Summary

In January 2007, USAID awarded an associate award to Pact to implement HIV/AIDS prevention and care

project, with major granting and capacity building components. Pact Malawi's efforts will go beyond

HIV/AIDS technical assistance, focusing as well on strengthening local partners' organizational capacity,

local ownership, and sustainability by addressing financial and programmatic accountability, including M

and E and financial management, leadership, management, governance, and strategic direction.

Background

Pact's PMTCT partners - Malamulo SDA Hospital in Thyolo District, CCAP Nkhoma Synod in Lilongwe

District, and Livingstonia Synod in Mzimba District, will contribute to scale-up of quality and comprehensive

PMTCT services in Malawi. These partner FBOs have experience in PMTCT from previous projects

supported through their hospitals and heath centers with PEPFAR funding.

Pact's program will be implemented within the context of the National PMTCT comprehensive program,

implementing partners, DHOs, which provide HIV test kits and other essential supplies for PMTCT services,

and with the BASICS program supported with USG funding for nutrition support. Effective referral systems

will be strengthened or established between PMTCT implementing partners and public sector facilities and

with community based organizations for psychosocial support and reduction of stigma and discrimination

surrounding HIV/AIDS.

Activity 1: Community Mobilization for PMTCT

Pact's three FBO partners, Malamulo, CCAP Nkhoma hospital and Livingstonia Synod Ekwendeni hospital,

will conduct community mobilization in their catchment areas targeting women of reproductive age and their

partners to use PMTCT services through sensitization on importance and benefits of the available services.

Community leaders and other gatekeepers, such as traditional healers, community women counselors,

traditional birth attendants, and grandparents - who are custodians of culture and have influence on

maternal and child health practices - will be targeted with messages to strengthen community support

PMTCT and use of services. Sensitization messages will also target men, who are often decision makers in

the family, to encourage them to participate in PMTCT activities and provide support and care for their

families by male PMTCT motivators. Information dissemination methods will include distribution of IEC

materials, drama, song, and involvement of PLWHA and post-test support groups and clubs.

Activity 2: HIV Testing and Counseling (HCT)

Pact's partners will provide HCT for PMTCT integrated in Maternal Child Health (MCH) services, including

ANC, labor and delivery, postnatal, family planning, under five, IMCI, and nutrition rehabilitation targeting

pregnant and breastfeeding mothers, as well as mothers with unknown HIV status and their partners. In

addition, exposed and suspected infants, such as children with TB, severe malnutrition, failure to thrive,

chronic malaria, and other severe illnesses at 18 months will be targeted for HIV testing and the parents

counseled for HIV. A family centered approach will be applied to identify other HIV-infected family members

through an index case, which could be a mother or child identified in the MCH services.

All three partners have already adopted provider-initiated HCT using the opt-out approach for PMTCT in

MCH services. Service providers will continue to offer routine HCT following group pre- test counseling to all

women and partners attending MCH services. Couple counseling will be encouraged to promote male

involvement. Post-test counseling for HIV-negative mothers will be provided counseling to maintain their

negative HIV sero status, family planning to prevent unwanted pregnancies, and referrals to support groups

for nutrition and infant feeding support.

HIV infected mothers' post-testing counseling will include information about available services and support,

including CD4 testing, ART for eligible clients, ARV prophylaxis, infant feeding counseling, follow up for

maternal health and nutrition, and mother support groups. In addition, HIV-positive women will be

encouraged to bring partners to be counseled and tested at PMTCT sites to enhance support for partners

irrespective of the men's HIV status, reduce stigma, and afford individuals/couples the opportunity to make

informed decisions on accessing care and treatment services.

Activity 3. Follow-up Care and Support for HIV-Positive Mothers During Pregnancy, Labor, and Delivery

Pact's partners will strengthen follow-up care and support services for HIV positive women through

pregnancy, labor, and delivery. During pregnancy the mother will be monitored, including WHO staging, HB

test, and clinical care management, such as continuation of prophylaxis treatment of OIs and ART. Maternal

nutrition will be assessed through routine ANC weight motoring, provision of micronutrient supplements, and

counseling on diet. Counseling is also provided on infant feeding options. Mothers will be encouraged to

disclose HIV status to family/partners through continued counseling and to deliver in health facilities, where

service providers will apply risk-reduction interventions for HIV transmission and administration of

appropriate ARV prophylaxis for exposed infants. All women with unknown HIV status in labor will routinely

be offered HCT.

ARV prophylaxis regimen will be administered to exposed infants; post-delivery follow up of mother-infant

pairs includes provision of health, nutrition, and family planning counseling and support for the mother. The

infant will be provided essential newborn heath care, cotrimoxazole prophylaxis administration from six

weeks of birth, ongoing pediatric presumptive HIV care, and infant feeding and nutrition support.

Activity 4: Post-Delivery Follow-up of Mother/Infant pairs

Pact's partners will provide follow-up services for mother and infant pairs. Exposed infants will be provided

ARV prophylaxis as per national guidelines, including those delivered at home if they report to the health

facility within 72 hours. The feeding option selected will be initiated and counseling provided to reinforce its

application and on essential newborn care, cotrimoxazole prophylaxis according to the national protocol,

immunizations, and monthly growth monitoring and assessment of presumptive signs for HIV will be

provided. If breastfeeding is selected, the partners will provide support for early breastfeeding cessation as

Activity Narrative: soon as the available, feasible, acceptable, sustainable, and safe (AFASS) criteria are met. Malamulo and

Ekwendeni hospitals will continue monthly monitoring of infant up to 18 months when HCT is conducted,

while Nkhoma hospital through the pilot project done in USG partnership with the MoH and Baylor Institute

on infant diagnosis and early ART for positive infants, will conduct infant HIV diagnosis with PCR at 6 weeks

and ensure HIV-positive infants access pediatric HIV treatment and care.

Post-delivery mothers will be provided post-natal care to reinforce the infant feeding method selected to

ensure mixed feeding is avoided. Mothers will also be monitored monthly for health assessment and clinical

staging/management.

Activity 5: Referrals and Links to Treatment, Care, and Support Services

Malamulo, Nkhoma, and Ekwendeni hospitals will strengthen or establish links for collaboration among

partners involved in provision of PMTCT services. Effective referral systems will be strengthened or

established for mothers and exposed infants to access available services along the continuum of care for

HIV/AIDS including ART, nutrition support, psychosocial support through mother support groups, which will

also include men, and other community support systems. Referral directories will be maintained to provide

easy access to information on types and location of available referral services. The referral system in place

will be reviewed periodically to ensure effectiveness in meeting clients' needs.

