In FY2010, DOD/PEPFAR activities supporting the Lesotho Defence Force will continue the successful collaboration that has been ongoing since 2002, which now supports LDF and Lesotho goals as outlined in the Lesotho Partnership Framework. Over the years, especially with the introduction of the PEPFAR program to Lesotho, the LDF has seen tremendous scale up of their HIV/AIDS program. This has included training of LDF nurses for ART, pharmacy training, renovation and equipping of laboratory facilities, provision of a mobile clinic for outreach to remote bases and surrounding communities, building of the Wellness Center which supports integrated care, conducting the first study of HIV prevalence and risk factors in the LDF, and implementation of an innovative electronic health record with portability for mobile services. PEPFAR funding has also supported education and sensitization of all ranks and family members on HIV prevention and care and a peer education program. DOD directly implements programs with the LDF through direct procurements and technical assistance. In FY2010, DOD/PEPFAR will support the continuation of the existing programs with an increased emphasis on long term capacity development and retention in the LDF. Utilizing FY2010 funding PEPFAR will support continued PMTCT training and provide alternative feeding supplements and training for mothers who choose not to breastfeed. PEPFAR/DOD will assist the LDF to strengthen their ability to prevent infections through peer-led prevention programs in all of the units, and

increased testing at all of the bases; and the use of data collected in the first LDF bio-behavioral survey. Nurses from San Marcos University, California will work with LDF and MOH nurses to train PwP trainers, work with local nurses to provide care and support, and provide clinical training to the nurses. PEPFAR/DOD supports LDF basic care activities including training to target reduction of stigma and discrimination, palliative care training, provision of home based care kits, and supplies for the new Wellness clinic and Mobile Clinic that may not be available through the Ministry of Health. TB/HIV activities will include training and technical assistance for the laboratory, training for healthcare workers, and for the peer educators. In the area of Counseling and Testing, PEPFAR/DOD will continue to support training and supervision of C/T with an emphasis on capacity-building so that the LDF may be able to do their own program management.

The LDF has identified several key areas for long term training to ensure appropriate clinical staffing. FY2010 PEPFAR funding will support the first year of a five-year plan for human resource development.

FY2010 funds will support preventive therapy, such as nutritional supplements, cotrimoxozole, and pain

relievers. Other care includes treatment of opportunistic infections, and support to those who are on PTB

medications and ARVs. Patients will also be supported spiritually and psychologically. Nutritional support

will be provided for adults meeting clinical guidelines, equipment as needed for clinical facilities and

support for capacity development through California State University, San Marcos School of Nursing and

other appropriate training opportunities. The program aligns with PEPFAR in Lesotho in an effort to assist

with the "Care and Support" work in the country and to provide assistance with the critical shortage of

nurses. Students will be placed at the military hospital and wellness clinic, and will visit patients in the

rural areas with the Mobile Clinic and provide care to those in need. Depending on the number of

students, 1-2 faculty will accompany students to provide supervision. Faculty will also provide educational

programs, training and services to the military and civilian medical/nursing professional and counselors

as requested. LDF family support groups and networks. LDF will organize regular meetings for PLWHA

and their families which will include training and guest speakers regarding HIV treatment literacy,

adherence, PwP, and general prevention. Community events will provide a venue for generating interest

and disseminating information about these groups. Addressing stigma and discrimination at both the

home and community levels. Community health workers and people living positively with HIV/AIDS will

be trained to address issues of stigma and discrimination at the community level. Health care workers will

address stigma and discrimination at the home level as part of overall home-based care.

DOD will provide technical assistance to work with the LDF on an assessment of OVC needs in the LDF

and development of referrals to civilian programs for service delivery.

Prevention with positives/healthy living training will be conducted through the unit peer educators.

The PEPFAR PWP program will be rolled out.

LDF family support groups/ LDF will organise regular meetings for PLWA and their families which will

include training on adherence and positive living.

Care will also include nutritional supplements for malnourished HIV positive individuals

Summary: LDF HCT activities will support HCT in the clinical and community settings. Funding will support PSI to train and supervise CT and to work with the LDF to increase their capacity to manage their own HCT program. Funding will also support provision of supplies. The mobile clinic will provide C/T to remote bases and to the surrounding communities.

Background: The LDF provides HCT to hospital and clinic patients and to the community. They have been leaders in the "Know Your Status" campaign with the technical support of PSI.

Activities: 1. Training of new counselors/testers - at least 12 new counselors will be trained 2. Refresher training for existing counselor/testers. The training program will refresh and update skills and focus on burn-out prevention 3. HCT test kits and supplies will be provided as needed to fill gaps 4. C/T will be offered prior to all MC 5. In coordination with LDF PSI VCT Councilors, provide 24 (twice monthly) VCT outreach services at LDF bases and clinics. 6. Counseling/Testing will be provided as a component of the HIV bio-behavioral surveillance project. Counselors trained for the survey will continue to work at LDF sites after the survey 7. All HIV patients will be referred to LDF clinical services for post test care and support 8. All TB and STI patients will be offered Counseling and Testing on an opt-out basis.

Nutritional support for HIV exposed infants up to 18 months of age will be provided. The pharmacist will

monitor the supply of supplements and track the nutritional status of the enrolled patients.

1) Surveillance and surveys: The LDF will build upon the data collection of the 2010 seroprevalence and

behavioral epidemiology risk survey (SABERS) with data analysis, report writing, conduct of a data

workshop and study dissemination. LDF will participate in Conferences with other militaries to discuss

SABERS and long term surveillance systems.

