This mechanism will continue to develop and build the institutional capacity of the Ministry of Defense/Namibian Defense Force (MOD/NDF) to strengthen ownership, leadership, management and planning capacities to ultimately provide a sustainable HIV/AIDS response in the Namibian military. The overall goal of this mechanism is to support the strategic goals and objectives of the 5 year National Strategic Framework (NSF) and the Partnership Framework Agreement (PFA) and the GHI. Approximately 15,000 MOD/NDF staff and civilian workers at the military bases and camps in 11 regions of the country. Integrating HIV services into services regularly provided at each military health facility. Strategies to transition are focusing on contributions to health systems strengthening through extensive in-service training of military health care workers in various aspects of HIV/AIDS related issues and pre-service training at both the University and Polytechnic of Namibia in laboratory and pharmacy fields and mentoring. Human resources for health are cross-cutting all programs and TB and Prevention with People Living with HIV are some of the Health Wrap-around activities. The mechanism addresses male norms and behaviors, through Positive Health Dignity and Prevention (PHDP), VCT and MC counseling. The monitoring and evaluation plan includes PEPFAR indicators and is fully integrated into the overall US DOD M&E plan for assistance to the MOD/NDF.

With COP12 funds, this continuing program will support the Ministry of Defence/Namibia Defence Force (MOD/NDF) to strengthen and expand high quality HIV care and support services both within and outside its health facilities. Core support activities include:

Support clinical HIV palliative care services: Provision of technical support to assist the military to expand and enhance clinical palliative care service delivery to established sites. In line with the Ministry of Health and Social Services strategy to decentralize HIV care and treatment, I-TECH will continue to provide TA to support integration of a package of HIV care into other services at other military health facilities. I-TECH will also provide necessary minor equipment and materials to allow decentralization of these services and health care workers will receive training as required to ensure they remain updated with the latest MoHSS guidelines.

Support community-centered palliative care: support groups and home-based care: Strengthen the existing support groups and in collaboration with DOD prevention partner assist the military to establish new support groups at different military bases as needed. I-TECH will continue to provide training to support group members on issues such as stress management, disclosure of status to others, etc.; promote opportunities for support group members to develop innovative strategies to support each other; promote interchange of ideas between support groups through targeted exchange visits if applicable; and further building capacity of military health care workers to share information at support group meetings on topics such as medicine adherence, PHDP, basic nutrition, and others. I-TECH will also continue to assist MOD/NDF home-based care givers to provide effective services to military members in need. Further, I-TECH will assist military health care workers to provide refresher training to home-based care givers on relevant palliative care topics; and promote opportunities for home-based care givers to meet, exchange ideas and develop innovative ways to improve their home-based care services.

Capacity Building: Train new home-based givers and other health care workers and provide in-service training, on different topics relevant to HIV care and support services including procurement of necessary equipment for training and implementation of service provision. I-TECH will also train selected military HIV experts on how to train others to provide HIV care and support in a training of trainers course and will co-facilitate during their first opportunities to train. Further, I-TECH will continue to train and coach selected military HIV experts in mentoring skills to enable them to better support colleagues in the field.

Quality assurance: Provide technical assistance to the MOD/NDF to develop assessment tools for quality of HIV patient care delivered. I-TECH will also coach the military health care workers who have been trained as mentors, to review the performance of military staff in correct HIV care and support according to MoHSS guidelines through utilization of monitoring tools to do chart reviews and inform case discussions with clinic staff and continue to assist the MOD/NDF to ensure accurate recording and reporting of patient data relevant to care and support as a basis for generating accurate monthly and quarterly reports as required by the Ministry, and to monitor and evaluate their own performance.

This continuing activity will support the Ministry of Defence and the Namibian Defence Force (MOD/NDF) to further strengthen its capacity to prevent tuberculosis (TB) and to identify and correctly and successfully manage patients with TB.

Support TB prevention and treatment services: Because PLHIV are more susceptible to TB disease than those without HIV, and in accordance with World Health Organization and Ministry of Health and Social Services (MOHSS) guidelines, PLHIV should be screened for TB at each clinic visit and should be offered Isoniazid Preventive Therapy (IPT) if they meet the eligibility criteria. In addition, every patient with TB should be tested for HIV. With COP12 funds, I-TECH will continue to provide TA support during mentoring visits to ensure TB prevention in patients attending clinics for HIV care and correct identification and management of patients who have TB, including testing for HIV. I-TECH will provide support to MOD health care workers to ensure that 100% of people with HIV accessing their MOD health facilities are screened for TB at each visit and that 100% of TB patients are tested for HIV.

Utilizing COP12 funds, I-TECH will assist the MOD/NDF to evaluate and to implement improvements in TB infection control (IC) in crowded military settings, in addition to continuing to assist in the assessment of TB IC in individual health facilities. I-TECH will also assist with minor equipment needed for the required improvements in TB IC. I-TECH will also assist the MOD/NDF to enhance military personnels knowledge about TB and services available through collaboration in the production of appropriate IEC materials for general distribution to all health facilities and bases and for use in National and International TB Days.

Capacity building: With COP12 funds, I-TECH will continue to train health care workers from throughout the military to prevent, diagnose and manage TB in the era of HIV and drug resistant TB and to provide IPT to eligible PLHIV. Training of health care workers will include procurement of any necessary equipment for training and implementation of service provision. With a view to long-term sustainability of the program, I-TECH will continue to co-facilitate with selected military TB experts in training of health care workers in TB. In further support of long-term effective and quality management of TB and TB prevention, I-TECH will continue to coach selected military TB experts in implementation of their mentoring skills to enable them to better support colleagues in the field.

Quality assurance (QA): During mentoring support visits, I-TECH mentors, together with the MOD trained mentors, will review the performance of military staff in correct screening and provision of TB prevention (IPT) and treatment according to MOHSS guidelines through chart reviews and case discussions with clinic staff. In addition, I-TECH will continue to assist the MOD/NDF to hold regular review meetings where IPT initiation and completion rates will be determined and TB management data will be evaluated. This activity will support sustainability of quality TB prevention and treatment services in the military.

This continuing activity will support the Ministry of Defence and the Namibia Defence Force (MOD/NDF) to further strengthen its capacity to perform high quality HIV-related laboratory services.

I-TECH has been assisting the MOD/NDF to establish a laboratory at the Grootfontein Military Hospital capable of catering for HV-related laboratory testing. I-TECH will provide TA to ensure continuing uninterrupted quality laboratory services by 1) ensuring appropriate use and maintenance of the latest laboratory equipment through on-site training and monitoring, assisting the MOD/NDF to maintain an effective and sustainable equipment process as new technology becomes available, and monitoring of equipment; 2) assist in the development, implementation and updating of clear and comprehensive standard operating procedures; and 3) assist the laboratory personnel to utilize and maintain an effective laboratory information system. In addition, I-TECH will assist MOD/NDF to identify which facilities might benefit from establishment of specimen processing areas, thus promoting safe and timely processing of specimens as well as ensuring accurate test results.

Capacity building: I-TECH will continue to assist MOD/NDF to build the human resource capacity in the laboratory services. With a view to sustainability, I-TECH will provide mentoring training to an expert laboratory technologist selected by MOD, and will coach the MOD mentor during routine mentoring support visits to give on-site training to their colleagues. To further enhance skills of laboratory staff, I-TECH will continue to facilitate in-service training through linkages with the Namibia Institute of Pathology (NIP) and Centre for Disease Control and Prevention (CDCs) International Laboratory Branch Consortium partners. I-TECH will continue to train on safe, high quality specimen collection. Furthermore, I-TECH will assist in the establishment and implementation of a specimen processing area in the military including procurement of necessary equipment for training and service provision.

Noting the scarcity of military laboratory personnel, a high degree of staff turn-over; and in anticipation of expanding and sustaining laboratory services, I-TECH provided four bursaries to military staff to attend the Polytechnic of Namibias pre-service laboratory technologist 4-year degree program. Depending on funding, two students will complete their studies in 2013. With COP12 funds under OHSS program area, I-TECH will support the remaining two students for enrolment in their 3rd year of study.

