The DRC Integrated HIV/AIDS Project (ProVIC) aims at reducing the incidence and prevalence of HIV and mitigate its impact on people living with HIV/AIDS (PLWHA) and their families. This objective will be achieved by: improving HIV/AIDS prevention, care and treatment services in 40 Champion Communities located in the 5 provinces of project (Bas Congo, Katanga, Kinshasa, Sud Kivu, and Orientale); increasing community involvement in health issues and services through sustainable community-based approaches; increasing the capacity of government and local civil-society partners and thereby empowering new local organizations and communities to plan, manage, and deliver quality HIV/AIDS services. ProVIC intends to work with and through grantees, and in collaboration with national government programs and other USG partners to ensure the achievement of its three intermediate results (IR): 1) HIV counseling, testing and prevention expanded and improves in target areas; 2) are, support, and treatment for PLWHA and (OVC) improved in target areas; and 3) health systems supported and strengthened in target zones. The project is closely working with government counterparts and the Champion Communities to ensure ongoing capacitation and effective transfer of skills, knowledge and best practices.

Since Year 2, three approaches have been introduced to work with adult PLWHA in the community: the positive living; the positive prevention strategy; and the palliative care strategy. The target populations are adolescents, adults and their families living in and around champion communities. Year 3 will continue these approaches, framed within an overarching strategy to build both resilience and capacity in the community increasing the number of people in target groups reached. Self-help groups (SHG), introduced in year 2, will be developed and strengthened and most importantly linked into the champion communities and health services in their community. The SHG will use a problem solving approach to look at common issues and use the forum to discuss and address these issues. The care givers will make regular visits to SHGs to identify those who need specific support and will make home care visits providing psychological, social, spiritual support and/or palliative care. They will also follow up on missing PLWHA, sick persons, families facing death, family facing stigma/discrimination, etc. PLWHA will be referred to SHG from other components of ProVIC project (HTC, PMCTC and medical or community structures) and they will be referred from SHG to community health facilities to address malnutrition and other OI, to NGO specialized in protection of vulnerable people to address legal issues. PLWHA will be linked to microfinance institutions in their area to get money for IGA to ensure their autonomy. Through the strategy above, the project responds to 2 and 3 priorities actions area of National strategic Plan against HIV/Aids and PEPFAR guidelines.

To ensure the quality of services, the project will create a format for keeping individual social and medical records. The Care and Support Specialist will train the nutritionist and care givers or social workers on how to complete these forms and also train the grantees on how to analyze the forms. They in turn will train the facilitators and members of the group on how to maintain the form and how to review them on a regular basis so that health and social needs are monitored and needs are referred, with the end result of improving overall wellbeing.

In FY12, the project established 193 child-to-child clubs and provided psychosocial support to 12005 OVC identified based on their level of vulnerability and provided services such as health referral, food and nutritional support, access to school or training in social entrepreneurship to get them autonomous. In addition, the child protection policy was institutionalized and disseminated among grantees and CC. In FY13 and in conformity with the PEPFAR Pivot Strategy OVC will be identified through pregnant women who test HIV+ in PMTCT supported sites and provided with desegregated and tailored services. ProVIC will also support OVC identified by CDC and DoD partners, but this will be phased out in October 2013 when a new OVC partner is functional in DRC who will support OVC identified from PEPFAR partners. The Child to Child approach will be intensified to boost childrens welfare, address their care and support needs, empowering OVC to achieve positive change, strengthen friendship among peers, participate in the solution of the problems that affect lives, in and around concerned HZ and CC. For OVC schooling for example, ProVIC intends to develop partnerships churches, communities and other educational networks to devise sustainable mechanisms and strategy to ensure the schooling of OVC once the funding of ProVIC ends. Block grants and other onetime investment opportunities will be explored.

Provide a minimum package of Care and support services-cotrimoxazole preventive therapy, HIV screening for TB patients and TB screening and referral for treatment for HIV patients, Prevention with positives, retention and adherence. Strengthen linkages with prevention and HTC activities for early enrollment in pre-ART or ART.

In COP 13, Provic will: improve the follow-up and referral for diagnosis of HIV-exposed infants and young children at the facility and community level through the network model; provide nutrition counseling linked to clinical- and home-based care for all HIV-infected persons, especially in areas in which malnutrition is endemic; and provide cotrimoxazole and bed nets. Early Infant Diagnosis (EID) will allow for follow-up and referral for diagnosis of HIV-exposed infants and young children at the facility and community level through the network model. The project will also link nutrition counseling to clinical- and home-based care for all HIV-infected youth, especially in areas in which malnutrition is endemic. This activity will support health facilities to improve health outcomes of HIV-infected children and HIV exposed infants and adolescents through the provision of comprehensive medical care, including early identification of HIV infection, no-cost ART and psychosocial support to HIV-infected children and their nuclear family members. This mechanism will support sites to ensure that care of HIV infected infants, children and adolescents form an integral part of maternal and child health, covering ANC, PMTCT, labor and delivery, postpartum and pediatric services. Most sites will need support to address gaps in equipment, supplies and medications.

ProVIC will ensure access to CD4 in all PMTCT sites, either through the installation of a PIMA or linkages to a site with a PIMS. EID will be expanded into new PMTCT sites. This project will continue to to address inadequate infrastructure, equip labs for proper diagnostics, and improve laboratory supply chain management. Furthermore, this IM will link up with the PEPFAR-supported national laboratory system to ensure all technicians are properly trained and forecasting and ordering reagents and supplies is correctly implemented.

Data quality assurance is a priority for ProVIC. It will ensure that all supported facilities are using the approved MOH patient registries and are accurately recording their data. This program will also work to link closely to the new computerized monitoring system that CDC is supporting.

In COP 13, ProVIC will provide targeted support to health zone management team : joint planning process, local capacity building, improvement of coordination mechanisms; support to PNLS (National AIDS Control Program) to update policies on PITC and prevention with positives. As in previous years, ProVIC will focus on issues related to the poor quality of service delivery. Support is provided at the national level to refine policies, norms and directives, and activities are rolled out at the provincial level to reinforce providers competency and address some key issues such retention of human resource in their setting, incentive.

Collaboration with others partners is a key issue for success. Activities are implemented closely in collaboration with its government counterpart, and achievements are designed according to the national HIV strategic plan. The government provides trainers, and USG partners provide any others needed resources to organize workshops, trainings. Support to the joint supervision and coordination meetings improves the quality of service delivery, and allows for needs based intervention adjustments.

The project will train health care workers in safe injection practices, including related infection prevention and control, handling healthcare waste, commodity-supply management and interpersonal communication, and improving health care waste management. Where appropriate, the project will construct proper waste disposal incinerators or waste pits.

Sexual prevention activities will be implemented in selected high PMTCT seropositivity health zones targeting youth at risk through peer education, using the UNAIDS "Four Knows". To reduce PMTCT bottlenecks, campaigns promoting male involvement will be conducted in selected health zones where the male involvement rate is under 20%. All communities activities not linked with PMTCT will be stopped to focus our efforts on high seropositivity health zones.

Using the PMTCT platform, the project will strengthen PITC by supporting the National HIV/AIDS Control Program to revise the PITC training module and expand the PITC in all facilities prioritizing TB patients, STI patients, and non-emergent-patients. With the family-centered approach, the project will target malnourished children, children of PLHIV and OVCs. mobile HTC for key poplulations will be conducted by health workers to increase linkages with care and treatment programs. customized indicators will be setted up to track these linkages in order to reduce the loss to follow-up. Quality assurance activities will occur in ProVIC-supported HCT sites via formative supervision, coaching, data analysis at the site level, as well as mystery clients and sharing of blood samples within the DRC quality assurance lab system.

The project will strengthen its key populations response with a core set of interventions for populations at high risk for HIV. These interventions comprise a package of services for key populations and for other vulnerable populations with full participation of the target key populations or other vulnerable group in the development, implementation, and monitoring of the programs. Based on the DRC epidemiologic profile, the project will scale-up a minimum, core set of interventions: peer education and outreach, risk reduction counseling, condom distribution and promotion, sexually transmitted infections screening and treatment, HIV testing and counseling, and strong linkages with care and treatment services, including PMTCT.

ProVIC PMTCT team will implement peer to peer sites in Kinshasa and Katanga. The existing ProVIC sites will serve as central sites to reinforce capacities of peripherals sites in terms of PMTCT. Also, we will organize a tailored TOT for the mentors across the targeted two provinces in 2012 and three others provinces in 2013. The pool of trained trainers and providers will help to scale up PMTCT activities across 4 provinces. In 2013, within the designated health zones, ProVIC will first consolidate comprehensive services within the PMTCT sites already engaged prior to expanding to new sites. New sites were identified in Katanga and surrounding Kisangani.

The "mentor mother" approach in selected peer support groups and the URC quality improvement will be scaled up.

Treatment activities will be present in both the General Reference Hospitals and PMTCT Spokes. 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. Each patient will undergo 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. At each visit, drug toxicity assessment will be conducted, and counseling on treatment adherence will be provided. Activities to support patient adherence will include psychosocial support group meetings and intensive follow up of patients by providers as well the use of the PLWHA volunteers to track patients and provide support outside of the clinical setting.

In COP 13, ProVIC will provide technical assistance to provincial PNLS to redeploy Clinton Health Access Initiative (CHAI) pediatric ARVs in PEPFAR-supported sites, and early initiation of ART and clinical/biological monitoring. 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. At each visit, drug toxicity assessment is conducted, and counseling on treatment adherence is provided. Outreach workers made up of People Living with HIV/AIDS volunteers will assist with patient tracking to improve adherence.