SUMMARY:

Medical Care Development International - South Africa (MCDI-SA) is a US-based private voluntary

organization (PVO) that is registered as a Section 21 company (NGO) in South Africa. MCDI-SA has been

successfully implementing community public-health and social support projects in KwaZulu-Natal, South

Africa, since 1995. Prior to PEPFAR funding, projects have incorporated activities focusing on traditional

Child Survival (CS) interventions, reducing HIV and AIDS through prevention among youth and

adolescents, assisting with CT/PMTCT site establishment, strengthening the government healthcare

system's provision of services to and creating support groups for HIV-infected and TB-affected individuals,

and supporting other health-supportive community-based initiatives. MCDI-SA seeks to prevent mother-to-

child transmission (MTCT) through a comprehensive training and support program. Target populations

include men and women of reproductive age, pregnant women, and people living with HIV and AIDS, and

children under five. The major emphasis areas are all gender-related issues (addressing male norms and

behaviors, increasing gender equity in HIV and AIDS programs, increasing women's access to income and

productive resources, increasing women's legal rights, and reducing violence and coercion), Human

Capacity Development (in-service training and retention strategy), Local Organization Capacity Building,

and include Child Survival and Safe Motherhood Wraparound Programs.

BACKGROUND:

FY 2008 PEPFAR funding will be used to expand MCDI-SA's ongoing PMTCT initiatives in rural Ndwedwe

sub-district to the three remaining sub-districts of Ilembe District Municipality in KwaZulu-Natal province.

The MCDI-SA PMTCT program is part of the Ndwedwe Integrated TB and HIV and AIDS program

(NITHAP), funded by the USAID Child Survival Program, as well as Ilembe District Child Survival Project

and UNICEF. Proposed activities are consistent with the South African Government's mission of preventing

the spread of HIV. The main partner in this activity area is Ilembe District Department of Health. Other

partners include South African non-governmental organizations (NGO) such as The Valley Trust and

National Association of People Living With HIV and AIDS (NAPWA) as well as the Campus Law Clinic at

the University of KwaZulu-Natal (UKZN). Activities in this area will provide the means to empower women of

reproductive age in general to protect the health and well-being of their children and themselves and will

provide pregnant women and HIV-infected pregnant women and mothers expanded access to counseling

and testing (CT), PMTCT and antiretroviral (ARV) services.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Capacity Building

MCDI-SA will continue to improve the capacity of local government-supported and volunteer-community

health workers to provide quality CT, traditional VCT and PMTCT; services, and to educate the community

on the importance of CT and PMTCT. Community Health Workers (CHWs), home-based care volunteers

(HBCV), and other community influencers, such as traditional healers, religious and traditional leaders, will

ensure that HIV-infected pregnant women and mothers adhere to PMTCT treatment and feeding protocols,

i.e. taking nevirapine at the onset of labor, either on arrival at the health facility for delivery, or at home in a

community setting (assisted by a birth companion) and adhering to exclusive infant feeding practices until

appropriate weaning commences.

Training of health providers and community outreach workers will include the following: (1) Training of sub-

district trainers, Community Health Facilitators (CHF) and health facility personnel on PMTCT/VCT and

household and community integrated management of childhood illnesses (C/HH IMCI) by MCDI-SA and

The Valley Trust; (2) CHFs will provide training to CHWs, HBCVs, Traditional Birth Attendants (TBAs), and

Traditional Healers (THs) on C/HH-IMCI and Community PMTCT; (3) Households and communities as well

as traditional healers and community and religious leaders will be reached by community workers and

provided with information about Community and Household Integrated Management of Childhood Illnesses

(C/HH-IMCI) and PMTCT. All training activities are based on the South African Government (SAG) PMTCT

protocols. In addition, community workers will be provided with sound knowledge of C/HH-IMCI and

community PMTCT and will serve as community advocates for CT and PMTCT to pregnant women in the

area. Community awareness is a key to increasing access to PMTCT services and adherence to

government healthcare and treatment protocols.

Training formats will be either small workshops held over one or more days or one-on-one mentoring and

will be conducted by qualified nurses and/or South African Qualification Authority (SAQA)-accredited

trainers. Training quality assurance will be measured through pre- and post-training evaluations as well as

periodic follow up evaluations whenever feasible.

