The lack of comprehensive training on HIV/AIDS prevention, care, and treatment for most practicing doctors, nurses, and pharmacists in Namibia is a significant obstacle to rapid scale-up of quality programs throughout this sparsely-populated country. Since FY04, the USG has funded the International Training and Education Center on HIV (I-TECH) to collaborate with the Ministry of Health and Social Services (MoHSS) to address this gap by increasing the capacity of the University of Namibia (UNAM), the National Health Training Center (NHTC) and its five Regional Health Training Centers (RHTCs), and the MoHSS Directorate of Special Programs to train new and existing health care workers in HIV/AIDS. I-TECH provides technical advisors, training and curriculum experts, clinical mentors, educational and training materials, monitoring and evaluation systems for training, infrastructure, training logistics, and funding for training. Based on new or updated national guidelines, I-TECH has facilitated the development of the Ministry's national training curricula on PMTCT, VCT, rapid HIV testing, Couples Counseling, TB/HIV, ARV, nutrition and HIV, Integrated Management of Adult Illness (IMAI), Dried Blood Spot (DBS) collection for HIV DNA-PCR for infants, and pediatric care/ARV. Support is also being provided to incorporate this new content into the pre-service training curricula for registered nurses at UNAM and for enrolled nurses at NHTC. I-TECH will play a critical role in the decentralization of palliative care and ARV through various levels of training ranging from didactic sessions to clinical mentoring. To date, a total of more than 3,800 health workers have been trained in the various HIV/AIDS topics.

In particular, the provision of family planning (FP) for PLWHA is also a primary prevention strategy for mother to child transmission. However, FP needs of HIV+ women and their partners have been largely overlooked in Namibia. Contraceptive use among Namibian women is high (38%), but anecdotal evidence suggests that women on ART are becoming pregnant unintentionally. This not only has implications for the mother's well-being but also for pediatric AIDS. Many women are also thinking of having another pregnancy and would like to discuss their options with their service providers. Namibian health workers are willing to address FP, but they are often constrained by a lack of information, training and clarity on messaging. HIV clinics lack clinical guidelines/protocols and IEC materials, as well as a formal referral system for FP.. Knowledge gaps exist among clinic staff; many HIV staff do not understand the concept of dual protection, while FP staff often believe their clients are at low risk for HIV.

In FY07, I-TECH will address this issue by integrating FP messages into curricula used for training MDs, RNs, and Community Counselors to make sure that appropriate messages are delivered, including appropriate gender and cultural considerations. Integrating curricula messaging into training is a step towards strengthening human development capacity as well as program linkages for a more integrated HIV program in the long term.

I-TECH began its support to the National PMTCT Program in 2004. In FY07, I-TECH will support the National PMTCT Program in three areas: 1) Technical assistance to the National Health Training Center (NHTC), 2) Tutor support visits to PMTCT Sites, and 3) Training for DNA-PCR testing of infants.

1) Technical assistance on training coordination, curriculum revision, and training monitoring and evaluation will be provided to the MoHSS, NHTC and RHTC so that they can deliver 15 in-service trainings and 5 refresher trainings in PMTCT for a total of 400 health care workers trained. The PMTCT curriculum will also require updating to incorporate the more efficacious PMTCT ARV regimen using short-course AZT in addition to single-dose nevirapine. The Global Fund supports PMTCT training costs while I-TECH provides the training expertise and logistical support. The salary support for the 5 in-service tutors placed throughout the NHTC network who will conduct these training is covered under Potentia_PMTCT_7334. Salary support for ITECH's lecturers at UNAM to integrate PMTCT into pre-service training is covered under Potentia_Support Services_7341.

(2) Tutor support visits to PMTCT Sites. I-TECH will support the costs of the 5 tutors to conduct 50 follow-up support visits to PMTCT sites to monitor transfer of learning from the PMTCT course and to provide additional, on-site teaching to health care workers on PMTCT issues.

(3) Training for DNA-PCR Testing of Infants. In FY06, I-TECH initiated training of health

workers in the collection of dried blood spot specimens for DNA-PCR testing of infants. By the end of 2006, 65 workers will be trained. I-TECH will continue this activity in FY07, conducting one TOT and 20 on-site trainings to train a total of 220 health care workers. A session on DNA-PCR will also be incorporated into the PMTCT training.

