The program directly contributes to the prevention care and treatment strategies of the National Strategic Framework on HIV and AIDS 2009 -2014 and the PEPFAR Partnership Framework Implementation plan by expanding comprehensive prevention, care and treatment to the military their families and the civilian community 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 the Phocweni clinic supported by other USDF clinic staff and Soka Uncobe. The USDF will continue to support decentralized services at all the military clinics. This will be achieved through improving HIV testing and counseling at all the USDF sites and ensuring that the USDF provides quality laboratory services to support clinical care for the USDF and the Ministry of Health. Pre-service training for all the critical health systems support will continue to be supported. Health systems support will continue through funding the support for a non-military physician.

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

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

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

Care for OVC is a growing concern in the USDF and Emergency Plan funding will support activities that strengthen 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 enable development of OVC programs. Based on needs assessments, specific interventions may include training caregivers, and providing increased OVC access to education, food, and other supportive services.

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

The goal of this budget code narrative is to decrease HIV/TB co-infections in the USDF. It is expanding on previous capacity building for the USDF in opportunistic infections, palliative care, and integrated management of adult illness (IMAI). This activity is a priority because military staff is at high risk for HIV and 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 service delivery, monitoring, and evaluation; (2) establish referral systems; and (3) strengthen infection prevention. They key activities of this budget code narrative include: assisting the military to scale-up the current TB services for HIV-infected clients, the MOH/URC will provide technical assistance to the USDF to conduct a situational analysis of TB prophylaxis and TB/HIV treatment in the military. To build capacity in service delivery, the MOH will continue to train military nurses and doctors to offer TB treatment and prophylaxis to HIV-infected clients. Nurses and counselors will be trained in adherence counseling to promote 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 to reinforce 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 the military's capacity to treat, or sputum negative TB suspects at facilities not staffed by a physician. Military sick bays on each base can also assist MoH to promote adherence and trace defaulters, besides other defaulter tracing mechanisms such as telephone contacts.

Supportive supervision and quality assurance (QA) activities will ensure linkages with the National TB Control Program and strengthen USDF clinical systems. Through linkages to the national program, the USDF 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, including quarterly palliative care meetings and annual supportive supervision visits. To complement these systems, MOH/URC clinical and nursing mentors will assist military staff through regularly scheduled on-site mentoring and support that includes support for TB prophylaxis services, screening for and treatment of TB disease in HIV-infected clients, and referral follow-up. Through this capacity building effort, MOH / URC will also ensure that USDF take full ownership of managing the TB/HIV program.

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

In FY 2012, the activities established in FY 2011 at the Phocweni clinic will continue. These include USDF 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 infant diagnosis 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 of early infant diagnosis and follow-up through training for PMTCT staff as well as lab technicians, and through the implementation and support of the transportation system. EGPAFs care and support model for HIV-positive children includes provision of regular clinical assessments (monthly for HIV-exposed infants and every six months for older, stable children); staging and baseline CD4 counts or percentages for all HIV-positive children; follow-up CD4 every six months or more frequently as needed; management of HIV-related illnesses, including OI diagnosis and treatment; and routine provision of Co-trimoxazole prophylaxis 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 having TB 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 INH prophylaxis.

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

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

Laboratory support is essential for implementation of a comprehensive and decentralized ART program in the military. Emphasizing the unique nature of the military and the issue of confidentiality of data, the USDF has established their own laboratory facilities where ART services will be provided. CDC and URC works 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 laboratory catchment 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 provide backup 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. The MOH has seconded a laboratory supervisor in the interim the USDF human capacity is being developed to support the laboratory facilities. An additional 4 students will be enrolled in FY-12 to train at diploma level. The National Referral laboratory will facilitate the training of at least 12 military laboratory personnel through MOH in order to ensure appropriate use of the new equipment and provision of quality services and sustainability of services at the military facilities. As the ART services expand, further training needs assessment in this important program area will be conducted so that additional military personnel can be trained to ensure sustainability. The USDF will continue to collaborate with the MOH in identifying and selecting critical members to be trained as laboratory technicians in order to ensure the suitability of services in the USDF facilities.

In addition, the USDF will also continue to seek the support of MOH in terms of quality assurance of the services provided in the military laboratory facilities. CD4 testing is an important tool for determining clinical 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 tests within military laboratories in order to ensure effective and sustainable ART service provision within the military 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 regularly monitor patients on HAART, it is anticipated that the requests for CD4 counts will increase markedly in the short term. Logistics for the procurement of pharmaceuticals will be discussed in details between the USDF and the MOH.

Currently counseling sessions are recorded manually making it difficult to adequately track which HIV positive personnel are receiving required counseling, who is missing appointments, and to coordinate support 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 for counseling to continue as soldier deploy to other camps. An additional benefit is that those involved in counseling and support activities will now have access to on-line support materials and a wider network of expertise.

Activities will include training of personnel from the USDF HIV/AIDS program office, chaplains office, and medical services in monitoring and evaluation techniques and reporting. This is currently one of the weakest aspects of the USDFs effort. This activity will specifically target military personnel and their family 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 programs to those behaviors associated with highest risk in the military. This activity will support the strategic plan by providing information on male behaviors in the USDF and directly linking behaviors to sero-positivity

Health System Strengthening is fundamental to the USDF and is in line with GOKS and USG partnership framework and, consequently, intersects all technical areas under the USDFs HIV/AIDS program activities. A common thread of institutional capacity building is woven throughout all activities, promoting USDF's competency at conceptualizing, planning, designing, managing, monitoring and evaluating 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 complete their 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 laboratory technology diploma, 1 degree in medicine, 4 for a diploma in Pharmacy tech and 2 students trained in palliative 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 for in-service training in ART, 1 laboratory assistant will be trained in ART laboratory, 2 TOT, 2 counselors in TOT counseling through IDI in Uganda.

Salary support for the USDF physician will be supported.

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

In FY 12, the Umbutfo Swaziland Defense Force will ensure that male circumcision efforts are rolled out as an additional method for HIV prevention. Through PEPFAR support, the military has expanded HIV care and treatment to 8 military-operated clinics. The USDF will build capacity for MC in the military through the training of providers, sensitization of soldiers and their partners for circumcision. The physical infrastructure 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 and services are attentive to socio-cultural context, human rights and ethical principles, health services strengthening, training, gender implications, service delivery, and program evaluation. These activities address the key legislative issues on gender, particularly with respect to male norms and stigma reduction.

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 soldiers practice sexual abstinence and fidelity, factors such as separation from families, mobility and age make them vulnerable to HIV. The USDF is implementing community-based activities among soldiers, their sexual 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 reflect best 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) and prevention of alcohol abuse.

In FY 2012, these activities will continue to reach at least 8 000 members of the military with prevention messages. The military AIDS support clubs will work to sensitize surrounding communities about risky sexual 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.

The activity supports the USDFs HIV/AIDS program by providing counseling and testing services to the military members and community members in the vicinity of the USDF sites. Funds for this activity will be used to provide in-service training for military nurses and HIV/AIDS counselors who conduct counseling and testing and to support the monitoring, evaluation and quality assurance. This activity will continue to support the USDFs HIV/AIDS program by providing military community with counseling and testing services at the military counseling and testing centers. Additional VCT centers will be opened, where not existent yet and the existing 8 USDFs clinics will be strengthened. At least 2500 soldiers will receive HIV counseling and testing services through these initiatives. The USDF will train 30 soldiers in counseling and 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 and expert clients to ensure adherence to treatment. At all levels attention will be given to increasing the gender equity in accessing HIV/AIDS programs and addressing stigma and discrimination as well as positive living. In collaboration with the MOH, VCT IEC materials will be improved and disseminated to all VCT 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 close collaboration with the MOH.

Combination prevention is being promoted as an effective strategy for HIV prevention. Having an appropriate mix of behavioral, biological, structural and cross-cutting activities is expected to lead to improved HIV prevention. Militaries require strong HIV prevention programs and provide excellent sources for evidence based programming for effective interventions. Military programs generally already contain some elements of combination prevention. In FY-12, this military will fill in major activity gaps for HIV prevention and increase the intensity of interventions. Evaluation of this approach will be done with a prevention approach to evaluations and comparison of incidence and prevalence (where baseline is available) before and after application of this approach. The USDF recently completed a biological/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 change communication (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 is implementing community-based activities among soldiers, their sexual partners, and surrounding communities 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 update communication 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 dual protection, and men as partners, gender-based violence and prevention of alcohol abuse. In FY-12, the USDF will continue these activities emphasizing correct and consistent condom use, ensuring condom access and availability (including minimizing the stigma surrounding condoms), promoting condom negotiation skills with partners, and emphasizing the role alcohol plays in risky behavior. Additional IEC materials promoting condom use will be developed. Peer educators will be retrained to reach 8000 individuals with prevention messages. The military drama group will work to sensitize surrounding communities about risky sexual behavior. Soldiers will be strongly encouraged to have HIV tests together with their partners. Male circumcision activities (early on described in CIRC narratives) will be equally closely integrated into this activity. Approximately 500 000 condoms will be distributed in FY-12. This activity is also related to HVAB, HVCT and CIRC activities.

In the military health network there are 9 military clinics throughout the country. In FY12, the USDF will work to increase access to prevention of mother-to-child transmission (PMTCT) services in military settings. PMTCT services will be integrated into existing infrastructure in military HIV/AIDS service delivery sites. The PMTCT partner will provide technical assistance for PMTCT services in 9 military clinic sites. The military will offer a standard package of PMTCT services to pregnant women which includes counseling and testing with informed consent, male partner and family-centered testing, intermittent preventive treatment (IPTp) in collaboration with the Presidents 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 PMTCT clients and their families, link PMTCT services with other HIV and MCH interventions, and assure an effective continuum of care by increasing patient involvement and community participation in PMTCT services. Military providers and technical staff at 9 military clinics will be trained through new and refresher on-the-job training in the expanded national PMTCT protocol, including use of site-level algorithms and checklists, as well as laboratory monitoring. The USDF will conduct performance improvement and QA of PMTCT services through regular supervision of sites, coaching, and strengthening capacity of sites in M&E of PMTCT. Efforts will support the development of QA and M&E skills, including in data collection, data use, and reporting. In collaboration with local services, providers will refer PMTCT clients and their families to HBC, OVC support, IGA, and facility- and community-based MCH services promoting key preventive interventions such as bed nets, immunizations, hygiene/safe drinking water and nutritional support. These community-based services will assist in the monitoring and tracking of pregnant and postpartum HIV-positive women and their infants, as well as promote MCH and PMTCT health-seeking behaviors which will intensify case finding and improve adherence to the new regimen. In addition will ensure referrals of pediatric patients from PMTCT to ARV services. The USDF through MOH, will provide ARV drugs, CD4 tests, rapid plasma reagin (RPR) test kits, polymerase chain reaction (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 drug management, 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 provide weaning food for exposed infants in need. In addition, the USDF will leverage food aid from other local resources to meet the other nutritional needs of these food insecure households. In collaboration with MOH, USDF will update the tools for community mobilization for PMTCT, provide training to community volunteers to promote PMTCT, and will work with clinical

The activity supports the USDFs HIV/AIDS program by providing a comprehensive care and treatment package that includes, but not limited to Pre-ART, ART and post-ART care, treatment and support services, to the military personnel, their families and community members within the neighborhood of the USDF clinics. The basic elements of care being; enrolment into chronic care for all HIV positive individuals, providing cotrimoxazole prophylaxis, TB screening for all HIV positive individuals using the national screening tool, sputum testing and radiologically using chest X-rays. Also, monitoring of CD4 levels, liver and kidney function, and complete blood count tests form the essential elements of care. All individuals found eligible for ART are started on treatment and clinically monitored according to the national HIV/ART treatment guidelines.

The USDF HIV/AIDS program shares the same ART clinical monitoring database, developed by the MOH in collaboration with other partners (MSH and ICAP), and the information obtained from this system is used to enhance quality patient care through direct use of data at point of care and data review exercises. At the site level, the data is used to inform the on-going quality improvement exercises, being technically supported by other partners besides MOH. All individuals initiated on antiretroviral therapy are followed 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 reducing the observed low defaulter rates in the USDF HIV/TB treatment program. Besides, the use of the expert client in provision of Pre-ART and ongoing counseling is increasingly becoming an evident strategy worth expanding. The physician, with support from MOH and other partners (ICAP) provide onsite mentoring and preceptorship, through continued medical education sessions and clinical update meetings for both nurses, counselors, expert clients and other staff involved in HIV/ART care. Direct supervision on HIV/ART care and treatment is provided by the physician. In-Service (short) nurse training in HIV/ART care among other areas is critical part of the HIV/ART services decentralization exercise to other USDF clinics. With the exception of the physician who is non-military personnel, all the care treatment and support 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 treatment services to all the 9 USDF clinics, strengthen the capacity of the clinics to provide quality and timely comprehensive care, enhance in-service training for military nurses, HIV/AIDS counselors, expert clients and other staff cadres involved in HIV/ART care, strengthen the monitoring and evaluation, and quality assurance component of the care and treatment, through training more data clerks among others. The funds will also USDFs HIV/AIDS program by providing a means to monitor and follow-up individuals initiated on therapy, to improve retention into the treatment program and ultimately improve on treatment outcomes that is a better quality and prolonged life the military community, their families and the communities.

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

The USDF in collaboration with EGPAF will train providers, including doctors, nurses, and other health cadres in the management of pediatric HIV using national guidelines. This training is a part of the series of 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 treatment services to ensure more comprehensive and continuous care for people leaving with HIV/AIDS. EGPAF will train health care providers in early infant diagnosis using the Dry Blood Spot (DBS) technique and link the USDF system to the national system of specimen collection and testing. Links to integrate clinical and community activities to improve early identification of clients, follow up, and retention in care will also be ensured.The USDF will also offer pediatric / child counseling to the children, their parents and other family members and this will involve firstly, the training of identified family personnel in the area of child counseling.

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

To support performance improvement systems and quality ART service delivery, EGPAF will conduct supportive supervision visits to the 9 facilities. EGPAF will continue supporting the USDF in conducting workshops 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, to educate 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 will facilitate 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 and mentorship programs, while still mentoring and actively supporting the sites whenever necessary.