Please describe the technical and programmatic plans for your program. This should include comprehensive goals and objectives, geographic coverage, target population, key contributions to health systems strengthening (if appropriate), description of cross-cussing programs and key issues (if selected), strategy to become more efficient over time, and M&E plans. (Limit: 5,500 characters)

The integrated HIV/AIDS project's objective is to reduce incidence and prevalence of HIV and mitigate its impact on PLWHA and their families. We will achieve this objective by working towards achieving three intermediate results:

- HCT and Prevention services expanded and improved in targeted areas: In line with the national strategy against HIV/AIDS, we recognize that community engagement is an important element in increasing the effectiveness of HCT and prevention services. Accordingly, we plan to mobilize communities to set and meet prevention objectives in line with their own priorities. Recognizing that each of the four regions (Kinshasa, Matadi, Lubumbashi, and Bukavu) where the project will intervene, presents unique risk factors that contribute to the spread of HIV, we will adapt and target MARP communities in each zone. In order to increase the uptake of testing services, we will bring HCT services closer to the community-level and coordinate with other projects to use BCC messaging to encourage

testing and other prevention strategies. Finally, we will draw on EGPAF's international experience to enhance PMTCT services currently offered by the AXxess project.

- Care, support, and treatment for PLWHA and OVC improved in targeted areas: The project will target PLWHA, OVCs and their communities in this component and will involve them in every step of implementation. Activities will be centered around the community and we will adopt the USG's strategy of integrating palliative care into the framework of the Family-Centered Continuum of HIV services. We will support PNLS and MINAS in developing and disseminating standard packages of services. For people living with HIV/AIDS, we will both improve the clinical aspects of palliative care and provide a holistic package of care and support interventions that improve not only their health but also their social and economic status. This includes interventions such as the positive living strategy, improvements to nutrition, legal rights, income-generating activities, etc. In addition, the project will develop a new comprehensive package of support for OVCs using the same holistic approach to ensure all aspects of the child's well-being are improved.

- Strengthening of health systems supported: In order to achieve the project results of improving prevention, and care, support, and treatment services, we must also build the capacity of governmental and non-governmental service providers. This project will play a supporting role in strengthening health systems at the central and provincial levels to better coordinate, plan, manage, and monitor health services in their areas with a particular emphasis on strengthening the flow and use of strategic information.

Our approach will increase efficiencies over time by working with existing local partners who are delivering critical HIV/AIDS services already and will build on the existing work that consortium members CRS and EGPAF are currently undertaking in country, by further refining their models and expanding their coverage. In addition, we will reach out to other partners also working in HIV/AIDS such as the Global Fund, PSI, AXxes, MSH, and others to leverage their resources and create more integrated services at the community level.

We will also focus on capacity-building to facilitate Congolese leadership and expand partners. The project will strengthen the capacity of government, civil society, and communities to deliver services and implement national strategies and protocols. Working with central and provincial PNLMS, PNLS, and MINAS to develop and disseminate norms and guidelines, the project will support them in their coordination and supervision role while also ensuring that our partners and services are in line with national guidelines.

Cross-cutting issues including the following:

- Food and Nutrition: Policy tools and service delivery: The project will be working with local partners to ensure PLWHA and OVC receive necessary food and nutrition support - Economic strengthening: PLWHA and OVC will receive support in income generating activities as part of their comprehensive care and support packages - Education: The project will be supporting the education of selected OVC as part of their support - Gender: The project will design a project-wide gender integration strategy that takes into account gender-specific vulnerabilities to HIV/AIDS and integrates specific interventions across the spectrum of services such as accessibility of HCT to both men and women, male involvement in PMTCT, education for female OVCs in particular and other integrated activities.

Our project monitoring and evaluation system will collect data on project outputs and trends and will also engage in evaluation of project approaches to determine their relative success and impact. We will design innovative approaches to collect data at the community level, and build the capacity of community, NGO, and government partners to collect, manage, and use data collected.

The project will continue partnerships with partners from the previous project such as AMO Congo, Foundation Femmes Plus, and the Bureau Diocésain des Oeuvres Médicales (BDOM), among others, and will ensure they can continue providing care and support services to PLWHA and OVC.

