Pact Malawi's mission is to help build strong communities that provide people with an opportunity to earn a dignified living, raise healthy families, and participate in democratic life. Pact achieves this by strengthening the capacity of grassroots organizations, coalitions, and networks, and by forging linkages among government, business, and the citizen sectors.

In 2007 Pact, Inc. was awarded a cooperative agreement from the USAID/Malawi to implement a HIV and AIDS grants management program in Malawi. This rapid response mechanism for HIV and AIDS in Malawi is part of Pact Malawi's global Community REACH (Rapid and Effective Action Combating HIV/AIDS) program, which offers competitive grant awards to local NGOs, CBOs, and FBOs to support best practices and innovative approaches to community-based HIV and AIDS prevention, care, and support activities. The Community REACH program is in its third year of implementation. To date, Pact Malawi has supported seven "roll-over" grantees from FHI and Save the Children, and twenty seven grantees have received awards through three competitive APS solicitations, including one request for proposals for a local organizational development partner.

Pact Malawi's strategic approach combines the efficient distribution of funds through the Community REACH grant mechanism with comprehensive technical assistance and capacity building for NGOs, supporting a coordinated, country-level US Government response to HIV and AIDS that is in line with the National AIDS Framework (NAF).

Pact Malawi Community REACH program complements and aligns itself to the goals of the NAF and USG-Malawi Partnership Framework by pursuing the following objectives: • To implement an effective and transparent grant award and administration system to support responsive, fast-track assistance to organizations responding to the HIV and AIDS pandemic in Malawi. • To provide implementers with access to financial resources and high-quality technical expertise they need to deliver effective programming and report results. • To expand and strengthen the Malawian civil society response to HIV and AIDS by providing capacity building to increase their capacity to provide and sustain HIV and AIDS and related health services.

Pact Malawi partners implement activities across the following PEPFAR program areas: Prevention AB, Prevention Other, PMTCT, OVC, HTC, Care and support/HBC, Strategic Information, and Capacity Building/Systems Strengthening. Target groups depend on the individual grantees' program, but range from general population to high risk groups including fishermen and sex workers.

Pact Malawi's partners for FY10 and 11 (1 October 2010- 30 September 2011) include: Community Partnership for Relief and Development (COPRED), Ekwendeni Mission Hospital, FVM Matunkha, Lusubilo, Mponela AIDS Information and counseling centre (MAICC), Malamulo, Namwera AIDS Coordination Committee (NACC), National Association of people living with HIV/AIDS in Malawi (NAPHAM), Nkhotakota AIDS Support Organization (NASO), Nkhoma Mission Hospital, Partners in Hope (PIH), Southern African AIDS Trust (SAT), Society for women Against HIV/AIDS in Malawi (SWAM), and Tovwirane.

All of Pact Malawi's sub partners will close grants in either FY10 or FY11. Pact will conclude required close-out activities for these programs by the program end date, September 30, 2011. However as Pact prepares for the end of project close outs, Pact continues to establish strong linkages with local HIV/AIDS NGO networks and NAC to ensure sub partners transition into meaningful partnerships with these organizations for sustainability of Pact supported activities. However in doing so, Pact also recognizes the Organizational Development and grant management capacity gaps that are faced by these entities respectively and will continue to engage with them as necessary to provide and strengthen support. An end of project evaluation will be conducted in FY11 and depending on findings; Pact will recommend that the most improved sub partners also transition into partnerships with either USAID, (as Primes), NAC or

National NGO networks according to technical or organizational competence levels.

Budget Summary PFIP Year 1 Funding - $4,371,100 PFIP Year 2 Funding - $2,850,000

V. Budget Code: HBHC

$751,140 - Year 1 $327,331 - Year 2

In FY10 Pact Malawi will support thirteen indigenous organizations to provide HBHC.

