Through the execution of this program with the Umbutfo Swaziland Defence Force (USDF), it is anticipated that there will be reduced HIV incidence, improved care and treatment outcomes, and better quality of life for troops, dependents and civilian staff members as well as a stronger USDF and other uniformed services for sustaining an effective HIV response.

This program directly contributes to the prevention and care and treatment strategies of the National Strategic Framework on HIV/AIDS 2009-2014 (NSF) and the Partnership Framework Implementation plan by expanding comprehensive care and treatment services and combination prevention to the military and other uniformed services. Through combination prevention, the program aims to reduce the rate of new infections among USDF troops and other uniformed services. The Phocweni clinic is the single point of MC services and a referral center for the entire military population. In terms of care and treatment, The USDF will continue to support decentralization of services to all military clinics. This will be achieved by improving HIV testing and counseling, increasing the number of USDF sites providing comprehensive care and treatment services through fixed sites and mobile clinics, and ensuring that the USDF provides quality laboratory services to support clinical care.

Two USDF personnel have been trained in monitoring and evaluation (M&E). This has provided the basis for development of an M&E program within the USDF. With FY2010 funding, the USDF will support M&E activities for HIV/AIDS and TB prevention, care and treatment. Monthly meetings with all implementing and oversight arms of the USDF program will be held to review progress and address barriers to successful programming. Internal quarterly review meetings will be conducted and information shared with external stakeholders. Capacity building for unit focal persons to handle M&E activities will be strengthened. Prevalence and risk indicators will be used to track the impact of the HIV/AIDS program and the need for care and treatment services.

Gender is a cross-cutting key issue for this activity. Approximately 10% of active duty military are female. One of the critical issues in the USDF is the position of women in the military. Women's HIV risk and gender relations will continue to receive focused attention in peer trainings, leadership communications. Technical assistance will be sought from US Military experts on women in the military regarding curriculum and best practices.

The USDF is in the process of mainstreaming the HIV and AIDS activities in the operations of the military. The future is that these activities form part of the USDF core functions at all levels. This process has begun with mainstreaming activities in all training including recruit training

Continued support for the USDF and SUSAH palliative care programs will address other identified equipment needs for basic care of HIV+ clients and their families, ongoing capacity building of trained, competent health care providers and HBC caregivers, education and support for USDF-SUSAH PLWHA and their families, and expenses for continued technical assistance. PLHWA will provide clinic-based support to HIV+ patients, using The Healthy Living curriculum. PLWHA provide counseling to support others living with HIV and their families. To assist with Care and Support initiatives for PLWHA and provide an international community nursing experience for students from California State University San Marcos School of Nursing, students from the University have been coming to Swaziland to learn and practice international community health through clinical experiences in the military, correctional clinics, community-based clinics within the country, and during home visits with voluntary caregivers. To decentralize and improve comprehensive adult care services for USDF, the following activities will be undertaken:

Training of unit nurses and caregivers to provide palliative care.

Support two to three duty tours of nursing students from the California State University San Marcos School of Nursing,

Support USDF garden initiative for better nutrition.

Strengthen positive living support to SUSAH treatment literacy training, prevention training PWP Healthy living curriculum

Support family support groups

Provide equipment and supplies

Currently the USDF provides, on a limited basis, ART initiation and refills of ARVs. The Phocweni Clinic is now certified to initiate patients on ART, with HIV-related care services offered at the including diagnosis and treatment, home-based care management, and referral of clients for palliative and hospice care. ARV service support will include training for nurses and other healthcare providers, and limited provision of equipment and supplies. The USDF seeks to expand provision of ART refills and follow-up care to all the USDF clinics. To further decentralize and improve adult treatment services, PEPFAR will support the activities outlined below:

Support ART physician for the HIV program

Train nurses and other healthcare providers with limited provision of equipment and supplies.

Expand provision of ART refills and follow-up care to all the USDF clinics.

Support PLHWA to provide clinic-based support to HIV+ patients, using the Healthy Living curriculum.

Train PLWHA in adherence counseling for HIV positive clients and their families

Conduct unit-based workshops to provide HIV literacy and support for PLWHA in addressing stigma and discrimination

Provide support to ensure high retention rate and adherence to treatment.

Support Institute of Infectious diseases IDI training for unit nurses

Improve drug storage facility

Provide ongoing training on data management system

To increase the percentage of USDF troops and their dependents who know their status, the following activities will be undertaken:

Train nurses in provider-initiated HIV testing and counseling,

Train counselors to provide couples counseling

Increase the percentage of USDF who are offered couples counseling

Provide Pre ART support to positive clients

Provide comprehensive service provision for TB to HIV positive clients.

