this mechanism will continue as previosly stated to support MDF activites and the communitites they serve

The goal of the collaboration between PCI and the MDF is to enhance the capacity of Malawis military leadership in leading the response towards reduced HIV prevalence among MDF personnel and their families. The objectives are:

?To engage and strengthen MDF leadership in response to HIV programming, including strategic planning, implementation, monitoring and evaluation focusing on Battalion and Company Commanders, Military Chaplains, and other key actors

To provide technical assistance to the MAMHS HIV & AIDS Program Unit and existing HIV prevention team members, on a range of HIV technical areas.

? o promote information sharing and learning on comprehensive HIV & AIDS programming between the Malawian and Zambian Defense Forces;

DHAPP promotes MDF ownership and leadership through strategic capacity building of human resources for a sustainable program. DHAPP adheres to Malawis National Action Framework and the PEPFAR country strategy and GHI Partnership Framework as well as the new National Strategic Plan for the government of Malawi. Through partnerships with government, other organizations and the private sector resources will be leveraged to ensure cost efficiency and sustainability. The program will ensure strict adherence to gender considerations through gender analysis and monitoring of appropriate gender indicators

MDF/PCI supports PLHIV support groups in three barracks. The program will prioritize formation of additional groups in nine barracks while strengthening existing groups. Training in PwP methodology will continue as new support groups are formed. MDF/PCI will use the PwP manual including updates where applicable. Hands on training with close mentoring will be used to complement the didactic approach in the manual. Master Trainers will be selected based on agreed criteria and in line with MOH standards. PLHIVs who have declared their status will be prioritized and trained to facilitate these groups. The Master Trainers will provide peer education on re-infection risk reduction, correct and consistent condom use, and support effective reproductive health choices with referral for contraceptive services when indicated.

Members of support groups will continue to provide adherence support in collaboration with clinics where PLHIV receive their ARV medication.

PCI will facilitate setting up IGAs at the 12 Military Units. PCI will use its GROW model with these groups. MDF/PCI will promote cross learning among groups to strengthen the weaker ones. PCI will continue to provide mentoring and supervision to facilitators of these support groups by providing targeted support when required.

MDF/PCI plans to introduce Nutritional assessments to facilitates nutrition support. The UNICEF supported program providing plumpy nut to malnourished PLWHA will be expanded to all 12 units of MDF. A cadre of health care workers within MDF will be selected and trained in carrying out nutritional assessments using MOH curricula. Job aids including pocket size charts to support this activity will be reviewed, revised and adopted from existing MOH/DHO materials. MDF/PCI plans to include nutrition information for PLHIV in the audiovisuals that will be produced to promote various interventions to be implemented under the program. Nutritional registers will be used to monitor progress of those receiving nutritional support following assessments. Further, MDF/PCI will collaborate with Baobab Health to implement an ICT based solution to capture data, store and analyze data for tracking recovery progress of those on nutritional support.

MDF/PCI will contribute to Malawi Governments goal of reducing morbidity and mortality due to TB including TB/HIV co-infection. This will include improvements in case detection and treatment outcomes. The program will work closely with the MOHs National TB Control Program to align strategies and activities. This will include planning for HIV test reagents to test TB clients, registers and other data collection tools (such as the ICT based solution from Baobab Health), training guidelines and BCC materials.

In our HIV prevention sensitization activities, we would use similar channels to sensitize the soldiers and their families about the co-infection especially its higher mortality and the need for early detection and treatment of TB in particular but HIV management as well. MDF/PCI will take a rights based approach to TB. The MDF/PCI will produce the audio/visuals with messages on TB prevention, detection and treatment.

MDF/PCI will provide training for peer educators, care givers and clinicians managing HIV clients on sensitizing their clients for TB screening. Training will include sensitization on common symptoms suggestive of TB, locations where for assessment and diagnosis, and the need for treatment adherence in those with confirmed TB. Master trainers will be identified within MDF to serve as a pool for downstream training, supervision and mentoring. We will tap into existing national trainers and use existing training materials and curricula. Where feasible clinicians attending PLHIV should offer TB screening as per national guidelines or refer them for such screening. The mobile CT facilities will also be used to collect sputum for TB screening. Similarly all TB patients should be offered HIV testing. Where MDF health facilities cannot render the service, referral to other facilities will be made. Home based care providers following up especially new TB client would need to facilitate screening of household contacts. Care givers would also facilitate treatment adherence to support compliance and reduce potential for resistance development.

