PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
NEW/REPLACEMENT NARRATIVE
This activity includes one primary component: support for Development Aid from People to People's
(DAPP) Total Control of the Epidemic (TCE) program to educate community members on HIV prevention
and to link these individuals to appropriate prevention, care, and treatment services.
Development Aid from People to People (DAPP) will continue to use Field Officers (FOs) from TCE to
provide door-to-door, age-appropriate education to community members on the consistent and correct use
of condoms and other prevention messages, including basic information and referrals for counseling and
testing, PMTCT, and STI services. Overall, TCE supports abstinence/be faithful, other prevention, adult
and pediatric care, and counseling and testing (CT) activities, and thus funding is allocated across these
five program areas. TCE is a highly organized mobilization strategy to individually educate and empower
community members to reduce risk of HIV and to access resources in the community. DAPP FOs assess
the risk level of household members and provide information and referrals accordingly.
The DAPP TCE program leverages resources from both PEPFAR and Global Fund (GF). TCE was
established in northern Namibia in 2005 with support from GF and PEPFAR. GF and PEPFAR funds
support TCE in Omusati, Oshana, Ohangwena, Oshikoto, Kavango, and parts of Caprivi and Khomas
Regions. The 2005 GF annual report singled out the DAPP TCE program as one of three success stories in
Namibia. DAPP's sister interventions in Zimbabwe and Botswana have been evaluated: the findings from
both countries showed that TCE program exposure was positively associated with increases in HIV-related
knowledge, less stigmatizing attitudes, and HIV testing.
In 2008, Global Fund support for DAPP temporarily ended in three regions. As a result DAPP activities
were scheduled to be suspended until the next successful Global Fund application. In each of the three
regions, TCE activities provide essential prevention services, and are highly valued by Regional AIDS
Coordinating Committees (RACOC), local leaders, and other government and nongovernmental
organizations. If TCE activities ended in the regions, the trained and skilled FOs may have been lost before
the program could continue with future Global Fund money. Government officials requested that PEPFAR
provide temporary "bridge" funding in order to maintain the continuation of services in the three regions. In
response to the government's request, PEPFAR provided the interim funding.
COP09 funds will support continued and more intensive AB activities within current regions. Because youth
are at high risk for HIV infection, particularly young girls, FOs emphasize abstinence messages to persons
in houses and schools under age 15. During the ongoing sessions with under-15-year-olds, the FOs will
discuss knowledge about HIV transmission; decisions to avoid HIV infection; delaying the first sexual
encounter; and pregnancy and STI risks.
PEPFAR is committed to the continued support and enhancement of this important prevention activity.
PEPFAR intends to utilize the DAPP field officers for delivery of new prevention and communication
activities related to prevention with positives, responsible drinking, and male circumcision education.
Funding from PEPFAR will support a total of 408 FOs, including 128 previously supported through GF.
Both GF and PEPFAR will continue to provide technical support to DAPP.
Despite PEPFAR's interim support for the TCE activities in GF-supported regions, overall PEPFAR funding
for DAPP in COP09 has been reduced and expansion into new regions and activities has been put on hold
to sharpen the focus of DAPP's efforts. Both PEPFAR and GF supported assessments of the TCE program
conducted by CDC technical advisors identified that efforts must be more targeted to impact behavior
change and linking individuals to services. With COP09 funds, CDC/Namibia and CDC/Atlanta will continue
to work closely with DAPP to begin an impact assessment of the TCE program and to revise and harmonize
the TCE curricula and to produce relevant job aids.
The assessment and refined curricula should also allow DAPP to improve linkages to community- and
facility-based services, and expand their efforts to mobilize at-risk persons to access CT services at both
facility-based and standalone sites. DAPP FOs are successful at promoting the importance of knowing your
status to clients with whom they interact; however, many of these clients live in rural areas with little or no
access to CT services. In 2008, the Permanent Secretary of the MOHSS approved delivery of CT services
in non-traditional settings for the first time. In DAPP, FOs in select sites will work in collaboration with newly
formed MOHSS mobile CT teams to link clients to testing. (Discussed in the DAPP narrative in HVCT).
These pilots will be evaluated in 2009 to determine whether DAPP could begin to deliver door-to-door CT
services to complement the MOHSS' mobile CT efforts.
The organizational structure of DAPP's TCE program is sound. FOs operate in a continuous learning and
support system. Initial training educates the FOs on the basics of HIV transmission, STIs and TB,
abstinence, condom education, and behavior change. In each region, groups of 50 FOs meet together
each Friday under the leadership of a TC with support from Special Forces (SF). FOs report numbers of
persons educated, share experiences, and ask questions; training is provided as appropriate and
challenging questions are addressed through the chain of command.
From October 2007 through September 2008, FOs reached 46,415 individuals with other prevention
messages, significantly exceeding their established target of 10,000. FOs register each member of a
household to avoid duplicate counting. FOs provide each household member with age-appropriate AB and
OP communications, and mobilize community members to access services, including VCT, TB, ART,
PMTCT, family planning, OVC, and STI. The FOs provide psychosocial support and simplified messaging
around ART adherence and pain management. Where possible, FOs coordinate with health care facilities
to provide critical transportation to rural persons in need of accessing essential HIV/AIDS services.
Community volunteers are key partners with the FOs, communities, and health care facilities. From
October 2007 through September 2008, FOs have recruited 55,862 active "passionates" -- volunteers who
assist with delivery of health messages and referrals. TCE also coordinates with PEPFAR-funded
Activity Narrative: volunteers supported by the PACT program to refer individuals for palliative care and OVC services.
Supportive supervision of all community caregivers is provided by TCE Special Forces Officers, CDC nurse
mentors, and primary health care nurses from nearby facilities. FOs and volunteers are currently facilitating
53 support groups for people living with HIV and AIDS and their families. These groups not only include
psycho-social support, but also operate various income-generating activities including community gardens,
poultry farming, and other locally sustainable enterprises..
FOs also organize community-wide HIV-related activities. Other prevention efforts include education in
HIV/AIDS for traditional leaders and traditional birth attendants, as well as the establishment of small
community libraries. For adults, young persons who ask, and those at high risk of contracting HIV through
sexual contact (such as migrant workers and spouses, persons having sex with partners of unknown HIV
status, persons with multiple partners), FOs discuss knowledge about HIV transmission, abstaining or being
faithful to one partner, and, if appropriate, prevention of HIV through correct and consistent use of condoms,
incorporating condom demonstrations and knowing where condoms are available. As appropriate, FOs will
also distribute condoms to those who have received education.
FOs are ideally suited for knowing where to reach at-risk persons with AB and OP messaging, including
patrons of bars and shebeens (licensed and unlicensed local drinking establishments), commercial sex
workers, and mobile populations. FOs conduct quarterly campaigns and events in the communities to
sensitize the population to the dangers of HIV and STIs. FOs provide information, distribute pamphlets with
explanations and photos/drawings of symptoms of STIs, treatment and sites for treatment, how to avoid
getting infected and emphasize the need to get tested for HIV if STI symptoms are present.
The TCE program serves as an entry point for building human resources capacity within Namibia, as a
number of FOs, all of whom are Namibian, are able to parlay their experiences into promotional
opportunities as community counselors within the MOHSS and New Start Centers. This strengthens the
career ladder and the capacity of community counselors and clinic facilities, as well as builds the technical
expertise of FOs. Not only will FOs become employed as community counselors, but they are able to build
community awareness into facilities and strengthen the HIV continuum with community partners.
DAPP is a partner in the Male Norms Initiative begun in Namibia in 2007, which seeks to address cultural
norms that factor into HIV transmission, including lack of health care seeking behavior by men, destructive
"inheritance" practices imposed on widows by male family members, multiple sex partners, transactional
and trans-generational sex, power inequities between males and females, and alcohol abuse.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16119
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16119 3927.08 HHS/Centers for Development Aid 7356 1058.08 Cooperative $1,790,133
Disease Control & People to People, Agreement
Prevention Namibia U62/CCU02516
6
7325 3927.07 HHS/Centers for Development Aid 4382 1058.07 Cooperative $1,704,888
3927 3927.06 HHS/Centers for Development Aid 3150 1058.06 DAPP $336,509
Disease Control & People to People,
Prevention Namibia
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
* Reducing violence and coercion
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $1,467,909
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
and pediatric care, and counseling and testing activities, and thus funding is allocated across these five
program areas. TCE is a highly organized mobilization strategy to individually educate and empower
PEPFAR is committed to the continual support and enhancement of this important prevention activity.
change and linking individuals to services. With COP08 funds, CDC/Namibia and CDC/Atlanta will continue
facility-based services, and expand their efforts to mobilize at-risk persons to access counseling and testing
(CT) services at both facility-based and standalone sites. DAPP FOs are successful at promoting the
importance of knowing one's HIV status to clients with whom they interact; however, many of these clients
live in rural areas with little or no access to CT services. In 2008, the Permanent Secretary of the Ministry
of Health and Social Services (MOHSS) approved delivery of CT in non-traditional settings for the first time.