Activity 6: Staff Capacity Building

Pact's partners will train staff in technical areas and to expand PMTCT services to meet demand created. In

addition Malamulo will provide mentoring support for other health facilities beginning to implement PMTCT

services through the government PMTCT scale up program. Staff will also be trained in strategic information

and data management to enable them to monitor program progress, and make changes as necessary to

effectively meet practice standards and program targets (See Pact's SI submission). Certified trainers will

be contracted to conduct the training using nationally approved training protocols and guidelines. Refresher

training will be provided to update service providers on current PMTCT service provision guidelines.

Activity 7: Annual Program Statement (APS)

Pact will release an APS for additional partners to implement similar PMTCT programs for FY 2009. Some

of the partners specified may be funded with FY 2008 EP funds; other partners will be added via the Annual

Program Statement mechanism.

Summary

In January 2007, the USG awarded an agreement to Pact to implement HIV/AIDS prevention and care

project, with major granting and capacity building components. Pact's efforts will go beyond HIV/AIDS

technical assistance, focusing as well on strengthening local partners' organizational capacity, local

ownership, and sustainability by addressing financial and programmatic accountability, including Monitoring

and Evaluation (M and E), financial management, leadership, management, governance, and strategic

direction. Pact will provide targeted technical assistance to organizations and foster networking and

communities of practice to address bottlenecks in implementation. In addition, Pact will participate in

national-level technical working groups, and work with relevant ministries and government bodies,

especially the National AIDS Commission (NAC), to ensure that its efforts contribute to the national

response to the pandemic.

Background

Three of Pact's partners, Malamulo Hospital, Synod of Livingstonia at Ekwendeni, and MACRO, have been

implementing interventions to promote abstinence and being faithful (AB) with Emergency Plan (EP) funding

through the Umoyo Network for in- and out-of-school youth. Other Pact partners, including Southern Africa

AIDS Trust (SAT), Malawi AIDS Information and Counseling Centre (MAICC), National Association of

People Living with HIV and AIDS in Malawi (NAPHAM), Lusubilo, Tutulane and Community Partnership for

Relief and Development (COPRED), and the Society for Women and AIDS in Malawi (SWAM), will support

implementation of new AB activities to contribute to the prevention and behavior change component of the

national HIV/AIDS program in Malawi. Strategies targeting youth, including abstinence and faithfulness to a

single, tested partner will be implemented to encourage healthy lifestyles.

The activities to be implemented in this program include mobilization of youth through existing structures

and/or establishing new ones through which services can be effectively delivered to the youth, e.g., schools,

church groups, and other of community based forums, facilitation of youth clubs, provision of youth friendly

services and training of peer educators and youth patrons, including faith leaders.

Faithfulness activities and messages will also be targeted to adults, and linked to activities in other program

areas.

People Living with HIV and AIDS (PLWHA) will be involved in all activities, including positive prevention

approaches. The AB program is closely linked to other prevention programs; therefore, effective referral

systems will be established to enable access to other HIV prevention and reproductive health services,

including condoms for sexually active and other at-risk youth, youth-friendly services, and HIV testing and

counseling services. In addition, AB activities will be linked to OVC programs for older OVC by

organizations that work in both areas. (See Pact's submissions in these other areas).

Activity 1: Community Sensitization and Youth Mobilization

Pact's implementing partners, SAT (through Friends of AIDS Support Trust), Malamulo, MAICC, and

Tutulane will sensitize community leaders, such as teachers, faith leaders, chiefs, and parents, on the

importance of the AB efforts for youth and their role in encouraging both male and female youth to

participate. Communities will also be sensitized more generally on faithfulness messages for all sexually

active members. All of Pact's partners will work with the youth targeted through schools, church youth

groups, older OVC groups and other similar community groups with information on the importance and

benefits of participating in AB efforts. Malamulo, Ekwendeni, and Nkhoma will mobilize youth using their

existing faith-based organizations, whereas sub partner SWAM will promote AB activities through

community structures such as Anankungwi (initiation counselors—elders in the community that provide

guidance and advice to youth), traditional dances and songs to highlight AB activities, as well as poems and

interactive drama sessions.

Activity 2: Facilitation of Youth Groups

Malamulo, Ekwendeni, SAT, Nkhoma, and Tutulane will support activities targeting both male and female

youth focusing on in-depth information, education, and communication on abstinence and faithfulness,

including life skills development to maintain a healthy lifestyle. SWAM and COPRED will work with the USG

-funded BRIDGE Project and district youth officers to strengthen youth clubs. The aim is to empower youth

to say no to sex until marriage and to resist pressures for early sex or sex with concurrent partners.

Different youth groups for in- and out-of-school youth will be targeted. A variety of skills will be developed

among young males, such as practicing negotiation and dialogue instead of violence and coercion,

practicing a healthy lifestyle, gender awareness and respect for girls, postponing sexual debut, and

faithfulness to one tested partner. The skills for young women and girls include self respect, resisting sexual

pressures, postponing sexual debut, and faithfulness to one tested partner. In particular Nkhoma,

Ekwendeni, and SAT will use the participatory life skills prevention tool the "Hope Kit," which has been

developed by the JHU's BRIDGE Project with EP funding.

Approaches such as sports, drama, and skills training will be used mainly by SAT, Tutulane, Ekwendeni,

and MAICC to encourage youth to spend their time productively, and to make learning fun. These activities

will also entail outreach to key gatekeepers, such as parents, teachers, and faith leaders to enable them to

reinforce healthy lifestyle, especially faithfulness messages, and equip them with skills to discuss sexual

matters with youth.

Activity 3: Youth Friendly Services (YFS)

Malamulo, Ekwendeni, MAICC, and Nkhoma will sensitize service providers on youth-friendly reproductive

health services and refer youth to these providers. The providers will reinforce AB and healthy lifestyle

information provided through youth groups, and encourage youth who have been sexually active to receive

HTC as well as promote faithfulness and monogamy to this population. YFS providers will also refer clients

to reproductive health services including STI management, HCT, and resource centers at district health

offices.

