The World Vision (WV) Preventive Care Package (PCP) program will continue to scale-up the previous PCP services for people living with HIV and AIDS (PLHIV). The PCP programs goal is to mitigate the impact of HIV/AIDS in Ethiopia and improve the quality of life of PLHIV, their households and the community through sustainable coordinated evidence-based interventions. Local sub-partner NEP+ will lead the behavior change communication (BCC) for HIV/AIDS prevention component through community outreach services to increase PLHIV knowledge, attitudes and practices as well as increased demand for the PCP kits. Tulane University will support the use of evidence-based interventions, high quality monitoring and evaluation (M&E) and Operations Research (OR). The program will start in Addis Ababa, SNNPR, Oromia, Tigray & Amhara regions and then scale-up to other regions. Project activities will ensure PCP components are available, acceptable, & sustainable to meet PLHIV care needs and promote adherence to and increase uptake of clinical services like HCT, PMTCT, ART, etc. The PCP services will be delivered by health facilities, Health Extension Workers (HEW) and various categories of PCP-Community Workers through strengthening referral linkages & coordination to ensure efficiency. As a transition mechanism, the program focuses on strengthening capacity and working through the govt systems with a local organization involving PLHIV. Activities will transition to host country (NEP+ and MOH) by year five of the program. The program has 3 vehicles available from phase I program and 2 approved new vehicle purchases through matching funds. Though no COP12 funds are being requested for this project, the project will continue as described using pipeline funds.

Adult care and support funding allocations for this continuing activity is to increase access to the Basic Preventive Care Package (BPCP) including safe water for PLHIV. PLHIV in resource-poor settings often have limited access to BPCP including safe water, hygiene and sanitation. PEPFAR/E through this project will strengthen the governments safe water initiative and strengthen implementing partners access to BPCP services for the PLHIV they serve. The BPCP package implementation is coordinated through collaboration with PEPFAR-supported partners (Universities and the CHAT-CS partners) providing comprehensive HIV/AIDS prevention, treatment, care and support services at health facilities (HF). Existing community networks (PLHIV support groups, etc) will be targeted, through the NEP+ coordination mechanism with active engagement of PCP community workers (CW) as the primary link between HF and communities. Partnerships also involve, FHI, SAVE-US/FBP, WFP, PMI, MOH/HAPCO, Health Education Center and AIDS Resource Centers. National BPCP distribution will be done in coordination with the current national PEPFAR/MOH logistics management system. BPCP kits will be distributed to PLHIV through HF and community-based care programs. The BPCP kits include a range of information and items to reduce morbidity: 1) Home or locally produced point-of-use water treatment; 2) Oral rehydration salts (ORS); 3) Basic hygiene products; 4) Antihelminthics; 5) Condoms (for sexually active clients), 6)Safe water storage vessels, 7) Long-Lasting Insecticide Treated Nets (LLITN) (as required), 8)IEC user-friendly, low-literacy materials about products, 9)Referral information. Activities also include: 1) Training of health providers at HF on the implementation of BPCP services; 2) Training and deployment of PCP-CW to counsel and educate clients to increase uptake of clinical services, 3) Healthy behaviors, proper use of BPCP kits; 4) Support of existing community-based education by the HEW and CW to create demand for health services delivered at the HF, community and HH level; and adapt/adopt the existing IEC/BCC and teaching materials.

