The program directly contributes to the prevention care and treatment strategies of the National StrategicFramework on HIV and AIDS 2009 -2014 and the PEPFAR Partnership Framework Implementation planby expanding comprehensive prevention, care and treatment to the military their families and the civiliancommunity within reach of the military program. Through combination prevention, the program aims to

reduce the rate of new infections among the USDF troops. MC services are provided through thePhocweni clinic supported by other USDF clinic staff and Soka Uncobe. The USDF will continue tosupport decentralized services at all the military clinics. This will be achieved through improving HIVtesting and counseling at all the USDF sites and ensuring that the USDF provides quality laboratoryservices to support clinical care for the USDF and the Ministry of Health. Pre-service training for all thecritical health systems support will continue to be supported. Health systems support will continue throughfunding the support for a non-military physician.

The goal of the program are to provide quality HIV treatment and care for military personnel, theirpartners and families, and community members who live in the surrounding areas. The basic carepackage includes clinical staging and baseline CD4 counts for all patients, CD4 cell count monitoringevery 6 months, prevention of opportunistic infections (OIs) through prophylaxis with cotrimoxazole(CTX) to eligible patients based on national guidelines, diagnosis and treatment of opportunisticinfections (OIs), psychosocial counseling (including counseling and referrals for HIV-positive femalevictims of domestic violence), and referrals for people living with HIV/AIDS (PLWHA) to community-basedbasic care and support (BCS) services based on their individual needs. HIV care packages will beprovided to all HIV+ individuals receiving care in 9 military sites. In order to improve the quality of HIVcare and treatment services, a minimum of 5 military health providers will be trained at the facility level inthe diagnosis and treatment of STIs/OIs/mental health disorders and these services will be integrated into9 clinics. To improve the health of HIV+ patients, a mobile treatment and care unit (MTCU) affiliated tothe health facility, will be maintained.

An outreach approach for HIV staging, clinical evaluation, and treatment initiation and follow-up withhard-to-reach HIV+ patients will be conducted. The MTCU will provide a continuum of care and treatmentservices, which includes but are not limited to: basic HIV laboratory tests, STI/OI screening andtreatment, provision of CTX prophylaxis, ART, ART adherence support, psychosocial support, familyplanning, nutrition counseling, prevention with positives (PWP), HIV status disclosure, spiritual care,bereavement care, and hygiene and malaria education. BCS activities are implemented in conjunctionwith other services such as VCT, FP, ART, TB/HIV, OIs, and/or STIs in military delivery settings. Peereducators will be retrained to provide social support to members.

Periodic inter-brigade/community interactive, experience-sharing discussion group workshops will beorganized to increase treatment adherence and share success stories witnessed during the course ofHIV therapy. PLWHA and their families will be referred to malaria prevention services, including theprovision of bed nets. For clinically-stable, healthier PLWHA, the USDF will work to strengthen referral tocommunity-based support groups to encourage treatment adherence and increase access to non-clinicalHIV care services. The USDF provides OI-related drugs, CD4 testing, and OI diagnostics for the clinicalmanagement of PLWHA enrolled in care. Technical assistance will be provided to the military tostrengthen linkages between community-based and clinic-based HIV care services. At brigade and/orcommunity levels, activities will include 1) the formation of civil-military allied associations of PLWHA andtraining of members in the provision of home-based care services, 2) access to locally-available and/orself-initiated nutritional support and 3) HIV prevention with positives which includes training of caregiverson adequate management, distribution and use of the care package and 4) HIV clinical case detection

and referral.

Strategic Area Budget Code Planned Amount

Care for OVC is a growing concern in the USDF and Emergency Plan funding will support activities thatstrengthen communities and families to meet the needs of children and families affected by HIV/AIDS.

Activities will include hosting technical assistance from Naval Medical Center San Diego to enabledevelopment of OVC programs. Based on needs assessments, specific interventions may includetraining caregivers, and providing increased OVC access to education, food, and other supportiveservices.

