Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 6899
Country/Region: Botswana
Year: 2007
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $150,000

Funding for Care: Orphans and Vulnerable Children (HKID): $150,000

These funds will further strengthen and support the Technical Assistance provided to the Government of Botswana and other active OVC stakeholders. The funds will support DSS to establish and strengthen its coordinating structures both at the national and district level and though a partner will no longer provide the support, HHS/CDC technical officers will strengthen their supportive activities. Ensuring that the same number of OVCs can be reached indirectly as initially envisaged.

Table 3.3.09: Program Planning Overview Program Area: Counseling and Testing Budget Code: HVCT Program Area Code: 09 Total Planned Funding for Program Area: $ 6,556,000.00

Program Area Context:

In FY05 and FY06, the USG provided support to the Government of Botswana (GOB) through procurement of rapid HIV test kits, training, social marketing, increasing service delivery outlets, and NGO capacity building. Through this collaboration and with other development partners, Counseling and Testing (CT) services have rapidly expanded in Botswana. In 2005, over 230,000 tests were performed; Tebelopele Voluntary Counseling and Testing (VCT) centers counseled and tested 89,000 clients (75% of whom were first time testers), and the government facilities tested over 142,000. These numbers are expected to increase by at least 10% in 2006. It is estimated that over 30% of the adult population has received CT, up from 25% in 2004 and 18% in 2001.

All Emergency Plan (EP) supported CT activities are aligned with the Botswana National HIV/AIDS Strategic Framework and the EP 5-year Strategic Plan. In 2006, the National AIDS Coordinating Agency (NACA) recommended a 40% increase in the numbers of people counseled and tested by the routine testing model, and a 25% increase in the number tested in the VCT setting. These projections guided the CT technical working group in setting targets for FY07.

Rapid HIV testing in Botswana is performed by a wide range of health professionals, including well trained and supervised lay counselors. The GOB, through the Central Medical Stores (CMS), supplies rapid HIV tests to both the government facilities and to NGOs like Tebelopele and Botswana Christian AIDS Intervention Programs (BOCAIP). However, supplies are inconsistent, with occasional "stock-outs", so that some facilities are sometimes unable to perform rapid HIV tests. Tebelopele centers use EP funds to procure back-up stock.

Routine CT is available in 608 of the 642 public health facilities, and is offered in all 24 health districts in Botswana. VCT is available through 16 freestanding Tebelopele centers and 15 satellites, covering the largest two cities (Gaborone and Francistown) and all the larger towns and villages in the country. BOCAIP also provides VCT in 11 centers located throughout the country.

Services Botswana's CT strategy includes a strategic mix of provider- and client-initiated models. Traditional VCT is provided by the network of Tebelopele centers, other NGOs and FBOs, and also by government facilities. The NGOs/FBOs also work with the Department of Public Service Management (DPSM) to provide VCT in the work place, and with churches to provide CT in church premises. Mobile CT in caravans is provided by Tebelopele, especially for remote areas. Routine HIV testing (RHT) is largely provided by public health facilities.

Couples CT has been extensively promoted by the Tebelopele VCT centers through a number of campaigns, and through PMTCT and other programs. During FY06, over 80 trainers and 200 counselors were trained in couples HIV counseling and testing (CHCT) using the CDC developed protocol. As a result of promotions and training, the proportion of VCT clients testing as couples at the Tebelopele centers increased from 8.6% to 13% in 2005/2006. In 2007, efforts will be made to develop and/or adapt a protocol for providing follow-up prevention and supportive counseling to discordant couples.

Post-test services such as on-going supportive and risk-reduction counseling are provided in all settings, including public health facilities, NGO/CBO/FBO, support groups of PLWHA, and through the home-based care program. However, the availability and accessibility of these services is limited.

There are various cadres of HIV counselors in Botswana, just as there are various training modules. The MOH developed a training guide for a basic certificate course in HIV/AIDS counseling. This is a 2-week theory and 2-week practicum course offered by local training institutions like the Institute of Development Management (IDM) and BOCAIP. In addition to this course, a 1-week VCT specific course is provided for

counselors working in the VCT and other settings.

Testing of children is done in clinical settings, with the consent of their parent or guardian. To adolescents, prevention education is provided by a wide range of programs, and CT is provided if their parent or guardian consents.

During FY06 and FY07, an innovative program to provide home-based CT (Counseling and Testing Outreach) will be piloted in Selebi-Phikwe and Bobonong in northern Botswana, which have among the highest HIV prevalence in the country. This program will help to address several factors that prevent people from accessing CT services, including shortage of human resources, inadequate and inconsistent supply of test kits and consumables, and stigma.

Referrals and linkages During FY06, Tebelopele worked to strengthen referral linkages of clients from VCT settings to public health facilities and community support groups, and from the community to VCT centers and health facilities. At the Tebelopele VCT centers, all HIV positive clients are given a confidential referral letter to a government facility for them to be assessed for ARV therapy, Isoniazide Preventive Therapy (IPT), PMTCT eligibility, and for opportunistic infections (OI). The referral form was revised to include key information and contacts that may facilitate follow up. Tebelopele is currently tracking the referral of clients.

Referrals and linkages are major themes for a wide range of programs, as in the following: •Through mobilization of over 2,000 community leaders throughout Botswana, Humana People to People has worked with Tebelopele and BOCAIP to get more people referred for CT using a card that is retained in the testing centers. •Working with key stakeholders, Tebelopele plans to collect blood samples for CD4 cell counting for VCT clients (HIV infected), providing on-going risk-reduction counseling, as well as linking them more effectively to care and treatment. This program aims to improve "prevention for positives." •Clients testing through the Counseling and Testing Outreach program will be referred to public clinics, to support groups for PLWHAs and to the home-based care program in the districts of Selebi-Phikwe and Bobirwa. •The Men Sector (led by the Botswana Prisons and Botswana Defense Force) collaborate with the NGOs, Peace Corps and the DPSM in promoting CT for men. Policy

A major policy breakthrough has been the consensus that GOB reached with the Nurses Association of Botswana (NAB) for nurses to perform rapid HIV testing. There is now an urgent need to train all nurses how to perform the rapid tests. Training has/is been planned for FY06 and 07.

The age of consent for HIV testing being 21 is a major barrier for CT for younger people, some of whom are already sexually active. NACA has recommended reducing this age to 16. This recommendation is being discussed by Parliament in 2006, before it becomes Law.

Redesigning the traditional VCT protocol to shorten it and target it to clients' needs also requires discussion and consensus among VCT providers. Currently there is a concern that the pre-test session is too lengthy for clients who are already well informed about HIV/AIDS.

In other efforts in FY07, USG will provide support to MOH to improve data collection for RHT by data entry clerks at each District Health Team. In addition, USG will support MOH at the national level to improve monitoring and evaluation. Challenges and gaps include:

•Preventive and supportive services for those already tested are inadequate. •There are still weaknesses in referral linkages among service providers. •The VCT protocol for same-visit test results is out-dated, requiring review. •Lack of CT protocols for children and adolescents, •Protocol for providing on-going prevention counseling for discordant couples is not available. •Reaching men and youth will require innovative strategies as they are currently inadequately served.

Program Area Target: Number of service outlets providing counseling and testing according to 51 national and international standards Number of individuals who received counseling and testing for HIV and 111,663 received their test results (including TB) Number of individuals trained in counseling and testing according to national 855 and international standards

Table 3.3.09: