South2South (S2S)will support the development and implementation of an innovative capacity building program that focuses on human resource development through training and mentoring of health workers involved in the care of pregnant women, infants, children, and adolescents affected by HIV and HIV/TB co-infection. S2S will provide Technical Assistance in Health Systems Strengthening,and Human Resources for Health. S2S has the following:Objective 1: To assist the National Department of Health to improve existing capacity building models, and where gaps are identified, to develop innovative capacity building programs to improve the HIV/TB outcomes for priority populations in selected demonstration sites. Objective 2: To build the capacity of DOH facility health workers, as well as NGOs, to deliver quality services to priority populations. Objective 3: To assist target districts through demonstration quality improvement projects to improve the quality of HIV/TB care, treatment, and support services to priority populations, with the aim of rapid scale-up and institutionalization of best practices identified. The program will be implemented in 3 demonstration sites in priority provinces, to be determined by SAG stakeholders. National-level technical assistance will be provided to National Department of Health initiatives. Handover to SAG training structures will occur through capacity building of regional training centre personnel, master-trainers, district management personnel, and PEPFAR district support partners. Capacity building output and outcome indicators will be monitored.

South2South capacity building and technical assistance to support Adult Care and Support including training and mentoring in the areas individual counselling, adherence counselling and support, and psychosocial support to adults affected by HIV/TB. Training material will be developed on request from SAG stakeholders. Capacity building will be provided as part of the district support program in 3 priority provinces, targeting lay counsellors, pharmacy assistants, PHC nurses, doctors, and community health workers. Capacity building will support the use of tools to support adherence and psychosocial support counselling. The program will be monitored by tracking competency checklists, monitoring the implementation and use of adherence readiness forms by health workers, observation of quality of counselling, and tracking specific DHIS indicators linked to quality of psychosocial support, such as loss to follow-up, and adherence rates. The program will be implemented in 3 selected sub-districts as demonstration projects. A comprehensive baseline assessment will identify areas for prioritization and guide program implementation. Following the baseline assessment, the S2S technical team will provide feedback to the facility staff on findings and, in collaboration with health facility staff, will confirm priorities, and support the facility in the development of activities and timelines to achieve targets, and agree upon a schedule for on-going site support. Districts will engage a network of facilities with a single sub-district that includes a referral facility and its feeder clinics (wedge) with its associated Regional Training Centre. During the following 9 months districts and RTCs will scale up these activities across all health facilities within the district. Lessons learned during the early part of the initiative will be applied across all hospitals and clinics, with a focus on rapid change to reflect on-going successes accomplished in care. All healthcare facilities in the sub-district and the associated RTC will be linked into a learning network to accelerate peer-to-peer learning, set common aims and goals and systematically improve the reliability of HIV care using quality improvement (QI) methods. Health workers will be taught how to use routine data to analyse performance gaps in the sequence of psychosocial care steps, select change ideas to close specific gaps, and to use quality improvement techniques. S2S team members will support facility staff through regular site visits that will include in-service training, system support and clinical mentorship activities. Sustainability will be achieved by training master-trainers and -mentors, capacitating the PEPFAR district support partner, and strengthening the RTCs. Operational and improvement science research will focus on evaluating programmes and identifying best practices for scale-up and implementation. National and provincial level capacity building activities will support the national and provincial PMTCT steering committees and the Paediatric Technical Working Group and the implementation of the PMTCT Action Framework and Paediatric Blueprint for Action.

South2South will support the integration of HIV/TB services to the following populations: pregnant women, infants, children, and adolescents. All capacity building activities, such as training curricula and mentoring tools, are aligned with SAG policies on HIV/TB treatment, prophylaxis, and screening. S2S training and mentoring incorporates an integrated approach to HIV/TB management in priority populations. The district support activities delivered by S2S includes a comprehensive baseline assessment of HIV/TB services and training needs relevant to TB/HIV. Training and mentoring will focus on gaps and weaknesses identified at baseline. HIV/TB indicators will be tracked and review quarterly with targeted district managers and facility supervisors, as part of quality improvement support. S2S has updated available mentoring tools to reflect the national TB and HIV M&E framework, and continuously incorporate newly developed tools in the capacity building program. Examples of achievements include the incorporation of routine TB screening for all pregnant women, re-inforced by the BANC register, PMTCT register, and screening for TB contacts during the postnatal period. Where opportunities exist for development of new training tools or curricula, and QI techniques, S2S will work with SAG stakeholders to ensure national dissemination. The capacity building program to support TB/HIV will be implemented in 3 selected sub-districts as demonstration projects. A comprehensive baseline assessment will identify areas for prioritization and guide program implementation. Districts will engage a network of facilities with a single sub-district that includes a referral facility and its feeder clinics (wedge) with its associated Regional Training Centre. During the following 9 months districts and RTCs will scale up these activities across all health facilities within the district. Lessons learned during the early part of the initiative will be applied across all hospitals and clinics, with a focus on rapid change to reflect on-going successes accomplished in care. All healthcare facilities in the sub-district and the associated RTC will be linked into a learning network to accelerate peer-to-peer learning, set common aims and goals and systematically improve the reliability of HIV/TB care using quality improvement (QI) methods. Health workers will be taught how to use routine data to analyse performance gaps in the sequence of HIV/TB care steps, select change ideas to close specific gaps, and to use quality improvement techniques. S2S team members will support facility staff through regular site visits that will include in-service training, system support and clinical mentorship activities. Sustainability will be achieved by training master-trainers and -mentors, capacitating the PEPFAR district support partner, and strengthening the RTCs. Operational and improvement science research will focus on evaluating programmes and identifying best practices for scale-up and implementation.

The capacity building support delivered to targeted districts, and the technical assistance input provided to national and provincial DOH structures include all health facility-based care aimed at extending and optimizing quality of life for HIV-infected children, adolescents, and their families throughout the care continuum through provision of clinical, psychological, spiritual, social, and prevention services. S2S training and mentoring activities support the principle that clinical care should include early infant diagnosis, prevention and treatment of OIs and other HIV/AIDS-related complications including malaria and diarrhea, pain and symptom relief, and nutritional assessment and support including food. S2S will provide technical assistance through capacity building, targeted operational research, and improvement science research to support the full spectrum of care and support to infant, children, and adolescents infected and affected by HIV, including scaling up pediatric participation in treatment programs, activities to support the needs of adolescents with HIV (ALHIV) (PwP, support groups, support for transitioning into adult services, adherence support, reproductive health services, educational support for in and out of school youth), supervision, improved quality of care and strengthening of health services, promoting integration with routine pediatric care, nutrition services and maternal health services, strengthening laboratory support and diagnostics for pediatric clients, ensure appropriate dispensation of CTX and INH, prophylaxis in infants, children and adolescents, nutritional evaluation and care of malnutrition in HIV+ infants, children and youth, psychosocial support of children and adolescents, including disclosure, adherence counseling, and support groups, increase direct linkages to the community to improve communication between facilities and community services for HIV+ children and youth. All of these activities will be supported through training and mentoring during capacity building in targeted districts. The program will be implemented in 3 selected sub-districts as demonstration projects. A comprehensive baseline assessment will identify areas for prioritization and guide program implementation. Districts will engage a network of facilities with a single sub-district that includes a referral facility and its feeder clinics (wedge) with its associated Regional Training Centre. Lessons learned during the early part of the initiative will be applied across all hospitals and clinics, with a focus on rapid change to reflect on-going successes accomplished in care. All healthcare facilities in the sub-district and the associated RTC will be linked into a learning network to accelerate peer-to-peer learning, set common aims and goals and systematically improve the reliability of HIV care using quality improvement (QI) methods. S2S team members will support facility staff through regular site visits that will include in-service training, system support and clinical mentorship activities. Sustainability will be achieved by training master-trainers and -mentors, capacitating the PEPFAR district support partner, and strengthening the RTCs. National and provincial level capacity building activities will support the national Paediatric Technical Working Group and the implementation of the Paediatric Blueprint for Action

South2South will provide capacity building support in the area of PMTCT through the implementation of an innovative capacity building program that combines training, with mentoring, and quality improvement techniques. The program will be implemented in 3 selected sub-districts as demonstration projects. A comprehensive baseline assessment will identify areas for prioritization and guide program implementation. Following the baseline assessment, the S2S technical team will provide feedback to the facility staff on findings and, in collaboration with health facility staff, will confirm priorities, and support the facility in the development of activities and timelines to achieve targets, and agree upon a schedule for on-going site support. Districts will engage a network of facilities with a single sub-district that includes a referral facility and its feeder clinics (wedge) with its associated Regional Training Centre. During the following 9 months districts and RTCs will scale up these activities across all health facilities within the district. Lessons learned during the early part of the initiative will be applied across all hospitals and clinics, with a focus on rapid change to reflect on-going successes accomplished in care. All healthcare facilities in the sub-district and the associated RTC will be linked into a learning network to accelerate peer-to-peer learning, set common aims and goals and systematically improve the reliability of HIV care using quality improvement (QI) methods. Health workers will be taught how to use routine data to analyse performance gaps in the sequence of PMTCT care steps, select change ideas to close specific gaps, and to use quality improvement techniques. S2S team members will support facility staff through regular site visits that will include in-service training, system support and clinical mentorship activities. Sustainability will be achieved by training master-trainers and -mentors, capacitating the PEPFAR district support partner, and strengthening the RTCs. Operational and improvement science research will focus on evaluating programmes and identifying best practices for scale-up and implementation. National and provincial level capacity building activities will support the national and provincial PMTCT steering committees and the implementation of the PMTCT Action Framework and Data for Action Reports. District support will prioritize supporting activities to ensure initiation of ART for eligible HIV+ pregnant women, program retention, and ART adherence among mothers and infants in care and treatment programs. The district support program will build health worker capacity to ensure initiation of ART for eligible HIV+ pregnant women, program retention, ART adherence among mothers and infants in care and treatment programs, activities to scale-up additional quality PMTCT interventions to increase HTC, including PITC of pregnant women at ANC, ANC attendance and facility deliveries, use of more effective ARV regimens, access to CD4 testing, and evidence-based interventions to reduce incident HIV infections during pregnancy, and improve care and support services at health facilities and in communities, activities supporting integration of PMTCT with ART and routine maternal child health/reproductive health services, especially family planning services, adult and pediatric treatment services, and broader prevention programs.

