INTEGRATED ACTIVITY FLAG:

This activity relates to activities in Condoms and Other Prevention (#7884), CT (#7625) and Basic Health Care and Support (#7885).

SUMMARY:

Humana People to People (Humana) implements a comprehensive, integrated ABC HIV and AIDS prevention program called Total Control of the Epidemic (TCE). TCE trains community members as Field Officers (FOs) to utilize a person-to-person campaign to reach every single household within target areas with AB messages, with the objective of changing community norms and individual behaviors. The major emphasis of the prevention program is community mobilization/participation, with additional emphasis on development of network/linkages/referral systems, information, education and communication (IEC) and training. Target populations are boys, girls, men, women, primary and high school students, community leaders, healthcare workers, teachers and pregnant women.

BACKGROUND:

TCE was launched by Humana in 2000 in Zimbabwe. The program has been implemented in five countries in Southern Africa reaching a population of three million people. Humana received its first PEPFAR funding in July 2005. Humana runs three TCE areas in the Mpumalanga and Limpopo provinces. In the first year of implementation, 200 community members were trained as Field Officers (FOs) and prevention services have been provided to about 60% of the targeted community members. Furthermore, FOs mobilized whole communities to address stigma and discrimination associated with HIV and AIDS and raised awareness related to HIV preventive behaviors. TCE will track service provision by gender and develop strategies to reach additional men with AB messages. FOs will also promote gender equity during their home-visits, by empowering both sexes. TCE trains community volunteers called Passionates to establish vegetable gardens, run children and youth clubs, and offer care and support to orphans and people living with HIV (PLHIV).

Humana works in partnership with the South African Government (SAG) and local municipalities. The Bohlabela District Municipality is a major partner, contributing over $140,000 per year to the program. The program has received several awards, including the 2003 Stars of Africa Award (in partnership with Johnson & Johnson) for best Corporate Social Investment Program in Health and HIV and AIDS in South Africa.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Household-based Person-by-Person Campaign

The TCE program uses a person-to-person campaign to reach every single household with information about HIV and AIDS within the targeted areas. Each FO is allocated a field of 2,000 people (approximately 350 households). Households are visited three times over a one-year period and receive targeted IEC messages emphasizing age-appropriate abstinence and faithfulness (AB) messages with the objective of changing community sexual norms. FOs visit households and engage individuals in discussions about HIV and AIDS and preventive behavior, and promote counseling and testing (CT) and prevention of mother-to-child transmission (PMTCT). FOs are trained to recognize potential signs and symptoms of advanced AIDS and HIV-related conditions and will refer individuals directly to public health clinics for CT, CD4 testing, HIV clinical staging, treatment of opportunistic infections, home-based care (HBC) and OVC services as needed.

Further, the program has a series of targeted interventions to reach schools, including teachers, men in workplaces, at bars and other settings, youth in after school clubs, and health workers on HIV and AIDS awareness and AB prevention. TCE organizes workshops for local leaders, traditional healers, and community-based organizations, to explain TCE and promote HIV awareness and prevention.

ACTIVITY 2: Human Capacity Building

FOs receive training on promoting AB messages particularly to the youth. Through weekly meetings, the FOs receive continuous training from the Special Forces in TCE and guest lecturers, first as lay-counselors and during the second year as educators. The training is based on experiences gathered in the field. TCE makes use of its own material, which is continuously tested and amended, and educational material developed by other organizations and the SAG. All programming is in line with SAG national prevention strategy. TCE often uses guest speakers from SAG and other organizations. Passionates are trained in HIV and AIDS and in communication and facilitation skills (such as running youth clubs).

ACTIVITY 3: Linkages and Networking

TCE's activities ensure that individuals receive appropriate care: - A key strategy of the prevention program is the promotion of CT. TCE works in partnership with South African organizations like loveLife, to provide CT services to the sites. All households receive messages on the benefits of CT and are informed where CT is available during home visits. - TCE also collaborates with PEPFAR partners, Broadreach and HIVSA and SAG hospitals which provide treatment to facilitate access to ARVs and related services such as support groups. - TCE has a strong partnership with the TB sub-directorate in the Bohlabela district. FOs are trained to raise awareness about TB, make referrals to clinics and collect sputum. - TCE works with public clinics to ensure that pregnant women have access to antenatal services and PMTCT. - TCE cooperates with SAG including the Department of Social Development to ensure that OVC and PLHIV identified through household visits are able to access social security and with the Department of Education to ensure children and youth access education and receive HIV and AIDS information and education.

Activity 4: Monitoring & Evaluation

TCE has developed a range of systems to measure the results of the program. Before starting in a new area, TCE carries out a baseline survey collecting information about knowledge, attitudes and practices in the area. Once the program is implemented, each FO has a household register, which keeps basic information about each household and is a continuous source of data to evaluate the progress of the program, such as number of people tested, number of OVC and pregnant women referred to PMTCT and STI services. This data can be used to track community behavior change. TCE has also developed a tool called Perpendicular Estimate System (PES), which is tailored to measure the impact of the program in the target areas; PES consists of a set of questions and demands to the individual in order to be TCE-compliant, which means being in control of HIV and AIDS in one's life; especially during the second and third year of the program, community members interact with their TCE Field Officers on an individual basis to make a PES-plan, which minimizes their risk of being infected and makes them live responsibly and positively if infected. This data provides information on individual behavior change in the target area. Throughout the program, the Field Officers and TCE Management meet on a weekly and monthly basis to evaluate the progress of the program. The meetings monitor progress of achieving targets and deliberate on the challenges faced in the field. Quarterly, TCE management meet with staff at the TCE Regional Headquarters in Zimbabwe to further evaluate the progress of the program and develop activities in order to increase impact.

These activities will contribute to the 2-7-10 goals of averting seven million new infections by increased knowledge and skills among community members in HIV prevention; reduced stigma; higher gender equity; increased knowledge about services (PMTCT and CT); strengthened linkages between other organizations in the area and government services; increased number of people knowing their HIV status; and higher mobilization and capacity among community members and local leaders to deliver prevention messages and offer care and support.

INTEGRATED ACTIVITY FLAG:

This program is related to Humana's activities in AB (#7624), CT (#7625) and Basic Health Care and Support (#7885).

SUMMARY:

Humana People to People (Humana) implements a comprehensive, integrated ABC HIV and AIDS prevention program called Total Control of the Epidemic (TCE). TCE trains community members as Field Officers (FOs) to utilize a person-to-person campaign to reach every single household within the target area with prevention messages including the correct use of condoms and on prevention of mother-to-child transmission (PMTCT). The major emphasis area is community mobilization/participation, while minor emphasis areas are development of network/linkages/referral systems, information, education and communication (IEC), and training. Key target populations are men, women, pregnant women, discordant couples, migrant workers, out-of-school youth, community leaders and traditional healers.

BACKGROUND:

TCE was launched by Humana in 2000 in Zimbabwe. The program has been implemented in five countries in Southern Africa, reaching a population of three million. Humana received its first PEPFAR funding in July 2005. Humana runs three TCE areas in the provinces of Mpumalanga and Limpopo. In the first year of implementation 200 community members have been trained as Field Officers (FOs) and prevention services have been provided to about 60% of the targeted community members. FOs mobilize communities to address stigma and discrimination associated with HIV and AIDS and to raise awareness of HIV preventive behaviors. TCE will track service provision by gender, and develop strategies to reach men with condoms and other prevention messages. FOs promote gender equity during their home-visits by empowering both sexes with information and education. TCE trains community volunteers -- known as Passionates -- to establish vegetable gardens, run children and youth clubs, offer care and support to orphans and people living with HIV (PLHIV).