Training of health care providers (which includes components on reducing stigma and discrimination) and promotion of positive nurse role models will support national PMTCT program efforts to reduce stigma and discrimination towards PLWHA. Promotion of PMTCT services also increases access for HIV+ women to ARV treatment.

The provision of family planning (FP) for persons living with HIV/AIDS and others at-risk is also a primary prevention strategy for mother to child transmission. However, FP needs, particularly for HIV+ women and their partners, have been largely overlooked in Namibia. Contraceptive use among Namibian women is high (38%), but anecdotal evidence suggests that women on ART are becoming pregnant unintentionally. This not only has implications for the mother's well-being but also for pediatric AIDS. Many women are also thinking of having another pregnancy and would like to discuss their options with their service providers. Namibian health workers are willing to address FP, but they are often constrained by a lack of information, training and clarity on messaging. HIV clinics lack clinical guidelines/protocols and IEC materials, as well as a formal referral system for FP. Knowledge gaps exist among clinic staff; many HIV staff do not understand the concept of dual protection, while FP staff often believe their clients are at low risk for HIV.

In FY07, I-TECH will address this issue by integrating FP messages into curricula used for training MDs, RNs, and Community Counselors to make sure that appropriate messages are delivered, including appropriate gender and cultural considerations. Integrating curricula messaging into training is a step towards strengthening human development capacity as well as program linkages for a more integrated HIV program in the long term. I-TECH will expand the target audience for FP training to include health providers within military bases.

This activity continues from FY06 & relates to Intrahealth activity (Capacity PC:BHCS_7404 & to I-TECH activity (ITECH PASS_7352). This activity includes technical support for 3 elements: (1) strengthening the MoHSS technical capacity to support the IMAI palliative care rollout; (2) expanding prevention with positives (PwP) strategies, including family planning (FP) & sexually transmitted infection (STI) care into the MoHSS HIV/AIDS trainings for health care providers; & (3) strengthening the integration & implementation of clinical nutrition for PLWHA into HIV/AIDS training & service delivery areas.

National leadership & implementation for facility-based palliative care for PLHWA is within the framework of WHO's Integrated Management of Adult Illness (IMAI) program for Namibia. In early 2006, I-TECH supported the MoHSS with a national policy review & curriculum adaptation workshop to decide on policy issues related to decentralization of ART services & to customize all 5 IMAI modules to the Namibian context. Implementation of the IMAI training standard will begin in 2006 with scale-up in 2007. Shifting tasks from physicians, nurses will begin providing palliative care & managing clients who are not yet eligible for ART & clients who have received their first 6 months of ART at hospital Communicable Disease Clinics. Technical advancement for pediatric care is provided by the MoHSS pediatric care & treatment training program & the MoHSS Integrated Management of Childhood Illness (IMCI) program. In COP07, I-TECH will support the MoHSS & these sites to begin implementing the IMAI modules, including the palliative care module. This will include a TOT program for nurses; adaptation of HIV-care related patient education materials for use in facilities & communities; 7 regional trainings that target the IMAI roll-out sites identified by MoHSS; 39 on-site support visits (3 per region) to IMAI sites from staff funded through Potentia (Potentia PC:BHCS_7340); 3 in-service trainings on OIs & palliative care for physicians. In addition to the IMAI program, select technical training & technical support will be provided to health providers in the private sector, in partnership with the MoHSS & the HIV Clinicians Society.

In combination with the other IMAI modules & pediatric curricula, health care workers will be able to address key elements of the preventive care package for adults & children (cotrimoxizole prophylaxis, TB screening & INH prophylaxis, CT, HIV child survival interventions, clinical nutrition, HIV prevention, etc), other OI management, ART adherence, routine clinical monitoring & systematic pain & symptom management. Support to further strengthen the prevention & nutrition components of the training program are addressed below. Costs associated with the IMAI program are shared with I-TECH activities #7353 & #7350.