Activity Narrative: Activity 4: Training of Peer Educators and Youth Patrons

All Pact's partners implementing AB activities will build the capacity of peer educators and youth patrons

(older youth that serve as role models and provide emotional support for youth) through training and follow-

up support and mentoring. In addition, to ensure continuity of services, the NGOs will also support

mechanisms for retention of trained peer educators for a reasonable period and replacing those who move

on by exposing them to various conferences, promotion of learning exchange visits, and providing them with

income generating activities. Other gatekeepers such as teachers and faith leaders will be oriented to

relevant skills to enable them to understand the program goals to effectively provide support for activities in

the future.

Activity 5: Open Days

Pact's AB partners will conduct outreach activities such as open days, during which an HIV prevention topic

will be chosen that will give high-risk target groups and the general population an opportunity to enter into

community dialogue. During the open days, services such as mobile VCT will be carried out by MACRO,

Ekwendeni Mission Hospital, Nkhoma, and Malamulo. The partners will also collaborate with District Health

Offices and other NGOs to provide VCT services during such community gatherings.

Pact will train the staff of partner organizations in monitoring, evaluation, and reporting, as well as in

organizational development and technical areas. See Pact's SI and Policy/Systems Strengthening

submissions.

Activity 6: Annual Program Statement (APS)

Pact will release an APS for additional partners to implement similar AB programs for FY 2009. Some of

the partners specified may be funded with FY 2008 EP funds; other partners will be added via the Annual

Program Statement mechanism.

Summary

The Nurses and Midwives Council of Malawi (NMCM), a new USG partner, will contribute to prevention of

medical transmission of HIV/AIDS and injection safety, strengthening implementation of universal

precautions to reduce risk of exposure to accidental needle stick injuries and exposure to blood and body

fluids, and provision of post exposure prophylaxis (PEP) in all the districts of Malawi.

Background

NMCM will be implementing this program for the first time as part of its leadership role as a regulatory body

responsible for ensuring safety of health sector service providers, especially nurses and midwives. National

guidelines for HIV prevention in the workplace are already in place (see JHPIEGO injection safety narrative)

but have not been effectively implemented by most health facilities. The program activities will build on the

work of JHPIEGO in further sensitizing Ministry of Health (MoH) officials on the planned program package,

printing and distribution of training and reference materials, training of health workers on infection

prevention and injection safety through application of universal precautions to reduce risk of exposure to

blood and other body fluids in the work setting, provision of PEP to exposed individuals, and advocacy for

strengthening systems for effective implementation of universal precautions and infection prevention

practices.

The activities are related to other prevention, care, and support programs Pact Malawi will be supporting, in

that services provided will be extended to community HIV/AIDS service providers. Exposed caregivers will

be referred to health facilities for PEP management, and exposed institutional service providers on PEP will

be referred to available psychosocial support services in the community. Furthermore, risk reduction is

integrated in all services with potential risk of HIV transmission through needle stick injuries and expose to

blood and other body fluids. In addition, the program will be linked to the logistics and supply units for

essential drugs, materials, equipment and supplies.

Activity 1: Informing Stakeholders about the Program

Pact Malawi's partner NMCM will begin preparation for program implementation by briefing MoH authorities

at different levels on the program package and implementation plan in order to ensure their support for the

program. In addition, this will facilitate adequate planning to meet the needs of the targeted beneficiaries at

the service provider level. A cascade method will be used to facilitate information flow from the top to the

implementation level. After MoH headquarters approval of the program, regional office will be briefed, which

will in turn brief the District Health Offices (DHO's), and finally information will be rolled out to institutions

and related organizations at the community level. Pact will ensure that these efforts are not repetitive of

what JHPIEGO has instituted. The intent is that Pact will extend the work of JHPIEGO nationally, including

the community level to ensure an effective system for linkage of exposed service providers to ARV

prophylaxis is in place.

Activity 2: Developing/Adapting Training Materials

NMCM will develop and adapt PEP training and reference materials to be used for training. Materials will be

designed for different categories of health workers at the facility level and also community-based service

providers involved in patient care in all districts of Malawi. The materials will focus on infection prevention,

universal precautions, and post exposure prophylaxis. Technical experts and trainers will be involved in

developing training materials. NMCM will develop a plan for materials distribution plan that will meet the

needs of each district.

Activity 3: Health Worker Training

NMCM will conduct training in all districts of Malawi targeting different categories of health workers on

infection prevention, universal precautions, and post exposure prophylaxis (PEP). Master trainers will train

trainers at the district level, who in turn will role out training to service providers at the institutional and

community levels. A separate training specifically on PEP will also be conducted in all the districts in the

country. The second training will target service providers who will be offering PEP, and will be conducted at

regional level. In addition, follow up supportive supervision will be provided by a team of trained supervisors

to ensure application of knowledge and skills gained. NMCM supervisors will be oriented to strategic

information management to facilitate effective monitoring of activities as well as maintaining relevant

records and regular reporting on program progress.

Activity 4: Advocacy for Availability of Essential Supplies for Prevention of HIV Transmission in the Work

Setting

NMCM will support advocacy activities to facilitate availability of essential supplies for implementation of

infection prevention and universal precautions practices by service providers, to reduce risk of HIV

transmission through PEP for exposed individuals. This will be done through lobbying and negotiating for

strengthened systems for logistics and provision of essential supplies and establishing relevant policies.

Pact Malawi will train NMCM staff in monitoring, evaluation, and reporting, as well as organizational

development matters. This integration is well described under Pact Malawi's SI and Policy/Systems

Strengthening submissions.

Summary

This is a comprehensive HIV prevention program, which will use different methods and approaches,

including the Hope Kit, a behavior change tool developed by the USG-funded Bridge Project, implemented

by John Hopkins Bloomberg School of Public Health and Save the Children. The activities for the program

will include training of facilitators for behavior change, education using the Bridge Project's "Hope Kit,"

community HIV prevention, and developing and disseminating Information, Education Communication (IEC)

materials. In addition, capacity building of technical skills in communication and strategic information

management will be offered. These programs will be implemented in collaboration with the Ministry of

Health (MoH), which provides condom supplies that are distributed to clients.