All 4 regions will be targeted for OVC services. Assessments and interventions will include participatoryapproaches and program evaluations. This initial focus will determine the numbers and needs of the OVCdependents for service delivery in the USDF, and integrated service delivery program, with relatedactivities described in the prevention and palliative care sections of this document.

Strategic Area Budget Code Planned Amount

The goal of this budget code narrative is to decrease HIV/TB co-infections in the USDF. It is expandingon previous capacity building for the USDF in opportunistic infections, palliative care, and integratedmanagement of adult illness (IMAI). This activity is a priority because military staff is at high risk for HIVand troops reside in congregate living settings that facilitate TB transmission.

The budget code has three main components that will assist the USDF to: (1) build capacity in servicedelivery, monitoring, and evaluation; (2) establish referral systems; and (3) strengthen infectionprevention. They key activities of this budget code narrative include: assisting the military to scale-up thecurrent TB services for HIV-infected clients, the MOH/URC will provide technical assistance to the USDFto conduct a situational analysis of TB prophylaxis and TB/HIV treatment in the military. To build capacityin service delivery, the MOH will continue to train military nurses and doctors to offer TB treatment andprophylaxis to HIV-infected clients. Nurses and counselors will be trained in adherence counseling topromote completion of drug regimens. In addition, the USDF will be assisted to establish a recording and

reporting system for Isoniazid Preventive Treatment (IPT). URC will continue to support the USDF toreinforce linkages with the National TB Control Program for the reporting of TB cases.

URC will assist the military to build a strong referral network for cases with drug resistance beyond themilitary's capacity to treat, or sputum negative TB suspects at facilities not staffed by a physician. Militarysick bays on each base can also assist MoH to promote adherence and trace defaulters, besides otherdefaulter tracing mechanisms such as telephone contacts.

Supportive supervision and quality assurance (QA) activities will ensure linkages with the National TBControl Program and strengthen USDF clinical systems. Through linkages to the national program, theUSDF will participate in quarterly regional monitoring and evaluation reviews of TB services. In addition,MOH will assist the USDF to establish systems for internal and external quality assurance, includingquarterly palliative care meetings and annual supportive supervision visits. To complement thesesystems, MOH/URC clinical and nursing mentors will assist military staff through regularly scheduledon-site mentoring and support that includes support for TB prophylaxis services, screening for andtreatment of TB disease in HIV-infected clients, and referral follow-up. Through this capacity buildingeffort, MOH / URC will also ensure that USDF take full ownership of managing the TB/HIV program.

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The USDF sites have approximately 1200 HIV-positive adults are enrolled in care. Of these, 800 arereceiving ART. In FY 2012 the USDF will provide support to significantly increase services for thepediatric population reached through military health care facilities. In FY 2011, the USDF provided anintegrated package of care and support services for HIV-exposed infants and HIV-positive children at thePhocweni clinic, including infant and child testing, initiation of ART for eligible children, provision ofprophylactic treatment and management of opportunistic infections.

In FY 2012, the activities established in FY 2011 at the Phocweni clinic will continue. These includeUSDF will provide care and support for HIV-exposed as well as infected children.

Care and support for HIV-exposed infants identified in PMTCT will include access to early infantdiagnosis using dried blood spots, provision of Co-trimoxazole prophylaxis until their HIV status is known,infant feeding support, and tracking of mothers and infants lost-to-follow-up for re-engagement in care.

To provide early initiation of ART for all HIV-positive infants, EGPAF will assist in the implementation ofearly infant diagnosis and follow-up through training for PMTCT staff as well as lab technicians, andthrough the implementation and support of the transportation system. EGPAF's care and support modelfor HIV-positive children includes provision of regular clinical assessments (monthly for HIV-exposedinfants and every six months for older, stable children); staging and baseline CD4 counts or percentagesfor all HIV-positive children; follow-up CD4 every six months or more frequently as needed; managementof HIV-related illnesses, including OI diagnosis and treatment; and routine provision of Co-trimoxazoleprophylaxis for eligible children and for all HIV-exposed infants.