Humana works in partnership with the Bohlabela District Municipality (now Mopane/Ehlanzeni districts), a major partner contributing over $140,000 per year to the program. TCE has received a number of awards, including the 2003 Stars of Africa Award (in partnership with Johnson and Johnson) for best Corporate Social Investment Program within Health/HIV/AIDS in South Africa.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Household-Based Person By Person Campaign

The TCE Program uses a person-to-person campaign to reach every single household with information about HIV and AIDS within the targeted areas. Each FO is allocated a field of 2,000 people (350 households). Households are visited three times over a one-year period and will receive targeted IEC messages emphasizing age-appropriate condoms and other prevention messages with the objective of changing community sexual norms. FOs visit households and engage individuals in discussions on preventive behavior and promote counseling and testing and PMTCT. FOs are trained to recognize potential signs and symptoms of advanced AIDS and HIV-related conditions, including STIs, and refer individuals directly to public health clinics for CT, CD4 testing, HIV clinical staging, and treatment of opportunistic infections. Although the TCE program focuses on AB messages, it will also provide appropriate community members with prevention messages like use of condoms and PMTCT. TCE carries out a series of targeted interventions to reach workplaces, at-risk youth and vulnerable population groups, such as taxi drivers, sex-workers and young men with information on the use of condoms. During the door-to-door campaigns, the FOs assess the needs of the individual. TCE organizes workshops for key players in the community, such as local leaders, traditional healers and community-based organizations to promote the use of condoms. TCE also establishes condom outlets in the homes of FOs and Passionates. Passionates undergo training in condom demonstration. The FOs also educate pregnant women on PMTCT and refer them

to antenatal clinics.

ACTIVITY 2: Human Capacity Building

Through weekly meetings, the FOs receive continuous internal training, in the first year as lay-counselors, during the second year as educators. The training is based on experiences gathered in the field. TCE makes use of both its own materials, which have been continuously tested and amended, and educational materials developed by other organizations and the government. TCE often makes use of guest speakers from government and other organizations for training purposes. Passionates are trained in HIV and AIDS and in communication and facilitation skills (such as running youth clubs), and some are trained to distribute and demonstrate the use of condoms.

ACTIVITY 3: Linkages with Sectors and Initiatives

TCE works in close collaboration with other stakeholders in the region. For example, the Department of Health provides all the condoms that are distributed by TCE; FOs mobilize and refer pregnant women to antenatal clinics for PMTCT. Furthermore, TCE has a strong partnership with the tuberculosis (TB) sub-directorate in the Bohlabela district, where FOs are trained to raise awareness about TB, make referrals to clinics and collect sputum. TCE also cooperates with SAG departments including the Department of Social Development to ensure that OVC and PLHIV, who are identified through household visits, are able to access social security. Through the door-to-door campaign, the FO will also identify patients in need of palliative care and can refer them to services provided under the TCE program or to other services.

ACTIVITY 4: Monitoring and Evaluation

TCE has developed a range of systems to measure the results of the program. Before starting in a new area, TCE carries out a baseline survey collecting information about knowledge, attitudes and practices in the area. Once the program has begun, each FO has a household register, which keeps basic information about each household and is a continuous source of data to evaluate the progress of the program, such as number of people tested, number of OVC and pregnant women referred to PMTCT and STI services. This data can be used to track community behavior change. TCE has also developed a tool called Perpendicular Estimate System (PES), which is tailored to measure the impact of the program in the target areas; PES consists of a set of questions and demands to the individual in order to be TCE-compliant, which means being in control of HIV and AIDS in one's life. During the second and third year of the program, community members interact with their TCE FOs on an individual basis to make a PES-plan, which minimizes their risk of being infected and makes them live responsibly and positively if infected. This data provides information on individual behavior change in the target area. Throughout the program, the FOs and TCE Management meet on a weekly and monthly basis to evaluate the progress of the program. The meetings monitor the progress of achieving targets and deliberate on the challenges faced in the field. Quarterly, TCE management meet with staff at the TCE Regional Headquarters in Zimbabwe to further evaluate the progress of the program and develop activities in order to increase impact.

These activities will contribute to the 2-7-10 goals of averting 7 million new infections by increased knowledge and skills among community members in HIV and AIDS prevention; reduced stigma; higher gender equity; increased knowledge about services (PMTCT and CT); increased use of condoms; strengthened linkages between other organizations in the area and government services; increased number of people knowing their HIV status; and higher mobilization and capacity among community members to deliver prevention messages and offer care and support.

INTEGRATED ACTIVITY FLAG:

The activity relates to Humana People to People's (Humana) activities in AB (#7624), OP (#7884), and CT (#7625). This partner may benefit from the Partnership for Supply Chain Management ARV Drugs activity (#7935), which will explore current pain and symptom management practices, drug availability and cost, and provide recommendations.

SUMMARY:

Humana implements a comprehensive HIV and AIDS prevention and care program called Total Control of the Epidemic. This program trains community members as Field Officers (FOs) to utilize a person-to-person campaign methodology to reach every single household within the project target area with HIV-related care services where necessary. The major emphasis area is community mobilization/participation, while minor emphasis areas are development of network/linkages/referral systems and training. Key target populations are PLHIV, pregnant HIV-infected women, families affected by HIV and AIDS, and caregivers.

BACKGROUND:

Humana implements a comprehensive, integrated ABC HIV and AIDS prevention and care program called Total Control of the Epidemic (TCE). Since 2000, the program has been implemented in five countries in Southern Africa reaching a population of 3 million people. This program trains community volunteers to reach every single household within the project target area with a comprehensive program that includes care, prevention and CT. Effort will be made to ensure equitable access to care services for both males and females (key legislative area). Since 2005 under PEPFAR, Humana runs 3 TCE areas in the Mpumalanga province and one area in the Limpopo province. With FY 2007 funding, Humana will add elements of palliative care to its program. Humana has previously implemented home-based care (HBC) programs and activities will be implemented according to the experiences gained from those programs and work across the region. Furthermore, Humana is implementing the TRIO program, which provides support for people on ARV treatment in Limpopo and Gauteng in a public-private partnership with Johnson & Johnson who provide $750,000 for similar activities in different geographic areas.

Humana works in partnership with the South African Government (SAG) and the Bohlabela District Municipality (now Mopane/Ehlanzeni districts), which is a major partner for the program and contributes with a significant counterpart support. The program has received a number of awards, including the 2003 Stars of Africa Award (in partnership with Johnson and Johnson) for best Corporate Social Investment Program within Health/HIV/AIDS in South Africa.

ACTIVITIES AND EXPECTED RESULTS:

Humana has identified a need for palliative care services in the existing TCE areas. In areas of Human operation, few HBC organizations exist or lack the capacity to effectively deliver services. TCE will implement palliative care activities with an emphasis on elements of the preventive care package with home-based care and treatment adherence programs.

ACTIVITY 1: Home-based care

TCE will follow one of two strategies depending on the local circumstances: 1) TCE will strengthen existing HBC initiatives carried out by local CBOs by sourcing funding and technical assistance to such programs, where it is appropriate, or 2) TCE will start its own HBC program and employ and train Passionates (community volunteers) as caregivers and monitor and support them in their work. The caregivers will form groups of 10-20 caregivers and employ a nurse to carry out supervision. In both strategies, TCE will train the caregivers on a weekly basis. TCE will make use of SA standard for HBC training and will also ensure that all caregivers are accredited by the SAG. The HBC program will provide and mobilize for the elements of the preventive care package and screening for pain and symptoms in addition to other clinical, psychological and social support to patients in need. The objective of the program is to bring relief and add quality to the lives of the patients and their families. The home-based caregivers will offer psychological and

spiritual support with the patients and their families. The caregivers will seek new and innovative solutions to daily challenges. The program will work in close conjunction with public or other private services, refer patients to such services, and where needed accompany patients to these services. In order to be able to meet the challenges of their work, the home-based caregivers will meet at least twice a week to receive continued training and support.

