A new mechanism in 2010, was TBD (mech 11088) in the 09 COP, split between AED and Pathfinder in Aug 09 reprogramming.

Goals and Objectives

- To increase from 25% to 30% the access rates to care programs for women and infants with AIDS-defining conditions

- To increase from 75% to 80% ART adherence rates for women and their infants identified in prevention of mother to child transmission of HIV (PMTCT) clinics

- To increase by 1,000 the number of HIV-positive pregnant mothers provided with psychosocial support and empowerment counseling

- To increase by 1,500 the number of male partners enrolled and active in PMTCT and other HIV-prevention programs

- To maintain at 52 the number of peer males trained to provide outreach in the target communities

- To expand the target intervention to groups of men of 500 or larger at two new sites

- To increase the number of door-to-door community activities to 32 villages in eight districts

Major Activities

AED and the Botswana Christian AIDS Intervention Program (BOCAIP) will build on the successful peer PMTCT program.

AED will use a three-pronged approach to address individual, contextual, and cultural factors to reduce mother-to-child transmission. This will include:

- Interpersonal/individual interventions delivered in clinics and communities

- Facility and health-systems strengthening

- Monitoring and evaluation (M&E) systems for evidence-based decision-making. AED will continue to make the community an extension of facility services for a seamless continuum of recruitment, care, and follow-up

Target Population

All newly identified HIV-positive mothers and pregnant women receiving antenatal care (ANC) services

Those mothers who have not yet been tested, or are eligible for and are not receiving, ARV prophylaxis

HIV-exposed infants up to the age of 18 months who need ARV prophylaxis or treatment

Men targeted by peer males

All partners of HIV-positive pregnant women, their adult male family members

Men in workplaces and elsewhere in the community

Geographic Coverage

52 health facilities and their catchment areas in nine districts: South East, Lobatse, Maun, Mahalapye, Kgalagadi South, Tutume, Masunga, Selebi-Phikwe and Bobirwa

Supporting Health Goals and Health System Strengthening

This program will support overstretched health-facility personnel in PMTCT case-management.

Peer volunteers will work closely with health workers to ensure that clients receive the appropriate combination of psychosocial support, community follow-up, and clinical interventions.

Staff will contribute to strengthened recording and reporting systems to improve the ability of healthcare providers to identify and manage priorities.

Wraparound issues of family planning, safe motherhood and child survival are integrated into this peer PMTCT program. Peer mothers counsel pregnant women and mothers on family planning, assist with birth planning, follow up on ANC and post-natal visits, and provide information to the mothers on safe infant feeding, early infant care, early infant diagnosis of HIV, and care for HIV-exposed babies.

Making the Most of Other HIV Resources

AED will implement strategies that leverage resources and make the project more cost-efficient and effective. This will include co-locating project staff within BOCAIP's existing offices, coordinating with other data-collection efforts and making use of existing data, task shifting, and making use of vehicles and buildings BOCAIP has received through donations.

AED will collaborate with Pathfinder International to share tools, approaches, and lessons learned to achieve synergy and optimize the use of resources.

Cross-Cutting Areas

AED and BOCAIP will conduct refresher training for all peer volunteers, as well as the district supervisors, thereby strengthening human resources for health, a PEPFAR cross-cutting issue.

Peer males will identify and reach out to men, including partners, fathers, grandparents, and traditional leaders. They will educate and recruit male partners of pregnant women to participate in the PMTCT process by conducting individual counseling, facilitating support groups, and conducting community discussions aimed at mobilizing men for HIV prevention and PMTCT support.

Monitoring and Evaluation

This project relies primarily on routine service statistics collected by peer volunteers capturing their daily interactions with clients. There are separate registers for women, men, babies born to HIV-positive women, and for health talks. On a monthly basis, these registers are summarized to generate the indicators required by CDC.

Monthly and semiannual supervision is conducted of each peer volunteer by district supervisors using a checklist to monitor program quality and provide feedback.

AED will conduct routine data quality investigations at each site to validate results and provide targeted assistance as needed.

Continual feedback will be sought from project beneficiaries and stakeholders to fine-tune the program. Key performance indicators will be analyzed to identify issues and monitor performance.

10.P.OP22: AED - Expansion of Counseling and Psy/Soc. Support - 300,000.00

In Year 2 of the program, AED and BOCAIP will continue to work with 52 trained peer males to target partners of HIV-positive pregnant women, their adult male family members, men in workplaces and the community to support women through the PMTCT process. These activities will take place in nine districts and 52 health facilities. AED will conduct a refresher training for all peer volunteers and district supervisors, and provide supportive supervision through site visits. AED will develop materials and job aids for peer volunteers to standardize consistent and quality messages. Interpersonal interventions will reach both men and women with information, support, and encouragement to practice healthy behaviors. Peer males will increase the involvement of male partners at clinics, with traditional leaders, in workplaces, homes and in the community. Peer males will also encourage men to accompany women to PMTCT services, receive couples counseling and testing, support mother and baby access to ARV services, and practice safe infant feeding. These interactions will lead to an increase in the uptake of testing among partners of pregnant women, reaching at least 20% of these men, and will be an important forum for HIV prevention education. Issues such as multiple concurrent partnerships, male circumcision, and alcohol use and HIV will be addressed. Prevention efforts will be bolstered by the development of male-focused materials and messages, and new initiatives such as football tournaments, script development for radio campaigns, or improved use of technology including cell phones to strengthen PMTCT. For all peer volunteers, the program will support opportunities for learning, skills-based achievement, and activities aimed at preventing burnout.

10.P.PM10: AED - Expansion of Counseling and Psy/Soc. Support - 612,500.00

In the second year of the program, AED and BOCAIP will continue to target newly identified HIV-positive pregnant women, women in the community yet to be tested, pregnant women who are eligible for and not receiving ARV prophylaxis or HAART, and HIV-positive mothers who have recently delivered, along with their HIV-exposed infants under 18 months of age through 52 trained peer mothers. These activities will take place in 52 health facilities in nine districts. AED will conduct a refresher training for all peer volunteers and district supervisors, and provide supportive supervision through site visits. AED will develop materials and job aids for peer volunteers to standardize and ensure quality messages. The peer volunteers will work closely with health workers to ensure that clients receive the appropriate combination of psychosocial support, community follow-up, and clinical interventions. Interpersonal interventions will reach women with information, support, and encouragement to practice healthy behaviors. Peer mothers will work to ensure that HIV-positive pregnant women access and adhere to ART or ARV prophylaxis, practice safe infant feeding, ensure that HIV-exposed babies are tested, are started on Cotrimoxazole prophylaxis and are put on HIV treatment, if required. Peer volunteers will work with mothers and their support systems to foster supportive attitudes and an environment for healthy behaviors and practices. For first-time antenatal clients, this project will implement a "buddy" system to help clients understand PMTCT interventions, feel supported, ask questions, express concerns, and be tracked for follow-up. Peer mothers will complement their clinic-based activities by conducting home visits to support ARV/ART adherence, promoting couples counseling and testing, supporting newborn access to ARV services and safe infant feeding practices. These interactions will be an important forum for HIV prevention education. Prevention efforts will be bolstered by the development of new initiatives such as improved use of technology including cell phones to strengthen PMTCT. For all peer volunteers, the program will support opportunities for learning and skills-based achievement.