SANRU will be delivering the revised minimum package of services for PMTCT, care and treatment, and lab services at the health zone level in Katanga province; These services will be provided in 27 health zones not previously receiving any HIV services. They are an umbrella organization that will sub-contract with several partners who will focus on PEPFAR programs in coordination with the MOH. They will also support PNLS in the implementation of the transition plan from option A to B+.

The target population includes HIV+ pregnant or post-partum women, HIV/TB co-infected patients, HIV infected men (coupled with HIV- women receiving prenatal 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, support for disclosure). SANRU 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 patient cohort supported by SANRU 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 SANRU will add on its activities support to orphans and vulnerable children as part of its family-centered care model. SANRU will build the capacity of health care workers to identify and/or select beneficiaries based on a 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. SANRU will work at its supported clinical sites to facilitate access to treatment for identified OVCs for malaria, diarrhea, malnutrition and other pediatric diseases 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. Family members of identified children will be linked to children support groups for psychosocial support--and these groups will be set up to refer children to existing pediatric care and treatment services when needed. SANRU will support health care providers to link patients with OVC services provided by others PEPFAR partners.

SANRU in collaboration with the Global Foundation and the Clinton Foundation will provide pediatric ARVs to HIV+ children (and co-infected with TB) referred to 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.To address food and nutrition insecurity among HIV+ affected patients, in collaboration with ACF and FANTA and the LIFT programs funded by USAID, SANRU'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, SANRU 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.

Provider-initiated rapid testing is implemented at all ANC centers and the TB clinics according to national guidelines.Target population include pregnant women visiting ANC centers, the care and treatment centers supported by SANRU, patients infected with tuberculosis in the TB clinics supported by SANRU, 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 which point referral is made for eligible patients for clinical follow up services. SANRU will provide technical assistance to PNLT for VCT at TB clinics in Lubumbashi.The collaboration with PEPFAR and the Global Fund 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, SANRU 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 SANRU 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 tested for HIV in health centers supported by SANRU 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. SANRU provides this message to those presenting for care at participating maternities, care and treatment centers and at educational presentations in the local communities in which SANRU operates. 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.

SANRU 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). SANRU PMTCT team applies criteria set by the National AIDS Control Program for selecting maternities. Staff 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 SANRU, 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 maternities in Kisangani. 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 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 weight 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. SANRU 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 year 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 dispensary nurse 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. 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. 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.