Pathfinder International will 1) improve HCT access; 2) strengthen the capacity of youth-friendly clinics to provide comprehensive HCT services 3) improve access to youth-friendly MTCT services including: prevention of HIV, prevention of unwanted pregnancies, protection and treatment of positive mother and baby and support and treatment for the mother and baby; 4) expand access to youth friendly sexual and reproductive, STI, TB and HIV/AIDS care and treatment services including treatment of opportunistic infections; and 5) improve the quality of life of young PLHA.. The goal is to reduce HIV rates among youth aged 10-24 years and reduce MTCT.. This includes expanded prevention, treatment and care coverage, as tracked through the national HIV/AIDS indicator surveys. For those infected through MTCT, services will be available at the clinic. These people transitioned to adult clinics at age 25. In order to contribute to the PHC re-engineering, the project will work with school health to address issues such as contraceptive health rights, teenage pregnancy, drugs and alcohol in schools, and HIV and AIDS among learners. The project is being implemented in Amathole District in the Eastern Cape, Uthukela district in KwaZulu Natal, Orange Farm in Gauteng and North West and Mpumalanga provinces. Where NAFCI clinics existed, the project will work with the clinic staff so needs of young people are served using the youth friendly approach. Target group is young people aged 10-24 years. Vehicles - None purchased so far. New request is for 2 vehicles. Total purchased vehicles will be 2. The purpose of the vehicles is for ongoing monitoring and support of the sites in the Eastern Cape and Kwa Zulu Natal. The cost of the vehicle is approximately US$ 38500 each.

The target group for this intervention is HIV positive young people between the ages of 10-24 years. The project will be implemented in: Amathole District in the Eastern Cape, Uthukela District in KwaZulu Natal, Orange Farm in Gauteng, Northwest, and Mpumalanga provinces (district and sites still to be allocated by the provincial department of health in Northwest and Mpumalanga provinces). Clients that are HIV positive will be linked immediately with a peer educator whenever possible to provide ongoing support and additional counseling, planning, and support. These clients will also be referred for community resources such as community-based home care which consists of identification of and referral for useful resources within the community, support to the families of the clients, and creating a conducive atmosphere for positive living. Young people beginning ART will be linked to youth support groups for treatment literacy training and will be provided with ongoing support for facilitation of healthy living and positive prevention, identifying a buddy, and disclosing to family, friends, and community members when the person is ready. An important activity in the support groups will be adherence support with young people exchanging experiences and finding solutions together. This activity will be conducted at each of the clinics in small groups and will focus on: difficulties in adapting to the requirements of ART; discussion of and concrete means and methods of coping with side effects of the drugs; discussion on secondary prevention, discordant couples, and reproductive/fertility counseling; the impact of stigma and discrimination and coping strategies; accessing other available services and resources; and optimal nutrition and positive living. For families with a PLWHA, peer educators will provide adherence support, including home visits, follow-up, and linkages to referral centers. Peer educators will be trained on referral systems, knowing when to refer clients, and how to refer appropriately. Peer educators will plan a key role in community sensitization and addressing stigma reduction around HIV and AIDS.

During intake and counseling sessions, counselors will offer HCT to all clinic clients and will provide crucial information on prevention and the importance of being tested for clients and their partners; importance of early diagnosis and initiation of treatment; and safer sex using condoms consistently and correctly; and double method for dual protection against STIs/HIV and pregnancy. Counseling will be conducted with all clients individually and will provide referrals to other health services and care and support services within the facility or at nearby facilities e.g referrals for male circumcision, sexual abuse, adolescent mental health problems substance abuse, etc. Youth testing negative will be offered the option of enrolment in the facilitys support group system. These support groups will reinforce the HIV prevention strategies - condoms, reduction in multiple partners, HIV testing, and treatment of other STIs. Emphasis will be on building young peoples skills to make appropriate choices around their sexual behavior so that they can protect themselves. They will also be invited to participate in local social mobilization activities planned for the youth within the catchment area. Irrespective of HIV status, all youth will be encouraged to enrol with local community based youth clubs that will serve as a liaison with the facility and will address other issues and goals chosen by the group members in addition to health issues to sustain the groups beyond the health issue component. The project will train peer educators from CBOs within the clinic catchment area to provide information on HIV/AIDS & SRH issues, provide individual and group support to youth who utilize the health care services and do home visits when they are needed. The peer educators will conduct a mapping exercise within surrounding communities to identify the different venues (schools, sports associations, faith-based organizations, etc.) where they will be able to reach young people. For instance, at schools, peer educators will give talks during classes and set up youth corners that the students can visit for more information or one-to-one sessions with the peer educators.

This project will be implemented in Amathole District in the Eastern Cape, Uthukela District in KwaZulu Natal, Orange Farm in Gauteng, Northwest province, and Mpumalanga province (districts still to be allocated). HCT and provider initiated counseling and testing will be routinely offered to young pregnant women. Their partners will also be encouraged to test and testing will be offered to couples. Efforts will be made to ensure that the pregnant women is offered PMTCT counseling and testing during her first ANC visit and subsequently if she declines during her first ANC visit. The project aims to increase access to family planning services for young positive women by integrating FP and HIV services and establishing referral systems, including counseling during pregnancy regarding future fertility planning. Service providers will be trained to offer up to date FP counseling and contraceptive services. Pathfinder will also provide treatment of the positive mother and baby through integrated quality ANC/PMTCT including initiation and continuation of treatment for the mother, PCR at six weeks for the HIV exposed infant, identification of HIV infected infants that are eligible for HAART, and initiating therapy according to national guidelines. Various activities will be implemented to reduce the loss to follow up in the PMTCT services, including reinforcement of the counseling process, tracing of mother-baby pairs using peer educators, and initiating support groups. Counseling on exclusive breastfeeding will also be offered to all positive pregnant women. The community will be mobilized through existing networks of peer educators and local NGOs. They will be trained and supported to identify young pregnant women; provide support to young women during pregnancy; promote safer sex; encourage facility delivery; provide information on PMTCT; and promote exclusive breast feeding. In addition, community mobilization campaigns, awareness raising campaigns, community workshops, street events, and health calendar awareness will be conducted to promote HCT and PMTCT. Support groups will also be formed at the sites. Activities for the support groups will include: ART adherence, palliative care, and reduction of stigma and discrimination.

Pathfinder will conduct Youth Friendly Service Assessments, using practical tools to assess gaps that need to be considered to improve community and facility services for young people. These will inform training content and approaches. Pathfinder will enhance/build the capacity of public sector providers, facility managers, peer educators, and organizations working at the community level around targeted facilities. The project will provide training to service providers and peer educators on technical subject matters that have been identified in the assessment such as HIV and AIDS management, NIMART, integration of services, provision of quality services, mentoring, and facilitation skills. There will also be service provider monthly supervision meetings, including participation of peer educators working in the clinic. These meetings will be conducted to ensure that the youth friendly approach is being practiced, and to exchange experiences and provide mutual support to avoid burnout. Periodic refresher training will also be conducted for the providers and peer educators. For youth that are on ART, providers will be trained to facilitate monitoring of illness stages through clinical staging, with CD4 counts and through viral load monitoring. Services will include Septrin prophylaxis, diagnosis and treatment of opportunistic infections, diagnosis and treatment of TB, and administration and monitoring of HAART. For youth receiving ARVs, providers will facilitate adherence and monitoring of treatment failure with CD4 counts. To monitor performance, an internal program monitoring system will enable staff and stakeholders to track progress against output indicators and generate progress reports on a quarterly and annual basis. Reports will allow for quick identification and dissemination of lessons learned, even during the life of the project. Data sources used to measure the proposed indicators will include: facility service statistics, training records, and project activity records.