Goal of MALAMU: To support the MOH in its goal of Eliminating Pediatric AIDS in DRC. The broad objectives of MALAMU are:

Increasing access to PMTCT including expanded delivery of services to achieve elimination of mother to child transmission of HIV.

Sustained Quality, Comprehensive, Integrated PMTCT services at supported facilities.

Strengthened National Health System by working directly with Health Zones in accordance with the MOHs plans for Health Zones.

MOHs policies, protocols and guidelines for PMTCT services to be reviewed and improved on a regular basis.

Links to Partnership Framework Implementation Plan Objectives:

As described in the PF, improving the quality of PMTCT services and the integration into broader MCH and HIV care and treatment programs will be a priority for MALAMU in FY2012. EGPAFs program is closely linked to the following key interventions identified in the PF: decentralized and improved quality of HIV services. To minimize disruption of service provision caused by the MOH policy of frequent staff rotation, EGPAF will continue to provide ongoing training and site support, M&E Plan

EGPAF will organize HIV integrated training for all the providers from central sites. The content of the training will help trainees to provide care and support to the HIV+ clients such as : Assessment of sexual activity and provision of condoms ; risk reduction counseling ; assessment for STIs and provision of care or referral for STI treatment and partner treatment, assessment of family planning needs and (if indicated) provision of contraception or safer pregnancy counseling or referral for family planning services, assessment of adherence and support or referral for adherence counseling , assessment of need and (if indicated) refer or enroll PLHIV in community-based program such as home-based care, support groups, post-test-clubs.

EGPAF will implement activities to improve the lives of orphans and other vulnerable children (OVC) affected by HIV/AIDS. Services will consist in ensuring access to basic education. OVCs under support will receive also health care services. Additional services will be provided as well such as targeted food and nutrition support, including support for safe infant feeding and weaning practices. EGPAF will ensure training of caregivers in HIV prevention and home-based care and strengthening community structures which protect and promote healthy child development .

EGPAF will implement TB activities in its supported sites. Activities will consist in : TB screening using clinical monitoring, related laboratory services. All identified TB patients will receive treatment according to DRC guidelines, including medication, counseling and support. Referal will be done to the TB units or TB service in the « peer to peer site » network. All clients attending EGPAF- supported facilities will be tested for HIV. Those identified HIV+will receive HIV care and treatment accordingly. In addition, some MDR identified will be referred for advanced analysis such as Gn-expert.EGPAF will ensure the implementation of TB infection control in all its supported-sites.

EGPAF will work closely with health zones and other partners to establish referral systems to capture children in need of care, including siblings of those enrolled. Establishment of strong formal linkages between communities and health facilities will increase access and retention in care for HIV-exposed, -affected, and -infected children. Family-centered HIV care and support services will be performed at all entry points (PMTCT, family planning, vaccination, and CPS). Facilities will reach out to families of index children or mothers. Activities will provide high quality and efficient care and support to improve childrens quality of life. These services may include: palliative care and psychosocial support programs for children families; Referral to care and TX services. Malamu will focus on the integration of HIV services within MCH settings, and integrated follow-up of mother-baby pairs. EGPAF will introduce a bidirectional referral system by integrating messages to families of HIV-exposed, affected, and infected children to improve quality of life, promote family centered care and support activities, and strengthen care networks. We will support clinical pediatric ART and care by:1. Organize trainings in pediatric care for site and health zone staff ; 2. Using pediatric patients as entry points for testing parents/guardians in order to improve parent/guardian health and child survival; We will provide pediatric adherence counseling and psychosocial support by: 1. Identify and train peer educators in pediatric adherence counseling of children on ART; 2. Training peer educators in disclosure counseling; 3. Strengthen referrals and awareness on child sexual abuse and the availability of HIV prevention strategies for abused children.

EGPAF will ensure training in waste management system and other activities to promote medical injection safety, including distribution/supply chain, cost and appropriate disposal of injection equipment and other related equipment and supplies

EGPAF will implement counseling and testing services in PMTCT facilities for in- patients attending EGPAF- supported health facilities( non pregnant women) and also all TB patient will be tested for HIV. The patients who will be tested HIV+ will be provided treatment in the facility or refered to one of the « peer to peer site » network facility. EGPAF will offer a training of providers, supplyies and other commodities for testing.