USDF will implement the new pediatric care and treatment guidelines through training and supervision.All pediatric patients will be screened for TB at least once every six months. Children suspected of havingTB will be investigated to establish a diagnosis, and treatment will be initiated as per national guidelines.Children without active TB disease but who were exposed to an active case will be provided with INHprophylaxis.

Swaziland Hospice at Home will support, pain and symptom management, end-of-life care integratedmanagement of childhood illness (IMCI) will be provided at all the USDF clinics. The clinics will alsodistribute long-lasting insecticide-treated nets (LLIN), implement safe water interventions, and providebasic hygiene education and community outreach services including referral for complimentary foodsupport.

Activities aiming at strengthening nutritional services at the USDF supported sites will include training ofhealth care providers and counseling to HIV-positive mothers during pregnancy and after delivery toenable them to make informed choices about infant feeding. The nutritional support package for childrenis comprised of nutritional assessments using anthropometric indicators, the provision of food support toHIV-exposed infants, and management of malnutrition with micronutrient and multivitamin supplements.

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Laboratory support is essential for implementation of a comprehensive and decentralized ART programin the military. Emphasizing the unique nature of the military and the issue of confidentiality of data, theUSDF has established their own laboratory facilities where ART services will be provided. CDC and URCworks very closely with the USDF and the MOH to support this laboratory. It is estimated that by the end

of the reporting period military members will be receiving ART within the military settings during FY 2012.This includes services provided to the neighboring MOH facilities and clinics within the USDF laboratorycatchment area. Laboratory services will therefore cater for patient evaluation before initiation of ART,monitoring the clients on ART and the counseling and testing services. This laboratory will providebackup services to the National Laboratory in times of need.

The USDF is in the process of providing a pre-service training 2 medical laboratory technicians. TheMOH has seconded a laboratory supervisor in the interim the USDF human capacity is being developedto support the laboratory facilities. An additional 4 students will be enrolled in FY-12 to train at diplomalevel. The National Referral laboratory will facilitate the training of at least 12 military laboratory personnelthrough MOH in order to ensure appropriate use of the new equipment and provision of quality servicesand sustainability of services at the military facilities. As the ART services expand, further training needsassessment in this important program area will be conducted so that additional military personnel can betrained to ensure sustainability. The USDF will continue to collaborate with the MOH in identifying andselecting critical members to be trained as laboratory technicians in order to ensure the suitability ofservices in the USDF facilities.

In addition, the USDF will also continue to seek the support of MOH in terms of quality assurance of theservices provided in the military laboratory facilities. CD4 testing is an important tool for determiningclinical eligibility for HAART and coupled with other basic laboratory tests for monitoring HIV-disease.The USDF recognizes that it essential to perform CD4 testing as well as other basic monitoring testswithin military laboratories in order to ensure effective and sustainable ART service provision within themilitary health delivery system. CD4 tests, chemistry and hematolgy are currently being sent to MOH.Due to increased referrals from the military counseling and testing services and the need to regularlymonitor patients on HAART, it is anticipated that the requests for CD4 counts will increase markedly inthe short term. Logistics for the procurement of pharmaceuticals will be discussed in details between theUSDF and the MOH.

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Currently counseling sessions are recorded manually making it difficult to adequately track which HIVpositive personnel are receiving required counseling, who is missing appointments, and to coordinatesupport between the various medical, social welfare, and religious offices who are providing support to an

HIV positive soldier or family member. The lack of automation at unit level also makes it difficult forcounseling to continue as soldier deploy to other camps. An additional benefit is that those involved incounseling and support activities will now have access to on-line support materials and a wider networkof expertise.

