Pact supports several PFIP goals and objectives. One of PACTs key goals is to develop human capacity in Swazilands NGOs, CBOs, and FBOs to promote the establishment and strengthening of viable and sustainable civil society organizations. Pact develops the capacity of partners to deliver HIV services which include HIV Counseling and Testing, home and facility-based care and support, ARV Treatment, and TB/HIV. Pact also develops the capacity of partners to deliver HIV prevention messages that promote positive behavior change through one-on-one and group based activities. Pact will develop the capacity of partners to deliver quality OVC services which include food and nutrition, education support, PSS, protection and legal support, economic strengthening, shelter and care, and health care. Pact provides extensive assistance to partner organizations in developing comprehensive program design documents that accurately reflect planned activities and clearly articulate defined goals and objectives. Pact supports teamwork between program and finance units and conducts organizational capacity assessments. A resource mobilization course provides information on strategies for diversifying their funding base for sustainability. Pact partners work in all four regions. Since HIV is affecting the general population, the targeting of HIV prevention is also generalized, with specific partners targeting specific groups. Pact partners target PLHIV for positive prevention, clinical care, ART, TB/HIV and support care. Impact mitigation activities target OVCs and caregivers. Pact will mentor CANGO to become a local UGM that will provide support to partners. Pact's strategic information support is provided through staff and institutional M&E capacity and M&E systems strengthening.

Pact partners will provide a range of facility and community based clinical and support care services. These services will include clinical, psychological, food and nutritional support, spiritual, social and prevention services. The primary emphasis for these activities is comprehensive direct service delivery for improved quality of life for PLHIV, TB-infected individuals, and training of caregivers and counselors.

Pact partners will scale-up existing care and support services to improve the lives of vulnerable children affected by HIV & AIDS. Partners will deliver services for vulnerable children across all seven service areas based on the needs of vulnerable children, their families, and communities. Service areas include access to basic education, health care services, targeted food and nutritional support, protection and legal aid, shelter and care, psychosocial support, and economic strengthening as well as the training and support of caregivers. TechnoServe will provide technical support to OVC partners to improve the socio-economic status of households with vulnerable children. Pact will build the capacity of partners to support family units/primary caregivers and strengthen community structures. Pact will coordinate technical assistance through the following: strengthening capacity of local organizations; strengthening monitoring and QA systems; and advocating for sound strategies, policies, and programs that benefit vulnerable children. Pact will share impact mitigation lessons and strategies across partners and within the region through meetings, workshops, and visits. Pact participates in the national network forums and coordinates an Impact Mitigation Technical Working Group. Pact capacity building efforts will ensure that programs reflect sound practices; are evidence-based; remain sensitive to the dynamics of the Swaziland HIV epidemic; and work to meet the needs of OVCs in a measurable way. Pact will support the NCCU in finalizing the development of the OVC quality service standards. Pact will work with two partners piloting the WORTH model to improve the socio-economic status of women through micro-finance savings and lendings. Pact will conduct training in Gender Mainstreaming to continue to build the technical and institutional strength of partners working in prevention and HTC. As part of the training Pact will collaborate with gender experts in the region to explore and share innovative approaches to gender programming. Pact will strengthen the capacity of SWAGAA to provide technical support to other partners in responding to issues of GBV.

Pact will continue to prioritize capacity development of local organizations to integrate TB/HIV screening in their programs for early detection and treatment of TB resulting to improved care and treatment services. This intervention supports the national strategic focus of early identification of TB so that referrals for treatment are made in a timely manner. Capacity development of partners will continue to focus on TB/HIV co-infection, TB screening, referrals for treatment, and guidelines to prevent the spread of TB. Pact will work in partnership with the National TB Program and URC to support partners providing TB/HIV interventions in communities by providing IEC materials, complete the national registers, and report data to the national M&E system. Pacts partner TB/HIV programming emphasizes mobilization activities for awareness, testing, and treatment to promote early detection and diagnosis of TB in the communities. Activities include sputum collection and testing at TB diagnostic centers, collecting TB test results and giving them to clients, and providing treatment adherence support within a community setting. Pacts primary goal is to provide necessary technical support while building the institutional capacity of partners to increase their effectiveness and capacity to achieve expanded, quality services and strengthening the management of financial and human resources. Pact will continue to build the technical and institutional strength of partners that will be working in the TB/HIV technical area.

Pact will support the care and support partners to systematically integrate pediatric care and support activities. Pact will build the technical and institutional strength of partners that will be working in Pediatric Care and Support for effective management of acute malnutrition, early detection and treatment of OIs, and creation of effective relevant referrals for further care and support as. HIV exposed infants will be monitored through regular DBS, and home visits to assess homestead situation. Nutritional supplements will be provided as necessary.

Pact's Strategic Information support to partners is provided through two broad areas: staff and institutional M&E capacity and M&E systems strengthening, with the overall aim of generating program improvement decision support information. Pact will provide training on MER, data quality management, data analysis, and database development for MER and program staff. Pact will continue to assist each partner in developing results frameworks that tracks success against both PEPFAR program and organizational indicators. Pact will assist partners in the development of MER plans and data quality management plans. Pact provides additional MER systems strengthening assistance to all partners in the following areas: review and development of effective data collection, analysis, and reporting tools; setting realistic and achievable targets; establishing and strengthening data quality management systems; conducting internal data quality audits; and verifying and validating partner and sub-partner data submissions. The primary emphasis areas for these activities are training and one-on-one mentoring and TA. Pact will conduct data quality assessments aimed at meeting quality requirements for reporting to internal and external audiences including PEPFAR. These assessments will enable Pact and partners to identify and strengthen the data management processes that are critical in ensuring high quality data. Pact will work with each partner to undertake and document findings from their programs data quality assessment and develop mitigation plans to address system gaps identified. Pact will provide comprehensive mentoring MER support to a UGM partner. Pact will conduct an assessment of the UGMs MER capacity, which will provide benchmark information on the status of human capacity and systems development, as well as processes for generating, managing, and using program data for decision making.

Pact carries out organizational capacity and technical assessments to develop individualized and crosscutting plans for tailored interventions for each partner. Primary emphasis areas are one-on-one mentoring, TA, and grant and financial management support. Interventions aim to strengthen and institutionalize organizational systems and processes and improve quality and standards of services delivery. Activities target local partner staff member who work directly on program implementation and monitoring as well as senior management. Pact will ensure adherence and compliance of Partners to USAID rules and regulations through grants management workshops. Pact will conduct MCAT (Management Capacity Re-assessments) for all existing partners. The findings from reassessments will assist Pact in developing specific grants and financial management TA for each partner. Technical re-assessments analyze key gaps in technical programming and are used to develop tailored plans for targeted interventions. All local Partners receive direct one-on-one TA to strengthen the design of programs to improve quality of service delivery, address gaps, and identify opportunities for scale-up. Pact will support its grantees to mainstream gender in all their HIV/AIDS focus areas by conducting gender assessments and developing strategies to address the gaps identified. Pact will continue to work with the identified UGM partner to transfer skills required for managing a UGM and mentoring implementing partners. Pact will develop a program of technical assistance to enhance civil societys involvement and success in the Global Fund program in Swaziland. Pact will work closely with the PEPFAR team, the CCM, NERCHA (and/or other principal recipients) and key stakeholders to design and implement technical assistance program that will address the capacity needs of civil society organizations including such areas as proposal writing, program planning, monitoring and evaluation and financial management.

Programming will support the National Strategic Framework prevention objectives of behavior change (including a workplace focus). Many activities link to HCT, which the NSF recognizes as a key strategy in prevention. Pact will support partners to implement prevention activities which support the attainment of the NSF, Partnership Framework, and SBCC strategy. Activities will address the drivers of the HIV epidemic in Swaziland: rates of partner change, prevalence of concurrent partners, sexual mixing patterns, sexual practices and condom use, age of sexual debut, and levels of sexual and physical abuse especially for women and girls. Pact partners prevention activities focus on appropriate messaging for social and behavior change in target populations. Social behavior change communication will be directed at specific behavioral outcomes including correct and consistent condom use, delayed sexual debut, fewer partners/reduction of MCPs, and issues of abuse and violence. Pact partners implement activities in schools, churches, community centers, and households. Approaches include community volunteers and peer educators to conduct age-appropriate activities, working with religious leaders to reach congregations with value-based prevention strategies, promoting HIV counseling and testing, and the use of other preventive services, road shows, and radio programming. All partners implementing HIV prevention activities will mainstream gender in their prevention activities to address some of the underlying gender norms and behaviors that influence further spread of HIV. Pact will strengthen and support the linkages of HIV prevention programs with MC programs. Sexaul prevention activities will support pre and post MC interventions. To ensure consistent, coherent and comprehensive HIV programming across all partners, and to be in line with the NSF, PF, and NSBCC, all partners implementing prevention activities will take part in the Pact Partners Prevention Technical Working Group (PPPTWG).

HIV testing and counseling (HTC) has been identified as the entry point for HIV prevention, treatment, and care and support. It is a key strategy to empower individuals at a personal level to make informed choices and decisions in seeking appropriate health care. Pact will build the technical and institutional strength of partners to increase testing opportunities and enable people who test positive to seek appropriate care and prevent transmission. HIV testing and counseling services to be supported will be both provider and client initiated. Pact will also ensure that partners scale up HTC services by increasing the number of both free-standing and provider initiated testing and counseling sites nationwide, targeting both key and rural populations, improving the ratio of male to female counselors and development of programs aimed at increasing couple/partner testing and counseling and disclosure of some services to lay counselors. Pacts partners provide HTC services from mobile sites, linking clients to treatment and care services including referrals for CD4 counts and referrals to support groups. HTC activities are utilized for personalized HIV prevention education to clients through pre- and post-test counseling sessions. Pact will strengthen the HTC partners capacity to mainstream gender in HTC and address underlying gender norms and behaviors and gender based violence issues that influence further spread of HIV. Partners will also forms strategic partnerships with MC providers to facilitate easy referrals and linkages of HTC to MC.

To strengthen programming in this area, partners will focus on reduction of new infections amongst sexually active individuals and also target high risk sexual populations such as commercial sex workers, truck drivers, uniformed forces, and mobile populations. This will entail dissemination of information on correct and consistent use of condoms in preventing sexual transmission of HIV, as well as systematic and continuous condom distribution. Partners will work with other stakeholders to ensure constant supply of condoms for distribution to sites. Partners will educate, demonstrate, and distribute condoms to sexually active adults. This intervention will increase: the availability and use of male and female condoms; the proportion of sexually active persons who use condoms consistently; and the number of new condom outlets per region. The primary emphasis for these activities is direct reach, service delivery, and training. Prevention activities will also be implemented to support the attainment of the NSF, Partnership Framework, and SBCC Strategy. All partners will mainstream gender in their prevention activities to address some of the underlying gender norms and behaviors that influence further spread of HIV. Pact will strengthen and support the linkages of HIV prevention programs with MC programs. Prevention activities will support pre and post MC interventions, and will continue to encourage the use of condoms before and after MC. Pact will work with traditional authorities to address the male norms and behaviors that influence further spread of HIV. Traditional authorities include a women regiment who are recognized as the cultural gate keepers in the country. Khulisa Umtfwana is an organization established by the Queen Mother to protect the traditional ways of raising children in communities. The program will address young people on gender norms and behaviors and GBV issues that are entrenched in the Swazi culture which have a direct impact on the spread of HIV. Partners will use community dialogues as the main tool to initiate discussions and develop strategies for positive cultural influences on gender and HIV.

Pact partners will support and provide ARV treatment at the local level to support the MOH's decentralized ART strategy. Partners will provide services which include HIV Counseling and Testing, CD4 count monitoring, ART initiation including Pre-ART counseling, ART treatment (act as a refill /outreach site to an ART centre), managing opportunistic infections, TB screening, TB treatment, and adherence support. Partners will be supported by the MOH with the supply of test kits, drugs and medication for treatment activities. Pacts partners will build on PEPFAR-funded activities to strengthen treatment services through specialized training that will improve and expand quality of care, as well as support grassroots initiatives for positive living treatment adherence.

Pediatric treatment will include routine assessment and treatment of OIs through the two partners. CD4 will be monitored every 3 months or more often if it seems that the symptoms are increasing. Cotrimoxazole will be initiated at different CD4 levels depending on the age and size of the child. Education is done every step of the way and in the presence of the childs care taker. The children will be given special attention along with their care-givers to teach how to take the medicine, when to ask for help, etc. Nutritional supplements will be given as needed.