08.C0612: Tebolopele - Prevention With Positives

Tebelopele engaged the District Multisectoral AIDS Committees (DMSACs) in building strong referral

linkages at all their center locations in the country. They continued use of the referral form, track of referrals,

and hold regular referral network meetings with service providers in each district. Screening of all clients for

TB using a questionnaire was introduced in 2007. Any clients reporting any of the TB symptoms were

referred to government clinics for evaluation. In addition, post-test clubs and supportive counseling were

introduced.

FY08 plans:

Referrals and linkages will be augmented by using Post-Test Clubs and the Youth Against Aids (YAA)

Volunteers to track clients tested at Tebelopele and referred for services. Tebelopele will work with HPP to

create community-based referral linkages, and to continue the involvement of traditional and spiritual

healers in prevention and referrals. Pregnant women will be referred to the Cervical Cancer Unit and to the

PMTCT program.

The Tebelopele VCT centers will continue to role out the Supportive Counseling program initiated in

FY2007, by providing Post Test and Supportive Counseling Services to those who test negative and

positive, both at Tebelopele VCT sites, as well as Provider Initiated Sites. Tebelopele now provides

supportive counseling at its fixed sites, with a package of services that includes TB suspect screening,

testing of family members, disclosure, discordant couples, education and prevention for positives.

To strengthen capacity and improve quality of services, Tebelopele will train its counselors and VCT site

managers in various aspects of Supportive Counseling, and in particular couples counseling.

08.C0901 Tebelopele - VCT Network

2007 Accomplishments

In January 2007, Tebelopele transitioned from a completely anonymous to confidential VCT services

delivery, with an option for anonymous services, for those who preferred it. By time of writing this COP, 75%

of clients were receiving confidential services. In 2006, Tebelopele counseled and tested 110,000 clients

(73% of whom were first-time testers) through 31 service delivery outlets. This number is expected to

increase by at least 12% in 2007. The GOB provided rapid HIV test kits and supplies including condoms.

Tebelopele used USG funds to procure back up stock of test kits to assure a steady supply.

Tebelopele engaged the District Multisectoral AIDS Committees (DMSACs) in building strong referral

linkages at all their center locations in the country. They continued use of the referral form, tracking of

referrals, and holding regular referral network meetings with service providers in each district. Screening of

all clients for TB using a questionnaire was introduced in 2007. Any clients reporting any of the TB

symptoms were referred to government clinics for evaluation. In addition, post-test clubs and supportive

counseling was introduced. CD4 cell counting at the VCT centers was not approved by GOB, and therefore

not implemented.

Community mobilization and social marketing continued in partnership with community based organizations

like Humana People to People (HPP) and BOCAIP, and through print and electronic media. Specific

campaigns targeting men were implemented, like the Zebras for Life, Test for Life. In this campaign,

Tebelopele worked with the Peace Corp Volunteers in various communities to mobilize people, especially

men, for testing.

From 2004 through 2007, Academy for Educational Development (AED) worked to build Tebelopele's

capacity to run as an independent NGO. Tebelopele is now able to also build the capacity of smaller NGOs

and CBOs. In 2007, Tebelopele worked with HPP and BOCAIP, providing support in M&E, reporting and

financial management.

With technical assistance from AED, Tebelopele established a sustainable organization from a systems and

procedures standpoint. Becoming a financially sustainable organization is an ongoing priority for

Tebelopele. In FY 2007, a Sustainability Plan was developed, focusing on: GOB to supply test kits and

supplies; creation of a counselor training unit for capacity building and for income generation; partnership

with private companies e.g. Medical Rescue International to support with some resources; increased use of

volunteers; fund raising; exploring fee for service, e.g. charging private companies for workplace VCT;

soliciting funds from other donors - an award of $600,000 was received from African Comprehensive

HIV/AIDS Partnership (ACHAP) (Gates Foundation, Merck and GOB Partnership).

To improve data quality, the use of electronic data capturing technology (Personal Digital Assistant - PDA)

was introduced. This has improved the timeliness and accuracy of VCT data and reporting.

Plans for 2008

Tebelopele will continue to provide high quality confidential and anonymous VCT services with same-visit

results, through 31 service outlets throughout Botswana. This activity will support 220 locally employed

staff including 104 HIV/AIDS counselors, other technical staff like lab technicians, community outreach

technicians and management staff who are responsible for providing VCT services on a daily basis. In

addition to its 31 directly managed sites, Tebelopele will support 32 additional civil society sites to provide

VCT services through training, mentoring and development of VCT service delivery systems. By building

the capacity of community-based organizations, it is expected that testing numbers will increase by 20%,

from 125,000 in 2007 to 150,000 clients (75% of whom will be first time testers).

Referrals and linkages will be augmented by using Post-Test Clubs and the Youth Against Aids (YAA)

Volunteers to track clients tested at Tebelopele and referred for services. Tebelopele will work with HPP to

create community-based referral linkages, and to continue the involvement of traditional and spiritual

healers in prevention and referrals. Pregnant women will be referred to the Cervical Cancer Unit and to the

PMTCT program.

PEPFAR funds are also requested to support the hiring of additional 40 lay counselors to enhance outreach

to specific target groups such as men, CSW, clients of CSWs, truck drivers, women and girls in cross

generational/transactional sex, through "mobile moonlight" VCT services. Tebelopele also plans to reach

more youth by advocating for the reduction of the age of consent for testing from 21 to 16 years, and by

youth outreach activities in schools and other locations. Through promotional events, such as Valentine's

month of Love in February, couples counseling and testing will be scaled up. The strategy of addressing

couples at the District Commissioner's office as they wait for the marriage ceremony was found to be

successful, and will be scaled up in 2008.

To promote and sustain a high demand for services, The Dialogue Group, Tebelopele's advertising agency,

will continue with the print and outdoor media production and placement, and the design and production of

all Tebelopele VCT information, education and communication (IEC) materials.

Funds are also requested for Tebelopele's continued collaboration with AED: strengthening utilization of

data and technology for more effective VCT services. In many activities Tebelopele is breaking new ground,

a factor that has not been documented for best practice or lessons learned in leading journals; supporting

new and expanded approaches to VCT. AED will work with Tebelopele and HPP to develop and implement

an effective strategy to provide VCT for CSWs and truck drivers in selected "high-risk locations". This

activity will be further supported by the HHS/CDC/BOTUSA BCC/prevention section, to augment

mobilization, prevention messages, and C&T outreach to these groups. Approaches will include cost-

effective, door-to-door VCT; providing technical assistance (TA) to Tebelopele as it develops its supportive

counseling service; mentoring Tebelopele in its expansion of NGO service provision; and ongoing support

for sustainability of Tebelopele in the areas of Board Governance, diversification of services and funding

sources, a Fee-For-Service, and establishing a clear memorandum of understanding (MOU) with GOB for

supplies from CMS.

Activity Narrative: 08.C0901 Tebelopele - VCT Network