ACTIVITY 2: Support for people on ARV treatment (TRIO)

TCE has developed a unique system to offer support to people on ARV treatment. It is called the TRIO, as it involves the patient, a family member or a friend, and a Field Officer. This system has been successfully tested in Botswana, where TCE has reached a population of 900,000 people. TRIO will seek to provide and mobilize for the elements of the preventive care package and ensuring that each patient adheres to the ARV treatment through a DOT strategy (Direct Observed Therapy). Patients in the Humana TRIO program will receive a package of care services tailored to their individual needs: education about ART and adherence; screening of OIs, pain, symptoms; nutritional counseling and support, e.g. by facilitating the patient receiving food parcels from the Department of Social Services or by vegetable gardens; and referring patients to positive living clubs or support groups, either run by TCE or other organizations. The FOs will undergo training as trainers in the above issues. The FOs will train family members in these areas, so they can offer the necessary support. In cases where needed, family members will also receive support from the FOs, e.g. by being referred to CT, PMTCT and other services in the area.

ACTIVITY 3: Linkages with sectors and initiatives

The activities within palliative care are a strongly integrated part of the TCE program. The Field Officers in the basic prevention activities of TCE are well-placed to identify community members in need of services. Through this prevention strategy, all households receive messages on the benefits of care services and the TRIO program, and are informed how to receive support from these programs. The care activities will be integrated closely to Humana's CT activities, where people who have tested positive and who need care can be referred to these programs to receive immediate support. Proposed collaboration includes:

-Linkages with PEPFAR partners (like Broadreach and PHRU) and SAG hospitals providing treatment to facilitate access to ARVs and related services such as support groups.

-A strong partnership with the TB sub-directorate in the Bohlabela district. FOs are trained to raise awareness about TB, make referrals to clinics and collect sputum.

-Working with public clinics to ensure that pregnant women have access to antenatal services and PMTCT.

-Cooperating with SAG departments including the Department of Social Development to ensure that OVC and people living with HIV who are identified through household visits are able to access social security.

-Working with the Department of Education to ensure children and youth access education and receive HIV and AIDS information and education.

These activities will contribute to the PEPFAR goal of reaching 10 million with care by offering care and support to people living with HIV and AIDS through the already existing TCE program.

INTEGRATED ACTIVITY FLAG:

This program is related to AB (#7624), Condoms and Other Prevention (#7884) and Basic Health Care and Support (#7885).

SUMMARY:

Humana People to People (Humana) implements an HIV and AIDS prevention program called Total Control of the Epidemic (TCE). TCE's voluntary counseling and testing (VCT) program focuses on providing VCT to household members during home visits, training lay counselors, supporting South African Government (SAG) services through human resources, piloting mobile testing, and following up with the household member to ensure that counseling and testing took place. The major emphasis area of the CT program is community mobilization/participation, while minor emphasis areas are development of network/linkages/referral systems and training. Key target populations are men, women, pregnant women, discordant couples, migrants, community leaders and traditional healers.

BACKGROUND:

TCE was first launched by Humana in 2000 in Zimbabwe. TCE has been implemented in five countries in southern Africa reaching a population of three million people. This program trains community members as Field Officers (FOs) to utilize a person-to-person campaign methodology to reach every single household within the project target area with a comprehensive HIV and AIDS program that includes prevention, VCT, and palliative care. Humana received its first PEPFAR funding in July 2005. Under PEPFAR, Humana runs three TCE areas in the province of Mpumalanga and one TCE area in the Limpopo province. With FY 2007 funding, Humana will add palliative care activities to its program. Humana has previously implemented home-based care programs both with TCE and other community programs in South Africa. Furthermore, Humana is at present implementing the TRIO program, a public-private partnership with Johnson & Johnson that provides support for people on ARV treatment in Limpopo and Gauteng. Lessons learned from this program and also from similar activities in Botswana will be used. Humana works in partnership with the SAG and the Bohlabela District Municipality (now Mopane/Ehlanzeni districts), the latter being a major partner of the program contributing with significant counterpart support. Humana's program has received a number of awards, including the 2003 Stars of Africa Award' (in partnership with Johnson and Johnson) for best Corporate Social Investment Program within Health/HIV/AIDS in South Africa.