PCI/MDF will collect all data as per GOM guidelines and feed this into the national database through the ICT TB solution from Baobab Health.

PCI will upgrade laboratories in selected clinics to perform EID, quality control of rapid HIV diagnosis and CD4 assays to support ART patient monitoring. PCI will also develop and disseminate job aides to support quality laboratory services for HIV, TB, STIs and train laboratory technicians in selected clinics for these new roles.

PCI will assess the MAHMS laboratories for relevant upgrades including equipment, consumables, etc. Training will be conducted for laboratory technicians in laboratory quality, data management and HIV, TB and STI diagnosis and support to treatment monitoring. Regular blood donation campaign strategy will be designed to be conducted within the military and surrounding communities to support availability of blood testing.

PCI/MDF will strengthen laboratories within the MAMHS facilities to better enhance diagnosis of HIV, TB, opportunistic infections and STI. PCI will specifically focus on early infant diagnosis using PCR, confirmation of randomly selected samples tested with rapid diagnostics for quality assurance, and expand access to CD4 assessment at the initiation of ART. PCI will also strengthen the capacity of the laboratories for treatment monitoring using viral load as well as testing samples during the planned SABERS.

PCI will in collaboration with the laboratory section of the Ministry of Health assess MAMHS laboratories for relevant upgrades in order to perform these tasks including procurement of new equipment, consumables and safety gear. Laboratory technicians in six clinics based on selection led by the MDF HIV Coordinator will be trained in basic laboratory quality assurance, laboratory safety, and laboratory data management and conducting of specific diagnostic tests for HIV, TB and STI.

PCI will provide technical assistance in the review/development of job aids such as for Dry Blood Spot technique, based on the experience from our India program supporting laboratory quality assurance.

PCI recognizes importance of strengthening strategic information component of MDFs work to effectively generate and utilize data to inform program planning and implementation. As a new initiative, MDF/PCI plans to strengthen epidemiological surveillance and to contribute towards MOHs disease surveillance efforts by partnering with Baobab Health to install state of the art ICT based solutions in 3MDF health facilities. The ICT based solutions will ease data capture, storage analysis and reporting. In addition, the system will link MDFs HMIS with MOHs MIS, providing a channel through which data from MDF health facilities contributes to national disease surveillance efforts (e.g. National TB Control Program). Internally, MDF will use data from the HMIS to understand and explain disease (including HIV&AIDS and TB) transmission dynamics and to design appropriate health promotion interventions. The HMIS will cover areas including ART, HTC, PMTCT, TB, STI, OPD and patient registration. A 4x4 vehicle will be required to support to all sites.

MDF/PCI plans to establish an internet connection in 3 health facilities of the MDF to link the HMIS to MDF Headquarters MIS and MOHs HMIS. The connection will assist in prompt submission of program progress reports. It will also improve communication between program implementation sites and stakeholders ensuring provision of timely support that improves program quality and results.

PCI/MDF will continue to build the capacity of M&E focal point persons at each Military Unit, and peer educators and support groups in the collection, storage, analysis and use of data through onsite trainings and mentorship. Data quality audits will continue on quarterly basis to ensure data activities are undertaken in line with ethical and quality guidelines. Moreover, MDF/PCI will ensure there is sufficient documentation to support program progress. Data from the program M&E system will feed into the National M&E system for HIV&AIDS and report to PEPFAR, DOD, NAC and stakeholders supporting MDF. Lessons learned from COP2010 show that provision of registers to all sections of the program improves coverage and quality of data. MDF/PCI will procure registers for data activities.

Training and re-training of unit commanders and unit HIV coordinators will be conducted along with training of spouses of senior officers in mobilization and sensitization of their colleague spouses. The HIV Strategic Plan will be finalized. Exchange visits between camps and with another country will occur. An exchange visit with either PCI Zambia or Botswana will be planned for the MFD to learn about programming in other countries where PCI has Uniformed Services Programs. PCI will conduct a 3-day training for MDF leaders in HIV & AIDS program management for National Technical Area Coordinators, 24 Regional HIV Coordinators and 12 Unit Commanders. A refresher training of mentorship for MDF leaders and HIV/AIDS leadership for 25 Unit Commanders will be conducted along with facilitation of the dissemination of the MDF Strategic Plan and Policy. A bi-annual 4-day workshop for the spouses of 45 senior officers in the sensitization, mobilization of the officers and soldier's wives about HIV prevention, treatment, care and support services will be conducted.

A 3-day quarterly supportive supervisory visit in 12 military units will be conducted along with quarterly joint planning meetings between the MDF and implementing partners and the National AIDS Commission.

A 2-day training in stock management will be conducted with all 24 Unit Coordinators and 24 peer educators. Assessing, upgrading and equipping 6 facilities providing antenatal care, delivery and post natal services will be completed. PCI in partnership with MDF will conduct a review meeting for 24 HIV and AIDS unit Coordinators. The objective of the three-day workshop will be to strengthen the capacity of the focal persons in every unit, so that work plans could be developed and HIV/AIDS information could effectively be disseminated to people in their units. During the meeting, unit-based HIV & AIDS Coordinators will also be updated on HIV/AIDS prevention, treatment, care and support. A review of each unit HIV/AIDS activities will also be conducted. PCI in collaboration with MDF will conduct trainings to improve facilitation skills for PCI and MDF staff. Through a five-day workshop, DHAPP MDF and PCI staff will improve their skills to become better learner-centered and objective facilitators. This will set the foundation for transitioning DHAPP over to MDF, and ensure continued effort from within MDF. PCI will engage a suitably qualified person to build the skill set of selected MDF personnel and PCI staff. PCI will intensify joint field visits and facilitate proactive coordination and collaboration among stakeholders at all of these levels through joint planning including service coordination and referrals, review and monitoring. Clarity of responsibilities through revised job descriptions, scopes of work and reporting channels to avoid duplication will be intensified within the MDF hierarchy through better dissemination. Quarterly coordination/joint planning meetings will be held between MDF and implementing partners and MDF/PCI will liaise with NAC and actively participate in coordination activities to be abreast with national coordination efforts.

PCI builds on MC efforts initiated in COP2011. Additional three facilities to conduct MC will be identified Site selection will be based on Government of Malawi policy and standards. In order to ensure safe circumcision, relevant staff from the three MDF clinics will be identified and trained in the range of comprehensive components of MC package as recommended by WHO/UNAIDS. This will include safe surgical circumcision including post surgical care, HCT on site or through referral, sexual risk reduction education including promotion of correct and consistent use as well as supply of condoms and STI management.

Trainings will utilize recommended curricula and guidelines adopted by the MOH. Accredited trainers will be used; a core of master trainers will be identified and trained in order to ensure roll out and post training support and supervision. Refurbishments and upgrades of facilities and purchase of equipment will be undertaken in selected MDF clinics where clinicians are trained so they can perform MC in those sites. Where the surgical procedure cannot be done within the MDF facility, clients will be referred to facilities previously identified and prior arrangements with agreed MOU made to access the procedure. Referral tools such as registers and slips with feedback would be used in order to track completion of referrals.

While demand generation for circumcision will target primarily male adults and adolescents, spouses will be secondary targets. The focus of demand generation will be on the benefits of MC, its limited protection and the need to continue using other prevention tools. It will also cover myths and misconceptions and the need for a comprehensive package including HIV testing for index clients and partner(s), condom use and STI management. Approaches such as the use of Theater for Development would be used. Satisfied clients would be encouraged to provide testimonies to allay fears of prospective clients. MDF/PCI will arrange mass camps to reach large numbers over a short period of time prior to which mass media campaigns will be undertaken. MDF/PCI will facilitate production of a DVD to generate demand for MC that will complement other military specific prevention messaging.

PCI will upgrade selected clinics with blood donor rooms, couches and other equipment/consumables to offer blood banking services. We plan to conduct blood donation campaigns within the MDF camps and surrounding communities. Additional laboratory technicians and clinicians will be trained in blood safety in collaboration with the Malawi Blood Transfusion Service Trust.