Individuals who are sexually active and are tested for HIV in health centers supported by EGPAF are provided information at time of testing on condom use; STI (including syphilis) transmission, prevention and treatment methods; and other risk-reducing behaviors, in addition to information on fidelity and reducing the number of partners. EGPAF provides this message to those presenting for care at participating maternities . Through the social marketing of condom usage and safer sex, this activity will be leveraged by the partnership and collaboration with USAIDs family planning initiative and PSI to acquire condoms and other family planning commodities for program beneficiaries. Participants interested in family planning services are referred to closest service provider. As couples counseling is highly suggested and honored, men are specifically targeted through sensitization sessions, which are linked to testing opportunities for those who choose to be tested. Training is provided to healthcare providers at participating health centers at program initiation and through periodic refresher training sessions.

During the Y1, MALAMU project will implement the peer to peer site strategy in order to improve the coverage and quality of PMTCT services in Kinshasa and Lubumbashi. This strategy consists of organizing the health facilities into service delivery networks in order to implement PMTCT services in the most cost effective manner within the targeted health zone. Under this model, high volume sites, serve as central sites in charge of supporting the peripheral sites.

Central sites:

EGPAF team has identified 13 centrals sites in Kinshasa and 5 in Lubumbashi. Central sites will be validated based on transparent criteria established in consultation with PNLS, including presence of highly trained and functioning staff able to serve as mentors, adequate infrastructure, and working systems and procedures. The highest volume facilities have been visited and selected as central sites based on pre-determined criteria including presence of PMTCT services, presence of skilled staff, and strength of maternal and child health services at the sites, etc

Satellite sites:

In collaboration with the health zones and provincial PNLS teams, all potential health facilities surrounding the main PMTCT sites were identified and classified by volume of catchment area populations seeking services, e.g. the number of pregnant women attending ANC services at those sites. The satellite sites will be linked to the central sites via a network of training, cross visits, and ongoing mentorship and support. EGPAF team has identified 40 satellites sites in Kinshasa and 17 in Lubumbashi.The EGPAF team will use the tools to identify SGBV risk for pregnant women attending ANC in the EGPAF supported PMTCT sites

EGPAF will offer care and support to HIV+ clients in order to provide skills and capacities to health care workers. It will also provide its supported-sites with appropriate materials and equipements to perform biological follow up of clients. Eligible patients will receive ART as well as specific OIs treatment according to the national guidelines.

Establishment of strong formal linkages between communities and health facilities will increase access and retention in care for HIV-exposed, -affected, and -infected adult.

EGPAFs strategy for PDTX activities will include early identification of infected children and provision of a basic package of services: ART, vaccinations, malaria prevention, vitamin A, and nutritional status assessments, to reduce morbidity and mortality and improve quality of life. EGPAF will work closely with health zones and other partners to establish referral systems to capture children in need of care, including siblings of those enrolled. Establishment of strong formal linkages between communities and health facilities will increase access and retention in care for HIV-exposed, -affected, and -infected children. Family-centered HIV care and support services will be performed at all entry points (PMTCT, family planning, vaccination, and CPS). Facilities will reach out to families of index children or mothers. Activities will provide high quality and efficient care and support to improve childrens quality of life. These services may include: palliative care and psychosocial support programs for children families; Referral to care and TX services. Malamu will focus on the integration of HIV services within MCH settings, and integrated follow-up of mother-baby pairs. EGPAF will introduce a bidirectional referral system by integrating messages to families of HIV-exposed, affected, and infected children to improve quality of life, promote family centered care and support activities, and strengthen care networks. We will support clinical pediatric ART and care by:1. Organize trainings in PDTX for site and health zone staff; 2. Training in clinical pediatric ART; 3. Using pediatric patients as entry points for testing parents/guardians in order to improve parent/guardian health and c child survival; We will provide pediatric adherence counseling and psychosocial support by: 1. Identify and train peer educators in pediatric adherence counseling of children on ART; 4. Training peer educators in disclosure counseling; 5. Strengthen referrals and awareness on child sexual abuse and the availability of HIV prevention strategies for abused children. The EGPAF team will use the tools to identify SGBV risk for pregnant women attending ANC in the EGPAF supported PMTCT sites.