2) HMIS: LDF has recently begun use of an electronic medical record system. Utilizing FY2010 funding

LDF will evaluate the rollout of the HMIS with respect to use of the computers and electronic records.

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3) M&E. PEPFAR will support the hiring of a Strategic Information officer who will work from within the

LDF to review all HIV programs for the existence of embedded monitoring and establishment of

monitoring systems where they are not currently in place, support the newly initiated HMIS system, and

support the use of from the 2010 LDF HIV SABERS. The SI officer will also importantly have primary

responsibility for LDF indicator targets and reporting

Summary: The Makoanyane Military Hospital has held workshops for senior officers to introduce the military HIV/AIDS policy and to get their support in implementing the policy and HIV/AIDS guidelines. HIV project coordinators have also had training to build their capacity in planning, monitoring and evaluation of the general HIV/AIDS program in Lesotho Defence Force. Background: The program aims at training military policy makers, HIV project coordinators and members of the HIV/AIDS team that all facilitate in HIV/AIDS program development. Activity: 1. MMH will continue training senior officers to introduce the military HIV/AIDS policy. • It will also continue the training of HIV coordinators on the strategic objectives of the program. This will help them to monitor and be able to evaluate all HIV/AIDS program and make plans to strengthen the program and plan activities for the programs. 2. Training of program coordinators on new monitoring and evaluation activities guidelines given by PEPFAR. Human capacity building and training of military health personnel. Nurses, pharmacists, laboratory technicians, and doctors will be trained on HIV treatment/ART and the provision of counseling to terminally-ill clients. The hospital provides training for chaplains on HIV and home-based care. Nurses and physicians and pharmacists will have the opportunity to attend future IDI trainings at Makere University in Uganda. Considering the crisis of trained technical manpower at Makoanyane Military Hospital of the Lesotho Defence Force (of Nurses, Pharmacists, Radiographers, Lab Technicians, etc), LDF has proposed that they implement a Five Year plan under which suitable candidates from MMH/LDF will be sent for various Nursing and other technical medical courses within Lesotho/South Africa every year, so that the vacancies can be filled up in a time bound program. The LDF plans to send

10 candidates each year (7 Nursing, 1 Lab Tech, 1 Radiographer & 1 Pharmacist), beginning 2010, to various Nursing Colleges in Lesotho for the said training program. 3. TB clinic renovation

MALE CIRCUMCISION STUDY HAS BEEN CONDUCTED

The Lesotho Defence Force is highly supportive of MC as an HIV prevention modality. A study of the prevalence of types of MC will be conducted in 2009 in conjunction with the LDF recruitment. Results of this study will provide information regarding the types of MC that men have, and will give an indication of the number of men who might benefit from medical MC who otherwise report that they are circumcised. This was funded in the FY08 COP.

The LDF currently provides MC, without PEPFAR support, on a very limited basis by the surgeons at Makoanyane Military Hospital (MMH). Once the Lesotho National MC Policy is adopted the LDF will scale up MC.

Training of medical personnel on MC will conducted jointly by JHAPHAIGO and PSI.

Comprehensive prevention will be integrated into the work flow for medical MC. The LDF has trained VCT counselors, peer educators, and nurses who provide HIV prevention education available at MMH.

Background:

LDF provides care at the Makoanyane Military Hospital and at its Wellness Center. It provides health

services including HIV/AIDS services through preventive, promotive, curative and rehabilitative care for

its clients. It provides these services to military personnel and their families and to personnel from other

uniformed services and government officials. The catchment population is estimated at 10,000. The

hospital has been providing PMTCT services since May 2006. The PMTCT program serves as an entry

point for husbands through the use of WHO standardized country protocols. Particular attention will be

paid to the referral of women identified at PMTCT who are HIV+ and need care follow-up and their

babies, and the male family members for HIV C/T and referrals to care.

Summary:

Prevention of mother to child transmission (PMTCT) program aims at training military health workers on

the WHO standardized country protocols and national guidelines to equip them with skills to care for HIV

infected mothers, their babies and fathers.

• Health workers will be trained on counseling and testing of mothers in the Ante natal clinics

• Provision of Antiretroviral treatment for PMTCT to mothers.

• Management of infants at delivery and after birth.

• Follow up of both the mothers and t

PEPFAR Lesotho laboratory activities with the LDF will include training for LDF personnel and provision of commodities not readily available through Ministry of Health Central Stores. Technical assistance will be provided as needed. Additional furnishings for the new facility will be provided as needed.

Background: DOD has support LDF laboratory activities since 2002. In addition to PEPFAR funding, DOD has secured $50,000 in FY06 Foreign Military Financing (FMF) assistance to be used for laboratory training, equipment and supplies. The FMF will be used during 2008 - 2009 to provide technical assistance, support long-term training for 2 technicians, and to provide furniture and equipment needed in the move from the MMH main hospital facility to the new MMH Hospital site.

Planned activities for FY10 include the following: 1) Training for laboratory technicians. This will be accomplished through a combination of targeted technical assistance and enrollment in a local laboratory technical school program. Both in-service and pre-service trainings will be supported. 2) Provision of commodities that are not provided nationally. 3) Furnishing of the renovated Makoanyane hospital laboratory including 4) Support the implementation of QA program including TB and HIV testing

Continuing previously funded activity, the new TB structure will be completed and furnished with extra

attention given to infection control. LDF personnel will attend appropriate clinical trainings. HIV testing

and referral systems will be enhanced.