SUMMARY: This project promotes a mix of community-based and clinical counseling and testing (CT) models. The Society for Family Health and the Population Services International (SFH/PSI) will manage a franchise network (under the brand name, New Start) of 12 stand-alone CT sites, each with a mobile CT program. From these CT sites, SFH will provide training and support to at least six healthcare facilities to increase the number of tuberculosis (TB) patients who receive HIV CT in clinical settings, and to private healthcare workers to enable them to make CT a routine part of medical care. Emphasis areas include community mobilization/participation, development of network/linkages/referral systems, local organization capacity development, quality assurance/quality improvement/supportive supervision and training. Primary target populations include men and couples for CT in non-medical settings, and TB patients for CT in medical settings. Higher risk populations such as prisoners, sex workers, and men who have sex with men are targeted when possible.

BACKGROUND: Activities are ongoing. New Start opened in December 2004. At this time, 83% of FY 2006 has elapsed and New Start has achieved 76% of its FY 2006 client flow goal and exceeded its training target. The program addresses gender issues (key legislative issue) primarily by targeting men and couples for CT. To date, 52% of clients are male and 11% are couples. Although funding for the TB/HIV project only arrived in July 2006, one medical facility in Durban was able to begin working with New Start in August, 2006. SFH works closely with and has strong support from the South African government at national and provincial levels. The program started off with PEPFAR funding and today is co-funded by the South African government.

ACTIVITIES AND EXPECTED RESULTS: ACTIVITY 1: SFH will manage a network of 12 stand-alone CT sites, each operating a mobile and workplace CT program. Three of the sites will be managed by SFH and nine by partner NGOs who will receive technical, financial, management, marketing and quality assurance support from SFH. The nine partner-managed "franchise" New Start sites will open in late 2006 and early 2007. Non-profit CT franchising has proven effective at building the capacity of local NGOs to provide CT services and increase client flow. New Start franchising is based on standardized systems for management, training, supervision, quality assurance and referrals and linkages to other services. SFH, the South African government and NICD will train New Start counselors and testing staff. SFH and NICD will carry out quality assurance. Marketing activities will use radio, public relations, print media and community mobilization to reach men and couples. Beginning in late 2006, Levi's will promote New Start services through Levi's stores, Levi's sponsored mobile CT and Levi's media activities. Mobile CT and below-the-line marketing will continue to target prisoners, men who have sex with men, and commercial sex workers when possible. Mobile CT activities will expand and work with a variety of hosts -- including workplaces, NGOs, communities, churches and government agencies such as the prison system and the commuter rail system. New Start has an agreement with the Anglican church to provide CT services through its parishes. New Start CT protocols include non-medical TB and STI screening. Each New Start site has a site-specific referral guide to allow counselors to refer clients to an array of post-test care and support services. Each New Start site also has a Referral Coordinator to maintain linkages with referral points. From New Start sites, SFH will provide training and support to NGOs not part of the New Start network in CT service provision and to private doctors in routine offer CT using rapid test kits. These training and quality assurance activities will be carried out in partnership with NICD and the FPD, the training arm of the South African Medical Association. ACTIVITY 2: SFH will increase the number of TB patients who are tested and referred for HIV treatment. The project will partner with and mentor NGO, private sector and/or government facilities, strengthen already existing systems and work to fill important gaps where the testing and referral of TB patients can be improved. The support provided to these TB healthcare providers will depend on the needs of the facilities and will include some or all of the following four assistance models: - SFH will provide training and support to partner organizations in routine provider-initiated CT, so partner organizations can introduce routine testing for TB patients. - SFH will provide training and support to partner organizations in client-initiated CT, so partner organizations can introduce and manage their own CT operations in TB facilities. - SFH will create New Start satellite operations at TB facilities. Partner organizations will

provide space and support to New Start to provide CT from TB facilities on a daily basis. - SFH will provide training and support to partner organizations who wish to open New Start franchises within TB facilities. Franchise partners will be fully integrated into the New Start network. Legislative issues addressed include gender issues and stigma and discrimination. Gender issues will be addressed through targeting men and couples for CT services. Testing rates among men are low. Encouraging couples CT allows women a structured environment to address HIV issues with their male partners. Diminishing HIV stigma is best achieved by increasing the number of people who learn their HIV status and disclose to family and friends. The proposed activities encourage sustainability by focusing on human capacity and organizational development. Franchising develops the capacity of a network of NGOs to provide high quality services, including the development of workplace programs that bring in revenue to partner NGOs. The proposed activities also encourage a sustainable response to the need to test large numbers by providing training and support to private doctors to make CT a routine part of medical care. Mobile CT activities bring together non-health sectors of society such as churches or workplaces in the fight against HIV. Activity 3. PSI/SFH will develop and carry out a mass media campaign to encourage HIV counseling and testing. PSI/SFH will work in partnership with Right to Care and at least one private sector partner. The campaign will be national and will culminate in a one week testing drive. This testing week will bring together PSI/SFH's New Start static site and mobile testing services, Right to Care's testing services and the testing services of other service providers, including other NGO and Government of South Africa testing services. The campaign's private sector partner will associate its brand with the campaign and spend its own funds on the campaign. Media used will include television or radio and public relations. The campaign and one week testing drive will take place in late 2007 or early 2008. SFH and Right to Care currently are developing the campaign, selecting campaign target groups, determining private sector partners and developing testing targets. SFH will work closely with the government of South Africa to ensure that the campaign has government support and buy-in at all levels. Activity 4: South to South. PSI-Lesotho will support the Know Your Status campaign in Lesotho by training counselors on rapid testing and quality assurance; providing mentoring and training to community health workers in the KYS; developing IEC materials for the KYS; procurement and delivery of rapid test kits for the KYS; expansion of mobile testing services to compliment the KYS campaign; providing TA to the KYS technical working group. Activity 5: PSI will appoint KYS liaison officers at each New Start site in Lesotho. Funds will also be used for a study tour to Uganda and Malawi.