In DAPP, FOs in select sites will work in collaboration with newly formed MOHSS mobile CT teams to link
clients to testing. (Discussed in the DAPP narrative for HVCT). These pilots will be evaluated in 2009 to
determine whether DAPP could begin to deliver door-to-door CT services to complement the MOHSS'
mobile CT efforts.
From October 2007 through September 2008, FOs reached 97,598 individuals with other prevention
messages, significantly exceeding their established target of 40,000. FOs register each member of a
household to avoid duplicate counting. The FOs provide each household member with age-appropriate AB
and OP communications, and mobilize community members to access services, including VCT, TB, ART,
volunteers supported by the PACT program to refer individuals for palliative care and OVC services.
53 support groups for people living with HIV and AIDS (PLWHA) and their families.
Activity Narrative: FOs also organize community-wide HIV-related activities. Other prevention efforts include education in
status, persons with multiple partners), FOs discuss knowledge about HIV transmission and prevention of
HIV through correct and consistent use of condoms, incorporating condom demonstrations and knowing
where condoms are available.
FOs carry condoms with them and also establish distribution points. TCE FOs obtain free condoms from
regional mechanisms through MOHSS so condoms are not included in this budget. FOs are ideally suited
for knowing where to go and who to reach with condoms: at bars and shebeens (licensed and unlicensed
local bars), commercial sex workers, and mobile populations. FOs conduct quarterly campaigns and events
in the communities to sensitize the population to the dangers of HIV and STIs. FOs provide information,
distribute pamphlets with explanations and photos/drawings of symptoms of STIs, treatment and sites for
treatment, how to avoid getting infected and emphasize the need to get tested for HIV if STI symptoms are
present.
Continuing Activity: 16120
16120 3931.08 HHS/Centers for Development Aid 7356 1058.08 Cooperative $312,743
7327 3931.07 HHS/Centers for Development Aid 4382 1058.07 Cooperative $397,850
3931 3931.06 HHS/Centers for Development Aid 3150 1058.06 DAPP $444,218
* Increasing women's legal rights
Estimated amount of funding that is planned for Human Capacity Development $205,159
Table 3.3.03:
(DAPP) Total Control of the Epidemic (TCE) Program to educate community members on HIV prevention
DAPP leverages basic care resources to support TCE Field Officers (FOs) to provide education about HIV
prevention, care (including TB) and treatment and to make referrals to available services. DAPP's sister
interventions in Zimbabwe and Botswana have been evaluated and the findings from both countries showed
that TCE program exposure was positively associated with better HIV-related knowledge, less stigmatizing
attitudes, and HIV testing.
In COP09, this activity will expand to:
1. Create more support groups for people living with HIV and AIDS (PLWHA) which incorporate psycho-
social support and small income-generating projects (e.g. community gardens and poultry farming);
2. Strengthen the technical capacity of FOs to educate and refer families for preventive care services; and
3. Integrate TCE activities with other PEPFAR-funded activities to strengthen the quality of services.
DAPP funding is in four other areas: HVAB, HVOP, PDCS, and HVCT. The TCE program is a highly
organized house-to-house mobilization strategy that aims to educate and empower members of a
community to reduce the risk of HIV, address stigma, and improve access to HIV and TB services. The
TCE program was initiated in northern Namibia in 2005 with support from the Global Fund and PEPFAR.
Global Fund supported the program in the regions of Omusati, Oshana, and parts of Ohangwena and
Oshikoto; PEPFAR supported the program in Kavango Region, the remaining parts of Ohangwena and
Oshikoto Regions, and parts of Khomas and Caprivi Regions.
In 2008, Global Fund support for DAPP temporarily ended in three regions. As a result, DAPP activities
were suspended until the next successful Global Fund application. In each region, the TCE program
provides essential information and referrals on prevention, care and treatment services. The TCE program
is highly valued by Regional AIDS Coordinating Committees (RACOCs), Constituency AIDS Coordinating
Committees (CACOCs), local leaders, and other government and nongovernmental organizations; these
same bodies periodically tap TCE FOs to deliver messages about upcoming health events (e.g. National
Immunization Days) or to distribute bed nets as they make their daily visits. If TCE activities had ended in
the regions, the trained and skilled cadre of FOs would have been lost before the program could continue
with future Global Fund support. Government officials requested that PEPFAR provide temporary "bridge"
funding in order to maintain the continuation of services in the three regions. In response to the
government's request, PEPFAR has provided the interim funding.
