Continuation from FY07. Development AID from People to People (DAPP) has 2 main AB activities in

Namibia: Total Control of the Epidemic (TCE) and Hope Humana. DAPP AB activities mainly involve house-

to-house AB education by trained TCE Field Officers (FOs) and community volunteers, and expanding

Hope Humana youth clubs in schools. Overall, TCE supports both prevention and care activities, and thus

funding is allocated across 3 program areas: HVAB (7325), HVOP (7327), and HBHC (7326). TCE is a

highly organized mobilization strategy to individually educate and empower community members to reduce

risk of HIV and to access resources in the community. The TCE FOs assess the risk level of household

members and provide information and referrals accordingly.

The DAPP TCE program leverages resources from both PEPFAR and Global Fund (GF). TCE was

established in northern Namibia in 2005 with support from GF and PEPFAR. GF and PEPFAR funds

support TCE in Omusati, Oshana, Ohangwena, Oshikoto, Kavango, and parts of Caprivi and Khomas

Regions. GF supports 290 community members trained as FOs. By the end of 2007, DAPP will have trained

and deployed a total of 450 community members as FOs; 272 of these positions are supported through

PEPFAR. Both GF and PEPFAR will continue to provide support to DAPP in FY08. The 2005 GF annual

report singled out TCE as one of 3 success stories in Namibia. DAPP's sister interventions in Zimbabwe

and Botswana have been evaluated: the findings from both countries showed that TCE program exposure

was positively associated with increases in HIV-related knowledge, less stigmatizing attitudes, and HIV

testing. DAPP's efforts address these components of the minimum package of prevention services: age-

appropriate behavior change communication, HIV counseling and testing, condom distribution, and linkages

with care, support and treatment. The condom distribution and linkages components support "B" messaging

for persons in discordant relationships.

PEPFAR funding for DAPP in FY08 is level and expansion into new regions has been put on hold to

sharpen the focus of DAPP's efforts. Both PEPFAR and GF supported assessments of DAPP conducted by

CDC technical advisors which identified that DAPP's efforts must be more targeted to impact behavior

change and linking individuals to services. Through FY08, CDC/Namibia and CDC/Atlanta will work closely

with DAPP on an impact assessment of the TCE program and to revise and harmonize the TCE curricula

with other curricula in-country, in particular with the curriculum used to train the Ministry of Health and

Social Services (MOHSS) community counselors (7329) and with CDC's Prevention with Positives

curriculum. These revisions will refine DAPP's communication strategies to optimize delivery of the AB and

OP approaches. Greater emphasis will be placed on approaches that achieve behavior change in terms of

being faithful to partner(s) of known HIV status and partner reduction, particularly for adult men. DAPP will

participate in an intensive USG-funded behavioral change communication training to enhance their

prevention messages, including gender-related messaging around partner reduction and family planning.

FY08 funds will support follow-up TA in monitoring and evaluating the program's impact on behavior

change.

The assessment and refined curricula should also allow DAPP to improve linkages to community- and

facility-based services, and add an outreach-based VCT component. DAPP FOs are successful at

promoting the importance of knowing your status to clients with whom they interact; however, many of these

clients live in rural areas with little or no access to CT services. In 2007, the Permanent Secretary of the

MOHSS approved delivery of VCT in non-traditional settings for the first time. DAPP FOs in select sites will

be trained in VCT and rapid testing in the same manner as MOHSS community counselors. These pilots

will be evaluated in 2008 to assess whether mobile VCT can become a priority activity for DAPP.

The organizational structure of DAPP's TCE program is sound. FOs operate in a continuous learning and

support system. Initial training educates the FOs on the basics of HIV transmission, STIs and TB,

abstinence, condom education, and behavior change. The course orients FOs to the TCE program and how

to use household registers to document activities. Role-playing enables practice in communicating

prevention messages. New FOs visit assigned households (2000 people per FO) with an experienced FO.

FOs report to the Troop Commander (TC). In each region, groups of 50 FOs meet together each Friday

under the leadership of a TC with support from Special Forces (SF). FOs report numbers of persons

educated, share experiences, and ask questions; training is provided as appropriate and challenging

questions are addressed through the chain of command. The sessions identify additional FO needs, which

are met by organizing trainings or linking with appropriate community resources. To assure quality, SF

members visit their FOs in the field on short notice. Through March 31, 2007, FOs have reached 147,054

community members (49% of the target population of 300,000) through household visits. FOs register

household members, provide targeted AB and OP communications (7327), and mobilize community

members to access services, including VCT, TB, ART, PMTCT, family planning, OVC, and STI. The FOs

provide psychosocial support and simplified messaging around ART adherence and pain management.

Where possible, FOs coordinate with health care facilities to provide critical transportation to rural persons

in need of accessing essential HIV/AIDS services.

The TCE program serves as an entry point for building human resources capacity within Namibia, as a

number of FOs, all of whom are Namibian, are able to parlay their experiences into promotional

opportunities as community counselors within the MOHSS (7331) and New Start Centers (7405). This

strengthens the career ladder and the capacity of community counselors and clinic facilities, as well as

builds the technical expertise of FOs. Not only will FOs become employed as community counselors, but

they are able to build community awareness into facilities and strengthen the HIV continuum with

community partners.

Community volunteers are key partners with the FOs, communities, and health care facilities. PEPFAR-

supported FOs have recruited and deployed nearly 2,000 volunteers to assist with delivery of health

messages and referrals. TCE also coordinates with PEPFAR-funded volunteers supported by the PACT

program (7412) to refer individuals for palliative care and OVC services. Supportive supervision of all

community caregivers is provided by TCE Special Forces Officers, CDC nurse mentors, and primary health

care nurses from nearby facilities. During FY07, FOs and volunteers facilitated 15 support groups for

PLWHA and their families, and organized community-wide HIV-related activities. FY08 funds will continue to

support these activities. TCE will continue to collaborate with Lironga Eparu (7404), the national PLWHA

umbrella NGO; the organizations represented within the Regional and Constituency AIDS Coordinating

Committees (RACOCs and CACOCs, respectively); local MOHSS officials; and other stakeholders to recruit

PLWHAs (especially members of minority groups, such as the San) as FOs. Recruitment of PLWHAs

continues to foster the development of effective HIV-related community support groups close to the home of

Activity Narrative: HIV/AIDS delivery sites. Gender issues are addressed: provision of equitable services to both male and

female PLWHA, support for disclosure of status, and messaging to encourage males to seek services.

DAPP is a partner in the Male Norms Initiative begun in Namibia in 2007.

FY08 funds will support continued and more intensive AB activities within current regions. If 70% of this

population is reached by FOs during the reporting period, 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, FOs emphasize

abstinence messages to persons in houses and schools under age 15. During the ongoing sessions with

under-15-year-olds, the FOs will discuss knowledge about HIV transmission; deciding not to get infected by

HIV; deciding to delay the first sexual encounter; and pregnancy and STI risk. For adults, young persons

who ask, and those at high risk of contracting HIV through sexual contact, FOs discuss knowledge about

HIV transmission; correct and consistent use of condoms, (demos used); and knowing where condoms are

available. As appropriate, FOs will also distribute condoms to those who have received education.

In 2008, DAPP will continue to receive subagreement funds through PACT (7412) to support Hope Humana

Youth Clubs in schools in Omusati Region, in cooperation with the Regional AIDS Coordinating Committees

(RACOC), local leaders and the Ministry of Education. DAPP has observed that the rate of teenage

pregnancies is high and that it is culturally acceptable for young girls to have babies and leave them to be

taken care of by their grandparents or aunts while they search for jobs or attend school. In 2008, over 100

schools in Omusati, Ohangwena, Oshikoto, and Kavango will participate in education sessions with games

and drama, and peer education with AB messages. The project involves training peer educators, teachers

and volunteers and targets boys and girls 14-19 years of age, focusing specifically on the girls and their

right to say no to sex, delay their sexual debut, and abstain before marriage. At the annual Hope Youth

Festival, students attend as representatives and make presentations, sharing their lessons learned with

their communities.

In an activity continuing from FY07, Development AID from People to People (DAPP) will continue to use

Field Officers (FOs) from its program, Total Control of the Epidemic (TCE), to educate adults and high-risk

persons on the consistent and correct use of condoms and other prevention messages, including basic

information and referrals for family planning and STI services. Overall, TCE resources support both

prevention and care activities and thus funding is allocated across three program areas: this area, as well

as HVAB (4382) and HBHC (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. A 2005 Global Fund annual report singled out TCE as one of

three success stories in Namibia. DAPP's sister interventions in Zimbabwe and Botswana have been

evaluated: the findings from both countries showed that TCE program exposure was positively associated

with increases in HIV-related knowledge, less stigmatizing attitudes, and HIV testing.

PEPFAR funding for DAPP in FY08 is essentially level and expansion of the TCE program into new regions

has been put on hold to better focus DAPP's efforts. PEPFAR and the Global Fund (GF) supported recent

assessments conducted by technical advisors from CDC which clearly identified that DAPP's efforts must

be more targeted to have a greater impact on behavior change and linking individuals to services. Through

FY08, CDC/Namibia and CDC/Atlanta will work closely with DAPP to initiate an impact assessment of the

TCE program and to revise and harmonize the TCE curricula with other prevention and care curricula in-

country, in particular with the curriculum used to train the Ministry of Health and Social Services (MOHSS)

community counselors (7329) and with CDC's Prevention with Positives curriculum. These revisions will

refine DAPP's communication strategies to optimize delivery of prevention education and referrals to

services. Greater emphasis will be placed on effective approaches to achieve behavioral change,

particularly for adult men. An intensive USG-funded behavioral change communication training will be

provided in the coming year to assist DAPP and other partners to enhance their prevention messages,

including the incorporation of gender-related issues around condom negotiation skills and family planning.

FY08 funds will support follow-up TA in monitoring and evaluating the TCE program's impact on behavior

change.

It is anticipated that the assessment and refined curricula will also allow DAPP to improve linkages to

community- and facility-based services, and add outreach-based VCT to their menu of services. DAPP FOs

are quite successful at promoting the importance of knowing your HIV status to clients with whom they

interact; however, many of these clients live in rural areas with little or no access to CT services. In 2007,

the Permanent Secretary of the MOHSS approved delivery of VCT in non-traditional settings for the first

time. DAPP FOs in select sites will be trained in VCT and rapid testing in the same manner as MOHSS

community counselors. These pilots will be evaluated in 2008 to assess whether mobile VCT can become

a priority activity within DAPP's programming.

Since 2005, DAPP has leveraged PEPFAR and GF resources to support TCE in the regions of Omusati,

Oshana, Ohangwena,Oshikoto, Kavango, and parts of Caprivi and Khomas Regions. GF supports 290

community members trained as FOs. The Global Fund also intends to continue support for TCE in FY08.

By the end of 2007, DAPP will have trained and deployed a total of 450 community members as FOs; 272

of these positions are supported through PEPFAR.

The organizational structure of DAPP's TCE program is sound and will likely remain unchanged. TCE field

officers (FOs) operate within a continuous learning and support system. Initial training will continue to

educate the FOs on the basics of HIV transmission, STIs and TB, 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. New FOs begin visiting assigned households (2000 people per FO) with an experienced FO.

FOs report to the Troop Commander (TC), their immediate supervisor. In each region, 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, and ask questions; training is provided as

appropriate and challenging questions are addressed through the chain of command. The weekly sessions

are effective in identifying additional FO 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 of efforts.

Through March 31, 2007, FOs have reached a total of 147,054 community members (49% of the target

population of 300,000) through household visits. Services provided by FOs include registration of

household members, appropriately targeted AB communications or other prevention communications

(7327), and mobilization of community members to access services, including VCT, TB, ART, PMTCT,

family planning, OVC, and STI services. The FOs further provide psychosocial support and simplified

messaging around ART adherence and pain management. Where possible, FOs will continue to coordinate

with health care facilities to provide critical transportation to rural persons in need of accessing essential

HIV/AIDS services including VCT and ART.

The TCE program continues to be an entry point for building human resources capacity within Namibia, as a

proportion of FOs, all of whom are Namibian, are able to parlay their experiences into promotional

opportunities as community counselors within MOHSS (7331) and New Start Centers (7405). This

strengthens the career ladder for Namibians and the capacity of community counselors and health facilities,

as well as builds the technical expertise of FOs. Not only will FOs become employed as community

counselors, but they are anticipated to build community awareness into facilities and strengthen the HIV

continuum of care between facilities and community partners.

Community volunteers are a key to the TCE program, and FOs have recruited and deployed nearly 2,000

community volunteers to assist with these health messages and referrals. Supportive supervision of all

community caregivers is provided by TCE Special Forces Officers, CDC nurse mentors, and primary health

care nurses from nearby facilities. During FY07, FOs and volunteers facilitated 15 support groups for

PLWHA and their families, and organized community-wide HIV-related activities. Other prevention efforts

include education in HIV/AIDS for traditional leaders and traditional birth attendants, as well as

establishment of small community libraries. 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, incorporating condom

demonstrations 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

Activity Narrative: 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. FOs

conduct quarterly campaigns and events in the communities to sensitize the population to the dangers of

HIV and 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.

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 HIV, basic care (including TB) and

prevention and to make referrals to available services. DAPP's sister interventions in Zimbabwe and

Botswana have been evaluated: the findings from both countries showed that TCE program exposure was

positively associated with better HIV-related knowledge, less stigmatizing attitudes, and HIV testing. In

2008, 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; and (3) integrate TCE activities with other PEPFAR-funded activities to strengthen the quality of

services. DAPP funding is in two other areas: HVOP and HVAB. The TCE program is a highly organized

house-to-house mobilization strategy that aims to individually educate and empower members of a

community to reduce the risk of HIV and stigma and improve access to HIV-specific services. The TCE

program was initiated in northern Namibia in 2005 with support from the Global Fund and PEPFAR. Global

Fund supported the program in the regions of Omusati, Oshana, and parts of Ohangwena and Oshikoto;

PEPFAR supported the program in Kavango Region, the remaining parts of Ohangwena and Oshikoto

Regions, and part of Khomas and Caprivi Regions.

By the end of 2007, DAPP will have trained and deployed a total of 450 community members as FOs; 272

of these positions are supported through PEPFAR funds. Through March 31, 2007, FOs have reached a

total of 147,054 community members (49% of the target population of 300,000) through household visits.

Services provided by FOs involve registration of household members; appropriately targeted ABC

messages and condoms; mobilization to seek VCT, TB, ART, PMTCT, family planning, OVC and STI

services; and delivery of psychosocial support. The FOs further provide simplified preventive care

messages for families (both adults and children) regarding the importance of cotrimoxizole prophylaxis; use

of long-lasting insecticide impregnated nets for HIV-positive pregnant women and children under five

(leveraged by Global Fund); safe water; personal hygiene; good nutrition and proper care for HIV-infected

children. Simplified messaging also includes ART adherence support and screening for pain and other

symptoms. Where possible, the FOs will coordinate with government sites to provide critical transportation

support to rural persons in need of accessing essential HIV/AIDS services including VCT and ART. In

FY08, DAPP will also work with I-TECH and PACT to strengthen community-level training in TB care which

will result in improved integration of TB screening and referrals in the DAPP and PACT community

programs. DAPP will also strengthen the integration of their HIV/AIDS program with their efforts in

Community TB DOTS.

Community volunteers are key partners with the FOs, communities and families. PEPFAR-supported FOs

have recruited and deployed more than 1,960 volunteers to assist with delivery of simplified prevention and

care messages. TCE also refers clients to community and home-based care services which are supported

by the USG and provided by PACT partners. Supportive supervision of all community caregivers is provided

by TCE Special Forces Officers and primary health care (PHC) nurses from the nearby facilities. During

2007, FOs and volunteers facilitated 15 support groups for PWLHA and their families. FY08 funds will

support ongoing delivery of the TCE program and strengthen technical implementation through training,

supervision, transportation support and building partnerships. TCE will work closely with Lironga Eparu

(7404), the national PLWHA umbrella NGO, the organizations represented within the Regional and

Constituency AIDS Coordinating Committees (RACOCs and CACOCs), local MOHSS officials, and other

stakeholders to recruit PLWHAs (especially members of minority groups, including the San) as FOs.

Recruitment of PLWHA will foster the development of effective HIV-related community support groups close

to the home of HIV/AIDS service delivery sites. In addition to support groups and the activities noted above,

DAPP will continue to initiate community gardening projects in areas identified by community leaders. The

DAPP activity addresses gender issues through the provision of equitable services both male and female

PLWHA, support for disclosure of HIV status, and improved male involvement in the program (e.g. improved

male participation, male responsibility in care-giving and support for female caregivers). DAPP/Namibia is a

partner in the Male Norms Initiative begun in Namibia COP 07.

The TCE Program continues to be an entry point for building human resource capacity within Namibia, as a

proportion of FOs, all of whom are Namibian, are able to parlay their experiences into promotional

opportunities as community counselors within MOHSS facilities and New Start Centers. This strengthens

the community-based career ladder and the human capacity of community counselors and clinic facilities,

as well as builds the technical capacity and communication skills of FOs. Not only will FOs become

employed as MOHSS-recognized community counselors, but they are anticipated to build community

awareness into facilities and further strengthen the continuum of care between facilities and community

partners who deliver HIV-related services.

In 2008, DAPP will expand the Omaheke Health Education Programme (OHEP) derived from Oxfam

Canada, which is recognized by the MOHSS as a national model for quality community and home-based

care. In the OHEP model, grade 12 community caregivers function predominantly as nursing assistants in

communities to deliver basic clinical screening and referrals within the communities, bridge the link between

health facilities and communities, and supervise community health volunteers. The TCE program in Oshana

will collaborate with community volunteers from PACT/Catholic AIDS Action to implement the model in

FY08. As a result, it is anticipated that FOs will be able to more effectively build the continuum of care

between the hospital, four health centers, nine clinics, and hundreds of community care points in Oshana,

as well as strengthen the quality of services, alleviate some of the HIV burden in the clinics, and build

community ownership of HIV/AIDS services in Namibian communities.

Funding for DAPP in COP08 is essentially level and expansion of the TCE program into new regions has

been put on hold to better focus DAPP's activities. InCOP07, PEPFAR and the Global Fund supported

assessments conducted by technical advisors from CDC which clearly identified that DAPP's efforts must

be more targeted to have a greater impact on behavior change and linking individuals to services. Through

FY08, CDC/Namibia and CDC/Atlanta technical advisors will work closely with DAPP to initiate an impact

assessment of the TCE program and to revise and harmonize the TCE curricula with other prevention and

care curricula in-country. It is hoped that the assessment and streamlined curricula will allow DAPP to

improve linkages to community- and facility-based services and add an important component to their

programming -- providing mobile VCT using rapid testing. DAPP FOs are quite successful at promoting the

importance of knowing your HIV status to clients with whom they interact; however, many of these clients

live in rural areas with little or no access to CT services. In 2007, the Permanent Secretary of the MOHSS

approved delivery of VCT in non-traditional settings for the first time. DAPP FOs in select sites will be

Activity Narrative: trained in VCT and rapid testing in the same manner as MOHSS community counselors. These pilots will

be evaluated in 2008 to assess whether mobile VCT can become a priority activity within DAPP's

programming.