07-C0616: Tebelopele.

This activity has USG Team Botswana Internal Reference Number C0616. This activity links to the following: C0609 & C0613 & C0901 & C0911 & P0513 & T1120.

Learning that one is HIV infected is the beginning of one's need for palliative care. CD4 cell counting is a post-test service that would not only facilitate timely, effective referral of sero-positive clients for treatment, but would also strengthen risk reduction counseling for HIV-infected clients. Making CD4 cell count more accessible for HIV infected clients, will make it possible to link ongoing supportive counseling with other support services, including nutrition interventions, family planning, screening for TB and other OIs, and other services in order to help these clients stay healthier longer before they qualify to enroll in ARV therapy. For those who need to be enrolled immediately on ARV treatment, this service will expedite the process of their enrollment. The CD4 screening processes are: ?Obtaining blood samples from clients ?Forwarding specimens to government laboratories for CD4 testing ?Interpreting clients' CD4 results ?Monitoring/supporting clients and/or refer appropriately to treatment centers

An extensive consultative process with MOH, MLG, and other key stakeholders will precede this proposed activity in order to obtain buy-in, guidance, and support for CD4 screening at Tebelopele voluntary counseling and testing (VCT) centers.

In FY07, Tebelobele will move from anonymous testing to confidential testing which will make referrals and follow up logistically easier

Assessment for CD4 cell count screening and piloting Tebelopele will pilot CD4 cell count screening in two centers in Gaborone and Selebi Phikwe. The rationale for selecting these locations is based on target population, space availability, and staff capacity. The factors considered include ?High HIV prevalence (BIAS II Survey 2004) ?Number of clients served per month ?Human resource capacity; both centers have two nurse counselors who could assist with phlebotomy ?Proximity to government hospitals for collaborative support and referrals Tebelopele will not perform CD4 test on site but monitor CD4 test results which would be received from government laboratories performing the test and will refer patients accordingly to treatment centers.

Target group The target population for the project is 100% of the clients who test HIV positive at the Tebelopele centers. However, provisions have been made for the likely client referrals from other service providers. A total of 7,360 clients are targeted through this intervention, including 5,520 Tebelopele VCT clients and 1,840 expected client referrals from other service providers.

Staff Requirements Six new positions for the project will include a data entry clerk, and a program coordinator. In addition, 24 existing Tebelopele VCT staff will support the project.. All necessary related staff training for CD4 screening (phlebotomy and interpretation of results) will be arranged. The MOH will be approached to assist in this training through the KITSO training program.

Space Space is available at both locations.

Referrals based on CD4 results The main referral linkages for the clients will include: ?National MOH Masa ARV treatment program ?Private practitioners/physicians ?PMTCT program ?Ongoing risk-reduction supportive counseling

The referrals will be facilitated using a comprehensive confidential referral form.

M&E ?All standard operating procedures will be in line with those of the MOH ?M&E staff at Tebelopele will review and revise data collection, recording and analysis systems and forms to include and utilize CD 4 screening data. These new data can then be used to inform program development.

Rollout Plan Feb. 07- March 07 ?Extensive consultation with relevant health authorities ?CD4 screening capacity assessment. o Manpower and skills requirements o Establishment of specific training needs/requirements and preparatory ground work through enquiries and general information gathering o Development of a project component of social marketing and PR strategy

April '07 - June '07 ?Recruitment and capacity building for the project ?Capacity building training o Scheduling and attendance ?Stakeholder briefings and consultations ?Sensitization of the public ?Development and production of IEC materials

July '07 - Dec '07 Conduct the six month pilot. It is expected that regular briefings with Tebelopele VCT and the MOH will be held as part of project monitoring to ensure that any incidents that may arise are addressed as early as possible.

Jan '08 - March '08 ?Evaluation of the pilot project to provide information regarding any actions that need to be taken to ensure that the scaling up of the program to other eligible Tebelopele VCT centers is done smoothly and efficiently. ?Preparations for roll out to other eligible centers oIncorporation of pilot evaluation recommendations oStakeholder consultations and briefings oAssessment of ear-marked centers oCapacity building for CD4 result monitoring oProject proposal with work plan and budget oImplementation

Prevention for Positives One component of the Tebelopele VCT program is to provide ongoing supportive risk reduction counseling for those who test positive but who do not qualify for treatment yet. This intervention covers: ?CD4 monitoring per Masa ART guidelines ?Client referrals for treatment ?Referrals to support groups and other supportive services ?Counseling for HIV infected clients, including the HIV negative partners in relationships with discordant HIV test results ?Personal HIV management and positive living

Systems Systems and procedures will be developed in line with MOH policies and guidelines. These include a record - keeping system and client tracking /follow-up system and procedures.

Social Marketing & PR Component IEC materials will be developed to introduce and explain the services, to communicate the benefits of the services, and the kind of referrals that come with the services. This activity includes content development and materials development and production

07-C0901-GHAI Tebelopele VCT Centers.

This activity has USG Team Botswana Internal Reference Number C0901. This activity links to the following: C0616 & C0809 & C0810 & C0815 & P0101 & P0103 & P0202 & P0205 & P0218 & T1201. Also links to a number of Counseling and Testing programs or activities (C0902 to C0912).

Tebelopele VCT centers have increased the numbers of people tested and counseled from 89,000 in 2005 to over 100,000 in 2006. Their goal is to counsel and test 125,000 (75% of whom will be first-time testers) in 2007. Tebelopele will continue to provide high quality-VCT services through 35 service outlets throughout Botswana. This activity will increase the organization capacity and support 133 locally employed full time staff and a pool of 20 part-time counseling staff.

The staff will include 62 full time counselors, 20 part-time counselors, and other technical staff like lab technicians, scientific officers, nurses, community outreach technicians and management staff who are responsible for providing VCT services through a network of 16 freestanding centers, 15 satellite sites and 4 mobile caravans located throughout the country. These staff will also provide an array of post-test services to clients testing HIV positive and HIV negative, including on-going prevention counseling to discordant couples and other clients, youth prevention education, and referral services to other care and prevention programs throughout Botswana.

Strengthening Referral Linkages During FY06 Tebelopele VCT introduced a "stubbed" referral form as a means to track client referrals for treatment and other care and support services. During FY06 Tebelopele VCT will evaluate the effectiveness of the "stub-based" referral tracking system and will work with NACA, MOH, MLG and other partners to formalize referral networks. In order to track client referrals and implement post-test services, Tebelopele is undertaking transition from anonymous to confidential VCT delivery during FY07. Tebelopele VCT will also conduct a study tour to Kenya and Uganda with the MOH and BOCAIP to learn from these countries' transition from anonymous to confidential services. The American International Health Alliance Twinning Center will facilitate the twinning activity. The twinning process will be with 2 Kenyan and Ugandan organizations that have excelled in the areas of confidential post-test services, youth-friendly prevention education and counseling services, and CD4 cell screening.

Post Test Services Post-test activities will be scaled up to improve prevention and care both for positive and for negative VCT clients. Tebelopele VCT will focus their post-test services efforts on the following areas: ?Ongoing risk reduction counseling for those who test positive and negative, as well as for discordant couples. ?Partner counseling and testing. ?CD4 cell measurement, as a important component of Tebelopele's planned post-test services package. ?Referral to post-test services as needed.

Youth Prevention HIV Education and Counseling Services In FY06 Tebelopele piloted in-school interactive "edutainment" activities. These were the pillar of mobilization activities for a comprehensive Youth Against AIDS (YAA) life skills program. Post-pilot evaluation was carried out to inform the subsequent larger rollout of the program. The focus of the youth program is to provide youth (both in-school and out) with prevention education, and counseling and testing for those whose guardians/parents consent for them to test.

Tebelopele VCT works with the Ministry of Education (MOE), schools/institutions, FBOs, Community Based Organizations (CBOs) and NGOs including BOCAIP, Hope Worldwide (HWW) Botswana, YWCA, Childline Botswana, Lifeline Botswana, Food Safe International, Botswana Baylor Children's Clinical Centre of Excellence and others to implement a comprehensive program. Other special partnerships include the business sector, which has sponsored a number of activities/events. In FY07 Tebelopele will strengthen and expand this program through youth-friendly centers (porta-campers at stand alone centers or at

other youth-friendly locations). Lessons learned from the planned study tour in Uganda and Kenya will assist in improving program implementation.

Social Marketing To increase demand for and utilization of VCT, Tebelopele will strengthen social marketing activities through community-based events/activities organized and implemented in collaboration with local District Multi-sectoral AIDS Committees (DMSACs), Peace Corp Volunteers (PCVs), Humana People to People, community leaders and other stakeholders including out-of-school-youth groups. Community mobilization and education will be continued in collaboration with the above stakeholders. It is expected that 125,000 clients will receive VCT through these sites in FY07. Social marketing campaigns like "Put your Love to the Test", "Passport to Life" and "Test for Life" will be supported and scaled up. Populations to be targeted include couples, rural men and youth.

Sustainability Plan Tebelopele VCT will continue to implement the sustainability strategy that was developed with the assistance of AED during FY06. The key elements of this strategy are the diversification of funding sources and the diversification of services offered. An operational plan and budget which is consistent with the Tebelopele strategy will be developed. Tebelopele then plans to hold a donor meeting to present their plan and budget to potential donors.

The work of Tebelopele is consistent with the goals of the Botswana NSF and of the EP. The NSF calls for 95% of the population to know their HIV status by 2009. The work of Tebelopele will contribute to reduction of stigma and discrimination associated with HIV/AIDS. Furthermore, Tebelopele's advocacy will contribute to reduction of the legal age of consent for HIV testing from 21 to 16. Finally, in reaching out to remote areas and in collaborations with key players like the Mens Sector (Botswana Defense Forces and Botswana Prisons) and the Peace Corps, Tebelopele's activities will reduce the gender inequalities in HIV testing.

Sub partner activities Institute for Development Management (IDM) Since Tebelopele became an independent NGO in 2004, the collaboration with IDM has continued through sub-contracting with IDM to provide on-going training of and mentoring of counselors. During FY07, Tebelopele will subcontract with IDM to train Tebelopele staff in basic counseling and in the VCT protocol for same-day results.

In order to maintain high-quality service provision, Tebelopele VCT will continue to train all new VCT counselors on HCT as per the international standards that have been adopted by the MOH in Botswana. The IDM is the only accredited training institution for VCT protocol and HIV voluntary counseling and testing in the country. During FY07 funding period IDM will provide training to 18 VCT counselors (2 groups of 9) in HCT and to 14 VCT counselors (2 groups of 7) in VCT protocols.

Dialogue Group The Dialogue Group is Tebelopele's advertising agency. The Dialogue Group provides specialized design and production of Information Education and Communication (IEC) materials and media placement.

Tebelopele believes that collaboration with the Dialogue Group is a cost-effective solution to its IEC/advertising needs. As an advertising agency, the Dialogue Group takes advantage of economies of scale, and is given preferential rates for media placement and production due to the large volumes of space and production they undertake as an agency.

During FY07 The Dialogue Group will do the following as part of Tebelopele VCT social marketing strategy implementation: ?Broadcast media production and placement ?Print media production and placement ?Outdoor media production and placement ?Design and production of all Tebelopele VCT IEC materials