Following this, the project will develop and implement a need-based package of care for PLWHA. The package will increase access to quality community- and home-based care and support and will be implemented in partnership with local partners.. Elements of the package will include:

• Home-based care kits to reduce opportunistic infections • Psychosocial support • Food and nutrition support • Income generating activities • Human rights and protection

The package will be implemented through local organizations following a competitive RFA process and the organizations will receive technical support from project staff and consultants. In addition, the project will expand and improve facility based services in palliative care through the following methods:

• Training of community providers or caregivers in prevention of opportunistic infections • Put in place a rapid communication system between health facilities and community providers • Ensure high quality palliative care kits are available to PLHIV • Train health facility staff to provide nutritional education • Work closely with the zones de santé teams to strengthen their ability to provide supervision and support to their staff. • Ensure PLWHA have access to TB testing and treatment

The project will provide support to orphans and vulnerable children. The project will develop a care and support package for OVC that will include the some or all of the following elements to be determined following a needs assessment process. It will be implemented in partnership with local partners.

• Education support • Income generating activities • Food and nutrition support, including kitchen gardens • Child protection • Health • Psychosocial support

The package will be implemented through local organizations following a competitive RFA process and the organizations will receive technical support from project staff and consultants.

The project will also build the capacity of MINAS to implement the national OVC action plan and will engage them extensively in the implementation of the community based package.

The procurement of ARV by the project is to be done according to standards and norms agreed upon by WHO and USAID

The project will provide ARV for pregnant women n the four sites (Kinshasa, Bas Congo, Katanga and Sud Kivu). Collaboration mechanism will be established between other partners such as Clinton Foundation, Global Fund, and MAP to ensure that eligible persons under project targets are receiving ARV on a regular basis.

First, the project will assume responsibility for HCT centers funded by the previous project and provide bridge funding so they can continue providing HCT services.

Next, the project will evaluate quality of existing HCT services in DRC and make recommendations for improvements that will be incorporated into the project's strategy. Improvements will be rolled out through a training of trainers approach in partnership with PNLS and other HCT providers.

The project will directly support the opening of new HCT centers through both the Champion Community approach whereby communities identify new sites for HCT services and also through a separate RFA process specifically intended to fund new HCT centers.

The project will also create links and synergies between TB testing and treatment and HIV testing and treatment by integrating TB and HIV testing, counseling and treatment. We will use the provider-initiated counseling and testing approach (PICT) to ensure that TB patients are tested consistently for HIV and that PLHIV are tested for TB. Where services are already integrated, we will support these sites through continuous capacity building and by helping them mobilize those in the community with tuberculosis to also get HIV testing.

To ensure continuous supply of commodities, the project will first conduct an assessment of the commodities needs for HCT and determine the best method for procuring them including how to partner with other organizations and leverage their systems.

The program will improve basic pediatric care through training of service providers to follow protocols

including screening, testing, nutrition, etc. where feasible and appropriate. Linkages will be developed

between USG funded primary health care activities and PEPFAR funded activities in order to develop a

strong referral network for infants and children in need of care and treatment services. Children will also

benefit from community based care efforts.

Quality, routine monitoring and evaluation will be improved by training and coaching key MOH staff in

order to support data for decision making as well as the national M&E system. The program will support

improved administrative and managerial record maintenance regarding services provided (M&E),

personnel records including training conducted, and procurement records

The project will support health system strengthening through supporting the increased capacity of provincial governments primarily in the areas of coordination, monitoring, supervision, and data collection and analysis. Additionally, we will provide assistance in training them in national norms and guidelines that flow down to the provincial level.

The project will also work to improve the capacity of NGO service providers by strengthening their skills in delivering standard care, support, and treatment packages. We will also build their capacity in grants management and reporting so that they are effective local partners for this project and build their capacity to implement projects in the long term.

Finally, we have developed activities aimed at strengthening strategic information systems at the community and facility level so that there is sufficient information to allow evidence-based programming and policy-making. We will support facilities, provincial governments, and the central government in improving data quality, data analysis and its use in decision making.

The project will establish collaboration mechanism with selected schools in the target areas to identify or develop youth clubs or associations "Life Club" which can be used to increase AB behaviours among these specific groups (Kinshasa 6, Bas Congo 5, Katanga 5, Kinshasa 6, Sud Kivu 4, total 26 for the 1st year). For each existing or to be created club, a series of activities aimed at developing and reinforcing skills based sexuality, knowledge, fidelity practices and norms for mutual respect and open sexual communication. Each member of the club will receive a kit that contains: HIV visual aids, flyers, pamphlets , any other items

For young men and women not attending school and street kids affected or infected by HIV, the project will collaborate with NGOs, churches and other community associations involved in care, support and treatment for OVC in project sites. The project will reinforce the capacity of these NGOs/Churches/community associations to identify emerging leaders among HIV infected or affected street kids, sharpen their skills based sexuality, improve their knowledge about HIV and responsible sexual behaviours and promote fidelity practices, mutual respect and open sexual communication. Participating partners will provide each member of the "Hope Club" (Kinshasa 4, Bas Congo 3, Katanga

3, Sud Kivu 3) with a kit that contains items described above.

With regards to couples, the project will collaborate with selected Churches and other organizations (Kinshasa 6 , Bas Congo 4 , Katanga 5 , Sud Kivu 4) involved in providing programs and services to couples to promote mutual fidelity and respect, open sexual communication, to discourage multiple partnership, sexual violences, provide information and knowledge on HIV-AIDS. The project will reinforce the capacity of these organizations by providing them with materials, training modules and skills needed to achieve the stated activities.

We will use our community mobilization approach, Champion Communities, to develop and implement cost-effective and successful prevention strategies. The model will bring communities together to set objectives related to HIV/AIDS prevention, care and support such as defining most as risk populations in their community, determining key issues or messages that will be instrumental in reducing HIV incidence in their community, etc.

To implement the approach, the project will select 40 communities (10 in each of the four geographical areas) in addition to 3-4 communities of MARPS such as uniformed personnel, truck drivers, sex workers, or miners. Working through local NGO partners, the project will first work closely with officials in local government to get their buy-in and support, and then conduct trainings with the communities, facilitating their goal-setting process and setting out a time-bound work plan for achieving the results. The project will also train peer educators at the community level in implementing the prevention methodologies that are selected, distributing relevant BCC materials, and performing other HIV/AIDS prevention education activities.

Identify PMTCT service gaps, technical assistance needs, and new sites. The project will assess the state of PMTCT in DRC, including a mapping exercise of both AXxes sites and any public, private, faith- based, or community-based sites. The mapping exercise will identify potential sites from these groups that should be targeted by project technical assistance.

Provide comprehensive PMTCT services to address services gaps. The project will conduct a rapid

diagnosis of AXxes-supported PMTCT centers, develop capacity-building plans, and implement plans in all AXxes zones de santé through a cascade training approach (i.e., TOT to PNLS and the AXxes teams, who will then train services providers). The project will also identify other partners from the mapping exercise that have already begun to integrate PMTCT into their services and others that have not done so but meet certain defined criteria as an eligible site, such as having a high volume of pregnant women or a high MARP population. The project will then design and conduct the same rapid assessment planned as part of the support to AXxes sites. This will lead to the development of capacity building plans for these sites which will be implemented using a cascade training approach.

Increase uptake of comprehensive PMTCT services and referral of pregnant women eligible for ART services. The project will focus on addressing the main barriers to uptake of PMTCT services at all levels of care. We will first increase ANC attendance (PMTCT services' entry point) through the Champion Community approach. We will involve community counsellors to increase the number of HIV+ women who return to PMTCT maternities to deliver. We will introduce counselling and rapid testing at labour and delivery for women of unknown sero-status. Finally, we will ensure follow-up of mothers and infants after birth: developing tracking systems for mother-baby pairs who are absent for follow-up visits, and conducting counsellor-led home visits.

The program will support the provision of equipment and reagents, training of laboratory technicians, and

establishing quality assurance and supervision systems (especially in Lubumbashi).

The project will work with PNT and PNLS, to identify gaps in order to create links and synergies between

TB and HIV counseling, testing and treatment. Once the gaps are identified, the project will reinforce the

capacity of the above structures in its intervention sites. This will include among other training of service

providers, supply of commodities and test kits, referral and counter referral services, and M&E. The

ultimate goal is to have a complete HIV package of services integrated in each in each PNT sites

(CSDT). The project will use the provider-initiated counseling and testing approach (PICT) to ensure that

TB patients are consistently tested for HIV and that PLWHA are tested for TB. Where services are

already integrated, the project will provide continuous capacity building activities and community

mobilization for infected TB patients to be HIV tested.