The United States Department of Defense HIV/AIDS Prevention Program, utilizing PEPFAR funding continues to support the Botswana Defence Force' s (BDF) efforts to prevent new HIV infections and mitigate the impact of HIV and AIDS among the BDF, their dependents, and civillian personnel. In 2009 DHAPP supported the BDF in conducting their first Seroprevalence and Behavioral Epidemiology Risk Survey(SABERS). Dissemination meetings were held and a final report was presented in early 2010.The current planning, interventions and programming are aligned with the recommendations resulting from the analysis of the survey findings. In addition to the SABERS, the BDF also undertook an in-depth study of their peer education program. In COP 12, DOD will continue to support execution of of the Botswana Defence Force's new Five-year Plan to combat HIV/AIDS within the military and will build upon the existing bilateral relationship. Programs to be supported include scaling up Safe Male Circumcision (SMC),support for training in TB Case Management and infection control, strenghthening of the laboratory capacity including laboratory accreditation. The BDF will pilot an Information System to enhance monitoring and reporting and support outpatient clinical care.

DOD/PEPFAR support for TB activities in the Botswana Defence Force has in the past been limited to support for training activities. The BDF did an assessment of their TB needs and identified several gaps causing limitations to their ability to provide effective care and treatment for those infected with TB. These include: 1) infrastructure, 2) equipment, 3) transportation, 4) human resources, and 5) training. While the needs may be great, due to limited funding, the scope of the support is reduced. To address infrastructure needs, small changes in clinic space will be made to improve infection control. DOD support will provide computers for improved monitoring of TB cases. Case management has not been as good as it might be due to a lack of transportation for monitoring of active TB cases. Funds will be used to improve staff access to TB patients including home visits. BDF will address personnel needs for TB cases. DoD will continue to support training for TB case management addressing case management, documentation, infection control, contact tracing, monitoring and evaluation, management support, and community level TB programs.COP FY2012 funding will support the BDF TB program to procure seven (7) motorcycles that will be used by service providers when conducting home visits to ensure that clients are adhering to medication. The funding will also be used to further train health care providers, especially middle and high level managers, in areas such as TB/HIV case management, documentation, infection control, contact tracing, monitoring and evaluation. The training will be conducted in collaboration with the national TB and HIV programs and will be embedded into the national training plan for TB/HIV. Each motorcycle will cost 30,000 BWP, which is approximately $4615 per motorcycle.

In the past fiscal years, PEPFAR has supported construction of prefab laboratories for three BDF camps across the country and procurement of laboratory equipment to roll out CD4 and viral load testing to more facilities. Training was also provided to the BDF laboratory staffs in quality management system, rapid HIV testing, and TB AFB microscopy. The laboratory network of the BDF is composed of about six labs. In FY 2012 one priority is to strengthen the BDF laboratory network by providing a sustainable Laboratory Information System (LIS) to all the BDF laboratories. Another priority is to develop the quality management system of the BDF laboratory network using the training package developed by the Centers for Disease Control and Prevention referred to as Strengthening Laboratory Management Towards Accreditation . The ultimate goal is to enroll these laboratories in the WHO stepwise accreditation process. FY 2012 funds will also be used to strengthen equipment maintenance and calibration capacity in the BDF laboratories. An additional focus for PEPFAR will be to provide technical assistance to develop and strengthen the Sir Seretse Khama Barracks to carry out disease surveillance for HIV, TB, and sexually transmitted infections.

DOD/PEPFAR support for SI activities in the BDF has provided tangible results for the BDF including their first HIV Seroprevalence and Behavioral Epidemiology Risk Survey (SABERS), an evaluation of the effect of camouflage graphics packaging on condom use, and a review of their prevention program monitoring. The BDF is requesting support to conduct a follow-up survey to the 2009 SABERS that will also be the baseline for a BDF cohort study. The cohort study will also support the the 2012 BAIS IV survey through the serial collection of blood samples for incidence calibration and provide data to evaluate the impact of the BDF prevention program including MC. HMIS will be supported through the electronic MC monitoring tools. DOD will partner with the BDF to build off of the MC electronic tools platform and adapt and existing electronic medical record system to provide electronic medical records for the outpatient clinics.

Botswana Defence Force has embraced the national initiative to roll out the safe male circumcision campaign in all BDF camps. This force wide campaign is aimed at providing the services to uniformed members of the BDF, civilian employees, spouses, and dependents. The services will also be extended to member organizations of the National Men Sector Committee such as the Police Service and Department of Prisons and Rehabilitation Services. Targeting members of the BDF is therefore, ideal for reaching large numbers of HIV negative sexually active men as part of the broader intergration into existing military HIV prevention program. Safe Male Circumcision education will also be offered to recruits in their training settings so they might be circumcised upon completion of their training.The goal is to provide Male Circumcision services to members of the BDF and member organisations of the National Men Sector aged 15-49 eligible men. This goal will be met through careful planning with the BDF Male Circumcision Coordinator, Commanding Officers, and Coordinator of the National Men Sector Committee. An outreach calender will be scheduled to address operational units through drama groups, SMC peer educators, and nurses providing Male Circumcision specific education and HIV counselors/testers. Clients in need of the circumcision will be actively scheduled to acccomplish this important goal. HIV Counselor/Testers will be trained to provide Safe Male Circumcision counseling and they will also conduct outreach for mobilisation campaigns. Funds will be used to provide technical assistance from US DOD personnel and procure commodities and equipment as needed.