ACTIVITY 2: Pre- and Post-Natal Support Through HIV-infected Mothers Support Groups and Birth

Companion Programs

MCDI-SA will continue its current efforts in providing HIV-infected women with psychosocial and other

support as part of the PMTCT program. With FY 2008 funding, MCDI-SA will establish HIV-infected Mothers

Support Groups in collaboration with the local National Association of People living With AIDS (NAPWA)

affiliate. Locally recruited lay counselors trained by MCDI-SA and NAPWA will offer additional educational

and psychological support to mothers support groups, and legal support will be provided through a

partnership with the UKZN Campus Law Clinic. These support groups will: (1) guide new mothers on

appropriate feeding practices; (2) assist new mothers in developing income generation and public

awareness/anti-stigma projects; and (3) encourage information sharing on accessing and adhering to

antiretroviral treatment (ART), childhood illness prevention, detection and treatment, accessing social

grants, involving men in maternal and child care, and addressing and reducing domestic violence. HIV-

infected mothers' support groups will be used as linkages between communities and health facility

PMTCT/CT and ART services. Groups also will be mentored in how to register themselves as community-

based organization who can receive funding for their own organized activities. Furthermore, birth

companions will be identified and trained by MCDI-SA and NAPWA trainers to accompany pregnant women

in all stages of the antenatal and postnatal periods. They will foster best practices in antenatal care, child

bearing, and infant feeding and care, including ensuring that HIV-infected mothers adhere to PMTCT

protocols related to self-administration of nevirapine in the home, when delivery does not take place in a

Activity Narrative: facility. In addition, Birth Companions will promote referral to the two ARV service centers in Ilembe sub-

district. The Support Group Facilitators will work with the district Department of Health Community Health

Facilitators, traditional birth attendants (TBAs), HBCVs and CHWs to identify Birth Companions among the

community, family members or volunteers.

ACTIVITY 3: Facility PMTCT Service Quality Assessments

Using an assessment tool developed in conjunction with the Ilembe District DOH under the current TB-HIV

service integration project, MCDI-SA will conduct annual assessments of PMTCT services at the facility

level. This tool is similar in format to the District Rapid Assessment Tool (DRAT) that was developed to

evaluate TB services in the Eastern Cape for the Equity Project, which has been adapted and expanded for

use in Ndwedwe under our TB-HIV project, NITHAP. This tool, which provides a more in-depth

understanding of service provision than current DoH data vehicles are able to collect and present, has

proven to be effective for TB services, and will be adapted to address PMTCT service quality. Each

assessment will evaluate the quality of PMTCT service provision in terms of number, training and tenure of

personnel; adequacy of physical space, supplies and equipment; integration with ANC, VCT, and TB

services; consistency of recording and reporting; and other key service points in compliance with NDOH

PMTCT guidelines. Results and recommendations will be discussed on-site with the service providers as

well as compiled and presented to the Ilembe District Health Management Team. DOH PMTCT program

managers will be trained on use of the tool and provided with electronic copies of the tool for their ongoing

use.

This project contributes to PEPFAR 2-7-10 goals by improving uptake and access of PMTCT services at

public health facilities, facilitating the linkages between PMTCT and ART services, and providing

psychosocial support to HIV-infected pregnant women and mothers, ensuring better adherence to PMTCT

protocols and reducing the number of new infant infections.

Organization Name: Medical Care Development International (MCDI)

Duration of Projects in years: 3 years

Prevention AB & OP:Objective 1: To prevent HIV/AIDS and other STIs and pregnancy among in and out-of-

school youth through tested peer education behavior change communication (BCC) activities and using

creative drama and film methods

MCDI undertakes to expand on and enhance its already successful activities in this area. IDCYSP activities

are in line with the PEPFAR objective of preventing HIV transmission through the promotion of safe and

healthy sexual behavior among HIV infected and uninfected individuals. Proposed activities are also

consistent with the South African Government's AIDS Programme mission of preventing the spread of HIV.

These proposed activities recognize the important role that community education, outreach and advocacy

can play in educating youth and preventing HIV/AIDS. Specifically, the youth activities will address

increased risk to youth and the disproportionately high risk among girls and young women. The Mobile

Education Unit will reach underserved rural communities. The education of community influencers in a

behavior change and communication approach will emphasize the particular vulnerabilities all of these

vulnerable groups, while creating a more supportive environment for PLWHA and youth.