Activities will include training of personnel from the USDF HIV/AIDS program office, chaplain's office, andmedical services in monitoring and evaluation techniques and reporting. This is currently one of theweakest aspects of the USDF's effort. This activity will specifically target military personnel and theirfamily members, especially those living with HIV AIDS. Estimated current target population is about 3000.Results from the survey will enable better service delivery planning, and targeting of prevention programsto those behaviors associated with highest risk in the military. This activity will support the strategic planby providing information on male behaviors in the USDF and directly linking behaviors to sero-positivity

Strategic Area Budget Code Planned Amount

Health System Strengthening is fundamental to the USDF and is in line with GOKS and USG partnershipframework and, consequently, intersects all technical areas under the USDF's HIV/AIDS programactivities. A common thread of institutional capacity building is woven throughout all activities,promoting USDF's competency at conceptualizing, planning, designing, managing, monitoring andevaluating effective HIV prevention strategies.

PEPFAR funding supports currently 4 students as undergraduates: 1 medical student in year 2 in FY-12,1 Pharmacy student - year 2 in FY-12, upgrading 2 nursing assistants to fully fledged nurses - year 2.Due to the current cash flow problems of the government 2 nursing students will be assisted to completetheir course work at the University of Swaziland and Southern Africa Nazarene University respectively.

In FY-12 the USDF would like to enroll a total of 9 students: 4 new students in medical laboratorytechnology diploma, 1 degree in medicine, 4 for a diploma in Pharmacy tech and 2 students trained inpalliative care at diploma level.

A total of 7 staff members of the USDF will be sent for in service training at IDI: 2 nurses will be sent forin-service training in ART, 1 laboratory assistant will be trained in ART laboratory, 2 TOT, 2 counselors inTOT counseling through IDI in Uganda.

Salary support for the USDF physician will be supported.

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The overall goal of this activity is to decrease new HIV infections in the USDF through the expansion ofmale circumcision (MC) services, emphasizing that MC be offered as part of an expanded approach toreduce HIV infections in conjunction with other prevention programs, including HIV testing andcounseling (TC), treatment for other sexually transmitted infections (STIs), promotion of safer-sexpractices and condom distribution. MC will not replace other known methods of HIV prevention and willbe considered as part of a comprehensive HIV prevention package. In FY 10, PEPFAR worked closelywith the Ministry of Health (MOH) and other donors in a national task force to develop policy thatrecognizes MC as an effective HIV prevention method alongside the ABC strategy. Expanding MC inthe military is considered vital since the military is predominately male, typically young, within thereproductive age group and highly mobile, and is considered a high risk group. The military provides anideal institutional setting to roll out of MC as an HIV prevention intervention as it has taken the lead incontrolling HIV transmission among troops.

In FY 12, the Umbutfo Swaziland Defense Force will ensure that male circumcision efforts are rolled outas an additional method for HIV prevention. Through PEPFAR support, the military has expanded HIVcare and treatment to 8 military-operated clinics. The USDF will build capacity for MC in the militarythrough the training of providers, sensitization of soldiers and their partners for circumcision. The physicalinfrastructure of clinical sites is ready to conduct proper circumcision.

MC is conducted on a voluntary basis on all soldiers requiring this service irrespective of HIV status andservices are attentive to socio-cultural context, human rights and ethical principles, health servicesstrengthening, training, gender implications, service delivery, and program evaluation. These activitiesaddress the key legislative issues on gender, particularly with respect to male norms and stigmareduction.

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The overall goal of this activity is to decrease new HIV infections through behavior change

communication. The focus is on abstinence and fidelity targeting military personnel. While some soldierspractice sexual abstinence and fidelity, factors such as separation from families, mobility and age makethem vulnerable to HIV. The USDF is implementing community-based activities among soldiers, theirsexual partners, and surrounding communities to promote abstinence and safer sexual behaviors.

