The project aims to reduce new HIV infections, vulnerability and risk amongst migrants and mobile populations and the communities they interact with by facilitating, promoting, and providing access to HIV and TB services, strengthening capacity, and advocating for migration policies. IOMs goals, objectives, and activities are fully aligned with the Partnership Framework and the NSP. The NSP includes migration issues as an HIV risk factor and migrants as a key population at risk. IOM implements evidence-based HIV prevention interventions targeting migrants and mobile population in Mpumalanga and Limpopo, and will extend support to Gauteng and KwaZulu-Natal, targeting migrants in hostels, migration centers, and high population density informal settlements. Support to SAG on system strengthening will focus on increasing the understanding to effectively address migration and health to improve policy development and service delivery. Cost efficiency strategies include: implementation of evidence-informed interventions; partnerships; strengthening of local organizations; improving human capacity; and resource mobilization. Transition will include capacity building plans for phasing over of activities and shifting of roles and relationships during the four year period M&E will include target setting based on baseline data, indicators, and regular collection of key data to track progress. Data collected will be used to review project plans and develop evidence-based advocacy interventions. IOM's support to SAG will also facilitate country ownership and build capacity for provincial health departments to adhere to international human rights and guidelines on migrant health issues. Impact assessment will be conducted at the end of the project cycle.

IOMs care and support program improves the physical, mental, and social wellbeing of HIV positive migrants, their families, and communities by providing referrals to gain access to psychosocial support, linking migrants to treatment services for opportunistic infections and ART. Focus will be on working with SAG to advocate for migrant health sensitive policies to be used at local level and to strengthen government and community systems to respond to the care needs of migrants and their families. IOM will work with target local municipalities to address social determinants of health such as food security, healthy living environment, and access to clean water and sanitation for migrants. IOM will provide TA to strengthen SAGs role in contributing to harmonizing HIV prevention and treatment responses in the SADC region. Main geographic coverage will be Limpopo (Vhembe, Mopani, Waterberg districts), Mpumalanga (Nkomazi), Gauteng, and KwaZulu Natal. 5,000 migrants will be reached with a minimum care and support package. Activities will address structural and environmental factors, including the development and implementation of migrant sensitive and responsive treatment and care policies and programs. IOM will also support SAG participation in regional and global efforts to address HIV and communicable diseases affecting mobile populations, and will provide support to implement and monitor the WHO Assembly resolution on Migrants Access to Health. At the local level, IOM will address food security, provide assistance to local farm owners to create food gardens, teach life skills to generate income, and provide links to support groups. IOM will provide training of change agents on community/ home based care and to provide psychosocial support. IOM will also continue with assisted voluntary returns for sick migrants linking with the IOM Irregular Migration Project, which supports prevention packages for HIV positive individuals. IOM will strengthen linkages and integration between HIV prevention with sexual reproductive health services, HIV Counseling and Testing (HCT), and TB programs to ensure a continuum of response.

Migrants live and work in conditions that facilitate TB infection and other communicable diseases in farm compounds, hostels and informal settlements. IOM will align the program with the national TB strategy which focuses on the 3I (Intensified active case finding, Isoniazid Prophylactic Treatment, and Infection control). Activities will address barriers to accessing health care services through advocacy, communication and social mobilization. Structural interventions include creating an enabling social and policy environment for migrants and affected communities. Support groups for TB affected individuals will be established and these will be used as a nexus for implementing various social and economic empowerment programs and will be linked to support groups for HIV positive individuals who are co-infected to ensure a continuum of response. TB information and education will be provided using various communication tools. These tools will be used to facilitate community dialogues and action to addressing the underlying factors contributing to HIV and TB transmission at a local level. A cadre of change agents will be recruited and trained to conduct basic TB screening and DOTS support. These will be linked to other government programs such as the community care/development workers, and expanded public works program and contribute to the revitalization and reengineering of PHC. Referral networks and partnerships with other local service providers will be strengthened to ensure a continuum of car

Focus at national level will strengthen SAG HCT systems to support direct delivery of HCT services at local level to migrant workers in target commercial farms. IOM will provide TA to SAG to develop strategies and programs for migrants working in commercial farms in Limpopo (Vhembe, Mopani, Waterberg districts) and Mpumalanga (Nkomazi). IOM's program will support the SAG HCT strategy to target hard to reach populations especially migrants in informal settlements and hostels. IOM will work through the relevant provincial, district and sub-district level structures to design, implement, and monitor HCT interventions on farms, including development of advocacy, communication and social mobilization strategies. In collaboration with sub-districts, support will also be provided to training of lay counselors within the target population (i.e. training change agents as lay counselors) to support HCT campaigns for migrant workers. Direct financial support will be provided to local CBOs serving as implementing agencies to provide outreach HCT services to migrant workers. This will include a full package of services including promotion of HCT services, test kits (where the SAG does not have sufficient supply), and logistical support. 10,000 migrants will be reached, with at least 5,000 testing and receiving their results. HCT services will include a wellness screening package with the key focus being on HCT and will be conducted in partnership with the local PHC services and linking migrants to local health services, care and support networks. IOM will support post-test clubs and provide referrals to medical male circumcision (MMC) services, prevention of mother-to-child transmission (PMTCT), ART, TB prophylactic treatment, psychosocial support, and prevention packages including condoms. In Limpopo specifically IOM will continue to link migrant to PEP services due to high levels of GBV and rape in Musina along the Zimbabwe border.

The focus of IOMs program is to implement HIV, STI and TB intervention in migrant areas such as commercial farms, mines, urban/peri-urban informal settlements, and border communities. Focus target areas are in Limpopo (Vhembe, Mopani, Waterberg districts), Mpumalanga (Inkomazi), and from 2013 in KZN and Gauteng targeting hard to reach areas. Support will be provided to SAG to address structural, environmental, and individual barriers to social and behavioral change, and to facilitate access to health services and address gender equity. IOM will advocate for policy/ legal frameworks responding to migrants rights to access health services, protection, and access to basic services. IOM will support the target provincial governments to regularize undocumented migrants and strengthen coordination mechanisms on migration issues. IOM will strengthen the capacity of service providers and CBOs to facilitate migrants' access to health services, support health management teams to incorporate migration health issues into district health plans; and support development and implementation of migration sensitive workplace policies and programs in key migration sectors. Change agents will be trained to facilitate the development and dissemination of local messages which are culturally sensitive and use appropriate languages yet based on scientific facts. IOM will support CBOs to distribute male and female condoms with relevant HIV prevention messages in target commercial farms, informal settlements, hostels and migration centers. Billboards, posters, and pamphlets will be used as additional communication channels with migrants and mobile populations. Messages will highlight HIV risks and vulnerability in migrant settings addressing multiple sexual partnerships, transactional sex, norms on masculinity, and gender based violence. Training and capacity building programs will be aligned with relevant national qualification framework and other services such TB, PMTCT and HCT will be linked and integrated.