IntraHealth International will continue implementation of a comprehensive prevention, care, and treatment program focused on the Sudan People's Liberation Army (SPLA) and through sub-grantee partners, support for programs in the higher prevalence areas in the Equatorias. Work with the SPLA will focus on the SPLA divisions in Central Equatoria, Western Equatoria, Eastern Equatoria and Lakes States; and with sub grantee partners IMC in Western Equatoria, Merlin in Eastern Equatoria and St. Bakhitas Health Center in Central Equatoria States.

Prevention: IntraHealth and partners will cover the following six sub areas:

1. PMTCT : Our approach to PMTCT will continue to include Rapid HIV testing and counselling for PMTCT at the antenatal and maternity clinic settings; combination short-course ARV prophylaxis or single dose Nevirapine for HIV+ mothers and infants, and referral for ART for mothers; Formation of mother-to-mother support groups where counseling and support for infant feeding, links to nutrition services, Family Planning for HIV+ women, client-provider counseling, STI testing and referral will be provided; Integration of HIV/AIDS education, care and support for the mothers-infant pair during immunization visits; and Improved record keeping for patient management and support for ANC sentinel surveillance.

2. Support for four existing PMTCT sites at the Juba Military Hospital with the SPLA, Tambura Hospital through IMC, Nimule Hospital through Merlin and the St. Bakhitas Health Center in Yei will continue. IMC will open two new PMTCT sites in Mupoi and Namutina PHCC (WES) and Lologo and Gurie in (CES). Merlin will open two PMTCT sites at the Hiyala and Pageri PHCCs in (EES). IntraHealth in addition, will support either the SPLA or a local CBO running a PHCC, to initiate PMTCT services in Lakes State.

3. Post Exposure Prophylaxis (PEP): All IntraHealth supported facilities providing VCT, PMTCT and ART services will be equipped to provide occupational accident/incident reports. Any health care provider occupationally exposed to HIV will be provided or referred for PEP.

4. Prevention with Positives (PwP): At a national level, IntraHealth will continue to support the HIV/AIDS Directorate at the Ministry of Health and the Southern Sudan HIV/AIDS Commission (SSAC) in the development of home based care guidelines and in development of strategies for referral from VCT/PMTCT to the ART centers or to the PLWHA support groups. IntraHealth will continue to provide PwP services for PLWHA through the support groups the SPLA support group, the CHECHE support group run by Merlin and the TIWE support group supported by IMC. IntraHealth plans to expand this service by supporting two community based organizations to initiate prevention with positives activities in Lakes State and in Kajokeji County in Central Equatoria State. IntraHealth and partners will continue to train PLWHA as support group educators whose roles among others will be to promote HIV/AIDS prevention among their peers. IntraHealth will adapt the CDC curriculum on PwP for these trainings.

5. Sexual and other behavioral risk prevention: IntraHealth and partners will continue to employ a comprehensive HIV/AIDS prevention approach that includes abstinence and being faithful (AB) as well as consistent and correct condom use (C). The communication strategies will be simple and clear and will reflect an integrated Behavior Change Communication (BCC) strategy of promoting ABC as well as linking partner reduction to couples-centered CT and use of condoms where status is unknown. The most at risk populations (MRP) that will continue to be targeted include military personnel who are away from their families, demobilized soldiers, transport workers, sexually active youth, transactional sex workers, and alcohol abusers. The program will continue to raise awareness on HIV/AIDS to reduce stigma and always use HIV/AIDS awareness activities as an entry to CT, PMTCT, care and treatment programs. Both small group and large group events will be used to effectively reach as many people as possible with HIV/AIDS prevention messages. Training remains a key component for effective implementation of HIV/AIDS sexual prevention activities; the following cadres will continue to receive training: HIV/AIDS educators; peer educators; and trainers through training of trainers (TOTs). IntraHealth will have a particular focus on persons with disabilities (mentally and physically) given their vulnerability to the risk of HIV infection.

6. Work place programs: The SPLA HIV/AIDS Secretariat will continue to be supported as a work place enterprise in the implementation of HIV/AIDS activities for the military personnel. In addition support for select SPLA directorates such as Training, Medical Corps, Administration and Signal Corps will be provided to mainstream HIV/AIDS activities into their operations including the curricula for basic, mid-level, and senior level command.

Counseling and Testing: At the national level, the MOH will be supported to develop new approaches to HCT. A study tour of senior MOH and SSAC officials involved in testing and counselling is planned to learn from other IntraHealth supported PITC programs. At the implementation level, four approaches to testing and counselling will be employed: 1) Static sites 2) mobile testing and counselling 3) family testing and counselling, and 4) provider initiated testing and counselling (PITC). IntraHealth and the SPLA will continue to run 10 static TC sites and one mobile team. IMC will continue to support two static sites (Tambura Hospital and Source Yubu PHCC) while Merlin will continue to support two static TC sites (Nimule Hospital and Pageri PHCC). IntraHealth and the SPLA in FY11 will expand the static sites to 15, while IMC will start additional site in Mupoi and Namutina PHCCs, while Merlin will expand to Hiyala PHCC. IntraHealth will continue to support the PITC activities at the Juba Military Hospital, IMC-run Tambura Hospital and Merlin-run Nimule Hospital. In FY11, IntraHealth with partners will identify and initiate PITC in two additional sites. It will continue to support the training of TC providers. IntraHealth through the VCT centers will also refer clients with STI symptoms for treatment.