ACTIVITIES AND EXPECTED RESULTS:

Humana will carry out five separate activities in this program area.

ACTIVITY 1: Human Capacity Development

TCE will increase the capacity of services for VCT in the target areas by establishing two VCT sites. TCE will train two nurses and six counselors for each site. The nurses and counselors will all receive a once-off training on VCT and thereafter they will be trained quarterly on data management, referrals and linkages and other refresher courses.

Counselors will be trained in accordance with SAG policy and guidelines. In addition, TCE will support the salaries of retired private sector nurses to provide testing services.

ACTIVITY 2: VCT Promotion and Support

VCT sites will actively target couples and encourage couples to go for counseling and testing as a strategy for reaching both women and men. The sites will also actively seek to test children of HIV-infected people. The VCT sites rely on mobilized clients and those referred by TCE Field Officers. In addition, TCE encourages the FOs and community volunteers (Passionates) to know their own status and thereby become good role models to other members of their community. The FOs are trained as lay-counselors, who will follow-up with people after testing and offer them the necessary ongoing support, either through referral to existing services or by establishing their own support systems, e.g. Positive Living Clubs and support groups.

ACTIVITY 3: VCT Services

Based on previous experience, TCE has identified a need for increased access to VCT in the areas where TCE operates. Under PEPFAR FY 2005, Humana has educated six counselors to work in VCT sites and collaborates with loveLife, a South African NGO, to run a VCT center from the TCE offices at Bushbuckridge in Limpopo province. Negotiations are taking place with the District Department of Health for TCE to start its own site and also to work at public VCT sites.

In FY 2007 TCE will employ counselors, who will be trained to work in and add value to VCT services at public clinics. The clinics will be selected in collaboration with the Department of Health in Bohlabela District in rural Limpopo, which straddles Limpopo and Mpumalanga provinces. The counselors will work to strengthen the linkages between the TCE prevention program and VCT services, in order to increase the number of people being tested. Furthermore, the counselors will work to strengthen links with existing services for HIV-infected individuals and treatment and care. Counseling sessions will specifically address male norms and behaviors that impact HIV. The sites will work with the District Department of Health, from which it will also receive supervisory support and test kits.

ACTIVITY 4: Mobile Testing

Activities in Bohlabela have shown that there are many people who can not afford to visit the local VCT site because of time and money. Practice in mobile testing in TCE has clearly shown that the number of people being tested will increase significantly if the testing is carried out in the communities. TCE is at present in negotiation with the District Department of Health about mobile testing. The idea is to arrange mobile VCT sites, which will be designed to ensure confidentiality, at places in the communities to increase the accessibility to testing. These sites could be established at a school, youth club, church or any other public site.

ACTIVITY 5: Linkages With Sectors and Initiatives

In addition to running its own sites, TCE mobilizes community members to go for testing at public VCT sites, educates pregnant women about PMTCT, and makes referrals to antenatal clinics. Other TCE collaborative activities include: - Work with PEPFAR partners (like Broadreach and HIVSA) and SAG hospitals providing treatment to facilitate access to ARVs and related services such as support groups. - Conduct TCE-run activities for palliative care. These activities may absorb some of the needs identified by the FOs during their door-to-door-campaign or at TCE's VCT sites. - A strong partnership with the TB sub-directorate in the Bohlabela district. FOs are trained to raise awareness about TB, make referrals to clinics and collect sputum. - Cooperation with SAG departments including the Department of Social Development to ensure that orphans and vulnerable children (OVC) and people living with HIV who are identified through household visits are able to access social grants. - Working with the Department of Education to ensure children and youth access education and receive HIV and AIDS information and education.

These activities will contribute to the PEPFAR goal of providing care to 10 million HIV-affected individuals through an increased number of people being tested and knowing their status resulting in fewer infections; reduction of stigma as a result of more people knowing their status; higher gender equity through counseling (individuals/couples); increased lifespan due to timely treatment of opportunistic infections, positive living, monitoring of CD4 counts and entry to treatment programs before developing AIDS; and strengthened linkages between services offered by government and other organizations.