OVC: Objective 2: To provide quality comprehensive and compassionate care for AIDS orphans and other

vulnerable children by expanding the model crèche to other areas, including access to essential health,

social, psychosocial and legal services for OVC and their households.

IDCYSP will encourage enrollment of OVC, specifically targeting those children in child- or sibling-headed

households, to crèches who are often excluded because of tuition fees through MCDI's previously

successful approach of fee waivers for orphans. In the Mavela crèche, enrollment increased from 40 to 100

through using this approach. OVC will be identified through MCDI PMTCT activities. They will also be

identified by home-based caregivers (HBCs), who are local community residents that have completed

secondary school and an MCDI 21-day training course to deliver palliative care. MCDI is currently

transitioning the supervision of HBCs to CBOs who have funding to support their income. IDCYSP will

provide legal support to OVC and their caretakers, which will have a significant impact on their current and

future economic well-being. Protecting and promoting the inheritance rights of OVC and fighting against

disinheritance is crucial to comprehensive care and support of these children.

Organization Name: Medical Care Development International (MCDI)

Duration of Projects in years: 3 years

Prevention AB & OP:Objective 1: To prevent HIV/AIDS and other STIs and pregnancy among in and out-of-

school youth through tested peer education behavior change communication (BCC) activities and using

creative drama and film methods

MCDI undertakes to expand on and enhance its already successful activities in this area. IDCYSP activities

are in line with the PEPFAR objective of preventing HIV transmission through the promotion of safe and

healthy sexual behavior among HIV infected and uninfected individuals. Proposed activities are also

consistent with the South African Government's AIDS Programme mission of preventing the spread of HIV.

These proposed activities recognize the important role that community education, outreach and advocacy

can play in educating youth and preventing HIV/AIDS. Specifically, the youth activities will address

increased risk to youth and the disproportionately high risk among girls and young women. The Mobile

Education Unit will reach underserved rural communities. The education of community influencers in a

behavior change and communication approach will emphasize the particular vulnerabilities all of these

vulnerable groups, while creating a more supportive environment for PLWHA and youth.

OVC: Objective 2: To provide quality comprehensive and compassionate care for AIDS orphans and other

vulnerable children by expanding the model crèche to other areas, including access to essential health,

social, psychosocial and legal services for OVC and their households.

IDCYSP will encourage enrollment of OVC, specifically targeting those children in child- or sibling-headed

households, to crèches who are often excluded because of tuition fees through MCDI's previously

successful approach of fee waivers for orphans. In the Mavela crèche, enrollment increased from 40 to 100

through using this approach. OVC will be identified through MCDI PMTCT activities. They will also be

identified by home-based caregivers (HBCs), who are local community residents that have completed

secondary school and an MCDI 21-day training course to deliver palliative care. MCDI is currently

transitioning the supervision of HBCs to CBOs who have funding to support their income. IDCYSP will

provide legal support to OVC and their caretakers, which will have a significant impact on their current and

future economic well-being. Protecting and promoting the inheritance rights of OVC and fighting against

disinheritance is crucial to comprehensive care and support of these children.

SUMMARY:

Medical Care Development South Africa (MCDI-SA) will carry out activities to support expansion of holistic,

comprehensive community HIV and AIDS and TB care and support from Ndwedwe sub-district to the other

sub-districts of Ilembe District in KwaZulu-Natal province. FY 2007 and FY 2008 PEPFAR funding will be

used to expand the primary activities of training, support and supervision of home-based care volunteers

(HBCVs) and Directly Observed Treatment, Short-course (DOTS) providers, as well as the introduction of

software to monitor home-based patient care. This will help to improve quality of care and treatment

adherence for those on TB medication and/or ART; facilitate linkages between HIV and AIDS and TB-

related community-based projects with the local health facilities; and build capacity among relevant

community-based organizations (CBOs).

The emphasis areas include human capacity development (Pre- and In-service training, Retention strategy),

local organization capacity building, and are extended through Child Survival and Safe Motherhood

Wraparound Programs. The target populations are children, adolescents and adults, discordant couples,

pregnant women, people living with HIV and AIDS, and orphans and vulnerable children.

BACKGROUND:

MCDI-SA is a US-based private voluntary organization (PVO) that is registered as a Section 21 company

(NGO) in South Africa. MCDI-SA has been successfully implementing community public health and social

support projects in KwaZulu-Natal, South Africa, since 1995. Prior to PEPFAR funding, projects have

incorporated activities focusing on traditional Child Survival (CS) interventions, reducing HIV/AIDS through

prevention among youth and adolescents, assisting with CT/PMTCT site establishment, strengthening the

government healthcare system's provision of services to and creating support groups for HIV-infected and

TB-affected individuals, and supporting other health-supportive community-based initiatives.

The activities proposed are expansions of those previously implemented by MCDI-SA in Ndwedwe sub-

district and are in line with the PEPFAR and SAG objective of providing quality palliative care for HIV-

infected and -affected individuals. The key program partner is the South African National Department of

Health (NDOH), whose current policies on HIV and TB care and gender equity inform all project objectives,

and whose representatives are actively engaged in the design and implementation of activities to promote

consistency and long-term sustainability. The NDOH has agreed to provide staff and financial support for

project activities, as needed. Other project partners include The Valley Trust, the National Association of

People With AIDS (NAPWA), and Strengthening Pharmaceutical Systems (SPS).

ACTIVITES AND EXPECTED RESULTS:

ACTIVITY 1: Training, Support and Supervision of HBCVs

Due to the large distances between households and health facilities throughout the Ilembe District, HBCVs

are a crucial part of a comprehensive system of care for people living with HIV and AIDS (PLHIV) and

people living with TB (PLWTB) and play a significant role in their day-to-day treatment. As part of its

ongoing USAID-funded Child Survival Project and the ongoing Ndwedwe Integrated HIV/AIDS Tuberculosis

Project, MCDI-SA will broaden its existing integrated home-based care (HBC) program in Ndwedwe sub-

district to the three other sub-districts of the Ilembe District: Maphumulo, Mandeni and KwaDukuza.

PEPFAR funds will be used to train new HBCVs in comprehensive home-based care skills during a three-

week course on providing quality care for community members, including elements of the preventive care

package, pain and symptom management and other palliative care services for PLHIV and PLWTB.

Trainers from The Valley Trust will assist with this activity. Supervisory training and checklists will be

provided, also in collaboration with The Valley Trust. Ilembe District community health facilitators (CHFs),

who are responsible for overseeing HBCV activities in the District, and previously trained HBCV will be

provided with refresher training in comprehensive home-based care skills for patients and their families.

Distinctions between the needs of adults and children will be emphasized, as well as gender-specific issues

such as integrating males into household care practices; increasing male knowledge of effective HIV

prevention measures; increasing women's and girls' use of healthcare services; and recognizing and

addressing domestic abuse against women and girls. Monthly meetings will be held between HBCVs and

facility staff members to promote consistent quality care. Trained HBCVs will also become eligible for

registration with the NDOH and to receive a government stipend for their work. Community-based

organizations (CBOs) will be identified and supported to serve as supervisors of HBCVs. CBOs will also

distribute HBCV supply kits, provide care for caregivers, assist with training, and arrange for HBCVs to

receive recognition for their work at community gatherings. MCDI-SA will provide participating HBCVs with

regular incentives, such as cell phone airtime, so that they will have the means to remain in contact with the

supervising CBOs, clients and health facilities. Supervised by MCDI-SA, the CBOs will work in collaboration

with CHFs to monitor and maintain the quality of services provided.

ACTIVITY 2: Introduction of Software to Monitor HBC Visits

Once HBCVs are trained, supported and supervised, and strong linkages are established with facility staff, it

will be important to monitor HBCVs activities. Consequently, the introduction of software to monitor HBC

visits is proposed. The Outreach Home-Based Care Database Software Program will be installed on DOH

computers to tracks HBC monthly visit rates, activities during visits, client conditions, and the number of

OVC in target communities. The system includes paper forms that are filled out by HBCV and their CBO

supervisors, and the data is then captured and analyzed at the District level. As part of its collaboration with

MCDI-SA, the RPM Plus project has agreed to collaborate with MCDI-SA to help institute this system as a

pilot test of the concept. MCDI-SA will collect and analyze the data initially and will train Ilembe District

health information officers to continue using the system to monitor the performance of its ongoing HBC

program with potential scale-up to the KwaZulu-Natal provincial level. This system will strengthen the

capacity of the District Health Office in monitoring health events at the community level and provide data to

show the breakdown by gender of those receiving care services. The data also will be used to monitor the

project's HBCV activities and inform project management decisions. The ultimate focus of this tool is to

provide feedback to service providers with a focus on quality improvement.