Quality Assurance/Accreditation: Laboratory accreditation is a lengthy process and requires several years to be achieved when a laboratorys services meet international quality standards. I-TECH will continue to assist the MOD/NDF Grootfontein laboratory to ultimately achieve accreditation through 1) strengthening internal quality assurance both during mentoring support visits and through anticipated collaboration with Namibia Institute of Pathology (NIP); and 2) continued enrollment in an External Quality Assurance (EQA) program that meets the requirements of the South African National Accreditation System (SANAS) and the International Medical Laboratory Accreditation Community. I-TECH will also assist MOD/NDF to monitor quality of services at the mini-laboratory at PMMHC and any specimen processing areas which are established in specific health facilities.

The overall objective of this continuing program is to assist the military in providing effective Information and Communications Technology (ICT) support for its HIV prevention, care and treatment programs.

Support implementation of effective health information systems: With COP12 funds, I-TECH will continue to provide TA support to the Defence Health Management Information System (DHMIS) Technical Working Group (TWG) and will assist with updating and further customization of HIV-related databases in response to changing programs and needs as required.

Capacity building: With COP12 funds, and with a view to long-term sustainability, I-TECH will continue to build capacity of MOD/NDF information communication technology (ICT) specialists in systems management and hardware maintenance. In addition, I-TECH will work side-by-side with identified expert ICT staff to continue the transfer of IT support to the MOD/NDFs MAPP. As needed, I-TECH will use COP12 funds to continue to train more military healthcare workers in basic computer skills and use of the HIV-related databases. They will also continue to receive training on how to use their own data for planning purposes.

Support monitoring and evaluation: With COP12 funds, I-TECH will assist the MOD/NDF to strengthen its capacity to monitor and evaluate HIV-related services and activities and to promote the use of data to continually improve the quality of HIV services. During mentoring support visits, I-TECH mentors together with military mentors, will assist staff to review registers and patient/client files, focusing on the quality of data collection, and will discuss strengths and weaknesses noted. With COP12 funds, and to further promote ownership and sustainability of quality assurance programs, the military mentors noted in the CIRC, HVCT, HTXS and HBHC sections will be coached to take over the quality assurance role. With COP12 funds I-TECH will continue to support regular reviews of HIV-related data, promoting the collection of good quality data, and the identification of areas to target for improved quality of services. Staff will continue to be assisted in generating reports needed for routine self-evaluation and for submission to higher military levels as required.

In order to effectively further understand issues and respond to them, it is necessary to do special evaluations from time to time. With COP12 funds, I-TECH will continue to assist the MOD/NDF to evaluate different aspects of HIV prevention, care and treatment services, to analyze and interpret information collected and utilize information to improve services. Areas requiring special evaluation may include training needs assessments, program performance evaluations and others.

The overall objective of this continuing program is to support the MOD/NDF to further develop institutional capacity, strengthen systems and advocate for an enabling environment for implementation and scale-up of the MOD/NDFs HIV prevention, treatment and care services. These activities will greatly contribute to long term ownership and sustainability of these programs.

Utilizing COP12 funds, I-TECH will continue to support pre-service and in-service training and the attendance of MOD/NDF staff members to appropriate and relevant local, national, regional and international trainings, conferences, meetings, courses and study tours. Training topics may include leadership, management, information technology (advanced and basic), monitoring and evaluation, strategic planning, stigma and discrimination, mentoring skills, and others. I-TECH will support senior MOD/NDF members to attend International Military HIV-related conferences to enhance their sharing of experiences and lessons learned.

Answering to a dire need for more pharmacists within the military, I-TECH began supporting one NDF staff member to attend the University of Namibias Pharmacy course in 2011. With COP12 funds, I-TECH will provide the student with a bursary for the 4th (final) year of pharmaceutical studies

Using COP12 funds, and with a view to long-term sustainability, I-TECH will continue to collaborate with the MODs HIV coordination and training offices to strengthen MOD capacity to coordinate and deliver HIV-related training internally, especially focusing on integration of health services, quality service delivery, enhanced information systems and reporting, improved HIV financing and good governance and leadership .

Finally, noting the scarcity of military laboratory personnel, a high degree of staff turn-over and in anticipation of expanding and sustaining laboratory services, I-TECH provided 4 bursaries to military staff to attend the Polytechnic of Namibias pre-service laboratory technologist 4-year degree program. Depending on funding, two students will complete their studies in 2013. With COP12 funds, I-TECH will continue to support the remaining two students for enrolment in their 3rd year of study.

Male circumcision is recognized as an important part of a comprehensive HIV prevention package. The goal of this continuing activity is to decrease new HIV infections in the Ministry of Defence/Namibian Defence Force (MOD/NDF) through strengthening and expansion of Male circumcision (MC) services within the military.

Support MC service-delivery and demand creation: With COP12 support, free and confidential MC services will continue to be offered to MOD/NDF staff by military health care workers as part of a comprehensive HIV prevention program which also includes HCT with referrals as necessary, treatment for other STI, counseling on risk-reduction and safer-sex practices, and condom distribution. Following the fundamentals of MC care, military MC services will include informed and voluntary decision making, medically safe clinical procedures and quality assurance. With I-TECH support, the MOD/NDF established adult MC services at Grootfontein Military Hospital where MC services started in June 2010. By November 2011, 111 military men had been circumcised at Grootfontein Military Hospital following appropriate HIV testing and counseling. With COP12 funds, I-TECH will continue to provide TA and mentoring support to facilitate effective and high-quality MC services in all MC services sites, including outreach services. I-TECH will also assist MOD/NDF to enhance MC demand-creation through collaboration in the production of appropriate IEC materials.

Capacity building: With COP12 funds, I-TECH will continue to support expansion of MC services through training of doctors and nurses as required in safe and effective provision of MC. Training will include procurement of necessary equipment for training and implementation of service-provision. Counselors will be trained on MC-specific counseling to supplement existing counseling messages on risk-reduction programs. In support of long-term sustainability, I-TECH will also continue to train and coach military MC mentors to enable them to better support their own colleagues in the field and will train selected MC providers in how to train others in a training of trainers (TOT) course.

Quality assurance (QA): With COP12 funds, I-TECH will continue to support the MOD/NDF in quality assurance of MC service provision. With previous funding, I-TECH facilitated proficiency certification of military service providers and with COP12 funds will continue to facilitate this process. I-TECH will assist the MOD/NDF to operationalize national supportive supervision QA tools, and will train and coach selected MOD/NDF members to carry out such supervision with a view to long-term sustainability of a quality service.

With COP12 funds, this continuing activity will support the Ministry of Defence and the Namibian Defence Force (MOD/NDF) to strengthen and expand high-quality HIV testing and counseling (HTC) services including patient- and provider- initiated TC and routine HIV screening. The HTC program provides pre-test counseling services, rapid HIV testing, post-test counseling for both HIV-negative and HIV-positive clients, and referral to the care and treatment programs for those members who test positive.

Support to HTC services and demand creation: In 2011, I-TECH supported MOD/NDF to test and counsel 3004 military members. I-TECH will continue to provide TA in support of quality testing services, for individuals who voluntarily seek HIV testing and those who are offered testing when visiting health facilities for any other reason, at all static and outreach testing sites. I-TECH will also assist the MOD/NDF to enhance demand creation for HIV testing through collaboration in the production of appropriate IEC materials for use at testing events and for distribution to all health facilities and bases.

Support MOD to carry out HTC outreach services: Providing outreach HTC services has been shown to be a successful strategy for increasing the number of military staff accessing HIV testing in Namibia. As such, I-TECH will continue to support the MOD/NDF to carry-out outreach HTC services to all bases within the country.

