The Kinshasa and Katanga-based TBD partner will aim to increase access to services and improve health outcomes of beneficiaries by strengthening capacity to provide HIV testing and counseling, family-centered HIV prevention and care and treatment in maternities and TB clinics in Kinshasa. Integration of sexual and gender-based violence (SGBV) activities will be included in maternities and care and treatment centers in Kinshasa. Technical assistance will be provided to continuum of care services including PMTCT, post-delivery monitoring and care of HIV+ women and newborns of unknown status, TB/HIV co-infection support, and family-based HIV treatment services: diagnosis, care, antiretroviral therapy and community and clinic-based psychosocial support. Information on family planning, tuberculosis, malaria prevention, and safe motherhood will be provided to patients; male partners can be tested. The Kinshasa-based TBD partner will strengthen the referral system between maternities and treatment centers to improve retention of pregnant women post -delivery, expand PMTCT services in Kinshasa, cover delivery costs, and maintain PSS groups for HIV/AIDS patients. The Kinshasa-based TBD partner will collaborate with global health organizations such as, the Global Fund, Clinton Foundation, National HIV/AIDS Control Program, UNFPA, and UNICEF, etc. to strengthen HIV services and obtain: ARVs, DNA PCR supplies, vitamins and supplements, bed nets, and water purification as they are available through the designated entities. The Kinshasa-based TBD partner will aim to increase the number of satellite sites within the network of maternity clinics.

There are 2 care and treatment centers in Kinshasa, Bomoi Health Center in NJili and Kalembelembe Pediatric Hospital in Lingwala. The target population includes HIV+ pregnant or post-partum women, HIV/TB co-infected patients, HIV infected men from non- HIV women found at PMTCT care, exposed and infected children and first in line family members as well as other sexual partners. Services provided include provider initiated voluntary testing and counseling, provision of prophylaxis for the treatment and prevention of opportunistic infections and malaria, ART to eligible patients currently provided by the Global Fund and Clinton Foundation, family planning and prevention of sexually transmitted infections, biological and clinical follow up, psychosocial support to help with patient retention (including support group meetings for enrolled patients, home visits, accompaniment for disclosure). The Kinshasa-based TBD partner will train providers who provide care to HIV+ individuals and their families and continue to develop a mentoring program to support clinicians trained as a part of this initiative.To address food and nutrition insecurity among HIV+ affected patients, in collaboration with Action Contre la Faim (ACF) and FANTA (Food and Nutrition Technical Assistance) and the LIFT (Livelihood and Food Security Assistance) programs funded by USAID. The Kinshasa-based TBD partner patient population will benefit from nutritional support services at the care and treatment sites as well as those living in communities where nutritional support is provided to HIV+ affected patients within assigned jurisdiction. Beneficiaries will also benefit from economic strengthening activities provided throughout the community through organizations funded by USAID and other PEPFAR collaborators. Continuous monitoring and evaluation will occur through database review and regular meetings based on specific program quality indicators such as: frequency of CD4 monitoring, cotrim prophylaxis, DNA PCR at 6 weeks, tracking of adherence and reports, choice of family planning method documented in charts. The outcomes of all of the monitoring and evaluation activities will be translated and documented in a final year -end report.

In all sites it will be assured that assessment for eligibility for the OVC program is provided. In FY13 TBD Kinshasa will add on its activities with support to orphan and vulnerable children as part of its family-centered care model. TBD Kinshasa will build capacity of health care workers to Identify/select beneficiaries based on recognized tool such as USAID Child Status Index and will focus on reducing barriers to health care, linking to nutrition services, and psychosocial care and support. TBD Kinshasa will work at its supported clinical sites to facilitate access to treatment for identified OVC for malaria, diarrhea, malnutrition and others pediatric disease through medical supply and materials equipment. Collaboration will be promoted with PMTCT, care and treatment sites by establishing linkage between care givers and families to ensure PLHIV remain connected to the continuum of care. Children family members will be linked to children support groups for psychosocial support--and these groups will be set up to refer children to exiting pediatric care and treatment services when needed. TBD Kinshasa will support health care providers to link patients with OVC services provided by others PEPFAR partners.

The Kinshasa-based TBD partner will be active in TB clinics in Kinshasa, and will oversee HIV VCT activities in each location. All HIV+ and TB co-infected patients and infected family members will receive cotrim prophylaxis and will be screened for ARV eligibility based on CD4 count and clinical staging.Co-infected patients will be provided HIV-related palliative care with cotrimoxizole prophylaxis.All TB/HIV co-infected patients will be referred to a PSS group.Regular screening for TB on all enrolled patients in care will be performed routinely to ensure that eligible patients are placed on treatment as soon as possible. All of these activities will be monitored regularly by program staff through direct observation and review of patient registers and records.To help address food and nutrition insecurity among HIV+ affected patients, in collaboration with ACF and FANTA and the LIFT programs funded by USAID, the Kinshasa-based TBD partner's patient population will benefit from nutritional support services at the care and treatment sites as well as those living in communities where nutritional support is provided to HIV+ affected patients within assigned jurisdiction. Beneficiaries will also benefit from economic strengthening activities provided throughout the community through organizations funded by USAID and other PEPFAR collaborators.Data will be reviewed for program evaluation, and the Kinshasa-based TBD partner will support a rapid skills transfer to the local health care personnel that provided ART at the clinic level. The Kinshasa-based TBD partner will intensify their technical assistance work for the National program by developing simplified database and data collection forms for ongoing use by the National program and their partners.The Kinshasa-based TBD partner will expand supportive supervision activities to assist the National program in expansion of its HIV testing activities, and the Kinshasa-based TBD partner will also provide program evaluation for the National program. Program evaluation will consist of documentation of acquired training knowledge through pre and post test results, clinical skills observation checklists and periodic quality assurance panel testing.

The Kinshasa-based TBD partner in collaboration with the Global Foundation and the Clinton Foundation will provide pediatric ARVs to HIV+ children (and co-infected with TB) referred to PACT care and treatment sites. Each HIV+ pediatric participant receives a comprehensive package of primary HIV care including: clinical follow-up with CD4 testing, prevention and treatment of opportunistic infections, malaria prevention and treatment, ART, reproductive health services, nutritional support and counseling, PSS, testing of family members and sexual partners at Bomoi Health Center and KLL. To address food and nutrition insecurity among HIV+ affected patients, in collaboration with ACF and FANTA and the LIFT programs funded by USAID, The Kinshasa-based TBD partner's patient population will benefit from nutritional support services at the care and treatment sites as well as those living in communities where nutritional support is provided to HIV+ affected patients to reduce barriers to adherence, and providers will be trained in nutrition for those on ART. Issues specific to pediatric HIV care, such as status disclosure, will be included in training sessions for program personnel. Additional aid and education is arranged for patients through PSS groups, both for those informed of their status and those unaware of their status. Continuous monitoring and evaluation will occur through database review and regular meetings based on specific program quality indicators such as: frequency of CD4 monitoring as compared to protocol recommendations, percentages of eligible patients who receive cotrim prophylaxis, percentage of clients with documented HIV status in the chart, tracking of adherence and reports, and tracking of disclosure status. As a center of excellence, the Kinshasa-based TBD partner will also conduct PDSA quality improvement activities, and share the processes and outcomes to the rest of the medical community. The outcomes of all of the monitoring and evaluation activities will be translated and documented in a final year-end report.

Safe waste management policies will be follwed at all sites. In FY13 TBD Kinshasa will enable all supported sites to build capacity and train health care workers to assure safe injection practice in their daily work by applying universal precautions. This includes the provision of safe injection supplies (single-use needles and syringes, sharps containers, e.g.) TBD Kinshasa will also apply behavior change communication (BCC) strategies aimed at both the community and health providers to promote safe injection practice and minimize demand for medically unnecessary injections. According to national health care waste management strategies, TBD Kinshasa will build provider and facility capacity to implement adequate waste management systems. This might include transport of waste to better-equipped sites by secured transportation for an appropriate disposal.

Provider-initiated rapid testing is implemented at all ANC centers, Bomoi Health Center, and the TB clinics according to national guidelines.Target population include pregnant women visiting ANC centers, the 2 care and treatment centers supported by the Kinshasa-based TBD partner, patients infected with tuberculosis in the 63 TB clinics supported by the Kinshasa-based TBD partner, male partners through sensitization activities, and first line family members of enrolled patients in care.Provider initiated testing and counseling is also offered to malnourished pediatric patients hospitalized at KLL, at which point referral is made for eligible patients for clinical follow up services. In fiscal year 2012, UNC-DRC will strengthen the implementation of the provider-initiated testing and counseling policy at KLL and Sango Plus, and will increase the HIV testing rate of first-line family members and sexual partners of UNC-DRC programs patients at ANC maternity sites and the two care and treatment centers. UNC-DRC will provide technical assistance to PNLT for VCT at TB clinics in Kinshasa and Kisangani.The collaboration with PEPFAR and the Global Funds Round 11 will assist in complementing programs activities by supplying test kits, laboratory supplies and other consumables, along with ARVs for care and treatment. In collaboration with the PNLS, UNC-DRC will also design and implement training sessions on testing and counseling and data quality assurance to healthcare workers in IMAI, PVV lay-health workers, expert patients, and maternity lab and clinical personnel and provide resources to ensure retention along the continuum of care for pregnant women and their infants through HIV diagnosis, care and treatment for the mother, and HIV testing and care and treatment (if indicated) of the exposed infant.Affected male partners of women identified through ANC at the Kinshasa-based TBD partner supported maternities will also trained in counseling and peer education.All of these activities will be monitored regularly by program staff through direct observation, provision of periodic quality assurance panel testing and review of patient registers.

Individuals who are sexually active and are HIV tested by the Kinshasa-based TBD partner supported health centers are provided information at time of testing on condom use; STI transmission, prevention and treatment methods; and other risk-reducing behaviors, in addition to information on fidelity and reducing the number of partners. The Kinshasa-based TBD partner provides this message to those presenting for care at participating maternities and PACT care and treatment centers and at educational presentations in the local communities in which the Kinshasa-based TBD partner operate. 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.

The Kinshasa-based TBD partner will provide technical assistance for rapid HIV testing, prenatal and post-delivery monitoring and care of HIV+ women and their newborns, family-based HIV treatment services and community and clinic-based psychosocial support (PSS). The Kinshasa-based TBD partner PMTCT team applies criteria set by the National AIDS Control Program for selecting maternities. Staffs at the maternities are trained on PNLS-approved curriculum and data is shared at the program, district, provincial and national level. PMTCT activities are integrated into existing antenatal care services including rapid HIV testing and counseling, TB screening, sulfadoxine-pyrimethamine for presumptive malaria treatment, promotion of insecticide-treated bed net use, tetanus vaccinations, routine iron and folate supplementation, and family planning counseling. HIV+ mothers and their infants are given prophylactic ARVs provided by the Global Fund and Clinton Foundation, and cotrimoxizole prophylaxis, and delivery costs are paid to encourage delivering at the maternities. HIV+ women are asked to join monthly PSS groups for informal life skills training, and program efforts are made to strengthen male partner involvement. Training and monitoring is provided to midwives, clinic nurses, and laboratory staff on new PMTCT best practices and patient care. Complemented by a network of partnerships between the Kinshasa-based TBD partner, USAID and PEPFAR funded organizations GBV education, screening, and referral for psychosocial community based services and care and treatment for STI, HIV and pregnancy prevention are provided through integrated network of PMTCT and care and treatment in 50 maternities in Kinshasa. HIV+ pregnant women and their children benefit from nutritional assistance provided by the ACF in selected communities.

The same population is targeted for this activity as for adult HIV care; a system that includes a family-centered approach to care and treatment. The Global Fund and Clinton Foundation provided ARVs to 993 HIV+ individuals through its activities so far. Each patient undergoes a comprehensive baseline assessment at program enrollment including clinical examination, nutritional and laboratory assessment, and psychosocial evaluation. HIV disease staging by clinical assessment and CD4 testing will determine ARV eligibility and patient visit schedules. Patients on ART are scheduled for monthly visits, until deemed clinically stable after which they may be seen every six months. Those who are seen every six months continue to be assessed by a nurse dispensarist on weight, ARV dosing, and drug adherence through questionnaires and pharmacy databases. At each visit, drug toxicity assessment is conducted, and counseling on treatment adherence is provided. As part of its centers of excellence activities, clinical patient outcomes such as improvements in CD4 counts and weights are tracked and monitored quarterly through streamlined data collection forms and review of patient and pharmacy databases that collect program quality indicators such as: frequency of CD4 monitoring, percentages of eligible patients who receive cotrim prophylaxis, adherence to protocol requirements of confirmatory testing, percentage of clients with documented HIV status in his/her chart, tracking of adherence and toxicity reports, and choice of family planning method documented in his/her chart. Activities to support patient adherence include psychosocial support group meetings and intensive follow up of patients by providers as well the use of the PVV volunteers to track patients and provide support outside of the clinical setting. The Kinshasa-based TBD partner will also conduct PDSA quality improvement activities, and share the processes and outcomes with the regional medical community. The outcomes of all of the monitoring and evaluation activities will be translated and documented in a final yearend report

The same population is targeted for this activity as for pediatric HIV care. Each patient undergoes a comprehensive baseline assessment at program enrollment including clinical examination, nutritional and laboratory assessment, and psychosocial evaluation. ARV eligibility and patient visit schedule will be assessed according to age and WHO recommendations. Patients will be seen every month for the first three months of participation and then every three months thereafter. Patients who are seen every three months will continue to be assessed by a nurse dispensarist on weight, ARV dosing, and drug adherence through questionnaires and pharmacy databases. At each visit, drug toxicity assessment is conducted, and counseling on treatment adherence is provided. Outreach workers made up of PVV volunteers will assist with patient tracking to improve adherence. Construction of internet-wired and better equipped conference rooms have been partially completed to effectively implement a telemedicine program at Bomoi and KLL, and enable the centers to host medical conferences and regional clinician training sessions. Nutrition programs funded by USAID will benefit patients at the care and treatment sites as well as those living in communities where nutritional support is provided to HIV+ affected patients within assigned jurisdiction. As centers of excellence, HIV pediatric treatment mentorships will occur at KLL and Bomoi, and expert opinions and best practices in pediatric ART treatment will be shared with other providers. Clinical patient outcomes such as improvements in CD4 counts and weights will be tracked and monitored quarterly through streamlined data collection forms and review of patient and pharmacy databases that collect program quality indicators such as: frequency of CD4 monitoring, percentages of eligible patients who receive cotrim prophylaxis, adherence to protocol requirements of DNA PCR at 6 weeks, percentage of clients with documented HIV status in his/her chart, tracking of adherence and toxicity reports, and choice of family planning method documented in his/her chart.