ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

BACKGROUND:

In South Africa, Humana People to People (Humana) has until now implemented eight Total Control of the

Epidemic (TCE) areas in Mpumalanga and Limpopo provinces with 400 field officers working with PEPFAR

funding. Humana has started 12 new TCE areas in four provinces with funding from the Global Fund to fight

AIDS, TB and Malaria and thereby extended the total outreach to 2.5 million people in five provinces.

ACTIVITY 1 (Household-based Person-by-Person Campaign) has been modified as follows:

In FY 2009, Humana will start one new TCE area to take the place of a TCE area in Bushbuckridge

Municipality that will close on the 30th September 2009. The total number of TCE areas will remain at 10.

ACTIVITY 2 (Human Capacity Building) will continue with training described in COP 2008, but FY 2009

funding will be used to send management and supervisory staff for further training at Frontline Institute in

Zimbabwe and KwaZulu-Natal Experimental College. This will contribute to strengthening overall leadership

of TCE activities as TCE continues to expand in South Africa.

ACTIVITY 3 (Linkages and Networking) will continue with these activities, but will enhance the activity by

creating linkages with even more government, non-governmental organizations, and departments as the

TCE program expands into new areas, and works with additional stakeholders. With the addition of the

HOPE Humana projects started in FY 2007, many of the AB activities run by the Passionates, such as clubs

and outreach to schools will be handed over to HOPE Humana Bushbuckridge following the closure of the

TCE in Bushbuckridge. Hope Humana is an HIV and AIDS intervention run by Humana, and it was

established in FY 2007 with PEPFAR funding to conduct counseling and testing and home-based care.

Hope Humana in Bushbuckridge and Mopani work closely with TCE as long as TCE is in the area; Hope will

continue in the area after the closure of TCE and will seek funding from other sources to sustain its activities

in the future, hereunder the provincial Department of Health and Social Services.

ACTIVITY 4 (Monitoring & Evaluation) has been modified. Corps Commanders and Division Commanders

will now meet as part of the leadership of TCE worldwide every two months at Humana's international

headquarters in Zimbabwe, replacing the quarterly meeting mentioned in COP FY 2008. This has allowed

the TCE Commanders to learn quickly from best practices used in other countries where TCE is operating

and has, as a result, enabled TCE in South Africa to reach a much higher percentage of its goals.

Since TCE in South Africa has expanded, it has become necessary to increase the number of coordinating

offices from one to three. This has led to the formation of a Corps Commander Forum (CCF), where the

Corps Commanders and their Deputies meet and make sure that all TCE in South Africa is moving in the

right direction. The CCF takes place over two days every month. One day is used for discussions about

results, public relations and partnership, and the second day is used for producing materials such as

pamphlets, manuals and newsletters. Humana will continue to use its tried and tested methods for

monitoring and evaluation that have proven themselves efficient and easy to use as well as comprehensive.

TCE will make improvements on monitoring and evaluation (M&E) tools based on experience in South

Africa and in other countries. PEPFAR-funded TCE in South Africa have adapted some of its systems to

capture the required indicators in AB and other program areas effectively and accurately.

Humana has also undergone a successful assessment of its data quality by Khulisa Management Services.

-------------

SUMMARY:

Humana People to People (Humana) implements a comprehensive, integrated ABC HIV prevention

program called Total Control of the Epidemic (TCE).TCE trains community members as Field Officers (FOs)

to utilize a person-to-person campaign to reach every single household within target areas with AB

messages, with the objective of changing community norms and individual behaviors. The emphasis of the

prevention program is gender, human capacity building and a TB wraparound. Target populations are

adolescents and adults and teachers.

BACKGROUND:

TCE was launched by Humana in 2000 in Zimbabwe. The program has been implemented in eight

countries in Southern Africa reaching a population of five million people. Humana has received PEPFAR

since July 2005. By August 2007, Humana had implemented five TCE areas in the Mpumalanga and

Limpopo provinces. Humana works in partnership with the South African Government (SAG) and local

municipalities. In the first year of implementation, 200 community members were trained as Field Officers

(FOs) and prevention services had been provided to about 60% of the targeted community members.

During FY 2006, follow-up visits were made to develop individual risk management plans with household

members. FOs mobilized whole communities to address stigma and discrimination associated with HIV and

AIDS and raised awareness related to HIV preventive behaviors. TCE tracks service provision by gender

and has developed strategies to reach men over and above those already reached with AB messages. FOs

also promotes gender equity during their home-visits, by empowering both males and females with gender-

specific knowledge about protecting themselves and their families. TCE has trained community volunteers

called Passionates that are responsible for establishing vegetable gardens, running children and youth

clubs, and offering care and support to orphans and people living with HIV (PLHIV). Since FY 2005, the

Mopani and Ehlanzeni District Municipalities have been major partners, contributing over $140,000 per year

to the program. The program has received several awards, including the 2003 Stars of Africa Award (in

partnership with Johnson & Johnson) for best Corporate Social Investment Program in Health and HIV and

AIDS in South Africa. TCE also expects to scale up its coverage with funding from Global Fund via the

South African National AIDS Council (SANAC) in 2008.

ACTIVITIES AND EXPECTED RESULTS:

Activity Narrative: ACTIVITY 1: Household-based Person-by-Person Campaign

The TCE program uses a person-to-person campaign over three years to reach every household with

information about HIV and AIDS within the targeted areas. Each FO is allocated a field of 2,000 people

(approximately 485 households). Households are visited at least three times over a three-year period and

receive targeted prevention messages emphasizing age-appropriate abstinence and faithfulness (AB) with

the objective of changing community sexual norms and addressing issues of multiple concurrent partnership

and cross-generational sex. FOs visit households and engage individuals in discussions about HIV and

AIDS and preventive behavior. FOs also provide information about government services such as counseling

and testing (CT), prevention of mother-to-child transmission (PMTCT), TB and sexually transmitted

infections (STI) services, social grants and home-based care and refer those in need. FOs also refer people

with symptoms of AIDS-related conditions directly to public health clinics for CD4 testing, HIV clinical

staging, and treatment of opportunistic infections. A tool called Perpendicular Estimate System (PES), has

been developed and tailored to measure the impact of the program in the target areas. PES consists of a

set of questions and demands to the individual in order to be TCE-compliant, which means being in control

of HIV and AIDS in one's life. During the second and third year of the program, community members

interact with their TCE FOs on an individual basis to make a PES-plan, which minimizes their risk of being

infected and makes them live responsibly and positively if infected. Further, the program has a series of

targeted interventions to reach schools, including teachers, youth in after school clubs, and health workers

on HIV and AIDS awareness and AB prevention. TCE organizes workshops for local leaders, traditional

healers, and community-based organizations, to explain TCE and promote HIV awareness and prevention.

In FY 2008, six new TCE areas will be started (including four TCE areas completed in 2007 that will be

replaced and an additional two TCE areas) bringing the total number of areas under PEPFAR to 10. These

areas are selected with regard to relationships that Humana already has with certain communities,

relationships with the health districts involved, the reach of other NGOs in the areas, and the need

presented by the communities. Some of the lessons learned in the previous years will be used to strengthen

the program including the refinement of PES, improved counseling for behavior change, and the

intensification of in-service training of the FOs. The continuation of the counseling and testing (started in FY

2005) and palliative care programs (started in FY 2007) are expected to have an influence on the

effectiveness of the AB campaign. The counseling, antiretroviral (ARV) adherence program, and the direct

observed therapy (TRIO) under palliative care will support the ARV program of the South African

Government (SAG).

ACTIVITY 2: Human Capacity Building:

Using FY 2008 funding FOs will receive training on promoting AB messages through the implementation of

door-to-door campaigns and other targeted interventions. FOs will receive ongoing in-training, through

weekly meetings. FOs will be trained as lay-counselors in year one and graduate to educators in the

subsequent year. The training is based on experiences gathered in the field. TCE makes use of its own

material, and educational material developed by other organizations and the SAG. All programming is in line

with the SAG national prevention strategy. Passionates are trained in HIV and AIDS and in communication

and facilitation skills, such as running youth clubs.

ACTIVITY 3: Linkages and Networking

TCE's activities ensure that individuals receive appropriate care. The establishment of linkages and

networking activity was initiated in FY 2006 and will continue in FY 2008. A key strategy of the prevention

program is the promotion of counseling and testing (CT). TCE works in partnership with South African

organizations like LoveLife, to provide CT services to the sites. All households receive messages on the

benefits of CT. Referrals to CT are provided during home visits. TCE also collaborates with other PEPFAR

partners and SAG hospitals, to ensure that referrals to treatment, care and support services are made. TCE

maintains a strong partnership with the TB sub-directorate in the Ehlanzeni and Mopani districts. FOs are

trained to raise awareness about TB in the context of HIV, make referrals to clinics and collect sputum. TCE

works with public clinics to ensure that pregnant women have access to antenatal services and PMTCT.

TCE also ensures cooperation with SAG including the Department of Social Development to ensure that

OVC and PLHIV identified through household visits are able to access social security and with the

Department of Education to ensure children and youth access education and receive HIV and AIDS

information and education on importance of abstinence and delaying sexual debut for the youth aged 10-14,

who have not started with sexual activity; and secondary abstinence and reduction on the number of sexual

partners using the be faithful prevention component.

ACTIVITY 4: Monitoring & Evaluation

TCE has developed a range of systems to measure the impact of the program. Before starting in a new

area, TCE carries out a baseline survey collecting information about knowledge, attitudes and practices in

the area. After implementation, each FO maintains a household register, which keeps basic information

about the household and provides a continuous source of data to evaluate the progress of the program.

Specific information that is collected includes number of people tested, number of OVC, and pregnant

women referred to PMTCT and STI services. The PES tool described under Activity 1 provides data that is

used to track community behavior change. This data provides information on individual behavior change in

the target area. Throughout the program, the FOs and TCE Management meet on a weekly and monthly

basis to evaluate the progress of the program. The meetings monitor progress in achieving targets and

deliberate on the challenges faced in the field. Quarterly, TCE management meet with staff at the TCE

Regional Headquarters in Zimbabwe to further evaluate the progress of the program and develop activities

in order to increase impact in people reached with prevention messages within the community.

These activities will contribute to the 2-7-10 PEPFAR goals of averting seven million new infections by

increased knowledge and skills among community members in HIV prevention; reduced stigma; improved

gender equity in access to information and services; increased knowledge about services (PMTCT and CT);

Activity Narrative: strengthened linkages between other organizations in the area and government services; increased number

of people knowing their HIV status; and increased mobilization and capacity among community members

and local leaders to deliver prevention messages and offer care and support.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13976

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13976 3020.08 U.S. Agency for Humana People to 6672 479.08 $1,267,000

International People in South

Development Africa

7624 3020.07 U.S. Agency for Humana People to 4491 479.07 $700,000

International People in South

Development Africa

3020 3020.06 U.S. Agency for Humana People to 2673 479.06 $600,000

International People in South

Development Africa

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

* Reducing violence and coercion

Health-related Wraparound Programs

* TB

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $551,015

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $67,000

Education

Water

Table 3.3.02:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

BACKGROUND:

In South Africa, Humana People to People has until now implemented eight Total Control of the Epidemic

(TCE) areas in Mpumalanga and Limpopo Provinces with 400 field officers working at any one time with

PEPFAR funding. Humana has started 12 new TCE areas in four provinces with funding from the Global

Fund to fight AIDS, TB and Malaria and thereby extended the total outreach to 2.5 million people in five

provinces.

ACTIVITY 1: Household-Based Person to Person

In FY 2009 Humana People to People plans to start one new TCE area to take the place of an area in

Bushbuckridge Municipality that will close on the 30th of September 2009. The total number of TCE areas

will remain as 10. TCE will further develop and strengthen referral networks in general and make more use

of family planning services and services against substance/alcohol abuse. In their door-to-door campaign,

field officers will continue to emphasize reduction of multiple and concurrent partners.

ACTIVITY 2 Human Capacity Building

In addition to the training described above, Humana People to People will also use FY 2009 funding to send

management and supervisory staff for further training at Frontline Institute in Zimbabwe and KwaZulu Natal

Experimental college as a way to strengthen overall leadership of TCE activities as TCE continues to

expand in South Africa.

ACTIVITY 3 Linkages with Sectors and Initiatives

As well as continuing to strengthen the links that have already been established, Humana People to People

will create linkages with more governmental and non-governmental organizations and departments as the

TCE program expands into new areas with new stakeholders. Additionally with the addition of the Hope

Humana projects many of the OSP activities run by the Passionates, such as campaigns to special

vulnerable groups and condom distribution will have been handed over to HOPE following the closure of the

TCE. Hope Humana leads HIV/AIDS interventions run by Humana and came to a start in FY2007 with

funding from PEPFAR to carry out counseling and testing (CT) and home-based care (HBC). Hope

Humana in Bushbuckridge and Mopani work in close conjunction with TCE as long as TCE is in the area;

Hope will continue in the area after the closure of TCE and seek to attract funding from other sources to

sustain its activities in the future, hereunder the Department of Health and Social Services.

ACTIVITY 4 Monitoring and Evaluation

Corps commanders and division commanders will now meet as part of the leadership of TCE worldwide

every two months at Humana's international headquarters in Zimbabwe, replacing the quarterly meeting

mentioned in COP FY 2008. This has allowed the TCE commanders to learn quickly from best practices

used in other countries where TCE is operating and has as a result meant that TCE in South Africa as been

able to reach a much higher percentage of its goals.

Since TCE in South Africa has expanded, it has become necessary to increase the number of coordinating

offices (corps offices) from one to three. This has led to the formation of a Corps Commander Forum (CCF),

where the corps commanders and their deputies meet and make sure that all TCEs in South Africa are

moving in the right direction. The CCF takes place over two days every month and one day is used for

discussions about results, public relations and partnership, while the second day is used for producing

materials such as pamphlets, manuals and newsletters. Humana will continue to use its tried and tested

methods for monitoring and evaluation that have proven themselves efficient and easy to use as well as

comprehensive. TCE will from time to time make improvements on its M&E tools based on experience in

South Africa and in other countries that gets pooled together in the aforementioned meeting. In the TCE

areas in South Africa that are PEPFAR funded Humana has adapted some of its systems to specifically

capture the required indicators in abstinence and being faithful (AB) and other program areas effectively

and accurately.

------------

SUMMARY:

Humana People to People (Humana) implements a comprehensive, integrated abstinence, be faithful and

condom (ABC) HIV and AIDS prevention program called Total Control of the Epidemic (TCE). TCE trains

community members as field officers (FOs). FOs utilize a person-to-person campaign approach to reach

every household within the target area with prevention messages including the correct and consistent use of

condoms and on prevention of mother-to-child transmission (PMTCT). The major emphasis area is

community mobilization/participation, while minor emphasis areas are development of

network/linkages/referral systems, information, education and communication (IEC), and training. Key target

populations are men, women, pregnant women, discordant couples, migrant workers, out-of-school youth,

community leaders and traditional healers.

BACKGROUND:

TCE was launched by Humana in 2000 in Zimbabwe. The program has been implemented in eight

countries in Southern Africa, reaching a population of five million. Humana received its first PEPFAR

funding in July 2005. As of August 2007, Humana had implemented its project in five PEPFAR funded TCE

areas in the provinces of Mpumalanga and Limpopo. FY 2008 will ensure expansion in the number of TCEs

in these provinces. In the first two years of implementation 400 community members were trained as FOs

and prevention services have been provided to 60% of the targeted community members. FOs mobilize

communities to address stigma and discrimination associated with HIV and AIDS and to raise awareness of

HIV preventive behaviors. TCE tracks service provision by gender, and develops strategies to reach men

Activity Narrative: with condoms and other prevention messages. FOs promote gender equity during their home-visits by

empowering both sexes with information and education and tailoring the information given to address

gender-specific vulnerabilities. TCE trains community volunteers - known as Passionates -- to establish

vegetable gardens, run children and youth clubs, and to offer care and support to orphans and people living

with HIV (PLHIV). Humana works in partnership with the Mopani and Ehlanzeni district municipalities, major

partners contributing over $140,000 per year to the program until the end of 2007. TCE has received a

number of awards, including the 2003 Stars of Africa Award (in partnership with Johnson and Johnson) for

best Corporate Social Investment Program within Health/HIV and AIDS in South Africa. TCE also expects to

scale up its coverage with funding from Global Fund via South African National AIDS Council (SANAC) in

2008.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Household-Based Person to Person Campaign

The TCE Program uses a person-to-person campaign to reach every single household with information

about HIV and AIDS within the targeted areas. Each FO is allocated a field of 2,000 people (350-485

households). Households are visited at least three times over a three-year period and receive targeted IEC

messages emphasizing age-appropriate prevention messages focusing on the use of condoms with the

objective of changing community sexual norms. FOs visit households and engage individuals in discussions

on preventive behavior and promote counseling and testing (CT) and PMTCT. FOs explain about

government services such as CT, prevention of mother-to-child transmission (PMTCT), TB programs, STI

screening, social grants and home-based care, and refer those in need. FOs also refer people with

symptoms of AIDS-related conditions directly to public health clinics for CD4 testing, HIV clinical staging,

and treatment of opportunistic infections. Although the TCE program focuses on AB messages, it also

provides sexually active and at-risk community members with prevention messages on the use of condoms

and PMTCT. TCE carries out a series of targeted interventions to reach people at workplaces, bars and

shebeens, armed forces, at-risk youth and vulnerable population groups, such as taxi drivers, sex-workers

and young men, with information on the use of condoms. During campaigns, the FOs assess the needs of

the individual, tailoring their messages to address the different needs of specific populations. FOs address

issues such as the increased risk of HIV transmission when engaging in casual sex encounters, in

commercial sex, cross-generational sex, transactional sex, having sex with an HIV-infected partner or one

whose status is unknown.

TCE has also developed a tool called Perpendicular Estimate System (PES), which is tailored to measure

the impact of the program in the target areas; PES consists of a set of questions and demands to the

individual in order to be TCE-compliant, which means being in control of HIV and AIDS in one's life. During

the second and third year of the program, community members interact with their TCE FOs on an individual

basis to make a PES-plan, which minimizes their risk of being infected and makes them live responsibly and

positively if infected.

TCE organizes workshops for key players in the community, such as local leaders, traditional healers and

community-based organizations to promote the use of condoms and CT. TCE also establishes condom

outlets in the homes of FOs and Passionates. The FOs educate pregnant women on PMTCT and refer

them to antenatal clinics. In the one-to-one counseling, FOs also address issues of domestic violence, child

abuse, alcohol abuse and use of drugs.

ACTIVITY 2: Human Capacity Building

Through weekly meetings, the FOs receive continuous internal training, in the first year as lay-counselors,

and during the second year as educators. The training is based on experiences gathered in the field. TCE

makes use of both its own materials, which are continuously tested and updated and educational materials

developed by other organizations and the government. TCE often makes use of guest speakers from

government and other organizations for training purposes. Passionates are trained in HIV and AIDS and in

communication and facilitation skills (such as running youth clubs), and some are trained to distribute and

demonstrate the use of condoms.