Strategic information is critical in implementing quality community and facility-based PCP services. PEPFAR/ E has been supporting implementation of the three ones: one plan, report, and budget, as per FMOH harmonization & the national HMIS manual. Per the HMIS reform, Community Information System (CIS) is being implemented at the HP level by the HEWs. The WV/PCP project proposes using the information gathered by the HEWs and HMIS to strengthen monitoring of the BPCP and community activities conducted by NEP+, ANECCA, and partners working at the community-level. The PCP program proposes to conduct a national PCP M&E capacity assessment at the HF and community levels to explore linkages with PCP monitoring with current HMIS and CIS. This includes supporting needs-based capacity building technical assistance to increase M&E and operations research (OR) skills. Subsequent mentoring will be provided to ensure adequate M&E/OR skill transfer. OR will be conducted to investigate the impact of PCP service provision on adherence to clinical appointments and adherence to ART. In the first stage, a cross sectional survey will be conducted. In stage two, a longitudinal study on sampled beneficiaries will be conducted. Tulane will be working through their established relationships with local universities, Health M&E Departments. TA in Data Quality Assurance (DQA) will be provided to improve data quality at health facilities using data auditing guidelines. A national data quality assessment will be conducted using LQAS to minimize and control double counting issues. BPCP will be mainstreamed in participatory review meetings and there will be trainings on Data Demand and Use for decision makers, HF and PCP-CWs. Coordination Mechanisms will be used as forums to share experiences and review performance, lessons learned, promising practices, and challenges. To strengthen BPCP services, the project proposes to develop a cellular phone-based, voice-driven, expert system to support diagnosis, consultation, follow-up, and education for PLHIV. This tool was developed by Tulane to be integrated with the FMOH Electronic Health Record System.

The PCP program focuses on Health Systems Strengthening (HSS) aligned with USAIDs GHI principles and the Partnership Framework. The PCP program strategies are aimed at strengthening health service delivery by improving access to and uptake of comprehensive services, strengthening health worker capacity in PCP, strengthening referral linkages, integrating supportive supervision (SS), and improving data collection and utilization. PCP will support the development of key PCP tools, standardized trainings, joint review and monitoring processes, and experience sharing protocols to strengthen existing systems. Community systems will be strengthened by building community structures, increasing demand and linking HEWs to PCP-CWs to promote task shifting for greater efficiency. The program will work with other PEPFAR partners to design a comprehensive capacity strengthening plan and transition to local the partner (NEP+) and host country recipient (FMOH). It will develop a detailed handover timeline to ensure that transition/sustainability plans are jointly implemented. The project will strengthen existing GOE systems and structures such as the logistics system and actively engage in the community-to-HC referral system by analyzing and strengthening referral system tools, ensuring accurate documentation and tracking of referrals. The logistics team will provide trainings to the HF staff to monitor, track, & report on PCP kit stock. The project will collaborate with the GOE and partners to ensure that periodic client satisfaction surveys include PCP by ensuring questions relevant to PCP program are addressed and data is analyzed and used to address critical issues. PCP will facilitate joint SS between HF staff & PCP partners to monitor: stock & supply of PCP kits at the health facilities; client usage of PCP kits & associated adherence; HC staff & PCP-CW skills in BCC and delivery of key PCP messages.

The PCP project will contribute to PMTCT service uptake by integrating PCP activities with PMTCT services at the health facilities (HF) and increasing awareness among clients of the community-based ANC, PNC, and child health activities. PCP kits contain IEC materials about PMTCT that PCP community workers (PCP-CW) will use to reinforce messages during home visits with HIV+ mothers. The project will link with PEPFAR PMTCT existing programs, promoting the mother-to-mother concept and integrating PCP information into these programs. PCP-CW will provide PMTCT referrals to clients that are pregnant or new mothers. The referral system will be strengthened through referral tracking and feedback loops. The PCP program will integrate antenatal and prenatal care with community prevention, care and support services, such as Nutrition, Assessment, Counseling and Support (NACS). ANC and PNC services are key entry points to integrate messages, PCP services, treatment and follow-up. The project will work through the PCP CW to improve PCP behaviors and practices, increase BPCP kit uptake, and educate HIV+ mothers on safe infant and young child feeding. The program will work with existing malnutrition assessment services at the HF for HIV+ mothers and their children, and will facilitate referrals for both services and follow up. There will be continued program support for micronutrients for PLHIV through routine ANC services. Upon referral for ANC and PNC visits, the project will encourage mothers to seek early infant diagnosis and work with partners such as ANECCA to ensure access to ART services as needed. They will also connect HIV+ mothers to PLHIV associations to register and receive adequate psychosocial support. Referrals to social programs, such as the NEP+ IGA, World Visions WISDOM MF institution and regional government will also be instituted. Pediatric patients will be linked to USG pediatric and OVC implementing partners to ensure access to relevant OVC services such as education, health, life skills, psychosocial support, and protection.