PEPFAR is committed to the continual support and enhancement of the TCE program and further intends to
utilize the DAPP field officers for delivery of new activities related to prevention with PLWHA (PwP),
responsible drinking, and male circumcision education. Funding from PEPFAR will support a total of 408
FOs, including 128 previously supported through GF. Both GF and PEPFAR will continue to provide
technical support to DAPP.
to sharpen the focus of DAPP's efforts. Both PEPFAR- and GF-supported assessments of the TCE
program conducted by CDC technical advisors identified that efforts must be more targeted to impact
behavior change and linking individuals to services. With COP09 funds, CDC/Namibia and CDC/Atlanta will
continue to work closely with DAPP to begin an impact assessment of the TCE program, revise and
harmonize the TCE curricula and produce relevant job aids. The assessment and refined curricula should
also allow DAPP to improve linkages to community- and facility-based services, and expand their efforts to
mobilize at-risk persons to access services at both health facilities and community sites. Furthermore,
DAPP and its large cadre of field officers are poised to be trained to deliver the community component of
the Prevention for Persons Living with HIV/AIDS (PWP) Initiative when that initiative is rolled out in the near
future.
The FOs further provide simplified preventive care messages for families regarding the importance of
cotrimoxizole prophylaxis; use of long-lasting insecticide impregnated nets for HIV-positive pregnant women
and children under five (leveraged by Global Fund); safe water; personal hygiene; and good nutrition and
proper care for HIV-infected children. Simplified messaging also includes ART adherence support and
screening for pain and other symptoms. From October 2007 through September 2008, FOs linked 927
individuals to home-based health care, established 836 TRIOs (treatment support groups), and recruited
981 individuals for PLWHA support groups. There are 53 support groups throughout the country. FOs
register each member of a household in their catchment area to avoid duplicate counting.
Where possible, the FOs will coordinate with government and community-based service delivery points to
provide critical transportation support to rural persons in need of essential services. In COP09, DAPP will
continue to work with I-TECH and the multi-national NGO PACT to strengthen community-level training in
TB care which will result in improved integration of TB screening and referrals in the DAPP and PACT
community programs. DAPP will also strengthen the integration of their HIV/AIDS program with their efforts
in community TB DOTS.
TCE volunteers are key partners with the FOs, communities, and health care facilities. From October 2007
through September 2008, FOs have recruited 55,862 active "passionates" - community volunteers who
assist with delivery of health messages and referrals. TCE also coordinates with volunteers supported by
PACT with PEPFAR funds to refer individuals for palliative care and OVC services. Supportive supervision
of all community caregivers is provided by TCE Special Forces Officers, CDC nurse mentors, and primary
health care nurses from nearby facilities.
Activity Narrative: COP09 will continue to support ongoing delivery of the TCE program and strengthen technical
implementation through training, supervision, transportation support, and partnership-building. TCE will
work closely with PLWHA organizations, the organizations represented within the RACOCs and CACOCs,
local Ministry of Health and Social Services (MOHSS) officials, and other stakeholders to recruit PLWHAs
(especially members of minority groups, including the San) as FOs. Recruitment of PLWHA will foster the
development of effective HIV-related community support groups and strengthen ties to service delivery
sites. In addition to support groups and the activities noted above, DAPP will continue to initiate community
gardens and other income-generating activities in areas identified by community leaders.
DAPP activities address gender issues through the provision of equitable services for both male and female
PLWHA, support for disclosing HIV status, and improved male involvement in the program (e.g. improved
male participation, male responsibility in care-giving and support for female caregivers). DAPP is a partner
in the Male Norms Initiative begun in Namibia in 2007, which seeks to address cultural norms that factor
into HIV transmission, including lack of health care seeking behavior by men, destructive "inheritance"
practices imposed on widows by male family members, multiple sex partners, transactional and trans-
generational sex, power inequities between males and females, and alcohol abuse.
The TCE Program continues to be an entry point for building human resource capacity within Namibia, as a
proportion of FOs, all of whom are Namibian, are able to parlay their experiences into promotional
opportunities as community counselors within MOHSS facilities and New Start Centers. This strengthens
the community-based career ladder and the capacity of counselors and clinic facilities, as well as builds the
technical capacity and communication skills of FOs. Not only will FOs become employed as MOHSS-
certified counselors, but they are anticipated to build community awareness into facilities and further
strengthen the continuum of care between facilities and community partners who deliver HIV-related
services.
Continuing Activity: 16121
16121 3929.08 HHS/Centers for Development Aid 7356 1058.08 Cooperative $105,303
7326 3929.07 HHS/Centers for Development Aid 4382 1058.07 Cooperative $100,288
3929 3929.06 HHS/Centers for Development Aid 3150 1058.06 DAPP $96,146
Estimated amount of funding that is planned for Human Capacity Development $98,458
Table 3.3.08:
(DAPP) Total Control of the Epidemic (TCE) Program to educate community members, including youth, on
HIV prevention and to link these individuals to appropriate prevention, care, and treatment services.
DAPP leverages basic care resources to support TCE Field Officers (FOs) to provide age-appropriate
education about HIV prevention, care (including TB) and treatment and to make referrals to available
services. DAPP's sister interventions in Zimbabwe and Botswana have been evaluated and the findings
from both countries showed that TCE program exposure was positively associated with better HIV-related
social support and small income-generating projects (e.g. community gardens and poultry farming). Though
these support groups are primarily comprised of adults, a recurring topic of discussion is caring for HIV-
impacted children.
2. Strengthen the technical capacity of FOs to educate and refer families for preventive care services.
DAPP funding is in four other areas: HVAB, HVOP, HBHC, and HVCT. The TCE program is a highly
organized house-to-house mobilization strategy that aims to educate and empower all members of a
community to reduce the risk of HIV and stigma and improve access to HIV-specific services. The TCE
program was initiated in northern Namibia in 2005 with support from the Global Fund and PEPFAR. Global
Fund supported the program in the regions of Omusati, Oshana, and parts of Ohangwena and Oshikoto;
PEPFAR supported the program in Kavango Region, the remaining parts of Ohangwena and Oshikoto
Regions, and parts of Khomas and Caprivi Regions.
is highly valued by Regional AIDS Coordinating Committees (RACOCs) and Constituency AIDS
Coordinating Committees (CACOCs), local leaders, and other government and nongovernmental
organizations; these same bodies periodically tap TCE FOs to deliver messages to families about upcoming
health events (e.g. National Immunization Days) or to distribute bed nets as they make their daily visits. If
TCE activities had ended in the regions, the trained and skilled cadre of FOs would have been lost before
the program could continue with future Global Fund support. Government officials requested that PEPFAR
response to the government's request, PEPFAR has provided the interim funding.
mobilize at-risk persons to access services for themselves and their children at both health facilities and
community sites.
981 individuals for PLWHA support groups. There are a total of 53 support groups throughout the country.
FOs register each member of a household in their catchment area to avoid duplicate counting.
provide critical transportation support to rural families in need of essential services. In COP09, DAPP will
continue to work with I-TECH and the multi-national NGO Pact to strengthen community-level training in TB
care which will result in improved integration of TB screening and referrals in the DAPP and Pact
assist with delivery of health messages and referrals. TCE also coordinates with funded volunteers
supported by Pact with PEPFAR funds to refer individuals for palliative care and OVC services. Supportive
supervision of all community caregivers is provided by TCE Special Forces Officers, CDC nurse mentors,
and primary health care nurses from nearby facilities.
Estimated amount of funding that is planned for Human Capacity Development $17,375
Table 3.3.10:
(DAPP) Field Officers to mobilize communities to access the Ministry of Health and Human
Services' (MOHSS) newly-initiated mobile CT services.
With USG funds and through other funding sources, DAPP leverages basic resources to support Field
Officers (FOs) in providing education about HIV prevention, care (including TB) and treatment and to make
referrals to available services. Funding under this activity will support:
1. Partial salary support and personnel costs for FOs in areas where CT outreach teams will be piloted;
2. Salary and related personnel costs for one outreach coordinator who will serve as the primary liaison
with the MOHSS;
3. Travel costs, including bicycles for DAPP FOs;
4. Printing of simple flyers and other inexpensive promotional materials in local languages that DAPP FOs
will distribute within targeted communities, including churches; and
5. Nominal costs associated with hosting coordination meetings that will be required between MOHSS,
DAPP, and community stakeholders.
A detailed description of DAPP's door-to-door Take Control of the Epidemic (TCE) Program, which will be
the platform for these mobilization efforts, is contained in the following program areas: HVAB, HVOP,
HBHC, and PDCS. The TCE Program is a highly organized house-to-house mobilization strategy that aims
to educate and empower members of a community to reduce the risk of HIV and stigma and improve
access to HIV and TB services. DAPP's sister interventions in Zimbabwe and Botswana have been
evaluated and the findings from both countries showed that TCE program exposure was positively
associated with better HIV-related knowledge, less stigmatizing attitudes, and HIV testing.