Pre-Art interventions

As Pact Malawi responds to and aligns itself with technical direction in the Partnership Framework, In FY 10 and 11 Pact Malawi partners implementing HBC programs will be encouraged and supported to focus on Pre ART interventions beyond community based HBC. Pact partners will continue to provide the following services to support pre- ART interventions and strategies; provision of cotrimoxazole prophylaxis to all eligible adults, children and infants, CD4 count checks every six months where services are available (Nkhoma, Lighthouse, Ekwendeni, Malamulo), monitoring clients to access the services and promoting referrals by providing transportation incentives(NAPHAM, LIHASO), Conduct screening /assessment and treatment of opportunistic infections including TB and STIs, Some partners will provide nutrition support including assessment and malnutrition prevention activities. Pact will ensure technical capacity for Pre-ART support is built among partners. Partners will also continue with community HBC programs and will provide services that encourage positive living and early access to HTC and ART.

Support for Families and Care Providers Partners implement activities to support family members and other care givers for PLHIV as part of a comprehensive care and support program. All partners providing care and support promote volunteer retention via training, provision of materials/incentives and self motivation. Self motivation for volunteers is one of the major motivating factors achieved by COPRED, Lighthouse and Nkhoma.

Nutrition Support Partners implement nutrition support programs for PLHIV as part of comprehensive care and support. Nutrition assessments for PLHIV are conducted through HBC programs using national guidelines at the facility and community level. Partners also provide nutritional supplements including likuni phala, RUTF. Partners provide nutrition counseling to PLHIV and their care givers to promote adequate diet, weight maintenance/gain, and proper hygiene and sanitation. Livingstonia Synod, Lusubilo, FVM Matunkha and COPRED continue to utilize their internal referral systems to link PLHIV clients to food and economic programs provided by their organizations but supported by other donors. All service partners' interventions for patient care, including food security, will be reinforced through a multi-sectoral approach of linking PLHIV to support groups for gardening and livestock rearing to meet nutritional needs, as well as to provide an income generating source for other needs. Ekwendeni hospital will from October this year implement a nutrition program known as Micronutrients and Health (MICAH) Project funded by USAID/Malawi which also complements the HIV/AIDS care efforts. The project is aimed at improving the health of women of child bearing age and children less than five years of age through micronutrient fortification of food..

Psychosocial Support Pact Malawi's partners also provide psychosocial support for PLHIVs and their families. They will facilitate the strengthening of post-test clubs and support groups for PLHIVs for positive living through

activities such as counseling and group therapy, shared learning, and information on ways for coping with common concerns of PLHIV. Integration of adherence counseling for Pre ART and ART clients is a priority. Pediatric HIV/AIDS Care Nkhoma and Livingstonia Synod will continue offering early pediatric HIV diagnosis and care at their facilities as this area of programming rolls out to other facilities nationally. All exposed infants of HIV+ mothers identified through PMTCT activities 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 are included. Partners without such facilities will continue to test children for HIV at 18 months. Please refer to the PMTCT narrative for additional information. Care givers utilize the care and support field guide to provide support to affected children. MAICC, PIH, Lighthouse, Tovwirane and Matunkha will train volunteers in pediatric HIV/AIDS care to build their capacity as care givers.

Preventative care During FY10, partners will work to strengthen positive prevention messages within care and support. Positive prevention covers a range of topics including prevention of re-infection which can lead to ART resistance, prevention of STIs, vertical transmission of HIV, and the importance of family planning.

Capacity Building of Service Providers and Partner Organization Partners will provide training, supportive supervision, and mentoring for HBC providers and volunteers. The partners train providers using national training protocols and guidelines. Training topics include general care and support, data management and community HBC. PACAM will conduct training for staff and continue providing technical support in implementation of care and support services for Pact Malawi partners.

Advocacy/Policy, Quality, and Standards Pact Malawi will continue supporting its partners to deliver services following the national guidelines and policies and minimum care package for care and support. Pact Malawi will continue using the quality assurance monitoring tool it developed in supporting partners. Pact Malawi will continue participating in national forums that work on development and monitoring of HIV care standards including the national HBC working group. Partners will utilize existing community mobilization strategies within their organizations to advocate for HBC in their communities and promote Care and support as part of integrated treatment, care, and support for both children and adults living with HIV/AIDS. PACAM will continue advocating to the government for access to pain management drugs such as Morphine as well the integration of the palliative care in the health workers training manuals. PACAM in collaboration with APCA will finalize and disseminate the OPIOD hand book and the volunteer's manual. Grantee Closeout

Of Pact Malawi's partners implementing HBC/PC activities, only Lighthouse and PACAM will close in FY10. Malamulo, COPRED, NASO, Lusubilo, NAPHAM, MAICC, PIH and Ekwendeni were selected through the FY09 APS to extend their programs through May 2011.

With Year 2 funding Pact will implement the following activities:

In FY11 Pact Malawi partners will continue to provide the range of care and support services mentioned above to support families and care givers, treatment of opportunistic infections, provide nutrition support, pediatric HIV/AIDS care, psychosocial support, spiritual support, policy/advocacy, and quality and standards of care development. Pact Malawi will continue to provide up to date technical assistance, organization capacity building support and financial assistance to these grantees. Pact Malawi's partners - COPRED, Malamulo, NASO , Tovwirane, Ekwendeni, MAICC , Malamulo , and PIH will continue implementing care and support including clinical care, preventative care, and psychosocial support. Pact Malawi's partners implementing HBC/PC activities will close in May 2011.

VI. Budget Code: HKID $893,250 - Year 1 $599,619 - Year 2

The Malawi government and USG have committed themselves to uplifting the lives of OVC through innovative interventions.

Social Mobilization to Increase Community Awareness of OVC Issues Pact Malawi's local partners target community leaders in their catchment areas with interventions to address the critical needs of OVC and the role they can play to encourage the community to support OVC programs. Interventions include sensitization on promotion of child protection, children's rights, prevention of harmful cultural practices, succession planning to reduce victimization of children in the case of a parent's death, as well as stigma and discrimination reduction. HIV prevention activities including referrals to HTC and PMTCT are integrated in to this process. Pact Malawi partners work closely with the Child Care Protection Workers (CCPW) who are under the DSWO to register and conduct community mobilization on child protection.

Age-Specific Interventions Age-group-specific interventions (0-5years, 5-8 years, 9-12 years, and 13-17years) are implemented by all partners to ensure each child receives relevant support to promote growth, development, and protection.

Programs for younger OVCs address the need for early childhood development (ECD) OVC growth monitoring; prevention of childhood illnesses including immunizations with support from health staff in their districts; clean water, hygiene and sanitation. Severely sick children are referred to health centers for additional care. Expanded 'kid's clubs' for school going children aged 6-12 to provide sports, counseling, conducting memory book sessions, psychosocial support, life skills

Older OVC aged 13-17 participate in youth clubs. Peer educators are supported with training. Partners provide education support for OVC in the form of school fees, uniforms, and other school requisites, and by monitoring the children's school performance. Partners will provide school fees for secondary school going OVCs as well as vocational skills. COPRED will renovate one of the CBCCs for OVCs.

Partners provide continuous technical support to households, communities and volunteers to strengthen their capacity to provide care and support for OVC, to be more responsive to the needs of OVC, and to take ownership of interventions within their community to address OVC issues.

Nutrition Support COPRED, NACC, MAICC and Tovwirane have communal gardens for their CBCC and they encourage the guardians to have a kitchen garden to meet the nutritional needs of OVC. MAICC has developed a partnership with Land'O' Lakes who provides 10% of their milk production weekly to the CBCCs. Under this program, 12 CBCCs are benefiting from the milk which is given to the children attending the CBCC. Communities are able to contribute food to the CBCCs including maize, groundnut, soya beans, and fruits. Pact partners are encouraged to link up with other organizations for nutritional support.

Technical Support to Partners Pact Malawi has developed a minimum package of OVC service provision that forms the basis for partners' OVC programming and helps to improve the quality of OVC services. Pact Malawi will also adapt the Child status index (CSI) tool which will be used to assess the needs of the OVC and monitor the services provided. Pact Malawi will ensure that all partners have volunteers/ caregivers that are trained on how to use the CSI and minimum standards. Targeted technical support for individual grantees will continue to be conducted based on grantee needs and technical gaps.

Grantee Closeout

Of Pact Malawi's partners implementing OVC programs, only Zomba Catholic Health Commission will close in FY10. COPRED, NASO, Lusubilo, NAPHAM, MAICC, NACC and Mathunkha were selected through the FY09 APS to extend their programs through May 2011.

With Year 2 funding PACT will implement the following activities:

Pact Malawi's local partners will continue to implement OVC interventions as outlined above and Pact will continue to provide technical guidance to sub partners to align implementation with the PEPFAR partnership framework. All of Pact Malawi's OVC grants will close out in May 2011.

VII. Budget Code: HVCT $558,650 - Year 1 $279,214 - Year 2

Pact Malawi's partners - Malamulo, MAICC, CCAP Nkhoma Synod, Ekwendeni, PIH, NACC, FVM Matunkha, Lighthouse, COPRED, NASO and MACRO are contributing to the national scale up of HTC in Malawi.

Community Mobilization In FY10 Pact Malawi's local partners will continue sensitizing and mobilizing communities for HTC. Community gate keepers will be involved in HIV/AIDS awareness interventions to utilize available HTC services, as well as encouraging individuals to go for. Partners will also target high-risk groups such as migrant workers, youth, and pregnant women and their partners (Malamulo, Ekwendeni); fishermen and sugar plantation workers, (SAT, SWAM); youth (MAICC, PIH), and rural, inaccessible communities (NACC, FVM Matunkha).

HIV Counseling and Testing In FY10 all Pact Malawi partners will continue working in collaboration with the District Health Offices to receive HIV test kits in order to provide HTC services to communities 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. A family centered model will be implemented by Lighthouse where client (PLHIV) households will have HTC services provided right in their homes. Door to door initiatives will continue to

be implemented by MAICC, PIH and Nkhoma.

Establishing/Strengthening an Effective Referral System All partners will maintain effective internal and external referral systems. Back referral mechanisms will also be strengthened. Partners will maintain inventory of necessary structures within their catchment areas to facilitate referral of clients such as TB and STI patients to HTC services and positive post-test clients to care and support services. HIV negative clients are referred to post-test clubs and other prevention programs in the community.

Capacity Building of Service Providers and Volunteers Implementing partners support capacity building of volunteers and service providers through trainings, supportive supervision, mentoring and coaching to ensure the application of knowledge and skills. Capacity building is provided in HIV counseling, including integration of PMTCT, STI, nutrition, and TB information; HIV testing using the rapid test; couple and child counseling. Service providers are trained in psychosocial support to support PLHIV groups and post-test clubs or to encourage their establishment where they do not exist. Community volunteers are targeted for development of skills in their related areas of involvement, such as community mobilization and community motivation. Pact Malawi trains partner organizations in monitoring, evaluation, and reporting, as well as organizational development. See Pact Malawi's SI and Policy/Systems Strengthening submissions.

Grantee Closeout Of Pact Malawi's partners implementing HTC programs, only Lighthouse and MACRO will close in FY10. Malamulo, MAICC, CCAP Nkhoma Synod, Ekwendeni, PIH, NACC, FVM Matunkha, COPRED, and NASO were selected through the FY09 APS to extend their programs through May 2011.

With Year 2 funding: Pact Malawi's partners - Malamulo, MAICC, CCAP Nkhoma Synod, Ekwendeni, PIH, NACC, FVM Matunkha, COPRED, and NASO will continue to contribute to a national scale up of HTC in Malawi. Pact Malawi's HTC grants will close out in 2011.

VIII. Budget Code: HVSI $125,190 - Year 1 $66,416 - Year 2

Pact provides M&E training to its partners to capture the impact and outcomes of their interventions in accordance with national and PEPFAR standards. At the district level, partners are encouraged to participate in the development of district implementation plans (DIP). Pact Malawi has global and local expertise in monitoring, evaluation, and reporting (MER), which it draws upon to provide technical assistance and capacity building for its local partners in Malawi. Pact Malawi conducts brief, introductory MER orientation in pre-award workshops followed by in-depth MER trainings as projects progress. Pact also provides focused, individualized MER technical assistance to partners during regular monitoring/supervision visits, and DQAs. Pact Malawi also provides its partners with MER tools, resources, and materials that can be used to strengthen their program implementation.

