Lesotho Know Your Status (KYS) Campaign Plan Leave no Mosotho out.....every life counts! Universal Access to HIV Testing and Counselling in Lesotho THE GATEWAY TO HIV PREVENTION, TREATMENT, CARE AND SUPPORT

Lesotho- KYS campaign: The questions 1. What it is KYS? 2. When and where? 3. How are you going to do it? 4. With whom? 5. What does it need to be built in the health facility to take over HIV+ and HIV- clients?

What is Universal Access to HIV Testing and Counseling in Lesotho ? A shared national vision to provide HIV testing and counseling services to all Basotho women, adolescents and men, as an "the gateway" to HIV prevention, treatment, care and support

What is the Know Your Status campaign main objective? All people above 12 years of age living in Lesotho will know their HIV status by the end of 2007, so that those who are negative remain negative and those who are positive can be treated and live productive lives.

Why is it necessary for all people living in Lesotho to know their HIV status? HIV rates in Lesotho are threatening the future of the country. Knowledge of HIV status combined with on-going counselling can impact positively on behaviour, especially for those who test positive HIV and AIDS prevention, care, treatment and support at the health centers are being scaled-up through IMAI. Greater numbers will be able to access these services. Early diagnosis of HIV and treatment will significantly ease the health sector's burden of caring for sick and dying HIV patients and decrease the number of new orphans.

What is the campaign's strategic approach? Communities will choose how testing and counselling should be progressively rolled out Community mobilization and education will follow Every household will be offered an HIV test and personal counselling Everybody tested and counselled will be referred to post-test services, according to their HIV status Using IMAI, prevention, treatment care and support services will be concurrently scaled up at the health centre level throughout the country to cover children and adults. This is critical to the success of the KYS campaign

HIV Testing and Counselling Service Provision 3,600 community health workers will be trained in HIV testing and counselling Five community members per village, including PLWHA and expert patients, will be trained in on-going counselling and HIV education Quality control assured through monitoring according to existing national standards

How to achieve impact? Must assure that everyone who tests positive or negative has access to essential prevention, treatment, care and support services within the catchment area Community-level mobilization, education and support groups Safer sex counselling and condoms Diagnosis and management of STIs Positive prevention (prevention for PLWHAs) Care for opportunistic infections Antiretroviral therapy Palliative care Nutritional and psychosocial support IMAI

How to bring the services down to the health centre? April 2005: IMAI guidelines adapted May 2005: ART District Coordinator and Patient Monitoring training June 2005: IMAI TOT and training of clinical teams from each of the health service (this included pediatric and mental health module) November 05: All hospitals providing ART November 2005: Clinical mentoring programme begun December 2005: Launch of KYS and of the operational plan (including IMAI scale up) January 2006: Scale up of training to all health centres 2006-ongoing: Expand clinical mentoring and follow-up of clinical teams in the whole country Universal access to quality services close to patient home

Central Ped/HIV District Second level ART/OI training IMCI Referral Care Manual Section on pediatric HIV care/ART Health Centre Operationalized guidelines and training material IMCI-HIV adaptation, IMAI Chronic Care with ART (includes CHILDREN), IMAI Palliative Care, Adolescent job aid Community Support ART and TB-ART treatment supporters, HIV patient self management booklet and patient education flipchart - for adolescent/adult Caregiver booklet- for adults/children Community Preparedness Mobilization and sensitization to increase prevention, care and treatment literacy of community The decentralized care through IMAI

Balancing the Right to Know and the Right to say No" HIV testing and counselling in Lesotho is never mandatory. All Basotho will be offered HIV testing and counselling Those providing HIV testing will receive training on how to obtain informed consent prior to testing and ensure client understanding

Strategic Objective 1 Create a policy environment that enables people in Lesotho to know their HIV status Develop HTC policy through consensus and participatory process with key stakeholders Approval of HTC policy by Cabinet Undertake media and advocacy campaign to publicize strategy

Strategic Objectives 2 & 3 2. To build widespread national support for, and local ownership of, the KYS campaign National, district and community consultation process Build and strengthen partnerships to support KYS campaign 3. To build knowledge, shift attitudes and influence behaviour on HIV AIDS, particularly HTC Undertake formative research to guide communication strategy Expand capacity of media to carry out campaign Produce audiovisual and print campaign support material

Strategic Objectives 4 & 5 4. Expand human capacity to conduct HIV testing and counselling Train community health workers Strengthen district management capacity Train lay counsellors and educators Work with key partners to build human capacity 5. Expand access to HIV testing and counselling especially at community level House to house offer of HIV testing & counselling by community health workers from within/outside community Provision of mobile and outreach testing and counselling services Expand HTC in all health facilities

Strategic Objectives 6 & 7 6. Strengthen logistics and supply management Procure and distribute test kits and consumables First test: DETERMINE Positive results confirmed with DOUBLE CHECK ELISA testing for quality assurance of test kits Equip districts with vehicles to manage campaign 7. Strengthen post-test services for HIV negatives and positives Strengthen referral system Provide support for HTC counsellors Scale-up IMAI essential package for prevention, treatment, care and support within health centres.

Strategic Objectives 8 & 9 8. Strengthen supervisory system at district and community levels Set up supervisory system for community level HTC Strengthen supervisory capacity of District Health Management Teamsthrough IMAI training Assure quality control of HIV testing 9. Strengthen monitoring and evaluation of HIV testing and counselling services Map service availability, including prevention HIV/ART Patient monitoring system Implement M and E system Monitor and track HIV epidemic, including behavioural data Evaluate the KYS campaign

Strategic Objective 10 Assure independent oversight of Know Your Status" campaign to ensure rights of community members are protected Form independent National HTC Monitoring Committee (NHMC) composed of members of civil society at national level to report directly to the National AIDS Commission Form District HTC Monitoring Committee (DHMC) to report to national level on suspected abuses (forced disclosure, violence, etc.) Form Community HTC Monitoring Committees (CHMC) to provide oversight monitoring of campaign roll-out at village level Orient all committee members in HTC human rights issues

Strategic Objective 11 Mobilize necessary resources to fully implement the Know Your Status campaign and IMAI scale up at national, district and community levels Engage partners to second staff and services for implementation of campaign Engage donors to fund campaign Engage private sector to take ownership and support campaign with both financial and in-kind support

Lesotho- KYS campaign: The questions 1. What it is KYS? 2. When and where? 3. How are you going to do it? 4. With whom? 5. What does it need to be built in the health facility to take over HIV+ and HIV- clients?

Thank you