The second I-TECH component builds on current efforts to strengthen prevention with positives messaging & referrals from health care workers by further integrating simplified prevention messages, STI care & FP/HIV messaging & referral into the MoHSS HIV/AIDS trainings. Health care workers play a key role in helping their clients reduce HIV risk behaviors, including the provision of FP for PLWHA as a primary prevention strategy for MTCT. FP needs of HIV-positive women & their partners have been largely overlooked in Namibia; anecdotal evidence suggests that women on ART are becoming pregnant unintentionally or that many women are thinking of having another pregnancy & would like to discuss their options with their service providers. Namibian health workers in HIV/AIDS clinics are willing to address FP, but they lack clinical guidelines/protocols & IEC materials, as well as a formal referral system for FP. Knowledge gaps exist among clinic staff; many HIV staff don't understand the concept of dual protection, while FP staff often believe their clients are at low risk for HIV. In FY07, I-TECH will utilize existing FP/HIV integration materials that are recommended & globally available to integrate FP messages, including appropriate gender & cultural considerations & support for disclosure of HIV status, reduction in alcohol use & gender-based violence into HIV/AIDS curricula for training physicians, nurses & community counselors. This also includes development of IEC materials for PLWHA. FP services & FP counseling itself is supported by the MoHSS. In addition to the prevention & FP elements, updates on appropriate STI care is needed for physicians & nurses. In FY07, I-TECH will support 2 trainer of trainer programs (TOTs) & 13 regional in-service trainings for a total of 300 physicians & nurses trained on newly updated STI prevention & care guidelines from MoHSS. These guidelines incorporate the latest recommendations on provision of VCT services to persons seeking STI services.

The third component addresses the critical need to build Namibian capacity to address clinical nutrition & HIV/AIDS. Routine nutrition counseling, assessment (via

anthropometric measurement) & monitoring of malnourished PLWHA is a critical program gap in Namibia. In FY06, I-TECH placed a nutrition advisor in the MoHSS to address these gaps. FY 07 support will include the following: (1) Continued support for the I-TECH nutrition advisor to provide technical assistance to the MoHSS, including finalization of clinical nutritional guidelines for HIV/AIDS, training on HIV/AIDS nutrition management & infant & young child feeding training, technical support & monitoring via on-site follow-up support visits to clinical sites. The advisor will also provide technical support & oversight to the targeted short-term nutritional supplementation for severely malnourished PLWHA who are on ART, an activity that is funded by the USG through MoHSS to the Namibia Red Cross Society (MoHSS ARV Services_7330); (2) A TOT & 5 regional in-service trainings on nutrition & HIV/AIDS for 120 health care workers; (3) a two-month short course in Namibia which would expand the base of nutrition & HIV expertise in-country (beyond the current 5 day course for health workers) by developing an HIV nutrition resource person for each region. They will provide nutrition assessment, monitoring & counseling & will also manage "nutrition corners" in select ART sites. The consultant/facilitator for this course will be identified & hired by FANTA (AED PC:BHCS_8021); (4) In partnership with FANTA & the MoHSS, the I-TECH nutrition advisor will provide technical support to develop nutrition tools which support health workers to appropriately manage nutrition & HIV. This will include development of an algorithm for clinical providers to manage metabolic complications with malnourished PLWHA & lipodistrophy associated with ART. IEC materials will also be developed on nutrition & symptom management for health providers at facility & community levels. The above mentioned approaches will enhance the decentralization of nutrition expertise within Namibia.

Gender considerations are integrated within the program by ensuring equitable training & support of male & female health care workers with the goal of equitable access to HIV/AIDS services for PWLWHA & their families throughout ITECH-supported programs.

The lack of comprehensive training on HIV/AIDS prevention, care, and treatment for most practicing doctors, nurses, and pharmacists in Namibia is a significant obstacle to rapid scale-up of quality programs throughout this sparsely-populated country. Since FY04, the USG has funded the International Training and Education Center on HIV (I-TECH) to collaborate with the Ministry of Health and Social Services (MOHSS) to address this gap by increasing the capacity of the University of Namibia (UNAM), the National Health Training Center (NHTC) and its five Regional Health Training Centers (RHTCs), and the MOHSS Directorate of Special Programs to train new and existing health care workers in HIV/AIDS. I-TECH provides technical advisors, training and curriculum experts, clinical mentors, educational and training materials, monitoring and evaluation systems for training, infrastructure, training logistics, and funding for training. Based on new or updated national guidelines, I-TECH has facilitated the development of the Ministry's national training curricula on PMTCT, VCT, rapid HIV testing, Couples Counseling, TB/HIV, ARV, nutrition and HIV, Integrated Management of Adult Illness (IMAI), Dried Blood Spot Collection for HIV DNA-PCR for infants, and pediatric care/ARV. Support is also being provided to incorporate this new content into the pre-service training curricula for registered nurses at UNAM and for enrolled nurses at NHTC. I-TECH will play a critical role in the decentralization of palliative care and ARV through various levels of training ranging from didactic sessions to clinical mentoring. To date, a total of more than 3,800 health workers have been trained in the various HIV/AIDS topics.