Key prevention strategies are 1) capacity building for peer education and interpersonal communication(IPC) sessions (including edutainment /dramas"), 2) capacity building for the chaplaincy program, and 3)promotion of counseling and testing services. The USDF will update communication materials to reflectbest practices in the following areas: couples counseling and testing, integration of family planning (FP)into HIV/AIDS prevention (including PMTCT), men as partners, gender-based violence (GBV) andprevention of alcohol abuse.

In FY 2012, these activities will continue to reach at least 8 000 members of the military with preventionmessages. The military AIDS support clubs will work to sensitize surrounding communities about riskysexual behavior. The soldiers will be strongly encouraged to get tested with their partners. MC activities(described in CIRC narratives) will be closely integrated into this activity. This activity is related to HVOP,HVCT and CIRC activities.

Strategic Area Budget Code Planned Amount

The activity supports the USDF's HIV/AIDS program by providing counseling and testing services to themilitary members and community members in the vicinity of the USDF sites. Funds for this activity will beused to provide in-service training for military nurses and HIV/AIDS counselors who conduct counselingand testing and to support the monitoring, evaluation and quality assurance. This activity will continue tosupport the USDF's HIV/AIDS program by providing military community with counseling and testingservices at the military counseling and testing centers. Additional VCT centers will be opened, where notexistent yet and the existing 8 USDF's clinics will be strengthened. At least 2500 soldiers will receive HIVcounseling and testing services through these initiatives. The USDF will train 30 soldiers in counselingand testing thereby increasing the capacity of the USDF towards addressing the impacts of the epidemic.Soldiers who test positive will be referred to an ARV program and will be monitored by the clinic staff andexpert clients to ensure adherence to treatment. At all levels attention will be given to increasing thegender equity in accessing HIV/AIDS programs and addressing stigma and discrimination as well aspositive living. In collaboration with the MOH, VCT IEC materials will be improved and disseminated to allVCT centers in the military. The program will also work closely with the MOH Supply Chain Management

System in procuring test kits and other medical consumables. Quality assurances will be done in closecollaboration with the MOH.

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Combination prevention is being promoted as an effective strategy for HIV prevention. Having anappropriate mix of behavioral, biological, structural and cross-cutting activities is expected to lead toimproved HIV prevention. Militaries require strong HIV prevention programs and provide excellentsources for evidence based programming for effective interventions. Military programs generally alreadycontain some elements of combination prevention. In FY-12, this military will fill in major activity gaps forHIV prevention and increase the intensity of interventions. Evaluation of this approach will be done with aprevention approach to evaluations and comparison of incidence and prevalence (where baseline isavailable) before and after application of this approach. The USDF recently completed abiological/behavioral survey. Data from the survey will be used as baseline for evaluations.

The overall goal of this activity is to decrease new HIV infections in the military through behavior changecommunication (BCC) with a focus on correct and consistent use of condoms. As indicated before,although some soldiers practice sexual abstinence and fidelity, factors such as separation from families,mobility and age are significant factors thay may increase their risk to acquiring HIV. The USDF isimplementing community-based activities among soldiers, their sexual partners, and surroundingcommunities to promote safer sexual behaviors. Similarly, the key prevention strategies here include; 1)peer education and interpersonal communication (IPC) sessions (including "cine-mobiles,edutainment/dramas"), and 2) promotion of counseling and testing services. The USDF will updatecommunication materials to reflect best practices in the following areas: couples counseling and testing,integration of family planning (FP) into HIV/AIDS prevention (including PMTCT), condoms for dualprotection, and men as partners, gender-based violence and prevention of alcohol abuse. In FY-12, theUSDF will continue these activities emphasizing correct and consistent condom use, ensuring condomaccess and availability (including minimizing the stigma surrounding condoms), promoting condomnegotiation skills with partners, and emphasizing the role alcohol plays in risky behavior. Additional IECmaterials promoting condom use will be developed. Peer educators will be retrained to reach 8000individuals with prevention messages. The military drama group will work to sensitize surroundingcommunities about risky sexual behavior. Soldiers will be strongly encouraged to have HIV tests togetherwith their partners. Male circumcision activities (early on described in CIRC narratives) will be equallyclosely integrated into this activity. Approximately 500 000 condoms will be distributed in FY-12. Thisactivity is also related to HVAB, HVCT and CIRC activities.

Strategic Area Budget Code Planned Amount

In the military health network there are 9 military clinics throughout the country. In FY12, the USDF willwork to increase access to prevention of mother-to-child transmission (PMTCT) services in militarysettings. PMTCT services will be integrated into existing infrastructure in military HIV/AIDS servicedelivery sites. The PMTCT partner will provide technical assistance for PMTCT services in 9 militaryclinic sites. The military will offer a standard package of PMTCT services to pregnant women whichincludes counseling and testing with informed consent, male partner and family-centered testing,intermittent preventive treatment (IPTp) in collaboration with the President's Malaria Initiative (PMI),antiretroviral (ARV) prophylaxis using combination ARV regimens and HAART for eligible women,services for women who may be victims of gender-based violence including referrals to appropriate care,informed counseling and support, referral for family planning (FP) and maternal and child health (MCH)services, follow-up of HIV-exposed infants for referral to appropriate services, and early infant diagnosis,if possible. In addition, the USDF will ensure access to a comprehensive network of services for PMTCTclients and their families, link PMTCT services with other HIV and MCH interventions, and assure aneffective continuum of care by increasing patient involvement and community participation in PMTCTservices. Military providers and technical staff at 9 military clinics will be trained through new andrefresher on-the-job training in the expanded national PMTCT protocol, including use of site-levelalgorithms and checklists, as well as laboratory monitoring. The USDF will conduct performanceimprovement and QA of PMTCT services through regular supervision of sites, coaching, andstrengthening capacity of sites in M&E of PMTCT. Efforts will support the development of QA and M&Eskills, including in data collection, data use, and reporting. In collaboration with local services, providerswill refer PMTCT clients and their families to HBC, OVC support, IGA, and facility- and community-basedMCH services promoting key preventive interventions such as bed nets, immunizations, hygiene/safedrinking water and nutritional support. These community-based services will assist in the monitoring andtracking of pregnant and postpartum HIV-positive women and their infants, as well as promote MCH andPMTCT health-seeking behaviors which will intensify case finding and improve adherence to the newregimen. In addition will ensure referrals of pediatric patients from PMTCT to ARV services. The USDFthrough MOH, will provide ARV drugs, CD4 tests, rapid plasma reagin (RPR) test kits, polymerase chainreaction (PCR) tests, rapid HIV test kits, and hemoglobin testing materials to all supported sites.

The USDF will also collaborate with local organizations to improve the capacity of providers in drugmanagement, coordinated site-level storage, inventory, tracking and forecasting. The USDF will refer

PLWHA and their families to malaria prevention services including bed net provision. The will provideweaning food for exposed infants in need. In addition, the USDF will leverage food aid from other localresources to meet the other nutritional needs of these food insecure households. In collaboration withMOH, USDF will update the tools for community mobilization for PMTCT, provide training to communityvolunteers to promote PMTCT, and will work with clinical

Strategic Area Budget Code Planned Amount

The activity supports the USDF's HIV/AIDS program by providing a comprehensive care and treatmentpackage that includes, but not limited to Pre-ART, ART and post-ART care, treatment and supportservices, to the military personnel, their families and community members within the neighborhood of theUSDF clinics. The basic elements of care being; enrolment into chronic care for all HIV positiveindividuals, providing cotrimoxazole prophylaxis, TB screening for all HIV positive individuals using thenational screening tool, sputum testing and radiologically using chest X-rays. Also, monitoring of CD4levels, liver and kidney function, and complete blood count tests form the essential elements of care. Allindividuals found eligible for ART are started on treatment and clinically monitored according to thenational HIV/ART treatment guidelines.