Trainings

In FY 10 and 11 in-depth detailed training on the Next Generation Indicators will be conducted for all Pact partners. This will enable partners to revisit their data collection tools to ensure that they are able to collect quality data for the new indicators. Improved MER skills acquired by participants facilitate sustained program quality beyond Pact's funding.

Data Quality Assessments and Quality Assurance All Data Quality Management Plans will be consolidated in FY10 through on-site mentorship and support visits from Pact Malawi. Pact Malawi developed a quality assurance framework for the program which is employed to strengthen development of minimum standards for key technical areas. During FY10, Pact will continue to address quality assurance issues through mentorship and support visits to partners and provision of focused and individualized M&E support to partners.

Grantee Closeout Pact Malawi's partners will close grants in either FY10 or FY11. Pact will conclude required close-out activities related to MER for these programs by the program end date, September 30, 2011.

XV. Budget Code: OHSS $400,860 - Year 1 $171,228 - Year 2

Through this program area, Pact Malawi provides capacity building technical assistance in several areas to the Government of Malawi and HIV/AIDS service providers. Pact has global and local expertise in capacity building activities related to organizational development, financial management, monitoring and evaluation, and HIV/AIDS policy and technical areas, which will contribute to enhanced operational efficiency and increased sustainability of organizations participating in the national response to HIV/AIDS.

Support to the Global Fund Secretariat In FY 10, Pact Malawi will recruit and train a program manager for a new, independent secretariat for the Malawi Global Fund Coordinating Committee. This manager, with support from Pact Malawi, will establish procedures and systems for the Secretariat and support the functioning of the MGFCC.

Organizational Development In FY 10 and 11, Pact Malawi, in conjunction with its local OD provider CABUNGO, will conduct two in- depth organizational development workshops for its partners on common themes that emerge from partners ISPs. Themes might include human resource management, volunteer retention, strategic planning, etc.

Pact will continue to coordinate and oversee the OD activities. These will include conducting joint trainings and targeted interventions as identified through partner Institutional Strengthening Plans (ISP). A strategy for close follows up after the interventions and indicators will be developed.

$83,460 - Year 1 $75,000 - Year 2

The National HIV and AIDS policy stipulates that the use of disposable sterilized injections can reduce the risk of HIV infection. The government has put in place systems to ensure that disposable materials and sterilizing equipment are in all health centers. Dissemination of appropriate and up-to-date information on the dangers associated with unsterilized material is a priority. Through USG/Pact Malawi funding the Nurse and Midwives Council of Malawi (NMCM) has produced Post Exposure Prophylaxis protocols and guidelines for use by health care workers. NMCM will receive a fixed price contract to finalize the dissemination of the PEP training materials during this fiscal year.

Reproduction and Dissemination of Training Materials

NMCM will reproduce PEP training manuals and guidelines developed in FY09 to be used for trainings during this fiscal year. Materials were 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 focus on infection prevention, universal precautions, and post exposure prophylaxis. Ministry on Health Technical experts and trainers were involved in developing the training materials. NMCM will develop a plan for materials distribution that will meet the needs of each district.

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 roll 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 the regional level.

NMCM's current grant was to end in FY10.

Additional one-time funding for HMIN:

Activity 1: Strengthening the current in-service PEP trainings being conducted by NMCM in FY11 to enable these trainings to incorporate a more substantial component to train providers in injection safety. As noted above the current trainings, while having some content on injection safety, are mainly focused on PEP. However, it would be e cost-effective to include more injection safety activities within these ongoing trainings

II. Budget Code: HVAB $834,600 - Year 1 $663,236 - Year 2

Partners implement a range of abstinence focused activities including mobilization of youth through existing and/or new structures (e.g., schools, church groups, and other community based forums);

facilitating youth clubs formation; provision of youth friendly services; and training of peer educators and youth patrons, including faith leaders.

