Program Expansion Supplement: Supporting HIV and Tuberculosis Response in the Kingdom of Lesotho through District-based Comprehensive Prevention, Care and Treatment Program and Health Systems Strengthening under PEPFAR

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The purpose of this funding opportunity announcement is to strengthen HIV/AIDS services and TB/HIV related collaborative activities in Lesotho using a district based model. District health teams are uniquely positioned to improve HIV prevention and care strategies with the district health facilities and communities. CDC will support HIV/TB services that should include the full continuum of HIV care and treatment. The full continuum includes strengthening identification of people living with HIV (PLHIV) through HIV testing and counseling (HTC) services, linkage to and enrollment in HIV care and treatment services for those diagnosed as HIV-positive, clinical staging and initiation of ART, retention in HIV clinical, adherence to ART, and ultimately full viral suppression. Activities should support strengthening this continuum of care for both adult and pediatric populations with specific attention paid to priority populations, including pregnant women, individuals co-infected with TB and HIV, adolescents, and children under 5 years. In addition, bidirectional linkages should be created between health facilities and community programs including community-related outreach, village health worker programs, and orphans and vulnerable children (OVC) programs as part of efforts to strengthen this continuum of care. The primary goal of the project is to develop and implement effective, replicable and sustainable programmatic models for supported districts to increase districts’ capacity to deliver HIV/TB prevention, care and treatment activities. This will be achieved through improving the identification of undiagnosed HIV infection, establishing and strengthening linkages into HIV care and treatment, and improving HIV outcomes along the continuum of care for PLHIV in Lesotho. In addition, the grantee will support further critical operational and service delivery components for effective provision of comprehensive HIV care and treatment services. This FOA is a follow on to CDC’s previous FOA PS09-930, for which revisions were made based on collaborative recommendations made by the United States Government (USG) PEPFAR Technical Working Groups (TWGs), USG PEPFAR Lesotho, local partners, and the Ministry of Health (MOH) in July 2013 for optimizing acceleration of HIV and TB/HIV care and treatment in Lesotho through integrated clinical services. The USG PEPFAR Lesotho program began using a district based approach that mandates only one USG care and treatment implementing partner per district. CDC supports clinical services in the following four Lesotho districts: Leribe, Berea, Quthing, and Qacha’s Nek. The program will also build and capitalize on the accomplishments and lessons learned since the national ARV implementation began in 2002. It will focus on institutionalization of routine and consistent use of systems designed to improve efficiencies in the districts and management that ultimately improve HIV/ TB patient outcomes. This program will reflect the geographic alignment of comprehensive clinic-based support to districts.

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