08.P0103 Pathfinder International - Psychosocial PMTCT support

2007 Accomplishments

The Pathfinder PMTCT activity provides: 1) peer counseling for women attending antenatal clinics and 2)

peer counseling by people living with HIV/AIDS (PLWHAs), including HIV-infected women from the PMTCT

program, for ART adherence. A mid-term review illustrated the programs' positive results in reaching

women and men in both clinic-based and community-based settings. To date the peer mothers counseling

project works at 14 antenatal clinics in four districts. The program increased counseling coverage in

targeted areas and the quality of services improved against standards. During the mid-term review both the

clients as well as the public sector providers indicated that the counseling services are valued by the sites.

To ensure linkages between different health facilities in the provision of ART, Botswana uses a site model,

which consists of a hospital (Infectious Disease Care Centers or IDCC) with 2 to 4 satellite clinics. The

adherence counseling program works currently in 8 IDCCs and 19 satellite clinics. 48 counselors and health

care workers (2 new adherence counselors, 20 lay counselors and 2 nurses) completed a 7-day adherence

counseling workshop. This brought totals to 73 adherence counselors and 22 master trainers receiving this

training to date.

2008 Plans

Minor changes based on the 2007 mid-term evaluation include expansion of the program into three new

sites (Serowe, Palapye and Maun. Refresher and new training courses for peer mothers will emphasize

program needs: 1) Encouraging peer mothers to take a greater role in helping women to get CD4 counts

done, attend ART evaluation clinics and enroll in ART in a timely manner; and 2) Providing information

about the choice between breastfeeding and formula feeding in accordance with the WHO IYCF curriculum

in use nationwide to retrain health workers in infant feeding. Pathfinder senior staff will attend the IYCF

course and produce training materials appropriate for peer mothers in consultation with MOH. Peer mothers

will continue to conduct home visits to follow-up clients after on-site counseling at the centre. The home

visits target infected mothers, their partners and families to discuss any issues of concern including stigma

reduction and PMTCT services. The need for HIV testing, CD4 testing and ARV clinic attendance for all

family members is part of these visits. Peer counselors in both programs will continue to establish support

groups and conduct community mobilization activities.

Capacity building in financial management, monitoring & evaluation, strategic planning and management

will continue at all sites. Site facilitators, counselor supervisors, peer mothers/ adherence counselors and

Ministry of Local Government (MLG) staff will receive in-service education. All previously graduated

mothers are eligible to attend a two week long entrepreneurial skills workshops in collaboration with MLG's

department of social services to equip the women with livelihood skills.

Weaknesses identified during the interim evaluation, including quality of recordkeeping at site level, will be

rectified. The US Centers for Disease Control and Prevention (CDC) field operation (BOTUSA) and MOH

will collaborate to examine PMTCT key indicators in program sites and compare them to non-program sites,

and to compare PMTCT indicators in new sites before and after implementation to estimate the impact of

the program. A final program evaluation is planned.

08.P0207 Pathfinder - Male focused interventions

This activity targets adult men (over age 25) for one-to-one peer education, based on a personal risk

assessment. Three local implementing partners carry out this activity through visits to households,

employment sites, and recreational clubs such as local football teams. The intervention is focused on

promoting partner reduction, correct and consistent condom use, and more equitable gender attitudes.

In 2007, Pathfinder selected implementing partners through a competitive process, worked with those

partners to develop work plans and contracts, liaised with relevant GOB partners in the target districts and

nationally to lay a stronger base of support for the project, developed project monitoring tools, held 3 work

shops with the implementing partners, and developed a comprehensive outreach manual that will guide the

intervention. The implementing partners selected additional staff and peer educators and participated in a

training of trainers (TOT) in the manual. As of September 2007, Pathfinder and its implementing partners

will have trained a large cadre of male peer educators, who will begin conducting outreach in the target

communities.

The risk assessments cover a range of critical issues including number of sexual partners, consistent and

correct use of condoms, alcohol misuse and risks associated with it, gender relations, HIV-related drug

adherence (ART, isoniazide preventive therapy [IPT]), and counseling and testing. We expect each

individual reached to have about 2 or more visits by a peer educator, for one-on-one discussion on the

above listed issues with emphasis on those raised in the personal assessment. The materials will include

specific information and support for men who are HIV positive. Referrals will be made to available services

such as HIV counseling and testing, Alcoholics Anonymous, and PMTCT. Clients who have been exposed

to key topics identified in their personal risk assessment will graduate and be invited to join a male support

group for continued education and motivation. These groups will be formed by Pathfinder implementing

partners in areas where they operate. The groups will have regular meetings at which members will give

each other support to maintain whatever positive change they will have achieved. Occasionally, presenters

will be invited to give talks on topics of interest to the groups. Opinion leaders like politicians, traditional

leaders and PLWHA who have gone public with their HIV status will also be invited occasionally to motivate

the men.