These results contribute to the PEPFAR 2-7-10 goals by improving access to and quality of care and

Activity Narrative: support for PLHIV and their families.

Organization Name: Medical Care Development International (MCDI)

Duration of Projects in years: 3 years

Prevention AB & OP:Objective 1: To prevent HIV/AIDS and other STIs and pregnancy among in and out-of-

school youth through tested peer education behavior change communication (BCC) activities and using

creative drama and film methods

MCDI undertakes to expand on and enhance its already successful activities in this area. IDCYSP activities

are in line with the PEPFAR objective of preventing HIV transmission through the promotion of safe and

healthy sexual behavior among HIV infected and uninfected individuals. Proposed activities are also

consistent with the South African Government's AIDS Programme mission of preventing the spread of HIV.

These proposed activities recognize the important role that community education, outreach and advocacy

can play in educating youth and preventing HIV/AIDS. Specifically, the youth activities will address

increased risk to youth and the disproportionately high risk among girls and young women. The Mobile

Education Unit will reach underserved rural communities. The education of community influencers in a

behavior change and communication approach will emphasize the particular vulnerabilities all of these

vulnerable groups, while creating a more supportive environment for PLWHA and youth.

OVC: Objective 2: To provide quality comprehensive and compassionate care for AIDS orphans and other

vulnerable children by expanding the model crèche to other areas, including access to essential health,

social, psychosocial and legal services for OVC and their households.

IDCYSP will encourage enrollment of OVC, specifically targeting those children in child- or sibling-headed

households, to crèches who are often excluded because of tuition fees through MCDI's previously

successful approach of fee waivers for orphans. In the Mavela crèche, enrollment increased from 40 to 100

through using this approach. OVC will be identified through MCDI PMTCT activities. They will also be

identified by home-based caregivers (HBCs), who are local community residents that have completed

secondary school and an MCDI 21-day training course to deliver palliative care. MCDI is currently

transitioning the supervision of HBCs to CBOs who have funding to support their income. IDCYSP will

provide legal support to OVC and their caretakers, which will have a significant impact on their current and

future economic well-being. Protecting and promoting the inheritance rights of OVC and fighting against

disinheritance is crucial to comprehensive care and support of these children.

SUMMARY:

Medical Care Development International - South Africa (MCDI-SA) is a U.S.-based private voluntary

organization (PVO) that is registered as a Section 21 company or non-governmental organization (NGO) in

South Africa. MCDI-SA has been successfully implementing community public health and social support

projects in KwaZulu Natal, South Africa, since 1995. Prior to PEPFAR support, projects focused on

traditional Child Survival (CS) interventions, reducing HIV through prevention among youth and

adolescents, assisting with counseling and testing (CT) and prevention of mother-to-child transmission

(PMTCT) site establishment, strengthening the government healthcare system's provision of services to and

creating support groups for HIV-infected and TB-affected individuals, and supporting other health-related

community-based initiatives.

Building on its USAID child survival program, MCDI-SA will use PEPFAR funding to carry out activities to

support the KwaZulu-Natal Department of Health's (KZNDOH) efforts to improve and increase use of the

CT services. These activities consist of three components: (a) training local health workers to provide

comprehensive counseling and testing services; (b) strengthening the capacity of HIV support groups for

networking with CT centers and communities for the reduction of stigma and discrimination; and (c)

incorporating community-based, youth-focused, home-based care, outreach and other approaches to

promote CT uptake. Target populations children under 5 years, children aged 5-9, adolescents aged 15-24,

and adults 25 and over, people living with HIV (PLHIV), and orphans and vulnerable children. The major

emphasis areas include gender-related issues (addressing male norms and behaviors, increasing gender

equity in HIV and AIDS programs, increasing women's access to income and productive resources,

increasing women's legal rights, and reducing violence and coercion), human capacity development

(training and retention strategy), local organization capacity building, and child survival and safe

motherhood wraparound programs.

