Development AID from People to People (DAPP) has two main AB activities in Namibia: Total Control of the Epidemic (TCE) and Hope Humana. DAPP AB activities principally involve house-to-house AB education by trained TCE Field Officers (FOs) and community volunteers, as well as the expansion of Hope Humana youth clubs in schools, along with a pilot program of sports clubs for adult men. Overall, TCE resources support more prevention than care activities, and thus funding is allocated across 3 program areas: DAPP AB_7325 as well as DAPP Condoms-Other Prevention_7327, and DAPP Basic Care_7326.

TCE is a highly organized house-to-house mobilization strategy that aims to individually educate and empower members of a community to reduce risk of HIV and to access HIV resources in the community. The TCE FOs assess the risk level of household members and provide information and referrals accordingly. TCE was established in northern Namibia in 2005 with support from the Global Fund and PEPFAR (in the regions of Omusati, Oshana, and part of Ohangwena and Oshikoto with Global Fund and remaining Ohangwena, Oshikoto, and part of Kavango Region with PEPFAR). The Global Fund supports 290 community members trained as FOs. Of note: the 2005 Global Fund annual report singled out TCE as one of 3 success stories in Namibia.

To date, with PEPFAR support TCE has recruited, trained, and employed an additional 150 community members as FOs who, as of July 31, 2006, reached 109,600 community members (36.5% of the target of 300,000) through household visits. The visits involve registration of household members, targeted AB communications or other prevention communications as appropriate, and mobilization of community members to seek VCT and PMTCT services. Community volunteers are a key, and PEPFAR-supported FOs have recruited and deployed more than 1,960 to assist with these health messages and referrals. FOs and volunteers facilitated 11 support groups and organized community-wide HIV-related activities. TCE works in close collaboration with many local organizations and PEPFAR partners, for example, through their distribution of local-language IEC materials developed by Johns Hopkins University and condoms provided through the MoHSS.

FY07 funds will support (1) continued and more intensive AB activities within current regions and (2) introduction of the program into additional regions, including the neighboring eastern half of Kavango region (in response to demand from political leaders), Caprivi region (which has Namibia's highest HIV/AIDS prevalence at 43% in 2004), and the central Khomas region (which includes the most densely populated and high-risk settlements in Namibia in Katutura, Windhoek). A total of 122 new FOs will be recruited and trained for these new regions, covering a population of 244,000, bringing the total population covered to 544,000. If 70% of this population is reached by FOs during the reporting period, and an estimated 40% or 152,320 will be reached with AB messages during the reporting period. (The remaining 60%, or 228,480 will be reached with OP messages.)

Because youth are at high risk for HIV infection, particularly young girls, persons in houses and schools under age 15, FOs emphasize abstinence messages. During the ongoing sessions with under-15-year-olds, the FOs discuss: 1) Knowledge about HIV virus, how it works and spreads; 2) General knowledge of sexual life, 3) Deciding not to get infected by HIV; 4) Deciding consciously to delay the first sexual encounter, and 5) Risks of teenage pregnancy

For adults, young persons who ask, and those at high risk of contracting HIV through sexual contact (such as migrant workers and spouses, persons having sex with a person of unknown HIV status, persons with multiple partners), FOs discuss:1) Knowledge about HIV transmission; 2) Prevention of HIV through correct and consistent use of condoms, including demonstrating how to use condoms; and 3) knowing where condoms are available. FOs also distribute condoms to those who have received education.

Support visits to TCE FOs have demonstrated that assistance is needed to refine their communication messages and strategies to optimize delivery of the AB approach and discussing other prevention. Especially in need of greater emphasis are effective approaches to achieve behavioral change in terms of being faithful to partner(s) of known HIV status and partner reduction, particularly for adult men. Support from a USG-funded behavioral change specialist will be provided in late 2006 to further support TCE to

enhance their prevention messages, including the incorporation of gender-related issues around partner reduction and family planning. FY 07 funds will support follow-up TA and retraining to ensure recommendations were implemented.

In 2007, DAPP will receive direct funding to continue its Hope Humana YOUTH CLUBS in schools (previously funded under FHI, now PACT). The program is now being implemented in Omusati Region in cooperation with the Regional Aids Coordinating Committees (RACOC), local leaders and the MOE. DAPP has observed that the rate of teenage pregnancies is high and that it is widely accepted in the culture that young girls/women have babies and leave them to be taken care of by their grandparents or aunts while they search for jobs and continue studying. In the school year 2007, 45 schools in Omusati will remain engaged in the program (22 previous schools and 23 new schools), and 25 new schools in Ohangwena, 25 in Oshikoto, and 25 in Kavango will join. This comprehensive youth education prevention program uses participatory education sessions with games and drama, and peer education with AB messages. The project involves training peer educators, teachers and volunteers and it targets boys and girls 14-19 years of age, focusing specifically on the girls and their right to say no to sex in relationships, delay the first sexual debut and promote abstinence before marriage. At the annual Hope Youth Festival, student participants from all schools make presentations and attend as representatives, sharing their lessons learned with their communities.

The TCE FO program operates within a continuous learning and support system. Initial training is a 4-week course on basics of HIV transmission, STIs, abstinence and behavior change, and appropriate condom education. The course orients FOs to the TCE mission and structure and how to use household registers to document all activities. Role-playing enables practice in communicating prevention messages. FOs begin visiting assigned households (2000 people per FO) with an experienced FO. FOs report to their immediate supervisor, the Troop Commander (TC). Groups of 50 FOs meet together each Friday under the leadership of a TCE TC with support from Special Forces (SF). FOs report numbers of persons educated, share experiences, ask questions; challenging questions are taken up to the Division Commander. The weekly sessions are effective in identifying additional FO information/skills needs, which are met by organizing trainings or linking with appropriate resource groups in the community. SF members also visit their FOs in the field on short notice to assure quality.

FY2007 funds ($7500 for 10 clubs) will go towards a pilot intervention targeting adult men in collaboration with the Johns Hopkins' University Nawa Sport initiative (see DAPP OP activity_7327 as well as Johns Hopkins activities in AB and C/Other Prevention_7455 and 7457). This activity involves TCE staff being trained as soccer coaches to then organize sports clubs for men to insert strong behavior change messages using sports language and creation of good role models. The messages will be reinforced each session on a weekly basis.

In this area, Development AID from People to People (DAPP) uses Field Officers (FOs) from its program,Total Control of the Epidemic (TCE), to provide education to adults and high-risk persons on the consistent and correct use of condoms. Overall, TCE resources support more prevention than care activities, and thus funding is allocated across 3 program areas: this area, as well as DAPP AB (#7325) and DAPP Basic Care (#7326).

TCE is a highly organized house-to-house mobilization strategy that aims to individually educate and empower members of a community to reduce risk of HIV and to access HIV-specific resources in the community. The TCE FOs assess the risk level of household members and provide information and referrals accordingly. TCE was established in northern Namibia in 2005 (in the regions of Omusati, Oshana, and part of Ohangwena and Oshikoto with Global Fund and remaining Ohangwena, Oshikoto, and part of Kavango Region with PEPFAR). The Global Fund supports 290 community members trained as FOs. Of note: the 2005 Global Fund annual report singled out TCE as one of 3 success stories in Namibia.

To date, with PEPFAR support TCE has recruited, trained, and employed an additional 150 local community members as FOs who, as of July 31, 2006, reached 109,600 community members (36.5% of the target population of 300,000) through household visits. The visits involve registration of household members, appropriately targeted AB and C communications, and mobilization of community members to seek volunteer counseling and testing (VCT) and PMTCT services. Community volunteers are a key, and PEPFAR FOs have recruited and deployed more than 1,960 community volunteers to assist with these health messages and referrals. FOs and volunteers facilitated 11 support groups and organized community-wide HIV-related activities.

"Other" prevention efforts include education in HIV/AIDS for traditional leaders and small community libraries. Of the 2006 target of 150 traditional leaders to be educated, 89 were by July 2006, and in 5 workshops, 65 more will be educated before the end of September, 2006. An additional 150 traditional leaders will be educated in new TCE areas. Of the 2006 target of 150 Field Libraries, 20 were established by July; 130 more will be established by September. An additional 150 will be established in new TCE areas. To support the MOHSS initiative to train traditional birth attendants (TBAs) in PMTCT referrals, TCE will help identify TBAs in Omusati, Kavango, and Caprivi (see Ministry PMTCT activity 7334).

Because youth are at high risk for HIV infection, FOs equip youth with skills that promote abstinence, particularly among young girls under the age of 15 years identified in houses and in schools. (see DAPP AB activity, 7325). During the ongoing sessions with under-15-year-olds, the FOs discuss: 1) Knowledge about HIV and how it spreads; 2) General knowledge of sexual life, 3) Deciding not to get infected by HIV; 4) Consciously deciding to delay the first sexual encounter, and 5) Risks of teenage pregnancy.

For adults, older family members, and parents, FOs use "be faithful" messages during one-to-one discussions: 1) Knowledge about HIV virus, transmission and prevention; 2) Avoiding infection by having general knowledge about sexual life, sticking to one faithful sexual partner and partner reduction; 3) Getting counseled and tested; 4) Staying negative and not spreading the virus when positive. For adults, young persons who ask, and those at high risk of contracting HIV through sexual contact (such as migrant workers and spouses, persons having sex with partners of unknown HIV status, persons with multiple partners), FOs discuss: 1) Knowledge about HIV transmission; 2) Prevention of HIV through correct and consistent use of condoms, including demonstrating how to use condoms; and 3) Knowing where condoms are available.