Capacity building in support of HTC services: I-TECH will continue to provide TA in support of expansion of HTC services (voluntary TC and provider-initiated TC (PITC)) through training of health care workers in comprehensive HIV counseling and rapid HIV testing, including training on any new approaches to testing and counseling. Supervisors of health facilities, including sickbays, will continue to be trained and coached in the promotion of PITC and routine screening as appropriate. In support of long-term effective and efficient management of HTC services, I-TECH will continue to train and coach military HTC site supervisors and HIV coordinators in leadership and supervision and continue to train HTC experts in mentoring skills to better support their own colleagues in the field. With a view to long-term sustainability of the program, I-TECH will train more HTC experts in how to train others in an HTC training of trainers (TOT) course including training on procurement of necessary equipment for training and implementation of HTC service provision.

Quality assurance: I-TECH will continue to provide TA in support of quality assurance (QA) of MOD/NDF HTC service provision. HTC site supervisors will benefit from ongoing QA coaching in maintaining a quality HTC service, including evaluating the quality of counseling sessions, actual testing, stock maintenance and record-keeping. Further, I-TECH will continue to assist the MOD/NDF to strengthen the integration of other essential programs with HTC services, such as TB screening, referrals for other services including ART for HIV positive clients, discussion of gender-based violence and male norms, positive health dignity and prevention (PHDP) and alcohol-use screening. I-TECH will also facilitate quarterly HTC program review meetings to augment quality assurance activities through data analysis and timely identification of areas for improvement. In support of sustainability, I-TECH will train officials selected by MOD to monitor and evaluate quality of HTC services.

The goal of this continuing program is to strengthen the capacity of the Ministry of Defence/Namibian Defence Force (MOD/NDF) to provide quality HIV treatment services for military and civilian employees working on military bases.

Support HIV treatment services: I-TECH supported the identification, renovation and opening of the HIV care and treatment center at Grootfontein Military Hospital (Fountain of Hope Clinic) in 2009. By the end of September 2011, 191 military members received ART at that facility. I-TECH will continue to provide TA for HIV treatment, appropriate initiation of ART, patient adherence to ARV, identification and management of treatment failure, pharmaceutical management, cervical cancer screening for HIV positive women, and other aspects of HIV treatment and to promote integration of other services, such as TB prevention and treatment, STI screening and prevention, family planning and others as appropriate. In addition, and in line with the Ministry of Health and Social Services strategy to decentralize HIV care and treatment to smaller health facilities which are closer to the patients, I-TECH will continue to provide TA to support integration of a package of HIV care and treatment into other services provided at sickbays and other smaller health facilities within the military.

I-TECH will continue to assist MOD/NDF to create more demand for military HIV treatment services through providing TA in the production and dissemination of appropriate IEC materials. Included in the materials will be updated practical information on how and where individuals can seek help. I-TECH will continue to support the military to enhance the capacity of military HCT sites and health facilities to effectively refer HIV-positive clients to military and other sites offering HIV treatment services.

Capacity building: I-TECH will continue assisting the MOD/NDF to build capacity of military doctors, nurses and pharmacists through in-service training and clinical mentoring, as well as through participation in national and international training. Timely training and mentoring will ensure military personnel are informed of new developments, such as changes to HIV treatment guidelines and protocols. I-TECH will continue to train more military nurses to provide ART services in line with the MOHSS strategy of decentralizing care to smaller health facilities. Training of health care workers will include procurement of necessary equipment for training and implementation of service provision. With a view to long-term sustainability of the program, I-TECH will continue to co-facilitate with selected military HIV experts in training of health care workers in ART-related courses. In further support of long-term effective and quality management of HIV, I-TECH will continue to coach selected military HIV experts in implementation of their mentoring skills to enable them to better support colleagues in the field.

Quality assurance: I-TECH and MOD mentors will review the performance of military staff in correct HIV treatment according to MoHSS guidelines through chart reviews and case discussions with clinic staff. I-TECH will continue to assist the MOD/NDF to ensure good quality HIV treatment for patients through correct recording and reporting of patient and pharmaceutical data as a basis for generating accurate monthly and quarterly reports, and to monitor and evaluate their performance.