The purpose is to support scale-up of prevention with positive activities in Bonjanala Platinum and Dr. Ruth Segomotsi Momapti districts, Northwest province to reduce new HIV infections. I-TECH, will collaborate with, and increase the capacity of provincial government programs.. I-TECH will expand and augment HCT with sexually transmitted infections syndromic management; tuberculosis screening; pregnancy testing; personalized risk-reduction counseling for promoting safer sexual behaviors, consistent and correct condom use, reducing the number of multiple concurrent sexual partners, and disclosure to sexual partners and appropriate family members; family planning; provision of male and femalcondoms; and referrals for medical male circumcision. This will be accomplishedby hosting eight community-based Wellness Days per month in Bonjanala Platinum district and 8 Wellness Days per month in Dr. Ruth Segomotsi Momapti district. A minimum of 43,200 people will be screened and counseled over the course of five years in Northwest Province. Referrals and linkages to Primary Health Centers (PHCs) will be a primary focus. I-TECH will also strengthen health systems by implementing a positive prevention training program for PHC nurses in 130 PHCs. I-TECH will train 300 district trainers to implement the PP program and train 520 clinical nurse mentors to build sustainability and local support for nurses initiating and managing ART in the North West Province. I-TECH will conduct training-of-trainers for local community members to facilitate the post test clubs (PTCs), building long-term sustainability for the program at the district level. Women will be prioritized for the TOTs.

I-TECH will support the NDoH HCT campaign by hosting sixteen Wellness Days per month in eight community-based venues in two districts in North West Province for any person over the age of 18 years of age. Wellness Days will include client-initiated HIV counseling and testing (using Bioline rapid tests) augmented with pregnancy testing, rapid RPR syphilis testing in pregnant women, syndromic management for STIs (using the NDoH guidelines), symptomatic screening and referral for TB, personalized risk-reduction counseling for family planning, education on ones sero-status, actively and safely facilitating mutual disclosure to sexual partners and appropriate household members, screening for interest in safe medical male circumcision, promotion of safer sexual behaviors (including partner reduction and alcohol risk-reduction), and emphasizing the importance of consistent and correct condom use. Condoms will be widely disseminated and female and male condom demonstrations will be integrated into counseling activities during Wellness Day activities, post-test clubs and in training at PHCs. The counseling standard for this program will be modeled on the client-centered, personalized risk model recommended by the U.S. CDC and World Health Organization (WHO). This counseling model is grounded in personalized risk assessment and the development of a realistic, personalized risk reduction plan for each participant. Furthermore, to optimize HCT services, I-TECH will encourage use of couples-based HCT for wellness days, where both partners are tested simultaneously and disclose their results to each other during post-test counseling, a strategy that has been documented to decrease rates of sero-conversion and reduce sexual risk behavior. A standard protocol for conducting couples-based HCT (including training testing counselors) will be used.

Referrals and linkages to follow-up services are a primary focus during Wellness Days. Persons testing positive for HIV, women presenting with vaginal discharge and lower abdominal pain, persons screened positive for TB using the screening tool, any pregnant woman regardless of HIV status, and men seeking medical male circumcision (MMC) will be referred to local PHCs. In order to increase linkage to care, those referred to a PHC will be given incentive cards to present to staff at the PHC in addition to the patient passport. If persons referred for follow-up at a PHC present their incentive card at primary health centers within two weeks of the Wellness Day, they will be given 20 Rand of cell phone air time at the conclusion of their appointment. All routine testing and treatment patient data will be collected during Wellness Days using the national data collection forms to ensure standardization of data collection and reporting. The data process will mirror that of the PHCs; HCWs will use tick sheets, registers, and other national tools.

I-TECH will conduct community mobilization through Post Test Clubs (PTCs). This will include establishing 64 PTCs (12 members each) and they will reach 302,400 community members. I-TECH will also conduct training for about 768 PTC members (the course will cover PwP messaging, HIV transmission risks, STI and other related content). I-TECH will conduct training on Prevention with Positives (PwP) for healthcare workers (HCWs). PwP will be added when training the clinical nurse mentors for NIMART. The target is to produce 1020 Nurse Trainers and 540 Nurse mentors. In addition, I-TECH will develop training and mentoring programs for M & E assistants and HCW in selected Primary Health Care facilities. The target is to train 20 officers per year. I-TECH will conduct a training of trainers which will includes staff in the NW-DOH supported by I-TECH, as well as staff from other districts in Northwest, so that they can roll out the training in their areas. The HCWs that will be trained on PwP will include lay counselors, nurses, health promoters and others staff who conduct patient counseling. This will enhance integration of PwP in all service points and it will improve linkages to care and treatment. This program plans to reach about 1,700,000 people in 5 years (340 000 per year) and the estimated unit cost is about $4.5 for each person reached.