PSI strives to tailor its HIV counseling and testing services appropriately for men and women, and to promote men and women (or men and men and women and women) to be counseled together as couples as a means to ensure gender equity. PSI will continue its efforts to encourage testing among men as a population with fewer regular encounters with the health care system and as leaders in their communities./families to set a positive example by knowing their HIV status. PSI will continue its work with MARPs including sex workers, MSM and mobile populations to increase HIV testing and subsequent HIV prevention and care/treatment seeking behaviors among these groups. Through PSIs Corporate AIDS Program, PSI will continue to expand the availability and accessibility of HTC services in the workplace.

The content of PSIs HIV counseling and testing work addresses a comprehensive set of counseling messages that covers prevention strategies, linkages to care and treatment as well as family planning messages and TB screening and subsequent referral. Counseling messages on these topics are tailored to the individual based on needs that emerge during the one-on-one counseling interaction. All counselors are trained to promote and discuss family planning when appropriate and to make referrals for family planning products and services. All counselors incorporate the TB screening tool into the counseling session and also discuss TB diagnosis and treatment and make referrals as appropriate.

PSI will support the MOH to firmly establish linkage to appropriate care and support services following community-based HIV testing in all 4 regions of Swaziland. PSI 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. PSI will expand the use of expert clients as additional post-test counselors for newly diagnosed HIV patients to other key community-based 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.

The PEPFAR Swaziland Pediatric HIIV care and support covers a target population of 0-15yrs. PEPFAR Swaziland supports family-centered approach to HIV care and treatment which includes family testing strategies at health care facilities (DBS for infants 0-18months and rapid test thereafter) as well as during home-based HTC. Children are tested as part of the family during home-based testing and are referred for care and support services similar to standard protocols for adult care and support. At health facilities, a family tree approach is used to identify all children in the family who need to be tested, using the parent as an index case at pre-ART and ART care points. There is an efficient system in place at health facilities to identify exposed infants for DBS. More than 95% of exposed infants currently receive DBS. The far majority (79%) of exposed infants are initiated on co-trimoxazole and over 95% are initiated on extended Nevirapine. The main challenge is tracking exposed infants to know what happens to them. PEPFAR Swaziland is currently working with the national strategic information department to set up a surveillance system to follow up exposed infants. PEPFAR supports adolescent clubs to provide peer support for adolescents living with HIV. These clubs meet regularly to discuss adherence issues, and how to live positively. Efforts are in place to strengthen adolescent care and support through special clinics where adolescents will receive more attention to issues specific to adolescents and to ensure smooth transition into the adult care and support programme to minimize lose to follow up. An adolescent TWG has recently been formed at the national level. This TWG which is a sub-committee of the Pediatric TWG will focus of adolescent specific issues to ensure that their issues are not lost between the adult and pediatric TWG discussions. PEPFAR Swaziland partners will participate in these meetings to provide technical support for both pediatric and adolescent issues. PEPFAR will support job aides and IEC materials that are kid friendly to support psychosocial and adherence counseling. PEPFAR Swaziland is supporting efforts to improve early enrollment of infants testing positive from DNA-PCR into care and treatment. Nurses are being trained both in didactic trainings and clinical attachments through a sub-award to Baylor Center of Excellence to acquire more knowledge and skills in diagnosis and management of pediatric opportunistic infection, pediatric phlebotomy as well as psychosocial and adherence needs of pediatrics. Starting from FY 13 through FY 14, the pediatric guidelines will be revised in line with current evidence to improve pediatric HIV care and support. World Food Programme has a food for prescription programme for children from 5yrs and above. PEPFAR partners support the implementation of this program by training healthcare workers on how to identify malnourished children using MUAC and/or BMI.

PSI will primarily provide technical support in strategic information to ensure that all community-based HTC partners have MIS and M&E systems that are in line with national, international and PEPFAR guidelines. PSI will help with the integration of the national HTC register and other relevant M&E forms for all partners/sites. PSI will help ensure that these organizations/sites are reporting into the MOH and will ensure that MIS systems are integrated and capacitated to support track key HTC indicators.

PSI will also help capacitate the Ministry of Health to collect, manage and use key program data to make evidence based decisions to ensure HTC program coverage. For example, PSI will provide technical support to the Ministry of Health to establish and maintain the health services tracking map. PSI will work through the HTC Core Team to ensure quarterly meetings to review the map and make decisions about the geographic location of services including HBHTC efforts. As part of quality improvement, PSI will lead mentorship sessions at HBHTC data collection level to ensure that the quality gaps are monitored and addressed. PSI will also help transition the database of lay counselors to the Ministry of Health and provide technical support to ensure this database is updated on a regular basis.

PSI will support human resources for health by seconding a person to the Ministry of Health to work closely with the National HTC Coordinator. This person will be focused on community based HTC outreach and will help coordinate all PSI and partner activities to ensure broad geographic reach of this HTC approach. A quarterly meeting with all community based HTC implementers will be held to share best practices and assist in capacitating CBOs. He will also help to coordinate HBHTC. He will establish a national HTC outreach protocol that can guide future community based HTC efforts. This National HTC Outreach Coordinator will be funded fully by PEPFAR for two years. Subsequently, integration options will be explored for the position with the Ministry of Health and/or to integrate the responsibilities with the existing responsibilities of the position seconded by EGPAF.

PSI grant activities will focus on providing HTC to the general population adults aged 15-49- through community-based HTC. In pursuit of the national strategic framework objectives to reach 196,000 people with HTC on an annual basis and to increase the proportion of men tested to 40% and of women to 50%, PSI will design and focus its activities to be appealing to both men (e.g. dip tanks) and women (e.g. VCT). PSI will also focus on reaching MARPs including sex workers, MSM and transport operators. The Luke Commission will help ensure that HTC reaches the most rural areas as well as the older age segments of the general population. PSI will collaborate with existing partners to provide HTC services in the workplace. Activities will be focused nation wide and will take place in a variety of settings. Outreach activities aim to take HTC services deep into the communities at community events, dip tanks, medical outreach camps, mobile circumcision services, targeted HTC campaign events, workplace and other innovative strategies. PSI will also continue to provide HTC in VCT settings through its New Start franchise network. PSI will conduct HBHTC to help fill in gaps in HTC geographic coverage. PSI will map all CB-HTC activities in the country and door to door HTC will be conducted as a fill-in-the-gap activity. PSI will work with EGPAF to ensure that there is synergy between facility based and community based HTC activities. PSI will continue to work with the Ministry of Health to refine, test and finalize the national referrals and linkage system. PSI will use its TRaC surveys to assess HTC uptake and to behavioral determinants that are correlated with HTC service utilization that will inform the design of communications activities to promote HTC and to normalize testing. PSI will assist MOH to develop an accurate and reliable M&E system that also harmonizes HTC and care and treatment data. PSI will support MOH to establish an HTC health services map using GPS coordinates. To help ensure harmonized messages on HTC across all HTC entry points, PSI will conduct a DELTA Marketing Planning for stakeholders to develop one national communication plan.