Procure supplies to support counseling and testing for all units

Provide refresher training for old counselors to incorporate finger prick

The USDF places strategic information at the core of its functions. The goal of SI is to improve strategic information so that USDF planning and implementation is based on sound program and epidemiologic data. This will be achieved through supporting a sound reporting system in place to provide regular reports at the operational unit level all the way up to the command office to be used for planning and mid-course correction, through periodic HIV sero-prevalence and behavioral risk information collection, through the collection and use of clinical care information to improve patient outcomes and monitoring of overall USDF health using National Indicators. Strategic information activities planned for the coming year include:

Collect standardized data from all USDF sites

Train M&E officers (peer educators, focal persons and adjutants)

Support monthly and quarterly meetings with all implementing and oversight arms of the USDF program.

Support external review meetings with stakeholders to share the state of the program

The goal of HSS is to improve the USDF's infrastructure and human capacity to adequately address HIV/AIDS prevention, care and support, treatment and strategic information. This will be achieved through an improved coordination with National HIV/AIDS bodies such as NERCHA, CCM, MOH, and Ministry of Public Service, improving the internal USDF HIV Program coordination with all components of the USDF addressing HIV/AIDS. The activities that will be supported include: 1. Improving human capacity of USDF troops already in the system to professional level for skills upgrade and specialized training to respond to the HIV/AIDS epidemic including clinical care, prevention, strategic information, and management; 2. Improving physical infrastructure and information technology ; 3. Develop human capacity to support information management systems.

The USDF has begun its MC activities through the support of PSI for training doctors and nurses to provide MC at the Phocweni clinic facility. The USDF's plan is to have MC provided to all troops requesting it at no cost. Specific activities during the coming year will include:

Develop an MC strategy for recruits

Recruit a surgeon to provide MC services to troops at the military clinic.

Conduct training for nurses in readiness to carry out MC and post surgical care to troops.

Support study tours and procurement of commodities

Develop an SBCC strategy including condom promotion

Provide support for MC IEC materials

Conduct MC awareness for troops.

Prevention activities to be conducted will build on the peer educator and drama troupe structure in the USDF to promote both AB and other prevention messages. The chaplaincy program for HIV and AIDS, spiritual and psychosocial support has been developed adapted from the CHATSEK program. This will support AB prevention interventions in the USDF and outreach services to the Church Forum.

Carry out formative work to help develop a women-focused prevention program

Review of peer education assignments with ongoing support training to have peer educators in all units including women.

Leadership training on women's rights, equality and sexual harassment. Technical assistance will be sought from US Military experts on women in the military regarding curriculum and best practices.

Build capacity of the Church forum to implement couples counseling

Training chaplains to support AB within the military.

Training of women trainer of trainers will be supported to attend IDI courses in Uganda.

Printing IEC materials

Prevention activities to be conducted will build on the peer educator and drama troupe structure in the USDF to promote both AB and other prevention messages. Other prevention activities will include:

Procurement of cami condoms

Implement a condom promotion strategy for the USDF,

Hold sivikela inhloko campaigns at unit level

Recording of USDF dramas venue support

IDI training for trainers

Peer educator workshops for women troops

Training workshop for adjutants, platoon commanders, sergeants and unit focal persons,

Refresher course for peer educators,

Community outreach awareness education

Unit awareness days for HIV and AIDS

Support prevention activities through the Commander's cup and other sports.

Support to the south to south initiative to support SADC militaries for PwP and prevention, treatment and care programs

The USDF is working with the Ministry of Health (MOH) on addressing TB. The University Research Council is providing technical support to the Phocweni clinic. A Memorandum of Understanding has been signed. MOH will provide training and supplies and reagents. TB activities will insure that the USDF is a qualified TB diagnostic center and an integrated part of the National TB Program. The activities listed below are planned for the coming year:

Include USDF in all trainings provided by the National TB program

Extend case finding and TB care to the Corrections Department including prisoners.

Train HIV counseling and testing providers to include TB case finding

Train TB healthcare providers to promote and provide HIV counseling and testing

Train all nurses in TB care issues

Provide supplies as needed.

Implement TB infection control measures at the Phocweni clinic and the operational unit clinics in the context of implementing the three I's

Ensure HIV testing for TB patients as well ART for eligible suspect patients

Support MDR-TB case finding and TB defaulter tracing: airtime and cell phones.

Participate in quarterly TB review meetings

Participate in the World Lung Conference