South2South capacity building support for Adult HIV Treatment include training clinicians and other health care providers on ART readiness and adherence counselling. S2S will deliver on-site training on ART readiness, adherence counselling and adherence tracking tools to health care workers such as facility-based counsellors, community health workers, nurses, doctors, and pharmacy assistants. Formal on-site trainings will be followed up by mentoring visits. Training of master-trainers and mentors will be prioritized to allow cascading of training and widespread use and supervision of adherence tracking and counselling tools. The impact of training and mentoring will be tracked through the use of competency checklists and pre/post-test questionnaires following training. Other indicators that reflect the quality of adherence counselling and support will be tracked, such as loss-to-follow-up-rate, ART resistance, adherence rates, and disclosure. The program to support adult treatment adherence will be implemented in 3 selected sub-districts as demonstration projects. A comprehensive baseline assessment will identify areas for prioritization and guide program implementation. Districts will engage a network of facilities with a single sub-district that includes a referral facility and its feeder clinics (wedge) with its associated Regional Training Centre. Lessons learned during the early part of the initiative will be applied across all hospitals and clinics, with a focus on rapid change to reflect on-going successes accomplished in care. All healthcare facilities in the sub-district and the associated RTC will be linked into a learning network to accelerate peer-to-peer learning, set common aims and goals and systematically improve the reliability of adherence counselling and support using quality improvement (QI) methods. S2S team members will support facility staff through regular site visits that will include in-service training, system support and clinical mentorship activities. Sustainability will be achieved by training master-trainers and -mentors, capacitating the PEPFAR district support partner, and strengthening the RTCs.

South2South support of Paediatric HIV Treatment includes the capacity building support to health workers in the roll-out and implementation of paediatric treatment guidelines, training of clinicians and other providers, supporting adherence and strategies to improve retention in the paediatric populations, supporting the monitoring and supervision of paediatric HIV services, and promoting integrated approaches to improve Paediatric HIV treatment outcomes. At national and provincial level, S2S will support Paediatric HIV treatment services through technical assistance to the Paediatric Technical Working Group, and the implementation of the Paediatric Blueprint for Action. District-level capacity building activities will include support of the full spectrum of paediatric HIV treatment services through training and mentoring on adherence in pediatric populations, improving retention on treatment, establishing functional linkages between programs and with the community to reduce losses to follow up and improve long-term outcomes, promoting integration of pediatric HIV treatment services into MCH platforms of service delivery and linkages with nutrition support programs, establishing linkages with community based activities, programs and services, expanding capacity to provide early infant diagnostic services, rolling out PITC HIV testing in infants, children and adolescents, improving treatment services to adolescents, including support to facilitate transitioning to adult services, family planning, educational and psychosocial support. The district-level support program will improve capacity to collect, analyze and use pediatric HIV data in collaboration with the USG and national program, improve the quality of services to evaluate treatment failure in pediatric HIV+ patients and access to second and third line ARVs for these children and youth, improving procurement and maintenance of adequate supplies of pediatric ARVs, and addressing issues of disclosure to PLHIV and ALHIV. The district-level program to support Paediatric HIV Treatment will be implemented in 3 selected sub-districts as demonstration projects. A comprehensive baseline assessment will identify areas for prioritization and guide program implementation. Districts will engage a network of facilities with a single sub-district that includes a referral facility and its feeder clinics (wedge) with its associated Regional Training Centre. Lessons learned during the early part of the initiative will be applied across all hospitals and clinics, with a focus on rapid change to reflect on-going successes accomplished in care. All healthcare facilities in the sub-district and the associated RTC will be linked into a learning network to accelerate peer-to-peer learning, set common aims and goals and systematically improve the quality of Paediatric HIV Treatment using quality improvement (QI) methods. S2S team members will support facility staff through regular site visits that will include in-service training, system support and clinical mentorship activities. Sustainability will be achieved by training master-trainers and -mentors, capacitating the PEPFAR district support partner, and strengthening the RTCs.