The goal of this program is to improve the health of the people of Zimbabwe through reduced HIV prevalence among young adults and reduced mortality and morbidity among PLHIV. The strategic objective is to increase the availability of social sector services and related products through the private sector. The program will aim to achieve the following objectives: (i) Expand and improve private sector based health services; (ii) Improve the availability and range of affordable health products or supplies (iii) Promote healthy behaviors. Implementation is at national scale with focus on areas of elevated HIV prevalence. Key target groups include women and men 15-29 years and most at risk populations. The project will maximize private sector contributions and rigorously monitor and contain costs. The program supports the national strategy and uses national indicators to measure performance. Linkages with both public and private sectors and activities complement national programs and strategies. Activities are conducted in close collaboration with MOHCW, NAC and ZNFPC, as well as numerous local and community based organizations. Monitoring and evaluation efforts continue to be strengthened and form the basis for the program's evidence based decision making process. VEHICLES purchased under this mechanism = 10. New requests in COP FY 2012 = 11. Total planned/purchased/leased vehicles for the life of this mechanism = 21. New request justification - COP FY 2012: 6 vehicles ($246,000) will be used for delivery of community outreach services for VCT and HIV prevention. 2 vehicles ($52,000) will be used for condom distribution and delivery of MARP prevention services. 3 vehicles ($75,000) will be used for monitoring and supervision of HIV prevention services.

With more people knowing their HIV status, the demand for post-test support services has increased significantly in recent years. PSI and local partners operate a franchise of 14 New Life post-test support centers and 14 outreach teams. A network of community-based counselors, peer counselors and support groups for PLHIV provide services directly in communities and to patients enrolled in the national PMTCT and ART programs. 138,094 PLHIV accessed care services delivered by New Life between Oct 10 and Aug 12 and 103 ART and OI clinics have been supported through the ART adherence counseling program. With FY12 funds, SPSS will continue to provide care services through New Life and will leverage funding from other donors to maintain service delivery throughout the country. New Life counselors and peer counselors will continue to provide psycho-social counseling and ART adherence counseling to patients and their families accessing public sector health care facilities. All centers will expand reach to workforces with provision of direct psycho-social counseling and information on positive living to HIV positive employees. These teams will also build the capacity of peer educators at workplaces to provide ongoing support, establish support groups for PLHIV and to sensitize employers and employees on the importance of post-test support services for their HIV positive colleagues. Quarterly supervisory visits to all sites are essential to assuring that quality of service is maintained. These visits are complemented by external mystery client surveys, refresher trainings for all providers and counselors and ongoing sharing of best practices. 24,000 HIV positive New Start clients received CD4 cell count through 4 centers and 4 outreach teams in FY2011, using point of care CD4 cell count laboratory services, funded by USG and 6 more devices were received recently. The additional laboratory services will ease the bottleneck in accessing antiretroviral therapy for people testing HIV positive at New Start CT facilities. Due to financial constraints the program had to postpone the expansion of the care services to include antiretroviral therapy and treatment of opportunistic infections to FY13.

PSI, in collaboration with the MOHCW, integrated TB symptomatic screening for all HIV positive clients accessing CT services in 2005 and currently 14% of all HIV positive clients tested through New Start are TB suspects. Due to constraints in the health system, referred HIV+ TB suspects are often not able to access clinical diagnosis or services. SPSS has therefore integrated TB smear microscopy into two New Start sites to facilitate early diagnosis and treatment of HIV infected TB patients. The program has successfully leveraged funds through TBREACH and will expand smear microscopy services to two additional sites in Masvingo and Mutare. In addition the program will:

I. Intensify active TB case finding and HIV testing at the community level through mobile units in 4 urban and peri-urban areas.

II. Identify 20,000 TB suspects with chronic cough, detect 5,460 smear-negative and 1,200 smear positive TB cases among 4 urban and peri-urban communities.

iii. Introduce GenXpert technology at New Start centers in Bulawayo and Harare to improve active TB case finding among HIV positive clients and detect an additional 300 HIV+ TB patients and refer these into TB care.

iv. Intensify the referral system between HTC and TB treatment centres, including referral tracing using SMS messaging and active referral tracking

PSI will monitor TB laboratory performance using internal and national external quality control mechanisms which are already in place. The program will use existing national M&E tools to report on implementation progress and participate in regular TB partnership meeting chaired by the MOHCW to exchange on progress and challenges in program implementation. The program will build on the work started so far by developing a multi - media communication campaign to increase awareness of the availability of TB diagnostic services to those who test HIV positive at the New Start centers. The campaign will seek to encourage sexually active people to know their status early at the New Start centers in order to receive early diagnosis of TB and receive appropriate medication if they are HIV positive.

Over 40,000 males have been circumcised since May 2009 including 30.608 in FY11. Assuming leveraging of funds from other donors (Gates and DFID) the program expects to reach 100,000 males in FY12. Service delivery at four major urban sites will be maintained and expansion to six additional fixed sites will cover all provinces. The majority of clients will be reached via mobile services provided by10 teams. The program will increase the number of health care staff providing safe MC through additional training using standard national training guidelines. Performance will be monitored using the current M&E tools, which are part of the national HMIS and using national agreed performance indicators. Quality of service is measured through regular internal and external supervisory visits using standard monitoring tools and a quality assurance and monitoring system ensures safe medical services. 99.5% of clients are tested for HIV prior to the procedure. To ensure this high percentage is maintained, all MC sites will provide CT services and the existing referral systems between CT and MC programs will continue. Currently all HIV positive clients are referred into appropriate care and treatment and receive comprehensive counseling at the MC sites. Leveraged funds will also be used to produce communications materials to increase awareness of MC in the communities through both Mass Media and interpersonal communications and the program will continue to use national MMC campaigns during school holidays and with traditionally circumcising communities to increase demand for MMC. Communication and demand creation activities will primarily target adolescent males 13-19 years old, the majority of whom have not yet initiated sexual activity and young adult males 20-29 years, many of whom are sexually active. A multi media campaign will provide accurate knowledge about the HIV prevention benefits of MC, womens involvement and the need to maintain positive behaviors post procedure. PSI will work with community-based youth organisations and volunteers to IPC activities and advocate with key groups including the media, womens groups and political, religious and traditional leaders.

PSI supported Zimbabwes National Behavior Change Program in implementing interpersonal and mass media communications to address concurrent sexual partnerships. Based on research which showed perceived costs and benefits as the key determinants of concurrency among sexually active adults, PSI developed and implemented a communications campaign in all provinces reaching 262,521 individuals in FY 2011.

FY12 funds will be used to implement the on-going Phase 2 communications campaign to reach young women ages 15-24 years who engage in concurrent sexual partnerships for luxuries (cell phone, cash, transportation) and married men, 25 39 years. Target group selection was based on epidemiological trends showing higher HIV prevalence among females in the 15-24 age groups than men in the same age groups reflecting significant levels of age disparate sexual relationships among the younger women and older men.

Edutainment shows coupled with small group discussions using standard discussion guides and flipcharts will be implemented in schools, colleges, at market places, beer halls, and community meetings. Special focus areas will include urban areas, growth points, farming areas including resettlement and commercial farms, along the highway and other high risk areas in all districts. IPC sessions will be complimented by lecture series in schools, colleges and at community gatherings to target young women and present tips and stories from successful women in the community to demonstrate that success is a result of personal drive and effort. An estimated 100 schools in urban and rural areas will be reached. Based on recent media research by the Zimbabwe Advertising Research Foundation showing higher listenership and readership figures of radio over television, emphasis will be on radio and newspaper placements to maximize reach of the target audience.

PSI will continue to monitor IPC sessions using the current M&E tools, field visits and regular training workshops for implementing partners.

59% of Zimbabweans have ever tested for HIV and 2.3 million have been tested through New Start since its inception in 1999 (an estimated 60% of the adult population in Zimbabwe). The program reaches equal proportions of men and women and 17% of all clients are couples. Mobile services ensure coverage of every district and provide services to the 60% of clients from rural areas. Currently 20% of 35,000 clients reached each month are from vulnerable population groups and populations at increased risk of HIV acquisition, such as migrant workers, displaced populations and sex workers and their clients. Over 95% of services are provided through a client initiated approach, but the program also supports the government in provider initiated CT at 4 sites located within public sector health care facilities. Client initiated services constitute an important approach to identify people living with HIV and represent an important HIV prevention intervention especially for discordant couples. PSI will maintain its 4 directly managed sites including 8 outreach teams located in the major urban areas as well as 13 local partner managed sites and outreach teams. The program expects to provide C&T services for 370,000 adults >16 years and 2,000 children <16 years of age and will continue to monitor performance using the current M&E tools and PEPFAR indicators. Quality will be monitored by Mystery Client surveys and quarterly supervisory visits. A strong referral system has been established and all referred clients are actively followed up to ensure that they reach the service provider. The program uses the serial testing algorithm in line with national guidelines and will monitor lab performance using internal and national external quality control mechanisms. Communications will normalize the process of accessing testing as a couple. IPC using small group discussions will encourage couples to get tested together and advocacy will also be conducted with political and traditional leaders, the media and religions organizations. Print materials (leaflets and posters) will promote couple testing and PSI will support the MOHCW to conduct nationwide HTC campaigns during specific calendar events.

Male and female condoms

29.2 million Protector Plus male condoms were distributed through SPSS in Zimbabwe in FY11 representing 35% of national distribution. High risk outlets, (liquor, tuck shops, pharmacies, service stations support groups and lodges) contributed 47% of total sales. 29,450,000 male condoms will be distributed in FY12 and direct distribution through 14 sales officers will continue to ensure availability in high risk areas including business centers, border towns, mining and farming encampments, and along the highway. Emphasis will be on stocking high risk outlets with late opening hours and catering to alcohol users. New emerging retail outlets will be identified to bridge the gap created by the virtual collapse of the wholesale channel. Small group discussions will aim to increase self efficacy to use condoms correctly; improve negotiation skill; normalize condom use and increase quality perceptions especially among couples in sero- discordant relationships, sex workers, migrant populations and alcohol users. PSI will integrate messages on knowledge of status, concurrency and MC and will support local implementing partners to provide behavior change communicaiotns using standard discussion guides. PSI will review the price, positioning and packaging to maintain positive value perceptions of the product. Radio, print and outdoor channels will be utilized to increase quality perceptions and acceptability of the product. According to ZNASP II, female condoms are an important prevention tool among high risk groups such as sex workers. PSI will continue to distribute care female condoms through a network of over 1,500 hair salons and will distribute 1,320,000 care condoms in FY12. To expand reach, new hair dressers and barbers will be identified and trained in high risk areas. PSI will work with local partners to reach young women in tertiary colleges and sex workers in high risk areas. Strong MIS systems will monitor route cycle compliance and coverage, access and product visibility will be measured to ensure targeting of high risk areas. PSI will continue to use existing monitoring tools to assess IPC implementing partners performance and improved based on feedback.

Additional funding will support Treatment Scale-up. Please refer to scale-up proposal.