Number of 0 2,142,400 4,284,800

existing and form psychosocial groups
more psychosocial strengthened and
support groups formed for PLWHIV
and literacy
classes for
PLWHIV.
[1] Priority group Sensitize teachers Number of teachers 0 494,400 988,800

include PLWHIV, on support and trained on support and
PLWD, OVCs care of school care of school children
children living living with HIV
with HIV
Subtotal 0 45,480,762 90,961,525
Program management costs 7.4% - 0 3,365,576.42 6,731,152.84
Total 0 48,846,339 97,692,678
52
Strategic Direction 4: Strengthening the integration of health and community systems.
KASF Objectives: 1] Reduce new HIV infections by 50% 2] Reduce AIDS related mortality by 25% 3] Reduce HIV related
stigma and discrimination by 50% 4] Increase domestic financing of HIV response by 50%
Increase Train Community Number of PLWHIV 0 2,500,000 5,000,000

access to HIV Volunteers on receiving home based
services by the Home Based HIV HIV care.
community care
through CUs
from 68 to 129 Develop and Increase in the % of the 0 31,917,444 42,556,592
CUs implement a HIV community reached
communication with key HIV messages
plan for scaling up
access of health
services to the
community.
Strengthening Number of 0 1,950,000 3,400,000

the existing nonfunctional CUs
nonfunctional CUs revived
Establish more Number of new CUs 3,400,000 4,000,000 5,000,000

functional CUs established
Conduct more Number people 0 2,317,500 4,635,000

outreach services reached through
using the beyond the beyond zero
zero ambulance ambulance
Lobby for the Number of staff 0 5,000,000 15,000,000

recruitment of recruited
more health staff
force.
Subtotal 3,400,000 47,684,944 75,591,592
Program management costs 7.4% 251,600.00 3,528,685.88 5,593,777.84
Total 3,651,600 51,213,630 81,185,370
53
Strategic Direction 5: Strengthening research and innovation to inform the NCHASP.
3 HIV studies Establish if MSM Study on the mode 0 500,000 500,000

conducted to and PWID are a of transmission study
inform on the key population in in Nyandarua County
HIV planning and Nyandarua County undertaken and results
programing in available
Nyandarua
Understand the Study on FSW done in 0 500,000 500,000
dynamic of FSW in Nyandarua and results
Nyandarua County available
Establish a County Research remains a key 100,000 100,000 100,000

HIV research agenda in the M&E WG
agenda under the and minutes available.
M&E TWG
Estimate Study on the condom 0 0 500,000

the condom requirement and
requirement effective distribution
and distribution channels done and
channels results available
Subtotal 100,000 1,100,000 1,600,000
Program management costs 7.4% 7,400.00 81,400.00 118,400.00
Total 107,400 1,181,400 1,718,400
54
Strategic Direction 6: Promote the utilization of strategic information for research, monitoring and evaluation of the
NCHASP.
Data on HIV is Build the capacity Number of health 0 10,000,000 15,000,000

available for of health workers workers trained
use to inform on data collection
on the NCHASP and reporting
implementation.
Procure and 10,000,000 15,000,000 18,000,000
distribute data
collection tools
Conduct periodic 500,000 500,000 500,000

data quality audits
Subtotal 10,500,000 25,500,000 33,500,000
Program management costs 7.4% 777,000.00 1,887,000.00 2,479,000.00
Total 11,277,000 27,387,000 35,979,000
55
Strategic Direction 7: Increasing domestic financing for sustainable HIV response in Nyandarua County.
KASF Objectives: Increase domestic financing of HIV response by 50%
Increase Lobby the county Number of meetings 400,000 1,600,000 3,200,000

domestic assembly and held between
funding for the public to in County assembly and
HIV response cooperate HIV department of health
in Nyandarua activities during per year
County by 10% by public participation
the year 2020 forums using
PLWHIV.
Conduct advocacy Number of advocacy 200,000 400,000 800,000

meetings with the meetings held per year
county leadership
commitment for
HIV response.
Develop an One framework 500,000 100,000 100,000

accountability developed
framework at
county level to
ensure alignment
of resources for HIV
response priority.
Create strategic One committee formed 100,000 100,000 100,000

private public
partnership for
HIV resource
mobilization.
Develop policy Number of policy briefs 100,000 400,000 800,000

briefs to strengthen developed
good governance of
HIV response.
subtotal 1,300,000 2,600,000 5,000,000
Program management costs 7.4% 96,200.00 192,400.00 370,000.00
Total 1,396,200 2,792,400 5,370,000
56
Strategic Direction 8: Promoting accountable leadership for delivery of the NCHASP by all sectors and actors
KASF objectives: 1] Reduce new HIV infections by 75% 2] Reduce AIDS related mortality by 25% 3]Reduce HIV related
NCHASP Key activity Indicator Baseline & Mid-term End term

result source target target
NCHASP Biomedical TWG meet on Number of 800,000 1,600,000 3,200,000

is well a quarterly basis biomedical TWG
coordinated conducted and
and progress minutes available
monitored
Behavioral TWG meet on a Number of Behavioral 800,000 1,600,000 3,200,000
quarterly basis TWG conducted and
minutes available
County Executive com- Number of County 400,000 400,000 800,000

mittee convened and Executive committee
holds regular meetings to meetings conducted
review the progress of the and minutes available
NCHASP implementation.
County HIV Committee Number of County 800,000 1,600,000 3,200,000

constituted and hold HIV Committee
quarterly review meetings conducted
meetings, and minutes available
County HIV Coordination Number of County 800,000 800,000 2,400,000

unit constituted and hold HIV Coordination unit
regular meetings meetings conducted
and minutes available
County NCHASP Number of County 800,000 800,000 2,400,000

monitoring committee NCHASP monitoring
convened and hold regular committee meeting
meetings conducted and
minutes available
Sub County / Constituency Number of sub 2,000,000 4,000,000 8,000,000

HIV committee county / constituency
constituted and hold meetings conducted
regular meetings and minutes available
Subtotal 6,400,000 10,800,000 23,200,000
Program management costs 7.4% 473,600.00 799,200.00 1,716,800.00
Grand total 1,061,971,230 1,530,556,065 1,977,769,737
57
A nnex
3 References
1. Kenya AIDS Strategic Framework which outlines country’s strategies in
addressing HIV and AIDS.
2. Vision 2030, which identifies health as a key building block for the
transformation of Kenya into a successful middle income country.
3. Health Sector Strategic plan (HSSP): NCHASP outlines that health and
community systems development priorities ensure effective health service
delivery.
4. Monitoring and evaluation framework. 2014/15-2018/19
5. Regional HIV frameworks that contribute to the objectives of regional
objectives including IGAD, East African Community, African Union Global
Commitment on HIV, Tuberculosis and Malaria.
6. Global commission on human right and law
7. Kenya fast-track plan to end HIV & AIDS among adolescents and young
people
8. The National HIV and AIDS stigma and discrimination index
58
A nnex
4 List of the County

Drafting and Technical
Teams
Drafting Team
1. Dr. Joram Muraya - County HIV/AIDs and Sexually Transmitted Diseases
Coordinator
2. Dr. Mbugua Peter Kungu - County Executive Committee Member - Health
3. Philomena Atsiaya - LEAD-TB
4. Samwel Kago - County Health Records and Information Officer
5. Dr. Irungu Mwangi - Chief Health Officer
6. Anne Wambui Njoroge - PLWHA (Kenya Network of Positive Teachers
(KENEPOTE) HIV and AIDS)
7. Dorcas Nyambura Kihara - MCA Member - Health
8. Mr. Samson Njiiri - Director of Social Services
9. Samwel Kimiti - County Commissioner
10. Gichuki Kariuki - County Director of Health
11. Patrick Kamwana - Sub-County AIDS Community Coordination, Ol’Kalou
12. Osborn Kiptoo - APHIA plus Kamili
13. Ben Kimutai - Centre for Health Solutions
14. Wachira Kariuki - Sub-County AIDS Community Coordination, Ndaragwa
sub-county
59
15. Moses Bakari - Sub-County AIDS Community Coordination, Kinangop sub-county

16. Paul Githiga - Sub-County AIDS Community Coordination, Ol’Jjoro Orok sub-county
17. Mwangi Peter - Sub-County AIDS Community Coordination, Kipipiri sub-county
Technical Review Team

18. Sang Chebet Gladys - National AIDS Control Council
19. Bryan Okiya - National AIDS Control Council
20. Ben Tisnanga Adika - Independent Consultant
21. Moses Mathu - National AIDS Control Council, Member of TST
22. Njeri Gachiri - National AIDS Control Council
60

Nyandarua Chasp

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NYANDARUA COUNTY

HIV & AIDS

Acronyms and Abbreviations......................................................................................................................... vi

Chapter 1: Introduction and Background Information on the County........................ 1

1.1 Background to the County...................................................................................................... 1

1.2 Demographic features............................................................................................................ 2

1.3 Economic conditions...............................................................................................................4

1.4 Health access and nutrition....................................................................................................4

Chapter 2: Situational Analysis: HIV Situation in Nyandarua............................................ 5

2.1 Geographical prioritization.....................................................................................................5

2.2 Drivers of HIV in Nyandarua...................................................................................................6

2.3 Priority population for HIV in the County..............................................................................6

2.4 Past interventions in the County...........................................................................................8

2.5 Nyandarua County HIV program analysis .............................................................................9

Chapter 3: Purpose, Rationale, Development and Guiding Principles of the

3.3 Process of developing the NCHASP..................................................................................... 11

4.2 Specific objectives................................................................................................................ 14

4.3 Strategic Directions.............................................................................................................. 14

Chapter 5: Implementation Arrangements...............................................................................34

Chapter 6: Monitoring and Evaluation of the NCHASP........................................................36

Chapter 7: RISK MITIGATION PLAN...................................................................................................... 37

Annex 1: Monitoring and Evaluation Framework for the NCHASP................................. 41

Annex 2: Resource Needed.................................................................................................................49

Annex 4: List of Drafting and Technical Review Team..........................................................59

AIDS Acquired Immune Deficiency CHW Community Health Worker

ARV Anti-Retroviral (drugs) FBOs Faith Based Organisations

BCC Behaviour Change Communication FSW Female Sex Workers

BMI Body Mass Index GBV Gender-Based Violence

CASCO County HIV/AIDs and Sexually GF Global Fund

CCC Comprehensive Care Centre HAART Highly Active Antiretroviral Therapy

CHRIO County Health Records and IDU Injecting Drug Users/Intravenous

CHS Centre for Health Solutions IEC Information, Education,

KDHS Kenya Demographic and Health NGOs Non-Government Organizations

MC Male Circumcision PEP Post-Exposure Prophylaxis

MoH Ministry of Health PMTCT Prevention of Mother-to-Child

NCPWD Nyandarua county people with

H.E. Daniel Waithaka Mwangi

1.1.1 Location and size

1.1.2 Administrative and political units

Table 1.1: County administrative units

Constituency Sub-County Area No. of electoral No. of No. of

Source: Nyandarua County Integrated Development Plan (NCIDP)

Figure 1.2: Political and administrative units in

The population is projected to grow to 688,618

1.2.2 Projected population for selected

No. Disease No. of cases

milk processing plants namely Brookside Dairy and 5 Pneumonia 34,504

the nearest health centre is 3.2 km. In the county,

2 Situational Analysis: HIV

Table 2.1: HIV situation in Nyandarua County

Indicator Numbers / Percentage

Source: Kenya HIV County HIV Profiles, 2014

2.1 Geographical prioritization

4 Kipipiri 579 8.6 Poverty: Driven by poverty most women engage

Table 2.3: Key HIV populations in Nyandarua County

Table 2.4: Vulnerable HIV populations in Nyandarua County

Past interventions in the County

3.3 Process of developing the NCHASP

3.4 Guiding principles