TB HIV Care Association (THCA) is implementing comprehensive HIV prevention programs in KZN (Sisonke District), WC (Cape Town and W.Coast) and EC (Alfred Nzo and OR Tambo Districts) and targets both men and women aged of 15-49. In its second year of implementation, THCA will expand its activities to include MMC in Northern Cape and Eastern Cape provinces as an additional intervention that will target HIV negative males of reproductive age (15-49 years).The goal of the program is to support the DOH to increase access to HIV and TB prevention, diagnosis, and treatment and adherence support. The objectives are to: prevent HIV through HCT and behavioral interventions; prevent HIV through biomedical interventions and structural interventions; and build capacity to strengthen TB/HIV integration. The programs goals are aligned with the National Strategic Plans key priority areas (KPA) for prevention, treatment, and care and support. The project aims to build and strengthen capacity of all relevant actors and to work with the community to educate and empower them to demand better health services, take ownership, and drive improvements in the health system. Strategies to build capacity include training of CHWs and DOH staff. The training will also address gender equity and masculinity norms. THCA has a developed M&E system to track progress and ensure quality services. Indicators will be monitored and reported on a quarterly basis to the project team, the District, and to PEPFAR. In order to facilitate its expansion plans. THCA will work closely with the DOH to ensure that staff are absorbed over the 5 years of the project. THCA intends to purchase 10 4X4 Toyota Hillux vehicles for the combination Prevention Program.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? No

THCA will provide a structured MMC package of services for adolescent and adult males aged 15 and 49 and their partners in NC and EC provinces. The goal is to decrease transmission of HIV in sexually active males and females. This will include providing HIV negative males access to MMC services, referral of HIV positive males to HIV care and treatment, and PWP services to prevent further HIV transmission. Males aged 15-49 years comprise 25% of the population (126,746). Areas that are more than 25 km away from facilities will be prioritized. . Provision of HCT services will identify HIV negative males who will be eligible for MMC and 80% will be circumcised by the end of project. MMC will be implemented using scheduled facility-based MMC and by creating MMC camps. Approximately 14,000 MMCs will be performed during 2013. Medical staff will be recruited and trained to provide circumcisions and manage referrals across prevention and treatment and care programs. THCA will employ mobile HCT and MMC teams in each of the sub-districts where they will be providing services and will work closely with the DOH to ensure that staff is absorbed over the 5 years of the project. To increase informed demand for MMC services, CHWs will be used to mobilize communities by door to door visits, distributing pamphlets, and making loudspeaker announcements to inform potential clients about where and when MMC services are available. THCA will also establish relationships with local and national media and peer educators will be used as MMC advocates and supporters. TBHC will recruit and appropriately train M&E staff to provide quality assurance and monitor service delivery through the implementation of an effective and efficient M&E system, which will address all the required MMC activities.

The program is implemented in three provinces, namely KZN (Sisonke District), WC (Cape Town Metro) and EC (Alfred Nzo and OR Tambo Districts) and targets both men and women aged 15 and 49. The HCT target for 2012 is 40% of the population aged 15-49 tested for HIV. HCT will be rendered through a strategic mix of service delivery models including: PITC in health facilities, fixed community based HCT sites, mobile HCT and home based HCT. Through these models, individual and couple counseling will be promoted and provided to both adults and adolescents. THCA will employ a mobile HCT team in each of the sub-districts to provide HCT. THCA mobile HCT teams will also play an important role in identifying high-risk areas and mobilizing people to be tested for HIV and follow-up purposes. HCT with TB and STI screening will identify HIV-positive clients, TB suspects and STI suspects who will be appropriately referred for diagnosis and treatment. Mobile HCT teams and HBCT teams will target the entire adult population based predominantly in rural areas in this district. PITC will be offered at health facilities to all clients. CT will be provided according to national guidelines for HCT, HBCT, rapid testing quality assurance, mentorship, PICT and couples counseling. In addition, clients will be referred for biomedical prevention interventions. The project interventions are designed to strengthen governmental systems through the provision of quality information to support planning, decision making, improve planning and management of human resources. THCA aims to build capacity in communities by educating and empowering them to demand better and sustainable health services. Strategies to build capacity to provide optimal HCT include training of CHWs on HBCT and professional HCWs on PITC. All cadres will be trained on data collection. TBHC will recruit and train M&E staff to provide quality assurance and monitor service delivery through the implementation of an effective and efficient M&E system which will address all the required MMC activities. CHWs will also be trained to address gender equity and masculinity norms.

THCA will embark on other preventive interventions targeting both males and females aged 15 and 49 years in KZN, EC and WC. These will provide clinical support and focus on integrating HIV prevention with primary health care programs and will include: Correct condom use with demonstration and distribution. Behavioral interventions for adults to promote correct and consistent condom use, reduce the number of sexual partners and concurrent partnerships. Promote MMC for HIV-negative men, promote and provide HCT including partner testing and disclosure and refer to PMTCT services. Age-appropriate youth interventions for youth not sexually active which will include counseling to delay sexual debut, working with parents and guardians to help improve connectedness and communication to youth about their values and expectations regarding adolescent behavior and providing necessary information and skills building to make their transition to sexual activity safer and healthier. For sexually active youth, interventions will include condom use, reducing the number of sexual partners and concurrent relationships, HCT, referral for MMC and PMTCT. PwP services will provide HIV prevention messages and also include HCT for sex partners and family members, counseling and support for HIV sero-discordant couples, support of disclosure, promotion of safer sex, STI screening and treatment, family planning and adherence counseling for clients on ART or PMTCT. Support of biomedical interventions by strengthening DoH efforts to improve clinical care through clinical mentorship and supportive supervision of providers in health facilities Training and mentorship to professional nurses on PMTCT guidelines including early infant PCR testing and paediatric ART initiation. Syndromic management of STIs at health facilities to symptomatic patients. Delivery of ART at primary care facilities through NIMART under the guidance of a roving medical officer. Prevention of HIV through structural interventions that address gender equity and masculinity norms thus reducing gender-based violence.