BACKGROUND:

This project will expand on and strengthen activities that MCDI-SA has been working on in KwaZulu-Natal

(KZN) for the last 10 years through funding from USAID's Health and Child Survival Grants Program. CT

will be promoted by (1) training health workers and lay counselors to provide pre-test counseling and CT

services for youth and adults in HIV and STI prevention; (2) promoting CT through community outreach,

education and advocacy; (3) strengthening the capacity of HIV support groups to become eligible for

registration as cooperatives; (4) training HIV support groups to promote HIV counseling and testing in CT

and PMTCT sites and in communities with an emphasis on reducing stigma and discrimination; and (5)

establishing youth clubs for girls and boys in-school and out-of-school for promotion of CT. Partners include

the KZNDOH, The Valley Trust (TVT), the National Association of People Living with HIV and AIDS

(NAPWA) and Community Health Committees (CHC).

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Training Healthcare Workers

MCDI-SA will continue to improve the capacity of local health workers to provide quality CT services and to

educate the community on the importance of CT in preventing HIV transmission and as an entry point for

treatment and care. A core team of sub-district trainers will be trained on CT, home based-care, anti-

retroviral (ARV) and TB treatment adherence. In turn, they will train facility nurses on National Department

of Health (NDOH) CT and TB/HIV protocols, so that each primary healthcare facility will have at least two

nurses trained on current NDOH CT and TB-HIV protocols. This activity will also include training on provider

-initiated testing and counseling (PITC).

ACTIVITY 2: Establishing and Strengthening Support Groups

MCDI-SA has demonstrated that the provision of easy access to HIV and AIDS support groups is one key

way of combating stigma and discrimination in health facilities and in communities. Existing support groups

in Ndwedwe sub-district will be strengthened to become eligible for registration as cooperatives. Sub-

districts will work closely with other organizations in a self-sustainable and self-sufficient entity. MCDI-SA

will also identify viable CT and PMTCT sites in other sub-districts of Ilembe District to establish additional

HIV and AIDS support groups, with the goal of strengthening their capacity to become sustainable

registered cooperatives. Support groups members will receive training and education on counseling and

advocacy.

ACTIVITY 3: Information, Education and Communication

A mobile education unit, staffed by two trained HIV-infected individuals from NAPWA's support groups, will

travel to tribal authorities to conduct information and education campaigns at, and in close proximity to, CT

sites. This will assist to (1) raise knowledge and awareness about CT services for HIV, STIs and TB

patients; and (2) explain how stigma, discrimination and sexual abuse are undermining the health and well-

being of their families, friends and neighbors. MCDI-SA will enlist and train members from community

church groups, traditional healers, and traditional leaders to participate in these information, education and

communication campaigns. Based on successful workshops conducted in Ndwedwe sub-district as part of a

previous project, MCDI-SA will hold additional workshops for influential community members to educate

them on CT services and the harmful effects of stigma and discrimination. Support group members will be

included in the training to discuss their own experiences with stigma and discrimination and the benefits of

using CT services.

ACTIVITY 4: HBC Facility Patient Liaison

Qualified home-based caregivers (HBCs) will be trained by MCDI-SA and placed in each of the seven

government hospitals and community health centers in the district to act as a liaison between CT, TB and

ARV patients and to educate and counsel TB/HIV clients and suspects in cross-testing, treatment literacy

and family directly observed treatment (DOT) support. The liaisons will increase the quality of services

provided to patients while facilitating provision of education and counseling services in facilities with high

patient headcounts and inadequate staffing.

Activity Narrative:

ACTIVITY 5: Facility CT Service Quality Assessments

Using an assessment tool developed in conjunction with the Ilembe District Department of Health under the

current TB/HIV service integration project, MCDI-SA will conduct annual assessments of CT services at the

facility level. Each assessment will evaluate the quality of service provision in terms of number, training and

tenure of personnel; adequacy of physical space, supplies and equipment; integration with antenatal care,

PMTCT, and TB services; consistency of recording and reporting; and other key service points in

compliance with NDOH CT guidelines. Results and recommendations will be discussed on site with the

service providers and will be compiled and presented to the Ilembe District Health Management Team.

Department of Health CT program managers will be trained to use the assessment tool and will be provided

with electronic copies of the tool for their ongoing use.

These activities contribute to the PEPFAR 2-7-10 goals by improving access to, and quality of counseling

and testing services in order to identify HIV-infected persons and to increase the number of persons

receiving antiretroviral services.