The TCE program was initiated in northern Namibia in 2005 with support from the Global Fund (GF) and
PEPFAR. PEPFAR currently supports the TCE program in Omusati, Oshana, Ohangwena, Oshikoto,
Kavango, Khomas, and Caprivi Regions.
PEPFAR is committed to the continued support and enhancement of this important prevention activity and
intends to utilize DAPP field officers for the delivery of new prevention and communication activities related
to prevention with positives, responsible drinking, and male circumcision education. Funding from PEPFAR
will support salaries for a total of 408 FOs and both GF and PEPFAR will continue to provide technical
support to DAPP.
Overall PEPFAR funding for DAPP door-to-door efforts in FY2009 COP has been reduced and expansion
into new regions and activities has been put on hold to sharpen the focus of DAPP's efforts. Both PEPFAR
and the Global Fund supported technical reviews of the TCE program conducted by CDC technical
advisors. The technical reviews identified the need for more targeted efforts to impact behavior change and
link individuals to services.
With FY2009 COP funds, CDC/Namibia and CDC/Atlanta will continue to work closely with DAPP to begin
an impact assessment of the TCE program and to revise and harmonize the TCE curricula as well as
produce relevant job aids. The assessment and refined curricula should also allow DAPP to improve
linkages to community- and facility-based services, and expand their efforts to mobilize at-risk persons to
access CT services at both facility-based and outreach sites, DAPP FOs are successful at promoting the
importance of knowing your status to clients with whom they interact; however, many of these clients live in
rural areas with little or no access to CT services. The May 2008 National Testing Day event clearly
demonstrated that Namibians are eager to access outreach services and in 2008, the Permanent Secretary
of the MOHSS approved delivery of CT in non-traditional settings for the first time. DAPP FOs in select
sites will work in collaboration with three MOHSS outreach teams to link clients to testing.
With FY2009 COP funds, the MOHSS will implement three outreach teams that will deliver prevention
counseling, CT services, and eventually ART services to remote areas of Namibia. Each MOHSS outreach
team will consist of: a camper van; four community counselors (two to provide counseling and testing and
two to coordinate logistics and supplies); a nurse; and a driver. DAPP FOs will assist the MOHSS in
developing a monthly schedule of visits to remote communities. The date of visits to each community will
be kept consistent (e.g. the first Thursday of each month) so that there will be minimal confusion about
where and when the team will visit.
For each outreach team, CT services and prevention education will be implemented first. A regimented
evaluation program will be put in place to determine cost per client, success in reaching first-time testers,
coordination between MOHSS and DAPP, and community receptiveness. Clients who access outreach
services will be asked how they were referred to assess DAPP FOs' ability to mobilize communities. Once
CT services are successfully implemented, ART will be phased in, one team at a time. If the outreach
teams are able to effectively deliver these aforementioned services, other components may be added,
including TB screening and DOTs, PMTCT, case management, and alcohol counseling and referrals. As
components are added, DAPP FOs will be oriented on how to mobilize communities for these services as
well.
DAPP FOs will work in conjunction with the MOHSS team, community leaders, and local radio stations to
promote each outreach visit. The outreach team will make every effort to position the van in a central
location, but there may be some clients who still may face difficulties in reaching the site. DAPP FOs will
further coordinate with churches and other community groups to provide transportation as necessary.
MOHSS personnel will carry out the initial linking of positive-testing community members with ART. FOs
will assist the MOHSS with this effort by ensuring that positive clients keep subsequent appointments and
adhere to their medications. FOs will also link these clients to DAPP's network of 53 support groups for
people living with HIV/ AIDS and their families.
Activity Narrative: These pilots will be evaluated in 2009 to determine whether DAPP could eventually begin to deliver door-to-
door CT services to complement the MOHSS' CT outreach efforts.
From October 2007 through September 2008, DAPP FOs were able to reach 97,598 individuals with
prevention messages, significantly exceeding their established target of 40,000. FOs register each member
of a household to avoid duplicate counting. DAPP's network of volunteers will further assist FOs with
mobilizing communities to access CT outreach services. From October 2007 through September 2008, the
FOs recruited 55,862 active "passionates" -- volunteers who assist with delivery of health messages and
referrals. FOs will utilize this network of passionates to spread the word about upcoming outreach team
visits to their communities.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $100,000
Table 3.3.14:
