EGPAF will support key intervention areas in the Partnership Framework through: Supporting the MOH to create an enabling environment for universal access to HTC within all health facilities; Supporting implementation of routine HTC services; Strengthening linkages and referrals; and Building provider capacity and strengthening health systems. This project will focus on HTC at primary care settings, which include clinics and PHUs, as the entry point for individuals to access HIV services. While most women are reached with HTC through ANC services, testing for men and children lag far behind. Expanding HTC to all service points, particularly STI, TB, inpatient and outpatient department (OPD) clinics, and expansion of routine screening of child and mother health cards, will significantly reduce missed opportunities for HTC and subsequent care and treatment services. This project will collaborate with the PEPFAR community HTC partner (PSI) to increase demand for routine HIV testing at every service point within health facilities. In Year 1, the project will reach 113 health facilities; by end of Year 3, the project will support 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 coordinate activities, maximize results, and leverage funding. EGPAF will also engage with the relevant departments in the MOH, as well as with the National Emergency Response Council on HIV and AIDS (NERCHA) and PSI and other partners, to facilitate implementation of the HTC communication strategy and the development of necessary HTC job aids and promotional materials/messages, avoiding duplication of efforts and waste.

EGPAF will support the MOH to firmly establish linkage to appropriate care and support services following provider-initiated HIV testing in all 4 regions of Swaziland. EGPAF will build on the successful pilot of the Patient Follow Up Standard Operating Procedures, which focuses on linkage to care, retention in care and defaulter tracing. EGPAF will pilot the use of expert clients as additional post-test counselors for newly diagnosed HIV patients in facility-based setting HTC settings. They also will develop and utilize new IEC materials to create demand for linkage to care. To assist in monitoring their efforts, they will develop/improve existing referrals forms, registers and monitoring systems. This effort will 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, clinical mentoring and supportive supervision, as well as the community linkages programmuch of which is primarily supported by ICAP.

EGPAFs 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 collaborate with PSI and URC to increase demand for routine HIV testing in tuberculosis (TB) clinical settings, both outpatient 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 so lower-level health facilities can better deliver these services to newly-diagnosed clients. Clinics will serve as platforms to access communities with HTC services through outreach, while the clinics themselves will be connected to secondary and tertiary health facilities through a strengthened referral network to ensure provision of care and treatment services.

EGPAF will advocate for and promote national efforts on task sharing and shifting to extend ART provision, starting with the MOH?s proposed special authority for nurses to initiate ART for pregnant women and TB clients as high priority groups.

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EGPAF will support the GKOS to achieve its goal of increasing the percentage of the population undergoing HIV testing each year to 50% of women and 40% of men by 2013 through strengthening health 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 finalize the national policy on routine HTC; national HTC scale up plan and development/adaptation of PIHT SOPs and job-aides. EGPAF will also build capacity health workers through training and mentorship on PITC including on couple HTC and pediatric PITC.

EGPAF will rollout PITC to all settings and service points including inpatient and outpatient facilities, TB clinics, STI services, ANC, family planning, child welfare units, and male circumcision sites using the national HIV testing algorithm. The facility-based PITC services support will take place in a phased manner, beginning in Year 1 (2011) with support to 113 health facilities, reaching all health facilities by Year 3. EGPAFs support will be tailored into 2 categories of health facilities. Category one health facilities which include largely the PHUs and clinics will receive the standard support which includes trainings, 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 and 5 health centers will receive the standard support as described under category one plus intensive support to implement PITC which includes placing lay counselors in TB units and OPD, renovation or upgrading the infrastructure to create space for PITC at OPDs, improve the client flow to facilitate linkages to care according to the national PITC SOP, Billboards to increase demand of HTC services and working with inpatient 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 mentorship once every month.