The main goal of this partner is to deliver HIV prevention and care interventions to individuals in household and community settings. These interventions include: home-based HIV VCT, education and behavior change counseling, counseling on ART adherence, and referrals to clinical services such as MC, PMTCT, and ART. As part of the USG contribution to the PF goal of enhancing prevention, USG contributions will seek to strengthen this community-based organizations capacity to design, implement and finance comprehensive HIV prevention programs at the community level. The PF is aligned with the priority prevention areas described in Namibias National Strategic Framework for HIV and AIDS 2010-2016. This partner works in the regions with the highest rates of HIV in Namibia (Omusati, Oshana, Oshikoto, Ohangwena, Kavango, Caprivi, and Khomas). USG is engaging the GRN in high level discussions on how government can support essential community services such as DAPP that have direct links and referrals to facility based services. DAPP is also partially funded by the Global Fund, but these resources are declining. At the moment, there is no other known donor to fund this organization. This activity is designed to be cost efficient. Local volunteers receive a modest monthly stipend. HIV test kits are procured through the existing MOHSS system. The DAPP community-based networks are utilized for other public health activities, e.g., distribution of insecticide-treated bed nets. The partner is required to have an extensive monitoring and evaluation (M&E) plan that is linked to PEPFAR and GRN indicator that includes number of individuals reached, tested, and linked to services.

DAPP will train and deploy at least 310 Field Officers (FO) to conduct door-to-door counseling and outreach sessions, as well as household-based HCT and referrals to clinical services. Additional details on these activities may be found in the HVCT and HVOP narratives. HBHC-related activities will include: 1) Referral information and links to appropriate care, and treatment services, including HIV care and treatment services, PMTCT, FP services, as well as TB and STI treatment in cooperation with MOHSS; 2) Referral information for social and health services including alcohol, abuse support, gender-based violence, and nutrition support; and 3) Condoms, as appropriate.

In addition, DAPP will provide extensive training for FO on the most up-to-date, evidence-based approaches for effective prevention counseling. The TBD partner will also produce appropriate job aids and tools for the field officers, as well as supporting information, education and communication (IEC) materials for clients.

DAPP will also be expected to conduct other community-based prevention efforts including education for traditional leaders, youth and other groups. DAPP will also establish tailored referral guides for each region, and will establish community-based resource centers. In addition, FOs will conduct public events to raise public awareness about HIV STI, and TB prevention, care, and treatment.

CDC will work with DAPP and USAID to ensure that DAPPs continuing work at the community level is complementary with other USG-supported community-based organizations. This on-going monitoring will contribute to the identification and removal of any duplicative activities. DAPPs community-based work is designed to improve health-seeking behaviors and increase access to healthcare services for poor and traditionally underserved communities in Namibia.

DAPP will train and deploy at least 310 Field Officers (FO) to conduct door-to-door counseling and outreach sessions, as well as household-based HCT and referrals to clinical services. Details on these activities may be found in the HVCT and HBHC narratives. PDCS-related activities will include:

Referral services (HIV, STI, and TB care and treatment, as well as preventive care) for families: FO will work with families to promote whole-family health. Emphasis will be placed on ensuring that family members of an HIV positive person (including children) are tested for HIV. Testing or referral for TB will be emphasized when at least one member may have TB disease. This program aims to increase access to cotrimoxazole prophylaxis and early initiation of ART. Adolescents will receive age-appropriate prevention messages for youth, including information on delaying sexual debut and abstinence. FO will also be vigilant to report suspected child sexual abuse.

Technical assistance to community support groups for PLWHA: FO will provide psycho-social support to community and PLWHA groups, as well as advice on small income-generating projects (e.g. community gardens), and capacity building for PLWHA to care for HIV-impacted children. Where older children and adolescents are already HIV-infected, support will be provided to facilitate the disclosure of HIV-status to infected children, adherence to OI prophylaxis and/or ART, caregivers concerns and referrals to OVC programs.

Direct Assistance People to People (DAPP) provides community-based services that link their clients for facility- based HIV care and treatment and now will include provide door-to-door testing. Currently DAPP manages clients through comprehensive household registers and reports results through summary forms. Much time is spent in recording information, transcribing it onto forms, and determining the reporting elements. As DAPP activities increase and align with national HIV care and treatment goals, more efforts must be made for monitoring, implementing assessments and operational research. The current staff composition and resources are not sufficient to undertake significant M&E activities.

In COP 13, SI funds for DAPP will be used for the following activities:

1) Hiring enough M&E staff required for accurate recording, reporting, interpreting and using data for program planning. Currently only 2-3 staff members perform M&E duties for the entire DAPP portfolio which goes beyond PEPFAR HIV activities.

2) M&E training workshops for all DAPP staff so that all know the importance of good data collection and analysis and can take part in DAPP and MOHSS monitoring and evaluation activities.

3) Statistical software training for DAPP M&E staff. Key M&E staff will be trained in software such as Epi Info , ArcGIS, and SAS to perform analyses and generate routine reports.

4) Equipment such as computers and statistical software packages

Implementation of CDC Families Matter!

Families Matter! is an intervention designed to promote positive parenting practices and effective parent-child communication about sexuality and sexual risk reduction for parents and guardians of 9-12 year olds. The Families Matter! Program (FMP) intervention is an adaptation of the US-based Parents Matter! curriculum which CDC has evaluated in the US and Kenya. The ultimate goal of FMP is to reduce sexual risk behaviors among adolescents, including delayed onset of sexual debut, by giving parents tools to deliver primary prevention to their children. Families Matter! is a community-based, group-level intervention delivered over five consecutive 3-hour sessions.

Costs for the program include personnel, such as an overall manager, facilitators and administration staff, as well as miscellaneous costs, such as for project materials, travel and office supplies. To ensure sustainability, materials and trainings will be shared with other organizations such as the Ministry of Gender, Equality and Child Welfare, Lifeline ChildLine, and others with an interest in family interventions.

Community-based public health interventions like Families Matter! are designed to contribute to USG Namibias access goals by improving the health-seeking behavior of youth and families. Linkages to and the sharing of materials with other public sector and civil society programs will contribute to USG Namibias transition goals.

The partner has trained and deployed 300 Field Officers (FO) to conduct door-to-door counseling and outreach sessions, as well as referrals, with individual households. Details on these activities may be found in the HVAB, HVOP and HBHC narratives. Field Officers will also perform the following HVCT-related activities:

Community mobilization to access MOHSS mobile and facility HCT services: FO will use their unique position in the community to mobilize demand for HCT services offered by the MOHSS. These services are delivered through four MOHSS vans, which will operate across several regions. FO will also work with the MOHSS team, community leaders, and local radio stations to promote each outreach visit. To support this activity, the partner will provide FO with salaries, transportation (e.g. a bicycle or transportation costs), printed materials (e.g. flyers and IEC materials in local languages), and support for public and MOHSS coordination meetings (e.g. tents, office space).

Delivery of HCT services during household outreach visits: In 2008, the MOHSS approved the delivery of HCT through non-traditional settings such as mobile/outreach delivery points for the first time. A subset of FO were trained in home-based HCT in COP11. In COP12, most of the remaining FOs will receive this training.

Expanding the reach of community-based HCT is a priority for the MOHSS as it seeks to raise the number of persons with new HIV infections who are diagnosed and referred to ART services for treatment. DAPPs activities will contribute to this national access to care objective, as well as to the access objectives described in the Namibia GHI Strategy. Utilizing lay healthcare workers who are recruited from, and retained in their local areas is an important component of CDCs investments in sustainable approaches to community-based services.

DAPP has trained and deployed 310 Field Officers (FO) to conduct door-to-door counseling and outreach sessions, as well as household-based HCT and referrals to clinical services. Details on these activities a are described across multiple program areas, including HVCT and HBHC. In COP12, HVOP-related activities will include:

Community Outreach: DAPP provides door-to-door, age-appropriate, education and prevention counseling to households and community members. Based on assessments conducted during the outreach visits, individually tailored packages of advice and services will be prepared. These packages will include: 1) Information on HIV counseling and testing, as well as counseling and rapid testing; 2) Information on strategies to reduce sexual risk taking behaviors (e.g., abstinence, multiple concurrent partnerships, correct and consistent condom use, responsible drinking); 3) Information and referrals for male circumcision where appropriate; 4) Tailored prevention information for PLWHA; 5) Referral information and links to appropriate care, and treatment services, including HIV care and treatment services, PMTCT, FP services, as well as TB and STI treatment in close cooperation with government health services; 6) Referral information for social and health services including alcohol, abuse support, gender-based violence, and nutrition support; and 7) Condoms as appropriate.

Training: DAPP provides extensive training for FO on the most up-to-date, evidence-based approaches for effective prevention counseling. DAPP will work with ITECH, which will produce appropriate job aids and tools for the field officers, as well as supporting information, education and communication (IEC) materials for clients.

Public Outreach to Special Groups and Public Information Campaigns: DAPP continues to conduct other community-based prevention efforts including education for traditional leaders, youth and other groups. DAPP will update referral guides for each region, and will support community-based resource centers. In addition, FOs will conduct public events to raise public awareness about HIV STI, and TB prevention, care, and treatment.

Community PWP: DAPP will continue to implement the PEPFAR-supported community PWP intervention tool kit. This tool kit will include prevention for PLWHIV messaging and referrals, but will also emphasize positive living and social support.

DAPP and CDC will work closely with USAID and Peace Corps to ensure that adequate coverage of community-based activities is achieved without overlap or duplication with other partners. By supporting increased health-seeking behaviors, DAPPs work will help more Namibians to access necessary HIV/AIDS and primary healthcare services.

Support to DAPP to strengthen community component of mother baby follow up through the use of field officers to: 1) Trace PMTCT clients as part of mother-baby follow up and; 2) Encourage/refer pregnant women and their exposed infants to PMTCT services. DAPP activities include community-based HIV prevention, HIV counseling and testing, and referral to services through door-to-door outreach. The Field Officers (FO) come from the communities they serve. Currently DAPP is working in several regions (Omusati, Oshana, Ohangwena, Oshikoto Kavango, Caprivi, Erongo, Otjozondupa and Khomas). Field officers also conduct outreach activities for youth and men and also help to organize PLWHA into support groups. DAPP has been involved in the mother-baby follow-up initiative in selected regions. This funding will enable DAPP to continue supporting the mother-baby follow-up activities and expand its support to the additional regions where they operate when MOHSS rolls out mother-baby follow-up nationwide.

CDC will work with DAPP and USAID to ensure that DAPPs continuing work at the community level is complementary with other USG-supported community-based organizations. This on-going monitoring will contribute to the identification and removal of any duplicative activities. DAPPs community-based work is designed to improve health-seeking behaviors and increase access to healthcare services for poor and traditionally underserved communities in Namibia.