The USDF HIV/AIDS program shares the same ART clinical monitoring database, developed by theMOH in collaboration with other partners (MSH and ICAP), and the information obtained from this systemis used to enhance quality patient care through direct use of data at point of care and data reviewexercises. At the site level, the data is used to inform the on-going quality improvement exercises, beingtechnically supported by other partners besides MOH. All individuals initiated on antiretroviral therapy arefollowed up using MOH developed tools and also telephonically, with the support of some partners(ICAP), in order to improve retention into the treatment program. This is helping tremendously in reducingthe observed low defaulter rates in the USDF HIV/TB treatment program. Besides, the use of the expertclient in provision of Pre-ART and ongoing counseling is increasingly becoming an evident strategy worthexpanding. The physician, with support from MOH and other partners (ICAP) provide onsite mentoringand preceptorship, through continued medical education sessions and clinical update meetings for bothnurses, counselors, expert clients and other staff involved in HIV/ART care. Direct supervision onHIV/ART care and treatment is provided by the physician. In-Service (short) nurse training in HIV/ARTcare among other areas is critical part of the HIV/ART services decentralization exercise to other USDFclinics. With the exception of the physician who is non-military personnel, all the care treatment andsupport services are being carried out by the USDF military personnel.

Funds for this activity in FY-12 will therefore be used to expedite decentralization of care and treatmentservices to all the 9 USDF clinics, strengthen the capacity of the clinics to provide quality and timelycomprehensive care, enhance in-service training for military nurses, HIV/AIDS counselors, expertclients and other staff cadres involved in HIV/ART care, strengthen the monitoring and evaluation, andquality assurance component of the care and treatment, through training more data clerks among others.The funds will also USDF's HIV/AIDS program by providing a means to monitor and follow-up individualsinitiated on therapy, to improve retention into the treatment program and ultimately improve on treatmentoutcomes that is a better quality and prolonged life the military community, their families and thecommunities.

Strategic Area Budget Code Planned Amount

Pediatric treatment is currently available at a very limited extent at the Phocweni military clinic wherethere is only one doctor trained in pediatric management.

The USDF in collaboration with EGPAF will train providers, including doctors, nurses, and other healthcadres in the management of pediatric HIV using national guidelines. This training is a part of the seriesof trainings on core competencies for these cadres and will also include ART and PMTCT management,in an effort to strengthen linkages between ART and other HIV/AIDS prevention, care and treatmentservices to ensure more comprehensive and continuous care for people leaving with HIV/AIDS. EGPAFwill train health care providers in early infant diagnosis using the Dry Blood Spot (DBS) technique andlink the USDF system to the national system of specimen collection and testing. Links to integrateclinical and community activities to improve early identification of clients, follow up, and retention in carewill also be ensured.The USDF will also offer pediatric / child counseling to the children, their parents andother family members and this will involve firstly, the training of identified family personnel in the area ofchild counseling.

Following the training, supervision visits to the service providers will be jointly conducted by EGPAF andthe USDF using supervisory tools that have been developed.

To support performance improvement systems and quality ART service delivery, EGPAF will conductsupportive supervision visits to the 9 facilities. EGPAF will continue supporting the USDF in conductingworkshops using the orientation package for lay workers on HIV/AIDS prevention, care and treatment,covering CT, PMTCT, Care and ART as well as linkages to other services such as TB and STIs, toeducate them on HIV/AIDS and provide them with accurate and relevant information they can

disseminate to more diverse populations.

To ensure sustainability, EGPAF works within the existing USDF structures and plans the USDF willfacilitate the development and dissemination of appropriate standard guidelines, protocols, and plans.EGPAF will continue to strengthen and expand facility-based performance improvement systems,providing increasing opportunities for the trained staff from model sites to lead supervision andmentorship programs, while still mentoring and actively supporting the sites whenever necessary.