P0103 Pathfinder

This activity links to: C0613 & C0901 & C0904 & C0907 & C0908 & C0911 & C0912 & P0106 & P0511 & T1101 & T1111 & T1114 & X1406.

Since November 2001, PMTCT has been available nationwide in Botswana. Despite the increase in PMTCT testing uptake from 62% in 2003 to 82% in 2005, the program continues to face several challenges, including providing ongoing support to infected women, poor male involvement, infant follow-up and testing, overcoming stigma and discrimination, and infant feeding and cultural beliefs This activity deals with the expansion of psychosocial and peer counseling services for HIV-infected women, their partners, and families. This 5-year program began in Oct. 2004 and will end in Sept. 2009. The program is designed to contribute towards the improvement of HIV prevention, care, and support services for HIV-infected pregnant women, their partners and families in Botswana. Pathfinder International is providing funding and technical assistance to the BOCAIP and BONEPWA in the form of technical expertise, ongoing institutional capacity building in project management and administration, financial management, supervision, monitoring and evaluation, and other areas of need. The activity is made up of 3 components. The 1st component, being undertaken by BOCAIP, is the establishment of a peer-counseling program for women attending antenatal clinics. In FY06, this activity expanded from 2 sites to 4 sites in Selibe Phikwe. In FY07, the peer counseling program will expand to 10 new sites. BOCAIP is developing and implementing a peer-counseling program in which HIV-infected pregnant women who have received PMTCT services are provided education, counseling, and support in government clinics in conjunction with existing counseling structures. This component will complement the promotion of the national plans for community based HIV/AIDS care services. The 2nd component is the establishment of a peer-counseling program at ART sites by BONEPWA. BONEPWA trains and supports PLWHA, including HIV-infected women from the PMTCT program, as ART adherence counselors. The peer mothers program is a clinic-based program because mothers are recruited and monitored within the PMTCT program at the clinic. In FY06, this activity expanded from 7 Infectious Disease Control Centers (IDCC) to 8 IDCCs plus 28 satellites. In FY07, the activity will expand to 2 additional IDCCs and 8 satellites. The counselors offer adherence support services to PLWHAs on ART therapy as well as those who are referred to the clinic to begin ART. This component is aimed at strengthening the linkage between PMTCT and the ART programs. The 3rd component Pathfinder will identify 1-2 additional sub grants in 2007 to address the challenge of lack of male involvement and further expand the peer mothers counseling and psychosocial program to new sites. Sub-partner Narratives 1. BOCAIP. For over 6 years, BOCAIP has offered counseling services and has acquired immense experience in this area. In some BOCAIP centers, a partnership already exists that allows BOCAIP staff to provide counseling services at government health facilities. Therefore, BOCAIP was selected to offer expanded and focused services to the PMTCT program by expanding the availability of peer counseling services to HIV-infected pregnant mothers, their partners, and families. Peer counseling is used to mobilize and educate women and empower them to adhere to PMTCT protocols through the family care approach. This strategy maximizes women's benefit from the available PMTCT services through mentoring, skills building, sharing experiences, and woman to woman empowerment. In FY06 this activity expanded from 2 sites to 4 sites in Selibe Phikwe. In FY07, the activity will expand to 10 new sites, including Mmathethe, Tsabong (Government Hospital), Tsabong (Clinic), Mmadinare, Tshesebe, Tsamaya, Lobatse, Bobonong, Masunga, and Tati Siding. 2. BONEPWA: The mission of BONEPWA is to improve the well being and quality of lives of PLWHA and their families, and to protect the nation of Botswana from new HIV infections through behavioral change, positive living, increased access to and utilization of care and support services. Creating a network of PLWHA was conceived in 1995 when it was recognized that PLWHA have a common goal, vision, and commitment, and creating a formal forum to bring them together would be useful. The network is seen as a national umbrella NGO that provides leadership and a united voice for PLWHA through support groups.

BONEPWA was selected to provide training and support to HIV infected women from the PMTCT Program who will work as peer counselors. These counselors will extend psychosocial support and counseling services to other HIV-infected mothers from the PMTCT program. BONEPWA identifies ART counselors from support groups. These counselors are then trained as peer ARV adherence counselors, and are based at the Infectious Disease Control Clinics (IDCCs) or ARV treatment clinics and satellites. Their roles include: a) Peer adherence counseling around PMTCT and ARV treatment at both the clinic and community levels. B) Provision of ongoing support through support groups. During FY05, services were initiated in Mahalapye, Gantsi, Gumare, Gweta, Letlhakane, and Tutume. Based on the experience and the needs of the districts, the services were expanded to satellites of the existing districts. Each district has 4 satellites, and all the satellites were covered. In FY06, the activities were expanded from 7 IDCCs to 8 IDCC,s plus 28 satellites. In FY07, BONEPWA will expand the services to Mahalapye IDCC, 4 Hukunsti satellites, Sefhare IDCC and its 4 satellites. 3. TBD: In year F07, the program will provide additional sub grants to 1-2 existing NGOs, CBOs and FBOs to expand the peer mothers' activity to new sites and to address the challenge of insufficient male involvement in PMTCT. The program will implement creative strategies such as targeting men when they come to the clinics to pick up baby formula for their babies, creating father support groups for the partners of mothers in the PMTCT program, conducting mobilization campaigns where partners are invited to share their experiences, and inviting influential men from the community to be advocates and give keynote addresses at these campaigns. These male involvement activities will enhance mobilization and education of individuals including partners, families, and communities about the availability of services and the benefits of utilizing these services. In addition, during home visits mothers will be encouraged to check if the infants are due for testing, and the peer counselors will assist the mothers to access infant testing at facilities. The following deliverables are expected: 1) Provision of on-going supportive counseling at all sites. It is expected that each peer mother will provide on-going supportive counseling to two HIV-infected mothers per day. 2) Community outreach at work places, churches, clinics - 1 outreach per week per site facilitator. 3) 1 home visit per day per mother. 4) 2 support group meetings per month (mothers and partners). Linkages Meeting the needs of growing numbers of PLWHA, their caregivers, and their family members requires the collective efforts of many facilities and organizations, both clinic- and community-based. In order to facilitate the sustainability of and continue the expansion of the program, linkages and coordination mechanisms will be strengthened at the local level. For instance, linkages with the national ARV treatment program (Masa) will be strengthened using the existing BOCAIP referral system. Clients will be also followed up by peer mothers and the site facilitators to ensure access for infected mothers and their babies to needed services.

07-P0210 Pathfinder Male focused activity.

This activity has USG Team Botswana Internal Reference Number P0210. This activity links to the following: C0907 & P0205 & P0207 & P0223 & P0226 & P0511 & PO511.

This entry represents the AB part of the program. The program's funding is split between the two program areas (AB and OP), at approximately 70% and 30%, respectively. The reason for dividing the funding is to allow the program to address the HIV prevention needs of a wider range of beneficiaries than they would with funding from only one of the prevention program areas. The program's effort will reflect the funding proportions noted here. The funding from the AB program area is intended to cover that part of the program that addresses partner reduction, faithfulness, intergenerational sex, transactional sex, gender based violence, abstinence, and the promotion of counseling and testing.

It is well established in Botswana and elsewhere in Southern Africa that men are more likely than women to engage in multiple sexual partnerships, more likely to drink and abuse alcohol, and are less likely to seek HIV-related services. For these and other reasons, in FY06, USG Botswana proposed a program to enhance programs that target adult men for HIV prevention and related issues, including gender relations, violence, and alcohol and substance abuse.

The program was recently awarded to Pathfinder. Pathfinder plans to draw on best practices in the region and elsewhere, and to build the capacity of local implementing organizations to the extent possible. In that program, Pathfinder proposes the following activities: 1) Draw on the Men as Partners program in South Africa and other successful projects to conduct interactive workshops on gender and HIV, create community role models, and produce relevant IEC materials to support these activities on a community level. The target area in year one of the program is 1 district center with 4 surrounding villages. It is hoped that 5,000 men will be reached with this activity. 2) Support peer education programs in some of the uniformed services in Botswana, whose employees are largely men and face increased risk of HIV due to their employment. The target is 4 barracks or training colleges in year one. It is hoped that at least 20 peer educators will be trained per site and this will bring their total to 80. It is also hoped that each of the 80 will reach 10 people, and the number of individuals to be reached would be 3,600. 3) Conduct peer education using the Men as Partners training materials in tertiary education settings. One technical college will be targeted in year one. Fifty peer educators will be trained and each one of them is hoped to reach at least 20 individuals. This will bring the total number of individuals reached to 1,000.

All activities will engage local CBOs, NGOs, and/or FBOs to be trained in the proposed intervention models and to carry them out. The specific local partners have not been selected, nor have the specific locations of the interventions; both will be selected soon.

07-P0511: Pathfinder: Male-targeted prevention interventions.

This activity has USG Team Botswana Internal Reference Number P0511. This activity links to the following: P0101 & P0103 & P0210 & P0503 & P0505 & P0510 & P0515.

This entry represents the OP part of the program. The program's funding is split between the two program areas (AB and OP), at approximately 70% and 30%, respectively. The reason for dividing the funding is to allow the program to address the HIV prevention needs of a wider range of beneficiaries than they would with funding from only one of the prevention program areas. The program's effort will reflect the funding proportions noted here. The funding from the Condoms and Other Prevention program area is intended to cover that part of the program that addresses correct and consistent condom use, discussions about STIs and referrals to/promotion of STI testing and treatment, as well as discussions about other HIV-related services, including ARV, PMTCT, and IPT.

It is well established in Botswana and elsewhere in Southern Africa that men are more likely than women to engage in multiple sexual partnerships, more likely to drink and abuse alcohol, and are less likely to seek HIV-related services. For these and other reasons, in FY06, USG Botswana proposed a program to enhance programs that target adult men for HIV prevention and related issues, including gender relations, violence, and alcohol and substance abuse.

The program was recently awarded to Pathfinder. Pathfinder plans to draw on best practices in the region and elsewhere, and to build the capacity of local implementing organizations to the extent possible. In that program, Pathfinder proposes the following activities: 4) Draw on the Men as Partners program in South Africa and other successful projects to conduct interactive workshops on gender and HIV, create community role models, and produce relevant IEC materials to support these activities on a community level. The target area in year one of the program is 1 district center with 4 surrounding villages. It is hoped that 5,000 men will be reached with this activity. 5) Support peer education programs in some of the uniformed services in Botswana, whose employees are largely men and face increased risk of HIV due to their employment. The target is 4 barracks or training colleges in year one. It is hoped that at least 20 peer educators will be trained per site and this will bring their total to 80. It is also hoped that each of the 80 will reach 10 people, and the number of individuals to be reached would be 3,600. 6) Conduct peer education using the Men as Partners training materials in tertiary education settings. One technical college will be targeted in year one. Fifty peer educators will be trained and each one of them is hoped to reach at least 20 individuals. This will bring the total number of individuals reached to 1,000.

All activities will engage local CBOs, NGOs, and/or FBOs to be trained in the proposed intervention models and to carry them out. The specific local partners have not been selected, nor have the specific locations of the interventions; both will be selected soon.