In collaboration with Government of Botswana (GOB), Tebelopele VCT Centers (TVCT) works to increase access to and utilization of high quality, integrated confidential Voluntary Counseling and Testing (VCT) & Provider- Initiated Testing and Counseling (PITC) services throughout Botswana.

TVCT services will reach men, women, youth and couples with increased efforts to reach under serviced groups like men and people in rural areas. To reduce the cost of outreach services, TVCT will identify and build capacity of local Civil Society Organizations (CSO) to provide services in remote areas. To leverage resources, TVCT will collaborate with Population Services (PSI) Botswana, CSO and GOB to strengthen linkages with Safe Male Circumcision (SMC). Innovative methods, including piloting point-of-care CD4 cell counting and use of cell phone technology will be evaluated and implemented to enhance post-test services and strengthen client referral. To complement GOBs Routine HIV Testing (RHT) program, TCVT will work with the Ministry of Health (MOH) and PEPFAR supported SMC partners to enhance counseling and testing in public health facilities in four to eight dedicated SMC sites. TVCT will further augment services by integrating psychosocial support, TB screening, risk reduction counseling, and support for disclosure to promote positive health, dignity and prevention.

TVCT will provide mentoring support to counselors and participate in MOHs quality assurance activities for rapid HIV testing. TVCTs Monitoring and Evaluation (M&E) system will be reviewed to enhance tracking of clients and integration of new services. To enhance sustainability beyond PEPFAR, TVCT will work to expand its donor base through actively engaging GOB and other potential donors.

With PEPFAR Botswana support, the Government of Botswana has developed the Positive Health Dignity and Prevention (PHDP) strategic plan (20092016) to harmonize and integrate the many prevention approaches in existing prevention, treatment, care, and support services in the country. A National PHDP Implementation Plan (2010 2016) was also developed to effectively guide implementation of activities and achieve the desired results. A civil society organizations (CSO) PHDP Implementation Plan (2010 2016) was also developed to serve as a blue print for the effective implementation of activities related to People Living with HIV AIDS (PLWHA) and ensure the continuum of care between the health care facility and the community of PLWHA. The PHDP goal is to reduce new HIV infections, HIV re-infection, sexually transmitted infections and promote the well being of PLWHA. The strategic objective is to improve the quality of service delivery by providing integrated and comprehensive PHDP services. The CSO will complement Government of Botswanas (GOB) efforts by integrating and strengthening service provision to PLWHA. Implementation will be guided by the Botswana minimum package of PHDP services at health facility and CSO levels. During FY 2012, Tebelopele Voluntary Counseling and Testing (TVCT) will work closely with Ministry of Health (MOH) to integrate and deliver the minimum package of PHDP services at selected 5 high volume sites. As a first critical step, TVCT will work to ensure that HIV infected clients get linked to services and enrolled in post test services. To ensure early care and treatment, all HIV infected clients will be referred to the ARV treatment program and other relevant programs at both TVCT and GOB supported PITC and post-test services. PLWHA will be educated on the importance of correct and consistent condom use and will be provided with an adequate supply of condoms. In addition, risk reduction counseling will be provided to address partner reduction and alcohol reduction. All negative or unknown status partners of PLWHA will be offered HIV testing at least every year. Discordant couples will be identified and provided with appropriate prevention counseling and services. Regular Sexually Transmitted Infections (STI) verbal screening and referral for treatment will be part of routine care and prevention for PLWHA. Provision of family planning education and counseling or safer pregnancy counseling will be provided to HIV-positive women and their partners as part of routine care to reduce unintended pregnancy and prevent maternal-to-child transmission. All HIV positive women will be referred for screening of cervical cancer. TVCT will work closely with the MOH in this endeavor to improve linkages and strengthen provision of PHDP services with the following targets during the reporting period: 1680 discordant couple counseling sessions, 9,456 clients referred for post test services, follow up of all clients referred will be conducted, psychological support services will be provided to 1,440 clients, STI verbal screening and referral to 660 clients, education and provision of male and female condoms to all PLWHA, which is an estimated 10,000 clients during the reporting period.

Tebelopele Voluntary Counselling Testing and Centres (TVCTC) is engaged in an effort to improve its internal processes and data management capabilities. The current system has been identified to have deficiencies and weaknesses. The primary weakness emanates from the fact that data collection is done in stand-alone mode. This means software versions need on be managed for over 200 mobile workstations. Stand-alone applications also cause a weakness in the collaborative effort of managing clients and client codes nationally. Tebelopele will aim to establish a secure and centralized Client Management module that ensures improved management of client codes for a better referral, possible follow-up and overall improved client experience.