Care: The following areas will be covered:

1. "Umbrella" and Clinical CareTotal care indicators: IntraHealth and partners will continue to provide comprehensive care services that will include clinical services, preventive services, and support services. Clinical services will include a broad range of services provided to HIVpositive individuals at facility, community and home settings including but not limited to provision of Cotrimoxazole prophylaxis, TB screening and provision of TB drugs. The preventive services will include interventions to prevent the transmission of HIV. Support services will include social, psychosocial and spiritual support offered to HIV-positive individuals and their families. The comprehensive care services will be implemented through various settings such as PMTCT, support groups mentioned under Prevention with Positives and through the ART centers. Expansion is expected to result in comprehensive care being provided in the various settings.

2. Clinical/Preventive Services- additional TB/HIV: HIV counseling and testing to TB patients will continue to be provided.

Treatment: For ARV services, with PEPFAR and Global Fund support, IntraHealth and the SPLA will continue to provide clinical care services at the Bilfam ART center and will expand these services to the SPLA Mapel base where IntraHealth and the SPLA are currently running a VCT service. The SPLA Medical Corps has offered space in the medical building for this service.

Health System Strengthening: The following six sub areas will be covered:

1. Laboratory Services: Laboratory services at the SPLA Bilfam and Juba Military Hospital will be strengthened in order to improve the quality of HIV/AIDS diagnostics. At a national level, IntraHealth proposes to be more engaged in supporting the national reference laboratory services as would be agreed.

2. OHSS: Human Resources for Health: Support for the in- service training of health care workers in TC, PITC, PMTCT, laboratory techniques and comprehensive HIV/AIDS management skills will continue. In addition, training of lay personnel in HIV counseling and testing, in HIV/AIDS prevention (HIV educators, peer educators, TOTs) and as home based care providers will continue. As part of the effort to build the capacity of the SPLA HIV/AIDS Secretariat and community based organizations, training will be conducted for personnel in management, organizational development, leadership skills and computer skills.

3. Health Systems Governance: Support and participation will continue to the MOH and SSAC in the development of HIV/AIDS policies, frameworks and guidelines. In addition, support for the SPLA HIV/AIDS Secretariat to develop, revise, and implement HIV/AIDS policies, frameworks and guidelines will continue.

4. Strategic information: Continue to build the capacity of the partners to collect and use strategic information by strengthening the monitoring and evaluation skills, HMIS and sentinel surveillance through training, supervision and mentoring.

Comprehensive care services will continue to be provided and include clinical services; preventive services; and support services. Clinical services will include a broad range of services provided to HIVpositive individuals at facility, community and home settings including but not limited to provision of Cotrimoxazole prophylaxis, TB screening and provision of TB drugs. The preventive services will include interventions to prevent the transmission of HIV. Support services will include any social, psychosocial or spiritual support offered to HIV-positive individuals and their families. The comprehensive care services will be implemented through various settings such as the PMTCT, the support groups mentioned under Prevention with Positives- and through the ART centers. Expansion is expected to result in comprehensive care being provided in the various settings. HIV counseling and testing to TB patients will continue to be provided.

At a national level, IntraHealth will continue to support the HIV/AIDS Directorate at the Ministry of Health and the Southern Sudan AIDS Commission (SSAC) in the development of home based care guidelines and in development of strategies for referral from VCT/PMTCT to the ART centers or to the PLWH support groups. IntraHealth will continue to provide Prevention with Positives (PwP) services for People Living with HIV (PLWH) through the support groups the SPLA support group, the CHECHE support group run by Merlin and the TIWE support group supported by IMC. I IntraHealth and partners will continue to train PLHIV as support group educators whose roles among others is promote HIV/AIDS prevention among their peers. IntraHealth will adapt the CDC curriculum on PwP for these trainings. With PEPFAR and Global Fund support, IntraHealth and the SPLA will continue to provide clinical care services at the Bilfam ART center .

At the national level, the MOH will be supported to develop new approaches to HCT. IntraHealth will continue to advocate and support the MoH HIV/AIDS Directorate to develop PITC guidelines and training manuals. IntraHealth will also support the MoH HIV/AIDS Directorate to train 20 providers in PITC. At the implementation level, four approaches to testing and counseling and will be employed: 1) Static sites 2) mobile counseling and testing 3) family and/or couple TC 4) provider initiated testing and counseling (PITC). IntraHealth will have 18 HCT sites as follows: IntraHealth and the SPLA will continue to run 11 static TC sites and one mobile. IMC will continue to support two static sites (Tambura Hospital and Source Yubu PHCC), Merlin will support three static TC sites (Nimule Hospital, Pageri PHCC and Moli PHCU) and St. Bakhita will support one (St. Bakhita Health Center). IntraHealth will initiate PITC activities at the Juba Military Hospital, IMC-run Tambura Hospital and Merlin-run Nimule Hospital. IntraHealth will continue to support the training of new TC providers and provide refresher training for the practicing TC providers. IntraHealth through the VCT centers will continue to refer clients that test HIV-positive to the closest and most convenient ART sites, those with STI symptoms for treatment to the health centers and those with family planning needs to the health facilities that provide family planning services. IntraHealth will continue to train health care providers and lay personnel in HIV counseling and testing both through pre and inservice trainings.

Continue to build the capacity of the partners to collect and use strategic information by strengthening the monitoring and evaluation skills, HMIS and sentinel surveillance through training, supervision and mentoring. Continue to use IQ Chart for ART patient monitoring and introduce an IntraHealth developed database to store the project's data.

As part of the effort to build the capacity of the SPLA HIV/AIDS Secretariat and community based organizations, training will be conducted for personnel in management, organizational development, leadership skills and computer skills. IntraHealth will continue to support the SPLA HIV/AIDS Secretariat to develop, revise, and implement HIV/AIDS policies, frameworks and guidelines. In the area of Health Systems Governance IntraHealth will continue to support and participate in the MOH and SSAC technical working groups and support both them in the development of HIV/AIDS policies, frameworks and guidelines.

A comprehensive HIV/AIDS prevention approach that includes abstinence and being faithful (AB) as well as consistent and correct condom use (C). The communication strategies are simple and clear and reflect an integrated behavior change communication strategy of promoting ABC as well as linking partner reduction to couples-centered CT and use of condoms where status is unknown. The populations that will continue to be targeted include military commanders, military personnel and their families, demobilized soldiers, community leaders and in and out of school youth. The program will continue to raise awareness on HIV/AIDS to reduce stigma and always use HIV/AIDS awareness activities as an entry to CT, PMTCT, care and treatment programs. Both small groups and large group events will be used to effectively reach as many people as possible with HIV/AIDS prevention messages. In addition, the program will continue to conduct targeted sessions for female soldiers, wives of commanders and PLHIV. Training remains a key component for effective implementation of HIV/AIDS sexual prevention activities; the following cadres will continue to receive training: HIV/AIDS educators; peer educators; and trainers, through training of trainers (TOTs). The training curricula developed in 2007 will be revised to reflect the current Southern Sudan environment. There will be a particular focus on persons with disabilities (mentally and physically through congenital disabilities or war-induced) given their vulnerability to the risk of HIV infection.

A comprehensive HIV/AIDS prevention approach that includes abstinence and being faithful (AB) as well as consistent and correct condom use (C). The communication strategies are simple and clear and reflect an integrated behaviour change communication strategy of promoting ABC as well as linking partner reduction to couples-centered CT and use of condoms where status is unknown. The most at risk populations that will continue to be targeted include military personnel who are away from their families, demobilized soldiers, transport workers, sexually active youth, transactional sex workers, and those who misuse alcohol. The program will continue to raise awareness on HIV/AIDS to reduce stigma and always use HIV/AIDS awareness activities as an entry to CT, PMTCT, care and treatment programs. Both small groups and large group events will be used to effectively reach as many people as possible with HIV/AIDS prevention messages. Training remains a key component for effective implementation of HIV/AIDS sexual prevention activities; the following cadres will continue to receive training: HIV/AIDS educators; peer educators; and trainers, through training of trainers (TOTs). There will be a particular focus on persons with disabilities (mentally and physically through congenital disabilities or war-induced) given their vulnerability to the risk of HIV infection.

Initiate the implementation of the new WHO PMTCT guidelines. The approach for PMTCT will be to continue: Rapid HIV counseling and testing for PMTCT at the antenatal and maternity settings; Combination short-course ARV prophylaxis or single dose Nevirapine for mother and infant pair (as per the new WHO PMTCT guidelines) and referral for ART for mothers; Formation of mother to mother support groups where counseling and support for infant feeding, links to nutrition services, FP for HIV+ women, client-provider counseling, STI testing and referral will be provided; Integration of HIV/AIDS education, care and support for the mothers-infant pair during immunization visits; and Improved record keeping for patient management and support for ANC sentinel surveillance.

Support for five existing PMTCT sites at the Juba Military Hospital with the SPLA, Tambura Hospital through IMC, Nimule Hospital and Pageri PHCC through Merlin and the St. Bakhitas Health Center in Yei will continue. In addition, IntraHealth will continue to provide pre-service training for new PMTCT providers and and in- service training for practising PMTCT providers.

Intrahealth will identify training opportunities within the country organized by the Ministry of Health or WHO for laboratory technicians or technologists. IntraHealth will provide training support in form of travel and accommodation expenses for the military laboratory staff to facilitate their attendance to these training workshops. The knowledge and skills acquired once put into practice will improve the quality of HIV/AIDS diagnostics and improve the Bilfam laboratory function within the SPLA health structure. in addition, IntraHealth will continue to provide technical assistance to the three sub grantee partners to improve their laboratory function and contribute to the country's health systems.

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