In this activity, funding in FY07 will cover:

(1) Five in-service trainings in TB/HIV for a total of 90 government medical officers and 50 private practitioners. These trainings will be conducted by staff of the National TB Control Program (NTCP) and physicians selected and trained by I-TECH as well as the I-TECH Physician Training Manager and Clinical Mentors. The curriculum already developed by the Ministry and I-TECH in 2005-06 will be used for these trainings. Clinical mentoring in TB/HIV will also be supported.

(2) The Integrated Management of Adult Illness (IMAI) course will also train health care workers, primarily nurses, in TB/HIV. (Costs for this activity are not reflected here but will be shared by Palliative Care: Basic Health Care and Support, project ITECH_PC:Basic Health_#7349 and ARV Services, project ITECH_ARV Services_#7350) The IMAI training package also addresses stigma and discrimination issues of health care workers through the use of Expert Patient Trainers.

(3) Two TOTs on TB for nurses will be conducted to train 40 nurses in the public health sector. These nurses will support the training of district level nurses in TB/HIV with funds provided for these trainings by the Global Fund.

The lack of comprehensive training on HIV/AIDS prevention, care, and treatment for most practicing doctors, nurses, and pharmacists in Namibia is a significant obstacle to rapid scale-up of quality programs throughout this sparsely-populated country. Since FY04, the USG has funded the International Training and Education Center on HIV (I-TECH) to collaborate with the Ministry of Health and Social Services to address this gap by increasing the capacity of the University of Namibia (UNAM), the National Health Training Center (NHTC) and its five Regional Health Training Centers (RHTCs), and the Directorate of Special Programs to train new and existing health care workers in HIV/AIDS. I-TECH provides technical advisors, training and curriculum experts, clinical mentors, educational and training materials, monitoring and evaluation systems for training, infrastructure, training logistics, and funding for training. Based on new or updated national guidelines, I-TECH has facilitated the development of the Ministry's national training curricula on PMTCT, VCT, rapid HIV testing, Couples Counseling, TB/HIV, ART, nutrition and HIV, IMAI, dried blood spot collection for HIV DNA-PCR for Infants, and pediatric care/ART. Support is also being provided to incorporate this new content into the pre-service training curricula for registered nurses at UNAM and for enrolled nurses at NHTC. I-TECH will play a critical role in the decentralization of palliative care and ART through various levels of training ranging from didactic sessions to clinical mentoring. To date, a total of more than 3800 health workers have been trained in the various HIV/AIDS topics. I-TECH training activities have been central to Namibia's success to date with meeting its prevention, care, and treatment targets and a long-term strategy is being implemented to reach those health workers still in need of training in HIV/AIDS.

Also, the provision of family planning (FP) for PLWHA is also a primary prevention strategy for mother to child transmission. However, FP needs of HIV-positive women and their partners have been largely overlooked in Namibia. Contraceptive use among Namibian women is high (38%), but anecdotal evidence suggests that women on ART are becoming pregnant unintentionally. This not only has implications for the mother's well-being but also for pediatric AIDS. Many women are also thinking of having another pregnancy and would like to discuss their options with their service providers. Namibian health workers are willing to address FP, but they are often constrained by a lack of information, training and clarity on messaging. HIV clinics lack clinical guidelines/protocols and IEC materials, as well as a formal referral system for FP, among other things. Knowledge gaps exist among clinic staff; many HIV staff do not understand the concept of dual protection, while FP staff often believe their clients are at low risk for HIV.

In FY07, I-TECH will address this issue by integrating FP messages into curricula used for training MDs, RNs, and Community Counselors to make sure that appropriate messages are delivered, including appropriate gender and cultural considerations.

I-TECH's emphasis areas in Counseling and Testing include training, local organization capacity building and human resources. Funding covers :

1) A total of 200 health workers will be trained in rapid HIV testing using the curriculum developed with USG support. This relates to Potentia_C&T_#7343, Potentia_C&T_#7336, MOHSS_PMTCT_#7334, and NIP_Lab Support_#7337.

2) One TOT in Voluntary Counseling and Testing and 10 subsequent in-service trainings to train a total of 220 health workers. These trainings will be conducted by 5 in-service tutors supported by Potentia at NHTC, see project Potentia_Other/PA/SS_#7341.

3) One TOT in Couples Counseling and 5 subsequent in-service trainings to train a total of 120 health workers. These trainings will be conducted by 5 in-service tutors supported by Potentia at NHTC, see project Potentia_Other/PA/SS_#7341.

4) 50 site visits (conducted by the in-service tutors) to health care facilities providing VCT services, to assess transfer of learning and to provide additional on-site teaching.

5) Development and delivery of training on Prevention with Positives. One TOT and 5 regional trainings will be held to train a total of 120 health workers.

The Couples Counseling training addresses the issues of male norms and behaviors and provides training on addressing domestic violence. Both VCT and Couples Counseling

training address the issue of stigma and discrimination by requiring health care workers to develop empathy for patients in role play counseling sessions.

The lack of comprehensive training on HIV/AIDS prevention, care, and treatment for most practicing doctors, nurses, and pharmacists in Namibia is a significant obstacle to rapid scale-up of quality programs throughout this sparsely-populated country. Since FY04, the USG has funded the International Training and Education Center on HIV (I-TECH) to collaborate with the Ministry of Health and Social Services to address this gap by increasing the capacity of the University of Namibia (UNAM), the National Health Training Center (NHTC) and its five Regional Health Training Centers (RHTCs), and the Directorate of Special Programs to train new and existing health care workers in HIV/AIDS, including the care and treatment of infants and young children. I-TECH provides technical advisors, training and curriculum experts, clinical mentors, educational and training materials, monitoring and evaluation systems for training, infrastructure, training logistics, and funding for training. Based on new or updated national guidelines, I-TECH has facilitated the development of the Ministry's national training curricula on PMTCT, VCT, rapid HIV testing, Couples Counseling, TB/HIV, ART, nutrition and HIV, IMAI, Dried Blood Spot Collection for HIV DNA-PCR for Infants, and pediatric care/ART. Support is also being provided to incorporate this new content into the pre-service training curricula for registered nurses at UNAM and for enrolled nurses at NHTC. I-TECH will play a critical role in the decentralization of palliative care and ART through various levels of training ranging from didactic sessions to clinical mentoring. To date, a total of more than 3800 health workers have been trained in the various HIV/AIDS topics.

I-TECH's emphasis areas in ARV services include training, local organization capacity building, and quality assurance and supportive supervision. Funding will cover:

1) Recruitment and salary support for four experienced HIV physicians-1 funded under Potential-to serve as Clinical Mentors (based at Katutura Hospital in Windhoek, Oshakati Hospital, Otjiwarango and Katima Mulilo) to provide on-site clinical supervision and mentoring to ART sites. They will work to support the IMAI roll-out and promote a multi-disciplinary approach to HIV care; work with local physicians to develop local capacity for both didactic and hands-on training; assess needs, and provide hands-on and didactic training to address knowledge and skill gaps. They will also work on distance learning initiatives; and assist with ongoing review of curricula, media products, and guidelines as needed.

2) One TOT in Integrated Management of Adult and Adolescent Illnesses (IMAI), which will take place following the adaptation of the World Health Organization's IMAI curriculum (scheduled for end 2006), which targets nurses. In addition, the IMAI training package includes a set of patient education materials that I-TECH will adapt for use in Namibia. Subsequently, 7 regional trainings will be conducted, targeting the IMAI roll-out sites identified by MoHSS. The IMAI training package addresses stigma and discrimination issues of health care workers through the use of Expert Patient Trainers. (These costs will be shared with ITECH_PC:Basic Health_#7349 and ITECH_PC:TB/HIV_ #7353.)