Humana will continue to implement the intervention by going door-to-door in select communities. Humana

will conduct group sessions focused on gender equity and will train men who hold influential positions like

corporate leaders, traditional leaders and politicians as advocates for male involvement in HIV prevention

programmes. The above activities will be implemented in eight villages in the two districts where Humana

operates.

True Men will continue to work in the Francistown area to target this intervention to miners from the two

area gold mines as well as social soccer teams and their supporters. The programme will expand to two

new sites in 2008.

Botswana Council of Churches (BCC) will implement the program in three districts, targeting male staff in 4

mission schools run by churches which are BCC members. The programme extends beyond schools to

communities around the schools.

In support of these activities and partners, Pathfinder will continue to support training in peer education and

outreach, including refresher trainings, to all relevant field officers. Pathfinder also will continue to

strengthen local implementing partners' operational systems and structures and will provide technical

support for their programme activities.

New for 2008, the program will forge stronger partnerships with health and other facilities that offer

counseling and testing for HIV so that people who test HIV positive at these facilities and other PLWHAs

who access services at these facilities are referred to the program for peer support in one-on-one and group

settings. This will entail sensitizing service providers about the program and its activities and establishment

of a referral network either from the program to the facilities or the reverse. The outreach and peer

materials will be adapted to better meet the needs of HIV positive men.

This activity is funded about 66% from the AB area, and 33% from the C/OP program area. The content of

the intervention is comprehensive in scope to meet the needs of sexually active adult men, including a

strong emphasis on multiple partnerships and fidelity, as well as gender equity, and important components

on alcohol abuse and condom use.

08.P0507 Pathfinder - Male focused prevention

This activity targets adult men (over age 25) for one-to-one peer education, based on a personal risk

assessment. Three local implementing partners carry out this activity through visits to households,

employment sites, and recreational clubs such as local football teams. The intervention is focused on

promoting partner reduction, correct and consistent condom use, and more equitable gender attitudes.

In 2007, Pathfinder selected implementing partners through a competitive process, worked with those

partners to develop work plans and contracts, liaised with relevant GOB partners in the target districts and

nationally to lay a stronger base of support for the project, developed project monitoring tools, held 3 work

shops with the implementing partners, and developed a comprehensive outreach manual that will guide the

intervention. The implementing partners selected additional staff and peer educators and participated in a

training of trainers (TOT) in the manual. As of September 2007, Pathfinder and its implementing partners

will have trained a large cadre of male peer educators, who will begin conducting outreach in the target

communities.

The risk assessments cover a range of critical issues including number of sexual partners, consistent and

correct use of condoms, alcohol misuse and risks associated with it, gender relations, HIV-related drug

adherence (ART, isoniazide preventive therapy [IPT]), and counseling and testing. We expect each

individual reached to have about 2 or more visits by a peer educator, for one-on-one discussion on the

above listed issues with emphasis on those raised in the personal assessment. The materials will include

specific information and support for men who are HIV positive. Referrals will be made to available services

such as HIV counseling and testing, Alcoholics Anonymous, and PMTCT. Clients who have been exposed

to key topics identified in their personal risk assessment will graduate and be invited to join a male support

group for continued education and motivation. These groups will be formed by Pathfinder implementing

partners in areas where they operate. The groups will have regular meetings at which members will give

each other support to maintain whatever positive change they will have achieved. Occasionally, presenters

will be invited to give talks on topics of interest to the groups. Opinion leaders like politicians, traditional

leaders and PLWHA who have gone public with their HIV status will also be invited occasionally to motivate

the men.

Humana will continue to implement the intervention by going door-to-door in select communities. Humana

will conduct group sessions focused on gender equity and will train men who hold influential positions like

corporate leaders, traditional leaders and politicians as advocates for male involvement in HIV prevention

programmes. The above activities will be implemented in eight villages in the two districts where Humana

operates.

True Men will continue to work in the Francistown area to target this intervention to miners from the two gold

mines as well as social soccer teams and their supporters. The programme will expand to two new sites in

2008.

Botswana Council of Churches (BCC) will implement the program in three districts, targeting male staff in 4

mission schools run by churches which are BCC members. The programme extends beyond schools to

communities around the schools.

In support of these activities and partners, Pathfinder will continue to support training in peer education and

outreach, including refresher trainings, to all relevant field officers. Pathfinder also will continue to

strengthen local implementing partners' operational systems and structures and will provide technical

support for their program activities.

New for 2008, the program will forge stronger partnerships with health and other facilities that offer

counseling and testing for HIV so that people who test HIV positive at these facilities and other PLWHA who

access services at these facilities are referred to the program for peer support in one-on-one and group

settings. This will entail sensitizing service providers about the program and its activities and establishment

of a referral network either from the program to the facilities or the reverse. The outreach and peer

materials will be adapted to better meet the needs of HIV positive men.

This activity is funded about 66% from the AB program area, and 33% from the C/OP program area. The

content of the intervention is comprehensive in scope to meet the needs of sexually active adult men,

including a strong emphasis on multiple partnerships and fidelity, as well as gender equity, and important

components on alcohol abuse and condom use.