Background

Pact's local partners in this program area will continue with USG FY 2008 funds programs that have been

supported by other sources. Tutulane, Ekwendeni, MAICC, SAT, MACRO, COPRED, Nkhoma, NAPHAM,

Malamulo, and SWAM have been implementing ABC activities with support from other organizations and

are linked to the overall national HIV/AIDS prevention program for Malawi. These partners will provide and

distribute condoms during outreach activities, HCT services, and through Community Based Distribution

Agents (CBDAs). These condoms will be supplied by District Health Officers (DHOs), Banja La Mtsogolo

(local NGO family planning centers), and MACRO. (Funds from Pact will not be used to purchase

condoms). The implementing partners will build on their previous experience to expand their programs

targeting men and women, especially high-risk groups such youth, migrant workers (SWAM, MACRO, SAT,

COPRED, and Tutulane) through HCT services, PMTCT services, youth friendly services, and links to

family planning services. The activities will also include outreach activities focusing on behavior change

interventions to minimize the spread of HIV through unsafe sex practices.

Activity 1: Training of Behavior Change Communication (BCC) Facilitators

Pact will support SWAM, Tutulane, MAICC, Nkhoma, SAT, Malamulo Ekwendeni, and COPRED to train

facilitators to use the Hope Kit HIV prevention training tool, which has been successfully used in Malawi to

assist people to move from knowledge to action. The tool uses experiential learning methods. The

facilitators selected will depend on the target group, such as peer educators, teachers, health workers,

counselors, faith leaders, and community leaders. Pact' Malawi's partners will be encouraged to collaborate

with the master trainers in the BRIDGE districts (Balaka, Chikwawa, Kasungu, Mangochi, Mulanje, Mzimba,

Ntcheu, and Salima).

Activity 2: Comprehensive HIV Prevention Activities

All of Pact's partners in this program area will support implementation of comprehensive HIV prevention

activities. Approaches such as promotion of safer-sex practices, condom distribution, promotion of

consistent and correct condom use - through static and outreach sites - sensitizing individuals and groups

on HIV prevention, other strategies such as HIV awareness campaigns. For example, SWAM will implement

activities relating to gender equity and women's empowerment through the formation of women's groups

and all-female youth clubs to help build self efficacy and decision making on HIV prevention issues,

reduction of stigma and discrimination through active involvement of PLWHA (NAPHAM), and advocacy for

leadership. In addition, Nkhoma, Malamulo, and Ekwendeni will provide clinical services on the

management of sexually transmitted infections (STI) as well as advocacy for political commitment.

HCT services will be provided alongside prevention activities whenever possible to enable individuals to

learn what their HIV status is and to be able to make informed decisions on prevention and/or accessing

care and support services.

Activity 3: Developing IEC Materials

Malamulo, SAT, NAPHAM, SWAM, and MACRO are planning to support the printing and distribution of IEC

materials that promote tested and approved prevention messages. Such materials will be printed and

distributed to relevant target groups including sexually active youth, seasonal migrant workers, and women

at high risk, fishermen, sugar plantation workers, and men with disposable income.

Activity 4: Training of service providers

Partners will support the capacity building of service providers through training, follow-up support, and

mentoring in technical skills and supervision of volunteers to ensure effective implementation and scale up

of HIV prevention programming. In addition, capacity building will also be provided in strategic information

management to ensure effective monitoring and reporting of program activities. See Pact's SI and

Policy/Systems Strengthening submissions (activity ID#11288).

Activity 5: Annual Program Statement (APS)

Pact will release an APS for additional partners to implement similar prevention programs for FY 2009.

Some of the partners specified may be funded with FY 2008 EP funds; other partners will be added via the

Annual Program Statement mechanism.

Summary

Using FY 2008 Emergency Plan (EP) funds, Pact will support 11 indigenous organizations for 2 years to

provide palliative care services including home based care, support for families and care givers, treatment

of opportunistic infections, nutrition support, pediatric HIV/AIDS care, psychosocial support, spiritual

support, policy/advocacy, and quality and standards of care. Pact will also provide M and E and

organizational capacity building assistance to these grantees.

Background

Several of Pact's partners - COPRED in Blantyre district, Lusubilo in Karonga, and Tutulane in Chitipa -

have been implementing projects on components of basic palliative care including clinical care,

psychosocial support and community home based care with funding through other organizations; these will

become new partners in FY 2008. Pact will also partner with the African Palliative Care Association, and the

Palliative Care Association of Malawi (PACAM) to strengthen PACAM's capacity and leadership role.

Other palliative care partners to be funded by Pact in FY 2008 have implemented similar programs with

PEPFAR funding through Family Health International and Save the Children. NAPHAM has proposed to

expand to new districts including Rumphi, Machinga and Nsanje.

In addition to capacity building, the Pact's partners will build on their experience to expand and strengthen

palliative care services to a holistic comprehensive approach to meet the social, mental, spiritual, and

physical needs of adults and children and their families under their care, through community home based

care, hospitals and health centers, static and outreach HCT sites, and post-test support groups for PLWHAs

and mother support groups. Such care will also include prevention and treatment of symptoms and relief of

pain wherever possible.

Activity 1: Home Based Care (HBC)

Pact will support partners COPRED, Lusubilo, Tutulane, Nkhoma Synod, Malamulo in Thyolo and

Chikwawa, Livingstonia Synod in Mzimba, MAICC in Dowa, and NAPHAM in Rumphi, Machinga, and

Nsanje to provide HBC including management of pain in collaboration with DHOs and trained volunteers.

HBC patients will be identified through referral systems. Caregivers will provide basic nursing to assist the

sick in self care to meet needs for hygiene, nutrition/fluids, exercise, and treatment. Related activities such

as fetching water/firewood and food preparation will also be conducted. Lighthouse will provide clinical

services through HBC by a team of clinicians. DHOs will provide support for HBC kits.

Health workers and health surveillance assistants provide technical support and supervision through regular

visits to the clients and their care givers in the community. An effective referral system, which ensures

feedback to the referring agent, will be established or strengthened to ensure links and referral of patients to

other palliative care services in order to ensure that patients in the HBC program receive comprehensive

care. Such services include nutrition, psychosocial/spiritual support, and clinical services for conditions that

cannot be managed via HBC.

All partners offering services will promote volunteer retention, via training and provision of

materials/incentives.

Activity 2: Support for Families, Care Providers

Partners will implement activities to support family members and other care givers for PLWHA as part of

comprehensive palliative care. Care providers at the family level will receive technical, spiritual, and

emotional support. They will learn basic care skills to ensure continuity of care in the absence of regular

visits from volunteers or health workers. In addition, advice and support to prevent burnout will be provided,

such as provision of day respite care for children in the family.

Activity 3: Nutrition Support

Partners will undertake nutrition support programs for PLWHA, as part of comprehensive palliative care.

