EGPAF will support key intervention areas in the Partnership Framework through: Supporting the MOH tocreate an enabling environment for universal access to HTC within all health facilities; Supportingimplementation of routine HTC services; Strengthening linkages and referrals; and Building providercapacity and strengthening health systems. This project will focus on HTC at primary care settings, whichinclude clinics and PHUs, as the entry point for individuals to access HIV services. While most women arereached with HTC through ANC services, testing for men and children lag far behind. Expanding HTC toall service points, particularly STI, TB, inpatient and outpatient department (OPD) clinics, and expansionof routine screening of child and mother health cards, will significantly reduce missed opportunities forHTC and subsequent care and treatment services. This project will collaborate with the PEPFARcommunity HTC partner (PSI) to increase demand for routine HIV testing at every service point withinhealth facilities. In Year 1, the project will reach 113 health facilities; by end of Year 3, the project willsupport all health facilities in Swaziland. EGPAF will leverage partnerships with USAID, ViiV, and PSI(new recipient of community-based HTC project) and URC lab infrastructure project to coordinateactivities, maximize results, and leverage funding. EGPAF will also engage with the relevant departmentsin the MOH, as well as with the National Emergency Response Council on HIV and AIDS (NERCHA) andPSI and other partners, to facilitate implementation of the HTC communication strategy and thedevelopment of necessary HTC job aids and promotional materials/messages, avoiding duplication ofefforts and waste.

EGPAF will support the MOH to firmly establish linkage to appropriate care and support servicesfollowing provider-initiated HIV testing in all 4 regions of Swaziland. EGPAF will build on the successfulpilot of the Patient Follow Up Standard Operating Procedures, which focuses on linkage to care, retentionin care and defaulter tracing. EGPAF will pilot the use of expert clients as additional post-testcounselors for newly diagnosed HIV patients in facility-based setting HTC settings. They also willdevelop and utilize new IEC materials to create demand for linkage to care. To assist in monitoring theirefforts, they will develop/improve existing referrals forms, registers and monitoring systems. This effortwill tie in closely with the full roll out of pre-ART as part of the HIV Comprehensive Package of Care,strengthened adherence and psychosocial support (APS) and PwP, the Expert Client initiative, clinicalmentoring and supportive supervision, as well as the community linkages program—much of which isprimarily supported by ICAP.

Strategic Area Budget Code Planned Amount

EGPAF's HTC activities will be aligned with national health sector response to HIV and AIDS(2009-2014) and the national policy guidelines for TB/HIV collaborative (2007). EGPAF will collaboratewith PSI and URC to increase demand for routine HIV testing in tuberculosis (TB) clinical settings, bothoutpatient and inpatient wards. HTC in these settings can yield high numbers of HIV-positive clients in

need of treatment.

EGPAF will collaborate with other care and treatment partners to further decentralize HIV services solower-level health facilities can better deliver these services to newly-diagnosed clients. Clinics will serveas platforms to access communities with HTC services through outreach, while the clinics themselves willbe connected to secondary and tertiary health facilities through a strengthened referral network to ensureprovision of care and treatment services.EGPAF will advocate for and promote national efforts on task sharing and shifting to extend ARTprovision, starting with the MOH?s proposed special authority for nurses to initiate ART for pregnantwomen and TB clients as high priority groups.

Strategic Area Budget Code Planned Amount

EGPAF will support the GKOS to achieve its goal of increasing the percentage of the populationundergoing HIV testing each year to 50% of women and 40% of men by 2013 through strengtheninghealth facility based Provider Initiated HIV Testing and Counseling (PITC) services.

EGPAF will continue to participate in the national HTC core team and support the MOH/SNAP to finalizethe national policy on routine HTC; national HTC scale up plan and development/adaptation of PIHTSOPs and job-aides. EGPAF will also build capacity health workers through training and mentorship onPITC including on couple HTC and pediatric PITC.

EGPAF will rollout PITC to all settings and service points including inpatient and outpatient facilities, TBclinics, STI services, ANC, family planning, child welfare units, and male circumcision sites using thenational HIV testing algorithm. The facility-based PITC services support will take place in a phasedmanner, beginning in Year 1 (2011) with support to 113 health facilities, reaching all health facilities byYear 3. EGPAF's support will be tailored into 2 categories of health facilities. Category one healthfacilities which include largely the PHUs and clinics will receive the standard support which includestrainings, on-site mentorship, support supervision, quality improvement and quality assurance activities,ensuring uninterrupted supply chain for HTC. Category two health facilities which include 5 hospitals and5 health centers will receive the standard support as described under category one plus intensive supportto implement PITC which includes placing lay counselors in TB units and OPD, renovation or upgradingthe infrastructure to create space for PITC at OPDs, improve the client flow to facilitate linkages to careaccording to the national PITC SOP, Billboards to increase demand of HTC services and working withinpatient wards staff including doctors and the nursing staff to implement routine PITC as standard care

in the inpatient wards. Moreover these category two sites will receive an intensive on-site mentorshiponce every month.