In an effort to ensure availability of high quality blood services, PCI/MDF will design regular campaign strategies to be conducted within the military and surrounding communities. In line with the overall BCC strategy, the campaigns will be conducted in the form of drama performances, open days, radio programs, IEC and school talks. MDF will also develop a directory of blood donors from the soldiers.

MDF/PCI in collaboration with Malawi Blood Transfusion Service Trust (MBTST) will also train an additional 10 laboratory technicians and 40 clinicians and nurses from all the health facilities in blood safety. The week-long training will be facilitated by MBTST using national guidelines derived from the World Health Organization (WHO). The training content will include blood typing, screening for HIV and Hepatitis, cross match, blood transportation, cold chain for blood and blood products and quality control.

PCI will renovate health facilities at units such as Chilumba Garrison, Mvera Support Battalion, and Malawi Armed Forces Colleges, to create laboratory departments with donor rooms, blood bank and receptions. Renovations will be done to existing structures.

PCI will also procure laboratory equipment. These include blood banks, couches, furniture, and polymerase chain reaction (PCR) machines.

MDF/PCI will implement HVAB activities that encourage risk reduction and promote HIV prevention through abstinence/be faithful in monogamous relationships. PCI will facilitate capacity building and technical assistance to MDF to strengthen implementation of behavior change strategies for the prevention of Sexually Transmitted Infections (STI) and HIV. PCI will work with the MDF to inform, inspire, and challenge the youth (age 14-30) to negotiate and refrain from sex before marriage, or otherwise delay debut of sexual activity by targeting in and out of school youth in communities surrounding the camps, as well as new recruits and unmarried military personnel, while promoting fidelity among married couples.

MDF/PCI will continue to support chaplains and peer educators to communicate AB messages through True Love Waits (TLW) for youth and True Love Stays (TLS) for married couples in all 12 Military Units. TLW challenges the youth to follow a principled plan for sex and marriage, build positive relationships with members of opposite sex, and save intercourse for a monogamous relationship. TLS encourages couples to remain faithful and avoid the dangers of multiple sexual partners. The TLW methodology is one of several used within the Peer Education Network that promote delayed sexual debut and abstinence. MDF/PCI will conduct quarterly quality assurance checks to ensure the peer education network is communicating accurate messages and sessions that conform to guidelines, using tools developed in the previous year. MDF/PCI will conduct joint supervisory and monitoring visits to carry out quality assurance checks.

The peer education network plays a key role in dissemination of AB messages on MDF bases and in surrounding communities. MDF/PCI will partner with Theatre For A Change (TfaC) to train 36 Master Peer Educators in an innovative approach using participant developed drama, monitoring & supportive visits that builds on earlier training conducted by TfaC with MDF. Interactive theatre techniques are used to assist participants make correct choices and behavior change. Many facilitators are former sex workers and PLHIV.

Although Malawis HIV counseling and testing strategy (HCT) is first and foremost about prevention, there are barriers to uptake of HCT, including stigma, loss of employment, low awareness of psychosocial and health benefits and access to trusted services. PCI will support MDF to increase uptake of HCT services by extending mobile HTC from six MDF military Units included in COP2011 to all 12 Units. Scale up of mobile HTC services will require a Land Cruiser vehicle.

MDF/PCI will continue to support home based HTC rolled out (COP2011) by training additional 60 volunteers to effectively reach soldier homes in the 12 bases and homes of surrounding civilian populations. MDF/PCI will procure 60 bicycles for the volunteers for home based HTC and maintain 60 bicycles for volunteers identified and trained in COP2011. Additionally, we will continue strengthening linkages between CT services and national entities to ensure procurement of adequate medical supplies. The success of the scale up of HTC services depends on availability of testing reagents in sufficient quantities at all times. MDF/PCI will work with MOH through DHOs to ensure HTC sites and mobile HTC (piloted in COP2011) facilities including home based HTC volunteers are provided with adequate quantities of test kits. MDF/PCI will procure 1500 kits to supplement those from MOH when bottlenecks arise.

MDF/PCI will continue to strengthen the improved referral system between HTC and CD4 testing, and collaborate with a number of stakeholders including MOH and CHAM to facilitate the establishment of links to central, district hospitals and mission hospitals for CD4 testing as part of overall strengthening of referral networks between HIV&AIDS services including mobile and static services, peer education, support groups, home-based care, and chaplaincy. Provision of onsite technical assistance and quality assurance for HTC services will continue in FY2012 that will use quality assurance tools recently adopted from MOH. MDF/PCI will constantly liaise with MOH to ensure recent developments in quality guidelines for HTC are reflected in the tools for joint supervision and quality assurance to national/international standards and requirements for HTC services.

PCI and the MDF recognize the urgency to link sexual prevention initiatives of the Extended National Action Framework, to the PEPFAR priorities as outlined in the Five Year Partnership Framework and the MDF Action Plan priorities. One common cross-cutting strategy identified in each of these documents is sexual prevention using evidence-based. Strengthening the capacity of MDF to be an effective partner in the implementation of the National Action Framework is therefore the goal of the PCI collaboration with MDF.

MDF/PCI will use FY2012 PEPFAR funding to conduct quarterly quality assurance assessments including HTC, PMTCT, ART, and HBC to ensure two-way referrals and outcomes are documented and Peer education, PMTCT, HTC,HIV/TB, MC and M&E networks are active. Further MDF/PCI will facilitate condom availability in all project settings and distribution channels including clinics, youth centers, and the peer education network and support groups. Moreover, MDF/PCI will address stigma and discrimination by engaging PLHA in the program. PCI will draw on internal expertise to build skill sets in a new approach called Participatory Video making. The approach aids greater control over decisions and precipitates change. In addition, Story Workshop and Pa Kachere will provide media collaborative support. PCI will also work with the MDF to integrate messages on alcohol abuse into all HIV prevention messages delivered by CT providers, peer educators and other relevant caregivers.

Target

Population Approx Dollar Amount Coverage number to be reached by each intervention component Activity

Military population ******* All 12 MDF Military Units Conduct quality assurance assessments of all HIV&AIDS activities

Military population 0 Condom distribution in all project settings and distribution channels reaching 10000 individuals

Facilitate distribution of condoms through outlets in MDF.

Military population ******* Participatory video development in 12 Units Participatory Video Development in MDF in collaboration with Story Workshop and Pa Kachere disseminating information and catalyzing change to reduce HIV&AIDS risk, increase positive living with their peers, nutrition, PMTCT, TB and gender equity, STI prevention

MDF/PCI will continue to support implementation of PMTCT activities that are aligned with the Malawi National Action Framework and other national strategic plan documents. With infrastructural upgrades undertaken with COP 11 funds, PCI will build the capacity of MDF facility health workers to provide quality clinical and community promotion of PMTCT services. MDF/PCI will provide ongoing supportive supervision and mentoring to enhance provision of quality services including conducting periodic program and data quality assessments.

At community level, PCI will support the MDF to intensify testing and counseling among adult and adolescents, including promotion of couple testing and counseling through static, door to door and mobile CT services, and increase male involvement in health facility and community based behavior change and communication (BCC) PMTCT services, through small group reflective discussions, and promote group actions that address issues identified during discussions. Further MDF/PCI will integrate antenatal, safe delivery and postnatal care, child health/infant feeding including referral for early infant diagnosis of HIV, family planning (FP), and gender information and messages in provider training and community based HIV prevention activities including drama. In addition MDF/PCI will intensify re-testing of pregnant and breastfeeding mothers and spouses and strengthen referral networks between communities and MDF health facilities, and between communities and collaborative service providers. MDF/PCI will promote PMTCT audiovisual messages produced in partnership with Pa Kachere and Story Workshop. The two partners will also support development of information, education and communication materials. PCI/MDF will train 200 health care workers in PMTCT and other core areas of maternal and child health, reproductive health and family planning.

The male peer educators will reach out to men with PMTCT messages including reducing gender based violence.

MDF/PCI plans to refurbish 6 MDF facilities (in addition to the 6 facilities refurbished in COP2011) and train 200 health care workers in PMTCT using MOH curricula.