3) 4 ART in-service trainings for 150 government physicians, to be conducted by the Physician Training Manager (PTM), the Clinical Mentors (CMs), and in-country physicians selected and trained by I-TECH.

4) 2 in-service trainings in ART for 50 private physicians, to be conducted in collaboration with the Namibia HIV Clinicians Society.

5) 4 pediatric HIV trainings for 100 health care workers, to be conducted by the PTM and CMs, and in-country physicians, selected and trained by I-TECH, and clinical rotations at Katutura Hospital.

6) 1 TOT and 5 regional training session on Adherence Counseling.

7) Curriculum development support to the content expert (funded through Potentia_ARV Services_ #7339) who will integrate HIV/AIDS and ARV treatment into the UNAM 1-year advanced nursing and pharmacotherapy program.

Funding currently covers: Recruitment and salary support for four experienced HIV physicians- funded under Potentia -to serve as Clinical Mentors (based at Katutura Hospital in Windhoek, Oshakati Hospital, Otjiwarango Hospital and Katima Mulilo Hospital) to

provide on-site clinical supervision and mentoring to ART healthcare providers. Mentors will work to support the IMAI roll-out and promote a multi-disciplinary approach to HIV care; work with local physicians to develop local capacity for both didactic and hands-on training; assess needs, and provide hands-on and didactic training to address knowledge and skill gaps. They will also work on distance learning initiatives; and assist with ongoing review of curricula, media products, and guidelines as needed. This additional funding will provide for another I-TECH Clinical Mentor to work in the northern regions. Expansion of the program has been requested by the DSP director. This mentor will serve additional sites, including both Ministry and FBO sites, providing direct mentoring exposure to additional healthcare personnel. Funding this position will also increase the number of mentors available to assist with Ministry directed trainings of all clinicians within Namibia, including those working in the MOD, who are soon to begin delivering ART services. The figure here includes salary, relocation costs and overhead.

The lack of comprehensive training on HIV/AIDS prevention, care, and treatment for most practicing doctors, nurses, and pharmacists in Namibia is a significant obstacle to rapid scale-up of quality programs throughout this sparsely-populated country. Since FY04, the USG has funded the International Training and Education Center on HIV (I-TECH) to collaborate with the Ministry of Health and Social Services to address this gap by increasing the capacity of the University of Namibia (UNAM), the National Health Training Center (NHTC) and its five Regional Health Training Centers (RHTCs), and the Directorate of Special Programs to train new and existing health care workers in HIV/AIDS. I-TECH provides technical advisors, training and curriculum experts, clinical mentors, educational and training materials, monitoring and evaluation systems for training, infrastructure, training logistics, and funding for training. Based on new or updated national guidelines, I-TECH has facilitated the development of the Ministry's national training curricula on PMTCT, VCT, rapid HIV testing, Couples Counseling, TB/HIV, ART, nutrition and HIV, IMAI, dried blood spot collection for HIV DNA-PCR for Infants, and pediatric care/ART. Support is also being provided to incorporate this new content into the pre-service training curricula for registered nurses at UNAM and for enrolled nurses at NHTC. I-TECH will play a critical role in the decentralization of palliative care and ART through various levels of training ranging from didactic sessions to clinical mentoring. To date, a total of more than 3800 health workers have been trained in the various HIV/AIDS topics. This activity relates to I-TECH 7352 for Policy Analysis and System Strengthening.

In 2006, CDC conducted an evaluation of the National Institute of Pathology (NIP) and in consultation with the NIP laboratory technical advisor, identified skills gaps among NIP staff to meet the demands of HIV & TB testing required to support the MoHSS plan for scaling up of treatment and care. In follow-up, I-TECH conducted a training needs assessment and recommended the creation of a training unit at NIP. Funding for NIP staffing and equipment for the proposed training unit is included under the NIP activity (HLAB #7337). The activities to be funded under this new I-TECH project include technical assistance and training facilitation to support the development of the training unit and the provision of in-service training for laboratory staff. Specifically, I-TECH will:

1) Develop curricula and conduct 10 in-service trainings for 200 laboratory staff on such topics as Use & Maintenance of Equipment, Standard Operating Procedures, Laboratory Safety, Site Supervision for HIV Rapid Testing, HIV/AIDS in the Workplace, and others. Training will be faciliated by the Namibia Institute of Pathology and the International Training Consortium.

