LINKAGES Quarterly Report (October 1 – December 31, 2017) – BOTSWANA

The project focused on men who have sex with men (MSM) and female sex workers (FSWs). Key interventions included training healthcare workers on provision of KP-friendly services, strengthening referral mechanisms to public health facilities, and conducting baseline assessments on availability of KP-centric services. In the quarter from October 1 to December 31, 2017, LINKAGES achieved 23% of the annual KP_PREV target and 11.2% of the annual HTS_TST target for FSWs; and 44% of the KP_PREV and 26% of HTS_TST annual targets for MSM. However, only 12 of the 23 FSWs who tested positive were successfully initiated on treatment in public facilities. To strengthen linkage to care and treatment, LINKAGES trained 181 healthcare workers on provision of KP-friendly services in five target districts. The project also engaged Tebelopele Voluntary Counseling and Testing Centers (TVCTC) as a new clinical partner to replace Botswana Family Welfare Association (BOFWA), which lost its funding due to the Protecting Lives in Global Health Assistance (PLGHA) policy. TVCTC's accreditation to provide ART services is pending approval by the Ministry of Health and Wellness (MoHW). In terms of direct service delivery, LINKAGES reached 1,051 FSWs and 294 MSM with HIV prevention interventions. A total of 422 FSWs and 179 MSM were tested for HIV and received their results, with 34 FSWs and 7 MSM testing positive. Twelve FSWs were newly enrolled in clinical care, and 12 FSWs were initiated on care. The project also strengthened referral mechanisms to public health facilities by training 181 healthcare workers from 66 public health facilities in five of six LINKAGES districts. These healthcare workers were sensitized on key population diversity and on the provision of quality, stigma-free HIV care services. The trainings built the capacity of HCWs to conduct risk assessments to identify high-risk individuals, create a KP-friendly environment, and mitigate violence prevention and response and values clarification. In addition, LINKAGES conducted baseline assessments on availability of KP-centric services in two health facilities in Gaborone with technical assistance from LINKAGES HQ using core funding. The exercise aimed at assessing HCWs' knowledge and understanding about key populations, identifying the needs of HCWs to improve their competency in provision of KP services, assessing availability of the necessary infrastructure, and making recommendations to MoHW. The project also participated in the establishment of the National Key Population Technical Working Group (TWG) under the MoHW. The terms of reference were developed and adopted by the MoHW. The TWG remains active and meets monthly to coordinate all partners and activities relating to KPs at national level. Furthermore, LINKAGES participated in the national Pre-Exposure Prophylaxis technical working group that is developing the national PrEP implementation plan, monitoring and evaluation tools, and training curriculum. The project also attended training on Plan4PrEP learning collaborative in Johannesburg, an initiative by OPTIONS consortium, which is an interlinked project between USAID and PEPFAR to expedite and sustain access to antiretroviral-based HIV prevention products. The project also engaged four lay counselors under TVCTC to provide HTC services in Gaborone, Francistown, and Selibe Phikwe as a stopgap measure while awaiting completion of setup and full-fledged TVCTC sites.