Tebelopele will hire and train 15 counselors and place them at dedicated safe male circumcision (SMC) sites across the country. The counselors will provide HIV counseling and testing, pre and post operative counseling, post operation follow up, linking patients to care and treatment as well as partner and discordant couples counseling and testing.

FY 2012 funds will support Tebelopele Voluntary Counseling & Testing (TVCT) Centers operations including personnel, infrastructure, management, logistics, supplies, and Monitoring and Evaluation (M&E) for the provision of VCT services to 106,000 clients (95% of these are clients >15 years). TVCT will intensify efforts in collaboration with civil society organizations (CSO) to target men in work places and through sports to increase the proportion of males receiving VCT from the current 46% to 50%. To strengthen counseling and testing in both VCT and routine HIV testing (RHT) settings, PEPFAR funds will also support the provision of counselor supervision, mentoring and support at regular VCT sites and at the dedicated SMC sites with a view of preventing counselor burn out and assuring the quality of counseling services.

To enhance its VCT services and maximize benefits to clients, FY 2012 funds will support TVCT in integrating other interventions into VCT services including Family Planning (FP) education and counseling, SMC education, counseling and referral, screening for Tuberculosis (TB) and alcohol abuse. TVCT will also provide Post-Test Club services including on-going prevention education, risk-reduction counseling, psychosocial support, and support for disclosure. Activities will include reviewing counseling protocols to incorporate counseling and screening for SMC, alcohol abuse and TB; targeted referral for both systems to ensure that men identified reach the SMC sites; and the development of TB screening tools. The review of protocols will include development of prevention messages to clients which reinforce those developed in Sexual Behavior Change Communication (SBCC) campaigns in the country.

TVCT will form key strategic partnerships aimed at introducing innovative and cost-effective HTC service delivery models. TVCT will partner with Population Services International (PSI)-Botswana to increase demand and uptake for HTC services. PSI Botswana will support TVCT in designing evidence-based, social marketing models for HTC demand creation, branding and increasing awareness of HTC and addressing drivers of the epidemic. TVCT will partner with Botswana Christian AIDS Intervention Program (BOCAIP) and Humana People to People (HPP) to support youth VCT and community mobilization respectively. Additionally, ten CSO located in remote and hard-to-reach areas will be identified and trained to provide VCT services in those areas. This strategy will cut the cost of outreach and enhance sustainability. With FY 2012 funds, TVCTC will also collaborate with CDC/Botswana and Government of Botswana (GOB) to pilot point-of-care CD4 measurements and investigation using the VCT infrastructure to offer rapid CD4 tests.

To improve referral and referral linkage to onward care, support and treatment, TVCT plans to implement a new innovative referral strategy. PEPFAR funds will also support the piloting of cell phone Short Message System (SMS) -based technology to enhance client referrals.

Botswana is currently experiencing a high burden mixed HIV epidemic with both high generalized prevalence among the mainstream population and suspected higher prevalence among concentrated key populations. Key populations (KP) in Botswana include sex workers and men who have sex with men (MSM). Although there has been a paucity of empirical evidence to quantify the size of the KP and the epidemiologic profile of HIV among these groups in Botswana, results of a recent bio-behavioral surveillance survey suggest that KP like sex workers and MSM could experience a substantial HIV and STI burden, and it is apparent that provision of prevention and treatment services for these groups is inadequate. Sex workers and MSM are also at heightened risk as both of these sexual behaviors are not only stigmatized, but are also illegal in Botswana (Botswana Modes of Transmission Study, 2010). Further, KP in Botswana may account for a considerable proportion of new infections in the country through heterosexual relationships.

To address the challenges in programming for KP, TVCT will support the establishment of a KP pilot project in a selected center. The project will provide targeted, comprehensive health services to reduce risk of HIV and STI infection, and improve physical and mental health among these stigmatized groups. The project will include both advocacy and service delivery approaches. The aim is to ensure an environment in which comprehensive services are provided in an appropriate, sensitive, holistic manner, in settings that ensure privacy and accessibility. The pilot will be condicted in one of three major urban centers (Kasane, Francistown and Selibe-Phikwe) along the eastern Botswana north-south transport corridor from the South African border in the south to the Zambia/Zimbabwe border in the north. Currently TVCT provides HIV testing, counselling and education; STI and TB screening; risk reduction counselling and education, as well as PHDP care and support services for both key and general populations. In addition to these core services, the pilot site will serve as a resource and meeting place for longer-term interventions such as KP support groups, counselling services, gender-based violence and livelihood programs.