FOs carry condoms with them and also establish distribution points. TCE obtains free condoms from regional mechanisms through MoHSS so condoms are not included in this budget. FOs are ideally suited for knowing where to go and who to reach with condoms: at bars and shebeens, commercial sex workers (CSWs), and mobile populations. By March 2006, after the first 6 months of PEPFAR support for TCE, FOs had distributed 426,954 condoms, including those distributed at the 170 local condom distribution points. [Of note: together with GF support, 2,505,178 condoms were distributed in all TCE areas.] FOs conduct quarterly campaigns and events in the communities to sensitize the population to the dangers of STIs. FOs provide information, distribute pamphlets with explanations and photos/drawings of symptoms of STIs, treatment and sites for treatment, how to avoid

getting infected and emphasize the need to get tested for HIV if STI symptoms are present.

FY07 funds will support (1) continued and more intensive activities within these regions and (2) introduction of the program into additional regions, including the neighboring eastern half of Kavango region (in response to a demand from political leaders) and Caprivi region (which has Namibia's highest HIV/AIDS prevalence at 43% in 2004), and the central Khomas region (which includes the most densely populated and high risk settlements in Namibia in Katutura, Windhoek). A total of 122 new FOs will be recruited and trained as part of these new programs, covering a population of 244,000.

The TCE FO program operates within a continuous learning and support system that facilitates the ongoing sharing of experiences and introduction of new subjects and tools. Initial training includes a 4-week course on basics of HIV transmission, STIs, abstinence and behavior change, and appropriate education on, demonstration, and distribution of condoms. The course orients FOs to the TCE mission and organization structure and how to use household registers to document all activities. Role-playing enables practice in communicating prevention messages. FOs begin visiting their assigned households (2000 people per FO) together with an experienced FO. FOs report to their immediate supervisor, the Troop Commander. Groups of 50 FOs meet together each Friday under the leadership of a TCE Troop Commander with support from Special Forces (SF). At these meetings, FOs report numbers of persons educated, share experiences and ask questions; challenging questions are taken up to the division commander. These weekly sessions have also proven effective in identifying additional information/skills needs of the FOs, which are then met by organizing trainings or linking with appropriate resource groups within the community, such as the local health facility, the Ministry of Gender Equality and Child Welfare, social services, etc. SF members also visit their FOs in the field on short notice, to assure they are visiting homes and to join them on visits to monitor quality of house-to-house education.

FY07 funds ($7500 for 10 clubs) will go towards a pilot intervention targeting adult men in collaboration with the Johns Hopkins' University Nawa Sport initiative (see DAPP AB#7325 as well as JHU activities in AB and C/Other Prevention 7455 and 7457). Nawa Sport involves TCE staff being trained as soccer coaches to then organize sports clubs for men to insert strong behavior change messages using sports language and creation of good role models. The messages will be reinforced each session on a weekly basis and condoms will be distributed at every sports session.

Development AID from People to People (DAPP) leverages basic care resources to support "Total Control of the Epidemic" (TCE) Field Officers (FOs) to provide education about care & prevention & to make referrals to available services. In 2007, this activity will expand to (1) create more support groups for PLWHA; (2) strengthen the technical capacity of FOs to educate about, and provide or refer for elements of the preventive care package for families; & (3) integrate TCE activities with other PEPFAR-funded activities to strengthen the quality of services. TCE funding is in 2 other areas: DAPP OP_7327 & DAPP AB_7325.

TCE is a highly organized house-to-house mobilization strategy that aims to individually educate & empower members of a community to reduce the risk of HIV and stigma & improve access to HIV-specific services. TCE was established in northern Namibia in 2005 with support from the Global Fund & PEPFAR (in the regions of Omusati, Oshana, & part of Ohangwena & Oshikoto with Global Fund & remaining Ohangwena, Oshikoto, & part of Kavango Region with PEPFAR). The Global Fund supports a total of 290 community members trained as FOs. With PEPFAR support, TCE has recruited, trained, & employed an additional 150 local community members as FOs who, as of July 31, 2006, reached 109,602 community members (36.5% of the target population of 300,000) through household visits.

Services provided by FOs involve registration of household members, appropriately targeted ABC messages & condoms DAPP OP_7327), mobilization to seek VCT, TB, ART, PMTCT, family planning, OVC & STI services, & in 2007, delivery of psychosocial support & simplified preventive care messages for families regarding the importance cotrimoxizole prophylaxis, VCT, use of bed nets for HIV-positive pregnant women & children under 5 (leveraged by Global Fund), TB screening, safe water, personal hygiene strategies, clinical nutritional counseling & child survival interventions for HIV infected children. This also includes ART adherence support & screening for pain & other symptoms. Community volunteers are key partners with FOs, communities & families, & PEPFAR-supported FOs have recruited & deployed more than 1,960 to assist with delivery of simplified, consistent prevention & basic care messages. TCE also links with PEPFAR-supported volunteers supported by the PACT program (PACT PC:BCHS_7412). Supportive supervision of all community caregivers is provided by TCE Special Forces Officers & primary health care (PHC) nurses in the nearby facilities. During 2006, FOs & volunteers facilitated 11 PWLHA support groups.

FY07 funds will support TCE expansion of the above mentioned services into three new geographic areas (Kavango, Caprivi & Khomas) & strengthen technical implementation through training, supervision, transportation support & building partnerships. TCE will work closely with Lironga Eparu (Capacity PC:BHCS_7404), the national PLWHA umbrella NGO & other stakeholders to recruit PLWHAs especially members of minority groups (including the San minority community) as FOs who will also foster the development of effective HIV-related community support groups close to the home of HIV/AIDS service delivery sites. Two new PLWHA support groups will be established in each of the new TCE areas near PHC clinics & activities will be focused on all the services described above, as well as, community gardening in areas identified by community leaders. The DAPP activity addresses gender issues through the provision of equitable services both male & female PLWHA, support for disclosure of HIV status & improved male involvement in the program. TCE Ohangwena will be supported to partner with Government sites to provide critical transportation support to rural persons in need of accessing essential HIV/AIDS services including VCT & ART.

Given the successes of the TCE program & notably the experience & educational background of FOs (minimum of grade 12 completion), four innovative prevention & care projects will be developed & implemented in FY07 which will: (1) strengthen the community-based career ladder & the human capacity of community counselors & clinic facilities; (2) build the technical capacity & communication skills of FOs; (3) build the technical capacity of FOs to deliver effective prevention with positive (PwP) messages; & (4) replicate lessons learned of Omaheke Health Education Programme (OHEP), which is recognized by the MoHSS as a national model for quality community & home-based care (CHBC). All three projects build upon the strengths of TCE & integrate TCE activities with other PEPFAR-supported programs. In consultation with the MoHSS, the first program entails selecting 2 TCE members in each of the TCE regions & graduating the FOs into the MoHSS Community Counselor Program MoHSS PC:BHCS_7331). TCE members who meet

the eligibility criteria for the MoHSS community counselor program will join the training program & work in nearby rapid-test certified locations. Not only will FOs become employed as MoHSS-recognized community counselors, but they are anticipated to build community awareness into facilities & further strengthen the continuum of care between facilities & communities who deliver HIV-related services. New FOs will be selected & trained in the communities to replace the graduates so there will be no disruption in services. Second, a recognized need is the limited counseling skills & training provided to FOs during their initial & ongoing technical program. In FY07, 20 TCE FO trainers will receive counseling & communication skills training by Lifeline Childline (PACT PC:BHCS_7412). It is anticipated that this will enable FOs to establish effective PLWHA support groups & equip FOs to better address the complexities of recommending disclosure to & testing of family members. The third element involves strengthening the prevention messaging & disclosure support across the TCE program. This will involve technical support & training by JHU (JHU PC:BHCS_7464) guided by an adapted flipchart which assists FOs to deliver effective & simplified prevention with positives messages & referrals. Lastly, within the Global Fund-supported TCE activities in the Oshana region, the TCE program will build upon its program to replicate CHBC lessons learned of the OHEP program. In the Omaheke OHEP model, grade 12 community caregivers function predominantly as nursing assistants in communities, to integrate basic clinical screening, screening & referrals in communities & homes, bridge the link between clinics & communities, & supervise community health volunteers. Support is also provided to form & train clinic health committees that support the PHC nurse to manage community health activities & formalize a link between communities & HIV-related services in facilities. The TCE program in Oshana, already with structures & staff & place from the Global Fund & support for community volunteers by PACT/Catholic AIDS Action (PACT PC:BHCS_7412), will utilize PEPFAR funds for technical support & training from the OHEP program to integrate elements of the model in FY07. As a result, it is anticipated that FOs will be able to more effectively build the continuum of care between the hospital, 4 health centers, 9 clinics & hundreds of community care points in Oshana, strengthen quality of services, alleviate some of the HIV burden off the clinics, & build community ownership & delivery of HIV/AIDS services in Namibian communities.