ACTIVITY 3: Linkages with Sectors and Initiatives

TCE works in close collaboration with other stakeholders in the region. For example, the Department of

Health provides all the condoms that are distributed by TCE and FOs mobilize and refer pregnant women to

public sector antenatal clinics for PMTCT. Furthermore, TCE has a strong partnership with the tuberculosis

(TB) sub-directorate in the Ehlanzeni and Mopani districts, where FOs are trained to raise awareness about

TB, make referrals to clinics and collect sputum. TCE also cooperates with SAG departments including the

Department of Social Development to ensure that OVC and PLHIV, who are identified through household

visits, are able to access social security. Through the door-to-door campaign, FOs identify patients in need

of palliative care and refer them to services provided under the TCE program or to other services.

ACTIVITY 4: Monitoring and Evaluation

TCE has developed a range of systems to measure the results of the program. Before starting in a new

area, TCE carries out a baseline survey collecting information about knowledge, attitudes and practices of

community members. After implementation, each FO has a household register and maintains basic

information about each household and is a continuous source of data to evaluate the progress of the

program, such as number of people tested, number of OVC and pregnant women referred to PMTCT and

STI services. Data from the PES campaign is used to track community behavior change. This data provides

information on individual behavior change in the target area. Throughout the program, the FOs and TCE

Management meet on a weekly and monthly basis to evaluate the progress of the program. The meetings

monitor the progress of achieving targets and deliberate on the challenges faced in the field. Quarterly, TCE

management meet with staff at the TCE Regional Headquarters in Zimbabwe to further evaluate the

Activity Narrative: progress of the program and develop activities in order to increase impact.

Special Forces and Development Instructors (international volunteers) monitor services and ensure quality

control through periodic spot check visits to households.

These activities will contribute to the 2-7-10 goals of averting 7 million new infections by increased

knowledge and skills among community members in HIV and AIDS prevention; reduced stigma; higher

gender equity; increased knowledge about services (PMTCT and CT); increased use of condoms;

strengthened linkages between other organizations in the area and government services; increased number

of people knowing their HIV status; and higher mobilization and capacity

New/Continuing Activity: Continuing Activity

Continuing Activity: 13977

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13977 7884.08 U.S. Agency for Humana People to 6672 479.08 $430,500

International People in South

Development Africa

7884 7884.07 U.S. Agency for Humana People to 4491 479.07 $500,000

International People in South

Development Africa

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Health-related Wraparound Programs

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $183,672

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $30,500

Education

Water

Table 3.3.03:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

ACTIVITY 1 Home-based care:

During FY 2007 Humana People to People (Humana) has managed to start its own home-based care

program in three local municipalities: Bushbuckridge in Mpumalanga and Greater Tzaneen and Greater

Letaba in Limpopo province. By FY 2009 the clients will no longer be identified by the Total Control of the

Epidemic (TCE) Field Officers as TCE will no longer be operating in these areas. Instead, the clients will be

identified by HOPE Activists, counselors working in the clinics, HOPE Counselors and by the Caregivers

themselves.

Humana will include and further develop the training of HOPE Caregivers in support of holistic palliative

care that includes services falling under emotional/psychological, social, clinical and physical (including pain

and symptom management) and spiritual needs, as well as integrated prevention services. The training will

also focus on issues around prevention with positives and will include services such as adherence and

disclosure support, family centered care, counseling and testing (CT), sexually transmitted infections (STIs),

alcohol assessment and counseling, bereavement support and wrap-around family planning programs. The

training program will include care and support for caregivers and referral networks. The caregivers are

trained in accordance with the Department of Health's 69-day training for Community Care Workers. In

addition to this, the caregivers also receive continuous training through Humana's internal trainings and bi-

monthly meetings where courses are held by the leadership of HOPE as well as guest speakers from the

Department of Health and other service providers.

ACTIVITY 2 Support for people on ARV treatment (TRIO):

This is a correction to the FY 2008 COP narrative regarding the description of the TRIO. A TRIO consists of

three people: someone who is HIV-infected and two TRIO Passionates (usually family members or close

friends). In the areas where TCE has finished its three-year program, the responsibility for supporting the

TRIOs will start to fall under the HOPE projects. Finally, a TRIO can be formed before the client starts

taking antiretrovirals (ARVs). When a TRIO is formed at this stage, it means that the client will be well

prepared for taking the treatment when the time comes.

Humana will include and further develop the training of Field Officers in HIV/family planning integration (for

prevention with positives). There will be a focus on developing skills and knowledge to support holistic

palliative care that includes services falling under Emotional, Social, Physical and Spiritual needs.

ACTIVITY 3 Linkages with sectors and initiatives:

As well as continuing to strengthen the links that have already been established, Humana People to People

will create linkages with more governmental and non-governmental organizations and departments as the

TCE program expands into new areas with new stakeholders. Humana will work to develop and strengthen

referral networks and working relationships with other organizations working within the same geographic

areas to aid in the provision of holistic service. This will be done by formalizing the referral systems, e.g.

entering signed agreements with networking partners. This will also include referrals of clients for STI

screening and management, family planning, and substance/alcohol abuse.

-----------------------------

SUMMARY:

Humana implements a comprehensive HIV and AIDS prevention and care program called Total Control of

the Epidemic. This program trains community members as Field Officers (FOs) to utilize a person-to-person

campaign methodology to reach every single household within the project target area with HIV-related care

services where necessary. The major emphasis area is community mobilization/participation, while minor

emphasis areas are development of referral systems and training. Key target populations are PLHIV,

pregnant HIV-infected women, families affected by HIV and AIDS, and caregivers.

BACKGROUND:

Since 2000, TCE has been implemented in eight countries in Southern Africa reaching a population of 5

million people. This program trains community volunteers to reach every single household within the project

target area with a comprehensive program that includes care, prevention and CT. Effort will be made to

ensure equitable access to care services for both males and females. In 2007 Humana has 5 PEPFAR

funded TCE areas in the Mpumalanga province and one area in the Limpopo province. With FY 2007

funding, Humana added elements of palliative care to its program. Humana has previously implemented

home-based care (HBC) programs and activities are implemented according to the experiences gained from

those programs and work across the region. Furthermore, Humana is implementing the TRIO program,

which provides support for people on ARV treatment in Limpopo and Gauteng in a public-private

partnership with Johnson & Johnson who have provided $750,000 for similar activities in different

geographic areas. Humana works in partnership with the South African Government (SAG) and the

Ehlanzeni and Mopani District Municipalities, which are major partners for the program and contribute with a

significant counterpart support. The program has received a number of awards, including the 2003 Stars of

Africa Award (in partnership with Johnson and Johnson) for best Corporate Social Investment Program

within Health/HIV and AIDS in South Africa.

ACTIVITIES AND EXPECTED RESULTS:

Humana has identified a need for palliative care services in the existing TCE areas. In the areas where

Humana operates, few HBC organizations exist or they lack the capacity to effectively deliver services. TCE

will implement palliative care activities with an emphasis on elements of the preventive care package with

home-based care and treatment adherence programs.

ACTIVITY 1: Home-based care

Activity Narrative: TCE will follow two strategies: 1) TCE strengthens existing HBC initiatives carried out by local CBOs

through training, monitoring and support of the caregivers and by employing a nurse who offers clinical

services to such programs, where it is appropriate, or 2) TCE starts its own HBC program and employs and

trains Passionates (community volunteers) as caregivers, and monitors and supports them in their work.

The caregivers will form groups of 10-20 and a nurse will be employed to carry out training and supervision

and offer clinical services to patients. The HBC program is implemented by Hope, a sub-program under

TCE with its own Project Leader and staff. The patients are identified through TCE's door-to-door campaign.

TCE makes use of SAG standards for HBC training and ensures that all caregivers are accredited by the

SAG. The HBC program provides and mobilizes for the elements of the preventive care package and

screening for pain and symptoms in addition to other clinical, psychological, social support and prevention

services to patients in need. The objective of the program is to bring relief and add quality to the lives of the

patients and their families. The home-based caregivers offer psychological and spiritual support to the

patients and their families, and clinical services, such as cleaning of wounds, analysis of symptoms,

monitoring of patients are offered by trained nurses. The program works in close conjunction with public or

other private services and refers patients to services; including where needed accompanying patients, and

conducting follow up visits. In order to be able to meet the challenges of their work, the home-based

caregivers will meet at least twice a week to receive continued training and support.

ACTIVITY 2: Support for people on ARV treatment (TRIO)

TCE has developed a unique system to offer support to people on ARV treatment. It is called the TRIO, as it

involves the patient, a family member or a friend, and a Field Officer. This system has been successfully

tested in Botswana, where TCE has reached a population of 900,000 people. TRIO will seek to provide and

mobilize for the elements of the preventive care package and ensuring that each patient adheres to the

ARV treatment through a Directly Observed Therapy strategy (DOT). Patients in the Humana TRIO program

will receive a package of care services tailored to their individual needs: education about ART and

adherence; screening for OIs, pain, symptoms; nutritional counseling and support, e.g. by facilitating the

patient receiving food parcels from the Department of Social Services or by vegetable gardens; and

referring patients to positive living clubs or support groups, either run by TCE or other organizations.

Volunteers will undergo training as trainers (TRIO supporters) in the above issues and carry out trainings of

family members and Passionates. In cases where needed, family members will also receive support from

the FOs, e.g. by being referred to CT, PMTCT and other services in the area. A nurse will be attached to the

program to offer clinical services to clients and to provide monitoring and supervision of services.

ACTIVITY 3: Linkages with sectors and initiatives

The activities within palliative care are a strongly integrated part of the TCE program. The Field Officers in

the basic prevention activities of TCE are well placed to identify community members in need of services.

Through this prevention strategy, all households receive messages on the benefits of care services and the

TRIO program, and are informed how to receive support from these programs. The care activities will be

integrated closely to Humana's CT activities, where people who have tested positive and who need care

can be referred to these programs to receive immediate support. Proposed collaboration includes: Linkages

with SAG clinics and hospitals providing treatment to facilitate access to ARVs and related services such as

support groups. A strong partnership with the TB sub-directorate in the Bohlabela district. FOs are trained to

raise awareness about TB, make referrals to clinics and collect sputum. Working with public clinics to

ensure that pregnant women have access to antenatal services and PMTCT. Working with the Department

of Education to ensure children and youth access education and receive HIV and AIDS information and

education.

These activities will contribute to the PEPFAR goal of reaching 10 million with care by offering care and

support to people living with HIV and AIDS through the already existing TCE program.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13978

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13978 7885.08 U.S. Agency for Humana People to 6672 479.08 $339,500

International People in South

Development Africa

7885 7885.07 U.S. Agency for Humana People to 4491 479.07 $300,000

International People in South

Development Africa

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing women's access to income and productive resources

* Reducing violence and coercion

Health-related Wraparound Programs

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $127,754

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $20,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $20,000

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $19,500

Education

Water

Table 3.3.08:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

ACTIVITY 1: Human Capacity Development

During FY 2007 Humana People to People's Total Control of the Epidemic (TCE) program increased the

number of counselors from six to eight per site, making 16 trained lay counselors in total. A new element in

the training of Hope counselors and field officers will be referrals to family planning during counseling of

people who are HIV-infected where Humana finds it appropriate.

ACTIVITY 2: Couseling and Testing (CT) Promotion and Support

In FY 2009 the Hope activists will take over from TCE to mobilize people to test in areas where TCE has

finished. By this time the HOPE activists (volunteers trained under HOPE Humana), many of them

Passionates, will be well established in the community. Both in TCE and in Hope, special actions will be

conducted to target men to be tested for HIV. This includes person-to-person (door-to-door) campaigns,

outreach to workplaces and shebeens, and campaigns among taxi and truck drivers.

ACTIVITY 3: CT Services

As of the middle of FY 2007, HOPE Humana Bushbuckridge gained permission from the Department of

Health to run its own CT site. Humana had expected to obtain permission to carry out CT in Mopani already

in July 2008. However, a series of new demands were put forward and they are still in the process of

seeking permission and hope to receive this permission in August 2008.

Also, more emphasis will be put on encouraging people to disclose to their partners and/or family members

in order be able to receive support e.g. from the TRIO programme, which TCE implements under palliative

care. TCE will also facilitate an increase in uptake of CT of males, youth and adults, MARPS (most at risk

populations) and persons in the 15 - 24 year age group. More information will also be given to clients about

family planning and referral to these services.

Additionally TCE field officers will be trained to screen clients for symptoms of TB by identifying people who

have been coughing for more than 3 weeks, having night sweats and losing weight. Clients showing these

symptoms will be referred to public health facilities for testing and treatment if necessary.

ACTIVITY 4: Mobile Testing

Humana now has permission to carry out mobile testing in Bushbuckridge. The mobile testing is performed

by nurses inside tents that are erected in the morning before the testing starts in whatever village the testing

is taking place that day. HOPE Humana sets up four tents, two for counseling and one for testing and one

as a waiting room. The set up has been approved by the Department of Health in the District. The concept

has been very well received by the communities, and the number of people tested increases significantly

with this campaign.

ACTIVITY 5: Linkages with Sectors and Initiatives

An additional and important linkage has been established with the PEPFAR-funded Bhubezi Health Centre

in training of nurses and caregivers and in provision of test kits. TCE field officers and HOPE counselors are

also referring to their services. Humana also is part of networking forums, where Bhubezi staff are active.

----------------------------------------------

SUMMARY:

Humana People to People (Humana) implements an HIV prevention program called Total Control of the

Epidemic (TCE). TCE's voluntary counseling and testing (CT) program focuses on (a) providing counseling

and testing (CT) to household members during home visits; (b) training lay counselors; (c) supporting South

African Government (SAG) services through human resources; (d) piloting mobile testing; and (e) following

up with household members to ensure that counseling and testing took place. The major emphasis area of

the CT program is community mobilization/participation, while minor emphasis areas are development of

network/linkages/referral systems and training. Key target populations are men, women, pregnant women,

discordant couples, migrants, community leaders, and traditional healers.

BACKGROUND:

Humana first launched TCE in Zimbabwe in 2000, and since then, TCE has been implemented in eight

countries in southern Africa reaching a population of five million people. This program trains community

members as Field Officers (FOs) to utilize a person-to-person campaign methodology to reach every single

household within the project target area with a comprehensive HIV and AIDS program that includes

prevention, CT, and palliative care. Humana received its first PEPFAR funding in July 2005. By FY 2007

Humana was managing five PEPFAR-funded TCE areas in the province of Mpumalanga and one TCE area

in Limpopo province. With FY 2007 funding, Humana will add palliative care activities to its program.

Humana has previously implemented care programs with TCE and other community programs in South

Africa. Furthermore, Humana is, at present, implementing the TRIO program, a public-private partnership

with Johnson & Johnson that provides support for people on antiretroviral treatment in Limpopo and

Gauteng. Lessons learned from this program and from similar activities in Botswana will be applied to

activities. Humana works in partnership with the SAG, and the Ehlanzeni and Mopani District Municipalities

are major partners of the program contributing with significant counterpart support. Humana's program has

received a number of awards, including the 2003 Stars of Africa Award (in partnership with Johnson &

Johnson) for best Corporate Social Investment Program within Health/HIV/AIDS in South Africa. In 2008,

TCE will expand its outreach activities with funds from the Global Fund through the South African National

Activity Narrative: Council on AIDS (SANAC).

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Development

TCE will increase the capacity of services for CT in the target areas by establishing two CT sites. TCE will

train two nurses and six counselors for each site. The nurses and counselors will all receive a once-off

training on CT and thereafter they provided with quarterly training on data management, referrals and

linkages and other refresher courses. Counselors will be trained in accordance with SAG policy and

guidelines. In addition, TCE will support the salaries of retired private sector nurses to provide testing

services.

ACTIVITY 2: CT Promotion and Support

CT sites will actively target couples and encourage them to go for counseling and testing as a strategy for

reaching both women and men. The sites will also actively seek to test children of HIV-infected people. The

TCE Field Officers will mobilize and refer clients to the CT sites. In addition, TCE encourages the FOs and

community volunteers (Passionates) to know their own status and thereby become good role models to

other members of their community. The FOs are trained as lay-counselors and will follow-up with people

after testing and offer them the necessary ongoing support, either through referral to existing services or by

establishing their own support systems, e.g. Positive Living Clubs and support groups.

ACTIVITY 3: CT Services

Based on previous experience, TCE has identified a need for increased access to CT in the areas where

TCE operates. Since 2005, Humana collaborated with loveLife, a South African NGO, to run a CT center

from the TCE offices at Bushbuckridge in Limpopo province. Negotiations are taking place with the District

Department of Health for TCE to start its own site and to work at public CT sites. In July 2007 Humana

obtained permission to start CT in Mopani District. Humana will have established two CT sites in FY 2007,

and these will be maintained in FY 2008. The CT sites together with the home-based care program will be

administered under a sub-program called Hope, which will continue to service each area after the three-

year TCE campaign ends.

ACTIVITY 4: Mobile Testing

Experience in the field has shown that many people cannot spare the time or money to visit their local CT

site. Experience in other TCE programs has demonstrated that mobile testing in communities has increased

the number of people tested. TCE is at present in negotiation with the District Department of Health about

mobile testing. Humana will carry out mobile testing from the two sites, both designed to ensure

confidentiality, at places in the communities to increase the accessibility to testing. These sites could be

established at a school, youth club, church or any other public site. In FY 2007, Humana will explore

possibilities of doing home-based testing. TCE is already carrying out home-based testing in Zambia and

Mozambique, where FOs are legally permitted to test.

ACTIVITY 5: Linkages with Sectors and Initiatives

In addition to running its own sites, TCE mobilizes community members to go for testing at public CT sites,

educates pregnant women about PMTCT, and makes referrals to antenatal clinics. Other TCE collaborative

activities include:

(a) working with PEPFAR partners and SAG hospitals to facilitate access to antiretroviral treatment and

related services such as support groups;

(b) conducting TCE-run activities for palliative care, which may absorb some of the needs identified by the

FOs during their door-to-door-campaign or at TCE's CT sites;

(c) Strengtheing a partnership with the TB sub-directorate in the Ehlanzeni and Mopani districts, as FOs are

trained to raise awareness about TB, make referrals to clinics and collect sputum;

(d) cooperating with SAG departments including the Department of Social Development to ensure that

orphans and vulnerable children (OVC) and people living with HIV who are identified through household

visits are able to access social grants;and

(e) working with the Department of Education to ensure children and youth access education and receive

information and education on HIV and AIDS.

These activities will contribute to the PEPFAR goal of providing care to 10 million HIV-affected individuals

through an increased number of people being tested and knowing their status resulting in fewer infections;

reduction of stigma as a result of more people knowing their status; higher gender equity through

counseling (individuals/couples); increased lifespan due to timely treatment of opportunistic infections,

positive living, monitoring of CD4 counts and entry to treatment programs before developing AIDS; and

strengthened linkages between services offered by government and other organizations.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13979

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13979 3021.08 U.S. Agency for Humana People to 6672 479.08 $582,000

International People in South

Development Africa

7625 3021.07 U.S. Agency for Humana People to 4491 479.07 $600,000

International People in South

Development Africa

3021 3021.06 U.S. Agency for Humana People to 2673 479.06 $200,000

International People in South

Development Africa

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

Health-related Wraparound Programs

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $224,283

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14: