SUMMARY:

This activity was awarded funding in September 2008 as part of the August 2008 reprogramming.

During year two of Men Taking Action (FY 2009), Catholic Medical Mission Board (CMMB) will introduce its

male-focused program in the communities surrounding three main sites of the Diocese of Port Elizabeth

(Eastern Cape Province) currently providing home-based care (HBC) services. The project will offer

counseling and testing services in a two-pronged approach to over 10,040 men-of whom 2,040 men will be

offered testing and counseling through the home and 8,000 men from parish-based networks will be offered

testing and counseling. Of the total number of men offered counseling and testing or pre-test counseled,

4,840 men minimum will be fully counseled and tested with their results delivered, and confirmation testing

and referrals carried out, as necessary.

BACKGROUND:

This project focuses on testing men, a vulnerable part of the population that has been underserved, or has

not been reached, through traditional CT services. However, as a core function of its programs, it aims to

reach a sizeable number from the community who will benefit from the CT services through raising the

awareness and eliminating destigmatization in the community, using "knowing one's status" as a vehicle.

The Men Taking Action utilizes lay community workers who will be trained in counseling and nurses will be

employed to perform the HIV testing. At a secondary and related level, men will be trained to be engaged

as: i.) leaders of the household (linking families to care & prevention services), ii.) vehicles of their own

health future (repeated counseling & testing and prevention behavior-change messages), and iii.)

community leaders in the mitigation of HIV/AIDS. Because Men Taking Action is fundamentally a

community-based activity, we expect that testing men through this program will increase overall uptake of

services for counseling and testing in families and communities.

Prevention and awareness education will be integrated into sensitization around counseling and testing and

continued "talking-up" of knowing one's status, which would be routinized in the home-based care visits

conducted by the home-based care worker to the families of the men and the community. The injection of

counseling and testing in the already established system of HBC is what makes this model unique in getting

the men in the community to gradually get tested and keep them informed about how to use their status to

remain healthy. The men will also be educated on disclosure and encouraged to take up voluntary

disclosure with their partners.

ACTIVITIES AND EXPECTED RESULTS:

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

ACTIVITY 1:

For the home-based counseling and testing of men, CMMB will roll out the program through its established

partner home-based care services in the Eastern Cape Province in the following dioceses: Port Elizabeth

(Care Ministries), Grahamstown (Assumptions Sisters), and King Williams Town and its surrounding villages

(King Williams Town AIDS Office). The home-based care worker, who already enjoys an established

relationship with the household, will recruit (at a minimum) four men from each household (and their

extended families) over the first year of the program and administer pre-test counseling to them. In

modification to the protocols discussed in the previous narrative, a nurse will accompany the home-based

care worker (or parish leader, as discussed in the next paragraph) to conduct the actual testing, using a

"finger-prick" rapid test method, as well as draw blood for confirmation testing, as necessary.

Similarly, CMMB will work with local parishes and parish mobilizer networks "Ududana" to incorporate male

testing and counseling and HIV and AIDS education surrounding testing and counseling into parish

meetings. The parish meetings that are referred to in the program are the regular weekly meetings of the

community members of the parishes (all men) that are conducted by the Ududana parish leaders (all men),

which mainly concern issues of faith, responsibility of the parish, and involvement in the community. They

are usually attended by anywhere between 20-40 men (at least) and last a couple of hours on a Sunday

afternoon. Traditionally, it will be followed-up by other parish activities or community activities in the

community, hence giving the opportunity to make the testing and counseling a part of a holistic community

awareness program (at no extra cost) around HIV and AIDS and importance of knowing one's status and

keeping health.

Due to start-up logistical and acceptance challenges, CMMB expects to test only 2,040 men from 1,020

households targeted. Similarly, it is expected that 35% of the men offered testing in the parish-based

testing will accept testing, thereby testing 2,800 men out of 8,000 men reached through parish-based

events. Therefore, the number of men tested and counseled will be 4,840. A total of six (6) nurses minimum

and thirty (30) home-based care workers and Ududana men will be trained and working with the program.

ACTIVITY 2:

CMMB, in partnership with the Diocesan HIV/AIDS Offices, has already established strong formal linkages

between the home-based care worker networks and the District Health Clinics. These linkages and referral

systems ensure proper referral mechanisms within the community, enrollment, and monitoring and

adherence for all HIV-infected persons to get treatment through the Ministry of Health programs. Other

Dioceses or areas that may not have as strong as a link will be assisted in establishing referral protocols

with the District Health Clinics as a part of the program. The Men Taking Action program will also work with

established local community-based organizations and parish-based systems and Ududana networks to

introduce men on treatment to care and support and adherence groups. Through the home-based care

worker, the program will also create new groups and follow-up with monitoring and targeted messages and

Activity Narrative: training. Similarly, Men Taking Action will create support groups amongst the rest of the communities' men

to bolster empowerment around HIV and AIDS prevention and regular counseling and testing (themselves

and family members).

ACTIVITY 3:

A core characteristic of the program is that it will link negative clients to prevention services in the

community that will be assessed and interlinked with our program. Similarly, through the strong relationship

and referral network structures of the Diocesan AIDS Offices and the District of Health Clinics, all those who

test (confirmed) positive for HIV/AIDS will be referred to care and treatment and support groups. Those who

are tested will also be educated in risk assessment around counseling and testing (i.e. continued primary

prevention and appropriate timeline for re-testing, or uptake and adherence to secondary prevention and

treatment and monitoring of immune system strength).

ACTIVITY 4:

Per Ministry of Health/South Africa guidelines, all men and affiliate family members will be offered an

'individual information session' before being tested. All persons testing positive will have their status

confirmed with a second rapid finger prick with a different test kit. Post-test counseling will be offered to both

positive and negative tested individuals emphasizing modes of transmission and the availability of specific

care, treatment and support services specific to their community/parish.

ACTIVITY 5:

Quality prevention and requisite counseling and testing messages will be developed based on baseline, mid

-term and final evaluation surveys. Mid-term and final evaluations will also include questions of clients

related to the accuracy and thoroughness of HIV-related information and related psychosocial support

provided by counseling staff and care providers.

MTA will abide by all standard universal precautions in management of any and all blood products.

Scale-up phase for FY2010 - FY2013 (pending continued and scaled-up support from PEPFAR):

During year three of the program (FY 2010), with satisfactory progress from the program and pending an

increased PEPFAR support for the scale-up efforts, CMMB will transition its direct implementation support

programs in the Eastern Cape Province to a sub-granting program, as well as expand implementation to

two other dioceses: Diocese of Ingwavuma (KwaZulu-Natal) and Diocese of Tzaneen (Limpopo). Given the

increased funding, as proposed, to supplement the scale-up efforts, the program intends to train an

additional 100 home-based care workers and nurses in counseling and testing, as well as reach 22,110

men with pre-test counseling, of whom 12,360 men minimum will be fully counseled and tested with their

results delivered and confirmation testing and referrals carried out, as necessary. The percentage of men

taking up testing and counseling (out of all who are offered testing and counseling and pre-test counseled at

the home or parishes) is expected to rise to over 50% for years two and beyond, which is in line with

Government of South Africa targets.

Similarly, in the following years, with continued and increased program funding from PEPFAR, the project

proposes to transition previous Diocese home- and parish-based testing and counseling to a local sub-

granting mechanism and scale-up throughout South Africa as follows:

It is worth noting, that given the current funding streams for the following years ($500K per year), only a

limited continuation of services and minimal scale-up throughout the five provinces can be achieved.

However, with continued and increased support from PEPFAR, given satisfactory achievement of targets,

CMMB can continue the Men Taking Action program in a sustainable manner and scale-up operations to

counsel and test over 125,661 men over five years.

New/Continuing Activity: Continuing Activity

Continuing Activity: 22317

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

22317 22317.08 HHS/Centers for Catholic Medical 9630 9630.08 $500,000

Disease Control & Mission Board

Prevention

Emphasis Areas

Gender

* Addressing male norms and behaviors

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14: