Total Control of the Epidemic (TCE) is an integrated HIV intervention model that aims to reduce the spread of HIV and to increase care and support for those infected or affected by the virus. TCE will be carried out in cooperation with Ministry of Health (MOH) and with technical support from the Federation Humana People to People (HPP). Project volunteers will reduce stigma by addressing public gatherings. Field workers are governed by terms of reference and are trained in confidential counseling and testing using the finger prick method and national guidelines. There are 50 field workers in each TCE area that meet twice a month to report, train and share experiences. Work will continue in Monze and Sinazongwe districts with plans to expand to 1-4 districts to reach up to 500,000 people. The TCE project will continue mobile ART services in Monze and start them in Sinazongwe utilizing MOH personnel with allowances and fuel provided by TCE. The project will provide a vehicle to Sinazongwe. TCE plans to start resource centers in Mazabuka, Monze and Sinazongwe in cooperation with MOH. TCE will work with AIDS Healthcare Foundation training HIV Medics from communities that lack medical personal. TCE will partner with established support groups, youth clubs and womens clubs in the operation areas in order to increase care and support for people living with HIV/AIDS (PLWHA) and MARPS and to make prevention and care activities for OVCs and PLWHAs sustainable through income generating activities. TCE will finalize operation in Mazabuka district and hand over operations to relevant partners. Focus will be on support to discordant couples, MARPs and youth. TCE will target service providers to increase their knowledge and participation in prevention, care and support activities.

The plan is to test 80,000 people for HIV in COP2012 and 160,000 in COP2013. All people tested HIV positive will receive psycho social support as well as training in positive living measures such as improved nutrition, hygiene, exercises etc. and will be supported with referral services both in term of medical support as well as social and spiritual support. This will be carried out by the field workers when they carry out home visits.

The project will further mobilise community volunteers called passionate. Each of the 150 field workers in COP2012 will mobilise 50 passionates which brings a total of 7,500 passionates operating in the operation areas. The passionate will be trained to support PLWHA through providing support to OVCs, taking part in Trios which is a support system for PLWHA to increase adherence to treatment. They will further take part in fighting stigma and discrimination, fight gender based violence etc.

The field workers further carry out community meetings, mobilise the traditional leaders and service providers such as community health workers to improve care and support for people living with HIV/AIDS, OVCs and care givers in the operation area.

Training of TB /ART Treatment Supporters: The project will identify clinics in need of TB/ART Treatment Supporters and will identify volunteers to take up this responsibility. Ministry of Health and DAPP will facilitate the 6-day training of 100 treatment supporters which will be carried out at district level in COP 2012. A similar number will be trained in COP 2013. They will subsequently be attached to specific clinics, will receive bicycles and will be paid a small monthly allowance.

The TB/ART treatment supporters will attend to clients at the clinic and will as well carry out DOTS in households, train clients and their families to improve nutrition, hygiene and to adhere to treatment.

The goal is that 90% of people found to be HIV-positive in the operational areas are linked to health facilities for TB screening through the services provided by the field workers as well as through the trained TB/ART treatment supporters and through community volunteers (Passionates) providing behaviour change communication.

The Field officers will identify babies born to HIV positive mothers and follow them up. They will remind the mother to take the babies for testing and also encourage the mother to be in the support groups, where they will be supporting each other and the babies.

Policy dialogue meetings at provincial level: Two (2) meetings will be conducted in COP 2012 with participants from stakeholders at district, provincial and national levels. The project will be used to carry out dialogue on policy and implementation of HIV related programs in order to strengthen an internal evaluation of results and to develop and institutionalize best practices. Will carry out, or assist another agent to carry out, a retrospective evaluation of their work in Mazabuka District.Smart Care medical electronic record systems will be used to store data and link from mobile Art to District Medical Offices and the project will set up trainings with MOH Smart Care to assist medical personnel in the Districts and FOs. In order to scale up the Smart Care systems.

Community health systems strengthening: Community mobilization will go hand in hand with improved health services. The field workers are attached to the local clinics and work in close cooperation with the staff and secure a very important link between the people in the community and the health services for increased uptake and follow up. The field workers report to the clinics on results and quality control are provided from the health system on the CT the field workers carry out. The project will further work with the Ministry of Health (MOH) to strengthen existing health services through a number of strategies including training of community service providers attached to the clinics such as community counselors, treatment supporters and peer educators in BCC to help reduce the workload for existing health/clinic staff.

Mobile ART Services: The project will support the MOH in establishing mobile ART services in each of the targeted districts to reach underserved rural communities, while supporting their utilization of the Smart Care medical electronic record system..Capacity Building of Medical Health Center Staff: The project will utilize training modules developed by CDC and scale up training carried out in Monze in COP 2010. The goal is to train 40 medical personal to provide improved services related to ART, pediatric care and Smart Care.Training of HIV Medics: The project plans to work with AIDS Healthcare Foundation in training of HIV Medics. The training that has been approved by MOH will be carried out at Chainama College for 3 months. The goal is to train 10 HIV Medics who after the training will provide services at health centers with lack of trained personal or at bigger work-places as a private public partnership.

Networking and collaboration between stakeholders at district level: The project will spearhead and strengthen existing networks at the district level such as DATF and will additionally call for meetings covering specific themes and needs such as M&E.

Field workers will carry out awareness messages on male circumcision and refer beneficiaries to other partners undertaking MC activities in the operational districts

Provision of AB messages to youth: The field workers will target both in and out of school youth through schools and youth clubs and will focus on AB messages such as delaying sexual debut but will also sensitize youth over 15 years of age on consistent and correct condom use.During COP 2012, at least 30,000 youth over the age of fifteen (15) in target districts will have been reached individually and through community meetings, youth club gatherings, schools churches etc., with AB messages and communication, including discussions related to gender mainstreaming. The goal for COP 2013 is to reach at least 75,000 youth.The field workers will work together with the clinics in their operation areas to strenghten the youth friendly corners and to sensitize youth to increase uptake of provided services from these facilities.The established resource centers will provide information and organise networking meeting for youth and for youth organisations.

Low uptake of Counseling and Testing (CT) is the main contributing factor to the spread of HIV. The ZDHS (2007) indicates that 75% of men and 57.3% of women in Southern Province have never accessed Counseling and Testing.

Door-to-door BCC, home-based counseling, testing and support: The field workers will provide key messages in relation to HIV health issues as well as BCC, counseling and testing, care and support. The home based approach has been designed using the following 5 steps: A) Introduction, B) HIV information counseling and testing, C) HIV Prevention strategies, D) Disclosure and knowing partners status, E) Supporting and encouraging others. The field officers will adjust interventions according to the need of each individual, such as discussion of risk reduction plans for those testing HIV negative, PwP support for those testing positive, referral for TB screening and PMTCT.

A minimum of 40,000 individuals will have counseled, tested and received result for HIV in each year in target disticts in COP 2012 and 80,000 in COP 2013. Field workers will carry out quality door-to-door HIV Counselling and Testing using the message guide developed by CDC in cooperation with DAPP.

Train community volunteers as counselors and train lay counselors to carry out finger prick testing: The project will identify 30 volunteers and 60 already trained counselors in areas without government CT services in each COP, to be trained to provide counseling and finger prick testing. The training as counselors will be at district level for 3 weeks, followed by 3 weeks practical exercises in their local clinics. The training of already trained counselors will be for 4 days on carrying out finger prick testing. The idea is to ensure sustainability of the CT services after completion of the TCE program.

Capacity building in communities carried out by field workers will include sensitization and mobilization of faith based organizations and traditional leaders, in order for them to take part in prevention and care activities and be in the forefront to fight stigma and discrimination and reduce misconceptions or harmful traditional practices. Community meetings will be organized by community volunteers (passionates) and facilitated by field workers in order to promote an open dialogue on how to influence HIV related practices and norms in the communities.

MARP activities: 1000 people identified as being part of Most at Risk Populations (MARPs) will have been reached with individiual and small group level interventions in COP 2012 and 2500 MARPs will be reached in COP 2013.MARP activities will include migrant workers such as people living in and attached to the fishing camps and fishing trade in Monze, Sinazongwe and Choma, sex workers and truck drivers especially connected to the coal mine in Sinazongwe.The identification of and personal support to MARP will be carried out by peer educators in cooperation with local and district stakeholders. The peer educators will pay special attention to these groups in terms of referral services.Action to reduce the risk of HIV transmission for MARPs will be implemented to meet the specific needs of the target groups and include: establishment of Night STI Clinics in areas attracting many sex workers and truck drivers, training and supporting peer educators,, physcosocial counselling, and other income generating activities.

Establishing condom distribution outlets and distributing condoms: The project will strengthen existing condom outlets, establish 750 additional outlets in COP 2012, train peer educators to distribute condoms and mobilize the District Medical Office (DMO) to ensure sufficient condoms from the MOH central supply. Similar activities will be carried out in COP 2013 establishing additional 750 condom outlets.

Providing PwP information to PLWHA: The field workers will strenghen existing support groups for PLWHA and will mobilize people testing positive to join existing support groups and, where needed, to establish new groups. One person from each group will be trained as trainer in order to train the whole group in PwP, mobilize the group members to take part in preventive advocacy and to improve management and leadership of the groups. The goal is to train 100 PLWHA as trainers to reach 100 groups in COP 2012.At least 6,000 PLHWA will have received information and support through a minimum Positives with Positives (PwP) package as defined by CDC during COP 2012. These activities will continue in COP 2013 and be doubled up when starting in new areas.

Many women do not give birth at health centers providing PMTCT services due to long distances, lack of awareness and lack of support from partners and community members. Lack of follow up for HIV positive mothers and their babies results in delayed or no treatment and tests before and after birth and poor adherence to advice on breastfeeding and weaning practices. Low male involvement in maternal and child health reduces the support to pregnant women and infants.Door-to-door BCC, home-based counseling, testing and support: The field officers will provide key messages in relation to PMTCT to pregnant mothers including the importance of early antenatal care (ANC), counseling and testing for HIV as well as behaviour change. They carry out finger-prick testing activities on pregnant mothers, preferably as part of couple counseling and conduct referrals for PMTCT to the health centers.Field Officers will make an individual plan for each baby born to an HIV-infected mother until 18 months old. Follow ups will be made to each mother.DAPP will in cooperation with CDC establish standardized messages and IEC materials related to the referral to ANC and follow up on babies born to HIV positive mothers.The project will focus on Strengthening PMTCT services through orientation of Traditional Birth Attendants (TBAs), Community Health Workers (CHWs) and other community stakeholders to increase early ANC and male involvement as well as follow up services for mothers and babies.The TBA will be sensitized to advocate for pregnant women to deliver at health centres and to support them before and after delivery.The community health service providers will be identified by the field workers and will be trained/ oriented locally at health centers for two days. The participants will learn about the importance of PMTCT, ANC and post-natal services, the dangers of multiple concurrent partners before, during and after pregnancy, and discuss gender mainstreaming. The training will further focus on increasing male involvement in reproductive health services, and the importance of couple counseling.At least 3,000 pregnant women will be tested and receive their resuls in COP 2012 and 6000 in COP 2013 in the target districts. 1,000 HIV-infected women will be identified in COP 2012 and 2,000 HIV infected women in COP 2013.The goal is that at least 50% of pregnant women in the operational areas who are eligible for PMTCT are linked to health centres for antiretrovirals and health lessons from the clinics to reduce mother to child transmission of HIV by the end of COP 2012.

Distances to health centers with ART services and limited number of facilities offering Antiretroviral Therapy (ART) and CT and other relevant services in rural communities, coupled with poverty, increases the number of defaulters among PLHWA receiving timely and adequate treatment for opportunistic infections.

Support District Medical Offices with mobile ART/ PMTCT/ TB services: The Mobile ART program started in COP 2011 will be strengthened in Monze district and will start in Sinazongwe district. The goal is to reach 15 clinics with comprehensive ART/PMTCT/TB services in the two districts in COP2012 in the two districts. The MOH will second qualified medical staff comprising a medical officer, a counselor, a laboratory technician, two nurses and a driver who will receive allowances during mobile services while the salary will be paid by the government. The project will further provide Sinazongwe with a strong vehicle to support the services and will assist DMO in Monze to maintain the vehicle provided in COP 2011. The field workers will assist to mobilize the community members to make good use of the provided mobile services. The goal is to assist District clinics to provide 2,400 newly enrolled adults and children living with HIV with ART and other medical services and in total to assist MOH in providing services to 4,400 PLWHA.

Initiating and institutionalizing community service providers review meetings at clinics: The project will initiate, and later institutionalize, with support from MOH, local stakeholder meetings at the clinics involving volunteers active in HIV prevention and treatment such as TBAs, CHWs, TB DOTS supporters, counselors and treatment supporters and peer educators. This activity will be carried out in cooperation with the Community AIDS Task Forces.

The goal is that 56% of adults and children in the operational areas who qualify for ART will have been linked to ART services at government clinics and/or mobile facilities through referrals carried out by field workers in the end of COP 2012.

This will be linked to the mobile ART program as described under point 13.