With Year 1 Funds Pact will implement the following:

Community Sensitization and Youth Mobilization Nine Pact Malawi implementing partners - SAT, Malamulo, MAICC, COPRED, FOCUS, Tovwirane, MBCA, MIAA and NASO - conduct community mobilization activities that include community sensitization meetings, drama, open days where social activities like football, netball are used to attract a large audience, learning exchange visits as well as targeted community meetings. In FY10, the partners will reshape these strategies to focus on smaller group activities that support interpersonal communication between PEs and the constituents they serve.

Facilitation of Youth Groups and Youth Friendly Services (YFS) All partners will continue to strengthen these existing youth groups through various capacity building activities targeting both male and female youth that focus on in-depth information sharing, education, and communication on abstinence and faithfulness, including life skills development to maintain a healthy lifestyle. Malamulo, Ekwendeni, MAICC, AHS and Nkhoma are sensitizing service providers on youth- friendly reproductive health services, and are providing referrals to reproductive health services including STI management, HTC, and resource centers at district health offices.

Training of Peer Educators and Youth Patrons All Pact Malawi'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, follow-up support, and mentoring. In FY10 Pact Malawi's AB partners will scale down mass outreach and other outreach activities and focus most of their attention on implementing small group youth discussions and other outreach activities as described above. Technical Assistance and coordination Pact Malawi will build the capacity of youth prevention organizations to access funds from the National AIDS Commission and the Global Fund. Specifically, Pact staff will work with these organizations to improve their documentation of best practices. Staff Capacity Building Pact Malawi's partners will continue training their staff in technical areas including BCC and interpersonal communication skills in order to strengthen their AB programs. Partners' staff member are also trained in strategic information and data management Grantee Closeout Of Pact Malawi's partners implementing AB activities, five will close at the end of FY10 (September 30,

2010): MIAA, CCC, MBCA, COVISODE, and FOCUS. The remaining partners were selected through the FY09 APS to extend their programs through May 2011. With Year 2 funds Pact will implement the following:

The following Pact Malawi partners will support the implementation of above mentioned AB activities contributing to the prevention and behavior change component of the national HIV/AIDS program in FY11: Malamulo Hospital, Synod of Livingstonia at Ekwendeni, Southern Africa AIDS Trust (SAT), Mponela AIDS Information and Counseling Centre (MAICC),Nkhoma National Association of People Living with HIV and AIDS in Malawi (NAPHAM), Lusubilo, Community Partnership for Relief and Development (COPRED), Nkhotakota AIDS Service Organization (NASO), Namwera AIDS Coordinating Committee (NACC), Society for Women and AIDS in Malawi (SWAM), Nkhotakota AIDS Service Organisation (NASO), Tovwirane, Partners in Hope (PIH), FVM-Matunkha. All Pact Malawi partners implementing AB will close in May 2011.

III. Budget Code: HVOP $417,300 - Year 1 $293,379 - Year 2

In FY10 Pact Malawi's local partners- Ekwendeni, MAICC, SAT, MACRO, COPRED, NAPHAM, Malamulo, FOCUS, CCC, NACC, FVM- Matunkha and SWAM- will be implementing AB activities linked to the overall national HIV/AIDS prevention program for Malawi. The implementing partners will build on their previous experiences to expand their programs in FY10/11 to target men and women, especially high-risk groups such as sexually active youth, migrant workers, with HVOP messages through HTC services, PMTCT services, youth friendly services, and links to family planning services.

With Year 1 funding Pact will implement the following:

Training of Behavior Change Communication (BCC) Facilitators Pact Malawi will continue to support SWAM, MAICC, Nkhoma, SAT, NACC, FOCUS, Malamulo, Ekwendeni, MBCA, and COPRED to train facilitators to use the Hope Kit HIV prevention training tool. This tool, developed through the Bridge program, uses experiential learning methods to assist people in moving from knowledge to action.

Comprehensive HIV Prevention Activities Pact Malawi's partners support the implementation of comprehensive HIV prevention activities that include the 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, and HIV awareness campaigns. Gender equity and women's empowerment build self efficacy and decision making skills on HIV prevention issues, reduction of stigma and discrimination through active involvement of PLHIV and advocacy for leadership, secondary prevention activities (prevention for positives). Activities also strive to promote provision of clinical services, management of sexually transmitted infections (STI), advocacy for policy adjustments and provision of HTC. Malamulo, MBCA, SAT, NAPHAM, SWAM, FOCUS, and MACRO are supporting the printing and distribution of IEC materials that promote HTC.

Staff Capacity Building Partners are supporting the capacity building of service providers through training, follow-up support, 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 through strategic information management (See Pact Malawi's SI and Policy/Systems Strengthening submissions).

Grantee Closeout

Of Pact Malawi's partners implementing HVOP activities, five will close at the end of FY10 (September 30, 2010): MIAA, CCC, MBCA, MACRO, and FOCUS. The remaining partners were selected through the FY09 APS to extend their programs through May 2011. With Year 2 funding pact will implement the following:

In FY11 All partners will provide HIV/AIDS prevention interventions beyond those focused on abstinence and/or being faithful as above. Condoms are supplied by District Health Officers (DHOs), Banja La Mtsogolo (local NGO family planning centers), and Population Services International (PSI). The implementing partners will build on their previous experiences to expand their programs in FY11 to target men and women, especially high-risk groups such as sexually active youth, migrant workers, with HVOP messages through HTC services, PMTCT services, youth friendly services, and links to family planning services. Pact Malawi will work to ensure that the partners understand OGAC ABC guidance in implementing their HVOP activities.

All Pact Malawi partners implementing HVOP activities will close out in May 2011.

I. Budget Code: MTCT ($374,577.00)

Pact Malawi has four FBO partners that are implementing PMTCT programs. These partners are proving PMTCT services in 20 health facilities Combined. The majority of their health facilities are in the rural areas, thereby improving accessibility to PMTCT services for rural populations. The PMTCT activities implemented through year 1 are summarized below.

Community Mobilization for PMTCT Pact Malawi's PMTCT partners conduct community mobilization activities in their catchment areas, including sensitization on the importance and benefits of available PMTCT services. Women of reproductive age and their partners; community leaders and other gatekeepers such as traditional healers, community women counselors, and 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 for PMTCT and encourage use of available services. Mainstreaming gender activities into PMTCT programs is also a key component.

HIV Counseling and Testing (HTC) Pact Malawi partners provide HTC for PMTCT as part of integrated Maternal Child Health (MCH) services. In addition, exposed and suspected infants including, but not limited to, children with TB, severe malnutrition, failure to thrive, chronic malaria, and other severe illnesses at 18 months will be targeted for HIV testing and their parents counseled for HIV. A family centered approach is applied to identify other HIV-infected family members through an index case, which could be a mother or child identified in the MCH services, post-Delivery Follow-up of Mother/Infant pairs. All four partners have already adopted provider-initiated HTC using the opt-out approach for PMTCT in MCH services

Follow-up Care and Support for HIV-Positive Mothers during Pregnancy, Labor, and Delivery Pact Malawi's partners will continue to strengthen follow-up care and support services for HIV positive women through pregnancy, labor and delivery. During pregnancy mothers are monitored using WHO staging, HB tests, CD4 count test, and clinical care management including initiation or continuation of prophylaxis treatment of OIs and ART. Health status of the women is monitored during their antenatal visit, those with high CD4 count at initial visit and not eligible for ART, are monitored during the follow up visits for any signs and if need be another CD4 check is done. Counseling on risk reduction and positive living is given. Maternal nutrition is assessed through routine ANC weight motoring, provision of micronutrient supplements, and counseling on diet related issues and infant feeding options.

Post-Delivery Follow-up of Mother/Infant pairs Pact Malawi's partners will continue to provide follow-up services for mother and infant pairs. All exposed infants, including those delivered at home if they reported to the health facility within 72 hours, will be provided ARV prophylaxis as per national guidelines. Mother's will be counseled on different infant feeding options, and on other essential newborn care including, but not limited to: Cotrimoxazole prophylaxis according to the national protocol, immunizations, monthly growth monitoring and assessment of presumptive signs for HIV. Monthly monitoring of mother and infant pair up to 18 months is conducted. Mechanisms to strengthen mother and infant follow up have also been developed by partners

Referrals and Links to Treatment, Care, and Support Services All partners implementing PMTCT activities will continue to strengthen and/or establish new links for collaboration among partners and referral systems for mothers and exposed infants to access available services along the continuum of care for HIV/AIDS including, but not limited to: ART, nutrition support, psychosocial support through mother support groups, and other community support systems.

Staff Capacity Building Partners will continue training their staff in PMTCT management to meet the increasing demand from the communities in which they work. Members of staff are 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 Malawi's SI submission).

Grantee Closeout Of Pact Malawi's four partners implementing PMTCT activities, only AHS will close at the end of FY10 (September 30, 2010). Malamulo, CCAP Nkhoma, and Ekwendeni were selected through the FY09 APS to extend their programs through May 2011. Prior to this date, Pact Malawi will submit an outline of the Final Program Report to the AOTRs for discussion and approval. This report will include a summary of the successes, challenges, and lessons learned regarding all programmatic areas.

With Year 2 funds Pact will implement the following activities:

Pact will have three FBO partners implementing PMTCT programs: Malamulo SDA Hospital, CCAP Nkhoma Hospita, and Livingstonia Synod Ekwendeni Hospital. These partners will be providing the above mentioned PMTCT activities in 12 health facilities; all the three are contributing to the scale-up of quality and comprehensive PMTCT services in Malawi. The majority of their health facilities are in the

rural areas, thereby improving accessibility to PMTCT services for rural populations. Malamulo, CCAP Nkhoma, and Ekwendeni's grants will close in May 2011.

1. Supporting national scale-up of lay cadres and expert patients through PACT's existing community- based partners

The move to start pregnant women on ART at an earlier CD4 count will necessitate more intensive psychosocial support, as data from several settings seem to indicate that such clinically well patients are at a higher risk for default than other patients starting ART. The Tingathe program, which is implemented in Malawi by Baylor College of Medicine, is an example of a successful intervention with lay cadres that has shown dramatic results in the improvement in the PMTCT cascade In order to cost-effectively scale- up such lay cadre/PSS approaches, the USG strategy will be to support Baylor to a sub-set of high- volume sites (see Baylor COP entry), but at the same time provide complementary support through a network of community-based platforms that are already on the ground to expand standardized approaches with lay workers in a way that is sustainable and can be taken to national scale. PACT has a strong network of indigenous implementing partners that the USG will build upon to saturate the districts where these partners are operating with community-support for PMTCT. These partners include MAICC in Dedza; Namwera in Mangochi; Towvirane in Rumphi; COPRED in Mwanza and Blantyre; FVM Manthuka in Rumphi; and NASO in Nkhota-Khota, and Lusibilo in Karonga. These efforts will be solely coordinated with the lay cadres to be supported by MSH, Baylor, and IYCN that are described in their associated COP entries to ensure there is standardization of approaches and no duplication of coverage. 2. Primary prevention and male involvement in the context of PMTCT Reported results of a male championship program in Mchingi and Mwanza districts have been very encouraging, with more than 75% of male partners reportedly attending ANC after an intensive community mobilization effort that engaged village headmen and traditional authorities. Through its cooperative agreement with the MOH, CDC will support an evaluation of the program in early 2010 to distill lessons learned which can be scaled-up to all districts. PACT's indigenous described above which have high population-based coverage and strong relationships with village leaders and traditional authorities in the district where they are operating will be used to scale-up community based activities to promote male involvement in PMTCT, couples counseling, and PwP within the PMTCT setting. Activities will especially emphasize increasing early and repeated antenatal care attendance and also delivery with a trained attendant; male attendance at ANC and partner testing; prevention with positives with the ANC setting, and also address broader male norms and issues such as prevention of domestic violence and stigma against PLHIV. This activity will be linked with the lay cadres and expert patients approach described above and operate in the same districts, using these cadres to implement the community mobilization activities.