Nutrition assessments for PLWHA using national guidelines will be conducted at the facility and community

level through HBC programs to identify malnourished patients for food support. Pact is also placing a

nutritionist at USAID to help facilitate and build technical capacity in the areas of infant and young child

nutrition, PMTCT, malnutrition recuperation and integration of nutrition concerns into agriculture

development

Nutrition counseling to promote adequate diet and weight maintenance/gain, including hygiene and

sanitation, will be provided to PLWHAs and their care givers. Tutulane, COPRED, MAICC, and Nkhoma will

establish referral systems to link HBC clients to organizations offering such services. Lighthouse, Lusubilo,

Livingstonia Synod, and NAPHAM will provide ready-to-use therapeutic foods for severely malnourished

PLWHAs. NAPHAM and Lighthouse will provide micronutrients to improve outcomes for malnourished

PLWHAs on clinical treatment. Livingstonia Synod will strengthen internal referral systems to link PLWHA

clients to food and economic programs provided by Ekwendeni Hospital.

All service partners' interventions for patient care, including food security, will be ensured through a multi-

sectoral approach by linking PLWHAs to support for gardening to grow food using low technology and

livestock rearing to meet nutritional needs, as well as an income generating source for other needs.

Activity 4: Psychosocial Support

The service partners will provide psychosocial support for PLWHAs and their families. They will facilitate

strengthening/formation of post-test clubs and support groups for PLWHAs for positive living through

activities such as counseling and group therapy, shared learning, and information on ways for coping with

common concerns of PLWHA.

Lighthouse will include adherence counseling for clients on ART to be provided within the community by

Activity Narrative: patients who graduate to become counselors to new palliative care patients. NAPHAM will strengthen

support groups and child care sessions in its new districts as well as transport support to access treatment.

Links to other related services along the continuum of care will be ensured through an effective referral

system. Referral feedback will be sought as well.

Activity 5: Pediatric HIV/AIDS Care

Malamulo and Livingstonia Synod have established links to a pilot project by the MoH and Baylor on

pediatric HIV diagnosis and care at their facilities. Children infected with HIV will be linked to services in

this program. All exposed infants of HIV+ mothers identified through PMTCT and all suspected HIV infants,

including those with TB, severe malnutrition, failure to thrive, chronic fevers, and severe childhood

conditions, and with unknown HIV status will be included. Partners without such facilities will test children

for HIV at 18 months. Pact will link with BASICS to provide technical guidance on basic health care for

peds.

Partners will provide follow-up care services for HIV infected children through institutional and community

services. Cotrimoxazole prophylaxis (provided through the GFATM) will be provided for all infants, and

eligible children will be put on ART through referral. Nutrition support will include encouraging exclusive

breastfeeding up to six months, therapeutic and supplementary feeding, and replacement feeding under

acceptable, affordable, sustainable and safe conditions. In addition, micronutrient supplementation will be

provided.

Psychosocial support will include counseling of older children, recreation, and play through links and referral

to OVC community based child care centers. Mothers will receive support for infant health and feeding

through mother/grandmother groups.

Activity 6: Capacity Building of Service Providers

Partners will provide training, supportive supervision, and mentoring for providers and volunteers. The

partners will train providers to meet expansion and quality of services needs, using national training

protocols and guidelines, including services being implemented for the first time, such as child counseling or

pain management.

In addition, providers will also be trained in monitoring and reporting to ensure adequate monitoring of the

program. Training will also be provided in organizational development.

Activity 7: Advocacy/policy, quality, and standards

Through a grant to the APCA and its partner organization in Malawi, PACAM, Pact will contribute to

advancing palliative care issues at the national level. This will include rolling out use of the new national

palliative care curriculum, as well as developing and disseminating care standards to ensure quality of

services.

Activity 8: Linkages

Palliative care is part of the integrated treatment, care, and support for both children and adults living with

HIV/AIDS. Thus the services are closely linked through internal and external referral systems to ensure

effective utilization of all available services along the HIV continuum of care. ART services for both children

and adults, including pregnant women, are provided through designated health facilities. Patients in areas

without such services are linked to treatment through an effective referral system. The program is

implemented in collaboration with the Ministry of Health through the District Health Offices (DHOs), which

provide drugs and supplies used for palliative care.

Activity 9: Annual Program Statement (APS)

With FY 2008 EP funding, Pact will release an APS for additional partners to implement similar palliative

care programs for FY 2009. Some of the partners specified may be funded with FY 2008 EP funds; other

partners will be added via the Annual Program Statement mechanism.

Summary

Pact's local partners are COPRED in Blantyre District, Console Homes in Lilongwe, Lusubilo in Karonga,

Mponella AIDS Information and Counseling Centre (MAICC) in Dowa, Tutulane in Chitipa, and NAPHAM in

Machinga, Rumphi, and Nsanje districts will support programs contributing to the National Plan of Action

(NPA) for OVC in Malawi, whose overarching goal is "to build and strengthen family, community, and

government capacities to scale up response for the survival, growth, protection and development of orphans

and other vulnerable children by the end of 2009."

Background

MAICC and the other partners have implemented simple but effective OVC care and support models

involving communities in the project cycle through community OVC committees (COVC's) focused on

addressing the needs of OVC at different age groups. Console Homes has implemented an OVC program

with a model that includes active participation of OVC in program management through an Orphan Affairs

Unit (OAU). Such models and other best practices will be replicated by the Pact Malawi's partners operating

in similar settings. Age group-specific interventions, i.e., 0-5years, 5-8 years, 9-12 years, and 13-18 years,

will be implemented by all the partners to ensure each child gets relevant support to promote growth,

development, and protection.

Pact's partners will identify and register OVC, then implement activities to meet the needs of OVC at

specific age groups. Activities will include community based child care centers, children's corners, formal

education, and vocational skills training. In addition, the selected NGOs will provide support for social

mobilization to enhance awareness on child rights and issues affecting OVC, for example, stigma and

discrimination and legal protection. Other activities will focus on strengthening community safety nets

through family and community economic empowerment and capacity building to enable them to meet the

needs of OVC, including shelter, health care, education, psychosocial support, and other material needs

such as food, clothing, and blankets. The partners will build capacity through training of staff and volunteers

in technical skills and monitoring, evaluation, and reporting to facilitate quality services and effective

program implementation.

The OVC activities will be implemented within the context of the national OVC program framework, school

support (school fees and uniforms), and school requisites (provided by the Ministry of Women and Child

Development as well as other partners). The OVC program is part of the overall HIV/AIDS impact mitigation

strategy for people affected and infected with HI and therefore, closely linked to other HIV/AIDS services

through effective referral systems including prevention, testing and counseling, PMTCT, treatment, care,

support, reduction of stigma, and psychosocial care through support groups and post-test clubs (see Pact's

submissions in these other areas).

Pact will also partner with the Hope for African Children Initiative (HACI) to provide OVC policy, advocacy,

and quality guidance to the Government of Malawi and organizations providing OVC services.

Activity 1: Social Mobilization to Increase Community Awareness of OVC issues

Pact with its local partners will target community leaders in their catchment areas with messages to help

them understand the critical needs of OVC and the role they can play to encourage the community to

support the program. Community members will be sensitized on issues affecting OVC and encouraged to

promote child protection, as well as stigma and discrimination reduction.

Pact's partners will support sensitization of the community on children's rights, prevention of harmful cultural

practices, families taking precautionary measures such as succession planning, and birth certification to

reduce suffering of children in the case of a parent's death. Furthermore, HIV prevention activities including

referral to HCT, PMTCT will be integrated in this process.

Activity 2: Identifying and registering OVC

Children aged 0-18 years will be targeted for support. Selected community members/leaders and project

staff for COPRED, Console Homes, Lusubilo, MAICC, and Tutulane, with support from Social Welfare

officers, will participate in the process using prescribed criteria to ensure gender balance and that only

intended beneficiaries are included. NAPHAM will target children of the PLWHA support groups' members.

The partners will provide support for community meetings and orientation of community members to OVC

selection procedures and selection of volunteers to assist with services. In addition, MAICC and Console

Homes will support renovation of centers to be utilized for different OVC activities by the community

members.

Activity 3: Care for OVC Aged 0-5 Years

All partners will support scale up of OVC care for children aged 0-5 years to address the need for normal

physical, cognitive, psychosocial, moral, spiritual, and emotional development through expansion of

community based child care services (CBCC) through existing centers. NAPHAM will provide child support

for PLWHA members, including recreation and feeding while the parents attend support group activities.

The service package for local partners will include health and nutrition counseling and feeding through the

CBCC centers, growth monitoring, and prevention of childhood illnesses including immunizations, with

support from health staff in their districts, clean water supply, hygiene, and sanitation. Children will have

early learning and play sessions for stimulation. Lusubilo will provide nutrition support through a

rehabilitation center for severely malnourished children, while all the partners will support OVC by

establishing home gardens. This service package will involve participation of volunteer community members

who will be trained and mentored to ensure quality of services. Parents and care givers will be supported

with skills acquisition in parenting to promote a conducive environment for normal child growth and

development.

Activity 4: Care for OVC Aged 5-8 Years

Local will support scale up of care for OVC aged 5-8 through transitioning children to formal school through

Activity Narrative: links and referral systems for children recommended for formal school enrollment and provision of

psychosocial support through expanding or establishing children's corners. Health and nutrition counseling

support will be provided and micronutrient supplementation, hygiene and sanitation, and treatment of

childhood illnesses through the HBC program, and severely sick children will be referred to the health

center. Children will be taught life skills, including prevention of child abuse, exploitation, and HIV. Lusubilo

will provide meals for OVC from homes without food through community feeding center, insecticide treated

bed nets. Play and recreation will constitute a major component of this service. Parents and care givers will

be provided skills to reinforce support and security provided through children's corners in the home.

Activity 5: Care and Support for OVC Aged 9-12 Years

Care and support for 9-12 year olds will be scaled up through formal school and provision of psychosocial

support services including sport and recreation, memory books, and other activities to build resilience.

MAICC and Tutulane will provide life skills and sports activities through youth resource centers. Health,

nutrition, hygiene, and sanitation support will be offered. Food rations to child-headed families will be

provided by Lusubilo and Tutulane, and referral of sick OVC to health centers will be done through HBC

program by all the partners. All the partners will support OVC homes with establishment of home gardens.

Children will also be taught life skills and the basics of health issues and HIV/AIDS.

Activity 6: Care and Support of Older OVC aged 12-18 Years

Services for this age group will target both boys and girls with services including psychosocial support and

protection from abuse and exploitation through youth programs, encouraging continuation of formal

education, sport, recreation, and life skills/HIV prevention through peer counseling and education on

abstinence and being faithful. Links will be made to HIV, including HTC, and reproductive health services

through youth friendly health services. Peer educators will be supported with training and other incentives to

keep them motivated. Console Homes will support other partners in implementing innovative interventions

to encourage youth participation in decision making on issues that concern them. Partners will provide

school support for OVC in form of school fees, uniforms, and other school requisites and monitoring the

children's school performance.

Activity 7: Household and community support

The partners will provide support to households and communities to strengthen their capacity to provide

care and support for OVC. This will enable them to be more responsive to the needs of OVC and take

ownership of interventions to address OVC issues. In addition support will be provided to empower them to

improve their economic capacity through access to credit and basic business skills. Support will also be

provided for other innovative approaches to strengthen the community safety nets, as well as food security

through support from agriculture extension workers and live stock rearing.

Activity 8: OVC Policy, Advocacy, and Quality Guidance

Pact will partner with the Hope for African Children Initiative (HACI) to provide guidance in these areas to

the Government of Malawi and organizations providing OVC services.

Activity 9: Annual Program Statement (APS)

Pact will release an APS for additional partners to implement similar OVC programs for FY 2009. Some of

the partners specified may be funded with FY 2008 EP funds; other partners will be added via the Annual

Program Statement mechanism.

Summary

Pact, together with local partners Malamulo Adventist Hospital in Thyolo district; MACRO in Lilongwe,

Blantyre, Zomba, Kasungu, Mzuzu, and Karonga Districts; MAICC Dowa; NAPHAM in Rumphi, Machinga,

and Nsanje Districts, Nkhoma Synod in Lilongwe; and Synod of Livingstonia/Ekwendeni in Mzimba District,

will contribute to scaling up HIV testing and counseling (HCT) in Malawi. The partner NGOs have

experience in delivery of HCT services through static and outreach sites within their catchment areas with

MACRO, Malamulo, MAICC, Nkhoma, and Synod of Livingstonia directly funded by PEPFAR. They will all

apply best practices and experience to scale up the current HCT services by establishing additional static

and outreach sites. MACRO will expand HCT services to remote inaccessible rural areas through mobile

HCT services with vans to be provided by National AIDS Commission (NAC).

Background

The partner NGOs in this program area will participate in the national HCT week and other national events

that provide opportunities for extending HCT to communities, especially in inaccessible areas. The NGOs

will support capacity building of staff to provide HCT through mobile services, integration of PMTCT

information in counseling, and training additional staff to meet the required quality and expansion of

services. Activities will target men, women, couples, and special groups such as in- and out-of-school

youth, TB and STI patients, HIV exposed and suspected infants at 18 months, and pregnant mothers at

sites where PMTCT is not available. The activities will include training and follow up support of staff;

community mobilization to increase service demand and utilization; and provision of comprehensive HCT

including individual or group pre-test counseling, HIV testing, post-test counseling, and continued post-test

support through groups for psychosocial support of HIV positive clients, and post-test clubs.

HCT services will be implemented in partnership with the Ministry of Health (MoH) and District Health

Offices (DHOs), which provide the HIV test kits to all service providers. HCT is the entry point for access to

other services for different levels of HIV prevention for negative clients and HIV treatment care and support

for HIV positive clients. Thus, the services are linked to HIV treatment services, including ART, which may

be provided within the same facility or through referral to another site. Referrals are also made to other post

-test services, including nutrition and psychosocial support that may be available within the facility or

through other organizations and community support systems, as well as to prevention activities in the

community.

Activity 1: Community Mobilization

Pact with its' local partners will sensitize and mobilize communities for HCT. Community leaders will be

sensitized on HIV/AIDS, the importance of HCT and the need for their involvement in influencing community

members to utilize available HCT services as well as promotion of individuals to go for HCT with their

partners. Community members will be targeted with appropriate messages on HIV, the importance of HCT,

and on services available to increase demand and utilization. Partners will target high-risk groups such as

migrant workers, youth, and pregnant women and their partners (Malamulo); fishermen and sugar plantation

workers, including pregnant women and their partners, (SAT and SWAM in Nkhotakota); youth (MAICC),

youth, pregnant women, and their partners by Synod Livingstonia Ekwendeni hospital; youth, migrant

workers, and rural, inaccessible communities (MACRO and NAPHAM). This will done with involvement of

PLWHAs and youth groups, using different culturally accepted methods such as drama, song, and dance.

Synod of Livingstonia will use male motivators to ensure mobilization of men for HCT and support for

PMTCT mothers.

Activity 2: HIV Testing and Counseling

Pact's partners, working in collaboration with the DHOs, which supply HIV test kits, will provide HCT

services to communities in their catchment through static and outreach sites, as well as mobile services

targeting men, women, youth, and HIV exposed and suspected infants aged 18 months and above.

Pregnant women will also be targeted by MAICC where PMTCT services don't exist; mothers will be

referred to Dowa District Hospital for ante-natal care and PMTCT services. All the partners will provide

couple counseling for individuals coming with their partners. Parents will be counseled for young children

who undergo testing, and child counseling provided for older children. Malamulo, Nkhoma, and Ekwendeni

hospitals, which are participating the pediatric diagnosis pilot project by Baylor Pediatric care in

collaboration with the MoH, will provide HCT services for children aged six months using PCR.

All the HCT partners will integrate TB and STI services, and chronically ill patients will be offered routine

HCT, applying the opt-out strategy. Pre-test counseling will be group or individual, depending on the

situation, and rapid HIV tests will be used to ensure clients get their test results the same day.

Post-test support will include individual post-test counseling by all the partners to provide clients the

opportunity to make an informed choice on use of treatment and other support services available. HIV

positive clients for Malamulo, Ekwendeni, and Nkhoma will be referred within their facilities for follow-up HIV

clinical care, including management of opportunistic infections, clinical staging, and ART for eligible clients

within their institutions; while the other organizations will refer clients to other facilities and to support

services, such as psychosocial support through groups for PLWHA, nutrition, and other community support

systems. HIV negative post-test support will include referral to post-test clubs and other prevention activities

for continued information, education, and communication to meet their needs for HIV prevention to maintain

a negative HIV status.

Activity 3: Establishing/Strengthening an Effective Referral System

Malamulo MACRO, MAICC, NAPHAM, Nkhoma Synod, Lusubilo, and Synod of Livingstonia will set up

effective internal and external referral systems to facilitate referral of clients, such as TB and STI patients, to

HCT services and post-test clients to care and support services. Referrals will be to clinical and other post-

test support services for HIV positive clients. HIV negative clients will be referred to post-test clubs and

other prevention programs in the community. In addition, the NGOs will strengthen or establish post-test

clubs and PLWHA support groups where they do not exist.

Activity Narrative: Activity 4: Capacity Building of Service Providers and Volunteers

Implementing partners will support capacity building of volunteers and service providers through training,

supportive supervision, and mentoring to ensure application of knowledge and skills to practice. The service

providers will be targeted for capacity building in HIV counseling, including integration of PMTCT, STI, and

TB information in counseling, and HIV testing using the rapid test, couple counseling, and child counseling.

In addition, service providers will be supported in capacity building in psychosocial support to enable them

to support strengthening PLWHA groups and post-test clubs or encourage establishment where they do not

exist in order to meet the community needs. Community volunteers will be targeted for development of skills

in their related areas of involvement, such as community mobilization, community counseling, and

psychosocial support.

Pact will train the staff of partner organizations in monitoring, evaluation, and reporting, as well as

organizational development matters. See Pact's SI and Policy/Systems Strengthening submissions.

The expected results include an increase in the number of service outlets providing HCT according to

national and international guidelines, increase in the number of individuals that receive testing and

counseling and receive their test results, increase in the number of PLWHA support groups and post-test

clubs, number of volunteers trained in community mobilization, increase in the number of service providers

trained in HCT, couple counseling, and child counseling, number of service providers trained in provision of

psychosocial support, and number of service providers trained in strategic information.

Activity 5: Annual Program Statement (APS)

Pact will release an APS for additional partners to implement similar AB programs for FY 2009. Some of

the partners specified may be funded with FY 2008 EP funds; other partners will be added via the Annual

Program Statement mechanism.

Summary

Pact is an umbrella organization working to support sub grantees implement the Emergency Plan (EP) in

Malawi.

Background

Pact has global and local expertise in monitoring, evaluation, and reporting (MER), which it will draw upon

to provide technical assistance and capacity building for its local partners in Malawi. Pact will conduct a

brief, introductory MER training in a pre-award workshop for its local partners, conduct an in-depth MER

workshop for partners, provide focused, individualized MER technical assistance to partners during regular

monitoring/supervision visits, and provide its partners with MER tools, resources, and materials that can be

used to strengthen their program implementation. Pact's MER officer will coordinate and oversee these

activities. The MER activities will be an integral part of and support Pact's partners' work in the prevention

and care program areas; see Pact's submissions in these program areas for details on districts in which the

work will be conducted.

Pact conducted a monitoring, evaluation, and reporting course for the 7 rollover grantees it worked with the

first nine months of its program. The training, conducted 14-16 March 2007 in Lilongwe, improved

participants' MER proficiency, and helped to support their MER efforts for their grant with Pact and in

general for their programs. Improved MER proficiency for participants will improve program monitoring, and

thereby enhance quality, as well as strengthen local partners' capacity.

Activity 1: Start-up Workshop:

Prior to finalizing sub-grants with local partners, Pact will conduct a week-long pre-award workshop. 2 days

of this workshop will be devoted to an MER overview. The starting point for each partner's MER plan will be

what was proposed in the APS submission. The outcome of this workshop will be a revised, strengthened

MER plan for each partner, which will serve as the basis for the partner to monitor and evaluate its own

work, and for Pact's evaluation of the partner in terms of its MER.

Activity 2: In-depth MER Workshop

A workshop will be conducted for Pact's current grantees, and, space permitting, former grantees and

National AIDS Commission (NAC)/Global Fund grantees. It will cover the principles and essential elements

of MER systems, identifying audiences and information needs, principles of results-based MER, including

having each partner develop a results framework, identifying anticipated inputs, outputs, outcomes, quality

assurance/improvement, understanding PEPFAR indicators and developing program indicators,

tracking/counting indicators, introduction to evaluation, and reporting and report writing. An emphasis will be

placed on using monitoring data for continuous program improvement.

A session on report writing will review the quarterly report format all grantees will be required to use,

explaining the nature and level of detail to be provided in each section. This session will also cover and

preparing success stories, as well as the format and expectations for annual and final reports. This training

will provide grantees with improved writing capacity, a transferable skill that facilitates sustainability.

Gender indicators in the partner's MER systems will capture how successfully partners are addressing

gender considerations.

The improved MER skills acquired by participants will contribute generally to the program capacity of the

individuals and partner organizations, thereby facilitating sustainability.

Activity 3: Focused, individualized MER Technical Assistance

Pact will work with partners during quarterly monitoring/supervision visits, and through regular telephone

and email communication to respond to MER needs and questions raised by the partners or in response to

observations by Pact's staff. Pact will also offer MER technical assistance to grantees of the National AIDS

Commission, funded by the Global Fund, and provide general technical leadership to HIV/AIDS programs.

Pact staff, in consultation with Pact HQ and regional staff, will pro-actively identify MER tools and resources

available locally, regionally, and globally that may be of benefit to Pact's partners and disseminate these.

Pact's MER officer will provide assistance as needed to partners in adapting these to the partners' needs.

Summary

Pact has global and local expertise in organizational development, financial management, and HIV/AIDS

policy and technical areas, which it will draw upon to provide technical assistance and capacity building for

its local partners in Malawi. Partners will include non-governmental, faith-based, and community based

organizations, the majority of which will be sub-grantees; national, regional, and local government bodies;

and national, regional, and international organizations. Through workshops and work with individual

grantees, Pact Malawi will provide technical assistance in budgeting and financial management and

organizational development issues, such as program implementation, administration, governance, and

resource mobilization.

Pact's finance staff will coordinate and oversee the financial activities, and Pact's grants manager and

program staff will coordinate and oversee Organizational Development (OD) activities.

Pact will also provide technical leadership to the Government of Malawi (GoM) and other partners at the

policy level on palliative and home based care, OVC, and prevention; in addition, training in HIV/AIDS

technical areas will be provided.

The policy and systems strengthening activities will be an integral part of and support Pact's partners' work

in the prevention and care program areas; see Pact's submissions in these program areas for details on

districts in which the work will be conducted. Pact began operating in January 2007. In the first six months

of the program, Pact staff have provided one-on-one technical assistance on organizational development

matters to the seven roll-over grantees that Pact has supported.

Activity 1: Start-up Workshop

Prior to finalizing sub-grants with local partners, Pact will conduct a week-long start-up workshop; one day

of this workshop will be devoted to budgeting and financial management and two days to other

organizational development issues.

Activity 2: Organizational Capacity Assessments (OCA) and Institutional Strengthening Plans (ISP)

Each partner will be assessed at the start of its grant using Pact's Organizational Capacity Assessment

(OCA) tool, which will provide an in-depth review of each partner's strengths and weaknesses in key areas

of organizational development, such as project implementation, governance, infrastructure, human

resources and administration, external relations and partnerships, and resource mobilization and

sustainability. Skills in these areas by definition strengthen organizations, thereby contributing to their

sustainability.

The results of the OCA will be used to develop an individualized institutional strengthening plan (ISP). Pact

will work with each grantee to ensure implementation of its ISP during the course of its grant.

Activity 3: Focused, individualized Organizational Development (OD) Technical Assistance

Pact will work with partners during quarterly monitoring/supervision visits, and through regular telephone

and email communication to respond to financial management and OD needs and questions raised by the

partners or in response to observations by Pact's staff.

Pact will also offer OD and other technical assistance to grantees of the National AIDS Commission, funded

by the Global Fund, and support for general technical leadership to HIV/AIDS programs.

Activity 4: Financial Management and OD Workshop

Pact will also conduct one in-depth financial management and organizational development workshop for its

partners.

Pact's finance staff will coordinate and oversee the financial management activities, and Pact's grants

manager and program staff will coordinate and oversee the OD activities.

Activity 5: Policy and System Support to the Government of Malawi

Pact will also provide technical leadership to the Government of Malawi and other partners at the policy

level on nutrition, palliative and home based care, prevention, and other evidence-based and best practices

related to HIV/AIDS prevention and care programming.

Activity 6: Capacity Building Training in HIV/AIDS Technical Areas

Pact staff will incorporate training on stigma reduction, community mobilization, and technical programming

in HIV/AIDS prevention and care into its pre-award workshops, its individual technical assistance to sub-

grantees, and in stand-alone workshops, responding to needs identified during the program year.