2) Develop a Lab Training and Resource Centre at the national reference lab in Windhoek.

This activity is a continuation and expansion of FY04/FY05/FY06 and also relates to Comforce (7322), Ministry of Health and Social Services (MoHSS) (7332), Potentia (7338), and ITECH Policy/Systems (7352).

The emphasis for this activity will be to conduct training to support the National Health Information System (HIS) Unit and the Monitoring and Evaluation (M+E) Unit of the National AIDS Programme in building capacity for the collection, analysis, and reporting of surveillance and routine health information related to HIV/AIDS. Training workshops will build capacity in personnel working directly or indirectly for the MoHSS to collect, summarize, analyze, and disseminate HIV/AIDS strategic information and thus advance the USG priority to use SI for program and policy improvement. This activity will also support a planning process for the FY08 behavioral and sero-survey for HIV (BSS+). It will leverage USG-supported technical advisors (#7322), equipment provided by USG (#7332), and personnel provided to the MoHSS with CDC support (#7338).

To support these efforts, the USG will use the expertise of I-TECH, an international NGO that has supported the MoHSS by training health care workers in skills and theory related to HIV/AIDS since 2003. I-TECH will coordinate training workshops on data collection and processing for those responsible for HIS/M+E around the country as well as the planning process for the BSS+. I-TECH will coordinate travel, venue, accommodations, meals, material production and other logistics for the workshops while technical instruction and facilitation will be the responsibility of topic-area specialists.

1) Training workshops in data entry/management/reporting: This is a continuation activity from FY04-FY06 that is being expanded in FY07. USG will support 6 central training workshops for data clerks and HIS officers to build their data entry, management, and reporting capacity so that they will be proficient in using the Ministry's management information systems for ART/PMTCT/VCT/TB. Selected participants of these workshops will also receive Training of Trainers (TOT) so they can give workshops in the regions where they work. This activity will leverage the presence of a computer laboratory housed at the MoHSS National Headquarters to train 20 individuals during each workshop.

An additional 6 regional-level capacity development workshops will be conducted by a national-level specialist in computer systems to build capacity in collection and reporting of ART/PMTCT/VCT/TB data. These workshops will target regions where data quality is questionable and will offer focused training for regional and district HIS officers using their own computers and data.

2) Training workshops in Monitoring and Evaluation (M+E): This sub-activity is new in FY07. USG will support 2 training workshops for MoHSS personnel and selected partners to build their capacity in the theory and practice of monitoring and evaluation of HIV/AIDS programs. Through this activity, 60 persons will be trained: 1 from each of 34 health districts, 1 from each of 13 health regions, 5 from the national level M+E and 8 from key partner organizations. This activity will provide travel, accommodations, and meals for participants as well as the meeting facilities.

3) Training workshops in Surveillance: This sub-activity is new in FY07. USG will support a training workshop for MoHSS personnel (HIV/AIDS health program administrators from the national and sub-national levels) to build capacity in the theory and practice of HIV surveillance. 20 individuals will be trained: 1 from each of 13 health regions and 7 from the national level. This activity will provide travel, accommodations, and meals for participants as well as the meeting facilities. International topic area specialists will be contracted to teach these workshops through the CDC mechanism.

4) Consensus building workshop for MoHSS HIS: This sub-activity is new in FY07 and will be supported by the USG M+E and HIS technical advisors. The MoHSS is in the process of selecting a new architecture for their routine health information system that will include the HIV/AIDS sub-systems as a component. This will replace the current system that has been in the field since 2000. Selection criteria may include (a) user friendliness, (b) networking capacity, (c) availability of local (in Namibia) support expertise, (d) cost. Candidate data structures may include proprietary and open-source solutions including Visual FoxPro, MySQL, SQL, and candidate front-end software may include JAVA and PHP. A 1-day retreat will be held at which candidate solutions from local and international

vendors will be showcased to upper MoHSS management and HIS/M+E program and technical personnel so they can select the best candidates and then assign criteria for the final selection of software and vendor. Technical personnel in the MoHSS will then take these decisions forward to select software and a vendor for the updated system for final approval by upper management. After software is developed according to decisions of upper management, a meeting will be held with HIS personnel from around the country to orient them on the architecture and functionality of the revised national health information system. This activity will provide travel, accommodations, meals, and facilities for the software selection and orientation process.

5) Planning for the FY08 Behavioral- and Sero-Survey for HIV (BSS+): Gaps in information needs to inform the National HIV and AIDS response continue to pose a challenge. Specifically, population-based HIV prevalence estimates have only been available from pregnant women leaving unknown their relationship to men and anyone outside age groups in which pregnancy is common. In addition, population-based estimates of high HIV risk behaviors (MSM, IDU, CSW) are unavailable as are estimates of HIV prevalence in these groups. Prevention strategies will benefit immensely from population-based estimates of these parameters. Findings from such a survey will improve impact through age-group, gender and behavioral segmentation strategies in national prevention strategies. This activity will plan a behavioral surveillance survey during COP07 for implementation in FY08. Planning will include three stakeholder meetings (1 national and 2 regional) to discuss the concepts, coordination structures, indicators, and measurement tools, laboratory testing methods and sample collection/processing logistics.

The lack of comprehensive training on HIV/AIDS prevention, care, and treatment for most practicing doctors, nurses, and pharmacists in Namibia is a significant obstacle to rapid scale-up of quality programs throughout this sparsely-populated country. Since FY04, the USG has funded the International Training and Education Center on HIV (I-TECH) to collaborate with the Ministry of Health and Social Services to address this gap by increasing the capacity of the University of Namibia (UNAM), the National Health Training Center (NHTC) and its five Regional Health Training Centers (RHTCs), and the Directorate of Special Programs to train new and existing health care workers in HIV/AIDS, including pediatric care and treatment. I-TECH provides technical advisors, training and curriculum experts, clinical mentors, educational and training materials, monitoring and evaluation systems for training, infrastructure, training logistics, and funding for training. Based on new or updated national guidelines, I-TECH has facilitated the development of the Ministry's national training curricula on PMTCT, VCT, rapid HIV testing, Couples Counseling, TB/HIV, ART, nutrition and HIV, IMAI, dried blood spot collection for HIV DNA-PCR for infants, and pediatric care/ART. Support is also being provided to incorporate this new content into the pre-service training curricula for registered nurses at UNAM and for enrolled nurses at NHTC. I-TECH will play a critical role in the decentralization of palliative care and ART through various levels of training ranging from didactic sessions to clinical mentoring. To date, a total of more than 3,800 health workers have been trained in the various HIV/AIDS topics.

I-TECH supports the PEPFAR program in Namibia through human resources and local organization capacity building in 7 programmatic areas. I-TECH funding within OHPS covers support activities that cut-across all of these program areas and are linked with personnel support provided by Potentia_Other/PA/SS_#7341). Activities include:

1) In-service training and professional development of 85 staff hired via Potentia for I-TECH. 2) Support and consultation to the Human Resource Development (HRD) Technical Advisor assigned to the MOHSS Division of Planning, Policy, and Human Resource Development to assist with policy development, human resource forecasting, training strategies, and strategic planning. 3) Development costs for a database for the skills audit, staffing norms and other studies conducted by the HRD Advisor. 4) Technical assistance to the Digital Video Conferencing (DVC) program and associated program costs including salary support for a DVC Advisor, costs associated with event coordination, and costs of materials for DVC events. 5) The purchase of a additional vehicles and a photocopier to support the delivery of training and site visit activities.

Digital video conferencing (DVC) has proven to be a very successful tool in getting much needed HIV-related training to persons providing health and social services to patients with HIV/AIDS. Namibia has one of the highest rates of HIV in the world. It is also the 2nd least populated country in the world. In Namibia, many clinicians and other caregivers provide services in rural areas. Currently, DVC training is provided in six sites throughout the country. Despite this coverage, these sites are not easily accessible to HIV caregivers, requiring extensive travel times and significant expense as traveling to some sites require an overnight stay. The assistant DVC coordinator recruited and hired through this activity will be responsible for establishing and monitoring the four new DVC training sites. This individual will ensure that these sites are consistent with the six existing sites, specifically with regard to the quality of space and the two-way video feed. He or she will also ensure consistency of record-keeping, including evaluations and other information such as number of attendees and their duty stations.